Accelerated testing for studying pavement design and performance (FY 2002) : research summary.

DOT National Transportation Integrated Search

2004-01-01

This report covers the Fiscal Year 2002 project conducted at the Accelerated Testing : Laboratory at Kansas State University. The project was selected and funded by the : Midwest States Accelerated Testing Pooled Fund Program, which includes Iowa, Ka...

Crowd Around: Expanding Your Donor Pool with Crowdfunding

ERIC Educational Resources Information Center

Jarrell, Andrea

2013-01-01

At most institutions, annual fund-giving is down. Crowdfunding sites allow people with a great idea or worthy cause to bypass traditional funding methods and take their case directly to web-savvy investors and donors. This article describes how higher education institutions are expanding their donor pool through such crowdfunding sites as USEED,…

Developing an International Pool of Certified Quality Reviewers

ERIC Educational Resources Information Center

Adair, Deborah

2017-01-01

This article covers the origins, growth, rationale, calibration, and inspiration of an international pool of certified Quality Matters™ (QM) Peer Reviewers. From the beginning in 2003, as a U.S. Department of Education, Fund for the Improvement of Postsecondary Education funded project, QM was developed as a faculty-centered, peer-based approach…

45 CFR 148.310 - Eligibility requirements for a grant.

Code of Federal Regulations, 2011 CFR

2011-10-01

... more coverage options through the pool. (d) The pool has in effect a mechanism reasonably designed to ensure continued funding of losses incurred by the State after the end of each fiscal year for which the State applies for Federal Funding in fiscal year (FY) 2005 through FY 2010 in connection with the...

45 CFR 148.310 - Eligibility requirements for a grant.

Code of Federal Regulations, 2012 CFR

2012-10-01

... more coverage options through the pool. (d) The pool has in effect a mechanism reasonably designed to ensure continued funding of losses incurred by the State after the end of each fiscal year for which the State applies for Federal Funding in fiscal year (FY) 2005 through FY 2010 in connection with the...

Accelerated testing for studying pavement design and performance (FY 2002) : performance of foamed asphalt stabilized base in full depth reclaimed asphalt pavement.

DOT National Transportation Integrated Search

2004-08-01

This report covers the Fiscal Year 2002 project conducted at the Accelerated Testing Laboratory at Kansas : State University. The project was selected and funded by the Midwest Accelerated Testing Pooled Fund Program , : which includes Iowa, Kansas, ...

17 CFR 200.20b - Director of Division of Investment Management.

Code of Federal Regulations, 2011 CFR

2011-04-01

... registered under the Investment Company Act of 1940 (15 U.S.C. 80a-1 et seq.) and pooled investment funds or... registered under the Investment Company Act of 1940 and pooled investment funds or accounts in connection... Investment Management. 200.20b Section 200.20b Commodity and Securities Exchanges SECURITIES AND EXCHANGE...

NACUBO's Guide to Unitizing Investment Pools. Second Edition

ERIC Educational Resources Information Center

Wheeler, Mary S.

2011-01-01

The National Association of College and University Business Officers' (NACUBO's) "Guide to Unitizing Investment Pools" addresses the principles and concepts for administering a consolidated investment pool. Unitization is the mechanism by which investment funds are pooled to maximize investment efficiencies and provide information for donors,…

Financing public healthcare institutions in Ghana.

PubMed

Akortsu, Mercy Akosua; Abor, Patience Aseweh

2011-01-01

The financing of healthcare services has been of a major concern to all governments in the face of increasing healthcare costs. For developing countries, where good health is considered a poverty reduction strategy, it is imperative that the hospitals used in the delivery of healthcare services are well financed to accomplish their tasks. The purpose of this paper is to examine how public hospitals in Ghana are financed, and the challenges facing the financing modes adopted. To achieve the objectives of the study, one major public healthcare institution in Ghana became the main focus. The findings of the study revealed that the main sources of financing the public healthcare institution are government subvention, internally-generated funds and donor-pooled funds. Of these sources, the internally generated fund was regarded as the most reliable, and the least reliable was the donor-pooled funds. Several challenges associated with the various financing sources were identified. These include delay in receipt of government subvention, delay in the reimbursement of services provided to subscribers of health insurance schemes, influence of government in setting user fees, and the specifications to which donor funds are put. The findings of this study have important implications for improving the financing of public healthcare institutions in Ghana. A number of recommendations are provided in this regard.

26 CFR 1.170A-5 - Future interests in tangible personal property.

Code of Federal Regulations, 2010 CFR

2010-04-01

... to a pooled income fund described in section 642(c)(5), which is maintained by a university. C... university, and creates an income interest in such painting for E for life. E is an individual not standing... contributed by D to the university. The trustee of the pooled income fund puts the painting to an unrelated...

26 CFR 25.2702-1 - Special valuation rules in the case of transfers of interests in trust.

Code of Federal Regulations, 2011 CFR

2011-04-01

... the retained interest is not a qualified interest (as defined in § 25.2702-3), the retained interest... remainder interest in the trust qualifies for a deduction under section 2522. (4) Pooled income fund. A transfer of property to a pooled income fund (as defined in section 642(c)(5)). (5) Charitable lead trust...

Joliet Junior College. Keep America Working, Sears Partnership Development Fund: Final Report.

ERIC Educational Resources Information Center

Mihelich, Andrew L.

In 1988, Joliet Junior College (JJC) initiated a Set-Aside Loan Pool, designed to provide entrepreneurs, who traditionally would not be able to obtain a small business loan because of a lack of equity, with an alternate source of funding. Ten financial institutions were contacted and asked for contributions to the Loan Pool. Over the next five…

The Waning Impact of School Finance Litigation on Inequality in Per Student Revenue during the Adequacy Era

ERIC Educational Resources Information Center

Condron, Dennis J.

2017-01-01

Since 1989, most states have faced "adequacy" lawsuits that target state constitutions' education clauses in aiming to boost funding provided to disadvantaged districts--which should reduce overall inequality in school funding. Using pooled time-series data on 44 states over 19 years spanning the adequacy era, this study examines how…

Transportation librarian's toolkit

DOT National Transportation Integrated Search

2007-12-01

The Transportation Librarians Toolkit is a product of the Transportation Library Connectivity pooled fund study, TPF- 5(105), a collaborative, grass-roots effort by transportation libraries to enhance information accessibility and professional expert...

Policy Options to Reduce Fragmentation in the Pooling of Health Insurance Funds in Iran

PubMed Central

Bazyar, Mohammad; Rashidian, Arash; Kane, Sumit; Vaez Mahdavi, Mohammad Reza; Akbari Sari, Ali; Doshmangir, Leila

2016-01-01

There are fragmentations in Iran’s health insurance system. Multiple health insurance funds exist, without adequate provisions for transfer or redistribution of cross subsidy among them. Multiple risk pools, including several private secondary insurance schemes, have resulted in a tiered health insurance system with inequitable benefit packages for different segments of the population. Also fragmentation might have contributed to inefficiency in the health insurance systems, a low financial protection against healthcare expenditures for the insured persons, high coinsurance rates, a notable rate of insurance coverage duplication, low contribution of well-funded institutes with generous benefit package to the public health insurance schemes, underfunding and severe financial shortages for the public funds, and a lack of transparency and reliable data and statistics for policy-making. We have conducted a policy analysis study, including qualitative interviews of key informants and document analysis. As a result we introduce three policy options: keeping the existing structural fragmentations of social health insurance (SHI)schemes but implementing a comprehensive "policy integration" strategy; consolidation of existing health insurance funds and creating a single national health insurance scheme; and reducing fragmentation by merging minor well-resourced funds together and creating two or three large insurance funds under the umbrella of the existing organizations. These policy options with their advantages and disadvantages are explained in the paper. PMID:27239868

Policy Options to Reduce Fragmentation in the Pooling of Health Insurance Funds in Iran.

PubMed

Bazyar, Mohammad; Rashidian, Arash; Kane, Sumit; Vaez Mahdavi, Mohammad Reza; Akbari Sari, Ali; Doshmangir, Leila

2016-02-11

There are fragmentations in Iran's health insurance system. Multiple health insurance funds exist, without adequate provisions for transfer or redistribution of cross subsidy among them. Multiple risk pools, including several private secondary insurance schemes, have resulted in a tiered health insurance system with inequitable benefit packages for different segments of the population. Also fragmentation might have contributed to inefficiency in the health insurance systems, a low financial protection against healthcare expenditures for the insured persons, high coinsurance rates, a notable rate of insurance coverage duplication, low contribution of well-funded institutes with generous benefit package to the public health insurance schemes, underfunding and severe financial shortages for the public funds, and a lack of transparency and reliable data and statistics for policy-making. We have conducted a policy analysis study, including qualitative interviews of key informants and document analysis. As a result we introduce three policy options: keeping the existing structural fragmentations of social health insurance (SHI)schemes but implementing a comprehensive "policy integration" strategy; consolidation of existing health insurance funds and creating a single national health insurance scheme; and reducing fragmentation by merging minor well-resourced funds together and creating two or three large insurance funds under the umbrella of the existing organizations. These policy options with their advantages and disadvantages are explained in the paper. © 2016 by Kerman University of Medical Sciences.

Morphology of drying blood pools

NASA Astrophysics Data System (ADS)

Laan, Nick; Smith, Fiona; Nicloux, Celine; Brutin, David; D-Blood project Collaboration

2016-11-01

Often blood pools are found on crime scenes providing information concerning the events and sequence of events that took place on the scene. However, there is a lack of knowledge concerning the drying dynamics of blood pools. This study focuses on the drying process of blood pools to determine what relevant information can be obtained for the forensic application. We recorded the drying process of blood pools with a camera and measured the weight. We found that the drying process can be separated into five different: coagulation, gelation, rim desiccation, centre desiccation, and final desiccation. Moreover, we found that the weight of the blood pool diminishes similarly and in a reproducible way for blood pools created in various conditions. In addition, we verify that the size of the blood pools is directly related to its volume and the wettability of the surface. Our study clearly shows that blood pools dry in a reproducible fashion. This preliminary work highlights the difficult task that represents blood pool analysis in forensic investigations, and how internal and external parameters influence its dynamics. We conclude that understanding the drying process dynamics would be advancement in timeline reconstitution of events. ANR funded project: D-Blood Project.

Performance measures and reporting for international border crossings.

DOT National Transportation Integrated Search

2016-04-01

There are several international borders shared among the ENTERPRISE Pooled Fund Study members (Washington State Department of Transportation, Minnesota Department of Transportation, Michigan Department of Transportation, Ministry of Transportation On...

12 CFR 567.6 - Risk-based capital credit risk-weight categories.

Code of Federal Regulations, 2013 CFR

2013-01-01

...) [Reserved] (vi) Indirect ownership interests in pools of assets. Assets representing an indirect holding of a pool of assets, e.g., mutual funds, are assigned to risk-weight categories under this section based upon the risk weight that would be assigned to the assets in the portfolio of the pool. An...

12 CFR 167.6 - Risk-based capital credit risk-weight categories.

Code of Federal Regulations, 2013 CFR

2013-01-01

...) [Reserved] (vi) Indirect ownership interests in pools of assets. Assets representing an indirect holding of a pool of assets, e.g., mutual funds, are assigned to risk-weight categories under this section based upon the risk weight that would be assigned to the assets in the portfolio of the pool. An...

12 CFR 567.6 - Risk-based capital credit risk-weight categories.

Code of Federal Regulations, 2014 CFR

2014-01-01

...) [Reserved] (vi) Indirect ownership interests in pools of assets. Assets representing an indirect holding of a pool of assets, e.g., mutual funds, are assigned to risk-weight categories under this section based upon the risk weight that would be assigned to the assets in the portfolio of the pool. An...

Safety evaluation of STOP AHEAD pavement markings

DOT National Transportation Integrated Search

2007-12-01

The Federal Highway Administration (FHWA) organized a Pooled Fund Study of 26 States to evaluate low-cost safety strategies as part of its strategic highway safety effort. One of the strategies chosen to be evaluated for this study was STOP AHEAD pav...

Safety evaluation of STOP AHEAD pavement markings

DOT National Transportation Integrated Search

2008-03-01

The Federal Highway Administration (FHWA) organized a Pooled Fund Study of 26 States to evaluate low-cost safety strategies as part of its strategic highway safety effort. One of the strategies chosen to be evaluated for this study was STOP AHEAD pav...

Safety evaluation of wet-reflective pavement markings : tech brief.

DOT National Transportation Integrated Search

2015-12-01

The Federal Highway Administration (FHWA) organized : 38 States for the FHWA Evaluation of Low-Cost Safety : Improvements Pooled Fund Study as part of its strategic : highway safety plan support effort. The purpose of the : study is to evaluate the s...

12 CFR 390.466 - Risk-based capital credit risk-weight categories.

Code of Federal Regulations, 2012 CFR

2012-01-01

... ownership interests in pools of assets. Assets representing an indirect holding of a pool of assets, e.g... would be assigned to the assets in the portfolio of the pool. An investment in shares of a mutual fund... positions; (5) Use clear, explicit criteria to classify assets into each internal rating grade, including...

Utah DOT weather responsive traffic signal timing.

DOT National Transportation Integrated Search

1996-01-01

This report provides background and summary of the scope of work for the pooled fund study, Durability of Geosynthetics for Highway Applications. Status and a summary of initial test results for each of the tasks in this study, as well as a sum...

Safety evaluation of flashing beacons at STOP-controlled intersections

DOT National Transportation Integrated Search

2008-03-01

The Federal Highway Administration (FHWA) organized a pooled fund study of 26 States to evaluate low-cost safety strategies as part of its strategic highway safety effort. One of the strategies chosen to be evaluated for this study was flashing beaco...

Safety evaluation of increasing retroreflectivity of STOP signs

DOT National Transportation Integrated Search

2008-03-01

The Federal Highway Administration (FHWA) organized a Pooled Fund Study of 26 States to evaluate low-cost safety strategies as part of its strategic highway safety effort. One of the strategies chosen to be evaluated for this study was STOP signs wit...

Safety evaluation of centerline plus shoulder rumble strips, TechBrief

DOT National Transportation Integrated Search

2015-09-01

The Federal Highway Administration (FHWA) organized 37 States to participate in the FHWA Evaluation of Low-Cost Safety Improvements Pooled Fund Study as part of its strategic highway safety plan support effort. The purpose of the study was to evaluat...

Safety evaluation of offset improvements for left-turn lanes

DOT National Transportation Integrated Search

2009-06-01

The Federal Highway Administration (FHWA) organized a pooled fund study of 26 States to evaluate low-cost safety strategies as part of its strategic highway safety effort. One of the strategies chosen to be evaluated for this study was offset improve...

Safety evaluation of flashing beacons at stop-controlled intersections

DOT National Transportation Integrated Search

2008-03-01

The Federal Highway Administration (FHWA) organized 26 States to participate in the FHWA Low-Cost Safety Improvements Pooled Fund Study as part of its strategic highway safety plan support effort. The purpose of the study is to evaluate the safety ef...

Safety evaluation of STOP AHEAD pavement markings TechBrief

DOT National Transportation Integrated Search

2008-03-01

The Federal Highway Administration (FHWA) organized 26 States to participate in the FHWA Low-Cost Safety Improvements Pooled Fund Study as part of its strategic highway safety plan support effort. The purpose of the study is to evaluate the safety ef...

Highway maintenance concept vehicle final report : phase four.

DOT National Transportation Integrated Search

2002-06-01

This report documents Phase IV of the Highway Maintenance Concept Vehicle (HMCV) project, : a pooled fund study sponsored by the Departments of Transportation of Iowa, Pennsylvania, and : Wisconsin. This report provides the background, including a br...

Enterprise Workplan for FY2002-2003

DOT National Transportation Integrated Search

2002-11-01

The ENTERPRISE Program is a pooled-fund with member agencies in the United States, Canada, and the Netherlands. Its main purpose is to use the pooled resources of its members, private sector partners and the United States federal government to develo...

Field testing of hand-held infrared thermography, phase II TPF-5(247) : final report.

DOT National Transportation Integrated Search

2016-05-01

This report is the second of two volumes that document results from the pooled fund study TPF-5 (247), Development of : Handheld Infrared Thermography, Phase II. The interim report (volume I) studied the implementation of handheld thermography : by p...

Accelerated pavement testing of low-volume paved roads with geocell reinforcement.

DOT National Transportation Integrated Search

2015-03-01

The Midwest States Accelerated Pavement Testing Pooled-Fund Program, financed by the highway : departments of Kansas, Iowa, Missouri, and New York, has supported an accelerated pavement testing (APT) project : to study the rehabilitation of low-volum...

Safety evaluation of increasing retroreflectivity of STOP signs

DOT National Transportation Integrated Search

2008-03-01

The Federal Highway Administration (FHWA) organized 26 States : to participate in the FHWA Low-Cost Safety Improvements Pooled : Fund Study to evaluate low-cost safety strategies as part of its : strategic highway safety plan support effort. The purp...

Accelerated testing for studying pavement design and performance (FY 2003) : research summary.

DOT National Transportation Integrated Search

2008-01-01

The Midwest States Accelerated Pavement Testing Pooled Fund Program, financed by : the highway departments of Missouri, Iowa, Kansas and Nebraska, has supported an : accelerated pavement testing (APT) project to compare the performance of stabilized ...

Safety evaluation of centerline plus shoulder rumble strips.

DOT National Transportation Integrated Search

2015-06-01

The Federal Highway Administration organized a pooled fund study of 38 States to evaluate low-cost safety strategies as part of its strategic highway safety effort. One of the strategies selected for evaluation was the combined application of centerl...

Safety evaluation of wet reflective pavement markers.

DOT National Transportation Integrated Search

2015-09-01

The Federal Highway Administration organized a pooled fund study of 38 States to evaluate low-cost safety : strategies as part of its strategic highway safety effort. One of the strategies selected for evaluation was the : application of wet-reflecti...

Safety evaluation of wet-reflective pavement markings.

DOT National Transportation Integrated Search

2015-09-01

The Federal Highway Administration organized a pooled fund study of 38 States to evaluate low-cost safety strategies as part of its strategic highway safety effort. One of the strategies selected for evaluation was the application of wet-reflective p...

Microcomputer software for storm drain hydraulic gradeline computation.

DOT National Transportation Integrated Search

1987-01-01

A microcomputer software module was developed for the computation of hydraulic gradeline in storm sewer systems. The computer module has been attached to the program '"HYDRA", which is being adopted by the FHWA organized Pooled Fund Study. on Integra...

Construction of crack-free bridge decks.

DOT National Transportation Integrated Search

2017-04-01

This serves as the final report on Transportation Pooled-Fund Program Project No. TPF-5(174), Construction : of Crack-Free Bridge Decks. The goal of the study was to implement the most cost-effective techniques for : improving bridge deck life ...

Safety evaluation of intersection conflict warning system.

DOT National Transportation Integrated Search

2016-06-01

FHWA organized a pooled fund study of 40 States to evaluate low-cost safety strategies as part of its strategic highway safety effort. One of the strategies selected for evaluation was intersection conflict warning systems (ICWSs). This strategy is i...

26 CFR 1.642(c)-5 - Definition of pooled income fund.

Code of Federal Regulations, 2010 CFR

2010-04-01

... contribution to the fund or of the purchase price of those assets purchased by the fund. This definition of... the income interest is designated, such beneficiaries may enjoy their shares of income concurrently... beneficiaries to whom the income is payable and the share of income distributable to each person so specified...

Safety evaluation of lane and shoulder width combinations on rural, two-lane, undivided roads

DOT National Transportation Integrated Search

2009-06-01

The Federal Highway Administration (FHWA) organized a pooled fund study of 26 States to evaluate low-cost safety strategies as part of its strategic highway safety effort. The goal of this study is to evaluate the safety effectiveness of various lane...

78 FR 36018 - Bond Guarantee Program; Notice of Guarantee Availability (NOGA) Inviting Qualified Issuer...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-14

... examination of Guarantee Applications is conducted. E. Relationship to other CDFI Fund programs. Award funds... Risk-Share Pool for each Bond Issue. F. Relationship and interplay with other Federal programs and...

Measuring Diversity of the National Institutes of Health-Funded Workforce.

PubMed

Heggeness, Misty L; Evans, Lisa; Pohlhaus, Jennifer Reineke; Mills, Sherry L

2016-08-01

To measure diversity within the National Institutes of Health (NIH)-funded workforce. The authors use a relevant labor market perspective to more directly understand what the NIH can influence in terms of enhancing diversity through NIH policies. Using the relevant labor market (defined as persons with advanced degrees working as biomedical scientists in the United States) as the conceptual framework, and informed by accepted economic principles, the authors used the American Community Survey and NIH administrative data to calculate representation ratios of the NIH-funded biomedical workforce from 2008 to 2012 by race, ethnicity, sex, and citizenship status, and compared this against the pool of characteristic individuals in the potential labor market. In general, the U.S. population during this time period was an inaccurate comparison group for measuring diversity of the NIH-funded scientific workforce. Measuring accurately, we found the representation of women and traditionally underrepresented groups in NIH-supported postdoc fellowships and traineeships and mentored career development programs was greater than their representation in the relevant labor market. The same analysis found these demographic groups are less represented in the NIH-funded independent investigator pool. Although these findings provided a picture of the current NIH-funded workforce and a foundation for understanding the federal role in developing, maintaining, and renewing diverse scientific human resources, further study is needed to identify whether junior- and early-stage investigators who are part of more diverse cohorts will naturally transition into independent NIH-funded investigators, or whether they will leave the workforce before achieving independent researcher status.

Measuring Diversity of the National Institutes of Health-Funded Workforce

PubMed Central

Heggeness, Misty L.; Evans, Lisa; Pohlhaus, Jennifer Reineke; Mills, Sherry L.

2017-01-01

Purpose To measure diversity within the National Institutes of Health (NIH) funded workforce. The authors use a relevant labor market perspective to more directly understand what the NIH can influence in terms of enhancing diversity through NIH policies. Method Using the relevant labor market (defined as those persons with advanced degrees working as biomedical scientists in the United States) as the conceptual framework, and informed by accepted economic principles, the authors used the American Community Survey (ACS) and NIH administrative data to calculate representation ratios of the NIH-funded biomedical workforce from 2008–2012 by race, ethnicity, sex, and citizenship status, and compared this to the pool of characteristic individuals in the potential labor market. Results In general, the U.S. population during this same time period was a poor comparison group to the NIH-funded scientific workforce. Furthermore, the representation of women and traditionally underrepresented groups in NIH-supported postdoc fellowships and traineeships and mentored career development programs was greater than their representation in the relevant labor market. The same analysis found that these demographic groups are less represented in the NIH-funded independent investigator pool. Conclusions While these findings provided a picture of current NIH-funded workforce and a foundation for understanding the federal role in developing, maintaining, and renewing diverse scientific human resources, further study is needed to identify whether junior- and early-stage investigators who are part of more diverse cohorts will naturally transition into independent NIH-funded investigators, or whether they will leave the workforce before achieving independent researcher status. PMID:27224301

Accelerated pavement testing of low-volume paved roads with geocell reinforcement : [technical summary].

DOT National Transportation Integrated Search

2015-03-01

The Midwest States Accelerated Pavement Testing Pooled-Fund Program, financed : by the highway departments of Kansas, Iowa, Missouri, and New York, has : supported an accelerated pavement testing (APT) project to study the rehabilitation : of low-vol...

Traffic and data preparation for AASHTO DARWin-ME analysis and design.

DOT National Transportation Integrated Search

2015-02-01

Pavement ME Design (MEPDG/DARWin-ME) is a significant advancement in pavement design, but : requires much more inputs from various sources. Through the transportation pooled fund study TPF- : 5(242), a full-production software Prep-ME with comprehens...

MEPDG Traffic Loading Defaults Derived from Traffic Pooled Fund Study

DOT National Transportation Integrated Search

2016-04-01

As part of traffic loading inputs, the Mechanistic-Empirical Pavement Design Guide (MEPDG), Interim Edition: A Manual of Practice requires detailed axle loading information in the form of normalized axle load spectra (NALS), number of axle per truck ...

Southeast regional fatal study : a causal chain analysis in North Carolina

DOT National Transportation Integrated Search

2002-01-01

This project completed the North Carolina portion of the pooled fund Southeast Fatal Analysis Project. In addition : to completing this portion of the causal chain analysis for NC Crashes, the project developed a ranked : comprehensive list of candid...

Health sector reforms in Argentina and the performance of the health financing system.

PubMed

Cavagnero, Eleonora

2008-10-01

In Argentina, health sector reforms put particular emphasis on decentralization and self-management of the tax-funded health sector, and the restructuring of the social health insurance during the 1990s. Unlike other countries in the region, there was no comprehensive plan to reform and unify the sector. In order to assess the effects of the reforms on the performance of the health financing system, this study looks at impacts on the three inter-related functions of revenue collection, pooling, and purchasing/provision of health services. Data from various sources are used to illustrate the findings. It was found that the introduction of cost recovery by self-managed hospitals increased their budgets only marginally and competition among social health insurance funds did not reduce fragmentation as expected. Although reforming the Solidarity Redistribution Fund and implementing a single basic package for the insured was an important step towards equity and transparency, the extent of risk pooling is still very limited. This study also provides recommendations regarding strengthening reimbursement mechanisms for public hospitals, and regulating the private sector as approaches to improving the fairness of the health financing system and protecting people from financial hardship as a result of illness.

Bismarck meets Beveridge on the Silk Road: coordinating funding sources to create a universal health financing system in Kyrgyzstan.

PubMed

Kutzin, Joseph; Ibraimova, Ainura; Jakab, Melitta; O'Dougherty, Sheila

2009-07-01

Options for health financing reform are often portrayed as a choice between general taxation (known as the Beveridge model) and social health insurance (known as the Bismarck model). Ten years of health financing reform in Kyrgyzstan, since the introduction of its compulsory health insurance fund in 1997, provide an excellent example of why it is wrong to reduce health financing policy to a choice between the Beveridge and Bismarck models. Rather than fragment the system according to the insurance status of the population, as many other low- and middle-income countries have done, the Kyrgyz reforms were guided by the objective of having a single system for the entire population. Key features include the role and gradual development of the compulsory health insurance fund as the single purchaser of health-care services for the entire population using output-based payment methods, the complete restructuring of pooling arrangements from the former decentralized budgetary structure to a single national pool, and the establishment of an explicit benefit package. Central to the process was the transformation of the role of general budget revenues - the main source of public funding for health - from directly subsidizing the supply of services to subsidizing the purchase of services on behalf of the entire population by redirecting them into the health insurance fund. Through their approach to health financing policy, and pooling in particular, the Kyrgyz health reformers demonstrated that different sources of funds can be used in an explicitly complementary manner to enable the creation of a unified, universal system.

Safety evaluation of installing center two-way left-turn lanes on two-lane roads

DOT National Transportation Integrated Search

2008-03-01

The Federal Highway Administration organized a Pooled Fund Study of 26 States to evaluate low-cost safety strategies as part of its strategic highway safety effort. One of the strategies chosen to be evaluated for this study was the installation of c...

The associations of parity and maternal age with small-for-gestational-age, preterm, and neonatal and infant mortality: a meta-analysis

PubMed Central

2013-01-01

Background Previous studies have reported on adverse neonatal outcomes associated with parity and maternal age. Many of these studies have relied on cross-sectional data, from which drawing causal inference is complex. We explore the associations between parity/maternal age and adverse neonatal outcomes using data from cohort studies conducted in low- and middle-income countries (LMIC). Methods Data from 14 cohort studies were included. Parity (nulliparous, parity 1-2, parity ≥3) and maternal age (<18 years, 18-<35 years, ≥35 years) categories were matched with each other to create exposure categories, with those who are parity 1-2 and age 18-<35 years as the reference. Outcomes included small-for-gestational-age (SGA), preterm, neonatal and infant mortality. Adjusted odds ratios (aOR) were calculated per study and meta-analyzed. Results Nulliparous, age <18 year women, compared with women who were parity 1-2 and age 18-<35 years had the highest odds of SGA (pooled adjusted OR: 1.80), preterm (pooled aOR: 1.52), neonatal mortality (pooled aOR: 2.07), and infant mortality (pooled aOR: 1.49). Increased odds were also noted for SGA and neonatal mortality for nulliparous/age 18-<35 years, preterm, neonatal, and infant mortality for parity ≥3/age 18-<35 years, and preterm and neonatal mortality for parity ≥3/≥35 years. Conclusions Nulliparous women <18 years of age have the highest odds of adverse neonatal outcomes. Family planning has traditionally been the least successful in addressing young age as a risk factor; a renewed focus must be placed on finding effective interventions that delay age at first birth. Higher odds of adverse outcomes are also seen among parity ≥3 / age ≥35 mothers, suggesting that reproductive health interventions need to address the entirety of a woman’s reproductive period. Funding Funding was provided by the Bill & Melinda Gates Foundation (810-2054) by a grant to the US Fund for UNICEF to support the activities of the Child Health Epidemiology Reference Group. PMID:24564800

Indian Country Fellows: Foundations Pool Resources to Support TCU Faculty Dissertations, Research

ERIC Educational Resources Information Center

Marchbanks, Rachael

2011-01-01

This article describes how the American Indian College Fund helps tribal college and university (TCU) faculty members conduct research and complete their Ph.D.s--and tackle unique challenges. Funded by the Andrew W. Mellon Foundation and the Alfred P. Sloan Foundation, the fellowship programs administered by the College Fund pay a one-year stipend…

34 CFR 601.21 - Code of conduct.

Code of Federal Regulations, 2011 CFR

2011-07-01

... for private education loans, including funds for an opportunity pool loan, to students in exchange for..., the term opportunity pool loan means a private education loan made by a lender to a student attending... functions during emergencies, including State-declared or Federally declared natural disasters, Federally...

40 CFR 35.419 - Purpose.

Code of Federal Regulations, 2010 CFR

2010-07-01

... enhance the response program of the State; capitalize a revolving loan fund for Brownfield remediation under section 104(k)(3) of CERCLA; or purchase insurance or develop a risk sharing pool, an indemnity pool, or insurance mechanism to provide financing for response actions under a State response program. ...

Evaluation of corrosion inhibitors for concrete bridge deck patches and overlays.

DOT National Transportation Integrated Search

2003-01-01

This report presents the results to date of a national pooled fund study initiated in August 1996 to evaluate the long-term performance of bridges and outdoor exposure slabs damaged by chloride-induced corrosion that have concrete containing corrosio...

Accelerated bridge construction (ABC) decision making and economic modeling tool.

DOT National Transportation Integrated Search

2011-12-01

In this FHWA-sponsored pool funded study, a set of decision making tools, based on the Analytic Hierarchy Process (AHP) was developed. This tool set is prepared for transportation specialists and decision-makers to determine if ABC is more effective ...

Verification, refinement, and applicability of long-term pavement performance vehicle classification rules.

DOT National Transportation Integrated Search

2014-11-01

The Long-Term Pavement Performance (LTPP) project has developed and deployed a set of rules for converting axle spacing and weight data into estimates of a vehicles classification. These rules are being used at Transportation Pooled Fund Study (TP...

Real time laser scanning of aggregate materials in highway construction : a transportation pooled fund study.

DOT National Transportation Integrated Search

2016-12-01

The quality and service life of the roadways that make up the highway transportation infrastructure are dependent upon : the selection and use of high quality aggregate materials. Five state transportation agencies participated in this Transportation...

Implementation and transition of data interchange for geotechnical and geoenvironmental specialists (DIGGS v2.0).

DOT National Transportation Integrated Search

2017-01-01

Data Interchange for Geotechnical and Geoenvironmental Specialists (DIGGS) is an XML-based system : developed under a Federal Highway Administration (FHWA) State Pooled Funding Study led by the : Ohio Department of Transportation (ODOT) from 2005 to ...

Strategies toward Cooperation.

ERIC Educational Resources Information Center

Johnson, Donald A.

1979-01-01

The Quad-Cities Graduate Study Center in Rock Island, Illinois, a voluntary, publicly funded, academic consortium, is described. It was incorporated as an experimental project to determine if pooling institutional resources were academically, financially, and administratively possible. It is now a model of inter-institutional cooperation providing…

Safety evaluation of intersection conflict warning systems (ICWS), TechBrief

DOT National Transportation Integrated Search

2016-02-02

The Federal Highway Administration (FHWA) organized 40 States to participate in the FHWA Evaluation of LowCost Safety Improvements Pooled Fund Study (ELCSI-PFS) as part of its strategic highway safety plan support effort. The goal of the ELCSI-PFS re...

40 CFR 35.736 - Purpose.

Code of Federal Regulations, 2010 CFR

2010-07-01

... establish or enhance the response program of the Tribe; capitalize a revolving loan fund for brownfield remediation under section 104(k)(3) of CERCLA; or purchase insurance or develop a risk sharing pool, an indemnity pool, or insurance mechanism to provide financing for response actions under a Tribal response...

Development of hydraulic computer models to analyze tidal and coastal stream hydraulic conditions at highway structures : phase 2 for the Pooled Fund Study, SPR-3(22)

DOT National Transportation Integrated Search

1997-12-01

Highway structures are subjected to stream instability and foundation scour resulting from dynamic flow conditions caused by tides, currents, storm surges, and upland runoff. This phase of the study (Phase II) focused on (1) making useful modificatio...

17 CFR 229.1113 - (Item 1113) Structure of the transaction.

Code of Federal Regulations, 2011 CFR

2011-04-01

... securities, and within each class, with respect to cash flows, credit enhancement or other support and any... narrative discussion of the allocation and priority structure of pool cash flows, present the flow of funds... any requirements directing cash flows from the pool assets (such as to reserve accounts, cash...

17 CFR 229.1113 - (Item 1113) Structure of the transaction.

Code of Federal Regulations, 2012 CFR

2012-04-01

... securities, and within each class, with respect to cash flows, credit enhancement or other support and any... narrative discussion of the allocation and priority structure of pool cash flows, present the flow of funds... any requirements directing cash flows from the pool assets (such as to reserve accounts, cash...

17 CFR 229.1113 - (Item 1113) Structure of the transaction.

Code of Federal Regulations, 2013 CFR

2013-04-01

... securities, and within each class, with respect to cash flows, credit enhancement or other support and any... narrative discussion of the allocation and priority structure of pool cash flows, present the flow of funds... any requirements directing cash flows from the pool assets (such as to reserve accounts, cash...

17 CFR 229.1113 - (Item 1113) Structure of the transaction.

Code of Federal Regulations, 2014 CFR

2014-04-01

... securities, and within each class, with respect to cash flows, credit enhancement or other support and any... narrative discussion of the allocation and priority structure of pool cash flows, present the flow of funds... any requirements directing cash flows from the pool assets (such as to reserve accounts, cash...

Accelerated testing for studying pavement design and performance (FY 2003) : evaluation of the chemical stabilized subgrade soil (CISL Experiment No. 12).

DOT National Transportation Integrated Search

2008-01-01

The Midwest States Accelerated Pavement Testing Pooled Fund Program, financed by the highway departments : of Missouri, Iowa, Kansas and Nebraska, has supported an accelerated pavement testing (APT) project to compare : the performance of stabilized ...

Utilization and management of maternal and child health funds in rural Nepal.

PubMed

Morrison, Joanna; Thapa, Rita; Sen, Aman; Neupane, Rishi; Borghi, Jo; Tumbahangphe, Kirti Man; Osrin, David; Manandhar, Dharma; Costello, Anthony

2010-01-01

Maternal and neonatal mortality rates are highest in the poorest countries, and financial barriers impede access to health care. Community loan funds can increase access to cash in rural areas, thereby reducing delays in care seeking. As part of a participatory intervention in rural Nepal, community women's groups initiated and managed local funds. We explore the factors affecting utilization and management of these funds and the role of the funds in the success of the women's group intervention. We conducted a qualitative study using focus group discussions, group interviews and unstructured observations. Funds may increase access to care for members of trusted 'insider' families adjudged as able to repay loans. Sustainability and sufficiency of funds was a concern but funds increased women's independence and enabled timely care seeking. Conversely, the perceived necessity to contribute may have deterred poorer women. While funds were integral to group success and increased women's autonomy, they may not be the most effective way of supporting the poorest, as the risk pool is too small to allow for repayment default.

A Review of Selected International Aircraft Spares Pooling Programs: Lessons Learned for F-35 Spares Pooling

DTIC Science & Technology

2016-01-01

fund its share of program costs , and how the program will manage divergence from a common configuration baseline. In the formal agreement establishing...total spare parts than if all the participants operated on a purely national basis because of differentials in demand, particularly for high- cost parts...by the House of Commons Committee of Public Accounts , whose findings were published in 2011, the international spares pooling contracts did not work

Effective financing of maternal health services: a review of the literature.

PubMed

Ensor, Tim; Ronoh, Jeptepkeny

2005-12-01

Health care can be funded in a number of ways ranging from direct user charges (out of pocket) payments to indirect methods that pool across time (prepayment) and across different risk and wealth groups (insurance and general taxation). All these methods can be used to finance maternal health services. When assessing the impact of financing mechanisms it is important to be aware of the different ways they effect service delivery patterns and utilisation. Specifically most systems have both equity and efficiency aspects that combine to impact on health service utilisation and health status. In general indirect methods that help families to pool the costs of maternal health services are preferable to direct methods of payment. It is also clear, however, that user charges may sometimes help to mitigate deficiencies in systems of pooled funding. Available literature suggests that financing mechanisms for maternal health services could be improved by systems that increase transparency, help to mitigate demand-side costs of services and provide funding for that promote transparent charging for services. While the limited experience of demand-side mechanisms for improving access to maternal health services more evaluation is required.

Intelligent transportation system (ITS) study for the Buffalo and Niagara Falls metropolitan area, Erie and Niagara Counties, New York : identification of institutional issues, working paper #2

DOT National Transportation Integrated Search

1997-06-18

Intelligent Transportation Systems (ITS) utilize advanced technology components on a local as well as a regional basis. On a regional basis, as is the case in this study, funding, knowledge and operations resources are often pooled from many sources....

Determinants of Budget Allocations to Academic Departments: A Case Study. ASHE 1987 Annual Meeting Paper.

ERIC Educational Resources Information Center

Winans, Glen T.

General fund budgetary determinants in 27 academic departments at the University of California Santa Barbara were studied for the period from 1977/78 through 1983/84. The focus was resource allocation and utilization within departments of the College of Letters and Science. The research design included a pooled multivariate regression analysis of…

Funding issues and options for pharmacists providing sessional services to rural hospitals in Australia.

PubMed

Tan, Amy Cw; Emmerton, Lynne M; Hattingh, H Laetitia; La Caze, Adam

2015-06-01

Many of Australia' s rural hospitals operate without an on-site pharmacist. In some, community pharmacists have sessional contracts to provide medication management services to inpatients. This paper discusses the funding arrangements of identified sessional employment models to raise awareness of options for other rural hospitals. Semistructured one-on-one interviews were conducted with rural pharmacists with experience in a sessional employment role (n =8) or who were seeking sessional arrangements (n = 4). Participants were identified via publicity and referrals. Interviews were conducted via telephone or Skype for ~40-55 min each, recorded and analysed descriptively. A shortage of state funding and reliance on federal funding was reported. Pharmacists accredited to provide medication reviews claimed remuneration via these federal schemes; however, restrictive criteria limited their scope of services. Funds pooling to subsidise remuneration for the pharmacists was evident and arrangements with local community pharmacies provided business frameworks to support sessional services. Participants were unaware of each other's models of practice, highlighting the need to share information and these findings. Several similarities existed, namely, pooling funds and use of federal medication review remuneration. Findings highlighted the need for a stable remuneration pathway and business model to enable wider implementation of sessional pharmacist models.

Underfunding of Federal University in Nigeria and Perceived Impact on Administration: An Exploratory Case Study

ERIC Educational Resources Information Center

Dimunah, Valentina Obioma

2017-01-01

Universities in Nigeria have historically faced underfunding, and at an operational level, compete for attracting the best pool of students, achieving the highest grades. Adequately funded universities not only ensure a higher standard of University curriculum, but also have the potential to result in competitive advantages over other…

Long-term Pavement Performance Program (LTPP) data analysis support : National Pooled Fund Study TPF-5(013). Effects of multiple freeze cycles and deep frost penetration on pavement performance and cost

DOT National Transportation Integrated Search

2006-11-01

The objectives of this study are to: (1) quantify the effects of frost penetration on pavement performance in climates with deep sustained frost as compared to environments with multiple freeze-thaw cycles, (2) investigate the effect that local adapt...

25 CFR 1001.5 - Application review and selection process for negotiations for funding agreements.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 25 Indians 2 2012-04-01 2012-04-01 false Application review and selection process for negotiations... process for negotiations for funding agreements. Upon acceptance into the applicant pool, the OSG will.... (c) Submission of a completed planning or negotiation grant application in the previous year. (d) A...

25 CFR 1001.5 - Application review and selection process for negotiations for funding agreements.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 2 2010-04-01 2010-04-01 false Application review and selection process for negotiations... process for negotiations for funding agreements. Upon acceptance into the applicant pool, the OSG will.... (c) Submission of a completed planning or negotiation grant application in the previous year. (d) A...

25 CFR 1001.5 - Application review and selection process for negotiations for funding agreements.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 25 Indians 2 2011-04-01 2011-04-01 false Application review and selection process for negotiations... process for negotiations for funding agreements. Upon acceptance into the applicant pool, the OSG will.... (c) Submission of a completed planning or negotiation grant application in the previous year. (d) A...

25 CFR 1001.5 - Application review and selection process for negotiations for funding agreements.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 25 Indians 2 2013-04-01 2013-04-01 false Application review and selection process for negotiations... process for negotiations for funding agreements. Upon acceptance into the applicant pool, the OSG will.... (c) Submission of a completed planning or negotiation grant application in the previous year. (d) A...

25 CFR 1001.5 - Application review and selection process for negotiations for funding agreements.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 25 Indians 2 2014-04-01 2014-04-01 false Application review and selection process for negotiations... process for negotiations for funding agreements. Upon acceptance into the applicant pool, the OSG will.... (c) Submission of a completed planning or negotiation grant application in the previous year. (d) A...

17 CFR 50.25 - Clearing requirement compliance schedule.

Code of Federal Regulations, 2013 CFR

2013-04-01

... participant; or an active fund. Category 2Entity means a commodity pool; a private fund as defined in section..., and is responsible for the documentation necessary for the account's beneficial owner to clear swaps... desires to clear the transaction, must comply with the requirements of section 2(h)(1)(A) of the Act no...

17 CFR 4.7 - Exemption from certain part 4 requirements for commodity pool operators with respect to offerings...

Code of Federal Regulations, 2012 CFR

2012-04-01

... percentage amounts and computational basis for each such fee and include a statement that the CPO is not able... percentage amounts and computational basis for each such fee and include a statement that the CPO is not able... fund, the commodity pool operator must disclose the percentage amounts and computational basis for each...

[Payment mechanisms and financial resources management for consolidation of Ecuador's health system].

PubMed

Villacrés, Tatiana; Mena, Ana Cristina

2017-06-08

Analyze the proposal by the Ministry of Public Health to reform the public financing model in Ecuador with regard to pooling of funds and payment mechanisms. A literature review was done of the financing model, the current legal framework, and the budgetary bases in Pubmed, SciELO, LILACS Ecuador, and regional LILACS using the key words health financing, health financing systems, capitation, pooling of funds, health system reform Ecuador, health system Ecuador, and health payment mechanisms. Books and other documents suggested by health systems experts were also included. Review of the financing model enabled identifying the historical segmentation of Ecuador's health system; out of this, the Ministry of Public Health conceived its proposal to reform the financing model. The Ministry's proposed solutions are pooling of funds and payment of services at the first level of care through payment per capita adjusted for socioeconomic and demographic risks. Progress made in reforming the financing model includes design of the proposals and their implementation mechanisms, and discussions with stakeholders. Implementation of these changes may produce improvements for the health system in efficiency, spreading of risks, incentives for meeting health objectives, as well as contribute to its sustainability and advance toward universal health coverage. Nevertheless, legal, political, and operational constraints are hampering their implementation.

Invest in Children Today for a Work Force Tomorrow.

ERIC Educational Resources Information Center

Penning, Nick

1989-01-01

To confront the growing proportion of disadvantaged children amidst the shrinking pool of future workers, Jule Sugarman (Washington State Secretary of Social and Health Services) has proposed a Children's Trust to fund existing and new programs for children. The program would be funded by a .3 percent payroll tax for both employers and employees.…

Trends in procurement costs for HIV commodities: a 7-year retrospective analysis of global fund data across 125 countries.

PubMed

Wafula, Francis; Agweyu, Ambrose; Macintyre, Kate

2014-04-01

Nearly 40% of Global Fund money goes toward procurement. However, no analyses have been published to show how costs vary across regions and time, despite the availability of procurement data collected through the Global Fund's price and quality reporting system. We analyzed data for the 3 most widely procured commodities for the prevention, diagnosis, and treatment of HIV. These were male condoms, HIV rapid tests, and the antiretroviral (ARV) combination of lamivudine/nevirapine/zidovudine. The compared costs, first across time (2005-2012), then across regions, and finally, between individual procurement reported through the price and quality reporting and pooled procurement reported through the Global Fund's voluntary pooled procurement system. All costs were adjusted for inflation and reported in US dollars. There were 2337 entries from 578 grants in 125 countries. The procurement cost for the ARV dropped substantially over the period, whereas those for condoms and HIV tests remained relatively stable. None of the commodity prices increased. Regional variations were pronounced for HIV tests, but minimal for condoms and the ARV. The unit cost for the 3-table ARV combination, for instance, varied between US$0.15 and US$0.23 in South Asia and the Eastern Europe/Central Asia regions, respectively, compared with a range of $0.23 (South Asia)-$1.50 (Eastern Europe/Central Asia) for a single diagnostic test. Pooled procurement lowered costs for condoms but not the other commodities. We showed how global procurement costs vary by region and time. Such analyses should be done more often to identify and correct market insufficiencies.

45 CFR 148.314 - Periods during which eligible States may apply for a grant.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Operation of Qualified High Risk Pools § 148.314 Periods during which eligible States may apply for a grant... connection with the operation of its qualified high risk pool. Funding for FY 2007 through FY 2010 under the... fiscal year, a State may apply for losses incurred in a partial fiscal year if a partial year audit is...

25 CFR 1000.29 - What happens if a Tribe/Consortium is selected from the applicant pool but does not execute a...

Code of Federal Regulations, 2014 CFR

2014-04-01

... Indians OFFICE OF THE ASSISTANT SECRETARY, INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR ANNUAL FUNDING... compact and annual funding agreement at any time unless: (1) It notifies the Director in writing that it... an agreement has no effect on the selection of up to 50 additional Tribes/Consortia in a subsequent...

25 CFR 1000.29 - What happens if a Tribe/Consortium is selected from the applicant pool but does not execute a...

Code of Federal Regulations, 2010 CFR

2010-04-01

... Indians OFFICE OF THE ASSISTANT SECRETARY, INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR ANNUAL FUNDING... compact and annual funding agreement at any time unless: (1) It notifies the Director in writing that it... an agreement has no effect on the selection of up to 50 additional Tribes/Consortia in a subsequent...

25 CFR 1000.29 - What happens if a Tribe/Consortium is selected from the applicant pool but does not execute a...

Code of Federal Regulations, 2012 CFR

2012-04-01

... Indians OFFICE OF THE ASSISTANT SECRETARY, INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR ANNUAL FUNDING... compact and annual funding agreement at any time unless: (1) It notifies the Director in writing that it... an agreement has no effect on the selection of up to 50 additional Tribes/Consortia in a subsequent...

25 CFR 1000.29 - What happens if a Tribe/Consortium is selected from the applicant pool but does not execute a...

Code of Federal Regulations, 2011 CFR

2011-04-01

... Indians OFFICE OF THE ASSISTANT SECRETARY, INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR ANNUAL FUNDING... compact and annual funding agreement at any time unless: (1) It notifies the Director in writing that it... an agreement has no effect on the selection of up to 50 additional Tribes/Consortia in a subsequent...

76 FR 8067 - Reporting by Investment Advisers to Private Funds and Certain Commodity Pool Operators and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-11

... other things, to assist the Financial Stability Oversight Council in its assessment of systemic risk in... for the assessment of systemic risk by FSOC.\\12\\ The records and reports must include a description of... section 204(b)(1) could be read in isolation to imply that the SEC requiring private fund systemic risk...

7 CFR Exhibit C to Subpart L of... - Housing in Underserved Areas

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 13 2011-01-01 2009-01-01 true Housing in Underserved Areas C Exhibit C to Subpart L... Allocation of Loan and Grant Program Funds Pt. 1940, Subpt. L, Exh. C Exhibit C to Subpart L of Part 1940... precedence over other processing priority methods. C. Colonias may access pooled RHTSA funds as provided in...

7 CFR Exhibit C to Subpart L of... - Housing in Underserved Areas

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 13 2012-01-01 2012-01-01 false Housing in Underserved Areas C Exhibit C to Subpart L... Allocation of Loan and Grant Program Funds Pt. 1940, Subpt. L, Exh. C Exhibit C to Subpart L of Part 1940... precedence over other processing priority methods. C. Colonias may access pooled RHTSA funds as provided in...

Wellness

MedlinePlus

... Nurses Exercise for Polio Survivors Anesthesia Concerns Pool/Water Therapy Other Resources Reports & CD from Task Force Medical/Clinical Publications ADVOCACY Issues Organizations Resources RESEARCH About The Research Fund New Request for 2018 ...

Orthotics

MedlinePlus

... Nurses Exercise for Polio Survivors Anesthesia Concerns Pool/Water Therapy Other Resources Reports & CD from Task Force Medical/Clinical Publications ADVOCACY Issues Organizations Resources RESEARCH About The Research Fund New Request for 2018 ...

Coughing

MedlinePlus

... Nurses Exercise for Polio Survivors Anesthesia Concerns Pool/Water Therapy Other Resources Reports & CD from Task Force Medical/Clinical Publications ADVOCACY Issues Organizations Resources RESEARCH About The Research Fund New Request for 2018 ...

Growing the Leadership Talent Pool: Perceptions of Heads, Middle Leaders and Classroom Teachers about Professional Development and Leadership Succession Planning within Their Own Schools

ERIC Educational Resources Information Center

Rhodes, Christopher; Brundrett, Mark

2009-01-01

This article reports on outcomes from a study funded by the National College for School Leadership designed to explore the factors that assist in the leadership development of teachers at a number of stages of their career development. More specifically, the study sought to identify issues associated with leadership talent identification,…

Journey to the Doctorate: Motivating Factors for Persistence and Completion of Doctoral Programs among McNair Scholars

ERIC Educational Resources Information Center

Baness King, Deborah

2011-01-01

Using a qualitative approach, this study investigated the perceptions of motivating factors for persistence and completion of the doctorate among low income, first generation and students of color that participated in the federally funded Ronald E. McNair Postbaccalaureate Achievement Program. Purposive sampling was used to obtain a pool of nine…

Cold Intolerance

MedlinePlus

... Nurses Exercise for Polio Survivors Anesthesia Concerns Pool/Water Therapy Other Resources Reports & CD from Task Force Medical/Clinical Publications ADVOCACY Issues Organizations Resources RESEARCH About The Research Fund New Request for 2018 ...

Alternative Therapies

MedlinePlus

... Nurses Exercise for Polio Survivors Anesthesia Concerns Pool/Water Therapy Other Resources Reports & CD from Task Force Medical/Clinical Publications ADVOCACY Issues Organizations Resources RESEARCH About The Research Fund New Request for 2018 ...

The evolution of anti-social rewarding and its countermeasures in public goods games.

PubMed

dos Santos, Miguel

2015-01-07

Cooperation in joint enterprises can easily break down when self-interests are in conflict with collective benefits, causing a tragedy of the commons. In such social dilemmas, the possibility for contributors to invest in a common pool-rewards fund, which will be shared exclusively among contributors, can be powerful for averting the tragedy, as long as the second-order dilemma (i.e. withdrawing contribution to reward funds) can be overcome (e.g. with second-order sanctions). However, the present paper reveals the vulnerability of such pool-rewarding mechanisms to the presence of reward funds raised by defectors and shared among them (i.e. anti-social rewarding), as it causes a cooperation breakdown, even when second-order sanctions are possible. I demonstrate that escaping this social trap requires the additional condition that coalitions of defectors fare poorly compared with pro-socials, with either (i) better rewarding abilities for the latter or (ii) reward funds that are contingent upon the public good produced beforehand, allowing groups of contributors to invest more in reward funds than groups of defectors. These results suggest that the establishment of cooperation through a collective positive incentive mechanism is highly vulnerable to anti-social rewarding and requires additional countermeasures to act in combination with second-order sanctions. © 2014 The Author(s) Published by the Royal Society. All rights reserved.

Transportation pooled fund project: energy sector developments.

DOT National Transportation Integrated Search

2016-08-01

The purpose of this research is to provide a mechanism for partner states to share information and experiences concerning responses to energy sector developments, and identify : areas for needed research.

Reducing Outbreaks: Using International Governmental Risk Pools to Fund Research and Development of Infectious Disease Medicines and Vaccines

PubMed Central

Erfe, J. Mark

2014-01-01

The deadliest Ebola outbreak the world has ever seen is currently ravaging West Africa, despite the concerted efforts of the World Health Organization and many national governments. The current picture is troubling, but not altogether unexpected. Ebola was initially identified in 1976, and since that time, few drugs have been developed to combat it. The same is true for myriad other dangerous infectious diseases to which the world is currently susceptible. One proposal that might prevent outbreaks of this scale and magnitude from recurring would be to have the World Health Organization (WHO) and its technical partners assess which of its member states are at high risk for a disease, either directly or indirectly, and facilitate the creation of international governmental risk pools of those member states. Risk pools would offer open-indexed grant contracts to fund vaccine and drug development for a particular disease, and pharmaceutical companies could browse the index to apply for these grants. If the risk-pool states and a particular company sign a contract, a mutually agreed upon amount of the vaccine or drug would be produced at a below-market purchase price for those states. In return, the company would keep any patents or intellectual property rights for the developed vaccines or drugs. Risk-pool countries that did not use their vaccine or drug could resell that supply on secondary markets to other countries outside of the risk pool. This arrangement will increase the supply of tested drug and vaccine candidates available for combatting unexpected outbreaks of any previously discovered major infectious disease in the future. PMID:25506281

Reducing outbreaks: using international governmental risk pools to fund research and development of infectious disease medicines and vaccines.

PubMed

Erfe, J Mark

2014-12-01

The deadliest Ebola outbreak the world has ever seen is currently ravaging West Africa, despite the concerted efforts of the World Health Organization and many national governments. The current picture is troubling, but not altogether unexpected. Ebola was initially identified in 1976, and since that time, few drugs have been developed to combat it. The same is true for myriad other dangerous infectious diseases to which the world is currently susceptible. One proposal that might prevent outbreaks of this scale and magnitude from recurring would be to have the World Health Organization (WHO) and its technical partners assess which of its member states are at high risk for a disease, either directly or indirectly, and facilitate the creation of international governmental risk pools of those member states. Risk pools would offer open-indexed grant contracts to fund vaccine and drug development for a particular disease, and pharmaceutical companies could browse the index to apply for these grants. If the risk-pool states and a particular company sign a contract, a mutually agreed upon amount of the vaccine or drug would be produced at a below-market purchase price for those states. In return, the company would keep any patents or intellectual property rights for the developed vaccines or drugs. Risk-pool countries that did not use their vaccine or drug could resell that supply on secondary markets to other countries outside of the risk pool. This arrangement will increase the supply of tested drug and vaccine candidates available for combatting unexpected outbreaks of any previously discovered major infectious disease in the future.

Promoting universal financial protection: evidence from seven low- and middle-income countries on factors facilitating or hindering progress

PubMed Central

2013-01-01

Although universal health coverage (UHC) is a global health policy priority, there remains limited evidence on UHC reforms in low- and middle-income countries (LMICs). This paper provides an overview of key insights from case studies in this thematic series, undertaken in seven LMICs (Costa Rica, Georgia, India, Malawi, Nigeria, Tanzania, and Thailand) at very different stages in the transition to UHC. These studies highlight the importance of increasing pre-payment funding through tax funding and sometimes mandatory insurance contributions when trying to improve financial protection by reducing out-of-pocket payments. Increased tax funding is particularly important if efforts are being made to extend financial protection to those outside formal-sector employment, raising questions about the value of pursuing contributory insurance schemes for this group. The prioritisation of insurance scheme coverage for civil servants in the first instance in some LMICs also raises questions about the most appropriate use of limited government funds. The diverse reforms in these countries provide some insights into experiences with policies targeted at the poor compared with universalist reform approaches. Countries that have made the greatest progress to UHC, such as Costa Rica and Thailand, made an explicit commitment to ensuring financial protection and access to needed care for the entire population as soon as possible, while this was not necessarily the case in countries adopting targeted reforms. There also tends to be less fragmentation in funding pools in countries adopting a universalist rather than targeting approach. Apart from limiting cross-subsidies, fragmentation of pools has contributed to differential benefit packages, leading to inequities in access to needed care and financial protection across population groups; once such differentials are entrenched, they are difficult to overcome. Capacity constraints, particularly in purchasing organisations, are a pervasive problem in LMICs. The case studies also highlighted the critical role of high-level political leadership in pursuing UHC policies and citizen support in sustaining these policies. This series demonstrates the value of promoting greater sharing of experiences on UHC reforms across LMICs. It also identifies key areas of future research on health care financing in LMICs that would support progress towards UHC. PMID:24228762

Promoting universal financial protection: evidence from seven low- and middle-income countries on factors facilitating or hindering progress.

PubMed

McIntyre, Di; Ranson, Michael K; Aulakh, Bhupinder K; Honda, Ayako

2013-09-24

Although universal health coverage (UHC) is a global health policy priority, there remains limited evidence on UHC reforms in low- and middle-income countries (LMICs). This paper provides an overview of key insights from case studies in this thematic series, undertaken in seven LMICs (Costa Rica, Georgia, India, Malawi, Nigeria, Tanzania, and Thailand) at very different stages in the transition to UHC.These studies highlight the importance of increasing pre-payment funding through tax funding and sometimes mandatory insurance contributions when trying to improve financial protection by reducing out-of-pocket payments. Increased tax funding is particularly important if efforts are being made to extend financial protection to those outside formal-sector employment, raising questions about the value of pursuing contributory insurance schemes for this group. The prioritisation of insurance scheme coverage for civil servants in the first instance in some LMICs also raises questions about the most appropriate use of limited government funds.The diverse reforms in these countries provide some insights into experiences with policies targeted at the poor compared with universalist reform approaches. Countries that have made the greatest progress to UHC, such as Costa Rica and Thailand, made an explicit commitment to ensuring financial protection and access to needed care for the entire population as soon as possible, while this was not necessarily the case in countries adopting targeted reforms. There also tends to be less fragmentation in funding pools in countries adopting a universalist rather than targeting approach. Apart from limiting cross-subsidies, fragmentation of pools has contributed to differential benefit packages, leading to inequities in access to needed care and financial protection across population groups; once such differentials are entrenched, they are difficult to overcome. Capacity constraints, particularly in purchasing organisations, are a pervasive problem in LMICs. The case studies also highlighted the critical role of high-level political leadership in pursuing UHC policies and citizen support in sustaining these policies.This series demonstrates the value of promoting greater sharing of experiences on UHC reforms across LMICs. It also identifies key areas of future research on health care financing in LMICs that would support progress towards UHC.

Environmental assessment, K Pool fish rearing, Hanford Site, Richland, Washington

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

NONE

1996-12-01

The US Department of Energy (DOE) has a need to respond to a request to lease facilities at the Hanford Site 100-KE and 100-KW filter plant pools (K Pools) for fish rearing activities. These fish rearing activities would be: (1) business ventures with public and private funds and (2) long-term enhancement and supplementation programs for game fish populations in the Columbia River Basin. The proposed action is to enter into a use permit or lease agreement with the YIN or other parties who would rear fish in the 100-K Area Pools. The proposed action would include necessary piping, pump, andmore » electrical upgrades of the facility; cleaning and preparation of the pools; water withdrawal from the Columbia River, and any necessary water or wastewater treatment; and introduction, rearing and release of fish. Future commercial operations may be included.« less

Carriers

MedlinePlus

... Funding Opportunities Research Conference Recruit for Clinical Trials Research Publications Spinraza Support & Care For Newly Diagnosed Care Packages Information Packets Equipment Pool Living With SMA Medical Issues Palliative Breathing Orthopedics Nutrition Equipment Daily Life At School At Home ...

Late Effects of Polio: An Overview

MedlinePlus

... Nurses Exercise for Polio Survivors Anesthesia Concerns Pool/Water Therapy Other Resources Reports & CD from Task Force Medical/Clinical Publications ADVOCACY Issues Organizations Resources RESEARCH About The Research Fund New Request for 2018 ...

Medical Issues: Breathing

MedlinePlus

... Funding Opportunities Research Conference Recruit for Clinical Trials Research Publications Spinraza Support & Care For Newly Diagnosed Care Packages Information Packets Equipment Pool Living With SMA Medical Issues Palliative Breathing Orthopedics Nutrition Equipment Daily Life At School At Home ...

Cure SMA

MedlinePlus

... Funding Opportunities Research Conference Recruit for Clinical Trials Research Publications Spinraza Support & Care For Newly Diagnosed Care Packages Information Packets Equipment Pool Living With SMA Medical Issues Palliative Breathing Orthopedics Nutrition Equipment Daily Life At School At Home ...

Medical Issues: Nutrition

MedlinePlus

... Funding Opportunities Research Conference Recruit for Clinical Trials Research Publications Spinraza Support & Care For Newly Diagnosed Care Packages Information Packets Equipment Pool Living With SMA Medical Issues Palliative Breathing Orthopedics Nutrition Equipment Daily Life At School At Home ...

Information about the Late Effects of Polio

MedlinePlus

... Nurses Exercise for Polio Survivors Anesthesia Concerns Pool/Water Therapy Other Resources Reports & CD from Task Force Medical/Clinical Publications ADVOCACY Issues Organizations Resources RESEARCH About The Research Fund New Request for 2018 ...

Is it feasible to pool funds for local children's services in England? Evidence from the national evaluation of children's trust pathfinders.

PubMed

Lorgelly, Paula; Bachmann, Max; Shreeve, Ann; Reading, Richard; Thorburn, June; Mugford, Miranda; O'Brien, Margaret; Husbands, Chris

2009-01-01

To describe how funds were pooled or otherwise jointly managed by National Health Service (NHS) primary care trusts and local authorities in England. To compare expenditure on local children's services by health, education and social services. We conducted a questionnaire survey of all 35 children's trust pathfinders, six months after they were launched, with a follow-up at 2.5 years. We also undertook an in-depth analysis of local authorities and primary care trusts, within eight pathfinder areas and three non-pathfinder areas, whereby we compared expenditure on children's services, interviewed managers and professionals and examined financial documents. Local authorities and NHS trusts coordinated expenditure in various ways, most commonly through informal agreements and aligning budgets but also by formally pooling budgets. The latter were usually for selected services such as child and adolescent mental health services, though four children's trusts pathfinders pooled (or aligned) their budgets for all children's services. Total expenditure per child was greatest for education, lowest for social services and intermediate for health. However, it was difficult to quantify education expenditure on children with health and social care needs, and health care expenditure on children. Sharing money for local children's services requires shared objectives, trust, and legal and accounting expertise. Several different mechanisms are permitted and many are feasible but programme budgeting for children's services could make them more effective.

Bridging miles to achieve milestones: Corporate social responsibility for primary health care.

PubMed

Gulati, Ruchie

2017-01-01

Sustainable Developmental Goals aim to provide "Good health for all". The task though immense ,requires equitable and efficient distribution of health resources to the community, reached predominantly by the Primary Health Centres. Strengthening these centres is essential to attain the goal. Adequate health financing is one of the important determinants for utilizing the optimal potential of these centres . Pooling funds from alternate financing strategies as Corporate Social Responsibility (CSR) funds may give impetus and facilitate healthcare affordability to the underserved population. This convergence of vision of corporate funding for "basic health services" may bridge the gap arising out of inadequate funding and facilitate "Good Health for all" in India.

Post-Polio Health International including International Ventilator Users Network

MedlinePlus

... Nurses Exercise for Polio Survivors Anesthesia Concerns Pool/Water Therapy Other Resources Reports & CD from Task Force Medical/Clinical Publications ADVOCACY Issues Organizations Resources RESEARCH About The Research Fund New Request for 2018 ...

Project report : Alaska travel information system

DOT National Transportation Integrated Search

2004-11-01

The Alaska Department of Transportation and Public Facilities (ADOT&PF) initiated the Alaska Travel Information System by joining the Condition Acquisition and Reporting System/511 (CARS/511) Pooled Fund in October 2002. CARS was jointly developed by...

24 CFR 983.5 - Description of the PBV program.

Code of Federal Regulations, 2011 CFR

2011-04-01

... program under an annual contributions contract (ACC) with HUD. In the PBV program, the assistance is... (budget authority) available under the PHA's voucher ACC. This pool of funding is used to pay housing...

24 CFR 983.5 - Description of the PBV program.

Code of Federal Regulations, 2010 CFR

2010-04-01

... program under an annual contributions contract (ACC) with HUD. In the PBV program, the assistance is... (budget authority) available under the PHA's voucher ACC. This pool of funding is used to pay housing...

REPORT ON 2017 MnROAD CONSTRUCTION ACTIVITIES

DOT National Transportation Integrated Search

2018-05-01

The National Road Research Alliance (NRRA), a multi-state pooled-fund program, exists to provide strategic implementation of pavement engineering solutions through cooperative research. NRRA is led by an Executive Committee of state DOT partners, and...

Pressurized storm sewer simulation : model enhancement.

DOT National Transportation Integrated Search

1991-01-01

A modified Pressurized Flow Simulation Model, PFSM, was developed and attached to the Federal Highway Administration, FHWA, Pool Funded PFP-HYDRA Package. Four hydrograph options are available for simulating inflow to a sewer system under surcharge o...

An alternative mechanism for international health aid: evaluating a Global Social Protection Fund.

PubMed

Basu, Sanjay; Stuckler, David; McKee, Martin

2014-01-01

Several public health groups have called for the creation of a global fund for 'social protection'-a fund that produces the international equivalent of domestic tax collection and safety net systems to finance care for the ill and disabled and related health costs. All participating countries would pay into a global fund based on a metric of their ability to pay and withdraw from the common pool based on a metric of their need for funds. We assessed how alternative strategies and metrics by which to operate such a fund would affect its size and impact on health system financing. Using a mathematical model, we found that common targets for health funding in low-income countries require higher levels of aid expenditures than presently distributed. Some mechanisms exist that may incentivize reduction of domestic health inequalities, and direct most funds towards the poorest populations. Payments from high-income countries are also likely to decrease over time as middle-income countries' economies grow.

1987 Annual Report of the Reservoir Control Center, Southwestern Division, Army Corps of Engineers

DTIC Science & Technology

1988-01-01

sediment ranges along the MClellan-Kerr Arkansas River Navigation Project. Due to the funding priorities assigned to reservoir sedimentation resurveys, it’ s...winter with the majority being released in February and March 1988. Numerous small deviations, which ranged from channel work to bridge construction...1987. This was still within the range of the conservation pool. The maximum pool elevation was 6,222.54 (61,668 ac-ft) on 20 June. Pueblo Reservoir is a

Philanthropy and hospital financing.

PubMed Central

Smith, D G; Clement, J P; Wheeler, J R

1995-01-01

OBJECTIVE. This study explores the relationships among donations to not-for-profit hospitals, the returns provided by these hospitals, and fund-raising efforts. It tests a model of hospital behavior and addresses an earlier debate regarding the supply price of donations. DATA SOURCES. The main data source is the California Office of Statewide Health Planning data tapes of hospital financial disclosure reports for fiscal years 1980/1981 through 1986/1987. Complete data were available for 160 hospitals. STUDY DESIGN. Three structural equations (donations, returns, and fund-raising) are estimated as a system using a fixed-effects, pooled cross-section, time-series least squares regression. PRINCIPAL FINDINGS. Estimation results reveal the expected positive relation between donations and returns. The reverse relation between returns and donations is insignificant. The estimated effect of fund-raising on donations is insignificantly different from zero, and the effect of donations on fund-raising is negative. Fund-raising and returns are negatively associated with one another. CONCLUSION. The empirical results presented here suggest a positive donations-returns relations and are consistent with a positive supply price for donations. Hospitals appear to view a trade-off between providing returns and soliciting donations, but donors do not respond equally to these two activities. Attempts to increase free cash flow through expansion of community returns or fund-raising activity, at least in the short run, are not likely to be highly successful financing strategies for many hospitals. PMID:8537223

Types of SMA (Spinal Muscular Atrophy)

MedlinePlus

... Funding Opportunities Research Conference Recruit for Clinical Trials Research Publications Spinraza Support & Care For Newly Diagnosed Care Packages Information Packets Equipment Pool Living With SMA Medical Issues Palliative Breathing Orthopedics Nutrition Equipment Daily Life At School At Home ...

2014 National Asset Management Conference and Training on Implementation Strategies.

DOT National Transportation Integrated Search

2014-07-01

This report documents the major research activities conducted as part of the Federal Highway Administration (FHWA) : Transportation Pooled Fund (TPF) Program project, TPF-5(275) 2014 National Asset Management Conference and Training on : Implementati...

2014 National Asset Management Conference and training on implementation strategies.

DOT National Transportation Integrated Search

2014-07-01

This report documents the major research activities conducted as part of the Federal Highway Administration (FHWA) : Transportation Pooled Fund (TPF) Program project, TPF-5(275) 2014 National Asset Management Conference and Training on : Implementati...

Consortium of accelerated pavement testers (CAPT).

DOT National Transportation Integrated Search

2016-05-01

FHWA and a group of state Departments of Transportation from nine of the 14 US Accelerated : Pavement Testing (APT) facilities have proposed the creation of a joint or pooled funded program to : encourage coordination among the various facilities and...

Instrumentation to Aid in Steel Bridge Fabrication : Bridge Virtual Assembly System

DOT National Transportation Integrated Search

2018-05-01

This pool funded project developed a BRIDGE VIRTUAL ASSEMBLY SYSTEM (BRIDGE VAS) that improves manufacturing processes and enhances quality control for steel bridge fabrication. The system replaces conventional match-drilling with virtual assembly me...

29 CFR 2550.408b-19 - Statutory exemption for cross-trading of securities.

Code of Federal Regulations, 2011 CFR

2011-07-01

... any other agreement or disclosure involving the asset management relationship. For purposes of section... customer or pooled fund or account. (2) The term “compliance officer” means an individual designated by the...

How to Fund Cancellation Ceilings on Multiyear Defense Contracts: A Risk Pooling Alternative

DTIC Science & Technology

1985-01-01

R t- Government faces a termination liability after the first year of the contract for EOQ material. This causes a need for higher authorizations...le items to the Defense inventory. EOQ liability on multiyear programs is currently fully funded to guarantee delivery of all prior- year systems...ýach program years’ buy of systems and the entire EOQ liability each year. -- Best satisfies Congress’ desire for protection against long-term

Snow removal performance metrics : final report.

DOT National Transportation Integrated Search

2017-05-01

This document is the final report for the Clear Roads project entitled Snow Removal Performance Metrics. The project team was led by researchers at Washington State University on behalf of Clear Roads, an ongoing pooled fund research effort focused o...

78 FR 17676 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-22

... of 2002, the Deficit Reduction Act of 2005 and the State High Risk Pool Funding Extension Act of 2006... April 22, 2013. OMB, Office of Information and Regulatory Affairs, Attention: CMS Desk Officer, Fax...

Philanthropy as a source of funding for nursing initiatives.

PubMed

Kleinpell, Ruth M; Start, Rachel; McIntosh, Erik; Worobec, Sophia; Llewellyn, Jane

2014-01-01

Nurse leaders are challenged with ensuring that research and evidence-based practices are being integrated into clinical care. Initiatives such as the Magnet Recognition Program have helped reinforce the importance of advancing nursing practices to integrate best practices, conduct quality improvement initiatives, improve performance metrics, and involve bedside nurses in conducting research and evidence-based practice projects. While seeking research funding is an option for some initiatives, other strategies such as seeking funding from grateful patients or from philanthropic resources are becoming important options for nurse leaders to pursue, as the availability of funding from traditional sources such as professional organizations or federal funding becomes more limited. In addition, more institutions are seeking and applying for funding, increasing the pool of candidates who are vying for existing funding. Seeking alternative sources of funding, such as through philanthropy, becomes a viable option. This article reviews important considerations in seeking funding from philanthropic sources for nursing initiatives. Examples from a multiyear project that focused on promoting a healthy work environment and improving nursing morale are used to highlight strategies that were used to solicit, obtain, and secure extension funding from private foundation funding to support the initiative.

Critical interactions between Global Fund-supported programmes and health systems: a case study in Papua New Guinea.

PubMed

Rudge, James W; Phuanakoonon, Suparat; Nema, K Henry; Mounier-Jack, Sandra; Coker, Richard

2010-11-01

In Papua New Guinea, investment by the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) has played an important role in scaling up the response to HIV and tuberculosis (TB). As part of a series of case studies on how Global Fund-supported programmes interact with national health systems, we assessed the nature and extent of integration of the Global Fund portfolios within the national HIV and TB programmes, the integration of the HIV and TB programmes within the general health system, and system-wide effects of Global Fund support in Papua New Guinea. The study relied on a literature review and 30 interviews with key stakeholders using the Systemic Rapid Assessment Toolkit and thematic analysis. Global Fund-supported activities were found to be largely integrated, or at least coordinated, with the national HIV and TB programmes. However, this has reinforced the vertical nature of these programmes with respect to the general health system, with parallel systems established to meet the demands of programme scale-up and the performance-based nature of Global Fund investment in the weak health system context of Papua New Guinea. The more parallel functions include monitoring and evaluation, and procurement and supply chain systems, while human resources and infrastructure for service delivery are increasingly integrated at more local levels. Positive synergies of Global Fund support include engagement of civil-society partners, and a reliable supply of high-quality drugs which may have increased patient confidence in the health system. However, the severely limited and overburdened pool of human resources has been skewed towards the three diseases, both at management and service delivery levels. There is also concern surrounding the sustainability of the disease programmes, given their dependence on donors. Increasing Global Fund attention towards health system strengthening was viewed positively, but should acknowledge that system changes are slow, difficult to measure and require long-term support.

Continued development of a non-proprietary, high-tension, cable end terminal system.

DOT National Transportation Integrated Search

2016-04-29

A non-proprietary, cable guardrail system is currently under development for the Midwest States Pooled Fund Program. : A cable guardrail end terminal was necessary to accompany the cable guardrail system. The objective of this research : project was ...

Demonstration and purchase of PG binder testing equipment phase 1 and 2 : final report.

DOT National Transportation Integrated Search

2014-04-01

A pooled fund project was undertaken to purchase new asphalt binder testing equipment for state : transportation agencies. The seven states that agreed to participate included: Connecticut, : Maine, Massachusetts, New Hampshire, New York, Rhode Islan...

STC Synthesis of Best Practices for Determining Value of Research Results : Research Project Capsule

DOT National Transportation Integrated Search

2012-09-01

The RAC Region II has initiated a collaborative research program consortium : through the Transportation Pooled Fund (TPF) Program. The research program : is called the Southeast Transportation Consortium (STC) and is intended to : encourage coordina...

STC synthesis of research results for water quality management at construction sites : research project capsule.

DOT National Transportation Integrated Search

2012-07-01

The RAC Region II has initiated a collaborative research program consortium through the : Transportation Pooled Fund (TPF) Program. The research program is called the Southeast : Transportation Consortium (STC) and is intended to encourage coordinati...

Verification of mechanistic-empirical design models for flexible pavements through accelerated pavement testing : technical summary.

DOT National Transportation Integrated Search

2014-08-01

Midwest States Accelerated Pavement Testing Pooled-Fund Program, financed by the : highway departments of Kansas, Iowa, and Missouri, has supported an accelerated : pavement testing (APT) project to validate several models incorporated in the NCHRP :...

78 FR 12349 - Proposed Information Collection; Land and Water Conservation Fund State Assistance Program

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-22

... Policy Act (NEPA). The analysis serves as part of the Federal administrative record required by NEPA and... recreation facility, such as a pool or ice rink to shelter them from cold climatic conditions and thereby...

Reporting Deferred Gifts: CASE-NACUBO Guidelines Ensure Consistency.

ERIC Educational Resources Information Center

Ridenour, James F.; Munger, Peter L.

1983-01-01

Three methods for reporting the value of a deferred gift are described: the tax method, net realizable value, and fair market value. Three major categories of deferred gifts are identified: pooled income funds, charitable remainder trusts, and charitable gift annuities. (MLW)

PROJECT REPORT : Alaska-Metro/Rural Deployment Project CARS/511 – Anchorage Integration

DOT National Transportation Integrated Search

2009-03-19

The Alaska Department of Transportation & Public Facilities (ADOT&PF) initiated the Alaska Travel Information System by joining the Condition Acquisition & Reporting System/511 (CARS/511) Pooled Fund in October 2002. CARS was jointly developed by the...

Verification of mechanistic-empirical design models for flexible pavements through accelerated pavement testing.

DOT National Transportation Integrated Search

2014-08-01

The Midwest States Accelerated Pavement Testing Pooled Fund Program, financed by the highway : departments of Kansas, Iowa, and Missouri, has supported an accelerated pavement testing (APT) project to : validate several models incorporated in the NCH...

Report of the 4th Workshop for Technology Transfer for Intelligent Compaction Consortium.

DOT National Transportation Integrated Search

2016-03-01

On October 2728, 2015, the Kentucky Transportation Cabinet (KYTC) hosted the 4th workshop for : the Technology Transfer for Intelligent Compaction Consortium (TTICC), a Transportation Pooled Fund : (TPF5(233)) initiative designed to identify, s...

Crowdfunding for cardiovascular research.

PubMed

Krittanawong, Chayakrit; Zhang, HongJu Janet; Aydar, Mehmet; Wang, Zhen; Sun, Tao

2018-01-01

The competition for public cardiovascular research grants has recently increased. Independent researchers are facing increasing competition for public research grant support and ultimately may need to seek alternative funding sources. Crowdfunding, a financing method of raising funds online by pooling together small donations from the online community to support a specific initiative, seems to have significant potential. However, the feasibility of crowdfunding for cardiovascular research remains unknown. Here, we performed exploratory data analysis of the feasibility of online crowdfunding in cardiovascular research. Copyright © 2017 Elsevier B.V. All rights reserved.

Utilizing Online Connectivity to Combat Reduced Federal Spending

NASA Astrophysics Data System (ADS)

Mayall, T.

2013-12-01

With a diminishing grant pool and increasing competition for federal funding, utilizing free online resources to collaborate with other scientists, share information and insights, and promote your research is critical to success. As budgets tighten, efficient use of both time and money is becoming more and more important. Tools such as Mendeley, ResearchGate, and Science Exchange enable scientists to promote their own work while gaining valuable connections and collaborations. Additionally, scientists can build their online presence to increase visibility for potential funding. Through intelligent use of these online tools, scientists can increase their chances of funding and minimize wasted time and resources. For this session, I will examine how to adapt to the changing landscape of federal funding through the effective use of social media and online tools.

The impact of state-level nutrition-education program funding on BMI: evidence from the behavioral risk factor surveillance system.

PubMed

McGeary, Kerry Anne

2013-04-01

Currently, there is insufficient evidence regarding which policies will improve nutrition, reduce BMI levels and the prevalence of obesity and overweight nationwide. This preliminary study investigates the impact of a nutrition-education policy relative to price policy as a means to reduce BMI in the United States (US). Model estimations use pooled cross-sectional data at the individual-level from the Centers for Disease Control's (CDC), Behavioral Risk Factor Surveillance System (BRFSS), state-level food prices from the American Chamber of Commerce Research Association (ACCRA) and funding for state-specific nutrition-education programs from the United States Department of Agriculture (USDA) from 1992 to 2006. The total number of observations for the study is 2,249,713 over 15 years. During this period, federal funding for state-specific nutrition-education programs rose from approximately $660 thousand for seven states to nearly $248 million for all fifty-two states. In 2011, federal funding for nutrition-education programs reached $375 million. After controlling for state-fixed effects, year effects and state specific linear and quadratic time trends, we find that nutrition education spending has the intended effect on BMI, obese and overweight in aggregate. However, we find heterogeneity as individuals from certain, but not all, income and education levels respond to nutrition-education funding. The results regarding nutrition-education programs suggest that large scale funding of nutrition-education programs may improve BMI levels and reduce obesity and overweight. However, more study is required to determine if these funds are able make the requisite dietary improvements that may ultimately improve BMI for individuals from low income and education-levels. Copyright © 2013 Elsevier Ltd. All rights reserved.

Association of funding and conclusions in randomized drug trials: a reflection of treatment effect or adverse events?

PubMed

Als-Nielsen, Bodil; Chen, Wendong; Gluud, Christian; Kjaergard, Lise L

2003-08-20

Previous studies indicate that industry-sponsored trials tend to draw proindustry conclusions. To explore whether the association between funding and conclusions in randomized drug trials reflects treatment effects or adverse events. Observational study of 370 randomized drug trials included in meta-analyses from Cochrane reviews selected from the Cochrane Library, May 2001. From a random sample of 167 Cochrane reviews, 25 contained eligible meta-analyses (assessed a binary outcome; pooled at least 5 full-paper trials of which at least 1 reported adequate and 1 reported inadequate allocation concealment). The primary binary outcome from each meta-analysis was considered the primary outcome for all trials included in each meta-analysis. The association between funding and conclusions was analyzed by logistic regression with adjustment for treatment effect, adverse events, and additional confounding factors (methodological quality, control intervention, sample size, publication year, and place of publication). Conclusions in trials, classified into whether the experimental drug was recommended as the treatment of choice or not. The experimental drug was recommended as treatment of choice in 16% of trials funded by nonprofit organizations, 30% of trials not reporting funding, 35% of trials funded by both nonprofit and for-profit organizations, and 51% of trials funded by for-profit organizations (P<.001; chi2 test). Logistic regression analyses indicated that funding, treatment effect, and double blinding were the only significant predictors of conclusions. Adjusted analyses showed that trials funded by for-profit organizations were significantly more likely to recommend the experimental drug as treatment of choice (odds ratio, 5.3; 95% confidence interval, 2.0-14.4) compared with trials funded by nonprofit organizations. This association did not appear to reflect treatment effect or adverse events. Conclusions in trials funded by for-profit organizations may be more positive due to biased interpretation of trial results. Readers should carefully evaluate whether conclusions in randomized trials are supported by data.

26 CFR 25.2702-0 - Table of contents.

Code of Federal Regulations, 2011 CFR

2011-04-01

...) Charitable remainder trust. (4) Pooled income fund. (5) Charitable lead trust. (6) Certain assignments of...) Qualified interest. (7) Qualified annuity interest. (8) Qualified unitrust interest. (9) Qualified remainder interest. (10) Governing instrument. (b) Valuation of retained interests. (1) In general. (2) Qualified...

MN/DOT research peer exchange : pooled fund financial management, August 20 - 23, 2007 : final report.

DOT National Transportation Integrated Search

2007-08-01

The Minnesota Department of Transportation Research Services Section hosted a peer exchange : on August 20-23, 2007 in Bloomington, Minnesota. Representatives from five state DOTs and : FHWA-Headquarters joined representatives from Mn/DOT and FHWA-Mi...

Best practices for achieving and measuring pavement smoothness, a synthesis of state-of-practice : [tech summary].

DOT National Transportation Integrated Search

2015-04-01

The RAC Region II has initiated a collaborative research program consortium : through the Transportation Pooled Fund (TPF) Program. The research program is : called the Southeast Transportation Consortium (STC) and is intended to encourage : coordina...

Medical care use and selection in a social health insurance with an equalization fund: evidence from Colombia.

PubMed

Trujillo, Antonio J

2003-03-01

This paper studies the relationship between health status and insurance participation, and between insurance status and medical use in the context of a social health insurance with an equalization fund (SHIEF). Under this system, revenues from a mandatory payroll tax are collected into a single pool (equalization fund) that reimburses for-profit insurance companies according to a capitated formula. Although competition should induce insurers to control costs without reducing the quality of service necessary to attract consumers, limitations in the capitation formula might induce insurers to select against bad risks, and limitations in the contribution system might induce more healthy individuals to evade enrollment. A three-equation model having social health insurance, private health insurance, and using medical services is estimated using a 1997 Colombian household survey. Consistent with similar studies, participation in SHIEF increases medical care use. On the other hand, the evidence on selection is somewhat mixed: individuals who report good health status are more likely to participate in SHIEF, while those without a chronic condition are less likely to participate in SHIEF. Copyright 2002 John Wiley & Sons, Ltd.

Who is looking for an internship and successful in obtaining one? Examining application data from REU programs funded through NSF GEO

NASA Astrophysics Data System (ADS)

Hubenthal, M.; Kelly, M.

2017-12-01

The Directorate for Geosciences (GEO) at the National Science Foundation (NSF) is currently funding 60 Research Experiences for Undergraduate (REU) sites. Each site offers opportunities for 8 to 12 undergraduates to participate in research within solid earth, oceans, atmospheric and cryosphere sciences. Because applicant data is collected at individual REU sites, the exact number of unique applicants to all REU sites, and the demographics of this national applicant pool has not been previously reported. While some sites do provide some of this information to NSF in annual reports, obtaining and combining such data is problematic because the percentage of individuals that apply to multiple programs is unknown and generally believed anecdotally to be high, especially for students traditionally underrepresented in the geosciences. Understanding both the scale and makeup of the national applicant pool is important for several reasons. First, very little is known about how the supply and geographic location of slots in REU programs compares to the demand from undergraduate STEM majors interested in research experiences. Second, research into internship programs and their role in the career development process are limited by a lack of baseline data that includes both successful and unsuccessful internship applicants across the various sub-disciplines of the Earth sciences. Finally, designing and refining efforts to engage underrepresented populations in STEM research, and measuring the impact of such efforts is difficult without baseline data for comparison. We will present aggregate application data from up to 20 GEO REU funded programs. These programs represent Oceans, Atmospheres and Earth Science research areas and includes over a thousand applicants. Preliminary analysis suggests the number of unique applicants in the pool is higher than anecdotally predicted. Similarly, unique applicants from underrepresented communities also appears higher than anticipated.

Entropy, pumped-storage and energy system finance

NASA Astrophysics Data System (ADS)

Karakatsanis, Georgios

2015-04-01

Pumped-storage holds a key role for integrating renewable energy units with non-renewable fuel plants into large-scale energy systems of electricity output. An emerging issue is the development of financial engineering models with physical basis to systematically fund energy system efficiency improvements across its operation. A fundamental physically-based economic concept is the Scarcity Rent; which concerns the pricing of a natural resource's scarcity. Specifically, the scarcity rent comprises a fraction of a depleting resource's full price and accumulates to fund its more efficient future use. In an integrated energy system, scarcity rents derive from various resources and can be deposited to a pooled fund to finance the energy system's overall efficiency increase; allowing it to benefit from economies of scale. With pumped-storage incorporated to the system, water upgrades to a hub resource, in which the scarcity rents of all connected energy sources are denominated to. However, as available water for electricity generation or storage is also limited, a scarcity rent upon it is also imposed. It is suggested that scarcity rent generation is reducible to three (3) main factors, incorporating uncertainty: (1) water's natural renewability, (2) the energy system's intermittent components and (3) base-load prediction deviations from actual loads. For that purpose, the concept of entropy is used in order to measure the energy system's overall uncertainty; hence pumped-storage intensity requirements and generated water scarcity rents. Keywords: pumped-storage, integration, energy systems, financial engineering, physical basis, Scarcity Rent, pooled fund, economies of scale, hub resource, uncertainty, entropy Acknowledgement: This research was funded by the Greek General Secretariat for Research and Technology through the research project Combined REnewable Systems for Sustainable ENergy DevelOpment (CRESSENDO; grant number 5145)

76 FR 66637 - Prohibited Transaction Exemption Procedures; Employee Benefit Plans

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-27

... independent fiduciary. In all events, the burden is on the applicant to demonstrate the independence of the... interest, pooled fund, qualified appraisal report, qualified independent appraiser, and qualified independent fiduciary. Definition of ``Affiliate''--Section 2570.31(a) of the proposed rule specifically...

Surveying the Field.

ERIC Educational Resources Information Center

Moore, Robert M.

1999-01-01

A survey of almost 150 colleges and universities found many are beginning to use integrated marketing approaches. Institutions report the most significant increases in all targeted areas (annual fund, applicant pool, enrollment yield) when their integrated marketing programs have the support of an alumni or trustee committee. Other findings…

Private Funds for Public Schools.

ERIC Educational Resources Information Center

Addonizio, Michael F.

2000-01-01

Discusses sources of nontraditional revenue for public school systems: the result of donor activities (the solicitation of goods, services, and money via direct and indirect donations); enterprise activities (the selling or leasing of services or facilities); and shared or cooperative activities (pooling functions with other agencies or…

17 CFR 1.17 - Minimum financial requirements for futures commission merchants and introducing brokers.

Code of Federal Regulations, 2011 CFR

2011-04-01

... date that they are accrued; (B) Interest receivable, floor brokerage receivable, commissions receivable from other brokers or dealers (other than syndicate profits), mutual fund concessions receivable and management fees receivable from registered investment companies and commodity pools: Provided, Such...

17 CFR 1.17 - Minimum financial requirements for futures commission merchants and introducing brokers.

Code of Federal Regulations, 2014 CFR

2014-04-01

... date that they are accrued; (B) Interest receivable, floor brokerage receivable, commissions receivable from other brokers or dealers (other than syndicate profits), mutual fund concessions receivable and management fees receivable from registered investment companies and commodity pools: Provided, Such...

17 CFR 1.17 - Minimum financial requirements for futures commission merchants and introducing brokers.

Code of Federal Regulations, 2012 CFR

2012-04-01

... date that they are accrued; (B) Interest receivable, floor brokerage receivable, commissions receivable from other brokers or dealers (other than syndicate profits), mutual fund concessions receivable and management fees receivable from registered investment companies and commodity pools: Provided, Such...

Environmental glasnost: protecting a resource you do not own

Treesearch

Malcomb Ross, Jr.

1992-01-01

The Upper Delaware River management plan offers an alternative to outright purchase and subsequent management of natural recreation areas. Advantages include providing for appropriate growth, pooling agency manpower and funding, and making the private sector more responsive to finding solutions to resource issues.

From scheme to system: social health insurance funds and the transformation of health financing in Kyrgyzstan and Moldova.

PubMed

Kutzin, Joseph; Jakab, Melitta; Shishkin, Sergey

2009-01-01

The aim of the paper is to bring evidence and lessons from two low- and middle-income countries (LMIs) of the former USSR into the global debate on health financing in poor countries. In particular, we analyze the introduction of social health insurance (SHI) in Kyrgyzstan and Moldova. To some extent, the intent of SHI introduction in these countries was similar to that in LMIs elsewhere: increase prepaid revenues for health and incorporate the entire population into the new system. But the approach taken to universality was different. In particular, the SHI fund in each country was used as the key instrument in a comprehensive reform of the health financing system, with the new revenues from payroll taxation used in an explicitly complementary manner to general budget revenues. From a functional perspective, the reforms in these countries involved not only the introduction of a new source of funds, but also the centralization of pooling, a shift from input- to output-based provider payment methods, specification of a benefit package, and greater autonomy for public sector health care providers. Hence, their reforms were not simply the introduction of an SHI scheme, but rather the use of an SHI fund as an instrument to transform the entire system of health financing. The study uses administrative and household data to demonstrate the impact of the reforms on regional inequality and household financial burden. The approach used in these two countries led to improved equity in the geographic distribution of government health spending, improved financial protection, and reduced informal payments. The comprehensive approach taken to reform in these two countries, and particularly the redirection of general budget revenues to the new SHI funds, explain much of the success that was achieved. This experience offers potentially useful lessons for LMIs elsewhere in the world, and for shifting the global debate away from what we see as a false dichotomy between SHI and general revenue-funded systems. By demonstrating that sources are not systems, these cases illustrate how, in particular by careful design of pooling and coverage arrangements, the introduction of SHI in an LMI context can avoid the fragmentation problem often associated with this reform instrument.

Creating a new investment pool for innovative health systems research.

PubMed

Laba, Tracey-Lea; Patel, Anushka; Jan, Stephen

2017-05-01

Recent trends in health research funding towards 'safe bets' is discouraging investment into the development of health systems interventions and choking off a vital area of policy-relevant research. This paper argues that to encourage investment into innovative and perceivably riskier health systems research, researchers need to create more attractive business cases by exploring alternative approaches to the design and evaluation of health system interventions. At the same time, the creation of dedicated funding opportunities to support this work, as well as for relevant early career researchers, is needed.

17 CFR 1.17 - Minimum financial requirements for futures commission merchants and introducing brokers.

Code of Federal Regulations, 2013 CFR

2013-04-01

... months from the date that they are accrued; (B) Interest receivable, floor brokerage receivable, commissions receivable from other brokers or dealers (other than syndicate profits), mutual fund concessions receivable and management fees receivable from registered investment companies and commodity pools: Provided...

Design of cable-to-post attachments for use in a non-proprietary, high-tension, cable median barrier.

DOT National Transportation Integrated Search

2013-08-01

Cable median barriers are widely used across the country to prevent cross-median crashes. Several years ago, the Midwest States Pooled Fund Program contracted with the Midwest Roadside Safety Facility (MwRSF) to develop a new, non-proprietary, high-t...

CASE Planned Giving Ideas. The Best of CASE CURRENTS.

ERIC Educational Resources Information Center

Carter, Virginia L., Ed.; Garigan, Catherine S., Ed.

Collected are articles by planned giving (deferred giving) experts on institutional commitment, policies, and programs to encourage various types of gifts to higher education institutions: bequests, unitrusts, annuity trusts, charitable income trusts (lead trusts), pooled income funds, gifts of land and so on. A major article covers how to hire…

Unit Method of Accounting for Investments.

ERIC Educational Resources Information Center

Jones, Leigh A.

1971-01-01

The unit method of accounting for investments, also called the market-value method, is defined as a procedure for accurately allocating income and investment gains and losses, both realized and unrealized, between component funds of an investment pool. This procedure provides a data base for the calculation of investment performance. Advantages of…

New Fund Allows Colleges to Pool Resources for Large-Scale Real-Estate Investments.

ERIC Educational Resources Information Center

McMillen, Liz

1988-01-01

The Real Estate Investment Trust, a companion organization to the Common Trust, allows colleges to commit as little as $50,000 for investments in commercial properties at minimum risk, which could protect endowments while providing returns comparable to those of the stock market. (MSE)

Community College Alumni: Predicting Who Gives

ERIC Educational Resources Information Center

Skari, Lisa Ann

2014-01-01

Due to the decrease in public funding, community colleges are in a position where they need to generate private gifts. Alumni represent the largest untapped pool of prospective donors, and the success of alumni giving at 4-year institutions illustrates the potential that exists for community colleges. To develop effective fundraising strategies,…

Teamwork Key for Pilot Plans on Teacher Pay

ERIC Educational Resources Information Center

Sawchuk, Stephen

2008-01-01

A variety of federally financed grants based on performance pay are providing insights into how districts and teachers can collaborate to implement sustainable programs designed to improve teaching and learning. The question of whether those Teacher Incentive Fund grants will yield measurably higher student achievement, applicant pools with…

Research Personnel: An Essay on Policy.

ERIC Educational Resources Information Center

National Commission on Research, Washington, DC.

The national need for an ample pool of research scientists is considered. Research in universities and in the federally funded research facilities is described, and the importance of the research these institutions do and the interweaving of research and instruction in universities are noted. Some manpower projections are included and questions…

"Wasting Talent"? Gender and the Problematics of Academic Disenchantment and Disengagement with Leadership

ERIC Educational Resources Information Center

Blackmore, Jill

2014-01-01

Confronted with the processes of massification, commercialisation, internationalisation and reduced funding, universities also face an ageing academic workforce, with implications of a shrinking pool from which to recruit managerial and research leaders. A feminist analysis suggests that the policy problematic has been wrongly conceptualised as…

17 CFR 50.25 - Clearing requirement compliance schedule.

Code of Federal Regulations, 2014 CFR

2014-04-01

... major security-based swap participant; or an active fund. Category 2Entity means a commodity pool; a... beneficial owner to clear swaps. (b) Upon issuing a clearing requirement determination under section 2(h)(2... Entity, or any other entity that desires to clear the transaction, must comply with the requirements of...

45 CFR 152.39 - Maintenance of effort.

Code of Federal Regulations, 2010 CFR

2010-10-01

...-EXISTING CONDITION INSURANCE PLAN PROGRAM Relationship to Existing Laws and Programs § 152.39 Maintenance... the contract is entered. (b) Failure to maintain efforts. In situations where a State enters into a..., against any State that fails to maintain funding levels for existing State high risk pools as required...

Institutional design and organizational practice for universal coverage in lesser-developed countries: challenges facing the Lao PDR.

PubMed

Ahmed, Shakil; Annear, Peter Leslie; Phonvisay, Bouaphat; Phommavong, Chansaly; Cruz, Valeria de Oliveira; Hammerich, Asmus; Jacobs, Bart

2013-11-01

There is now widespread acceptance of the universal coverage approach, presented in the 2010 World Health Report. There are more and more voices for the benefit of creating a single national risk pool. Now, a body of literature is emerging on institutional design and organizational practice for universal coverage, related to management of the three health-financing functions: collection, pooling and purchasing. While all countries can move towards universal coverage, lower-income countries face particular challenges, including scarce resources and limited capacity. Recently, the Lao PDR has been preparing options for moving to a single national health insurance scheme. The aim is to combine four different social health protection schemes into a national health insurance authority (NHIA) with a single national fund- and risk-pool. This paper investigates the main institutional and organizational challenges related to the creation of the NHIA. The paper uses a qualitative approach, drawing on the World Health Organization's institutional and Organizational Assessment for Improving and Strengthening health financing (OASIS) conceptual framework for data analysis. Data were collected from a review of key health financing policy documents and from 17 semi-structured key informant interviews. Policy makers and advisors are confronting issues related to institutional arrangements, funding sources for the authority and government support for subsidies to the demand-side health financing schemes. Compulsory membership is proposed, but the means for covering the informal sector have not been resolved. While unification of existing schemes may be the basis for creating a single risk pool, challenges related to administrative capacity and cross-subsidies remain. The example of Lao PDR illustrates the need to include consideration of national context, the sequencing of reforms and the time-scale appropriate for achieving universal coverage. Copyright © 2013 Elsevier Ltd. All rights reserved.

The OPTN Deceased Donor Potential Study: Implications for Policy and Practice.

PubMed

Klassen, D K; Edwards, L B; Stewart, D E; Glazier, A K; Orlowski, J P; Berg, C L

2016-06-01

The Organ Procurement and Transplantation Network (OPTN) Deceased Donor Potential Study, funded by the Health Resources and Services Administration, characterized the current pool of potential deceased donors and estimated changes through 2020. The goal was to inform policy development and suggest practice changes designed to increase the number of donors and organ transplants. Donor estimates used filtering methodologies applied to datasets from the OPTN, the National Center for Health Statistics, and the Agency for Healthcare Research and Quality and used these estimates with the number of actual donors to estimate the potential donor pool through 2020. Projected growth of the donor pool was 0.5% per year through 2020. Potential donor estimates suggested unrealized donor potential across all demographic groups, with the most significant unrealized potential (70%) in the 50-75-year-old age group and potential Donation after Circulatory Death (DCD) donors. Actual transplants that may be realized from potential donors in these categories are constrained by confounding medical comorbidities not identified in administrative databases and by limiting utilization practices for organs from DCD donors. Policy, regulatory, and practice changes encouraging organ procurement and transplantation of a broader population of potential donors may be required to increase transplant numbers in the United States. © Copyright 2016 The American Society of Transplantation and the American Society of Transplant Surgeons.

The administrative costs of community-based health insurance: a case study of the community health fund in Tanzania

PubMed Central

Borghi, Josephine; Makawia, Suzan; Kuwawenaruwa, August

2015-01-01

Community-based health insurance expansion has been proposed as a financing solution for the sizable informal sector in low-income settings. However, there is limited evidence of the administrative costs of such schemes. We assessed annual facility and district-level costs of running the Community Health Fund (CHF), a voluntary health insurance scheme for the informal sector in a rural and an urban district from the same region in Tanzania. Information on resource use, CHF membership and revenue was obtained from district managers and health workers from two facilities in each district. The administrative cost per CHF member household and the cost to revenue ratio were estimated. Revenue collection was the most costly activity at facility level (78% of total costs), followed by stewardship and management (13%) and pooling of funds (10%). Stewardship and management was the main activity at district level. The administration cost per CHF member household ranged from USD 3.33 to USD 12.12 per year. The cost to revenue ratio ranged from 50% to 364%. The cost of administering the CHF was high relative to revenue generated. Similar studies from other settings should be encouraged. PMID:24334331

A new ambulatory classification and funding model for radiation oncology: non-admitted patients in Victorian hospitals.

PubMed

Antioch, K M; Walsh, M K; Anderson, D; Wilson, R; Chambers, C; Willmer, P

1998-01-01

The Victorian Department of Human Services has developed a classification and funding model for non-admitted radiation oncology patients. Agencies were previously funded on an historical cost input basis. For 1996-97, payments were made according to the new Non-admitted Radiation Oncology Classification System and include four key components. Fixed grants are based on Weighted Radiation Therapy Services targets for megavoltage courses, planning procedures (dosimetry and simulation) and consultations. The additional throughput pool covers additional Weighted Radiation Therapy Services once targets are reached, with access conditional on the utilisation of a minimum number of megavoltage fields by each hospital. Block grants cover specialised treatments, such as brachytherapy, allied health payments and other support services. Compensation grants were available to bring payments up to the level of the previous year. There is potential to provide incentives to promote best practice in Australia through linking appropriate practice to funding models. Key Australian and international developments should be monitored, including economic evaluation studies, classification and funding models, and the deliberations of the American College of Radiology, the American Society for Therapeutic Radiology and Oncology, the Trans-Tasman Radiation Oncology Group and the Council of Oncology Societies of Australia. National impact on clinical practice guidelines in Australia can be achieved through the Quality of Care and Health Outcomes Committee of the National Health and Medical Research Council.

Common Market measures to promote the use of solar energy - The demonstration project

NASA Astrophysics Data System (ADS)

Kaut, W.

A series of solar technical projects being conducted under the auspices of the Common Market is discussed. The history and legal foundations of this demonstration project, previous proposal requests and their results, and the experiences to date and present status of the project are assessed. Twenty-six projects proposals are being funded; the only German one concerns solar heating of swimming pools. The economic and administrative aspects of these projects are detailed. Problems of the project are discussed, including the allocation of funds between older and newer aspects and financial constraints.

Long-term care financing through Federal tax incentives.

PubMed

Moran, D W; Weingart, J M

1988-12-01

Congress and the Administration are currently exploring various methods of promoting access to long-term care. In this article, an inventory of recent legislative proposals for using the Federal tax code to expand access to long-term care services is provided. Proposals are arrayed along a functional typology that includes tax mechanisms to encourage accumulation of funds, promote purchase of long-term care insurance, or induce the diversion of funds accumulated for another purpose (such as individual retirement accounts). The proposals are evaluated against the public policy objective of encouraging risk pooling to minimize social cost.

Long-term care financing through Federal tax incentives

PubMed Central

Moran, Donald W.; Weingart, Janet M.

1988-01-01

Congress and the Administration are currently exploring various methods of promoting access to long-term care. In this article, an inventory of recent legislative proposals for using the Federal tax code to expand access to long-term care services is provided. Proposals are arrayed along a functional typology that includes tax mechanisms to encourage accumulation of funds, promote purchase of long-term care insurance, or induce the diversion of funds accumulated for another purpose (such as individual retirement accounts). The proposals are evaluated against the public policy objective of encouraging risk pooling to minimize social cost. PMID:10312964

Key Educational Factors in the Education of Students with a Medical Condition

ERIC Educational Resources Information Center

Capurso, Michele; Dennis, John L.

2017-01-01

The education of children with a medical condition represents a unique educational context. The key educational factors that can help these children continue their education despite the burdens associated with their illness were discussed and analysed by a pool of experts for an EU funded project. In this context, "relationships,"…

7 CFR 993.58 - Deferment of time for withholding.

Code of Federal Regulations, 2011 CFR

2011-01-01

..., and shall be in an amount computed by multiplying the pounds of natural condition prunes for which... shall be used by the committee to purchase from handlers a quantity of natural condition prunes, up to..., with reserve pool funds for distribution to equity holders. (3) If for any reason the committee is...

7 CFR 993.58 - Deferment of time for withholding.

Code of Federal Regulations, 2010 CFR

2010-01-01

..., and shall be in an amount computed by multiplying the pounds of natural condition prunes for which... shall be used by the committee to purchase from handlers a quantity of natural condition prunes, up to..., with reserve pool funds for distribution to equity holders. (3) If for any reason the committee is...

University Research Funding: The United States Is Behind and Falling

ERIC Educational Resources Information Center

Atkinson, Robert D.; Stewart, Luke A.

2011-01-01

Research and development drives innovation and innovation drives long-run economic growth, creating jobs and improving living standards in the process. University-based research is of particular importance to innovation, as the early-stage research that is typically performed at universities serves to expand the knowledge pool from which the…

Public Swimming Pools | Florida Department of Health

Science.gov Websites

Phone Numbers WIC Income Guidelines How WIC Works WIC Foods Food Vendors Health Care Providers Nutrition Materials What is WIC? WIC is a federally funded nutrition program for Women, Infants, and Children. WIC provides the following at no cost: healthy foods, nutrition education and counseling, breastfeeding support

The Investment Policy Statement

ERIC Educational Resources Information Center

Griswold, John S.; Jarvis, William F.

2011-01-01

Successful investing for long-term funds requires a strategic plan. This is true despite--indeed, because of--the fact that the future is unknowable. The plan must be specific, embodying in concrete terms the best thinking of the board of trustees about the investment pool, its goals and purposes; but it also needs to be sufficiently flexible to…

MASH test nos. 3-11 and 3-10 on a non-proprietary cable median barrier.

DOT National Transportation Integrated Search

2016-05-17

The Midwest States Pooled Fund has been developing a new non-proprietary cable median barrier. This system : incorporates four evenly spaced cables, Midwest Weak Posts spaced at 8 to 16 ft (2.4 to 4.9 m) intervals, and a bolted, : tabbed bracket to a...

"Planned Giving" Gains Favor Among Donors and Colleges.

ERIC Educational Resources Information Center

Bailey, Anne Lowrey

1986-01-01

Planned or deferred giving (through which a donor to a college or university contributes capital in the form of an annuity, life-income trust, insurance policy, pooled income fund, real estate, or other asset, to the institution but retains its financial benefit during his lifetime) is an increasingly popular form of donation to endowments. (MSE)

7 CFR 1000.76 - Payments by a handler operating a partially regulated distributing plant.

Code of Federal Regulations, 2011 CFR

2011-01-01

... and pricing program, shall pay to the market administrator for the producer-settlement fund the amount... pooling of producer returns under a State government's milk classification and pricing program shall pay... disposed of as route disposition in the marketing area; (2) For orders with multiple component pricing...

MASH test nos. 3-17 and 3-11 on a non-proprietary cable median barrier.

DOT National Transportation Integrated Search

2015-11-01

The Midwest States Pooled Fund has been developing a new design for a non-proprietary high-tension cable median barrier. This new system incorporates four evenly spaced cables, Midwest Weak Posts (MWPs) spaced at 8 to 16 ft (2.4 to 4.9 m) intervals, ...

Aid alignment: a longer term lens on trends in development assistance for health in Uganda

PubMed Central

2013-01-01

Background Over the past decade, development assistance for health (DAH) in Uganda has increased dramatically, surpassing the government’s own expenditures on health. Yet primary health care and other priorities identified in Uganda’s health sector strategic plan remain underfunded. Methods Using data available from the Creditor Reporting System (CRS), National Health Accounts (NHA), and government financial reports, we examined trends in how donors channel DAH and the extent to which DAH is aligned with sector priorities. The study follows the flow of DAH from the donor to the implementing organization, specifying the modality used for disbursing funds and categorizing funds based on program area or support function. Findings Despite efforts to improve alignment through the formation of a sector-wide approach (SWAp) for health in 1999 and the creation of a fund to pool resources for identified priorities, increasingly DAH is provided as short-term, project-based support for disease-specific initiatives, in particular HIV/AIDS. Conclusion These findings highlight the need to better align external resources with country priorities and refocus attention on longer-term sector-wide objectives. PMID:23425287

Enhancing the actinide sciences in Europe through hot laboratories networking and pooling: from ACTINET to TALISMAN

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

Bourg, S.; Poinssot, C.

2013-07-01

Since 2004, Europe supports the strengthening of the European actinides sciences scientific community through the funding of dedicated networks: (i) from 2004 to 2008, the ACTINET6 network of excellence (6. Framework Programme) gathered major laboratories involved in nuclear research and a wide range of academic research organisations and universities with the specific aims of funding and implementing joint research projects to be performed within the network of pooled facilities; (ii) from 2009 to 2013, the ACTINET-I3 integrated infrastructure initiative (I3) supports the cost of access of any academics in the pooled EU hot laboratories. In this continuation, TALISMAN (Trans-national Accessmore » to Large Infrastructures for a Safe Management of Actinides) gathers now the main European hot laboratories in actinides sciences in order to promote their opening to academics and universities and strengthen the EU-skills in actinides sciences. Furthermore, a specific focus is set on the development of advanced cutting-edge experimental and spectroscopic capabilities, the combination of state-of-the art experimental with theoretical first-principle methods on a quantum mechanical level and to benefit from the synergy between the different scientific and technical communities. ACTINET-I3 and TALISMAN attach a great importance and promote the Education and Training of the young generation of actinides scientists in the Trans-national access but also by organizing Schools (general Summer Schools or Theoretical User Lab Schools) or by granting students to attend International Conference on actinide sciences. (authors)« less

Innovative financing for health: what is truly innovative?

PubMed

Atun, Rifat; Knaul, Felicia Marie; Akachi, Yoko; Frenk, Julio

2012-12-08

Development assistance for health has increased every year between 2000 and 2010, particularly for HIV/AIDS, tuberculosis, and malaria, to reach US$26·66 billion in 2010. The continued global economic crisis means that increased external financing from traditional donors is unlikely in the near term. Hence, new funding has to be sought from innovative financing sources to sustain the gains made in global health, to achieve the health Millennium Development Goals, and to address the emerging burden from non-communicable diseases. We use the value chain approach to conceptualise innovative financing. With this framework, we identify three integrated innovative financing mechanisms-GAVI, Global Fund, and UNITAID-that have reached a global scale. These three financing mechanisms have innovated along each step of the innovative finance value chain-namely resource mobilisation, pooling, channelling, resource allocation, and implementation-and integrated these steps to channel large amounts of funding rapidly to low-income and middle-income countries to address HIV/AIDS, malaria, tuberculosis, and vaccine-preventable diseases. However, resources mobilised from international innovative financing sources are relatively modest compared with donor assistance from traditional sources. Instead, the real innovation has been establishment of new organisational forms as integrated financing mechanisms that link elements of the financing value chain to more effectively and efficiently mobilise, pool, allocate, and channel financial resources to low-income and middle-income countries and to create incentives to improve implementation and performance of national programmes. These mechanisms provide platforms for health funding in the future, especially as efforts to grow innovative financing have faltered. The lessons learnt from these mechanisms can be used to develop and expand innovative financing from international sources to address health needs in low-income and middle-income countries. Copyright © 2012 Elsevier Ltd. All rights reserved.

Balancing the funds in the New Cooperative Medical Scheme in rural China: determinants and influencing factors in two provinces.

PubMed

Zhang, Luying; Cheng, Xiaoming; Liu, Xiaoyun; Zhu, Kun; Tang, Shenglan; Bogg, Lennart; Dobberschuetz, Karin; Tolhurst, Rachel

2010-01-01

In recent years, the central government in China has been leading the re-establishment of its rural health insurance system, but local government institutions have considerable flexibility in the specific design and management of schemes. Maintaining a reasonable balance of funds is critical to ensure that the schemes are sustainable and effective in offering financial protection to members. This paper explores the financial management of the NCMS in China through a case study of the balance of funds and the factors influencing this, in six counties in two Chinese provinces. The main data source is NCMS management data from each county from 2003 to 2005, supplemented by: a household questionnaire survey, qualitative interviews and focus group discussions with all local stakeholders and policy document analysis. The study found that five out of six counties held a large fund surplus, whilst enrolees obtained only partial financial protection. However, in one county greater risk pooling for enrolees was accompanied by relatively high utilisation levels, resulting in a fund deficit. The opportunities to sustainably increase the financial protection offered to NCMS enrolees are limited by the financial pressures on local government, specific political incentives and low technical capacities at the county level and below. Our analysis suggests that in the short term, efforts should be made to improve the management of the current NCMS design, which should be supported through capacity building for NCMS offices. However, further medium-term initiatives may be required including changes to the design of the schemes. Copyright (c) 2009 John Wiley & Sons, Ltd.

A Review Of Innovative International Financing Mechanisms To Address Noncommunicable Diseases.

PubMed

Meghani, Ankita; Basu, Sanjay

2015-09-01

Noncommunicable diseases have become prevalent in low- and middle-income countries. A key question that remains unresolved is how to support the development of systems to prevent and treat noncommunicable disease through international financing mechanisms. We conducted a review of articles and grey literature published from 2000 through 2014 on innovative financing models proposed or used for other disease control efforts. We found that the greatest available evidence supported pooled funding models, where funding from multiple groups is combined for a specific investment, with such models previously deployed in vaccine and infectious disease funding areas. Robust evidence also supported the viability of international transactions taxes or levies placed on specific transactions to fund investments in drug procurement and supply, and of the front-loading of development aid through bond sales, particularly to stabilize funding and subsidize drug procurement. Far less compelling evidence was available to support diaspora bonds or debt reduction programs as mechanisms to aid low- and middle-income countries' health systems in financing noncommunicable disease prevention and care services. Project HOPE—The People-to-People Health Foundation, Inc.

76 FR 71127 - Reporting by Investment Advisers to Private Funds and Certain Commodity Pool Operators and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-16

... Form PF is designed, among other things, to assist the Financial Stability Oversight Council in its... several changes from the proposal that are designed to respond to commenter concerns. Consistent with the... members of FSOC. The design of Form PF is not intended to reflect a determination as to where systemic...

7 CFR 4290.1600 - Secretary's authority to issue and guarantee Trust Certificates.

Code of Federal Regulations, 2011 CFR

2011-01-01

... the timely payment of the principal and interest thereon. Any such guarantee of such TC is limited to the principal and interest due on the Debentures in any Trust or Pool backing such TC. The full faith... any TC. (b) Authority to arrange public or private fundings of Leverage. The Secretary in his or her...

25 CFR 1001.9 - Selection criteria for tribes/consortia seeking advance planning grant funding.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 25 Indians 2 2013-04-01 2013-04-01 false Selection criteria for tribes/consortia seeking advance..., DEPARTMENT OF THE INTERIOR SELF-GOVERNANCE PROGRAM § 1001.9 Selection criteria for tribes/consortia seeking... before a tribe/consortium is admitted into the applicant pool? Any tribe/consortium that is not a self...

Untapped Resources, Untapped Labor Pool: Using Federal Highway Funds to Prepare Women for Careers in Construction

ERIC Educational Resources Information Center

Hegewisch, Ariane; Henrici, Jane; Shaw, Elyse; Hooper, Thomas

2014-01-01

Women are underrepresented in highway, street, and bridge construction where employment is projected to grow by more than 20 percent until 2022. Creating sustainable pathways into construction careers fills critical hiring needs for industry while improving economic security for women, as these jobs typically provide family-supporting wages with…

The Tanda: A Practice at the Intersection of Mathematics, Culture, and Financial Goals

ERIC Educational Resources Information Center

Martin, Lee; Goldman, Shelley; Jimenez, Osvaldo

2009-01-01

We present an analysis and discussion of the "tanda," a multiperson pooled credit and savings scheme (a rotating credit association or RCA), as described by two informants from Mexican immigrant communities in California. In the tanda, participants contribute regularly to a common fund which is distributed to participants on a rotating…

77 FR 67032 - Self-Regulatory Organizations; Chicago Board Options Exchange, Incorporated; Notice of Filing and...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-08

... Basis for, the Proposed Rule Change 1. Purpose The Exchange proposes to amend its marketing fee. The marketing fee is assessed on certain transactions of Market-Makers, Designated Primary Market-Makers (``DPMs'') and e-DPMs.\\3\\ The funds collected via this marketing fee are then put into pools controlled by DPMs...

Planned Giving Administration: The Business Officer's Guide [with DVD

ERIC Educational Resources Information Center

Brostrom, Forrest C.

2005-01-01

Some people associate planned giving with fancy trusts and exotic tax plans. The truth is far simpler and more profound. This book provides a comprehensive review of the subject, from the relative simplicity of outright gifts and bequests to the more complex workings of pooled income funds and retained life estates. The author lends a common sense…

Guide to the Administration of Charitable Remainder Trusts. Third Edition.

ERIC Educational Resources Information Center

Clark, David W.; And Others

This is the third edition of a workbook prepared as a kind of primer for those responsible for the administration of charitable remainder trusts in accordance with the Tax Reform Act of 1969. The topics covered include: trust administration in general; pooled income fund; unitrust; annuity trust; gift annuity; short term income (lead) trust; gift…

Mentoring the Next Researcher Generation: Reflections on Three Years of Building VET Research Capacity and Infrastructure

ERIC Educational Resources Information Center

Barratt-Pugh, Llandis Gareth

2012-01-01

During 2008-2011, the National Centre for Vocational Education Research (NCVER) funded a programme to build Australian VET research capacity and rejuvenate what has been seen as the existing "greying" researcher pool. This paper is a reflective narrative about experiences of constructing the programme with a specific focus on the…

7 CFR 4290.1600 - Secretary's authority to issue and guarantee Trust Certificates.

Code of Federal Regulations, 2010 CFR

2010-01-01

... the timely payment of the principal and interest thereon. Any such guarantee of such TC is limited to the principal and interest due on the Debentures in any Trust or Pool backing such TC. The full faith... any TC. (b) Authority to arrange public or private fundings of Leverage. The Secretary in his or her...

Java across Different Curricula, Courses and Countries Using a Common Pool of Teaching Material

ERIC Educational Resources Information Center

Ivanovic, Mirjana; Budimac, Zoran; Mishev, Anastas; Bothe, Klaus; Jurca, Ioan

2013-01-01

Under the auspices of a DAAD funded educational project, a subproject devoted to different aspects of teaching the Java programming language started several years ago. The initial intention of the subproject was to attract members of the subproject to prepare some teaching materials for teaching essentials of the Java programming language. During…

Empowering patients through eHealth: a case report of a pan-European project.

PubMed

Lettieri, Emanuele; Fumagalli, Lia P; Radaelli, Giovanni; Bertele', Paolo; Vogt, Jess; Hammerschmidt, Reinhard; Lara, Juan L; Carriazo, Ana; Masella, Cristina

2015-08-05

This paper crystallises the experience developed by the pan-European PALANTE Consortium in dealing with the generation of relevant evidence from heterogeneous eHealth services for patient empowerment in nine European Regions. The European Commission (EC) recently funded a number of pan-European eHealth projects aimed at empowering European patients/citizens thus transforming the traditional patient/citizen role in the management of their health (e.g., PALANTE, SUSTAIN, CARRE, HeartCycle, Empower). However, the heterogeneity of the healthcare systems, of the implemented services and of the target patients, the use of ad-hoc definitions of the salient concepts and the development of small-size experiences have prevented the dissemination of "global" results and the development of cumulative knowledge. The main challenge has been the generation of large-scale evidence from heterogeneous small-size experiences. Three lessons have been collectively learnt during the development of the PALANTE project, which involves 9 sites that have implemented different eHealth services for empowering different typologies of patients. These lessons have been refined progressively through project meetings, reviews with the EC Project Officer and Reviewers. The paper illustrates the ten steps followed to develop the three lessons. The first lesson learnt is about how EC-funded projects should develop cumulative knowledge by avoiding self-crafted measures of outcome and by adopting literature-grounded definitions and scales. The second lesson learnt is about how EC-funded projects should identify ambitious, cross-pilot policy and research questions that allow pooling of data from across heterogeneous experiences even if a multi-centre study design was not agreed before. The third lesson learnt is about how EC-funded projects should open their collections of data and make them freely-accessible to the scientific community shortly after the conclusion of the project in order to guarantee the replicability of results and conclusions. The three lessons might provide original elements for fuelling the ongoing debate about the capability of the EC to develop evidence-based policies by pooling evidence from heterogeneous, local experiences.

Implementing Global Fund programs: a survey of opinions and experiences of the Principal Recipients across 69 countries.

PubMed

Wafula, Francis; Marwa, Charles; McCoy, David

2014-03-24

Principal Recipients (PRs) receive money from the Global Fund to fight AIDS, Tuberculosis and Malaria (Global Fund) to manage and implement programs. However, little research has gone into understanding their opinions and experiences. This survey set out to describe these, thereby providing a baseline against which changes in PR opinions and experiences can be assessed as the recently introduced new funding model is rolled out. An internet based questionnaire was administered to 315 PRs. A total of 115 responded from 69 countries in Africa, Asia, Eastern Europe and Latin America. The study was conducted between September and December 2012. Three quarters of PRs thought the progress update and disbursement request (PU/DR) system was a useful method of reporting grant progress. However, most felt that the grant negotiation processes were complicated, and that the grant rating system did not reflect performance.While nearly all PRs were happy with the work being done by sub-Recipients (92%) and Fund Portfolio Managers (86%), fewer were happy with the Office of the Inspector General (OIG). Non-government PRs were generally less happy with the OIG's work compared to government PRs.Most PRs thought the Global Fund's Voluntary Pooled Procurement system made procurement easier. However, only 29% said the system should be made compulsory.When asked which aspects of the Global Fund's operations needed improvement, most PRs said that the Fund should re-define and clarify the roles of different actors, minimize staff turnover at its Secretariat, and shorten the grant application and approval processes. All these are currently being addressed, either directly or indirectly, under a new funding model. Vigorous assessments should nonetheless follow the roll-out of the new model to ensure the areas that are most likely to affect PR performance realize sustained improvement. Opinions and experiences with the Global Fund were varied, with PRs having good communication with Fund Portfolio Managers and sub-Recipients, but being unhappy with the grant negotiation and grant rating systems. Recommendations included simplifying grant processes, finding performance assessment methods that look beyond numbers, and employing Local Fund Agents who understand public health aspects of programs.

Case study in health information management: strategic planning.

PubMed

Homan, C V

1992-08-01

The strategic planning process has proven to be invaluable to Riverside Hospital's success. Involvement of all levels of the organization and integration of plans solidifies organizational commitments and provides a framework that assures accomplishment of overall goals. With major developments in computerization of medical records and other systems that support patient care data analysis on the horizon, Riverside's integrated plans are defining crucial information system projects. As the pool of available resources for projects continues to shrink, the planning format described assures funding of information system needs that will secure a position for Riverside in the health care marketplace of the future.

Explaining public support for space exploration funding in America: A multivariate analysis

NASA Astrophysics Data System (ADS)

Nadeau, François

2013-05-01

Recent studies have identified the need to understand what shapes public attitudes toward space policy. I address this gap in the literature by developing a multivariate regression model explaining why many Americans support government spending on space exploration. Using pooled data from the 2006 and 2008 General Social Surveys, the study reveals that spending preferences on space exploration are largely apolitical and associated instead with knowledge and opinions about science. In particular, the odds of wanting to increase funding for space exploration are significantly higher for white, male Babyboomers with a higher socio-economic status, a fondness for organized science, and a post-secondary science education. As such, I argue that public support for NASA's spending epitomizes what Launius termed "Apollo Nostalgia" in American culture. That is, Americans benefitting most from the old social order of the 1960s developed a greater fondness for science that makes them more likely to lament the glory days of space exploration. The article concludes with suggestions for how to elaborate on these findings in future studies.

MASH TEST NO. 3-10 OF A NON-PROPRIETARY, HIGH-TENSION CABLE MEDIAN BARRIER FOR USE IN 6H:1V V-DITCH (TEST NO. MWP-8)

DOT National Transportation Integrated Search

2017-05-10

The Midwest States Pooled Fund Program has been developing a prototype design for a non-proprietary, high-tension cable median barrier for use in a 6H:1V V-ditch. This system incorporates four evenly spaced cables, Midwest Weak Posts (MWP) spaced at ...

13 CFR 108.1600 - SBA authority to issue and guarantee Trust Certificates.

Code of Federal Regulations, 2011 CFR

2011-01-01

... guarantee the timely payment of the principal and interest thereon. Any guarantee by SBA of such TC is limited to the principal and interest due on the Debentures in any Trust or Pool backing such TC. The full... of any TC. (b) SBA authority to arrange public or private fundings of Leverage. SBA in its discretion...

26 CFR 1.642(c)-7 - Transitional rules with respect to pooled income funds.

Code of Federal Regulations, 2010 CFR

2010-04-01

... later, on the date of its creation and ending the day before the date on which it meets the requirements..., such share being based on the fair market value of the property in which such life interest was... value of the total commingled property on the date of separation. The percentage share shall be the...

East Europe Report.

DTIC Science & Technology

1986-07-08

Pooling of Funds for undeveloped Areas Called Unsatisfactory (Dragoljub Vukovic ; KOMUNIST, 30 May 86) 29 Croatian Role in Kosovo Development...12-13 [Article by Dragoljub Vukovic : "Without Economic Coercion" first paragraph is KOMUNIST introduction] [Text] The volume of investments...broader and more effective cooperation in science and technology must be accelerated. /6662 CSO: 2400/316 48 JpRs~FpD 8 J ">y^t099 POLITICS

Adding to the Pool of Methods for Program Evaluation: A Comparison of Latent Class Analysis and Propensity Score Analysis

ERIC Educational Resources Information Center

Taylor, Lauren Christine

2013-01-01

Considering the amount of funding that is distributed to educational research each year, leaders and policymakers have a vested interest in finding scientifically based evidence that answers causal questions regarding program effectiveness. The importance of program evaluation has long been recognized in many fields of research; however, the most…

Remainder Gifts Under the Tax Reform Act of 1969: A Post-Final Regulation Outline, With Forms

ERIC Educational Resources Information Center

Myers, John Holt

1973-01-01

Reviews the Tax Reform Act of 1969 with regard to income, estate, or gift tax deductions available for the gift or bequest of a remainder interest. Compares the various types of deductible charitable remainder gifts. Legal forms are included for pooled income fund trusts and for charitable remainder annuity trust gifts and unitrust gifts. (JT)

13 CFR 108.1600 - SBA authority to issue and guarantee Trust Certificates.

Code of Federal Regulations, 2010 CFR

2010-01-01

... guarantee the timely payment of the principal and interest thereon. Any guarantee by SBA of such TC is limited to the principal and interest due on the Debentures in any Trust or Pool backing such TC. The full... of any TC. (b) SBA authority to arrange public or private fundings of Leverage. SBA in its discretion...

Assistive Technology as an Evolving Resource for a Successful Employment Experience

ERIC Educational Resources Information Center

Murphy, Patricia M.

2005-01-01

Strategic pooling of assistive technology, human resources and funding options has made meaningful employment possible for the 25-year-old man with cerebral palsy who is the subject of this paper. Since graduating from high school four years ago, he has held a part-time job at the warehouse of a bookseller. To perform his job, which involves…

Health insurance in South Africa: an empirical analysis of trends in risk-pooling and efficiency following deregulation.

PubMed

Söderlund, N; Hansl, B

2000-12-01

This paper reports an empirical investigation into the pattern of private health insurance coverage in South Africa before and after deregulation of the health insurance industry. More specifically, we sought to measure trends in risk-pooling over the period 1985-95, and to assess the impact of risk pooling on the costs of health insurance cover over this period. South African mutual health insurers (Medical Schemes) have existed for over 100 years, and have been regulated under a specific Act since 1967. Up until 1989, health insurers were required by law to community rate their premiums, and were not allowed to exclude high-risk enrolees from cover. In 1989 these regulations were removed, effectively allowing health insurers to risk-rate the cover which they provided, and exclude 'medically uninsurables'. Data were obtained from the office of the health insurance regulator (the Registrar of Medical Schemes) for the period 1985-95, and consisted of the statutory returns from all registered medical schemes for each year during the study period. Multiple regression methods were used to assess the determinants of changes in the risk pools of insurers, and their costs. Both cross-sectional and longitudinal models were estimated. Unadjusted data suggest changes in risk-pooling since the deregulation period after 1985. Health insurers with open enrolment had worse than average risk profiles in the 1980s, but this reversed by the early 1990s, leaving them with significantly better risk profiles by 1995. Worsening risk profiles were associated with decreasing fund size, higher loss-ratios and past premium increases. Most models showed that risk rating of premiums was consistently associated with higher premiums, after adjustment for risk, quality, scale and other environmental differences between insurers. Likely explanations include the additional costs required for marketing and underwriting risk-rated policies, insufficient incentives to use cost-control techniques, and higher levels of moral hazard associated with diminished risk-pooling. Current re-regulation of risk-pooling within medical schemes may thus improve both equity and efficiency of private health care cover.

Legume Genome Initiative at the University of Oklahoma

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

Bruce A. Roe

2004-02-27

Consolidated Appropriations Resolution, 2003 Conference Report for the Department of Energy's Biological and Environmental Research (BER) program provided $481,000 for the Legume Genome Initiative at the University of Oklahoma. These funds were used to support our research that is aimed at determining the entire sequence of the gene rich regions of the genome of the legume, Medicago truncatula, by allowing us to obtain a greater degree of finished BAC sequences from the draft sequences we have already obtained through research funded by the Noble Foundation. During the funding period we increased the number of Medicago truncatula BACs with finished (Bermudamore » standard) sequences from 109 to 359, and the total number of BACs for which we collected sequence data from 584 to 842, 359 of which reached phase 2 (ordered and oriented contigs). We also sequenced a series of pooled BAC clones that cover additional euchromatic (gene rich) genomic regions. This work resulted in 6 refereed publications, see below. Genes whose sequence was determined during this study included multiple members of the plant disease resistance (R-gene) family as well as several genes involved in flavinoid biosynthesis, nitrogen fixation and plant-microbial symbosis. This work also served as a prelude to obtaining NSF funding for the international collaborative effort to complete the entire sequence of the Medicago truncatula genomic euchromatic regions using a BAC based approach.« less

Whole exome sequencing in recurrent early pregnancy loss

PubMed Central

Qiao, Ying; Wen, Jiadi; Tang, Flamingo; Martell, Sally; Shomer, Naomi; Leung, Peter C.K.; Stephenson, Mary D.; Rajcan-Separovic, Evica

2016-01-01

STUDY HYPOTHESIS Exome sequencing can identify genetic causes of idiopathic recurrent pregnancy loss (RPL). STUDY FINDING We identified compound heterozygous deleterious mutations affecting DYNC2H1 and ALOX15 in two out of four families with RPL. Both genes have a role in early development. Bioinformatics analysis of all genes with rare and putatively pathogenic mutations in miscarriages and couples showed enrichment in pathways relevant to pregnancy loss, including the complement and coagulation cascades pathways. WHAT IS KNOWN ALREADY Next generation sequencing (NGS) is increasingly being used to identify known and novel gene mutations in children with developmental delay and in fetuses with ultrasound-detected anomalies. In contrast, NGS is rarely used to study pregnancy loss. Chromosome microarray analysis detects putatively causative DNA copy number variants (CNVs) in ∼2% of miscarriages and CNVs of unknown significance (predominantly parental in origin) in up to 40% of miscarriages. Therefore, a large number of miscarriages still have an unknown cause. STUDY DESIGN, SAMPLES/MATERIALS, METHODS Whole exome sequencing (WES) was performed using Illumina HiSeq 2000 platform on seven euploid miscarriages from four families with RPL. Golden Helix SVS v8.1.5 was used for data assessment and inheritance analysis for deleterious DNA variants predicted to severely disrupt protein-coding genes by introducing a frameshift, loss of the stop codon, gain of the stop codon, changes in splicing or the initial codon. Webgestalt (http://bioinfo.vanderbilt.edu/webgestalt/) was used for pathway and disease association enrichment analysis of a gene pool containing putatively pathogenic variants in miscarriages and couples in comparison to control gene pools. MAIN RESULTS AND THE ROLE OF CHANCE Compound heterozygous mutations in DYNC2H1 and ALOX15 were identified in miscarriages from two families with RPL. DYNC2H1 is involved in cilia biogenesis and has been associated with fetal lethality in humans. ALOX15 is expressed in placenta and its dysregulation has been associated with inflammation, placental, dysfunction, abnormal oxidative stress response and angiogenesis. The pool of putatively pathogenic single nucleotide variants (SNVs) and small insertions and deletions (indels) detected in the miscarriages showed enrichment in ‘complement and coagulation cascades pathway’, and ‘ciliary motility disorders’. We conclude that CNVs, individual SNVs and pool of deleterious gene mutations identified by exome sequencing could contribute to RPL. LIMITATIONS, REASONS FOR CAUTION The size of our sample cohort is small. The functional effect of candidate mutations should be evaluated to determine whether the mutations are causative. WIDER IMPLICATIONS OF THE FINDINGS This is the first study to assess whether SNVs may contribute to the pathogenesis of miscarriage. Furthermore, our findings suggest that collective effect of mutations in relevant biological pathways could be implicated in RPL. STUDY FUNDING AND COMPETING INTEREST(S) The study was funded by Canadian Institutes of Health Research (grant MOP 106467) and Michael Smith Foundation of Health Research Career Scholar salary award to ERS. PMID:26826164

The private funding of public research. New directions in the administration of occupational and environmental health research.

PubMed

Cullen, M R; Upton, A; Buffler, P; Robins, T; Schenker, M; Fine, L; Wiencek, R; Widess, E; Chiazze, L

1994-12-01

Dr. Cullen: The experience with the new research models, starting with the prototypic experience of the rubber industry studies of the 1970s and expanding to diverse sectors of American industry in the 1980s, has yielded some important lessons for the future. In closing this symposium I shall try to summarize these briefly. Certain strengths of the evolving process seem common to each of the models. Alone and collectively, the new research arrangements have quite apparently served to increase substantially the pool of funds available to the academic sector for the study of occupational health and safety problems. As a consequence, a larger pool of investigators has participated in the research process, greatly strengthening the future academic capability and experience of our fragilely supported teaching centers. Combined with the involvement of the academic centers in the review process, there has been an undeniable broadening and deepening of the nation's research output and long-term capability in occupational health. On the side of the private sector, the new relationships have led to marked progress in the knowledge base about health and safety problems, with a heavily directed focus on those of greatest relevance to the industries involved. The credibility of the knowledge acquired has been enhanced, an important achievement in a society in which perception of truth is often as important as the truth itself! Because of the requirements of the process for broad involvement by the organizations which undertake these activities, health and safety have achieved far greater visibility and attention by corporate and union leaders who may have previously had no involvement in issues of health and safety.(ABSTRACT TRUNCATED AT 250 WORDS)

HIV vaccine development: would more (public) money bring quicker results?

PubMed

Winsbury, R

1999-01-01

Globally, $200-250 million/year are devoted to HIV vaccine research. Most of those funds pay for basic research rather than product development. Moreover, most of the funds are aimed at the HIV strain commonly found in the US and Europe, and not at the strains common to Africa and other developing countries. While US President Bill Clinton set in 1997 a 10-year target for the development of an HIV vaccine, that target date is looking increasingly unlikely. International vaccine and pharmaceutical companies typically drive vaccine research and development. However, concern over the ultimate profitability of developing and marketing an HIV vaccine, and the fear of major litigation should an eventual vaccine go awry have caused such firms to shy away from investing large amounts of money into HIV vaccine development. These companies somehow have to be attracted back into the field. A World Bank special task force is slated to present its report by mid-1999 on possible funding mechanisms to promote HIV vaccine development. It remains to be resolved whether public funds could and should be used, perhaps through a pooled international vaccine development fund. 2 new International AIDS Vaccine Initiative projects are described.

Systematic review finds that study data not published in full text articles have unclear impact on meta-analyses results in medical research.

PubMed

Schmucker, Christine M; Blümle, Anette; Schell, Lisa K; Schwarzer, Guido; Oeller, Patrick; Cabrera, Laura; von Elm, Erik; Briel, Matthias; Meerpohl, Joerg J

2017-01-01

A meta-analysis as part of a systematic review aims to provide a thorough, comprehensive and unbiased statistical summary of data from the literature. However, relevant study results could be missing from a meta-analysis because of selective publication and inadequate dissemination. If missing outcome data differ systematically from published ones, a meta-analysis will be biased with an inaccurate assessment of the intervention effect. As part of the EU-funded OPEN project (www.open-project.eu) we conducted a systematic review that assessed whether the inclusion of data that were not published at all and/or published only in the grey literature influences pooled effect estimates in meta-analyses and leads to different interpretation. Systematic review of published literature (methodological research projects). Four bibliographic databases were searched up to February 2016 without restriction of publication year or language. Methodological research projects were considered eligible for inclusion if they reviewed a cohort of meta-analyses which (i) compared pooled effect estimates of meta-analyses of health care interventions according to publication status of data or (ii) examined whether the inclusion of unpublished or grey literature data impacts the result of a meta-analysis. Seven methodological research projects including 187 meta-analyses comparing pooled treatment effect estimates according to different publication status were identified. Two research projects showed that published data showed larger pooled treatment effects in favour of the intervention than unpublished or grey literature data (Ratio of ORs 1.15, 95% CI 1.04-1.28 and 1.34, 95% CI 1.09-1.66). In the remaining research projects pooled effect estimates and/or overall findings were not significantly changed by the inclusion of unpublished and/or grey literature data. The precision of the pooled estimate was increased with narrower 95% confidence interval. Although we may anticipate that systematic reviews and meta-analyses not including unpublished or grey literature study results are likely to overestimate the treatment effects, current empirical research shows that this is only the case in a minority of reviews. Therefore, currently, a meta-analyst should particularly consider time, effort and costs when adding such data to their analysis. Future research is needed to identify which reviews may benefit most from including unpublished or grey data.

Systematic review finds that study data not published in full text articles have unclear impact on meta-analyses results in medical research

PubMed Central

Blümle, Anette; Schell, Lisa K.; Schwarzer, Guido; Oeller, Patrick; Cabrera, Laura; von Elm, Erik; Briel, Matthias; Meerpohl, Joerg J.

2017-01-01

Background A meta-analysis as part of a systematic review aims to provide a thorough, comprehensive and unbiased statistical summary of data from the literature. However, relevant study results could be missing from a meta-analysis because of selective publication and inadequate dissemination. If missing outcome data differ systematically from published ones, a meta-analysis will be biased with an inaccurate assessment of the intervention effect. As part of the EU-funded OPEN project (www.open-project.eu) we conducted a systematic review that assessed whether the inclusion of data that were not published at all and/or published only in the grey literature influences pooled effect estimates in meta-analyses and leads to different interpretation. Methods and findings Systematic review of published literature (methodological research projects). Four bibliographic databases were searched up to February 2016 without restriction of publication year or language. Methodological research projects were considered eligible for inclusion if they reviewed a cohort of meta-analyses which (i) compared pooled effect estimates of meta-analyses of health care interventions according to publication status of data or (ii) examined whether the inclusion of unpublished or grey literature data impacts the result of a meta-analysis. Seven methodological research projects including 187 meta-analyses comparing pooled treatment effect estimates according to different publication status were identified. Two research projects showed that published data showed larger pooled treatment effects in favour of the intervention than unpublished or grey literature data (Ratio of ORs 1.15, 95% CI 1.04–1.28 and 1.34, 95% CI 1.09–1.66). In the remaining research projects pooled effect estimates and/or overall findings were not significantly changed by the inclusion of unpublished and/or grey literature data. The precision of the pooled estimate was increased with narrower 95% confidence interval. Conclusions Although we may anticipate that systematic reviews and meta-analyses not including unpublished or grey literature study results are likely to overestimate the treatment effects, current empirical research shows that this is only the case in a minority of reviews. Therefore, currently, a meta-analyst should particularly consider time, effort and costs when adding such data to their analysis. Future research is needed to identify which reviews may benefit most from including unpublished or grey data. PMID:28441452

The role of the Technical Review Panel of the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria: an analysis of grant recommendations.

PubMed

Schmidt-Traub, Guido

2018-04-01

The independent Technical Review Panel (TRP) of the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria is a unique mechanism to review funding proposals and to provide recommendations on their funding. Its functioning and performance have received little attention in the scientific literature. We aimed to identify predictors for TRP recommendations, whether these were in line with the Global Fund's ambition to give priority to countries most in need, and whether they correlated with grant performance. We combined data on proposals and applications under the Rolling Continuation Channel, TRP recommendations and grant implementation during the rounds-based mechanism (2002-2010) with country characteristics. Ordered logistic and OLS regressions were used to identify predictors for per-capita funding requests, TRP recommendations, Global Fund funding and grant performance ratings. We tested for financial suppression of large funding proposals and whether fragile or English-speaking countries performed differently from other countries. We found that funding requests and TRP recommendations were consistent with disease burden, but independent of other country characteristics. Countries with larger populations requested less funding per capita, but there is no evidence of financial suppression by the TRP. Proposals from fragile countries were as likely to be recommended as proposals from other countries, and resulting grants performed equally well except for lower performance of HIV/AIDS grants. English-speaking countries obtained more funding for TB and malaria than other countries. In conclusion, the independent TRP acted in line with the guiding principles of the Global Fund to direct funding to countries most in need without ex ante country allocation. The Global Fund appears to have promoted learning on how to design and implement large-scale programs in fragile and non-fragile countries. Other pooled financing mechanisms may consider TRP operating principles to generate high-quality demand, to promote learning and to direct resources to countries most in need.

Investing in Wisconsin's Future: A Proposal for a State Higher Education Nest Egg Program. WISCAPE Viewpoints

ERIC Educational Resources Information Center

Winters, Dennis

2010-01-01

Wisconsin will face serious challenges in the coming decades if it fails to increase the size and quality of the state workforce talent pool. One potential solution is a "Higher Ed Nest Egg Program", which would put $1,000 per student per year into an account with the sole purpose that the funds be used for postsecondary education in…

13 CFR 107.1240 - Funding of Licensee's draw request through sale to short-term investor.

Code of Federal Regulations, 2010 CFR

2010-01-01

... which will be established at the time of the pooling of your security; (2) The purchase of your security... SBA sells your Debenture to a short-term investor: (1) The sale price will be the face amount. (2) At... Participating Security to a short-term investor, the sale price will be the face amount. (d) Licensee's right to...

Hard-to-fill vacancies.

PubMed

Williams, Ruth

2010-09-29

Skills for Health has launched a set of resources to help healthcare employers tackle hard-to-fill entry-level vacancies and provide sustainable employment for local unemployed people. The Sector Employability Toolkit aims to reduce recruitment and retention costs for entry-level posts and repare people for employment through pre-job training programmes, and support employers to develop local partnerships to gain access to wider pools of candidates and funding streams.

Houston-Area Community Colleges Reap Rewards of Cooperative Television Campaign. Presentation to the National Council of Community Relations National Conference.

ERIC Educational Resources Information Center

Boatright, Joyce; Lestarjette, Steve

In response to a statewide economic crisis resulting in a 9% funding cut for Texas community colleges, the presidents of nine Houston area community colleges formed a consortium to pool their resources and aggressively market the colleges. Since 1986, the Gulf Coast Consortium has mounted late-summer television and radio advertising campaigns to…

Cancer megafunds with in silico and in vitro validation: accelerating cancer drug discovery via financial engineering without financial crisis

PubMed Central

Yang, Xianjin; Debonneuil, Edouard; Zhavoronkov, Alex; Mishra, Bud

2016-01-01

Advances in financial engineering are radically reshaping the biomedical marketplace. For instance, new methods of pooling diversified drug development programs by placing them in a special purpose vehicle (SPV) have been proposed to create a securitized cancer megafund allowing for debt and equity participation. In this study, we perform theoretical and numerical simulations that highlight the role of empirical validation of the projects comprising a cancer megafund. We quantify the degree to which the deliberately designed structure of derivatives and investments is key to its liquidity. Research megafunds with comprehensive in silico and laboratory validation protocols and ability to issue both debt, and equity as well as hybrid financial products may enable conservative investors including pension funds and sovereign government funds to profit from unique securitization opportunities. Thus, while hedging investor's longevity risk, such well-validated megafunds will contribute to health, wellbeing and longevity of the global population. PMID:27275544

Cancer megafunds with in silico and in vitro validation: accelerating cancer drug discovery via financial engineering without financial crisis.

PubMed

Yang, Xianjin; Debonneuil, Edouard; Zhavoronkov, Alex; Mishra, Bud

2016-09-06

Advances in financial engineering are radically reshaping the biomedical marketplace. For instance, new methods of pooling diversified drug development programs by placing them in a special purpose vehicle (SPV) have been proposed to create a securitized cancer megafund allowing for debt and equity participation. In this study, we perform theoretical and numerical simulations that highlight the role of empirical validation of the projects comprising a cancer megafund. We quantify the degree to which the deliberately designed structure of derivatives and investments is key to its liquidity. Research megafunds with comprehensive in silico and laboratory validation protocols and ability to issue both debt, and equity as well as hybrid financial products may enable conservative investors including pension funds and sovereign government funds to profit from unique securitization opportunities. Thus, while hedging investor's longevity risk, such well-validated megafunds will contribute to health, well being and longevity of the global population.

An evaluation of health benefit modification in Taft-Hartley health and welfare funds: implications for encouraging tobacco-cessation coverage.

PubMed

Au-Yeung, Caroline M; Weisman, Susan R; Hennrikus, Deborah J; Forster, Jean L; Skoog, Rodney; Luneburg, Wade; Hesse, Bernie

2010-12-01

An estimated one fifth of all U.S. adult smokers receive health benefits through insurance plans administered by Taft-Hartley Health and Welfare Funds. Most funds do not offer comprehensive tobacco-cessation services to fund participants despite evidence that doing so would be cost effective and save lives. This paper examines the decision-making processes of Minnesota-based fund trustees and advisors to identify factors that influence decisions about modifications to benefits. Formative data about the process by which funds make health benefit modifications were collected in 2007-2008 from 25 in-depth key informant interviews with fund trustees and a cross-section of fund advisors, including administrators, attorneys, and healthcare business consultants. Analyses were performed using a general inductive approach to identify conceptual themes, employing qualitative data analysis software. The most commonly cited factors influencing trustees' decisions about health plan benefit modifications-including modifications regarding tobacco-cessation benefits-were benefit costs, participants' demand for services, and safeguarding participants' health. Barriers included information gaps, concerns about participants' response, and difficulty projecting benefit utilization and success. Advisors wielded considerable influence in decision-making processes. Trustees relied on a small pool of business, legal, and administrative advisors to provide guidance and recommendations about possible health plan benefit modifications. Providing advisors with evidence-based information and resources about benefit design, cost/return-on-investment (ROI), effectiveness, and promotion may be an effective means to influence funds to provide comprehensive tobacco-cessation benefits. Copyright © 2010 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Cross-national comparison of capitation funding: the American, British and Dutch experience.

PubMed

Persaud, D; Narine, L

1999-05-01

In this paper we review the performance of the capitation payment systems of three countries--the Adjusted Average Per Capita Cost (AAPCC) system used in the United States to reimburse Health Maintenance Organizations (HMOs) for insuring Medicare recipients, a somewhat similar system in the Netherlands which reimburses third-party payers for insuring the entire population and a weighted system utilized in Britain for regional funding. Our review revealed significant problems with the current version of the AAPCC formula as there is evidence of the biased selection of beneficiaries and actual losses to Medicare through its use. Furthermore, several studies show that the demographic adjusters utilized in the AAPCC formula are extremely poor predictors of future healthcare utilization relative to the potential of direct and indirect health status measures. The Dutch experience with capitated funding has been similar to that of the United States. While Dutch researchers have built on the work of their American counterparts they acknowledge that further work is needed before a fully functional system is implemented. Britain's weighted system has fulfilled its original mandate to redistribute healthcare resources based on population need but recent changes giving increased influence to age weighting could reverse some of these gains. A number of proposed improvements to these risk adjustment problems were reviewed including the development of diagnostic cost groups, the coexisting hierarchical conditions model and the use of community-rated high-risk pooling. The findings from this study can help others narrow the alternatives they need to consider when thinking of introducing capitation funding or refining already existing systems.

Collaborative Orthopaedic Research Between and Within Institutions.

PubMed

Wolf, Brian R; Verma, Nikhil N; Spindler, Kurt P; Wright, Rick W

2017-02-15

Collaborative research is common in many medical disciplines; however, the field of orthopaedics has been relatively slow to adopt this type of research approach. Collaborative research efforts can occur between multiple institutions and, in some instances, may benefit from subspecialty society sponsorship. Collaborative research efforts between several research spheres within a single institution also can be advantageous. Collaborative research has many benefits, including a larger number of patients in studies, more power in the research, and better generalizability. In addition, collaborative research efforts allow resources to be pooled within and between institutions. The challenges of collaborative research include data management, funding, and the publication of manuscripts that have many authors.

State of the Plastic Surgery Workforce and the Impact of Graduate Medical Education Reform on Training of Plastic Surgeons.

PubMed

Janes, Lindsay; Lanier, Steven T; Evans, Gregory R D; Kasten, Steven J; Hume, Keith M; Gosain, Arun K

2017-08-01

Although recent estimates predict a large impending shortage of plastic surgeons, graduate medical education funding through the Centers for Medicare and Medicaid Services remains capped by the 1997 Balanced Budget Act. The authors' aim was to develop a plan to stimulate legislative action. The authors reviewed responses of the American Society of Plastic Surgeons, American College of Surgeons, and American Medical Association from January of 2015 to a House Energy & Commerce Committee request for input on graduate medical education funding. In addition, all program directors in plastic surgery were surveyed through the American Council of Academic Plastic Surgeons to determine their graduate medical education funding sources. All three organizations agree that current graduate medical education funding is inadequate to meet workforce needs, and this has a significant impact on specialty selection and distribution for residency training. All agreed that funding should be tied to the resident rather than to the institution, but disagreed on whether funds should be divided between direct (allocated to residency training) and indirect (allocated to patient care) pools, as is currently practiced. Program directors' survey responses indicated that only 38 percent of graduate medical education funds comes from the Centers for Medicare and Medicaid Services. Organized medicine is at risk of losing critically needed graduate medical education funding. Specific legislation to support additional graduate medical education positions and funding (House Resolutions 1180 and 4282) has been proposed but has not been universally endorsed, in part because of a lack of collaboration in organized medicine. Collaboration among major organizations can reinvigorate these measures and implement real change in funding.

The Oman Drilling Project

NASA Astrophysics Data System (ADS)

Matter, J.; Kelemen, P. B.; Teagle, D. A. H.

2014-12-01

With seed funds from the Sloan Foundation, the International Continental Drilling Program (ICDP) approved a proposal by 39 international proponents for scientific drilling in the Oman ophiolite. Via observations on core, geophysical logging, fluid sampling, hydrological measurements, and microbiological sampling in a series of boreholes, we will address long-standing, unresolved questions regarding melt and solid transport in the mantle beneath oceanic spreading ridges, igneous accretion of oceanic crust, mass transfer between the oceans and the crust via hydrothermal alteration, and recycling of volatile components in subduction zones. We will undertake frontier exploration of subsurface weathering processes in mantle peridotite, including natural mechanisms of carbon dioxide uptake from surface waters and the atmosphere, and the nature of the subsurface biosphere. Societally relevant aspects include involvement and training of university students, including numerous students from Sultan Qaboos University in Oman. Studies of natural mineral carbonation will contribute to design of engineered systems for geological carbon dioxide capture and storage. Studies of alteration will contribute to fundamental understanding of the mechanisms of reaction-driven cracking, which could enhance geothermal power generation and extraction of unconventional hydrocarbon resources. We hope to begin drilling in late 2015. Meanwhile, we are seeking an additional $2M to match the combined Sloan and ICDP funding from national and international funding agencies. Matching funds are needed for operational costs of drilling, geophysical logging, downhole fluid sampling, and core description. Information on becoming part of the named investigator pool is in Appendix 14 (page 70) of the ICDP proposal, available at https://www.ldeo.columbia.edu/gpg/projects/icdp-workshop-oman-drilling-project. This formal process should begin at about the time of the 2014 Fall AGU Meeting. Meanwhile, potential investigators who can help raise matching funds, e.g. for core description as part of petrological or structural studies or for drill site operations, are encouraged to contact the authors of this abstract.

26 CFR 1.642(c)-6T - Valuation of a remainder interest in property transferred to a pooled income fund (temporary).

Code of Federal Regulations, 2010 CFR

2010-04-01

... at 9.4 percent for age 55 .16192 Factor at 9.6 percent for age 55 .15755 Difference .00437... of a remainder interest is determined under this section. See, however, § 1.7520-3(b) (relating to... S in paragraph (e)(6) of this section. For purposes of the computations under this section, the age...

26 CFR 25.7520-1 - Valuation of annuities, unitrust interests, interests for life or terms of years, and remainder...

Code of Federal Regulations, 2010 CFR

2010-04-01

...) ESTATE AND GIFT TAXES GIFT TAX; GIFTS MADE AFTER DECEMBER 31, 1954 General Actuarial Valuations § 25.7520... certain circumstances), in the case of gifts made after April 30, 1989, the fair market value of annuities.... (2) For a gift to a pooled income fund prior to May 1, 2009, see § 1.642(c)-6A (Income Tax...

European Science Notes Information Bulletin. Report on Current European and Middle Eastern Science

DTIC Science & Technology

1992-10-01

oceanographers. This has occurred at a time of current radar systems . The independent develop- rapidly increasing government interest in and fund...over each area in which surface current is ment of the waves (some motions caused by wave determined (for HF systems , averaging time spans action and...Ocean Observing System ; high-resolution model capabilities; ocean- atmosphere interface; Surface Density Depression Pool; forecasting INTRODUCTION tion

Tobacco control funding for low-income and middle-income countries in a time of economic hardship.

PubMed

Stoklosa, Michal; Ross, Hana

2014-11-01

To assess how levels of tobacco control funding for low-income and middle-income countries (LMIC) changed following the 2008-2009 global economic downturn. In order to estimate the amount of tobacco control funding in LMICs, we created an integrated database of Development Assistance to Control Tobacco (DACT). This database includes data on funding from bilateral and multilateral donors, non-governmental organisations, private foundations and the corporate sector. The database contains information on 1389 disbursements awarded by 30 entities between 2000 and 2012. DACT declined only marginally from US$68.8 million (US$0.016 per adult) in 2009 to US$68.2 million (US$0.016 per adult) in 2011, but deviated significantly from its 2000 to 2009 trend. The sources of funding remain highly concentrated, with nearly a half of the money coming from the Bloomberg Initiative and the Bill & Melinda Gates Foundation in 2011. The relative importance of institutional and research grants has declined. Our findings are consistent with the patterns in general levels of development assistance for health: after a decade of rapid growth, funding for tobacco control activities in LMICs has levelled off. Just as the tobacco control community is beginning to envision the endgame for tobacco, the funding remains erratic, inadequate, and highly vulnerable due to its level of concentration. Innovative financing mechanisms might help to increase the funding pool. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Strategies for success among OPOs: a study of three organ procurement organizations.

PubMed

Shafer, T J; Kappel, D F; Heinrichs, D F

1997-03-01

Productivity among organ procurement organizations varies widely in the US, and the pressure to determine critical success factors increases as the organ pool shrinks and managed care expands. This study compared three successful organ procurement organizations, identified commonalities among them in cost of doing business, and examined direct and indirect expenses, staffing, specialized requestor programs, and professional and public education programs. The three organ procurement organizations were chosen because of their performance in terms of donors per million population, complexity, and size. The following key indicators were compared and analyzed: annual operating budget, size and composition of staff, funds and resources invested in professional education versus public education, tissue recovery operations, results of minority initiatives, and employee compensation programs.

Power and Agenda-Setting in Tanzanian Health Policy: An Analysis of Stakeholder Perspectives

PubMed Central

Fischer, Sara Elisa; Strandberg-Larsen, Martin

2016-01-01

Background: Global health policy is created largely through a collaborative process between development agencies and aid-recipient governments, yet it remains unclear whether governments retain ownership over the creation of policy in their own countries. An assessment of the power structure in this relationship and its influence over agenda-setting is thus the first step towards understanding where progress is still needed in policy-making for development. Methods: This study employed qualitative policy analysis methodology to examine how health-related policy agendas are adopted in low-income countries, using Tanzania as a case study. Semi-structured, in-depth, key informant interviews with 11 policy-makers were conducted on perspectives of the agenda-setting process and its actors. Kingdon’s stream theory was chosen as the lens through which to interpret the data analysis. Results: This study demonstrates that while stakeholders each have ways of influencing the process, the power to do so can be assessed based on three major factors: financial incentives, technical expertise, and influential position. Since donors often have two or all of these elements simultaneously a natural power imbalance ensues, whereby donor interests tend to prevail over recipient government limitations in prioritization of agendas. One way to mediate these imbalances seems to be the initiation of meaningful policy dialogue. Conclusion: In Tanzania, the agenda-setting process operates within a complex network of factors that interact until a "policy window" opens and a decision is made. Power in this process often lies not with the Tanzanian government but with the donors, and the contrast between latent presence and deliberate use of this power seems to be based on the donor ideology behind giving aid (defined here by funding modality). Donors who used pooled funding (PF) modalities were less likely to exploit their inherent power, whereas those who preferred to maintain maximum control over the aid they provided (ie, non-pooled funders) more readily wielded their intrinsic power to push their own priorities. PMID:27285513

Power and Agenda-Setting in Tanzanian Health Policy: An Analysis of Stakeholder Perspectives.

PubMed

Fischer, Sara Elisa; Strandberg-Larsen, Martin

2016-02-09

Global health policy is created largely through a collaborative process between development agencies and aid-recipient governments, yet it remains unclear whether governments retain ownership over the creation of policy in their own countries. An assessment of the power structure in this relationship and its influence over agenda-setting is thus the first step towards understanding where progress is still needed in policy-making for development. This study employed qualitative policy analysis methodology to examine how health-related policy agendas are adopted in low-income countries, using Tanzania as a case study. Semi-structured, in-depth, key informant interviews with 11 policy-makers were conducted on perspectives of the agenda-setting process and its actors. Kingdon's stream theory was chosen as the lens through which to interpret the data analysis. This study demonstrates that while stakeholders each have ways of influencing the process, the power to do so can be assessed based on three major factors: financial incentives, technical expertise, and influential position. Since donors often have two or all of these elements simultaneously a natural power imbalance ensues, whereby donor interests tend to prevail over recipient government limitations in prioritization of agendas. One way to mediate these imbalances seems to be the initiation of meaningful policy dialogue. In Tanzania, the agenda-setting process operates within a complex network of factors that interact until a "policy window" opens and a decision is made. Power in this process often lies not with the Tanzanian government but with the donors, and the contrast between latent presence and deliberate use of this power seems to be based on the donor ideology behind giving aid (defined here by funding modality). Donors who used pooled funding (PF) modalities were less likely to exploit their inherent power, whereas those who preferred to maintain maximum control over the aid they provided (ie, non-pooled funders) more readily wielded their intrinsic power to push their own priorities. © 2016 by Kerman University of Medical Sciences.

Out of pocket payments and social health insurance for private hospital care: Evidence from Greece.

PubMed

Grigorakis, Nikolaos; Floros, Christos; Tsangari, Haritini; Tsoukatos, Evangelos

2016-08-01

The Greek state has reduced their funding on health as part of broader efforts to limit the large fiscal deficits and rising debt ratios to GDP. Benefits cuts and limitations of Social Health Insurance (SHI) reimbursements result in substantial Out of Pocket (OOP) payments in the Greek population. In this paper, we examine social health insurance's risk pooling mechanisms and the catastrophic impact that OOP payments may have on insured's income and well-being. Using data collected from a cross sectional survey in Greece, we find that the OOP payments for inpatient care in private hospitals have a positive relationship with SHI funding. Moreover, we show that the SHI funding is inadequate to total inpatient financing. We argue that the Greek health policy makers have to give serious consideration to the perspective of a SHI system which should be supplemented by the Private Health Insurance (PHI) sector. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Faster and Cheaper: Creating a Culture of Innovation for AFRL Intellectual Property

DTIC Science & Technology

2016-01-01

Martin Haemming, “Funding Innovation through Venture Capital: A Global Perspective,” in Tony Davila, Marc J. Epstein, and Robert Shelton, eds., The...Innovation, 145. Although, there are cautions against using patents as a measure of success. Petra Moser, “Patents and Innovation: Evidence from...Economic History,” Journal of Economic Perspectives vol. 27, no. 1 (Winter 2013), 24-25, 40. Ryan Lampe and Petra Moser, “Do Patent Pools Encourage

Implementing Global Fund programs: a survey of opinions and experiences of the Principal Recipients across 69 countries

PubMed Central

2014-01-01

Background Principal Recipients (PRs) receive money from the Global Fund to fight AIDS, Tuberculosis and Malaria (Global Fund) to manage and implement programs. However, little research has gone into understanding their opinions and experiences. This survey set out to describe these, thereby providing a baseline against which changes in PR opinions and experiences can be assessed as the recently introduced new funding model is rolled out. Methodology An internet based questionnaire was administered to 315 PRs. A total of 115 responded from 69 countries in Africa, Asia, Eastern Europe and Latin America. The study was conducted between September and December 2012. Findings Three quarters of PRs thought the progress update and disbursement request (PU/DR) system was a useful method of reporting grant progress. However, most felt that the grant negotiation processes were complicated, and that the grant rating system did not reflect performance. While nearly all PRs were happy with the work being done by sub-Recipients (92%) and Fund Portfolio Managers (86%), fewer were happy with the Office of the Inspector General (OIG). Non-government PRs were generally less happy with the OIG’s work compared to government PRs. Most PRs thought the Global Fund’s Voluntary Pooled Procurement system made procurement easier. However, only 29% said the system should be made compulsory. When asked which aspects of the Global Fund’s operations needed improvement, most PRs said that the Fund should re-define and clarify the roles of different actors, minimize staff turnover at its Secretariat, and shorten the grant application and approval processes. All these are currently being addressed, either directly or indirectly, under a new funding model. Vigorous assessments should nonetheless follow the roll-out of the new model to ensure the areas that are most likely to affect PR performance realize sustained improvement. Conclusions Opinions and experiences with the Global Fund were varied, with PRs having good communication with Fund Portfolio Managers and sub-Recipients, but being unhappy with the grant negotiation and grant rating systems. Recommendations included simplifying grant processes, finding performance assessment methods that look beyond numbers, and employing Local Fund Agents who understand public health aspects of programs. PMID:24661793

Arbovirus circulation, temporal distribution, and abundance of mosquito species in two Carolina bay habitats.

PubMed

Ortiz, D I; Wozniak, A; Tolson, M W; Turner, P E

2005-01-01

Carolina bays, a type of geomorphic feature, may be important in the ecology of mosquito vectors in South Carolina. Their hydrology varies from wetland habitats with marked flooding/drying regimes to permanently flooded spring-fed lakes. Moreover, they possess characteristics that contribute to the support of a particularly abundant and diverse invertebrate fauna. Although it has been estimated that 2,700+ bays exist in South Carolina, approximately 97% have been altered; < or = 200 bays remain intact, and only 36 are protected by state-funded conservation projects. We conducted a study in two distinct Carolina bay habitats, Savage Bay Heritage Preserve (SBHP) and Woods Bay State Park (WBSP), from June 1997 to July 1998 to determine mosquito temporal distribution, species composition, and the occurrence of arbovirus activity. The largest mosquito collection was obtained at WBSP (n = 31,172) representing 25 species followed by SBHP (n = 3,940) with 24 species. Anopheles crucians complex were the most common species encountered in both bays. Two virus isolates were obtained from SBHP in 1997: Keystone (KEY) virus from Ochlerotatus atlanticus-tormentor and Cache Valley (CV) virus from Oc. canadensis canadensis. Twenty-nine (29) arbovirus-positive pools were obtained from WBSP: 28 in 1997 and one in 1998. KEY virus was isolated from three pools of Oc. atlanticus-tormentor and Tensaw (TEN) virus was isolated from two pools of An. crucians complex; 10 isolates could not be identified with the sera available. Additionally, 14 pools of An. crucians complex tested positive for Eastern equine encephalitis (EEE) virus antigen. These represent the first record of KEY and CV viruses in South Carolina. Our data indicate the presence of high mosquito density and diversity in both Carolina bay habitats, which may be influenced, in part, by seasonal changes in their hydroperiods. The study of mosquito and arbovirus ecology in Carolina Bay habitats could provide more information on the transmission dynamics of arboviruses and its impact on human and animal arboviral disease occurrence in South Carolina.

Intra-arterial therapies for unresectable and chemorefractory colorectal cancer liver metastases: a systematic review and meta-analysis.

PubMed

Levy, Jordan; Zuckerman, Jesse; Garfinkle, Richard; Acuna, Sergio A; Touchette, Jacynthe; Vanounou, Tsafrir; Pelletier, Jean-Sebastien

2018-06-07

A large proportion of patients with colorectal cancer liver metastases (CRCLM) not amenable to curative liver resection will progress on systemic therapy. Intra-arterial therapies (IAT) including conventional transarterial chemoembolization (cTACE), drug eluting beads (DEB-TACE) and yttrium-90 radioembolization (Y-90) are indicated to prolong survival and palliate symptoms. The purpose of this systematic review and meta-analysis is to compare the survival benefit and radiologic response of three intra-arterial therapies in patients with chemorefractory and unresectable CRCLM. A systematic search for eligible references in the Cochrane Library and the EMBASE, MEDLINE and TRIP databases from January 2000 to November 2016 was performed in accordance with PRISMA guidelines. Methodological quality of included studies was assessed using the MINORS scale. One-year overall survival rates and RECIST responder rates were pooled using inverse-variance weighted random-effects models. Overall survival outcomes were collected according to transformed pooled median survivals from first IAT with a subgroup analysis of patients with extrahepatic disease. Twenty-three prospective studies were included and analyzed: 5 cTACE (n = 746), 5 DEB-TACE (n = 222) and 13 Y-90 (n = 615). All but five were clinical trials. Eleven of 13 Y-90 studies were industry funded. Pooled RECIST response rates with 95% confidence intervals (CI) were: cTACE 23% (9.7, 36), DEB-TACE 36% (0, 73) and Y-90 23% (11, 34). The pooled 1-year survival rates with CI were: cTACE, 70% (49, 87), DEB-TACE, 80% (74, 86) and Y-90, 41% (28, 54). Transformed pooled median survivals from first IAT and ranges for cTACE, DEB-TACE and Y-90 were 16 months (9.0-23), 16 months (7.3-25) and 12 months (7.0-15), respectively. Significant heterogeneity in inclusion criteria and reporting of confounders, including previous therapy, tumor burden and post-IAT therapy, precluded statistical comparisons between the three therapies. Methodological and statistical heterogeneity precluded consensus on the optimal treatment strategy. Given the common use and significant cost of radioembolization in this setting, a more robust prospective comparative trial is warranted. Copyright © 2018 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

Restructuring Primary Health Care Markets in New Zealand: from Welfare Benefits to Insurance Markets

PubMed Central

Howell, Bronwyn

2005-01-01

Background New Zealand's Primary Health Care Strategy (NZPHCS) was introduced in 2002. Its features are substantial increases in government funding delivered as capitation payments, and newly-created service-purchasing agencies. The objectives are to reduce health disparities and to improve health outcomes. Analysis The NZPHCS changes New Zealand's publicly-funded primary health care payments from targeted welfare benefits to universal, risk-rated insurance premium subsidies. Patient contributions change from fee-for-service top-ups to insurance premium top-ups, and are collected by service providers who, depending upon their contracts with purchasers, may also be either insurance agents or risk-bearing insurance companies. The change invokes the tensions associated with allocating risk-bearing amongst providers, patients and insurance companies that accompany all insurance-based funding instruments. These include increases in existing incentives for over-consumption and new incentives for insurers to limit their exposure to variations in patient health states by engaging in active patient pool selection. The New Zealand scheme is complex, but closely resembles United States insurance-based, risk-rated managed care schemes. The key difference is that unlike classic managed care models, where provider remuneration is determined by the insurer, the historic right for general practitioners to autonomously set patient charges alters the fiscal incentives normally available to managed care organisations. Consequently, the insurance role is being devolved to individual service providers with very small patient pools, who must recoup the premium top-ups from insured individuals. Premium top-ups are being collected only from those individuals consuming care, in proportion to the number of times care is sought. Co-payments thus constitute perfectly risk-rated premium levies set by inefficiently small insurers, raising questions about the efficiency and equity of a 'universal' insurance system pooling total population demands and costs. The efficacy of using financial incentives to constrain costs and encourage innovation when providers retain the right to arbitrarily recoup costs directly from patients, is also questioned. Results Initial evidence suggests that total costs are higher than initially expected, and prices to some patients have risen substantially under the NZPHCS. Limited competition and NZPHCS governance requirements mean current institutional arrangements are unlikely to facilitate efficiency improvements. System design changes therefore appear indicated. PMID:16144544

Small-Island Perceptions of Scholarships: Perspectives from Jamaica

NASA Astrophysics Data System (ADS)

Hyman, T. A.

2017-12-01

The Caribbean has the lowest tertiary enrolment in the Western Hemisphere. This figure currently stands at 10% of the population, instead of a desired 30%. [1] Jamaica specifically, has seen a decline in tertiary education enrolment at major institutions such as the University of Technology, Northern Caribbean University, with the only exception being the University of the West Indies showing a marginal increase of 3.6% in 2016. The inability to cover the cost of tertiary education by citizens is a deterrent - despite government subsidies of up to 80%. Scholarship resources exist in Jamaica, but the challenge is the small number of scholarships granted, in proportion to a large applicant pool. Consequently, only the highest performing students are selected at the expense of other higher performing students. Interestingly though, scholarship resources exist internationally for tertiary studies. In the United States for example, US$100 million funds go unclaimed each year due to a lack of awareness. The European Union (EU) will also invest 80 million Euros in research and innovation from 2014 to 2020, with these funds air marked for partnerships between the EU and the rest of the world. The overall aim of this research is to assess the awareness of Jamaicans ages 17 to 45 years, in terms of their knowledge of these international funds, their perceptions of scholarships as a source of tertiary education financing, and preferences for physical locations of study. [1] UWI Professor Archibald McDonald

Where will the money come from? Alternative mechanisms to HIV donor funding.

PubMed

Katz, Itamar; Routh, Subrata; Bitran, Ricardo; Hulme, Alexandra; Avila, Carlos

2014-09-16

Donor funding for HIV programs has flattened out in recent years, which limits the ability of HIV programs worldwide to achieve universal access and sustain current progress. This study examines alternative mechanisms for resource mobilization. Potential non-donor funding sources for national HIV responses in low- and middle-income countries were explored through literature review and Global Fund documentation, including data from 17 countries. We identified the source, financing agent, magnitude of resources, frequency of availability, as well as enabling and risk factors. Four non-donor funding sources for HIV programs were identified: earmarked levy for HIV from country budgets; risk-pooling schemes such as health insurance; debt conversion, in which the creditor country reduces the debt of the debtor country and allocates at least a part of that reduction to health; and concessionary loans from international development banks, which unlike grants, must be repaid. The first two are recurring sources of funding, while the latter two are usually one-time sources, and, if very large, might negatively affect the debtor country's economy. Insurance schemes in five African countries covered less than 6.1% of the HIV expenditure, while social health insurance in four Latin American countries covered 8-11% of the HIV expenditure; in Colombia and Chile, it covered 69% and 60%, respectively. Most low-income countries will find concessionary loans hard to repay, as their HIV programs cost 0.5-4% of GDP. Even in a middle-income country like India, a US$255 million concessionary loan to be repaid over 25 years provided only 7.8% of a 5-year HIV budget. Earmarked levies provided only 15% of the annual HIV funding needs in Zimbabwe and Kenya. Debt conversion provided the same share in Indonesia, but in Pakistan it was much higher - the equivalent of 45% of the annual cost of the national HIV program. Domestic sources of funding are important alternatives to consider and might be able to replace donor HIV funding in specific country contexts, coupled with effective prioritization and efficiency measures. Successful resource mobilization design and implementation require close collaboration with other sectors, particularly with the Ministry of Finance, to make sure that the new financing mechanism is fully synchronized with economic growth and that HIV investments yield returns in the form of higher social benefits.

Regional and temporal trends in malaria commodity costs: an analysis of Global Fund data for 79 countries.

PubMed

Wafula, Francis; Agweyu, Ambrose; Macintyre, Kate

2013-12-30

Although procurement consumes nearly 40% of Global Fund's money, no analyses have been published to show how costs vary across regions and time. This paper presents an analysis of malaria-related commodity procurement data from 79 countries, as reported through the Global Fund's price and quality reporting (PQR) system for the 2005-2012 period. Data were analysed for the three most widely procured commodities for prevention, diagnosis and treatment of malaria. These were long-lasting insecticide-treated nets (LLINs), malaria rapid diagnostic tests (RDTs) and the artemether/lumefantrine (AL) combination treatment. Costs were compared across time (2005-2012), regions, and between individual procurement reported through the PQR and pooled procurement reported through the Global Fund's voluntary pooled procurement (VPP) system. All costs were adjusted for inflation and reported in US dollars. The data included 1,514 entries reported from 79 countries over seven years. Of these, 492 entries were for LLINs, 330 for RDTs and 692 for AL. Considerable variations were seen by commodity, although none showed an increase in cost. The costs for LLINs, RDTs and AL all dropped significantly over the period of analysis. Regional variations were also seen, with the cost for all three commodities showing significant variations. The median cost for a single LLIN ranged from USD 4.3 in East Asia to USD 5.0 in West and Central Africa. The cost of a single RDT was lowest in West and Central Africa at US$ 0.57, and highest in the Latin American region at US$ 1.1. AL had the narrowest margin of between US$ 0.06 per tablet in sub-Saharan Africa and South Asia, and US$ 0.08 in the Latin American and Eastern Europe regions. This paper concludes that global procurement costs do vary by region and have reduced overall over time. This suggests a mature market is operating when viewed from the global level, but regional variation needs further attention. Such analyses should be done more often to identify and correct market insufficiencies.

What strategy should France implement for H2020?

PubMed

Dhainaut, Jean-François; Diebolt, Vincent; Pouletty-Lefèbvre, Brigitte; Baker, Angela; Bassompierre, François; Borel, Thomas; Braunstein, David; Demotes, Jacques; François, Bruno; Huet, Stéphane; Micallef, Joëlle; Misse, Christophe; Molon, Annamaria; Rascol, Olivier; Ravoire, Sophie; Schwartz, Bertrand; Donne, Nathalie; Donne, Nathalie; Fusaï, Guillaume; Pouletty, Philippe; Vicaut, Eric

2015-01-01

The initiation of Horizon 2020--the European Union's 8th Framework Programme for Research and Innovation, allotted a budget of 79 billion euros--provides an opportunity to review France's participation in previous Framework Programmes. Indeed, French participation does not match either its scientific importance or its financial investment. While France contributed 16.5 to 17% of the EU's 7th Framework Programme research budget, its return through the funding of coordinated projects in which French teams are participating stands at around 12.5 to 13%, a shortfall of 600 million euros. Although the situation depends on the type of activity, French participation in clinical research appears to be smaller than that of its neighbours, with fewer responses to European calls for proposals. While France has many assets, which include the assured funding of clinical research, structured thematic networks and the initiation of major national programmes, it suffers from the dilution of resources due to France's regional development policy, the lack of multidisciplinarity and the ignorance of both the medical and scientific community and the institutions to which they belong as to how Horizon 2020 actually works. We propose three types of strategy to encourage proposals for coordinated clinical research projects or projects involving French teams, and to help in the drawing up of applications: Broaden the vision of our children, students and colleagues, helping them to adapt to the globalisation of knowledge throughout their educational and professional lives. Recognise the value of European actions to influence the European landscape and change mentalities. Help and support project initiators by pooling skills within a limited number of expert centres designed to assist them in their funding application. • Broaden the vision of our children, students and colleagues, helping them to adapt to the globalisation of knowledge throughout their educational and professional lives. • Recognise the value of European actions to influence the European landscape and change mentalities. • Help and support project initiators by pooling skills within a limited number of expert centres designed to assist them in their funding application. © 2015 Société Française de Pharmacologie et de Thérapeutique.

Pooling public and private funds in the patient's interest: the case for long-term care insurance.

PubMed

Launois, R

1996-09-01

Although the extent of medical care in France may be thought adequate, the same does not apply to the social medicine sector. The Assurance-maladie paid 87.7% of hospital health expenditure in 1994, whereas direct funding of home assistance amounted to only 9%. In contrast, a recent Legos study (Bungener M. et al. Le bilan économique et financier du secteur médico social, Université de Paris IX, Legos, Janvier 1994) [1] estimated that home assistance costs represent 41-50% of medical-social expenditure. When people are unable to manage because of the high costs of their invalidity, the social security system comes to their assistance, although only under Draconian conditions involving compulsory "family support commitments" and the state's claim on the inheritance of the beneficiary (total costs for hospital admission and boarding and the dual limits of 1000F liabilities and 250,000F net assets for home assistance). The elderly well appreciate the severity of this problem and are deeply distressed by the thought of dependency. Many, however, live under the illusion that the social security system or, to a lesser extent, the mutual funds will come to their assistance, although the problems involved lie partly outside their remits. We therefore need to design new systems to allow the elderly to finance their costs should they become dependant.

Methow River Studies, Washington: abundance estimates from Beaver Creek and the Chewuch River screw trap, methodology testing in the Whitefish Island side channel, and survival and detection estimates from hatchery fish releases, 2013

USGS Publications Warehouse

Martens, Kyle D.; Fish, Teresa M.; Watson, Grace A.; Connolly, Patrick J.

2014-01-01

Salmon and steelhead populations have been severely depleted in the Columbia River from factors such as the presence of tributary dams, unscreened irrigation diversions, and habitat degradation from logging, mining, grazing, and others (Raymond, 1988). The U.S. Geological Survey (USGS) has been funded by the Bureau of Reclamation (Reclamation) to provide evaluation of on-going Reclamation funded efforts to recover Endangered Species Act (ESA) listed anadromous salmonid populations in the Methow River watershed, a watershed of the Columbia River in the Upper Columbia River Basin, in north-central Washington State (fig. 1). This monitoring and evaluation program was funded to document Reclamation’s effort to partially fulfill the 2008 Federal Columbia River Power System Biological Opinion (BiOp) (National Oceanographic and Atmospheric Administration, Fisheries Division 2003). This Biological Opinion includes Reasonable and Prudent Alternatives (RPA) to protect listed salmon and steelhead across their life cycle. Species of concern in the Methow River include Upper Columbia River (UCR) spring Chinook salmon (Oncorhynchus tshawytscha), UCR summer steelhead (O. mykiss), and bull trout (Salvelinus confluentus), which are all listed as threatened or endangered under the ESA. The work done by the USGS since 2004 has encompassed three phases of work. The first phase started in 2004 and continued through 2012. This first phase involved the evaluation of stream colonization and fish production in Beaver Creek following the modification of several water diversions (2000–2006) that were acting as barriers to upstream fish movement. Products to date from this work include: Ruttenburg (2007), Connolly and others (2008), Martens and Connolly (2008), Connolly (2010), Connolly and others (2010), Martens and Connolly (2010), Benjamin and others (2012), Romine and others (2013a), Weigel and others (2013a, 2013b, 2013c), and Martens and others (2014). The second phase, initiated in 2008, focuses on the evaluation of the M2 reach (rkm 66– 80) of the mainstem Methow River prior to restoration actions planned by Reclamation and Yakama Nation. The M2 study was designed to help understand the inter-relationships between stream habitat and the life history of various fish species to explain potential success or limitations in response to restoration actions. To help document changes derived by restoration, two reference reaches (Upper Methow between rkm 85 and 90, and Chewuch River between rkm 4 and 11) were identified based on relative lack of disturbance, proximity to the restoration reach, and relative unconfined geomorphology. A control reach (Lower Methow between rkm 57 and 64, also referred to as “Silver Reach”) was 2 identified based on its similar disturbance as the reference reach, proximity to the restoration reach, and relatively unconfined geomorphology. Products to date include Barber and others (2011), Bellmore (2011), Tibbits and others (2012), Bellmore and others (2013), Benjamin and others (2013), Romine and others (2013b), Bellmore and other (2014), Martens and others (2014), and Martens and Connolly (2014). The third phase of work has been to help with the development and to provide data for modeling efforts. Most of the planned M2 reach restoration is focused on the creation or improvement of offchannel habitat, especially side channels. The pre-restoration portion of this study has been documented by Martens and Connolly (2014). Side channel restoration actions were initiated in 2012 (Whitefish Island side channel, also referred to as SC3; rkm 76) and are planned to continue over the next several years. The Whitefish Island side channel was modified to maintain hydrological connection with the mainstem throughout the year. In addition, several log structures were installed and pools were deepened to create fish habitat. Prior to restoration, this side channel would lose hydrological connection with the mainstem Methow River, leaving one large pool near the bottom of the side channel and several shallow isolated pools that may or may not go dry. In seasonally connected side channels, juvenile salmonid survival in pools less than 100 cm average depth was lower than in pools greater than 100 cm average depth (Martens and Connolly, 2014). In this report, we document our field work and analysis completed in 2013. During 2013, USGS sampling efforts were focused on resampling of three reaches in Beaver Creek, testing methodology in the Whitefish Island side channel, conducting hatchery survival estimates, and operating a screw trap on the Chewuch River (funded by Yakama Nation; fig. 1). The Beaver Creek sampling effort was a revisit of three index sites sampled continuously from 2004 to 2007 to look at the fish response to barrier removal. Methodology testing in Whitefish Island side channel was done to determine the best method for evaluating fish populations after restoration efforts in side channels (previous sampling methods were determined to be ineffective after pools were deepened). Hatchery survival estimates were completed to monitor fish survival in the Methow and Columbia Rivers, while the screw trap was operated to estimate migrating fish populations in the Chewuch River and track passive integrated transponder (PIT)-tagged fish. In addition, we maintained a network of PIT-tag interrogation systems (PTIS), assisted Reclamation with fish removal events associated with stream restoration (two people for 9 days; 14 percent of summer field season), and conducted a stream metabolism study designed to help parameterize and calibrate the stream productivity model (Bellmore and others, 2014) with model validation.

Challenges facing the finance reform of the health system in Chile.

PubMed

Herrera, Tania

2014-05-28

Financing is one of the key functions of health systems, which includes the processes of revenue collection, fund pooling and acquisitions in order to ensure access to healthcare for the entire population. The article analyzes the financing model of the Chilean health system in terms of the first two processes, confirming low public spending on healthcare and high out-of-pocket expenditure, in addition to an appropriation of public resources by private insurers and providers. Insofar as pooling, there is lack of solidarity and risk sharing leading to segmentation of the population that is not consistent with the concept of social security, undermines equity and reduces system-wide efficiency. There is a pressing need to jumpstart reforms that address these issues. Treatments must be considered together with public health concerns and primary care in order to ensure the right to health of the entire population.

A resource-sharing model based on a repeated game in fog computing.

PubMed

Sun, Yan; Zhang, Nan

2017-03-01

With the rapid development of cloud computing techniques, the number of users is undergoing exponential growth. It is difficult for traditional data centers to perform many tasks in real time because of the limited bandwidth of resources. The concept of fog computing is proposed to support traditional cloud computing and to provide cloud services. In fog computing, the resource pool is composed of sporadic distributed resources that are more flexible and movable than a traditional data center. In this paper, we propose a fog computing structure and present a crowd-funding algorithm to integrate spare resources in the network. Furthermore, to encourage more resource owners to share their resources with the resource pool and to supervise the resource supporters as they actively perform their tasks, we propose an incentive mechanism in our algorithm. Simulation results show that our proposed incentive mechanism can effectively reduce the SLA violation rate and accelerate the completion of tasks.

Cooling of hot bubbles by surface texture during the boiling crisis

NASA Astrophysics Data System (ADS)

Dhillon, Navdeep; Buongiorno, Jacopo; Varanasi, Kripa

2015-11-01

We report the existence of maxima in critical heat flux (CHF) enhancement for pool boiling on textured hydrophilic surfaces and reveal the interaction mechanism between bubbles and surface texture that governs the boiling crisis phenomenon. Boiling is a process of fundamental importance in many engineering and industrial applications but the maximum heat flux that can be absorbed by the boiling liquid (or CHF) is limited by the boiling crisis. Enhancing the CHF of industrial boilers by surface texturing can lead to substantial energy savings and reduction in greenhouse gas emissions on a global scale. However, the fundamental mechanisms behind this enhancement are not well understood, with some previous studies indicating that CHF should increase monotonically with increasing texture density. However, using pool boiling experiments on a parametrically designed set of plain and nano-textured micropillar surfaces, we show that there is an optimum intermediate texture density that maximizes CHF and further that the length scale of this texture is of fundamental significance. Using imbibition experiments and high-speed optical and infrared imaging, we reveal the fundamental mechanisms governing the CHF enhancement maxima in boiling crisis. We acknowledge funding from the Chevron corporation.

The economic impact of Marfan syndrome: a non-experimental, retrospective, population-based matched cohort study

PubMed Central

2014-01-01

Background Marfan syndrome is a rare disease of the connective tissues, affecting multiple organ systems. Elevated morbidity and mortality in these patients raises the issue of costs for sickness funds and society. To date, there has been no study analysing the costs of Marfan syndrome from a sickness fund and societal perspective. Objective To estimate excess health resource utilisation, direct (non-)medical and indirect costs attributable to Marfan syndrome from a healthcare payer and a societal perspective in Germany in 2008. Methods A retrospective matched cohort study design is applied, using claims data. For isolating the causal effect of Marfan syndrome on excess costs, a genetic matching algorithm was used to reduce differences in observable characteristics between Marfan syndrome patients and the control group. 892 patients diagnosed with Marfan syndrome (ICD-10 Q87.4) were matched from a pool of 26,645 control individuals. After matching, we compared health resource utilisation and costs. Results From the sickness fund perspective, an average Marfan syndrome patient generates excess annual costs of €2496 compared with a control individual. From the societal perspective, excess annual costs amount to €15,728. For the sickness fund, the strongest cost drivers are inpatient treatment and care by non-physicians. From the sickness fund perspective, the third (25–41 years) and first (0–16 years) age quartiles reveal the greatest surplus in total costs. Marfan syndrome patients have 39% more physician contacts, a 153% longer average length of hospital stay, 119% more inpatient stays, 33% more prescriptions, 236% more medical imaging and 20% higher average prescription costs than control individuals. Depending on the prevalence, the economic impact from the sickness fund perspective ranges between €24.0 million and €61.4 million, whereas the societal economic impact extends from €151.3 million to €386.9 million. Conclusions Relative to its low frequency, Marfan syndrome requires high healthcare expenditure. Not only the high costs of Marfan syndrome but also its burden on patients’ lives call for more awareness from policy-makers, physicians and clinical researchers. Consequently, the diagnosis and treatment of Marfan syndrome should begin as soon as possible in order to prevent disease complications, early mortality and substantial healthcare expenditure. PMID:24954169

The economic impact of Marfan syndrome: a non-experimental, retrospective, population-based matched cohort study.

PubMed

Achelrod, Dmitrij; Blankart, Carl Rudolf; Linder, Roland; von Kodolitsch, Yskert; Stargardt, Tom

2014-06-23

Marfan syndrome is a rare disease of the connective tissues, affecting multiple organ systems. Elevated morbidity and mortality in these patients raises the issue of costs for sickness funds and society. To date, there has been no study analysing the costs of Marfan syndrome from a sickness fund and societal perspective. To estimate excess health resource utilisation, direct (non-)medical and indirect costs attributable to Marfan syndrome from a healthcare payer and a societal perspective in Germany in 2008. A retrospective matched cohort study design is applied, using claims data. For isolating the causal effect of Marfan syndrome on excess costs, a genetic matching algorithm was used to reduce differences in observable characteristics between Marfan syndrome patients and the control group. 892 patients diagnosed with Marfan syndrome (ICD-10 Q87.4) were matched from a pool of 26,645 control individuals. After matching, we compared health resource utilisation and costs. From the sickness fund perspective, an average Marfan syndrome patient generates excess annual costs of €2496 compared with a control individual. From the societal perspective, excess annual costs amount to €15,728. For the sickness fund, the strongest cost drivers are inpatient treatment and care by non-physicians. From the sickness fund perspective, the third (25-41 years) and first (0-16 years) age quartiles reveal the greatest surplus in total costs. Marfan syndrome patients have 39% more physician contacts, a 153% longer average length of hospital stay, 119% more inpatient stays, 33% more prescriptions, 236% more medical imaging and 20% higher average prescription costs than control individuals. Depending on the prevalence, the economic impact from the sickness fund perspective ranges between €24.0 million and €61.4 million, whereas the societal economic impact extends from €151.3 million to €386.9 million. Relative to its low frequency, Marfan syndrome requires high healthcare expenditure. Not only the high costs of Marfan syndrome but also its burden on patients' lives call for more awareness from policy-makers, physicians and clinical researchers. Consequently, the diagnosis and treatment of Marfan syndrome should begin as soon as possible in order to prevent disease complications, early mortality and substantial healthcare expenditure.

A National Coordinating Center for Prehospital Trauma Research Funding Transfusion Using Stored Fresh Whole Blood

DTIC Science & Technology

2016-09-01

bank data base 28-30 5% Analyze blood bank data base 28-33 0% Other Major Tasks: Identification of communities in the UCLA catchment area 1-3 N/A...coagulopathy in real-time is underway. The Blood Bank is working to identify a pool of whole blood donors and incorporating the new product (FWB) in...Blood Bank , emergency Room, Trauma, Operating Room, Intensive Care Unit, etc) to coordinate and streamline standard operating procedures for the

Discriminative feature-rich models for syntax-based machine translation.

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

Dixon, Kevin R.

This report describes the campus executive LDRD %E2%80%9CDiscriminative Feature-Rich Models for Syntax-Based Machine Translation,%E2%80%9D which was an effort to foster a better relationship between Sandia and Carnegie Mellon University (CMU). The primary purpose of the LDRD was to fund the research of a promising graduate student at CMU; in this case, Kevin Gimpel was selected from the pool of candidates. This report gives a brief overview of Kevin Gimpel's research.

Getting by on credit: how district health managers in Ghana cope with the untimely release of funds

PubMed Central

Asante, Augustine D; Zwi, Anthony B; Ho, Maria T

2006-01-01

Background District health systems in Africa depend largely on public funding. In many countries, not only are these funds insufficient, but they are also released in an untimely fashion, thereby creating serious cash flow problems for district health managers. This paper examines how the untimely release of public sector health funds in Ghana affects district health activities and the way district managers cope with the situation. Methods A qualitative approach using semi-structured interviews was adopted. Two regions (Northern and Ashanti) covering the northern and southern sectors of Ghana were strategically selected. Sixteen managers (eight directors of health services and eight district health accountants) were interviewed between 2003/2004. Data generated were analysed for themes and patterns. Results The results showed that untimely release of funds disrupts the implementation of health activities and demoralises district health staff. However, based on their prior knowledge of when funds are likely to be released, district health managers adopt a range of informal mechanisms to cope with the situation. These include obtaining supplies on credit, borrowing cash internally, pre-purchasing materials, and conserving part of the fourth quarter donor-pooled funds for the first quarter of the next year. While these informal mechanisms have kept the district health system in Ghana running in the face of persistent delays in funding, some of them are open to abuse and could be a potential source of corruption in the health system. Conclusion Official recognition of some of these informal managerial strategies will contribute to eliminating potential risks of corruption in the Ghanaian health system and also serve as an acknowledgement of the efforts being made by local managers to keep the district health system functioning in the face of budgetary constraints and funding delays. It may boost the confidence of the managers and even enhance service delivery. PMID:16916445

Getting by on credit: how district health managers in Ghana cope with the untimely release of funds.

PubMed

Asante, Augustine D; Zwi, Anthony B; Ho, Maria T

2006-08-17

District health systems in Africa depend largely on public funding. In many countries, not only are these funds insufficient, but they are also released in an untimely fashion, thereby creating serious cash flow problems for district health managers. This paper examines how the untimely release of public sector health funds in Ghana affects district health activities and the way district managers cope with the situation. A qualitative approach using semi-structured interviews was adopted. Two regions (Northern and Ashanti) covering the northern and southern sectors of Ghana were strategically selected. Sixteen managers (eight directors of health services and eight district health accountants) were interviewed between 2003/2004. Data generated were analysed for themes and patterns. The results showed that untimely release of funds disrupts the implementation of health activities and demoralises district health staff. However, based on their prior knowledge of when funds are likely to be released, district health managers adopt a range of informal mechanisms to cope with the situation. These include obtaining supplies on credit, borrowing cash internally, pre-purchasing materials, and conserving part of the fourth quarter donor-pooled funds for the first quarter of the next year. While these informal mechanisms have kept the district health system in Ghana running in the face of persistent delays in funding, some of them are open to abuse and could be a potential source of corruption in the health system. Official recognition of some of these informal managerial strategies will contribute to eliminating potential risks of corruption in the Ghanaian health system and also serve as an acknowledgement of the efforts being made by local managers to keep the district health system functioning in the face of budgetary constraints and funding delays. It may boost the confidence of the managers and even enhance service delivery.

Health insurance for all long-term care workers: estimated costs and coverage impacts in Minnesota and recommendations for States.

PubMed

Wright, Bernadette; Gruman, Cindy; Alecxih, Lisa; Knatterud, Larhae

2012-01-01

A major barrier to building a strong workforce to meet the growing need for long-care is lack of affordable health benefits. This study projects impacts of funding health coverage for all long-term care workers in Minnesota. Under the most cost effective model plan design, enrollment in employer-sponsored coverage would increase 73% to 100% for individual coverage and 26% to 42% for family coverage. Total monthly costs would be $698/worker in the commercial market or $634/worker through a new dedicated risk pool. Based on our findings and past research, the authors present recommendations for structuring and implementing a long-term care worker health insurance initiative.

Medicare Payment Penalties and Safety Net Hospital Profitability: Minimal Impact on These Vulnerable Hospitals.

PubMed

Bazzoli, Gloria J; Thompson, Michael P; Waters, Teresa M

2018-02-08

To examine relationships between penalties assessed by Medicare's Hospital Readmission Reduction Program and Value-Based Purchasing Program and hospital financial condition. Centers for Medicare and Medicaid Services, American Hospital Association, and Area Health Resource File data for 4,824 hospital-year observations. Bivariate and multivariate analysis of pooled cross-sectional data. Safety net hospitals have significantly higher HRRP/VBP penalties, but, unlike nonsafety net hospitals, increases in their penalty rate did not significantly affect their total margins. Safety net hospitals appear to rely on nonpatient care revenues to offset higher penalties for the years studied. While reassuring, these funding streams are volatile and may not be able to compensate for cumulative losses over time. © Health Research and Educational Trust.

The Norrtaelje model: a unique model for integrated health and social care in Sweden.

PubMed

Bäck, Monica Andersson; Calltorp, Johan

2015-01-01

Many countries organise and fund health and social care separately. The Norrtaelje model is a Swedish initiative that transformed the funding and organisation of health and social care in order to better integrate care for older people with complex needs. In Norrtaelje model, this transformation made it possible to bringing the team together, to transfer responsibility to different providers, to use care coordinators, and to develop integrated pathways and plans around transitions in and out of hospital and from nursing homes to hospital. The Norrtaelje model operates in the context of the Swedish commitment to universal coverage and public programmes based on tax-funded resources that are pooled and redistributed to citizens on the basis of need. The experience of Norrtaelje model suggests that one way to promote integration of health and social care is to start with a transformation that aligns these two sectors in terms of high level organisation and funding. This transformation then enables the changes in operations and management that can be translated into changes in care delivery. This "top-down" approach must be in-line with national priorities and policies but ultimately is successful only if the culture, resource allocation and management are changed throughout the local system.

Library Services Funding Assessment

NASA Technical Reports Server (NTRS)

Lorig, Jonathan A.

2004-01-01

The Glenn Technical Library is a science and engineering library that primarily supports research activities at the Glenn Research Center, and provides selected services to researchers at all of the NASA research centers. Resources available in the library include books, journals, CD-ROMs, and access to various online sources, as well as live reference and inter-library loan services. The collection contains over 77,000 books, 800,000 research reports, and print or online access to over 1,400 journals. Currently the library operates within the Logistics and Technical Information Division, and is funded as an open-access resource within the GRC. Some of the research units at the GRC have recently requested that the library convert to a "pay-for-services" model, in which individual research units could fund only those journal subscriptions for which they have a specific need. Under this model, the library would always maintain a certain minimum level of pooled-expense services, including the ready reference and book collections, and inter-library loan services. Theoretically the "pay-for-services" model would encourage efficient financial allocation, and minimize the extent to which paid journal subscriptions go unused. However, this model also could potentially negate the benefits of group purchases for journal subscriptions and access. All of the major journal publishers offer package subscriptions that compare favorably in cost with the sum of individual subscription costs for a similar selection of titles. Furthermore, some of these subscription packages are "consortium" purchases that are funded collectively by the libraries at multiple NASA research centers; such consortia1 memberships would be difficult for the library to pay, if enough GRC research units were to withdraw their pooled contributions. cost of collectively-funded journal access with the cost of individual subscriptions. My primary task this summer is to create the cost dataset framework, and collect as much of the relevant data as possible. Hopefully this dataset will permit the research units at the GRC, and library administration as well, to make informed decisions about future library funding. Prior to the creation of the actual dataset, I established a comprehensive list of the library s print and online journal subscriptions. This list will be useful outside the context of the cost analysis project, as an addition to the library website. The cost analysis dataset s primary fields are: journal name, vendor, publisher, ISSN (International Standard Serial Number, to uniquely identify the titles), stand-alone price, and indication as to the presence of the journal in current GRC Technical Library consortium membership subscriptions. The dataset will hopefully facilitate comparisons between the stand-alone journal prices and the cost of shared journal subscriptions for groups of titles.

Public funding for research on antibacterial resistance in the JPIAMR countries, the European Commission, and related European Union agencies: a systematic observational analysis

PubMed Central

Kelly, Ruth; Zoubiane, Ghada; Walsh, Desmond; Ward, Rebecca; Goossens, Herman

2016-01-01

Summary Background Antibacterial resistant infections are rising continuously, resulting in increased morbidity and mortality worldwide. With no new antibiotic classes entering the market and the possibility of returning to the pre-antibiotic era, the Joint Programming Initiative on Antimicrobial Resistance (JPIAMR) was established to address this problem. We aimed to quantify the scale and scope of publicly funded antibacterial resistance research across JPIAMR countries and at the European Union (EU) level to identify gaps and future opportunities. Methods We did a systematic observational analysis examining antibacterial resistance research funding. Databases of funding organisations across 19 countries and at EU level were systematically searched for publicly funded antibacterial resistance research from Jan 1, 2007, to Dec 31, 2013. We categorised studies on the basis of the JPIAMR strategic research agenda's six priority topics (therapeutics, diagnostics, surveillance, transmission, environment, and interventions) and did an observational analysis. Only research funded by public funding bodies was collected and no private organisations were contacted for their investments. Projects in basic, applied, and clinical research, including epidemiological, public health, and veterinary research and trials were identified using keyword searches by organisations, and inclusion criteria were based on the JPIAMR strategic research agenda's six priority topics, using project titles and abstracts as filters. Findings We identified 1243 antibacterial resistance research projects, with a total public investment of €1·3 billion across 19 countries and at EU level, including public investment in the Innovative Medicines Initiative. Of the total amount invested in antibacterial resistance research across the time period, €646·6 million (49·5%) was invested at the national level and €659·2 million (50·5%) at the EU level. When projects were classified under the six priority topics we found that 763 (63%) of 1208 projects funded at national level were within the area of therapeutics, versus 185 (15%) in transmission, 131 (11%) in diagnostics, 53 (4%) in interventions, and only 37 (3%) in environment and 39 (3%) in surveillance. Interpretation This was the first systematic analysis of research funding of antibacterial resistance of this scale and scope, which relied on the availability and accuracy of data from organisations included. Large variation was seen between countries both in terms of number of projects and associated investment and across the six priority topics. To determine the future direction of JPIAMR countries a clear picture of the funding landscape across Europe and Canada is needed. Countries should work together to increase the effect of research funding by strengthening national and international coordination and collaborations, harmonising research activities, and collectively pooling resources to fund multidisciplinary projects. The JPIAMR have developed a publicly available database to document the antibacterial resistance research collected and can be used as a baseline to analyse funding from 2014 onwards. Funding JPIAMR and the European Commission. PMID:26708524

Health financing and integration of urban and rural residents' basic medical insurance systems in China.

PubMed

Zhu, Kun; Zhang, Luying; Yuan, Shasha; Zhang, Xiaojuan; Zhang, Zhiruo

2017-11-07

China is in the process of integrating the new cooperative medical scheme (NCMS) and the urban residents' basic medical insurance system (URBMI) into the urban and rural residents' basic medical insurance system (URRBMI). However, how to integrate the financing policies of NCMS and URBMI has not been described in detail. This paper attempts to illustrate the differences between the financing mechanisms of NCMS and URBMI, to analyze financing inequity between urban and rural residents and to identify financing mechanisms for integrating urban and rural residents' medical insurance systems. Financing data for NCMS and URBMI (from 2008 to 2015) was collected from the China health statistics yearbook, the China health and family planning statistics yearbook, the National Handbook of NCMS Information, the China human resources and social security statistics yearbook, and the China social security yearbook. "Ability to pay" was introduced to measure inequity in health financing. Individual contributions to NCMS and URBMI as a function of per capita disposable income was used to analyze equity in health financing between rural and urban residents. URBMI had a financing mechanism that was similar to that used by NCMS in that public finance accounted for more than three quarters of the pooling funds. The scale of financing for NCMS was less than 5% of the per capita net income of rural residents and less than 2% of the per capita disposable income of urban residents for URBMI. Individual contributions to the NCMS and URBMI funds were less than 1% of their disposable and net incomes. Inequity in health financing between urban and rural residents in China was not improved as expected with the introduction of NCMS and URBMI. The role of the central government and local governments in financing NCMS and URBMI was oscillating in the past decade. The scale of financing for URRBMI is insufficient for the increasing demands for medical services from the insured. The pooling fund should be increased so that it can better adjust to China's rapidly aging population and epidemiological transitions as well as protect the insured from poverty due to illness. Individual contributions to the URBMI and NCMS funds were small in terms of contributors' incomes. The role of the central government and local governments in financing URRBMI was not clearly identified. Individual contributions to the URRBMI fund should be increased to ensure the sustainable development of URRBMI. Compulsory enrollment should be required so that URRBMI improves the social medical insurance system in China.

Incidence and prevalence of patellofemoral pain: A systematic review and meta-analysis

PubMed Central

Selfe, James; Thacker, Damian; Hendrick, Paul; Bateman, Marcus; Moffatt, Fiona; Rathleff, Michael Skovdal; Smith, Toby O.; Logan, Pip

2018-01-01

Background Patellofemoral pain is considered one of the most common forms of knee pain, affecting adults, adolescents, and physically active populations. Inconsistencies in reported incidence and prevalence exist and in relation to the allocation of healthcare and research funding, there is a clear need to accurately understand the epidemiology of patellofemoral pain. Methods An electronic database search was conducted, as well as grey literature databases, from inception to June 2017. Two authors independently selected studies, extracted data and appraised methodological quality. If heterogeneous, data were analysed descriptively. Where studies were homogeneous, data were pooled through a meta-analysis. Results 23 studies were included. Annual prevalence for patellofemoral pain in the general population was reported as 22.7%, and adolescents as 28.9%. Incidence rates in military recruits ranged from 9.7–571.4/1,000 person-years, amateur runners in the general population at 1080.5/1,000 person-years and adolescents amateur athletes 5.1%–14.9% over 1 season. One study reported point prevalence within military populations as 13.5%. The pooled estimate for point prevalence in adolescents was 7.2% (95% Confidence Interval: 6.3%–8.3%), and in female only adolescent athletes was 22.7% (95% Confidence Interval 17.4%–28.0%). Conclusion This review demonstrates high incidence and prevalence levels for patellofemoral pain. Within the context of this, and poor long term prognosis and high disability levels, PFP should be an urgent research priority. PROSPERO registration CRD42016038870 PMID:29324820

Killer whale caller localization using a hydrophone array in an oceanarium pool

NASA Astrophysics Data System (ADS)

Bowles, Ann E.; Greenlaw, Charles F.; McGehee, Duncan E.; van Holliday, D.

2004-05-01

A system to localize calling killer whales was designed around a ten-hydrophone array in a pool at SeaWorld San Diego. The array consisted of nine ITC 8212 and one ITC 6050H hydrophones mounted in recessed 30×30 cm2 niches. Eight of the hydrophones were connected to a Compaq Armada E500 laptop computer through a National Instruments DAQ 6024E PCMCIA A/D data acquisition card and a BNC-2120 signal conditioner. The system was calibrated with a 139-dB, 4.5-kHz pinger. Acoustic data were collected during four 48-72 h recording sessions, simultaneously with video recorded from a four-camera array. Calling whales were localized by one of two methods, (1) at the hydrophone reporting the highest sound exposure level and (2) using custom-designed 3-D localization software based on time-of-arrival (ORCA). Complex reverberations in the niches and pool made locations based on time of arrival difficult to collect. Based on preliminary analysis of data from four sessions (400+ calls/session), the hydrophone reporting the highest level reliably attributed callers 51%-100% of the time. This represents a substantial improvement over attribution rates of 5%-15% obtained with single hydrophone recordings. [Funding provided by Hubbs-SeaWorld Research Institute and the Hubbs Society.

The Type 1 Homodimeric Reaction Center in Heliobacterium modesticaldum

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

Golbeck, John

In this funding period, we (i) found that strong illumination of Heliobacterium modesticaldum cells results in saturation of the electron acceptor pool, leading to reduction of the acceptor side and the creation of a back-reacting state that gives rise to delayed fluorescence; (ii) noted that when the FX cluster is reduced in purified reaction centers, no electron transfer occurs beyond A0, even though a quinone is present; (iii) observed by photochemically induced dynamic nuclear polarization (photo-CIDNP) studies of whole cells of Heliobacterium mobilis that primary charge separation is retained even after conversion of the majority of BChl g to Chlmore » aF. ; and (iv) purified a homogeneous preparation of reaction center cores, which led to promising crystallization trials to obtain a three-dimensional structure.« less

A Centralized Auction Mechanism for the Disability and Survivors Insurance in Chile

NASA Astrophysics Data System (ADS)

Reyes H., Gonzalo

As part of the pension reform recently approved in Chile, the government introduced a centralized auction mechanism to provide the Disability and Survivors (D&S) Insurance that covers recent contributors among the more than 8 million participants in the mandatory private pension system. This paper is intended as a case study presenting the main distortions found in the decentralized operation of the system that led to this reform and the challenges faced when designing a competitive auction mechanism to be implemented jointly by the Pension Fund Managers (AFP). In a typical bilateral contract the AFP retained much of the risk and the Insurance Company acted in practice as a reinsurer. The process to hire this contract was not competitive and colligated companies ended up providing the service. Several distortions affected competition in the market through incentives to cream-skim members by AFPs (since they bear most of the risk) or efforts to block disability claims. Since the price of this insurance is hidden in the fees charged by AFPs for the administration of individual accounts and pension funds there was lack of price transparency. Since new AFPs have no history of members’ disability and mortality profile the insurance contract acted as a barrier to entry in the market of AFP services, especially when D&S insurance costs reached 50% of total costs. Cross-subsidies between members of the same AFP, inefficient risk pooling (due to pooling occurring at the AFP rather than at the system level) and regulatory arbitrage, since AFPs provided insurance not being regulated as an insurance company, were also present. A centralized auction mechanism solves these market failures, but also gives raise to new challenges, such as how to design a competitive auction that attracts participation and deters collusion. Design features that were incorporated in the regulation to tackle these issues, such as dividing coverage into predefined percentage blocks, are presented here.

Analysis of the ‘reformpool’-activity in Austria: is the challenge met?

PubMed Central

Czypionka, Thomas; Röhrling, Gerald

2009-01-01

Aim The purpose of our study is to analyse the activities initiated by the foundation of the reformpools on the regional level. We wanted to see not only what projects have emerged from these funds, but also how the incentives of this special way of funding influence the activity and what overall impact can be expected on health services delivery in the future. Context In Austria, all expenses in the outpatient sector are borne by the statutory health insurance. But in the inpatient sector, SHI just co-finances about 45% of all costs incurred by patients, with the rest contributed by the federal, regional and municipal level. This, however, leads to a number of problems in today's epidemiological situation with patients in need of many different interventions in the course of their chronic disease. Originally with the aim of finding solutions to these interface problems between inpatient and outpatient care, the healthcare reform 2005 instated the instrument of the reformpool. The reformpool unites funds from social health insurance and regions to finance projects that develop new ways of health services delivery across the sectors. In the course of recent reforms, it became explicitly possible to sponsor projects of integrated care, which had de facto already been the case before. Theory The reform pool has various disincentives or wrong incentives compared to e.g. the German ‘Anschubfinanzierung’ for IC-contracts, which was probably a role-model for the Austrian reformpool, because of the underlying differences in the healthcare system and the distinct differences in the regulation. For example, the ‘Anschubfinanzierung’ in Germany withdraws money from the available funds for contract physicians to finance IC-projects, whereas in Austria, their fees are fixed. So in Austria, there is no incentive to retrieve money by participating in such projects. For the stakeholders supplying the pool, mainly the sickness funds and the regions, many projects inflict additional costs on the one or on the other in the future. So as both parties have to agree on projects, there is a strong basic disincentive to grant funds in the present. If a project is in both their interest because it is reducing costs, the care providers might not be interested to participate, as this would diminish their revenues in the future. What is more, the federal control over the (region-based) funds and projects is poor, which might lead to duplication of efforts and missing scale-efficiency in some regions. Methods and data For our analysis, we conducted a survey with a standardised questionnaire sent to the management of the regional health funds, which are responsible for the reformpool funds. The questionnaire was checked by experts of the federal association of social security institutions. We also conducted an on-site visit of the reformpool-manager, a programme which can be used to evaluate the reformpool-projects. In addition, we used all available evaluation reports of projects to assess the situation of evaluation of the projects. Furthermore, we used financial data from the regional health funds, the federal association of social security institutions, from the ministry of health and the regional health funds to assess the usage of the reformpool. (Preliminary) Results The qualitative results are mixed. Some projects are promising with regard to improvements of the current situation and are well evaluated. Many projects neglect the requirement of the reformpool to be such as to yield a monetary benefit for the system but only focus on improving service delivery. Some evaluations are not well operationalised and thus, arguments why these projects should be transformed to ordinarily financed services will be lacking. The reformpool activity set on very slowly, with only one project already started in 2005, the first possible year. In 2007 we see the highest number (23) of new projects granted and the highest monetary volume, €11 Mio total for 21 of them 1, with activity subsiding in 2008 (6 projects with a volume of € 2.5 Mio total for 5 of them 1) and most certainly in 2009 (with diminishing tax revenues and health insurance contributions) with only one project granted in the first quarter of the year. Of all funds (theoretically) available, only about 16% have been put to use in a reformpool project per year, with high variation (e.g. in the region of Styria over 30%, in Tyrol only 1.5%). (Preliminary) Conclusions From our study we can tell that the instrument of reformpool was not devised well concerning its incentive structure, and the interest to conduct such projects is diminishing. Stricter control of the requirements by the federal level, more pronounced requirements, a dedication of the funds to projects instead of a virtual budget and more cooperation between regions could improve the effectiveness of the instrument. Conflicts of interest: The project was funded by the federal association of social security institutions. All authors are researchers at the IHS and hold no commercial interests in the subject. Additional information: Founded by the economist Oskar Morgenstern and the sociologist Paul Lazarsfeld, the IHS (Institute for Advanced Studies) is a non-profit post-graduate teaching and research facility in the fields of economics, sociology and politology, and one of the two Austrian institutes preparing the official economic forecast for Austria. For more than a decade, it has been one of the major research facilities in the fields of health economics and health policy in Austria.

Peginesatide in patients with anemia undergoing hemodialysis.

PubMed

Fishbane, Steven; Schiller, Brigitte; Locatelli, Francesco; Covic, Adrian C; Provenzano, Robert; Wiecek, Andrzej; Levin, Nathan W; Kaplan, Mark; Macdougall, Iain C; Francisco, Carol; Mayo, Martha R; Polu, Krishna R; Duliege, Anne-Marie; Besarab, Anatole

2013-01-24

Peginesatide, a synthetic peptide-based erythropoiesis-stimulating agent (ESA), is a potential therapy for anemia in patients with advanced chronic kidney disease. We conducted two randomized, controlled, open-label studies (EMERALD 1 and EMERALD 2) involving patients undergoing hemodialysis. Cardiovascular safety was evaluated by analysis of an adjudicated composite safety end point--death from any cause, stroke, myocardial infarction, or serious adverse events of congestive heart failure, unstable angina, or arrhythmia--with the use of pooled data from the two EMERALD studies and two studies involving patients not undergoing dialysis. In the EMERALD studies, 1608 patients received peginesatide once monthly or continued to receive epoetin one to three times a week, with the doses adjusted as necessary to maintain a hemoglobin level between 10.0 and 12.0 g per deciliter for 52 weeks or more. The primary efficacy end point was the mean change from the baseline hemoglobin level to the mean level during the evaluation period; noninferiority was established if the lower limit of the two-sided 95% confidence interval was -1.0 g per deciliter or higher in the comparison of peginesatide with epoetin. The aim of evaluating the composite safety end point in the pooled cohort was to exclude a hazard ratio with peginesatide relative to the comparator ESA of more than 1.3. In an analysis involving 693 patients from EMERALD 1 and 725 from EMERALD 2, peginesatide was noninferior to epoetin in maintaining hemoglobin levels (mean between-group difference, -0.15 g per deciliter; 95% confidence interval [CI], -0.30 to -0.01 in EMERALD 1; and 0.10 g per deciliter; 95% CI, -0.05 to 0.26 in EMERALD 2). The hazard ratio for the composite safety end point was 1.06 (95% CI, 0.89 to 1.26) with peginesatide relative to the comparator ESA in the four pooled studies (2591 patients) and 0.95 (95% CI, 0.77 to 1.17) in the EMERALD studies. The proportions of patients with adverse and serious adverse events were similar in the treatment groups in the EMERALD studies. The cardiovascular safety of peginesatide was similar to that of the comparator ESA in the pooled cohort. Peginesatide, administered monthly, was as effective as epoetin, administered one to three times per week, in maintaining hemoglobin levels in patients undergoing hemodialysis. (Funded by Affymax and Takeda Pharmaceutical; ClinicalTrials.gov numbers, NCT00597753 [EMERALD 1], NCT00597584 [EMERALD 2], NCT00598273 [PEARL 1], and NCT00598442 [PEARL 2].).

Research Project for Increasing the Pool of Minority Engineers

NASA Technical Reports Server (NTRS)

Gott, Susan F. (Technical Monitor); Rogers, Decatur B.

2003-01-01

The NASA Glenn Research Center (GRC) funded the 2001-2002 Tennessee State University (TSU) Research Project for increasing the pool of minority engineers. The NASA GRC/TSU Research Project is designed to develop a cadre of SMET professionals who have academic and research expertise in technical areas of interest to NASA, in addition to having some familiarity with the mission of the NASA Glenn Research Center. The goal of increasing minority participation in SMET disciplines was accomplished by: (1) introducing and exposing 96 minority youth to Science, Math, Engineering, and Technology (SMET) careers and to the required high school preparation necessary to make high school graduation, college attendance and engineering careers a reality through the campus based pre-college SMET program: Minority Introduction to Engineering (MITE); (2) by providing financial support through scholarships for four (4) TSU engineering students to NASA; (3) familiarization with the SMET profession and with NASA through summer internships at NASA GRC for two TSU NASA Glenn Research Scholars; and experiences through research internships at NASA GRC.

Tennessee State University (TSU) Research Project For Increasing The Pool of Minority Engineers

NASA Technical Reports Server (NTRS)

Rogers, Decatur B.; Merritt, Sylvia (Technical Monitor)

2000-01-01

The NASA Glenn Research Center funded the 1998-1999 Tennessee State University (TSU) Research Project for Increasing the Pool of Minority Engineers. The NASA/GRC-TSU Research Project developed a cadre of engineers who have academic and research expertise in technical areas of interest to NASA, in addition to having some familiarity with the mission of the NASA/Glenn Research Center. Increased minority participation in engineering was accomplished by: (1) introducing and exposing minority youth to engineering careers and to the required high school preparation necessary to access engineering through two campus based precollege programs: Minority Introduction to Engineering (MITE), and Engineering and Technology Previews; (2) providing financial support through the Research Scholars Program for minority youth majoring in engineering disciplines of interest to NASA; (3) familiarization with the engineering profession and with NASA through field trips and summer internships at the Space and Rocket Center, and (4) with practical research exposure and experiences through research internships at NASA/GRC and at TSU.

How the World Trade Organisation is shaping domestic policies in health care.

PubMed

Price, D; Pollock, A M; Shaoul, J

1999-11-27

High up on the agenda of the World Trade Organisation (WTO) is the privatisation of education, health, welfare, social housing and transport. The WTO's aim is to extend the free market in the provision of traditional public services. Governments in Europe and the US link the expansion of trade in public services to economic success, and with the backing of powerful medico-pharmaceutical, insurance, and service corporations, the race is on to capture the share of gross domestic product that governments currently spend on public services. They will open domestic European services and domestic markets to global competition by government procurement agreements, dispute-settlement procedures, and the investment rules of global financial institutions. The UK has already set up the necessary mechanisms: the introduction of private-sector accounting rules to public services; the funding of public-sector investment via private-public partnerships or the private finance initiative; and the change to capitation funding streams, which allows the substitution of private for public funds and services. We explain the implications of these changes for European public-health-care systems and the threat they pose to universal coverage, solidarity through risk-pooling, equity, comprehensive care, and democratic accountability.

Research Challenges and Opportunities for Clinically Oriented Academic Radiology Departments.

PubMed

Decker, Summer J; Grajo, Joseph R; Hazelton, Todd R; Hoang, Kimberly N; McDonald, Jennifer S; Otero, Hansel J; Patel, Midhir J; Prober, Allen S; Retrouvey, Michele; Rosenkrantz, Andrew B; Roth, Christopher G; Ward, Robert J

2016-01-01

Between 2004 and 2012, US funding for the biomedical sciences decreased to historic lows. Health-related research was crippled by receiving only 1/20th of overall federal scientific funding. Despite the current funding climate, there is increased pressure on academic radiology programs to establish productive research programs. Whereas larger programs have resources that can be utilized at their institutions, small to medium-sized programs often struggle with lack of infrastructure and support. To address these concerns, the Association of University Radiologists' Radiology Research Alliance developed a task force to explore any untapped research productivity potential in these smaller radiology departments. We conducted an online survey of faculty at smaller clinically funded programs and found that while they were interested in doing research and felt it was important to the success of the field, barriers such as lack of resources and time were proving difficult to overcome. One potential solution proposed by this task force is a collaborative structured research model in which multiple participants from multiple institutions come together in well-defined roles that allow for an equitable distribution of research tasks and pooling of resources and expertise. Under this model, smaller programs will have an opportunity to share their unique perspective on how to address research topics and make a measureable impact on the field of radiology as a whole. Through a health services focus, projects are more likely to succeed in the context of limited funding and infrastructure while simultaneously providing value to the field. Copyright © 2016 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

Factors that affect the uptake of community-based health insurance in low-income and middle-income countries: a systematic protocol

PubMed Central

Adebayo, Esther F; Ataguba, John E; Uthman, Olalekan A; Okwundu, Charles I; Lamont, Kim T; Wiysonge, Charles S

2014-01-01

Introduction Many people residing in low-income and middle-income countries (LMICs) are regularly exposed to catastrophic healthcare expenditure. It is therefore pertinent that LMICs should finance their health systems in ways that ensure that their citizens can use needed healthcare services and are protected from potential impoverishment arising from having to pay for services. Ways of financing health systems include government funding, health insurance schemes and out-of-pocket payment. A health insurance scheme refers to pooling of prepaid funds in a way that allows for risks to be shared. The health insurance scheme particularly suitable for the rural poor and the informal sector in LMICs is community-based health insurance (CBHI), that is, insurance schemes operated by organisations other than governments or private for-profit companies. We plan to search for and summarise currently available evidence on factors associated with the uptake of CBHI, as we are not aware of previous systematic reviews that have looked at this important topic. Methods This is a protocol for a systematic review of the literature. We will include both quantitative and qualitative studies in this review. Eligible quantitative studies include intervention and observational studies. Qualitative studies to be included are focus group discussions, direct observations, interviews, case studies and ethnography. We will search EMBASE, PubMed, Scopus, ERIC, PsycInfo, Africa-Wide Information, Academic Search Premier, Business Source Premier, WHOLIS, CINAHL and the Cochrane Library for eligible studies available by 31 October 2013, regardless of publication status or language of publication. We will also check reference lists of included studies and proceedings of relevant conferences and contact researchers for eligible studies. Two authors will independently screen the search output, select studies and extract data, resolving discrepancies by consensus and discussion. Qualitative data will be extracted using standardised data extraction tools adapted from the Critical Appraisal Skills Program (CASP) qualitative appraisal checklist and put together in a thematic analysis where applicable. We will statistically pool data from quantitative studies in a meta-analysis; but if included quantitative studies differ significantly in study settings, design and/or outcome measures, we will present the findings in a narrative synthesis. This protocol has been registered with PROSPERO (ID=CRD42013006364). Dissemination Recommendations will be made to health policy makers, managers and researchers in LMICs to help inform them on ways to strengthen and increase the uptake of CBHI. PMID:24531450

Factors that affect the uptake of community-based health insurance in low-income and middle-income countries: a systematic protocol.

PubMed

Adebayo, Esther F; Ataguba, John E; Uthman, Olalekan A; Okwundu, Charles I; Lamont, Kim T; Wiysonge, Charles S

2014-02-14

Many people residing in low-income and middle-income countries (LMICs) are regularly exposed to catastrophic healthcare expenditure. It is therefore pertinent that LMICs should finance their health systems in ways that ensure that their citizens can use needed healthcare services and are protected from potential impoverishment arising from having to pay for services. Ways of financing health systems include government funding, health insurance schemes and out-of-pocket payment. A health insurance scheme refers to pooling of prepaid funds in a way that allows for risks to be shared. The health insurance scheme particularly suitable for the rural poor and the informal sector in LMICs is community-based health insurance (CBHI), that is, insurance schemes operated by organisations other than governments or private for-profit companies. We plan to search for and summarise currently available evidence on factors associated with the uptake of CBHI, as we are not aware of previous systematic reviews that have looked at this important topic. This is a protocol for a systematic review of the literature. We will include both quantitative and qualitative studies in this review. Eligible quantitative studies include intervention and observational studies. Qualitative studies to be included are focus group discussions, direct observations, interviews, case studies and ethnography. We will search EMBASE, PubMed, Scopus, ERIC, PsycInfo, Africa-Wide Information, Academic Search Premier, Business Source Premier, WHOLIS, CINAHL and the Cochrane Library for eligible studies available by 31 October 2013, regardless of publication status or language of publication. We will also check reference lists of included studies and proceedings of relevant conferences and contact researchers for eligible studies. Two authors will independently screen the search output, select studies and extract data, resolving discrepancies by consensus and discussion. Qualitative data will be extracted using standardised data extraction tools adapted from the Critical Appraisal Skills Program (CASP) qualitative appraisal checklist and put together in a thematic analysis where applicable. We will statistically pool data from quantitative studies in a meta-analysis; but if included quantitative studies differ significantly in study settings, design and/or outcome measures, we will present the findings in a narrative synthesis. This protocol has been registered with PROSPERO (ID=CRD42013006364). Recommendations will be made to health policy makers, managers and researchers in LMICs to help inform them on ways to strengthen and increase the uptake of CBHI.

2011 Summary: Coastal wetland restoration research

USGS Publications Warehouse

Kowalski, Kurt P.; Wiley, Michael J.; Wilcox, Douglas A.; Carlson Mazur, Martha L.; Czayka, Alex; Dominguez, Andrea; Doty, Susan; Eggleston, Mike; Green, Sean; Sweetman, Amanda

2014-01-01

The Great Lakes Restoration Initiative (GLRI) projects currently taking place in Great Lakes coastal wetlands provide a unique opportunity to study ecosystem response to management actions as practitioners strive to improve wetland function and increase ecosystem services. Through a partnership between the U.S. Geological Survey – Great Lakes Science Center (GLSC), U.S. Fish and Wildlife Service (USFWS), and Ducks Unlimited, a GLRI-funded project has reestablished the hydrologic connection between an intensively managed impounded wetland (Pool 2B) and Crane Creek, a small Lake Erie tributary, by building a water-control structure that was opened in the spring of 2011. The study site is located within the USFWS Ottawa National Wildlife Refuge (ONWR) and lies within the boundaries of the U.S. Environmental Protection Agency (EPA)-designated Maumee River Area of Concern. The broad objective of the project is to evaluate how hydrologically reconnecting a previously diked wetland impacts fish, mollusks, and other biota and affects nutrient transport, nutrient cycling, water quality, flood storage, and many other abiotic conditions. The results from this project suggest large system-wide benefits from sustainable reestablishment of lake-driven hydrology in this and other similar systems. We comprehensively sampled water chemistry, fish, birds, plants, and invertebrates in Crane Creek coastal wetlands, Pool 2A (a reference diked wetland), and Pool 2B (the reconnected wetland) in 2010 and 2011 to: 1) Characterize spatial and seasonal patterns for these parameters. 2) Examine ecosystem response to the opening of a water-control structure that allows fish passage Our sampling efforts have yielded data that reveal striking changes in water quality, hydrology, and fish assemblages in our experimental unit (2B). Prior to the reconnection, the water chemistry in pools 2A and 2B were very similar. Afterwards, we found that the water chemistry in reconnected Pool 2B was more similar to Crane Creek (e.g., greater turbidity, higher concentration of nitrogen). Sites closest to the structure showed the most creek influence with that influence decreasing with distance from the structure, suggesting that input water from Crane Creek is not mixing fully with the pool water. We also found that water level fluctuations were much greater in the reconnected wetland due to the influence of seiches in Lake Erie. We measured the nutrient concentrations of water flowing into and out of Pool 2B during seiche events and found that the phosphorous and nitrogen concentrations generally were drastically reduced after pulsing through the reconnected wetland. Fish response to the reconnection was equally striking. High-resolution sonar revealed extensive bidirectional movement of fish through the structure on a daily and seasonal basis. There also were significant increases in both the catch per unit effort (CPUE) and the species richness of all sites in Pool 2B from 2010 to 2011. Reconnecting the diked pool to the larger Crane Creek wetland complex, and therefore Lake Erie, has opened up rich new habitat for many fish species. Thirteen species of fish not previously found in the pool entered through the structure and actively used the reconnected wetland. We also found that the wetland functions as a productive spawning ground and nursery area with notable shifts in the predominant age-class of several species of fish, especially northern pike. We observed no negative effects of reconnection on the avian or vegetative communities. All sites within the connected pool had increases in diversity and abundance in the avian community and decreases in the species richness and Floristic Quality Assessment Index values for vegetative communities. After one year of study, data suggest that maintaining a hydrologic connection between diked and coastal wetlands in Lake Erie allows fishes to use vegetated habitats regularly, reduces the concentration of nutrients in coastal waters, and maintains productive habitats for birds and other biota.  It will be important to continue to monitor the status of the reconnected wetland to determine the effect of long-term connection to Crane Creek and Lake Erie.  If conditions degrade, periodic management actions involving hydrologic isolation of the rehabilitated coastal wetland could be used to mimic intermediate levels of disturbance and maintain wetland vegetation.

Public funding for research on antibacterial resistance in the JPIAMR countries, the European Commission, and related European Union agencies: a systematic observational analysis.

PubMed

Kelly, Ruth; Zoubiane, Ghada; Walsh, Desmond; Ward, Rebecca; Goossens, Herman

2016-04-01

Antibacterial resistant infections are rising continuously, resulting in increased morbidity and mortality worldwide. With no new antibiotic classes entering the market and the possibility of returning to the pre-antibiotic era, the Joint Programming Initiative on Antimicrobial Resistance (JPIAMR) was established to address this problem. We aimed to quantify the scale and scope of publicly funded antibacterial resistance research across JPIAMR countries and at the European Union (EU) level to identify gaps and future opportunities. We did a systematic observational analysis examining antibacterial resistance research funding. Databases of funding organisations across 19 countries and at EU level were systematically searched for publicly funded antibacterial resistance research from Jan 1, 2007, to Dec 31, 2013. We categorised studies on the basis of the JPIAMR strategic research agenda's six priority topics (therapeutics, diagnostics, surveillance, transmission, environment, and interventions) and did an observational analysis. Only research funded by public funding bodies was collected and no private organisations were contacted for their investments. Projects in basic, applied, and clinical research, including epidemiological, public health, and veterinary research and trials were identified using keyword searches by organisations, and inclusion criteria were based on the JPIAMR strategic research agenda's six priority topics, using project titles and abstracts as filters. We identified 1243 antibacterial resistance research projects, with a total public investment of €1·3 billion across 19 countries and at EU level, including public investment in the Innovative Medicines Initiative. Of the total amount invested in antibacterial resistance research across the time period, €646·6 million (49·5%) was invested at the national level and €659·2 million (50·5%) at the EU level. When projects were classified under the six priority topics we found that 763 (63%) of 1208 projects funded at national level were within the area of therapeutics, versus 185 (15%) in transmission, 131 (11%) in diagnostics, 53 (4%) in interventions, and only 37 (3%) in environment and 39 (3%) in surveillance. This was the first systematic analysis of research funding of antibacterial resistance of this scale and scope, which relied on the availability and accuracy of data from organisations included. Large variation was seen between countries both in terms of number of projects and associated investment and across the six priority topics. To determine the future direction of JPIAMR countries a clear picture of the funding landscape across Europe and Canada is needed. Countries should work together to increase the effect of research funding by strengthening national and international coordination and collaborations, harmonising research activities, and collectively pooling resources to fund multidisciplinary projects. The JPIAMR have developed a publicly available database to document the antibacterial resistance research collected and can be used as a baseline to analyse funding from 2014 onwards. JPIAMR and the European Commission. Copyright © 2016 Kelly et al. Open Access article distributed under the terms of CC BY. Published by Elsevier Ltd.. All rights reserved.

Design Considerations for Financing a National Trust to Advance the Deployment of Geologic CO2 Storage and Motivate Best Practices

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

Dooley, James J.; Trabucchi, Chiara; Patton , Lindene

2010-03-01

This paper explores how the flawed, widely held public policy view of an ever growing risk associated with long-term carbon dioxide (CO2) storage profoundly influences the public policy dialogue about how to best address the long term risk profile for geologic storage. In order to accomplish this, the authors present evidence from the rapidly emerging science and engineering of CO2 storage which demonstrates that, with proper site characterization and sound operating practices, retention of stored CO2 will increase with time thus invalidating the premise of an ever growing risk. The authors focus on key issues of fit, interplay, and scalabilitymore » associated with a trust fund funded by a hypothetical $1/tonCO2 tipping fee for each ton of CO2 stored in the United States under WRE450 and WRE550 climate policies. The authors conclude there is no intrinsic value in creating a trust fund predicated solely on collecting a fixed fee that is not mapped to site-specific risk profiles. If left to grow unchecked, a trust fund that is predicated on a constant stream of annual payments unrelated to the site’s risk profile could result in the accumulation of hundreds of billions to more than a trillion dollars in real terms contributing to significant opportunity cost of capital. Further, rather than mitigating the financial consequences of long-term CCS risks, this analysis suggests a blanket $1/tonCO2 tipping fee may increase the probability and frequency of long-term risk by eliminating financial incentives for sound operating behavior and site selection criteria – contribute to moral hazard. At a minimum, effective use of a trust fund requires: (1) strong oversight regarding site selection and fund management, and (2) a clear process by which the fund is periodically valued and funds collected are mapped to the risk profile of the pool of covered CCS sites. Without appropriate checks and balances, there is no a priori reason to believe that the amount of funds held in trust will map to the actual amount of funds needed to address long-term care expenses and delimited compensatory damages. For this reason, the authors conclude that the financing of a trust fund or other risk management instrument should be based on a site delimited estimate of future expected financial consequences rather than on the random adoption of a fixed funding stream, e.g., a blanket $1/ton , because it ‘sounds’ reasonable.« less

Expanding access and choice for health care consumers through tax reform.

PubMed

Butler, S; Kendall, D B

1999-01-01

A refundable tax credit for the uninsured would complement the existing job-based health insurance system while letting people keep their job-based coverage if they wish. Among the wide variety of design options for a tax credit, policy and political analysis does not reveal an obvious choice, but a tax credit based on a percentage of spending may have a slight advantage. Congress should give states maximum flexibility to use existing funding sources to supplement the value of a federal tax credit and encourage the use of techniques to create stable insurance pools.

Experimental analysis of 7.62 mm hydrodynamic ram in containers

NASA Astrophysics Data System (ADS)

Deletombe, E.; Fabis, J.; Dupas, J.; Mortier, J. M.

2013-02-01

The design of fuel tanks with a reduced vulnerability with respect to hydrodynamic ram pressure (HRAM) effects is of an increasing need in the Civil (e.g. the Concorde accident), and Defence (military aircraft, unmanned vehicle systems) aircraft industries. The presented work concerns experimental research which aims at observing two hydraulic ram events - both induced by a 7.62 mm bullet shot in very different containers - throughout their various steps until the final collapse of the generated cavity, in order to study the nature of HRAM, the influence of the containers geometry, and to measure original dynamic data for numerical modelling developments and validation. For that purpose, test configurations and experimental results are described, documented and discussed. They concern two types of firing tests that were performed at ONERA using the NATO 7.62 mm projectile, respectively in the frame of ONERA (pool) and EUCLID (caisson) funded research projects. The authors concentrate on two topics: on the one hand, digital image analysis to measure the cavity geometry during its growth and collapse phases and, on the other hand, pressure measurements that catch the transient shock wave. The originality of the work consists in the fact that - compared with other published works - the phenomenon is studied up to tens of milliseconds in a very large pool for theoretical analysis of the bullet/liquid interactions only, and in a realistic fuel tank specimen to consider influence of boundary conditions onto the cavity characteristics (geometry, dynamics).

Efficacy and safety of brivaracetam for partial-onset seizures in 3 pooled clinical studies

PubMed Central

Mameniškienė, Rūta; Quarato, Pier Paolo; Klein, Pavel; Gamage, Jessica; Schiemann, Jimmy; Johnson, Martin E.; Whitesides, John; McDonough, Belinda; Eckhardt, Klaus

2016-01-01

Objective: To assess the efficacy, safety, and tolerability of adjunctive brivaracetam (BRV), a selective, high-affinity ligand for SV2A, for treatment of partial-onset (focal) seizures (POS) in adults. Methods: Data were pooled from patients (aged 16–80 years) with POS uncontrolled by 1 to 2 antiepileptic drugs receiving BRV 50, 100, or 200 mg/d or placebo, without titration, in 3 phase III studies of BRV (NCT00490035, NCT00464269, and NCT01261325, ClinicalTrials.gov, funded by UCB Pharma). The studies had an 8-week baseline and a 12-week treatment period. Patients receiving concomitant levetiracetam were excluded from the efficacy pool. Results: In the efficacy population (n = 1,160), reduction over placebo (95% confidence interval) in baseline-adjusted POS frequency/28 days was 19.5% (8.0%–29.6%) for 50 mg/d (p = 0.0015), 24.4% (16.8%–31.2%) for 100 mg/d (p < 0.00001), and 24.0% (15.3%–31.8%) for 200 mg/d (p < 0.00001). The ≥50% responder rate was 34.2% (50 mg/d, p = 0.0015), 39.5% (100 mg/d, p < 0.00001), and 37.8% (200 mg/d, p = 0.00003) vs 20.3% for placebo (p < 0.01). Across the safety population groups (n = 1,262), 90.0% to 93.9% completed the studies. Treatment-emergent adverse events (TEAEs) were reported by 68.0% BRV overall (n = 803) and 62.1% placebo (n = 459). Serious TEAEs were reported by 3.0% (BRV) and 2.8% (placebo); 3 patients receiving BRV and one patient receiving placebo died. TEAEs in ≥5% patients taking BRV (vs placebo) were somnolence (15.2% vs 8.5%), dizziness (11.2% vs 7.2%), headache (9.6% vs 10.2%), and fatigue (8.7% vs 3.7%). Conclusions: Adjunctive BRV was effective and generally well tolerated in adults with POS. Classification of evidence: This analysis provides Class I evidence that adjunctive BRV is effective in reducing POS frequency in adults with epilepsy and uncontrolled seizures. PMID:27335114

Consolidating the social health insurance schemes in China: towards an equitable and efficient health system.

PubMed

Meng, Qingyue; Fang, Hai; Liu, Xiaoyun; Yuan, Beibei; Xu, Jin

2015-10-10

Fragmentation in social health insurance schemes is an important factor for inequitable access to health care and financial protection for people covered by different health insurance schemes in China. To fulfil its commitment of universal health coverage by 2020, the Chinese Government needs to prioritise addressing this issue. After analysing the situation of fragmentation, this Review summarises efforts to consolidate health insurance schemes both in China and internationally. Rural migrants, elderly people, and those with non-communicable diseases in China will greatly benefit from consolidation of the existing health insurance schemes with extended funding pools, thereby narrowing the disparities among health insurance schemes in fund level and benefit package. Political commitments, institutional innovations, and a feasible implementation plan are the major elements needed for success in consolidation. Achievement of universal health coverage in China needs systemic strategies including consolidation of the social health insurance schemes. Copyright © 2015 Elsevier Ltd. All rights reserved.

Commercializing biomedical research through securitization techniques.

PubMed

Fernandez, Jose-Maria; Stein, Roger M; Lo, Andrew W

2012-10-01

Biomedical innovation has become riskier, more expensive and more difficult to finance with traditional sources such as private and public equity. Here we propose a financial structure in which a large number of biomedical programs at various stages of development are funded by a single entity to substantially reduce the portfolio's risk. The portfolio entity can finance its activities by issuing debt, a critical advantage because a much larger pool of capital is available for investment in debt versus equity. By employing financial engineering techniques such as securitization, it can raise even greater amounts of more-patient capital. In a simulation using historical data for new molecular entities in oncology from 1990 to 2011, we find that megafunds of $5–15 billion may yield average investment returns of 8.9–11.4% for equity holders and 5–8% for 'research-backed obligation' holders, which are lower than typical venture-capital hurdle rates but attractive to pension funds, insurance companies and other large institutional investors.

Viewing the Kenyan health system through an equity lens: implications for universal coverage

PubMed Central

2011-01-01

Introduction Equity and universal coverage currently dominate policy debates worldwide. Health financing approaches are central to universal coverage. The way funds are collected, pooled, and used to purchase or provide services should be carefully considered to ensure that population needs are addressed under a universal health system. The aim of this paper is to assess the extent to which the Kenyan health financing system meets the key requirements for universal coverage, including income and risk cross-subsidisation. Recommendations on how to address existing equity challenges and progress towards universal coverage are made. Methods An extensive review of published and gray literature was conducted to identify the sources of health care funds in Kenya. Documents were mainly sourced from the Ministry of Medical Services and the Ministry of Public Health and Sanitation. Country level documents were the main sources of data. In cases where data were not available at the country level, they were sought from the World Health Organisation website. Each financing mechanism was analysed in respect to key functions namely, revenue generation, pooling and purchasing. Results The Kenyan health sector relies heavily on out-of-pocket payments. Government funds are mainly allocated through historical incremental approach. The sector is largely underfunded and health care contributions are regressive (i.e. the poor contribute a larger proportion of their income to health care than the rich). Health financing in Kenya is fragmented and there is very limited risk and income cross-subsidisation. The country has made little progress towards achieving international benchmarks including the Abuja target of allocating 15% of government's budget to the health sector. Conclusions The Kenyan health system is highly inequitable and policies aimed at promoting equity and addressing the needs of the poor and vulnerable have not been successful. Some progress has been made towards addressing equity challenges, but universal coverage will not be achieved unless the country adopts a systemic approach to health financing reforms. Such an approach should be informed by the wider health system goals of equity and efficiency. PMID:21612669

Alternative solutions for public and private catastrophe funding in Austria

NASA Astrophysics Data System (ADS)

Gruber, M.

2008-07-01

The impacts of natural hazards as well as their frequency of occurrence during the last decades have increased decisively. Therefore, the public as well as the private sector are expected to react to this development by providing sufficient funds, in particular for the improvement of protection measures and an enhanced funding of damage compensation for affected private individuals, corporate and public entities. From the public stance, the establishment of an appropriate regulatory environment seems to be indispensable. Structural and legal changes should, on the one hand, renew and improve the current distribution system of public catastrophe funds as well as the profitable investment of these financial resources, and on the other hand, facilitate the application of alternative mechanisms provided by the capital and insurance markets. In particular, capital markets have developed alternative risk transfer and financing mechanisms, such as captive insurance companies, risk pooling, contingent capital solutions, multi-trigger products and insurance securitisation for hard insurance market phases. These instruments have already been applied to catastrophic (re-)insurance in other countries (mainly the US and off-shore domiciles), and may contribute positively to the insurability of extreme weather events in Austria by enhancing financial capacities. Not only private individuals and corporate entities may use alternative mechanisms in order to retain, thus, to finance certain risks, but also public institutions. This contribution aims at analysing potential solutions for an improved risk management of natural hazards in the private and the public sector by considering alternative mechanisms of the capital and insurance markets. Also the establishment of public-private-partnerships, which may contribute to a more efficient cat funding system in Austria, is considered.

Accelerating adoption of genetically modified crops in Africa through a trade liability regime.

PubMed

Smyth, Stuart J; Kerr, William A; Phillips, Peter W B

2013-06-01

Given the apparently unbridgeable divide that has developed between the 25 odd countries that grow and trade GM crops and the evolving EU regulatory hurdles, it may be time to consider alternative strategies for realizing a global market for agricultural products. Africa is one area of the world where the battle over GM agriculture is being played out, yet it is the continent where GM could have the greatest positive impact. Numerous African nations, given their long-standing trade connections to European nations, fear that allowing the commercialization of GM crops could lead to comingling of GM and conventional products and, hence, the loss of export opportunities to the EU. These are legitimate concerns. One potential solution that warrants serious consideration would be to establish a pool of funds that could be accessed by African agricultural commodity exporters in instances where exports to Europe are rejected. A production levy could be imposed in leading industrial adopting nations (i.e., Australia, Canada and the United States). The revenue raised would provide an endowment fund that could be used to offset the costs arising from import refusals. African-sourced shipments rejected by the EU will most certainly have alternate markets, but could receive a reduced price or incur higher costs associated with serving alternate markets. The intent of the fund would be to compensate for the real difference between the net returns contracted with European importers and the final market price received. This article examines the feasibility of establishing such a fund and discusses the funding options. © 2013 Society for Experimental Biology, Association of Applied Biologists and John Wiley & Sons Ltd.

Experimental and numerical studies on three dimensional GTA weld pool convection: Non-axisymmetric effects

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

Joshi, Y.; Dutta, P.; Schupp, P.E.

1995-12-31

Observations of surface flow patterns of steel and aluminum GTAW pools have been made using a pulsed laser visualization system. The weld pool convection is found to be three dimensional, with the azimuthal circulation depending on the location of the clamp with respect to the torch. Oscillation of steel pools and undulating motion in aluminum weld pools are also observed even with steady process parameters. Current axisymmetric numerical models are unable to explain such phenomena. A three dimensional computational study is carried out in this study to explain the rotational flow in aluminum weld pools.

Stakeholders' views on maternity care shortcomings in rural Ghana: An ethnographic study among women, providers, public, and quasiprivate policy sector actors.

PubMed

Ayanore, Martin Amogre; Pavlova, Milena; Biesma, Regien; Groot, Wim

2018-01-01

Access to skilled provider and emergency obstetric care is not universal across all districts in Ghana. The lived experiences of 3 stakeholder groups on maternity care shortcomings in 3 rural Ghanaian districts are examined in this study. We applied an ethnographic study approach where field data were collected between March to May 2015 in 3 rural districts of northern Ghana. Data were collected among women with recent births experiences (n = 90), health care providers (n = 16), and policy actors (n = 6). Transcripts were read through to identify similar and divergent stakeholders' views. Significant expressions and experiences of stakeholders on maternity care shortcomings were extracted and evaluated to define key themes. Four themes emerged: social/community factors, payments for health care, facility level factors, and policy level factors. The results show that traditional women's roles divest time for maternity care. Poor transport arrangements, insufficient health workforce, health funding gaps, insurance reimbursements delays, and catastrophic health expenditures on travel and drugs are attested as major barriers across all stakeholder groups in all districts studied. The discussion of the study findings suggests it is important to ascertain the scale of informal payments and their impacts on health access. Investments in health workforce and reliable ambulatory service systems could help address poor referral difficulties in rural areas of the country. Social support for community initiatives that pool funds could provide extra resources and relieve cost access-related challenges for using maternity care in rural settings in Ghana. Copyright © 2017 John Wiley & Sons, Ltd.

Results of the 1974 NACUBO Comparative Performance Study and Investment Questionnaire.

ERIC Educational Resources Information Center

National Association of College and University Business Officers, Washington, DC.

The 1974 Comparative Performance Study includes 150 endowment pools representing 136 institutions. The market value of the pools which provided information as of June 30, 1974, was 6.9 billion dollars. The study identifies endowment pools by code and indicates each pool's investment objective, approximate market value, the percentage in cash and…

Vernal Pools Detection Using High-Resolution LiDAR Data and Aerial Imagery in Hubbardston, Massachusetts

NASA Astrophysics Data System (ADS)

Jiang, Jiaxin

Vernal pool refers to temporary or semi-permanent pools that occur in surface depressions without permanent inlets or outlets. Because they periodically dry out, vernal pools are free of fish and essential to amphibians, some reptiles, birds, and mammals for breeding habitats. In Massachusetts, vernal pool habitats are found in woodland depressions, swales or kettle holes where water is contained for at least two months in most years. However, vernal pools are delicate ecosystems. These systems are fragile to human activities such as urbanization. Understanding the current situation of vernal pools helps city planners make wiser decisions. This study focuses on identifying vernal pools in the state of Massachusetts with high-resolution light detection and ranging (LiDAR) data and aerial imagery. By using high-resolution light detection and ranging data, aerial imagery, land use data, the MassDEP Hydrography layer and the Soil Survey Geographic Database, the approach located over 1800 potential vernal pools in a 108 km 2 study area in Massachusetts. The assessment of the study result shows the commission rate was 5.6% and omission rate was 7.1%. This method provides an efficient way of locating vernal pools over large areas.

External Validity of the New York University Caregiver Intervention: Key Caregiver Outcomes Across Multiple Demonstration Projects.

PubMed

Fauth, Elizabeth B; Jackson, Mark A; Walberg, Donna K; Lee, Nancy E; Easom, Leisa R; Alston, Gayle; Ramos, Angel; Felten, Kristen; LaRue, Asenath; Mittelman, Mary

2017-06-01

The Administration on Aging funded six New York University Caregiver Intervention (NYUCI) demonstration projects, a counseling/support intervention targeting dementia caregivers and families. Three sites (Georgia, Utah, Wisconsin) pooled data to inform external validity in nonresearch settings. This study (a) assesses collective changes over time, and (b) compares outcomes across sites on caregiver burden, depressive symptoms, satisfaction with social support, family conflict, and quality of life. Data included baseline/preintervention ( N = 294) and follow-up visits (approximately 4, 8, 12 months). Linear mixed models showed that social support satisfaction increased ( p < .05) and family conflict decreased ( p < .05; Cohen's d = 0.49 and 0.35, respectively). Marginally significant findings emerged for quality of life increases ( p = .05) and burden decreases ( p < .10). Depressive symptoms remained stable. Slopes did not differ much by site. NYUCI demonstrated external validity in nonresearch settings across diverse caregiver samples.

Sleeping money: investigating the huge surpluses of social health insurance in China.

PubMed

Liu, JunQiang; Chen, Tao

2013-12-01

The spreading of social health insurance (SHI) worldwide poses challenges for fledging public administrators. Inefficiency, misuse and even corruption threaten the stewardship of those newly established health funds. This article examines a tricky situation faced by China's largest SHI program: the basic health insurance (BHI) scheme for urban employees. BHI accumulated a 406 billion yuan surplus by 2009, although the reimbursement level was still low. Using a provincial level panel database, we find that the huge BHI surpluses are related to the (temporarily) decreasing dependency ratio, the steady growth of average wages, the extension of BHI coverage, and progress in social insurance agency building. The financial situations of local governments and risk pooling level also matter. Besides, medical savings accounts result in about one third of BHI surpluses. Although these findings are not causal, lessons drawn from this study can help to improve the governance and performance of SHI programs in developing countries.

Hydrologic Observatories: Design, Operation, and the Neuse Basin Prototype

NASA Astrophysics Data System (ADS)

Reckhow, K.; Band, L.

2003-12-01

Hydrologic observatories are conceived as major research facilities that will be available to the full hydrologic community, to facilitate comprehensive, cross-disciplinary and multi-scale measurements necessary to address the current and next generation of critical science and management issues. A network of hydrologic observatories is proposed that both develop national comparable, multidisciplinary data sets and provide study areas to allow scientists, through their own creativity, to make scientific breakthroughs that would be impossible without the proposed observatories. The core objective of an observatory is to improve predictive understanding of the flow paths, fluxes, and residence times of water, sediment and nutrients (the "core data") across a range of spatial and temporal scales across `interfaces'. To assess attainment of this objective, a benchmark will be established in the first year, and evaluated periodically. The benchmark should provide an estimate of prediction uncertainty at points in the stream across scale; the general principle is that predictive understanding must be demonstrated internal to the catchment as well as its outlet. The core data will be needed for practically any hydrologic study, yet absence of these data has been a barrier to larger scale studies in the past. However, advancement of hydrologic science facilitated by the network of hydrologic observatories is expected to focus on a set of science drivers, drawn from the major scientific questions posed by the set of NRC reports and refined into CUAHSI themes. These hypotheses will be tested at all observatories and will be used in the design to ensure the sufficiency of the data set. To make the observatories a national (and international) resource, a key aspect of the operation is the support of remote PI's. This support will include a resident staff of scientists and technicians on the order of 10 FTE's, availability of dormitory, laboratory, workshop space for all scientists, and the awarding of travel support out of observatory funds. The conflicting goals of support for a PI-designed observatory and a network of community-available observatories will be achieved by allocation of resources to assure both goals will be met. It is proposed that these resources be divided into three pools: Core data pool. Data to be collected by the observatory PI's and staff, and where possible, augmented by existing (e.g., USGS) data collection. Design pool. Available to support the designs of observatory PI's. Community pool. Available to non-PI scientists to test cross-observatory hypotheses. Application of these design and operation concepts to the design of the Neuse basin prototype hydrologic observatory is briefly discussed.

Longevity of Wood-Forced Pools in an Old-Growth Forest

NASA Astrophysics Data System (ADS)

Buffington, J. M.; Woodsmith, R. D.; Johnson, A. C.

2009-12-01

Wood debris plays an important role in scouring pools in forest channels and providing resultant habitat for aquatic organisms. We investigated the longevity of such pools in a gravel-bed river flowing through old-growth forest in southeastern Alaska by aging trees and “bear’s bread” fungi (Ganoderma applanatum, Fomitopsis pinicola) growing on pool-forming wood debris. Ages were determined by counting annual growth rings from cores and cross sections of trees and fungi growing on the wood debris. These ages are minimum values because they do not account for lag time between debris recruitment and seedling/spore establishment on the debris, nor do they account for flood scour that may periodically reset tree and fungi growth on the debris. The study stream has a gradient of about 1%, bankfull width and depth of 13.3 and 0.78 m, respectively, median grain size of 18 mm, a high wood loading (0.8 pieces/m), and a correspondingly low pool spacing (0.3 bankfull widths/pool), with 81% of the pools forced by wood debris. The size of wood debris in the study stream is large relative to the channel (average log length of 7.6 m and diameter of 0.35 m), rendering most debris immobile. Eighty-one pool-forming pieces of wood were dated over 1.2 km of stream length, with 28% of these pieces causing scour of more than one pool. In all, 122 wood-forced pools were dated, accounting for 38% of all pools at the site and 47% of the wood-forced pools. Fifty-three percent of the wood-forced pools lacked datable wood because these pieces either: were newly recruited; had been scoured by floods; or were contained below the active channel elevation, prohibiting vegetation establishment on the wood debris (the most common cause). The debris age distribution declined exponentially from 2 to 113 yrs., with a median value of 18 yrs. Similar exponential residence time distributions have been reported in other studies, but our analysis focused specifically on the ages of pool-forming wood as opposed to all in-channel wood. Most pool scour was relatively recent (60% ≤ 25 yrs. old), but 16% of the pools were old features (50-100+ yrs.), indicating long-term availability of pool habitats at the study site. Future studies will use these results to develop a wood budget model that accounts for pool scour and availability of pool habitats. For such modeling, our data suggest that stand-replacing disturbances (e.g. wildfire, riparian clear cutting) will cause a sharp drop in the numbers of wood-forced pools, as most of those are ≤ 25 yrs. old.

Going All In: Unfavorable Sex Ratios Attenuate Choice Diversification.

PubMed

Ackerman, Joshua M; Maner, Jon K; Carpenter, Stephanie M

2016-06-01

When faced with risky decisions, people typically choose to diversify their choices by allocating resources across a variety of options and thus avoid putting "all their eggs in one basket." The current research revealed that this tendency is reversed when people face an important cue to mating-related risk: skew in the operational sex ratio, or the ratio of men to women in the local environment. Counter to the typical strategy of choice diversification, findings from four studies demonstrated that the presence of romantically unfavorable sex ratios (those featuring more same-sex than opposite-sex individuals) led heterosexual people to diversify financial resources less and instead concentrate investment in high-risk/high-return options when making lottery, stock-pool, retirement-account, and research-funding decisions. These studies shed light on a key process by which people manage risks to mating success implied by unfavorable interpersonal environments. These choice patterns have important implications for mating behavior as well as other everyday forms of decision making. © The Author(s) 2016.

Partner-built ecosystem science - The National Ocean Partnership Program as a builder of EBM Tools and Data

NASA Astrophysics Data System (ADS)

Hoffman, P. L.; Green, R. E.; Kohanowich, K. M.

2016-02-01

The National Ocean Partnership Program (NOPP) was created in 1997 by federal public law to identify "and carry out partnerships among federal agencies, academia, industry, and other members of the oceanographic scientific community in the areas of data, resources, education, and communications." Since that time, numerous federal agencies have pooled talent, funding, and scientific resources (e.g. ships, aircraft, remote sensors and computing capability) to address pressing ocean science needs which no one entity can manage alone. In this presentation, we will address the ways the National Ocean Policy identifies ecosystem-based management (EBM) as a foundation for providing sound science-based and adaptable management to maintain the health, productivity, and resilience of U.S. ocean, coastal, and Great Lakes ecosystems. Because EBM is an important approach for efficient and effective interagency, multi-jurisdictional, and cross-sectoral marine planning and management, ocean science partnerships such as those provided by NOPP create a pool of regionally-pertinent, nationally-available data from which EBM decision makers can draw to address critical management issues. Specifically, we will provide examples drawn from the last five years of funding to illustrate how the NOPP process works, how it is managed by a federal Interagency Working Group (IWG-OP), and how EBM practitioners can both partner with others through the NOPP and offer guidance on the implementation of projects beneficial to the regional needs of the EBM community. Projects to be discussed have been carried out under the following themes: Arctic Cumulative Impacts: Marine Arctic Ecosystem Study (MARES) - Ecosystem Dynamics and Monitoring of the Beaufort Sea: An Integrated Science Approach. Biodiversity Indicators: Demonstration of a U.S. Marine Biodiversity Observation Network (Marine BON) Long-Term Observations: Coordinated Regional Efforts That Further the U.S. Integrated Ocean Observing System (IOOS) Best Practices: Developing Environmental Protocols and Monitoring to Support Ocean Renewable Energy and Stewardship. We intend to leave the EBM community with a recognition that the NOPP already serves as a valuable partner source for science to inform EBM and to encourage participation in the process.

Partner-built ecosystem science - The National Ocean Partnership Program as a builder of EBM Tools and Data

NASA Astrophysics Data System (ADS)

Hoffman, P. L.; Green, R. E.; Kohanowich, K. M.

2016-12-01

The National Ocean Partnership Program (NOPP) was created in 1997 by federal public law to identify "and carry out partnerships among federal agencies, academia, industry, and other members of the oceanographic scientific community in the areas of data, resources, education, and communications." Since that time, numerous federal agencies have pooled talent, funding, and scientific resources (e.g. ships, aircraft, remote sensors and computing capability) to address pressing ocean science needs which no one entity can manage alone. In this presentation, we will address the ways the National Ocean Policy identifies ecosystem-based management (EBM) as a foundation for providing sound science-based and adaptable management to maintain the health, productivity, and resilience of U.S. ocean, coastal, and Great Lakes ecosystems. Because EBM is an important approach for efficient and effective interagency, multi-jurisdictional, and cross-sectoral marine planning and management, ocean science partnerships such as those provided by NOPP create a pool of regionally-pertinent, nationally-available data from which EBM decision makers can draw to address critical management issues. Specifically, we will provide examples drawn from the last five years of funding to illustrate how the NOPP process works, how it is managed by a federal Interagency Working Group (IWG-OP), and how EBM practitioners can both partner with others through the NOPP and offer guidance on the implementation of projects beneficial to the regional needs of the EBM community. Projects to be discussed have been carried out under the following themes: Arctic Cumulative Impacts: Marine Arctic Ecosystem Study (MARES) - Ecosystem Dynamics and Monitoring of the Beaufort Sea: An Integrated Science Approach. Biodiversity Indicators: Demonstration of a U.S. Marine Biodiversity Observation Network (Marine BON) Long-Term Observations: Coordinated Regional Efforts That Further the U.S. Integrated Ocean Observing System (IOOS) Best Practices: Developing Environmental Protocols and Monitoring to Support Ocean Renewable Energy and Stewardship. We intend to leave the EBM community with a recognition that the NOPP already serves as a valuable partner source for science to inform EBM and to encourage participation in the process.

Improving Pool Fencing Legislation in Queensland, Australia: Attitudes and Impact on Child Drowning Fatalities

PubMed Central

2017-01-01

Four-sided, non-climbable pool fencing is an effective strategy for preventing children from drowning in home swimming pools. In 2009, the Queensland Government introduced legislation to improve the effectiveness of pool fencing. This study explores community attitudes towards the effectiveness of these legislative changes and examines child (<5 years) drowning deaths in pools. Data from the 2011 Queensland Computer-Assisted Telephone Interviewing (CATI) Social Survey include results from questions related to pool ownership and pool fencing legislation. Fatal child drowning cases between 1 January 2005 and 31 December 2015 were sourced from coronial data. Of the 1263 respondents, 26/100 households had a pool. A total of 58% believed tightening legislation would be effective in reducing child drowning deaths. Pool owners were more likely to doubt the effectiveness of legislation (p < 0.001) when compared to non-pool owners. Perceptions of effectiveness did not differ by presence of children under the age of five. There were 46 children who drowned in Queensland home pools (7.8/100,000 pools with children residing in the residence/annum) between 2005 and 2015. While pool owners were less likely to think that tightening the legislation would be effective, the number of children drowning in home swimming pools declined over the study period. Drowning prevention agencies have more work to do to ensure that the most vulnerable (young children in houses with swimming pools) are protected. PMID:29186787

State budget transfers to Health Insurance Funds for universal health coverage: institutional design patterns and challenges of covering those outside the formal sector in Eastern European high-income countries.

PubMed

Vilcu, Ileana; Mathauer, Inke

2016-01-15

Many countries from the European region, which moved from a government financed and provided health system to social health insurance, would have had the risk of moving away from universal health coverage if they had followed a "traditional" approach. The Eastern European high-income countries studied in this paper managed to avoid this potential pitfall by using state budget revenues to explicitly pay health insurance contributions on behalf of certain (vulnerable) population groups who have difficulties to pay these contributions themselves. The institutional design aspects of their government revenue transfer arrangements are analysed, as well as their impact on universal health coverage progress. This regional study is based on literature review and review of databases for the performance assessment. The analytical framework focuses on the following institutional design features: rules on eligibility for contribution exemption, financing and pooling arrangements, and purchasing arrangements and benefit package design. More commonalities than differences can be identified across countries: a broad range of groups eligible for exemption from payment of health insurance contributions, full state contributions on behalf of the exempted groups, mostly mandatory participation, integrated pools for both the exempted and contributors, and relatively comprehensive benefit packages. In terms of performance, all countries have high total population coverage rates, but there are still challenges regarding financial protection and access to and utilization of health care services, especially for low income people. Overall, government revenue transfer arrangements to exempt vulnerable groups from contributions are one option to progress towards universal health coverage.

Self-formed waterfall plunge pools in homogeneous rock

NASA Astrophysics Data System (ADS)

Scheingross, Joel S.; Lo, Daniel Y.; Lamb, Michael P.

2017-01-01

Waterfalls are ubiquitous, and their upstream propagation can set the pace of landscape evolution, yet no experimental studies have examined waterfall plunge pool erosion in homogeneous rock. We performed laboratory experiments, using synthetic foam as a bedrock simulant, to produce self-formed waterfall plunge pools via particle impact abrasion. Plunge pool vertical incision exceeded lateral erosion by approximately tenfold until pools deepened to the point that the supplied sediment could not be evacuated and deposition armored the pool bedrock floor. Lateral erosion of plunge pool sidewalls continued after sediment deposition, but primarily at the downstream pool wall, which might lead to undermining of the plunge pool lip, sediment evacuation, and continued vertical pool floor incision in natural streams. Undercutting of the upstream pool wall was absent, and our results suggest that vertical drilling of successive plunge pools is a more efficient waterfall retreat mechanism than the classic model of headwall undercutting and collapse in homogeneous rock.

Obesity, overweight and cancer mortality in the Asia-Pacific Cohort Studies Collaboration: pooled analyses of 424 519 participants

PubMed Central

Parr, Christine Louise; Batty, G. David; Lam, Tai Hing; Barzi, Federica; Fang, Xianghua; Ho, Suzanne C; Jee, Sun Ha; Ansary-Moghaddam, Alireza; Ueshima, Hirotsugu; Woodward, Mark; Huxley, Rachel R

2014-01-01

SUMMARY Background Excess weight is an established risk factor for several cancers but there are sparse data from Asian populations in whom overweight and obesity is increasing rapidly and adiposity can be substantially greater for the same body mass index (BMI) compared to Caucasians. Methods We examined associations of adult BMI with cancer mortality (overall and 20 sites) in geographic populations from Asia and Australia/New Zealand (ANZ) within the Asia Pacific Cohort Studies Collaboration using Cox regression. Pooled data from 39 cohorts (recruitment 1961-99, median follow-up 4 years) were analyzed for 424 519 participants (77% Asian; 41% female; mean recruitment age 48 years) with individual data on BMI. Findings After excluding follow-up < 3 years, 4872 cancer deaths occurred in 401 215 participants. Hazard ratios (95% CI) for cancer sites with increased mortality risk in the obese (≥30 kg/m2) relative to the normal weight (18.5-24.9 kg/m2) were: 1.21 (1.09-1.36) for all-cause cancer (excluding lung and upper-aero digestive tract), 1.50 (1.13-1.99) for colon, 1.68 (1.06-2.67) for rectum, 1.63 (1.13-2.35) for breast in women aged ≥ 60 years, 2.62 (1.57-4.37) for ovary, 4.21 (1.89-9.39) for cervix, 1.45 (0.97-2.19) for prostate, and 1.66 (1.03-2.68) for leukaemia with the increased risk associated with a 5-unit increment in BMI ≥ 18.5 kg/m2 ranging from 1.13 (0.91-1.40) for rectum to 1.45 (1.00-2.11) for cervix. There was little evidence of regional differences in relative risk except for oropharynx and larynx where the association was inverse in ANZ but absent in Asia. Interpretation Overweight and obese individuals in populations across the Asia-Pacific region are at significantly increased risk of mortality from cancer. Strategies to prevent overweight and obesity across Asia are required to reduce the burden of cancer expected to occur if the obesity epidemic continues. Funding The APCSC has been funded by the National Health and Medical Research Council of Australia, the Health Research Council of New Zealand and Pfizer Inc., through an unrestricted medical grant. PMID:20594911

Variability in chemical composition and abundance of the rare tertiary relict Pinus heldreichii in Serbia.

PubMed

Bojović, Srdjan; Nikolić, Biljana; Ristić, Mihailo; Orlović, Saša; Veselinović, Milorad; Rakonjac, Ljubinko; Dražić, Dragana

2011-09-01

The particular significance of the whitebark pine (Pinus heldreichii Christ.) stems from the fact that it is a tertiary relict and Balkanic subendemite covering a very narrow and intermittent area in Serbia. A representative pool of 48 adult trees originating from three populations, one recently discovered natural (Population I) and two planted populations (Populations II and III) was investigated in order to evaluate the intra- and interpopulation variability of the essential oil of the complete fund of P. heldreichii in Serbia. In the pine-needle-terpene profile, 104 compounds were detected, 84 of which could be identified. Among the essential-oil constituents, monoterpenes and sesquiterpenes dominated, comprising ca. 90% of the essential oil. The terpenic profile of Population I was characterized by a predominance of monoterpenes (e.g., limonene (1), α-pinene, and Δ(3) -carene (4)), while sesquiterpenes (e.g., germacrene D (2) and β-caryophyllene (3)) obviously preponderated in the profile of Populations II and III. This study also demonstrated that the abundance of whitebark pines in Serbia had significantly changed over the last few decades. The number of individuals in the natural population had increased, while the number of individuals in the planted populations had decreased. Today, the whitebark pine fund in Serbia comprises less than 250 trees. 2011 Verlag Helvetica Chimica Acta AG, Zürich.

Families as full research partners: what's in it for us?

PubMed

Vander Stoep, A; Williams, M; Jones, R; Green, L; Trupin, E

1999-08-01

This article describes a children's managed mental health care program that incorporates both a family participation service model and a family-initiated evaluation model. The authors begin by tracing the evolution of the family support and the participatory research movements leading to current developments in children's mental health services research. In the King County Blended Funding Project, three service systems pool funds that are spent flexibly by child and family teams. Family advocates have led efforts to design and implement the project evaluation. During this process, many tensions have arisen between meeting the demands of both scientific rigor and multiple community stakeholders. Examples are given of the issues raised by family advocates and research scientists as together they established a theory of change, identified meaningful outcomes, selected measurement tools, and implemented the evaluation protocol. Guidelines are given for how services research partnerships can be successfully built to better address community needs. This article was selected as a distinguished research paper based on a presentation by the authors at the 1998 11th annual research conference titled "A system of Care for Children's Mental Health: Expanding the Research Base." This conference is sponsored annually by the Research and Training Center for Children's Mental Health, Department of Child and Family Studies, Louis de la Parte Florida Mental Health Institute, University of South Florida, Tampa.

Experimental study on the stability and failure of individual step-pool

NASA Astrophysics Data System (ADS)

Zhang, Chendi; Xu, Mengzhen; Hassan, Marwan A.; Chartrand, Shawn M.; Wang, Zhaoyin

2018-06-01

Step-pools are one of the most common bedforms in mountain streams, the stability and failure of which play a significant role for riverbed stability and fluvial processes. Given this importance, flume experiments were performed with a manually constructed step-pool model. The experiments were carried out with a constant flow rate to study features of step-pool stability as well as failure mechanisms. The results demonstrate that motion of the keystone grain (KS) caused 90% of the total failure events. The pool reached its maximum depth and either exhibited relative stability for a period before step failure, which was called the stable phase, or the pool collapsed before its full development. The critical scour depth for the pool increased linearly with discharge until the trend was interrupted by step failure. Variability of the stable phase duration ranged by one order of magnitude, whereas variability of pool scour depth was constrained within 50%. Step adjustment was detected in almost all of the runs with step-pool failure and was one or two orders smaller than the diameter of the step stones. Two discharge regimes for step-pool failure were revealed: one regime captures threshold conditions and frames possible step-pool failure, whereas the second regime captures step-pool failure conditions and is the discharge of an exceptional event. In the transitional stage between the two discharge regimes, pool and step adjustment magnitude displayed relatively large variabilities, which resulted in feedbacks that extended the duration of step-pool stability. Step adjustment, which was a type of structural deformation, increased significantly before step failure. As a result, we consider step deformation as the direct explanation to step-pool failure rather than pool scour, which displayed relative stability during step deformations in our experiments.

The spatial variability of water chemistry and DOC in bog pools: the importance of slope position, diurnal turnover and pool type

NASA Astrophysics Data System (ADS)

Holden, Joseph; Turner, Ed; Baird, Andy; Beadle, Jeannie; Billett, Mike; Brown, Lee; Chapman, Pippa; Dinsmore, Kerry; Dooling, Gemma; Grayson, Richard; Moody, Catherine; Gee, Clare

2017-04-01

We have previously shown that marine influence is an important factor controlling regional variability of pool water chemistry in blanket peatlands. Here we examine within-site controls on pool water chemistry. We surveyed natural and artificial (restoration sites) bog pools at blanket peatland sites in northern Scotland and Sweden. DOC, pH, conductivity, dissolved oxygen, temperature, cations, anions and absorbance spectra from 220-750nm were sampled. We sampled changes over time but also conducted intensive spatial surveys within individual pools and between pools on the same sampling days at individual study sites. Artificial pools had significantly greater DOC concentrations and different spectral absorbance characteristics when compared to natural pools at all sites studied. Within-pool variability in water chemistry tended to be small, even for very large pools ( 400 m2), except where pools had a layer of loose, mobile detritus on their beds. In these instances rapid changes took place between the overlying water column and the mobile sediment layer wherein dissolved oxygen concentrations dropped from values of around 12-10 mg/L to values less than 0.5 mg/L over just 2-3 cm of the depth profile. Such strong contrasts were not observed for pools which had a hard peat floor and which lacked a significant detritus layer. Strong diurnal turnover occurred within the pools on summer days, including within small, shallow pools (e.g. < 30 cm deep, 1 m2 area). For many pools on these summer days there was an evening spike in dissolved oxygen concentrations which originated at the surface and was then cycled downwards as the pool surface waters cooled. Slope location was a significant control on several pool water chemistry variables including pH and DOC concentration with accumulation (higher concentrations) in pools that were located further downslope in both natural and artificial pool systems. These processes have important implications for our interpretation of water chemistry and gas flux data from pool systems, how we design our sampling strategies and how we upscale results.

What’s in the Pool? A Comprehensive Identification of Disinfection By-Products and Assessment of Mutagenicity of Chlorinated and Brominated Swimming Pool Water

EPA Science Inventory

Swimming pool disinfectants and disinfection by-products (DBPs) have been linked to human health effects, including asthma and bladder cancer, but no studies have provided a comprehensive identification of DBPs in pool water and related those DBPs to the mutagenicity of pool wate...

The Role of Prostatitis in Prostate Cancer: Meta-Analysis

PubMed Central

Yunxia, Zhang; Zhu, Hong; Liu, Junjiang; Pumill, Chris

2013-01-01

Objective Use systematic review methods to quantify the association between prostatitis and prostate cancer, under both fixed and random effects model. Evidence Acquisition Case control studies of prostate cancer with information on prostatitis history. All studies published between 1990-2012, were collected to calculate a pooled odds ratio. Selection criteria: the selection criteria are as follows: human case control studies; published from May 1990 to July 2012; containing number of prostatitis, and prostate cancer cases. Evidence Synthesis In total, 20 case control studies were included. A significant association between prostatitis and prostate cancer was found, under both fixed effect model (pooled OR=1.50, 95%CI: 1.39-1.62), and random effects model (OR=1.64, 95%CI: 1.36-1.98). Personal interview based case control studies showed a high level of association (fixed effect model: pooled OR=1.59, 95%CI: 1.47-1.73, random effects model: pooled OR= 1.87, 95%CI: 1.52-2.29), compared with clinical based studies (fixed effect model: pooled OR=1.05, 95%CI: 0.86-1.28, random effects model: pooled OR= 0.98, 95%CI: 0.67-1.45). Additionally, pooled ORs, were calculated for each decade. In a fixed effect model: 1990’s: OR=1.58, 95% CI: 1.35-1.84; 2000’s: OR=1.59, 95% CI: 1.40-1.79; 2010’s: OR=1.37, 95% CI: 1.22-1.56. In a random effects model: 1990’s: OR=1.98, 95% CI: 1.08-3.62; 2000’s: OR=1.64, 95% CI: 1.23-2.19; 2010’s: OR=1.34, 95% CI: 1.03-1.73. Finally a meta-analysis stratified by each country was conducted. In fixed effect models, U.S: pooled OR =1.45, 95%CI: 1.34-1.57; China: pooled OR =4.67, 95%CI: 3.08-7.07; Cuba: pooled OR =1.43, 95%CI: 1.00-2.04; Italy: pooled OR =0.61, 95%CI: 0.13-2.90. In random effects model, U.S: pooled OR=1.50, 95%CI: 1.25-1.80; China: pooled OR =4.67, 95%CI: 3.08-7.07; Cuba: pooled OR =1.43, 95%CI: 1.00-2.04; Italy: pooled OR =0.61, 95%CI: 0.13-2.90.CONCLUSIONS: the present meta-analysis provides the statistical evidence that the association between prostatitis and prostate cancer is significant. PMID:24391995

[Is continuing medical education under suspicion of corruption? Contribution to the discussion by the Committee for Quality Preservation of the Swiss Society of Gynaecology and Obstetrics].

PubMed

Drack, G; Kuhn, H P; Haller, U

2003-04-01

The requirements laid down by law and by the medical profession itself with regard to continuing medical education have recently been tightened. The cost of good training is high, both in time and money. Sponsoring, especially by the pharmaceutical industry, has helped to keep costs down for individual participants. The question of a tariff system for the payment of compulsory training is now being raised. Rates have been set to ensure that, in the future, indirect costs are covered. In the event of a full tariff-based payment of costs being introduced, various disadvantages could be expected both for participants and the quality of the training. Changes in Swiss criminal law and the new medicines act do not forbid sponsoring, but they do call for rules of professional ethics and of personnel law in public hospitals governing behaviour in respect of funding by sponsors. Various sponsoring models are conceivable with differences in allocation to organizers, individual participants or distribution via a pool system. There are strong arguments in favour of continuing the existing practice of mixed funding by participants and sponsoring, provided that it is subject to certain rules of transparency. What is lacking to date is a political decision on the issue of funding for continuing medical education.

Primary health care in Canada: systems in motion.

PubMed

Hutchison, Brian; Levesque, Jean-Frederic; Strumpf, Erin; Coyle, Natalie

2011-06-01

During the 1980s and 1990s, innovations in the organization, funding, and delivery of primary health care in Canada were at the periphery of the system rather than at its core. In the early 2000s, a new policy environment emerged. This policy analysis examines primary health care reform efforts in Canada during the last decade, drawing on descriptive information from published and gray literature and from a series of semistructured interviews with informed observers of primary health care in Canada. Primary health care in Canada has entered a period of potentially transformative change. Key initiatives include support for interprofessional primary health care teams, group practices and networks, patient enrollment with a primary care provider, financial incentives and blended-payment schemes, development of primary health care governance mechanisms, expansion of the primary health care provider pool, implementation of electronic medical records, and quality improvement training and support. Canada's experience suggests that primary health care transformation can be achieved voluntarily in a pluralistic system of private health care delivery, given strong government and professional leadership working in concert. © 2011 Milbank Memorial Fund. Published by Wiley Periodicals Inc.

Integrating funds for health and social care: an evidence review.

PubMed

Mason, Anne; Goddard, Maria; Weatherly, Helen; Chalkley, Martin

2015-07-01

Integrated funds for health and social care are one possible way of improving care for people with complex care requirements. If integrated funds facilitate coordinated care, this could support improvements in patient experience, and health and social care outcomes, reduce avoidable hospital admissions and delayed discharges, and so reduce costs. In this article, we examine whether this potential has been realized in practice. We propose a framework based on agency theory for understanding the role that integrated funding can play in promoting coordinated care, and review the evidence to see whether the expected effects are realized in practice. We searched eight electronic databases and relevant websites, and checked reference lists of reviews and empirical studies. We extracted data on the types of funding integration used by schemes, their benefits and costs (including unintended effects), and the barriers to implementation. We interpreted our findings with reference to our framework. The review included 38 schemes from eight countries. Most of the randomized evidence came from Australia, with nonrandomized comparative evidence available from Australia, Canada, England, Sweden and the US. None of the comparative evidence isolated the effect of integrated funding; instead, studies assessed the effects of 'integrated financing plus integrated care' (i.e. 'integration') relative to usual care. Most schemes (24/38) assessed health outcomes, of which over half found no significant impact on health. The impact of integration on secondary care costs or use was assessed in 34 schemes. In 11 schemes, integration had no significant effect on secondary care costs or utilisation. Only three schemes reported significantly lower secondary care use compared with usual care. In the remaining 19 schemes, the evidence was mixed or unclear. Some schemes achieved short-term reductions in delayed discharges, but there was anecdotal evidence of unintended consequences such as premature hospital discharge and heightened risk of readmission. No scheme achieved a sustained reduction in hospital use. The primary barrier was the difficulty of implementing financial integration, despite the existence of statutory and regulatory support. Even where funds were successfully pooled, budget holders' control over access to services remained limited. Barriers in the form of differences in performance frameworks, priorities and governance were prominent amongst the UK schemes, whereas difficulties in linking different information systems were more widespread. Despite these barriers, many schemes - including those that failed to improve health or reduce costs - reported that access to care had improved. Some of these schemes revealed substantial levels of unmet need and so total costs increased. It is often assumed in policy that integrating funding will promote integrated care, and lead to better health outcomes and lower costs. Both our agency theory-based framework and the evidence indicate that the link is likely to be weak. Integrated care may uncover unmet need. Resolving this can benefit both individuals and society, but total care costs are likely to rise. Provided that integration delivers improvements in quality of life, even with additional costs, it may, nonetheless, offer value for money. © The Author(s) 2015.

Integrating funds for health and social care: an evidence review

PubMed Central

Goddard, Maria; Weatherly, Helen; Chalkley, Martin

2015-01-01

Objectives Integrated funds for health and social care are one possible way of improving care for people with complex care requirements. If integrated funds facilitate coordinated care, this could support improvements in patient experience, and health and social care outcomes, reduce avoidable hospital admissions and delayed discharges, and so reduce costs. In this article, we examine whether this potential has been realized in practice. Methods We propose a framework based on agency theory for understanding the role that integrated funding can play in promoting coordinated care, and review the evidence to see whether the expected effects are realized in practice. We searched eight electronic databases and relevant websites, and checked reference lists of reviews and empirical studies. We extracted data on the types of funding integration used by schemes, their benefits and costs (including unintended effects), and the barriers to implementation. We interpreted our findings with reference to our framework. Results The review included 38 schemes from eight countries. Most of the randomized evidence came from Australia, with nonrandomized comparative evidence available from Australia, Canada, England, Sweden and the US. None of the comparative evidence isolated the effect of integrated funding; instead, studies assessed the effects of ‘integrated financing plus integrated care’ (i.e. ‘integration’) relative to usual care. Most schemes (24/38) assessed health outcomes, of which over half found no significant impact on health. The impact of integration on secondary care costs or use was assessed in 34 schemes. In 11 schemes, integration had no significant effect on secondary care costs or utilisation. Only three schemes reported significantly lower secondary care use compared with usual care. In the remaining 19 schemes, the evidence was mixed or unclear. Some schemes achieved short-term reductions in delayed discharges, but there was anecdotal evidence of unintended consequences such as premature hospital discharge and heightened risk of readmission. No scheme achieved a sustained reduction in hospital use. The primary barrier was the difficulty of implementing financial integration, despite the existence of statutory and regulatory support. Even where funds were successfully pooled, budget holders’ control over access to services remained limited. Barriers in the form of differences in performance frameworks, priorities and governance were prominent amongst the UK schemes, whereas difficulties in linking different information systems were more widespread. Despite these barriers, many schemes – including those that failed to improve health or reduce costs – reported that access to care had improved. Some of these schemes revealed substantial levels of unmet need and so total costs increased. Conclusions It is often assumed in policy that integrating funding will promote integrated care, and lead to better health outcomes and lower costs. Both our agency theory-based framework and the evidence indicate that the link is likely to be weak. Integrated care may uncover unmet need. Resolving this can benefit both individuals and society, but total care costs are likely to rise. Provided that integration delivers improvements in quality of life, even with additional costs, it may, nonetheless, offer value for money. PMID:25595287

An Evaluation of Different Target Enrichment Methods in Pooled Sequencing Designs for Complex Disease Association Studies

PubMed Central

Day-Williams, Aaron G.; McLay, Kirsten; Drury, Eleanor; Edkins, Sarah; Coffey, Alison J.; Palotie, Aarno; Zeggini, Eleftheria

2011-01-01

Pooled sequencing can be a cost-effective approach to disease variant discovery, but its applicability in association studies remains unclear. We compare sequence enrichment methods coupled to next-generation sequencing in non-indexed pools of 1, 2, 10, 20 and 50 individuals and assess their ability to discover variants and to estimate their allele frequencies. We find that pooled resequencing is most usefully applied as a variant discovery tool due to limitations in estimating allele frequency with high enough accuracy for association studies, and that in-solution hybrid-capture performs best among the enrichment methods examined regardless of pool size. PMID:22069447

Assessment of the cardiovascular safety of saxagliptin in patients with type 2 diabetes mellitus: pooled analysis of 20 clinical trials.

PubMed

Iqbal, Nayyar; Parker, Artist; Frederich, Robert; Donovan, Mark; Hirshberg, Boaz

2014-02-04

It is important to establish the cardiovascular (CV) safety profile of novel antidiabetic drugs. Pooled analyses were performed of 20 randomized controlled studies (N = 9156) of saxagliptin as monotherapy or add-on therapy in patients with type 2 diabetes mellitus (T2DM) as well as a subset of 11 saxagliptin + metformin studies. Adjudicated major adverse CV events (MACE; CV death, myocardial infarction [MI], and stroke) and investigator-reported heart failure were assessed, and incidence rates (IRs; events/100 patient-years) and IR ratios (IRRs; saxagliptin/control) were calculated (Mantel-Haenszel method). In pooled datasets, the IR point estimates for MACE and individual components of CV death, MI, and stroke favored saxagliptin, but the 95% CI included 1. IRR (95% CI) for MACE in the 20-study pool was 0.74 (0.45, 1.25). The Cox proportional hazard ratio (95% CI) was 0.75 (0.46, 1.21), suggesting no increased risk of MACE in the 20-study pool. In the 11-study saxagliptin + metformin pool, the IRR for MACE was 0.93 (0.44, 1.99). In the 20-study pool, the IRR for heart failure was 0.55 (0.27, 1.12). Analysis of pooled data from 20 clinical trials in patients with T2DM suggests that saxagliptin is not associated with an increased CV risk.

Variability of chlorination by-product occurrence in water of indoor and outdoor swimming pools.

PubMed

Simard, Sabrina; Tardif, Robert; Rodriguez, Manuel J

2013-04-01

Swimming is one of the most popular aquatic activities. Just like natural water, public pool water may contain microbiological and chemical contaminants. The purpose of this study was to study the presence of chemical contaminants in swimming pools, in particular the presence of disinfection by-products (DBPs) such as trihalomethanes (THMs), haloacetic acids (HAAs) and inorganic chloramines (CAMi). Fifty-four outdoor and indoor swimming pools were investigated over a period of one year (monthly or bi-weekly sampling, according to the type of pool) for the occurrence of DBPs. The results showed that DBP levels in swimming pools were greater than DBP levels found in drinking water, especially for HAAs. Measured concentrations of THMs (97.9 vs 63.7 μg/L in average) and HAAs (807.6 vs 412.9 μg/L in average) were higher in outdoor pools, whereas measured concentrations of CAMi (0.1 vs 0.8 mg/L in average) were higher in indoor pools. Moreover, outdoor pools with heated water contained more DBPs than unheated pools. Finally, there was significant variability in tTHM, HAA9 and CAMi levels in pools supplied by the same municipal drinking water network, suggesting that individual pool characteristics (number of swimmers) and management strategies play a major role in DBP formation. Copyright © 2012 Elsevier Ltd. All rights reserved.

Perceived challenges to achieving universal health coverage: a cross-sectional survey of social health insurance managers/administrators in China.

PubMed

Shan, Linghan; Wu, Qunhong; Liu, Chaojie; Li, Ye; Cui, Yu; Liang, Zi; Hao, Yanhua; Liang, Libo; Ning, Ning; Ding, Ding; Pan, Qingxia; Han, Liyuan

2017-06-02

China has achieved over 96% health insurance coverage. However, universal health coverage (UHC) entails population coverage and the range of services covered and the extent to which health service costs are covered. This study aimed to determine the performance of the health insurance system in China in terms of its role in UHC and to identify challenges in the progress of UHC as perceived by health insurance managers/administrators. A cross-sectional questionnaire survey was conducted in Beijing, Ningbo, Harbin and Chongqing over the period of 2014 and 2015. A stratified cluster random sampling strategy was adopted to select study participants. A total of 1277 (64.8%) respondents who reported familiarity with the current health insurance system and the requirements of UHC provided valid data for analyses. They gave a rating on the role of the current health insurance system in achieving UHC. A multivariate logistic regression model was developed to determine the associations between the rating and the features of insurance arrangements. There was consensus among the respondents on the performance of the current health insurance system in terms of its role in UHC, regardless who they were and what responsibility they held in their organisation (ie, policy development, managing fund transactions, and so on). Overall, about 45% of the respondents believed that there is a long way to go to achieve UHC. The low rating was found to be associated with limited financial protection (OR=1.656, 95% CI 1.279 to 2.146), healthcare inequity (OR=1.607, 95% CI 1.268 to 2.037), poor portability (OR=1.347, 95% CI 1.065 to 1.703) and ineffective supervision and administration of funds (OR=1.339, 95% CI 1.061 to 1.692) as perceived by the respondents. Health insurance managers/administrators in China are pessimistic about the achievements of the current health insurance system. They are concerned about the overall lack of benefit that insurance programmes bring to members, including low levels of entitlements, large healthcare inequity, limited financial protection and poor portability. A singular amendment of the structural design of the existing funds may not be enough to offer a satisfactory solution to these identified barriers. There is a need to increase funding capacities, to develop unified and consistent policies and to increase the level of fund pooling. © 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.

Perceived challenges to achieving universal health coverage: a cross-sectional survey of social health insurance managers/administrators in China

PubMed Central

Shan, Linghan; Wu, Qunhong; Liu, Chaojie; Li, Ye; Cui, Yu; Liang, Zi; Hao, Yanhua; Liang, Libo; Ning, Ning; Ding, Ding; Pan, Qingxia; Han, Liyuan

2017-01-01

Objective China has achieved over 96% health insurance coverage. However, universal health coverage (UHC) entails population coverage and the range of services covered and the extent to which health service costs are covered. This study aimed to determine the performance of the health insurance system in China in terms of its role in UHC and to identify challenges in the progress of UHC as perceived by health insurance managers/administrators. Methods A cross-sectional questionnaire survey was conducted in Beijing, Ningbo, Harbin and Chongqing over the period of 2014 and 2015. A stratified cluster random sampling strategy was adopted to select study participants. A total of 1277 (64.8%) respondents who reported familiarity with the current health insurance system and the requirements of UHC provided valid data for analyses. They gave a rating on the role of the current health insurance system in achieving UHC. A multivariate logistic regression model was developed to determine the associations between the rating and the features of insurance arrangements. Results There was consensus among the respondents on the performance of the current health insurance system in terms of its role in UHC, regardless who they were and what responsibility they held in their organisation (ie, policy development, managing fund transactions, and so on). Overall, about 45% of the respondents believed that there is a long way to go to achieve UHC. The low rating was found to be associated with limited financial protection (OR=1.656, 95% CI 1.279 to 2.146), healthcare inequity (OR=1.607, 95% CI 1.268 to 2.037), poor portability (OR=1.347, 95% CI 1.065 to 1.703) and ineffective supervision and administration of funds (OR=1.339, 95% CI 1.061 to 1.692) as perceived by the respondents. Conclusion Health insurance managers/administrators in China are pessimistic about the achievements of the current health insurance system. They are concerned about the overall lack of benefit that insurance programmes bring to members, including low levels of entitlements, large healthcare inequity, limited financial protection and poor portability. A singular amendment of the structural design of the existing funds may not be enough to offer a satisfactory solution to these identified barriers. There is a need to increase funding capacities, to develop unified and consistent policies and to increase the level of fund pooling. PMID:28576890

Regional variation in the biogeochemical and physical characteristics of natural peatland pools.

PubMed

Turner, T Edward; Billett, Michael F; Baird, Andy J; Chapman, Pippa J; Dinsmore, Kerry J; Holden, Joseph

2016-03-01

Natural open-water pools are a common feature of northern peatlands and are known to be an important source of atmospheric methane (CH4). Pool environmental variables, particularly water chemistry, vegetation community and physical characteristics, have the potential to exert strong controls on carbon cycling in pools. A total of 66 peatland pools were studied across three regions of the UK (northern Scotland, south-west Scotland, and Northern Ireland). We found that within-region variability of pool water chemistry was low; however, for many pool variables measured there were significant differences between regions. PCA analysis showed that pools in SW Scotland were strongly associated with greater vegetative cover and shallower water depth which is likely to increase dissolved organic carbon (DOC) mineralisation rates, whereas pools in N Scotland were more open and deeper. Pool water DOC, particulate organic carbon and dissolved CH4 concentrations were significantly different between regions. Pools in Northern Ireland had the highest concentrations of DOC (mean=14.5 mg L(-1)) and CH4 (mean=20.6 μg C L(-1)). Chloride and sulphate concentrations were significantly higher in the pools in N Scotland (mean values 26.3 and 2.40 mg L(-1), respectively) than elsewhere, due to a stronger marine influence. The ratio of UV absorbance at 465 nm to absorbance at 665 nm for pools in Northern Ireland indicated that DOC was sourced from poorly humified peat, potentially increasing the bioavailability and mineralisation of organic carbon in pools compared to the pools elsewhere. This study, which specifically aims to address a lack of basic biogeochemical knowledge about pool water chemistry, clearly shows that peatland pools are highly regionally variable. This is likely to be a reflection of significant regional-scale differences in peatland C cycling. Copyright © 2015 Elsevier B.V. All rights reserved.

[Surveillance of the sanitary conditions of a public swimming pool in the city of Palermo (Italy)].

PubMed

Maida, Carmelo Massimo; Di Benedetto, Maria Antonella; Firenze, Alberto; Calamusa, Giuseppe; Di Piazza, Florinda; Milici, Maria Eleonora; Romano, Nino

2008-01-01

In a previous study we evaluated the microbiological quality of water of seven pools in the city of Palermo through evaluation of bacterial indicators of faecal contamination and of protozoa (Giardia and Cryptosporidium). In this study we also searched for the presence of fungi in two swimming pools of a public swimming facility in the same city. Samples were collected from both pools, their filtration systems and floor surfaces of the facility. Chemical-physical and microbiological examination of water of the two pools have shown that quality of water depends on the concentration of residual free chlorine and on the number of bathers in the pool. The values of four microbiological parameters (bacterial load at 22 degrees C and 36 degrees C, presence of coagulase-negative Staphylococci and Pseudomonas spp.) increased with diminishing chlorine concentrations and with increasing number of pool users. Faecal bacteria, Giardia and Cryptosporidium were not found. On the other hand, various fungi were isolated from floor surfaces and pool water even in the presence of optimal chlorine concentrations. This study confirms the importance of regular maintenance of pool disinfection systems and suggests the need to search for other micro-organisms not included in the current legislation (Giardia, Cryptosporidium and fungi).

A comparative survey of missed initial and follow-up appointments to psychiatric specialties in the United kingdom.

PubMed

Mitchell, Alex J; Selmes, Thomas

2007-06-01

Missed appointments are common in psychiatry. Nonattendance at the initial appointment may have different prognostic significance than nonattendance at subsequent appointments. This study examined the frequency of missed appointments among 9,511 initial outpatient appointments and 7,700 follow-up appointments across ten psychiatric subspecialties in a publicly funded mental health service in the United Kingdom. The pooled missed appointment rate was 15.9%, higher than in previous studies on primary and secondary care attendance in the United Kingdom. Nonattendance was lowest on Fridays, in winter months, and in geriatric psychiatry and highest for substance abuse services and in community psychiatry. In most services, attendance improved after the initial appointment, but in psychosomatic medicine and geriatric psychiatry this pattern was reversed. There was a low rate of missed appointments in geriatric psychiatry, rehabilitation psychiatry, cognitive-behavioral therapy, and psychosocial medicine. A high nonattendance rate was found among persons with drug and alcohol difficulties and to a lesser extent in general adult psychiatry. Future studies should consider initial and follow-up appointments as distinct.

Designing and evaluating health systems level hypertension control interventions for African-Americans: lessons from a pooled analysis of three cluster randomized trials.

PubMed

Pavlik, Valory N; Chan, Wenyaw; Hyman, David J; Feldman, Penny; Ogedegbe, Gbenga; Schwartz, Joseph E; McDonald, Margaret; Einhorn, Paula; Tobin, Jonathan N

2015-01-01

African-Americans (AAs) have a high prevalence of hypertension and their blood pressure (BP) control on treatment still lags behind other groups. In 2004, NHLBI funded five projects that aimed to evaluate clinically feasible interventions to effect changes in medical care delivery leading to an increased proportion of AA patients with controlled BP. Three of the groups performed a pooled analysis of trial results to determine: 1) the magnitude of the combined intervention effect; and 2) how the pooled results could inform the methodology for future health-system level BP interventions. Using a cluster randomized design, the trials enrolled AAs with uncontrolled hypertension to test interventions targeting a combination of patient and clinician behaviors. The 12-month Systolic BP (SBP) and Diastolic BP (DBP) effects of intervention or control cluster assignment were assessed using mixed effects longitudinal regression modeling. 2,015 patients representing 352 clusters participated across the three trials. Pooled BP slopes followed a quadratic pattern, with an initial decline, followed by a rise toward baseline, and did not differ significantly between intervention and control clusters: SBP linear coefficient = -2.60±0.21 mmHg per month, p<0.001; quadratic coefficient = 0.167± 0.02 mmHg/month, p<0.001; group by time interaction group by time group x linear time coefficient=0.145 ± 0.293, p=0.622; group x quadratic time coefficient= -0.017 ± 0.026, p=0.525). RESULTS were similar for DBP. The individual sites did not have significant intervention effects when analyzed separately. Investigators planning behavioral trials to improve BP control in health systems serving AAs should plan for small effect sizes and employ a "run-in" period in which BP can be expected to improve in both experimental and control clusters.

Investigation of rare and low-frequency variants using high-throughput sequencing with pooled DNA samples

PubMed Central

Wang, Jingwen; Skoog, Tiina; Einarsdottir, Elisabet; Kaartokallio, Tea; Laivuori, Hannele; Grauers, Anna; Gerdhem, Paul; Hytönen, Marjo; Lohi, Hannes; Kere, Juha; Jiao, Hong

2016-01-01

High-throughput sequencing using pooled DNA samples can facilitate genome-wide studies on rare and low-frequency variants in a large population. Some major questions concerning the pooling sequencing strategy are whether rare and low-frequency variants can be detected reliably, and whether estimated minor allele frequencies (MAFs) can represent the actual values obtained from individually genotyped samples. In this study, we evaluated MAF estimates using three variant detection tools with two sets of pooled whole exome sequencing (WES) and one set of pooled whole genome sequencing (WGS) data. Both GATK and Freebayes displayed high sensitivity, specificity and accuracy when detecting rare or low-frequency variants. For the WGS study, 56% of the low-frequency variants in Illumina array have identical MAFs and 26% have one allele difference between sequencing and individual genotyping data. The MAF estimates from WGS correlated well (r = 0.94) with those from Illumina arrays. The MAFs from the pooled WES data also showed high concordance (r = 0.88) with those from the individual genotyping data. In conclusion, the MAFs estimated from pooled DNA sequencing data reflect the MAFs in individually genotyped samples well. The pooling strategy can thus be a rapid and cost-effective approach for the initial screening in large-scale association studies. PMID:27633116

Introducing risk adjustment and free health plan choice in employer-based health insurance: Evidence from Germany.

PubMed

Pilny, Adam; Wübker, Ansgar; Ziebarth, Nicolas R

2017-12-01

To equalize differences in health plan premiums due to differences in risk pools, the German legislature introduced a simple Risk Adjustment Scheme (RAS) based on age, gender and disability status in 1994. In addition, effective 1996, consumers gained the freedom to choose among hundreds of existing health plans, across employers and state-borders. This paper (a) estimates RAS pass-through rates on premiums, financial reserves, and expenditures and assesses the overall RAS impact on market price dispersion. Moreover, it (b) characterizes health plan switchers and investigates their annual and cumulative switching rates over time. Our main findings are based on representative enrollee panel data linked to administrative RAS and health plan data. We show that sickness funds with bad risk pools and high pre-RAS premiums lowered their total premiums by 42 cents per additional euro allocated by the RAS. Consequently, post-RAS, health plan prices converged but not fully. Because switchers are more likely to be white collar, young and healthy, the new consumer choice resulted in more risk segregation and the amount of money redistributed by the RAS increased over time. Copyright © 2017 Elsevier B.V. All rights reserved.

The 2010 U.S. health care reform: approaching and avoiding how other countries finance health care.

PubMed

White, Joseph

2013-07-01

This article describes and analyzes the U.S. health care legislation of 2010 by asking how far it was designed to move the U.S. system in the direction of practices in all other rich democracies. The enacted U.S. reform could be described, extremely roughly, as Japanese pooling with Swiss and American problems at American prices. Its policies are distinctive, yet nevertheless somewhat similar to examples in other rich democracies, on two important dimensions: how risks are pooled and the amount of funds redistributed to subsidize care for people with lower incomes. Policies about compelling people to contribute to a finance system would be further from international norms, as would the degree to which coverage is set by clear and common substantive standards--that is, standardization of benefits. The reform would do least, however, to move the United States toward international practices for controlling spending. This in turn is a major reason why the results would include less standard benefits and incomplete coverage. In short, the United States would remain an outlier on coverage less because of a failure to make an effort to redistribute--a lack of solidarity--than due to a failure to control costs.

Rank-based pooling for deep convolutional neural networks.

PubMed

Shi, Zenglin; Ye, Yangdong; Wu, Yunpeng

2016-11-01

Pooling is a key mechanism in deep convolutional neural networks (CNNs) which helps to achieve translation invariance. Numerous studies, both empirically and theoretically, show that pooling consistently boosts the performance of the CNNs. The conventional pooling methods are operated on activation values. In this work, we alternatively propose rank-based pooling. It is derived from the observations that ranking list is invariant under changes of activation values in a pooling region, and thus rank-based pooling operation may achieve more robust performance. In addition, the reasonable usage of rank can avoid the scale problems encountered by value-based methods. The novel pooling mechanism can be regarded as an instance of weighted pooling where a weighted sum of activations is used to generate the pooling output. This pooling mechanism can also be realized as rank-based average pooling (RAP), rank-based weighted pooling (RWP) and rank-based stochastic pooling (RSP) according to different weighting strategies. As another major contribution, we present a novel criterion to analyze the discriminant ability of various pooling methods, which is heavily under-researched in machine learning and computer vision community. Experimental results on several image benchmarks show that rank-based pooling outperforms the existing pooling methods in classification performance. We further demonstrate better performance on CIFAR datasets by integrating RSP into Network-in-Network. Copyright © 2016 Elsevier Ltd. All rights reserved.

Characterizing convective cold pools: Characterizing Convective Cold Pools

DOE PAGES

Drager, Aryeh J.; van den Heever, Susan C.

2017-05-09

Cold pools produced by convective storms play an important role in Earth's climate system. However, a common framework does not exist for objectively identifying convective cold pools in observations and models. The present study investigates convective cold pools within a simulation of tropical continental convection that uses a cloud-resolving model with a coupled land-surface model. Multiple variables are assessed for their potential in identifying convective cold pool boundaries, and a novel technique is developed and tested for identifying and tracking cold pools in numerical model simulations. This algorithm is based on surface rainfall rates and radial gradients in the densitymore » potential temperature field. The algorithm successfully identifies near-surface cold pool boundaries and is able to distinguish between connected cold pools. Once cold pools have been identified and tracked, composites of cold pool evolution are then constructed, and average cold pool properties are investigated. Wet patches are found to develop within the centers of cold pools where the ground has been soaked with rainwater. These wet patches help to maintain cool surface temperatures and reduce cold pool dissipation, which has implications for the development of subsequent convection.« less

Characterizing convective cold pools: Characterizing Convective Cold Pools

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

Drager, Aryeh J.; van den Heever, Susan C.

Cold pools produced by convective storms play an important role in Earth's climate system. However, a common framework does not exist for objectively identifying convective cold pools in observations and models. The present study investigates convective cold pools within a simulation of tropical continental convection that uses a cloud-resolving model with a coupled land-surface model. Multiple variables are assessed for their potential in identifying convective cold pool boundaries, and a novel technique is developed and tested for identifying and tracking cold pools in numerical model simulations. This algorithm is based on surface rainfall rates and radial gradients in the densitymore » potential temperature field. The algorithm successfully identifies near-surface cold pool boundaries and is able to distinguish between connected cold pools. Once cold pools have been identified and tracked, composites of cold pool evolution are then constructed, and average cold pool properties are investigated. Wet patches are found to develop within the centers of cold pools where the ground has been soaked with rainwater. These wet patches help to maintain cool surface temperatures and reduce cold pool dissipation, which has implications for the development of subsequent convection.« less

[The gene pool of Belgorod oblast population: study of biochemical gene markers in populations of Ukraine and Belarus and the position of the Belgorod population in the Eastern Slavic gene pool system].

PubMed

Lependina, I N; Churnosov, M I; Artamentova, L A; Ishchuk, M A; Tegako, O V; Balanovskaia, E V

2008-04-01

The characteristics of the gene pools of indigenous populations of Ukraine and Belarus have been studied using 28 alleles of 10 loci of biochemical gene markers (HP, GC, TF, PI, C'3, ACP1, GLO1, PGM1, ESD, and 6-PGD). The gene pools of the Russian and Ukrainian indigenous populations of Belgorod oblast (Russia) and the indigenous populations of Ukraine and Belarus have been compared. Cluster analysis, multidimensional scaling, and factor analysis of the obtained data have been used to determine the position of the Belgorod population gene pool in the Eastern Slavic gene pool system.

Design of association studies with pooled or un-pooled next-generation sequencing data.

PubMed

Kim, Su Yeon; Li, Yingrui; Guo, Yiran; Li, Ruiqiang; Holmkvist, Johan; Hansen, Torben; Pedersen, Oluf; Wang, Jun; Nielsen, Rasmus

2010-07-01

Most common hereditary diseases in humans are complex and multifactorial. Large-scale genome-wide association studies based on SNP genotyping have only identified a small fraction of the heritable variation of these diseases. One explanation may be that many rare variants (a minor allele frequency, MAF <5%), which are not included in the common genotyping platforms, may contribute substantially to the genetic variation of these diseases. Next-generation sequencing, which would allow the analysis of rare variants, is now becoming so cheap that it provides a viable alternative to SNP genotyping. In this paper, we present cost-effective protocols for using next-generation sequencing in association mapping studies based on pooled and un-pooled samples, and identify optimal designs with respect to total number of individuals, number of individuals per pool, and the sequencing coverage. We perform a small empirical study to evaluate the pooling variance in a realistic setting where pooling is combined with exon-capturing. To test for associations, we develop a likelihood ratio statistic that accounts for the high error rate of next-generation sequencing data. We also perform extensive simulations to determine the power and accuracy of this method. Overall, our findings suggest that with a fixed cost, sequencing many individuals at a more shallow depth with larger pool size achieves higher power than sequencing a small number of individuals in higher depth with smaller pool size, even in the presence of high error rates. Our results provide guidelines for researchers who are developing association mapping studies based on next-generation sequencing. (c) 2010 Wiley-Liss, Inc.

Practice and Educational Gaps in Cosmetic Dermatologic Surgery.

PubMed

Waldman, Abigail; Sobanko, Joseph F; Alam, Murad

2016-07-01

This article identifies gaps in the practice of cosmetic dermatology and cosmetics education, and how to overcome these limitations. There is a rapid development of new devices and procedures, with limited data, patient-reported outcomes, and comparative effectiveness research from which to develop best cosmetic practice. There is a need for increased research and funding dedicated to these goals, improved and convenient training for staff to adopt new devices/procedures, and continuous evolution of databases to pool outcome data and develop outcome sets. Resident education can be improved by dedicated resident cosmetic clinics, didactic teaching from visiting professors, attendance of cosmetic dermatology courses and meetings, and encouraging postresidency training. Copyright © 2016 Elsevier Inc. All rights reserved.

Assessment of the cardiovascular safety of saxagliptin in patients with type 2 diabetes mellitus: pooled analysis of 20 clinical trials

PubMed Central

2014-01-01

Background It is important to establish the cardiovascular (CV) safety profile of novel antidiabetic drugs. Methods Pooled analyses were performed of 20 randomized controlled studies (N = 9156) of saxagliptin as monotherapy or add-on therapy in patients with type 2 diabetes mellitus (T2DM) as well as a subset of 11 saxagliptin + metformin studies. Adjudicated major adverse CV events (MACE; CV death, myocardial infarction [MI], and stroke) and investigator-reported heart failure were assessed, and incidence rates (IRs; events/100 patient-years) and IR ratios (IRRs; saxagliptin/control) were calculated (Mantel-Haenszel method). Results In pooled datasets, the IR point estimates for MACE and individual components of CV death, MI, and stroke favored saxagliptin, but the 95% CI included 1. IRR (95% CI) for MACE in the 20-study pool was 0.74 (0.45, 1.25). The Cox proportional hazard ratio (95% CI) was 0.75 (0.46, 1.21), suggesting no increased risk of MACE in the 20-study pool. In the 11-study saxagliptin + metformin pool, the IRR for MACE was 0.93 (0.44, 1.99). In the 20-study pool, the IRR for heart failure was 0.55 (0.27, 1.12). Conclusions Analysis of pooled data from 20 clinical trials in patients with T2DM suggests that saxagliptin is not associated with an increased CV risk. PMID:24490835

Science communication and vernal pool conservation: a study of local decision maker attitudes in a knowledge-action system.

PubMed

McGreavy, Bridie; Webler, Thomas; Calhoun, Aram J K

2012-03-01

In this study, we describe local decision maker attitudes towards vernal pools to inform science communication and enhance vernal pool conservation efforts. We conducted interviews with town planning board and conservation commission members (n = 9) from two towns in the State of Maine in the northeastern United States. We then mailed a questionnaire to a stratified random sample of planning board members in August and September 2007 with a response rate of 48.4% (n = 320). The majority of survey respondents favored the protection and conservation of vernal pools in their towns. Decision makers were familiar with the term "vernal pool" and demonstrated positive attitudes to vernal pools in general. General appreciation and willingness to conserve vernal pools predicted support for the 2006 revisions to the Natural Resource Protection Act regulating Significant Vernal Pools. However, 48% of respondents were unaware of this law and neither prior knowledge of the law nor workshop attendance predicted support for the vernal pool law. Further, concerns about private property rights and development restrictions predicted disagreement with the vernal pool law. We conclude that science communication must rely on specific frames of reference, be sensitive to cultural values, and occur in an iterative system to link knowledge and action in support of vernal pool conservation. Copyright © 2011 Elsevier Ltd. All rights reserved.

Cool Water Formation and Trout Habitat Use in a Deep Pool in the Sierra Nevada, California

Treesearch

KATHLEEN R. MATTHEWS; NEIL H. BERG; AZUMA DAVID L.

1994-01-01

We documented temperature stratification in a deep bedrock pool in the North Fork of the American River, described the diel movement of rainbow trout Oncorhynchus mykiss and brown trout Salmo trutta. and determined whether these trout used cooler portions of the pool.From July 30 to October 10, 1992, the main study pool and an adjacent pool were stratified(temperature...

Impact and quantification of the sources of error in DNA pooling designs.

PubMed

Jawaid, A; Sham, P

2009-01-01

The analysis of genome wide variation offers the possibility of unravelling the genes involved in the pathogenesis of disease. Genome wide association studies are also particularly useful for identifying and validating targets for therapeutic intervention as well as for detecting markers for drug efficacy and side effects. The cost of such large-scale genetic association studies may be reduced substantially by the analysis of pooled DNA from multiple individuals. However, experimental errors inherent in pooling studies lead to a potential increase in the false positive rate and a loss in power compared to individual genotyping. Here we quantify various sources of experimental error using empirical data from typical pooling experiments and corresponding individual genotyping counts using two statistical methods. We provide analytical formulas for calculating these different errors in the absence of complete information, such as replicate pool formation, and for adjusting for the errors in the statistical analysis. We demonstrate that DNA pooling has the potential of estimating allele frequencies accurately, and adjusting the pooled allele frequency estimates for differential allelic amplification considerably improves accuracy. Estimates of the components of error show that differential allelic amplification is the most important contributor to the error variance in absolute allele frequency estimation, followed by allele frequency measurement and pool formation errors. Our results emphasise the importance of minimising experimental errors and obtaining correct error estimates in genetic association studies.

A Critical Analysis of Purchasing Arrangements in Kenya: The Case of the National Hospital Insurance Fund

PubMed Central

Munge, Kenneth; Mulupi, Stephen; Barasa, Edwine W.; Chuma, Jane

2018-01-01

Background: Purchasing refers to the process by which pooled funds are paid to providers in order to deliver a set of health care interventions. Very little is known about purchasing arrangements in low- and middle-income countries (LMICs), and certainly not in Kenya. This study aimed to critically analyse purchasing arrangements in Kenya, using the National Hospital Insurance Fund (NHIF) as a case study. Methods: We applied a principal-agent relationship framework, which identifies three pairs of principal-agent relationships (government-purchaser, purchaser-provider, and citizen-purchaser) and specific actions required within them to achieve strategic purchasing. A qualitative case study approach was applied. Data were collected through document reviews (statutes, policy and regulatory documents) and in-depth interviews (n=62) with key informants including NHIF officials, Ministry of Health (MoH) officials, insurance industry actors, and health service providers. Documents were summarised using standardised forms. Interviews were recorded, transcribed verbatim, and analysed using a thematic framework approach. Results: The regulatory and policy framework for strategic purchasing in Kenya was weak and there was no clear accountability mechanism between the NHIF and the MoH. Accountability mechanisms within the NHIF have developed over time, but these emphasized financial performance over other aspects of purchasing. The processes for contracting, monitoring, and paying providers do not promote equity, quality, and efficiency. This was partly due to geographical distribution of providers, but also due to limited capacity within the NHIF. There are some mechanisms for assessing needs, preferences, and values to inform design of the benefit package, and while channels to engage beneficiaries exist, they do not always function appropriately and awareness of these channels to the beneficiaries is limited. Conclusion: Addressing the gaps in the NHIF’s purchasing performance requires a number of approaches. Critically, there is a need for the government through the MoH to embrace its stewardship role in health, while recognizing the multiplicity of actors given Kenya’s devolved context. Relatively recent decentralisation reforms present an opportunity that should be grasped to rewrite the contract between the government, the NHIF and Kenyans in the pursuit of universal health coverage (UHC). PMID:29524953

Methodological Flaws, Conflicts of Interest, and Scientific Fallacies: Implications for the Evaluation of Antidepressants' Efficacy and Harm.

PubMed

Hengartner, Michael P

2017-01-01

In current psychiatric practice, antidepressants are widely and with ever-increasing frequency prescribed to patients. However, several scientific biases obfuscate estimates of antidepressants' efficacy and harm, and these are barely recognized in treatment guidelines. The aim of this mini-review is to critically evaluate the efficacy and harm of antidepressants for acute and maintenance treatment with respect to systematic biases related to industry funding and trial methodology. Narrative review based on a comprehensive search of the literature. It is shown that the pooled efficacy of antidepressants is weak and below the threshold of a minimally clinically important change once publication and reporting biases are considered. Moreover, the small mean difference in symptom reductions relative to placebo is possibly attributable to observer effects in unblinded assessors and patient expectancies. With respect to trial dropout rates, a hard outcome not subjected to observer bias, no difference was observed between antidepressants and placebo. The discontinuation trials on the efficacy of antidepressants in maintenance therapy are systematically flawed, because in these studies, spontaneous remitters are excluded, whereas half of all patients who remitted on antidepressants are abruptly switched to placebo. This can cause a severe withdrawal syndrome that is easily misdiagnosed as a relapse when assessed on subjective symptom rating scales. In accordance, the findings of naturalistic long-term studies suggest that maintenance therapy has no clear benefit, and non-drug users do not show increased recurrence rates. Moreover, a growing body of evidence from hundreds of randomized controlled trials suggests that antidepressants cause suicidality, but this risk is underestimated because data from industry-funded trials are systematically flawed. Unselected, population-wide observational studies indicate that depressive patients who use antidepressants are at an increased risk of suicide and that they have a higher rate of all-cause mortality than matched controls. The strong reliance on industry-funded research results in an uncritical approval of antidepressants. Due to several flaws such as publication and reporting bias, unblinding of outcome assessors, concealment and recoding of serious adverse events, the efficacy of antidepressants is systematically overestimated, and harm is systematically underestimated. Therefore, I conclude that antidepressants are largely ineffective and potentially harmful.

Innovating patient care delivery: DSRIP's interrupted time series analysis paradigm.

PubMed

Shenoy, Amrita G; Begley, Charles E; Revere, Lee; Linder, Stephen H; Daiger, Stephen P

2017-12-08

Adoption of Medicaid Section 1115 waiver is one of the many ways of innovating healthcare delivery system. The Delivery System Reform Incentive Payment (DSRIP) pool, one of the two funding pools of the waiver has four categories viz. infrastructure development, program innovation and redesign, quality improvement reporting and lastly, bringing about population health improvement. A metric of the fourth category, preventable hospitalization (PH) rate was analyzed in the context of eight conditions for two time periods, pre-reporting years (2010-2012) and post-reporting years (2013-2015) for two hospital cohorts, DSRIP participating and non-participating hospitals. The study explains how DSRIP impacted Preventable Hospitalization (PH) rates of eight conditions for both hospital cohorts within two time periods. Eight PH rates were regressed as the dependent variable with time, intervention and post-DSRIP Intervention as independent variables. PH rates of eight conditions were then consolidated into one rate for regressing with the above independent variables to evaluate overall impact of DSRIP. An interrupted time series regression was performed after accounting for auto-correlation, stationarity and seasonality in the dataset. In the individual regression model, PH rates showed statistically significant coefficients for seven out of eight conditions in DSRIP participating hospitals. In the combined regression model, the coefficient of the PH rate showed a statistically significant decrease with negative p-values for regression coefficients in DSRIP participating hospitals compared to positive/increased p-values for regression coefficients in DSRIP non-participating hospitals. Several macro- and micro-level factors may have likely contributed DSRIP hospitals outperforming DSRIP non-participating hospitals. Healthcare organization/provider collaboration, support from healthcare professionals, DSRIP's design, state reimbursement and coordination in care delivery methods may have led to likely success of DSRIP. IV, a retrospective cohort study based on longitudinal data. Copyright © 2017 Elsevier Inc. All rights reserved.

Estimating the efficacy of Alcoholics Anonymous without self-selection bias: An instrumental variables re-analysis of randomized clinical trials

PubMed Central

Humphreys, Keith; Blodgett, Janet C.; Wagner, Todd H.

2014-01-01

Background Observational studies of Alcoholics Anonymous’ (AA) effectiveness are vulnerable to self-selection bias because individuals choose whether or not to attend AA. The present study therefore employed an innovative statistical technique to derive a selection bias-free estimate of AA’s impact. Methods Six datasets from 5 National Institutes of Health-funded randomized trials (one with two independent parallel arms) of AA facilitation interventions were analyzed using instrumental variables models. Alcohol dependent individuals in one of the datasets (n = 774) were analyzed separately from the rest of sample (n = 1582 individuals pooled from 5 datasets) because of heterogeneity in sample parameters. Randomization itself was used as the instrumental variable. Results Randomization was a good instrument in both samples, effectively predicting increased AA attendance that could not be attributed to self-selection. In five of the six data sets, which were pooled for analysis, increased AA attendance that was attributable to randomization (i.e., free of self-selection bias) was effective at increasing days of abstinence at 3-month (B = .38, p = .001) and 15-month (B = 0.42, p = .04) follow-up. However, in the remaining dataset, in which pre-existing AA attendance was much higher, further increases in AA involvement caused by the randomly assigned facilitation intervention did not affect drinking outcome. Conclusions For most individuals seeking help for alcohol problems, increasing AA attendance leads to short and long term decreases in alcohol consumption that cannot be attributed to self-selection. However, for populations with high pre-existing AA involvement, further increases in AA attendance may have little impact. PMID:25421504

Estimating the efficacy of Alcoholics Anonymous without self-selection bias: an instrumental variables re-analysis of randomized clinical trials.

PubMed

Humphreys, Keith; Blodgett, Janet C; Wagner, Todd H

2014-11-01

Observational studies of Alcoholics Anonymous' (AA) effectiveness are vulnerable to self-selection bias because individuals choose whether or not to attend AA. The present study, therefore, employed an innovative statistical technique to derive a selection bias-free estimate of AA's impact. Six data sets from 5 National Institutes of Health-funded randomized trials (1 with 2 independent parallel arms) of AA facilitation interventions were analyzed using instrumental variables models. Alcohol-dependent individuals in one of the data sets (n = 774) were analyzed separately from the rest of sample (n = 1,582 individuals pooled from 5 data sets) because of heterogeneity in sample parameters. Randomization itself was used as the instrumental variable. Randomization was a good instrument in both samples, effectively predicting increased AA attendance that could not be attributed to self-selection. In 5 of the 6 data sets, which were pooled for analysis, increased AA attendance that was attributable to randomization (i.e., free of self-selection bias) was effective at increasing days of abstinence at 3-month (B = 0.38, p = 0.001) and 15-month (B = 0.42, p = 0.04) follow-up. However, in the remaining data set, in which preexisting AA attendance was much higher, further increases in AA involvement caused by the randomly assigned facilitation intervention did not affect drinking outcome. For most individuals seeking help for alcohol problems, increasing AA attendance leads to short- and long-term decreases in alcohol consumption that cannot be attributed to self-selection. However, for populations with high preexisting AA involvement, further increases in AA attendance may have little impact. Copyright © 2014 by the Research Society on Alcoholism.

Biochemical and immunohistochemical characterization of proteins in Hürthle cell carcinoma.

PubMed

De Keyser, L; Layfield, L; Van Herle, A; Costin, A; Lewin, K

1984-10-01

The present study reports the biochemical and immunohistochemical findings in the cytosol of a Hürthle cell carcinoma as compared with that of normal thyroid tissue. Sephadex G-200 chromatography of the extract derived from a Hürthle cell carcinoma and from normal thyroid tissue revealed three identical pools. Pool I consisted mainly of thyroglobulin (Tg), pool II corresponded to albumin, while pool III contained unidentified low molecular weight fragments which could not be studied further. Hürthle cell carcinoma, pool I, had a Tg content of 12.9 micrograms Tg/mg equivalent tissue and a 127I content of 5,6 mole/mole of Tg. Its sialic acid content was undetectable, however. In pool I of the normal thyroid gland, the respective values were 62.8 micrograms Tg/mg equivalent tissue, 21.3 +/mole 127I/mole Tg, and 15.4 mole sialic acid/mole Tg. The albumin contained in both pools II was shown to be ioidinated at the following levels: 0.025 mole 127I/mole albumin in Hürthle tumor pool II vs 1.28 mole 127I/mole albumin in normal thyroid pool II. Immunohistochemical studies confirmed the presence of Tg and albumin in the malignant Hürthle cells and acini and colloid. Thus, Hürthle cell carcinoma contained Tg and albumin. The Tg content was five times less compared with control tissue. Both proteins (Tg and albumin) were poorly iodinated in Hürthle carcinoma tissue, and the iodination of albumina seemed to be more severely impaired. The site of synthesis of both proteins could not be derived from the present studies.

Ten-year survey of program directors: trends, challenges, and mentoring in prosthodontics. Part 1.

PubMed

Munoz, Deborah M; Kinnunen, Taru; Chang, Brian M; Wright, Robert F

2011-10-01

This study consisted of two parts. Part 1 was a survey of US program directors, and Part 2 reports on the survey findings distributed to the deans of US dental schools. Both surveys evaluated observations of trends in prosthodontic education. The first survey (2005) of program directors and deans was published in 2007. This second survey was conducted in 2009. The 2009 survey provided 10-year data on trends in prosthodontics as reported by program directors. A national e-mail survey of 46 program directors was used to collect enrollment data for years 1 to 3 of prosthodontics training for US and international dental school graduates, the total number of applicants and applications considered, and the trends over time of applicants to prosthodontics for US dental school graduates and for international graduates. In addition, the program directors were asked to rank 13 key factors that may have contributed to any changes in the prosthodontic applicant pool. Program directors were also asked for information on student financial incentives and whether their programs were state or federally funded, and whether their sponsoring institution was a dental school. Of the 46 program directors, 40 responded, for an 87% response rate. Respondents reported that 66% of their enrollees were graduates of US dental schools. Between 2000 and 2009 the applicant pool in prosthodontics nearly doubled, with 50% of the program directors reporting an increase in US-trained applicants, 42.5% reporting no change, and only 7.5% reporting a decrease. Using the Spearman correlation for the 10-year survey, there was a positive, statistically significant correlation that society's demand for a higher level of training and credentialing and interest in prosthodontics among dental students contributed to an increase in the number of US dental graduates applying to prosthodontic programs. Only four programs offered no financial packages to offset tuition. The remaining 36 respondents reported some financial package. Among the respondents, there were 23 state-sponsored programs and 6 sponsored by private universities; the remaining 9 were sponsored by hospitals or federal agencies. A nearly doubled applicant pool and more US-trained applicants to prosthodontics ensure a much more competitive applicant pool for our specialty. In the 2009 survey, program directors reported that factors such as society's demand for a higher level of training and credentialing, interest in prosthodontics among US dental students, advances in implant, esthetic, and reconstructive dentistry, literature pertaining to the need of prosthodontists for the future, marketing of prosthodontics as a career, and the dollar value of prosthodontic training have all had some impact on increasing the mentored applicant pool to prosthodontic training in the United States. © 2011 by The American College of Prosthodontists.

A survey of program directors: trends, challenges, and mentoring in prosthodontics. Part 1.

PubMed

Wright, Robert F; Dunlop, Ryan A; Kim, Frances M; Douglass, Chester W

2008-01-01

This study consisted of two parts. Part 1, a survey of program directors, was conducted to examine current trends in advanced education in prosthodontics in the United States. Part 2 will report on the survey results distributed to the deans of US dental schools to evaluate their observations of trends in prosthodontics. A national e-mail survey of 45 program directors was used to collect enrollment data for years 1 to 3 of prosthodontics training for US and international dental school graduates, the total number of applicants and applications considered, and the trends over time of applicants to prosthodontic programs for US dental school graduates and for international graduates. In addition, the program directors were asked to rank 13 key factors that may have contributed to any changes in the prosthodontic applicant pool. Comments were accepted on why more or less US- or internationally trained applicants have applied. Program directors were also asked for information on student financial incentives, whether their programs were state or federally funded, and whether their sponsoring institution was a dental school. Of the 45 program directors, 39 responded, for an 86.7% response rate. Respondents reported that 64% of their enrollments were graduates of US dental schools. Between 2000 and 2004 the applicant pool in prosthodontics increased by 23%, with 41% of program directors reporting an increase in US-trained applicants, 46.2% reporting no change, and only 12.8% reporting a decrease. Using the Spearman correlation, there was a moderate, positive statistically significant correlation that the following factors contributed to an increase in the number of US dental graduates applying to prosthodontic programs: (1) mentoring by prosthodontists at the predoctoral level, (2) interest in prosthodontics among US dental students, and (3) society's demand for a higher level of training and credentialing, (4) data depicting current and projected income for dental specialists, and (5) number of trained prosthodontists full- or part-time faculty at the predoctoral level. Only five programs offered no financial packages to offset tuition. The remaining 34 respondents reported some financial package. Among the respondents, there were 25 state-sponsored programs, 9 sponsored by private universities, and 5 sponsored by hospitals or federal agencies. An increased applicant pool and more US-trained applicants to prosthodontics programs create a more competitive applicant pool for our specialty. Program directors reported that factors such as mentoring, society's demand for a higher level of training and credentialing, data depicting current and projected income for prosthodontists, exposure to prosthodontic faculty at the predoctoral level, the dollar value of prosthodontic training, and advances in implant, aesthetic, and reconstructive dentistry have all had some impact on increasing the applicant pool to prosthodontic training in the United States.

Formation and maintenance of a forced pool-riffle couplet following loading of large wood

NASA Astrophysics Data System (ADS)

Thompson, D. M.; Fixler, S. A.

2017-11-01

Pool-riffle maintenance has been documented in numerous studies, but it has been almost impossible to characterize detailed natural pool-riffle formation mechanisms because of the lack of baseline data prior to pool establishment. In 2013, a study was conducted on the Blackledge River in Connecticut to document the formation of a new pool-riffle couplet on a section of river that had previously been studied from 1999 to 2001. In 2001, the study reach contained a scour hole with a residual depth of 0.08 ± 0.09 m downstream of a 1930s paired deflector with no identifiable riffle immediately downstream. At this time, a large, severely undercut, hemlock tree was noted along the left bank. Sometime between fall 2001 and 2004, the tree fell perpendicular to flow across the channel and formed a large wood (LW) jam and new pool-riffle couplet several meters downstream of the old scour hole. Pool spacing along the reach decreased from 4.47 bankfull widths (BFW) in 1999 to 3.83 BFW after the new pool-riffle couplet formed. The new pool has a residual depth, the water depth of the streambed depression below the elevation of the immediate downstream hydraulic control, of 1.36 ± 0.075 to 1.59 ± 0.075 m, which resulted from a combination of 1.32 ± 0.09 m or less of incision below the old scour hole (95.6% or less of the depth increase) and up to 0.18 ± 0.09 m of downstream deposition and associated backwater formation (13.2% or less of the depth increase). To assess dynamic stability of the pool-riffle couplet over several flood cycles, surficial fine-sediment and organic material along the reach were quantified. The 23-m-long pool stores 25.7% of the surficial fine grained sediments and 15.4% of organic material along a 214-m-long reach that includes one additional artificially created pool. An adjacent 50-m-long secondary channel impacted by the LW jam stores 65.3% of the surficial fine-grained sediments and 54.8% of organic material along the full reach.

78 FR 39781 - Consequence Study of a Beyond-Design-Basis Earthquake Affecting the Spent Fuel Pool for a U.S...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-02

... Spent Fuel Pool Study). The purpose of this study was to examine if faster removal of older, colder... NRC Library at http://www.nrc.gov/reading-rm/adams.html . To begin the search, select ``ADAMS Public... of postulated spent fuel pool accidents. The purpose of this study is to examine if faster removal of...

Environmental controls of C, N and P biogeochemistry in peatland pools.

PubMed

Arsenault, Julien; Talbot, Julie; Moore, Tim R

2018-08-01

Pools are common in northern peatlands but studies have seldom focused on their nutrient biogeochemistry, especially in relation to their morphological characteristics and through seasons. We determined the environmental characteristics controlling carbon (C), nitrogen (N) and phosphorus (P) biogeochemistry in pools and assessed their evolution over the course of the 2016 growing season in a subboreal ombrotrophic peatland of eastern Canada. We showed that water chemistry variations in 62 pools were significantly explained by depth (81.9%) and the surrounding vegetation type (14.8%), but not by pool area or shape. Shallow pools had larger dissolved organic carbon (DOC) and total nitrogen (TN) concentrations and lower pH than deep pools, while pools surrounded by coniferous trees had more recalcitrant DOC than pools where vegetation was dominated by mosses. The influence of depth on pool biogeochemistry was confirmed by the seasonal survey of pools of different sizes with 47.1% of the variation in pool water chemistry over time significantly explained. Of this, 67.3% was explained by the interaction between time and pool size and 32.7% by pool size alone. P concentrations were small in all pools all summer long and combined with high N:P ratios, are indicative of P-limitation. Our results show that pool biogeochemistry is influenced by internal processes and highlight the spatial and temporal heterogeneity of nutrient biogeochemistry in ombrotrophic peatlands. Copyright © 2018 Elsevier B.V. All rights reserved.

PASSCAL Instrument Center Support for Cryoseismology: Methodologies, Challenges, Development and Instrumentation

NASA Astrophysics Data System (ADS)

Beaudoin, B. C.; Anderson, K. R.; Bilek, S. L.; Carpenter, P.; Childs, D.; Chung, P.; Huerta, A. D.; Lingutla, N.; Nikolaus, K.; Winberry, J. P.

2017-12-01

Remote portable seismic stations are, in most cases, constrained by logistics and cost. High latitude operations introduce environmental, technical and logistical challenges that require substantially more engineering work to ensure robust, high quality data return. Since 2006, IRIS PASSCAL has been funded by NSF to develop, deploy, and maintain a pool of polar specific seismic stations. At roughly the same time, PASSCAL began supporting experiments specifically targeting glacier dynamics such as the mechanisms of subglacial hydrology, basal shear stress, ice stream stick slip mechanisms, and glacier seismicity. Although much of the development for high-latitude deployments was directly applicable to cryoseismology, these new experiments introduced a unique series of challenges including high ablation, standing water, and moving stations. Our polar development objectives have focused on: Reducing station power requirements, size and weight; Extending the operational temperature of a station; Simplifying logistics; Engineering solutions that are cost effective, manufacturable, serviceable and reusable; And, developing high-latitude communications for both state-of-health and data transmission. To these ends, PASSCAL continues testing new power storage technology, refining established power systems for lighter and smaller power banks, and exploring telemetry solutions to increase high-bandwidth communication options and abilities for remote seismic stations. Further enhancing PASSCAL's ability to support cryoseismology is a recent NSF funded collaborative effort lead by Central Washing University joined by IRIS and New Mexico Tech to build a Geophysical Earth Observatory for Ice Covered Environments (GEOICE). The GEOICE instrument, power system and other integrated ancillary components are designed to require minimal installation time and logistical load (i.e., size and weight), while maximizing ease-of-use in the field and optimizing costs of instrumentation and experiment consumables. The instrument capability will include a hybrid seismograph pool of broadband and intermediate elements, for observation of both long-period and intermediate-to-short-period signals, and a high-frequency node element.

Turkish Compulsory Earthquake Insurance and "Istanbul Earthquake

NASA Astrophysics Data System (ADS)

Durukal, E.; Sesetyan, K.; Erdik, M.

2009-04-01

The city of Istanbul will likely experience substantial direct and indirect losses as a result of a future large (M=7+) earthquake with an annual probability of occurrence of about 2%. This paper dwells on the expected building losses in terms of probable maximum and average annualized losses and discusses the results from the perspective of the compulsory earthquake insurance scheme operational in the country. The TCIP system is essentially designed to operate in Turkey with sufficient penetration to enable the accumulation of funds in the pool. Today, with only 20% national penetration, and about approximately one-half of all policies in highly earthquake prone areas (one-third in Istanbul) the system exhibits signs of adverse selection, inadequate premium structure and insufficient funding. Our findings indicate that the national compulsory earthquake insurance pool in Turkey will face difficulties in covering incurring building losses in Istanbul in the occurrence of a large earthquake. The annualized earthquake losses in Istanbul are between 140-300 million. Even if we assume that the deductible is raised to 15%, the earthquake losses that need to be paid after a large earthquake in Istanbul will be at about 2.5 Billion, somewhat above the current capacity of the TCIP. Thus, a modification to the system for the insured in Istanbul (or Marmara region) is necessary. This may mean an increase in the premia and deductible rates, purchase of larger re-insurance covers and development of a claim processing system. Also, to avoid adverse selection, the penetration rates elsewhere in Turkey need to be increased substantially. A better model would be introduction of parametric insurance for Istanbul. By such a model the losses will not be indemnified, however will be directly calculated on the basis of indexed ground motion levels and damages. The immediate improvement of a parametric insurance model over the existing one will be the elimination of the claim processing period, which would certainly be a major difficulty for the expected low-frequency/high intensity loss case of Istanbul.

Relationship of weed shiner and young-of-year bluegill and largemouth bass abundance to submersed aquatic vegetation in Navigation Pools 4, 8, and 13 of the Upper Mississippi River, 1998-2012

USGS Publications Warehouse

DeLain, Steven A.; Popp, Walter A.

2014-01-01

Aquatic vegetation provides food resources and shelter for many species of fish. This study found a significant relationship between increases in submersed aquatic vegetation (SAV) in four study reaches of the Upper Mississippi River (UMR) and increases in catch-per-unit-effort (CPUE) of weed shiners (Notropis texanus) and age-0 bluegills (Lepomis macrochirus) and largemouth bass (Micropterus salmoides) when all of the study reaches were treated collectively using Long Term Resource Monitoring Program (LTRMP) vegetation and fish data for 1998–2012. The selected fishes were more abundant in study reaches with higher SAV frequencies (Pool 8 and Lower Pool 4) and less abundant in reaches with lower SAV frequencies (Pool 13 and Upper Pool 4). When each study reach was examined independently, the relationship between SAV frequency and CPUE of the three species was not significant in most cases, the primary exception being weed shiners in Lower Pool 4. Results of this study indicate that the prevalence of SAV does affect relative abundance of these vegetation-associated fish species. However, the poor annual relationship between SAV frequency and age-0 relative abundance in individual study reaches indicates that several other factors also govern age-0 abundance. The data indicate that there may be a SAV frequency threshold in backwaters above which there is not a strong relationship with abundance of these fish species. This is indicated by the high annual CPUE variability of the three selected fishes in backwaters of Pool 8 and Lower Pool 4 when SAV exceeded certain frequencies.

An evaluation of population index and estimation techniques for tadpoles in desert pools

USGS Publications Warehouse

Jung, Robin E.; Dayton, Gage H.; Williamson, Stephen J.; Sauer, John R.; Droege, Sam

2002-01-01

Using visual (VI) and dip net indices (DI) and double-observer (DOE), removal (RE), and neutral red dye capture-recapture (CRE) estimates, we counted, estimated, and censused Couch's spadefoot (Scaphiopus couchii) and canyon treefrog (Hyla arenicolor) tadpole populations in Big Bend National Park, Texas. Initial dye experiments helped us determine appropriate dye concentrations and exposure times to use in mesocosm and field trials. The mesocosm study revealed higher tadpole detection rates, more accurate population estimates, and lower coefficients of variation among pools compared to those from the field study. In both mesocosm and field studies, CRE was the best method for estimating tadpole populations, followed by DOE and RE. In the field, RE, DI, and VI often underestimated populations in pools with higher tadpole numbers. DI improved with increased sampling. Larger pools supported larger tadpole populations, and tadpole detection rates in general decreased with increasing pool volume and surface area. Hence, pool size influenced bias in tadpole sampling. Across all techniques, tadpole detection rates differed among pools, indicating that sampling bias was inherent and techniques did not consistently sample the same proportion of tadpoles in each pool. Estimating bias (i.e., calculating detection rates) therefore was essential in assessing tadpole abundance. Unlike VI and DOE, DI, RE, and CRE could be used in turbid waters in which tadpoles are not visible. The tadpole population estimates we used accommodated differences in detection probabilities in simple desert pool environments but may not work in more complex habitats.

Comparison of Exposure Controls, Item Pool Characteristics, and Population Distributions for CAT Using the Partial Credit Model

ERIC Educational Resources Information Center

Lee, HwaYoung; Dodd, Barbara G.

2012-01-01

This study investigated item exposure control procedures under various combinations of item pool characteristics and ability distributions in computerized adaptive testing based on the partial credit model. Three variables were manipulated: item pool characteristics (120 items for each of easy, medium, and hard item pools), two ability…

Strategies implemented by 20 local tobacco control agencies to promote smoke-free recreation areas, California, 2004-2007.

PubMed

Satterlund, Travis D; Cassady, Diana; Treiber, Jeanette; Lemp, Cathy

2011-09-01

Since 2000, local jurisdictions in California have enacted hundreds of policies and ordinances in an effort to protect their citizens from the harmful effects of secondhand smoke. We evaluated strategies used by state-funded local tobacco control programs to enact local smoke-free policies involving outdoor recreational spaces. The Tobacco Control Evaluation Center analyzed 23 final evaluation reports that discussed adopting local smoke-free policies in outdoor recreational facilities in California. These reports were submitted for the 2004 through 2007 funding period by local tobacco control organizations to the California Department of Public Health, Tobacco Control Program. We used a comparative technique whereby we coded passages and compared them by locale and case, focusing on strategies that led to the enactment of smoke-free policies. Our analysis found the following 6 strategies to be the most effective: 1) having a "champion" who helps to carry an objective forward, 2) tapping into a pool of potential youth volunteers, 3) collecting and using local data as a persuasive tool, 4) educating the community in smoke-free policy efforts, 5) working strategically in the local political climate, and 6) framing the policy appropriately. These strategies proved effective regardless of whether policies were voluntary, administrative, or legislative. Successful policy enactment required a strong foundation of agency funding and an experienced and committed staff. These results should be relevant to other tobacco control organizations that are attempting to secure local smoke-free policy.

Comparison of Individual and Pooled Stool Samples for the Assessment of Soil-Transmitted Helminth Infection Intensity and Drug Efficacy

PubMed Central

Mekonnen, Zeleke; Meka, Selima; Ayana, Mio; Bogers, Johannes; Vercruysse, Jozef; Levecke, Bruno

2013-01-01

Background In veterinary parasitology samples are often pooled for a rapid assessment of infection intensity and drug efficacy. Currently, studies evaluating this strategy in large-scale drug administration programs to control human soil-transmitted helminths (STHs; Ascaris lumbricoides, Trichuris trichiura, and hookworm), are absent. Therefore, we developed and evaluated a pooling strategy to assess intensity of STH infections and drug efficacy. Methods/Principal Findings Stool samples from 840 children attending 14 primary schools in Jimma, Ethiopia were pooled (pool sizes of 10, 20, and 60) to evaluate the infection intensity of STHs. In addition, the efficacy of a single dose of mebendazole (500 mg) in terms of fecal egg count reduction (FECR; synonym of egg reduction rate) was evaluated in 600 children from two of these schools. Individual and pooled samples were examined with the McMaster egg counting method. For each of the three STHs, we found a significant positive correlation between mean fecal egg counts (FECs) of individual stool samples and FEC of pooled stool samples, ranging from 0.62 to 0.98. Only for A. lumbricoides was any significant difference in mean FEC of the individual and pooled samples found. For this STH species, pools of 60 samples resulted in significantly higher FECs. FECR for the different number of samples pooled was comparable in all pool sizes, except for hookworm. For this parasite, pools of 10 and 60 samples provided significantly higher FECR results. Conclusion/Significance This study highlights that pooling stool samples holds promise as a strategy for rapidly assessing infection intensity and efficacy of administered drugs in programs to control human STHs. However, further research is required to determine when and how pooling of stool samples can be cost-effectively applied along a control program, and to verify whether this approach is also applicable to other NTDs. PMID:23696905

Highlights of the 1983 Federal-state cooperative water resources program

USGS Publications Warehouse

Gilbert, B.K.; Buchanan, T.J.

1983-01-01

The U.S. Geological Survey Federal-State Cooperative Water Resources Program in fiscal year 1983 continued to concentrate on investigations of highest priority to the Nation. Hydrologic data collection and interpretive studies were underway in every State, Puerto Rico, and several U.S. territories with focus on such current concerns as ground-water contamination, floods, impacts of toxic wastes, acid precipitation, and stream quality. During the year, this 50-50 matching program was carried out in working partnership with more than 800 State, regional, and local agencies. Joint funding from all sources totaled approximately $92 million. Details of the program are mutually negotiated at the working level by representatives of the Survey and representatives of the cooperating agencies. The pooling of interests results in a balanced effort that directs combined resources to hydrologic investigations having the most significance to both parties. A few of the highlights for FY 1983, and how the program is developed with other agencies are described. (USGS)

New pharmacokinetic methods. III. Two simple test for deep pool effect

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

Browne, T.R.; Greenblatt, D.J.; Schumacher, G.E.

1990-08-01

If a portion of administered drug is distributed into a deep peripheral compartment, the drug's actual elimination half-life during the terminal exponential phase of elimination may be longer than determined by a single dose study or a tracer dose study (deep pool effect). Two simple methods of testing for deep pool effect applicable to drugs with either linear or nonlinear pharmacokinetic properties are described. The methods are illustrated with stable isotope labeled (13C15N2) tracer dose studies of phenytoin. No significant (P less than .05) deep pool effect was detected.

Classification of upper Mississippi River pools based on contiguous aquatic/geomorphic habitats

USGS Publications Warehouse

Koel, Todd M.

2001-01-01

Navigation pools of the upper Mississippi River (UMR) vary greatly in terms of available contiguous aquatic/geomorphic habitats. These habitats are critical for the biotic diversity and overall productivity of the floodplain corridor of each pool. In this study, similarities among pools 4-26 and an open river reach (river kilometer 47-129) of the UMR were determined from multivariate analysis of eleven habitat types that were hydrologically-contiguous (non-leveed). Isolated floodplain habitats were not included in final analyses because this isolation limits their contribution to overall riverine productivity, in part due to a lack of hydrological connectivity to the main channel during the flood pulse. Cluster analysis based on simple Euclidean distance was used to produce two major pool groups and five pool subgroups. Important habitat variables in defining pool groups, as interpreted from principal components analysis (PCA) axis 1, were contiguous floodplain shallow aquatic area and contiguous impounded area. The habitat variable most important in defining pool subgroups, as interpreted from PCA axis 2, was tertiary channel. Most notably, pool 6 was more similar to pools 14-24 than other upper pools, and pools 19 and 25 were more similar to pools 4-13 than other lower pools. These results were quite different from those of two previous investigators, primarily because only areas of non-isolated aquatic habitat were considered.

The Perceived Impact of the Patient Protection and Affordable Care Act on North Carolina's Free Clinics.

PubMed

Swan, Greg A; Foley, Kristie L

2016-01-01

The Patient Protection and Affordable Care Act of 2010 (ACA) may dramatically affect the demographics of the uninsured population and the funding prospects for free health clinics. We conducted a cross-sectional survey of 64 of 80 free clinics (80.0% response rate) in North Carolina to assess free clinic directors' knowledge of the ACA and their perceptions of how the ACA would affect clinic operations. Free clinic directors were knowledgeable about well publicized aspects of the ACA (eg, lack of Medicaid expansion in North Carolina), but they were less knowledgeable about provisions such as the Federal Tort Claims Act and high-risk pools, which may have direct and indirect effects on free clinics. Directors expressed concern over the unintended consequences of the ACA, such as reduced funding and reduced volunteerism. Anticipated clinic changes as a result of the ACA include initiation of electronic medical records and, to a lesser extent, a move to become "hybrid" clinics (federally qualified health center look-alikes). This study is focused on North Carolina free clinics that are members of the North Carolina Association of Free Clinics (NCAFC). Findings cannot be generalized to non-NCAFC free clinics or to free clinic networks outside the state. Despite its effort to expand health insurance coverage, the ACA may have unintended consequences to low-cost free clinics that serve uninsured populations. ©2016 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.

Iris-Claw Intraocular Lens and Scleral-Fixated Posterior Chamber Intraocular Lens Implantations in Correcting Aphakia: A Meta-Analysis.

PubMed

Jing, Wu; Guanlu, Liang; Qianyin, Zheng; Shuyi, Li; Fengying, He; Jian, Liu; Wen, Xu

2017-07-01

A meta-analysis to compare iris-claw intraocular lens (IC-IOL) and scleral-fixated posterior chamber intraocular lens (SF-PCIOL) implantations in correcting aphakia without sufficient capsular support. Eligible studies were collected through PubMed, Web of Science, Embase, and the Cochrane library. The pooled relative risks (RR), pooled standardized mean difference (SMD), and their 95% confidence interval of the eligible studies were then calculated. Seven studies met our inclusion criteria, involving 232 and 158 eyes in IC-IOL and SF-PCIOL groups, respectively. The pooled SMD of the mean postoperative corrected distance visual acuity (CDVA) (logMAR) was -0.25. The pooled RR of the eyes achieving 20/40 or better postoperatively was 1.16. The pooled SMD of the surgical time was -2.97. The pooled RR of the surgical complications was 0.86. The pooled RR of IOL dislocation, retinal detachment (RD), and cystoid macular edema (CME) between the two groups were 0.22, 0.63, and 0.64. Implantation of IC-IOL has a more simple procedure and shorter learning curve than SF-PCIOL implantation in correcting aphakia without sufficient capsular support.

Outcomes following severe hand foot and mouth disease: A systematic review and meta-analysis.

PubMed

Jones, Eben; Pillay, Timesh D; Liu, Fengfeng; Luo, Li; Bazo-Alvarez, Juan Carlos; Yuan, Chen; Zhao, Shanlu; Chen, Qi; Li, Yu; Liao, Qiaohong; Yu, Hongjie; Rogier van Doorn, H; Sabanathan, Saraswathy

2018-04-20

Hand, foot and mouth disease (HFMD) caused by enterovirus A71 (EV-A71) is associated with acute neurological disease in children. This study aimed to estimate the burden of long-term sequelae and death following severe HFMD. This systematic review and meta-analysis pooled all reports from English and Chinese databases including MEDLINE and Wangfang on outbreaks of clinically diagnosed HFMD and/or laboratory-confirmed EV-A71 with at least 7 days' follow-up published between 1st January 1966 and 19th October 2015. Two independent reviewers assessed the literature. We used a random effects meta-analysis to estimate cumulative incidence of neurological sequelae or death. Studies were assessed for methodological and reporting quality. PROSPERO registration number: 10.15124/CRD42015021981. 43 studies were included in the review, and 599 children from 9 studies were included in the primary analysis. Estimated cumulative incidence of death or neurological sequelae at maximum follow up was 19.8% (95% CI:10.2%, 31.3%). Heterogeneity (Iˆ2) was 88.57%, partly accounted for by year of data collection and reporting quality of studies. Incidence by acute disease severity was 0.00% (0.00, 0.00) for grade IIa; 17.0% (7.9, 28.2) for grade IIb/III; 81.6% (65.1, 94.5) for grade IV (p = 0.00) disease. HFMD with neurological involvement is associated with a substantial burden of long-term neurological sequelae. Grade of acute disease severity was a strong predictor of outcome. Strengths of this study include its bilingual approach and clinical applicability. Future prospective and interventional studies must use rigorous methodology to assess long-term outcomes in survivors. There was no specific funding for this study. See below for researcher funding. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

Refining the Results of a Classical SELEX Experiment by Expanding the Sequence Data Set of an Aptamer Pool Selected for Protein A

PubMed Central

2018-01-01

New, as yet undiscovered aptamers for Protein A were identified by applying next generation sequencing (NGS) to a previously selected aptamer pool. This pool was obtained in a classical SELEX (Systematic Evolution of Ligands by EXponential enrichment) experiment using the FluMag-SELEX procedure followed by cloning and Sanger sequencing. PA#2/8 was identified as the only Protein A-binding aptamer from the Sanger sequence pool, and was shown to be able to bind intact cells of Staphylococcus aureus. In this study, we show the extension of the SELEX results by re-sequencing of the same aptamer pool using a medium throughput NGS approach and data analysis. Both data pools were compared. They confirm the selection of a highly complex and heterogeneous oligonucleotide pool and show consistently a high content of orphans as well as a similar relative frequency of certain sequence groups. But in contrast to the Sanger data pool, the NGS pool was clearly dominated by one sequence group containing the known Protein A-binding aptamer PA#2/8 as the most frequent sequence in this group. In addition, we found two new sequence groups in the NGS pool represented by PA-C10 and PA-C8, respectively, which also have high specificity for Protein A. Comparative affinity studies reveal differences between the aptamers and confirm that PA#2/8 remains the most potent sequence within the selected aptamer pool reaching affinities in the low nanomolar range of KD = 20 ± 1 nM. PMID:29495282

Refining the Results of a Classical SELEX Experiment by Expanding the Sequence Data Set of an Aptamer Pool Selected for Protein A.

PubMed

Stoltenburg, Regina; Strehlitz, Beate

2018-02-24

New, as yet undiscovered aptamers for Protein A were identified by applying next generation sequencing (NGS) to a previously selected aptamer pool. This pool was obtained in a classical SELEX (Systematic Evolution of Ligands by EXponential enrichment) experiment using the FluMag-SELEX procedure followed by cloning and Sanger sequencing. PA#2/8 was identified as the only Protein A-binding aptamer from the Sanger sequence pool, and was shown to be able to bind intact cells of Staphylococcus aureus . In this study, we show the extension of the SELEX results by re-sequencing of the same aptamer pool using a medium throughput NGS approach and data analysis. Both data pools were compared. They confirm the selection of a highly complex and heterogeneous oligonucleotide pool and show consistently a high content of orphans as well as a similar relative frequency of certain sequence groups. But in contrast to the Sanger data pool, the NGS pool was clearly dominated by one sequence group containing the known Protein A-binding aptamer PA#2/8 as the most frequent sequence in this group. In addition, we found two new sequence groups in the NGS pool represented by PA-C10 and PA-C8, respectively, which also have high specificity for Protein A. Comparative affinity studies reveal differences between the aptamers and confirm that PA#2/8 remains the most potent sequence within the selected aptamer pool reaching affinities in the low nanomolar range of K D = 20 ± 1 nM.

Effects of riffle length on the short-term movement of fishes among stream pools.

Treesearch

David George Lonzarich; Mary Ruth Elger Lonzrich; Melvin L. Warren

2000-01-01

Recent research has suggested that the within-habitat dynamics of fish populations and assemblages can be affected by the spatial distribution of habitats within streams. In this study, we determined the extent to which pool isolation (length of riffles connecting adjacent pools) influenced fish movement in two Arkansas streams. We marked individuals from 12 pools...

Controls on the size and occurrence of pools in coarse-grained forest rivers

Treesearch

John M. Buffington; Thomas E. Lisle; Richard D. Woodsmith; Sue Hilton

2002-01-01

Controls on pool formation are examined in gravel- and cobble-bed rivers in forest mountain drainage basins of northern California, southern Oregon, and southeastern Alaska. We demonstrate that the majority of pools at our study sites are formed by flow obstructions and that pool geometry and frequency largely depend on obstruction characteristics (size, type, and...

Forest and pasture carbon pools and soil respiration in the southern Appalachian mountains

Treesearch

Paul V. Bolstad; James M. Vose

2005-01-01

Our ability to estimate the changes in carbon (C) pools and fluxes due to forest conversion is hampered by a lack of comparative studies. We measured above- and belowground C pools and soil respiration flux at four forested and four pasture sites in the southern Appalachian Mountains. Above- and belowground C pools were significantly larger (P

Safety Barrier Guidelines for Home Pools [and] How To Plan for the Unexpected.

ERIC Educational Resources Information Center

Consumer Product Safety Commission, Washington, DC.

Each year, hundreds of young children die and thousands come close to death due to submersion in residential swimming pools. The United States Consumer Products Safety Commission studied data on drownings and child behavior, as well as information on pool and pool barrier construction, and concluded that the best way to reduce child drownings in…

Effects of commercial harvest on shovelnose sturgeon populations in the Upper Mississippi River

USGS Publications Warehouse

Koch, Jeff D.; Quist, Michael C.; Pierce, Clay L.; Hansen, Kirk A.; Steuck, Michael J.

2009-01-01

Shovelnose sturgeon Scaphirhynchus platorynchus have become an increasingly important commercial species in the upper Mississippi River (UMR) because of the collapse of foreign sturgeon (family Acipenseridae) populations and bans on imported caviar. In response to concerns about the sustainability of the commercial shovelnose sturgeon fishery in the UMR, we undertook this study to describe the demographics of the shovelnose sturgeon population and evaluate the influence of commercial harvest on shovelnose sturgeon populations in the UMR. A total of 1,682 shovelnose sturgeon were collected from eight study pools in 2006 and 2007 (Pools 4, 7, 9, 11, 13, 14, 16, and 18). Shovelnose sturgeon from upstream pools generally had greater lengths, weights, and ages than those from downstream pools. Additionally, mortality estimates were lower in upstream pools (Pools 4, 7, 9, and 11) than in downstream pools (Pools 13, 14, 16, and 18). Linear regression suggested that the slower growth of shovelnose sturgeon is a consequence of commercial harvest in the UMR. Modeling of potential management scenarios suggested that a 685-mm minimum length limit is necessary to prevent growth and recruitment overfishing of shovelnose sturgeon in the UMR.

The performance of magnetic resonance imaging in the detection of triangular fibrocartilage complex injury: a meta-analysis.

PubMed

Wang, Z X; Chen, S L; Wang, Q Q; Liu, B; Zhu, J; Shen, J

2015-06-01

The aim of this study was to evaluate the accuracy of magnetic resonance imaging in the detection of triangular fibrocartilage complex injury through a meta-analysis. A comprehensive literature search was conducted before 1 April 2014. All studies comparing magnetic resonance imaging results with arthroscopy or open surgery findings were reviewed, and 25 studies that satisfied the eligibility criteria were included. Data were pooled to yield pooled sensitivity and specificity, which were respectively 0.83 and 0.82. In detection of central and peripheral tears, magnetic resonance imaging had respectively a pooled sensitivity of 0.90 and 0.88 and a pooled specificity of 0.97 and 0.97. Six high-quality studies using Ringler's recommended magnetic resonance imaging parameters were selected for analysis to determine whether optimal imaging protocols yielded better results. The pooled sensitivity and specificity of these six studies were 0.92 and 0.82, respectively. The overall accuracy of magnetic resonance imaging was acceptable. For peripheral tears, the pooled data showed a relatively high accuracy. Magnetic resonance imaging with appropriate parameters are an ideal method for diagnosing different types of triangular fibrocartilage complex tears. © The Author(s) 2015.

Addressing data privacy in matched studies via virtual pooling.

PubMed

Saha-Chaudhuri, P; Weinberg, C R

2017-09-07

Data confidentiality and shared use of research data are two desirable but sometimes conflicting goals in research with multi-center studies and distributed data. While ideal for straightforward analysis, confidentiality restrictions forbid creation of a single dataset that includes covariate information of all participants. Current approaches such as aggregate data sharing, distributed regression, meta-analysis and score-based methods can have important limitations. We propose a novel application of an existing epidemiologic tool, specimen pooling, to enable confidentiality-preserving analysis of data arising from a matched case-control, multi-center design. Instead of pooling specimens prior to assay, we apply the methodology to virtually pool (aggregate) covariates within nodes. Such virtual pooling retains most of the information used in an analysis with individual data and since individual participant data is not shared externally, within-node virtual pooling preserves data confidentiality. We show that aggregated covariate levels can be used in a conditional logistic regression model to estimate individual-level odds ratios of interest. The parameter estimates from the standard conditional logistic regression are compared to the estimates based on a conditional logistic regression model with aggregated data. The parameter estimates are shown to be similar to those without pooling and to have comparable standard errors and confidence interval coverage. Virtual data pooling can be used to maintain confidentiality of data from multi-center study and can be particularly useful in research with large-scale distributed data.

Developing hand therapy skills in Bangladesh: experiences of Australian volunteers.

PubMed

O'Brien, Lisa; Hardman, Alison

2014-01-01

Bangladesh is a developing country whose health system is highly dependent on project funding from foreign countries. Interplast Australia & New Zealand have supported volunteer hand therapists to provide training to local staff in the management of hand injuries and burns since 2006. We aimed to explore and describe the volunteers' own experience and provide recommendations for future therapy capacity building projects in developing countries. This qualitative study involved nine volunteer therapists, who attended a focus group to discuss their experiences, including the key milestones, challenges, and progress achieved. The two authors analyzed transcripts independently and emergent themes were discussed and identified by consensus. Overall the experience was extremely positive and rewarding for volunteers. Key learnings and challenges encountered in this project were cultural differences in learning styles, the need to adapt our approach to 2 facilitate sustainable local solutions, attrition of skilled local staff, and concerns regarding volunteer health and safety. Recommendations for similar projects include allowing adequate time for in-country scoping and planning, coordination and pooling of resources, and the use of strategies that encourage the shift to confident local ownership of ongoing learning and skill development. Volunteering in a health capacity building program in developing countries can be a challenging but immensely rewarding experience. Programs designed to meet the health demands in developing countries should emphasize adequate training of professionals in the use of transferable, sustainable and cost effective techniques. Time spent in the scoping and planning phase is crucial, as is coordination of efforts and pooling of resources. 2C. Crown Copyright © 2014. Published by Elsevier Inc. All rights reserved.

Attention deficit/hyperactivity disorder and risk of injuries: A systematic review and meta-analysis

PubMed Central

Amiri, Shahrokh; Sadeghi-Bazargani, Homayoun; Nazari, Soulmaz; Ranjbar, Fatemeh; Abdi, Salman

2017-01-01

Abstract: Background: This study systematically reviewed the literature in order to determine the effect of Attention-Deficit Hyperactivity Disorder (ADHD) on injuries and assessed the magnitude of the potential association. Methods: A systematic review of the studies examining the association of ADHD and injuries was carried out across multiple databases. Odds ratios and standardized mean differences were pooled. Results: A total of 35 studies were selected for quantitative analysis. The association of ADHD and injuries was confirmed over the meta-analysis of eligible studies. The odds ratio pooled over all comparative studies was 1.96(95% CI: 1.6-2.4) using random effects model. Pooled odds ratio of 2.1 and 2.17 were calculated respectively when cohort and case-control studies or just cohort studies were included. The pooled odds ratio reduced to 1.8(CI:1.45-2.3) when studies on specific injuries were removed. For studies comparing scores of rating scales, the pooled standardized mean difference was 0.61(95% CI: 0.03-1.2). Conclusions: Those with ADHD are nearly two times more likely to be injured. PMID:28554188

Mercury bioaccumulation in wood frogs developing in seasonal pools

USGS Publications Warehouse

Loftin, Cynthia S.; Calhoun, Aram J.K.; Nelson, Sarah J.; Elskus, Adria; Simon, Kevin S.

2012-01-01

Seasonal woodland pools contribute significant biomass to terrestrial ecosystems through production of pool-breeding amphibians. The movement of amphibian metamorphs potentially transports toxins bioaccumulated during larval development in the natal pool into the surrounding terrestrial environment. We documented total mercury (THg) in seasonal woodland pool water, sediment, litter, and Lithobates sylvaticus LeConte (Wood Frog) in Acadia National Park, ME. THg concentrations in pool water varied over the study season, increasing during April—June and remaining high in 2 of 4 pools upon October refill. Water in pools surrounded by softwoods had lower pH, greater dissolved organic carbon, and greater THg concentrations than pools surrounded by hardwoods, with seasonal patterns in sediment THg but not litter THg. THg increased rapidly from near or below detection in 1–2 week old embryos (<0.2 ng; 0–0.49 ppb wet weight) to 17.1–54.2 ppb in tadpoles within 6 weeks; 7.2–42.0% of THg was methyl Hg in tadpoles near metamorphosis. Metamorphs emigrating from seasonal pools may transfer mercury into terrestrial food webs.

Comprehensive analysis of correlation coefficients estimated from pooling heterogeneous microarray data

PubMed Central

2013-01-01

Background The synthesis of information across microarray studies has been performed by combining statistical results of individual studies (as in a mosaic), or by combining data from multiple studies into a large pool to be analyzed as a single data set (as in a melting pot of data). Specific issues relating to data heterogeneity across microarray studies, such as differences within and between labs or differences among experimental conditions, could lead to equivocal results in a melting pot approach. Results We applied statistical theory to determine the specific effect of different means and heteroskedasticity across 19 groups of microarray data on the sign and magnitude of gene-to-gene Pearson correlation coefficients obtained from the pool of 19 groups. We quantified the biases of the pooled coefficients and compared them to the biases of correlations estimated by an effect-size model. Mean differences across the 19 groups were the main factor determining the magnitude and sign of the pooled coefficients, which showed largest values of bias as they approached ±1. Only heteroskedasticity across the pool of 19 groups resulted in less efficient estimations of correlations than did a classical meta-analysis approach of combining correlation coefficients. These results were corroborated by simulation studies involving either mean differences or heteroskedasticity across a pool of N > 2 groups. Conclusions The combination of statistical results is best suited for synthesizing the correlation between expression profiles of a gene pair across several microarray studies. PMID:23822712

Effect of obstructive sleep apnea hypopnea syndrome on lipid profile: a meta-regression analysis.

PubMed

Nadeem, Rashid; Singh, Mukesh; Nida, Mahwish; Waheed, Irfan; Khan, Adnan; Ahmed, Saeed; Naseem, Jawed; Champeau, Daniel

2014-05-15

Obstructive sleep apnea (OSA) is associated with obesity, metabolic syndrome, and dyslipidemia, which may be related to decrease androgen levels found in OSA patients. Dyslipidemia may contribute to atherosclerosis leading to increasing risk of heart disease. Systematic review was conducted using PubMed and Cochrane library by utilizing different combinations of key words; sleep apnea, obstructive sleep apnea, serum lipids, dyslipidemia, cholesterol, total cholesterol, low density lipoprotein (LDL), high density lipoprotein (HDL), and triglyceride (TG). Inclusion criteria were: English articles, and studies with adult population in 2 groups of patients (patients with OSA and without OSA). A total 96 studies were reviewed for inclusion, with 25 studies pooled for analysis. Sixty-four studies were pooled for analysis; since some studies have more than one dataset, there were 107 datasets with 18,116 patients pooled for meta-analysis. All studies measured serum lipids. Total cholesterol pooled standardized difference in means was 0.267 (p = 0.001). LDL cholesterol pooled standardized difference in means was 0.296 (p = 0.001). HDL cholesterol pooled standardized difference in means was -0.433 (p = 0.001). Triglyceride pooled standardized difference in means was 0.603 (p = 0.001). Meta-regression for age, BMI, and AHI showed that age has significant effect for TC, LDL, and HDL. BMI had significant effect for LDL and HDL, while AHI had significant effect for LDL and TG. Patients with OSA appear to have increased dyslipidemia (high total cholesterol, LDL, TG, and low HDL).

Advising on Preferred Reporting Items for patient-reported outcome instrument development: the PRIPROID.

PubMed

Hou, Zheng-Kun; Liu, Feng-Bin; Fang, Ji-Qian; Li, Xiao-Ying; Li, Li-Juan; Lin, Chu-Hua

2013-03-01

The reporting of patient-reported outcomes (PRO) instrument development is vital for both researchers and clinicians to determine its validity, thus, we propose the Preferred Reporting Items for PRO Instrument Development (PRIPROID) to improve the quality of reports. Abiding by the guidance published by the Enhancing the QUAlity and Transparency Of health Research (EQUATOR) Network, we had performed 6 steps for items development: identified the need for a guideline, performed a literature review, obtained funding for the guideline initiative, identified participants, conducted a Delphi exercise and generated a list of PRIPROID items for consideration at the face-to-face meeting. Twenty three items subheadings under 7 topics were included: title and structured abstract, rationale, objectives, intention, eligibility criteria, conceptual framework, items generation, response options, scoring, times, administrative modes, burden assessment, properties assessment, statistical methods, participants, main results, and additional analysis, summary of evidence, limitations, clinical attentions, and conclusions, item pools or final form, and funding. The PRIPROID contains many elements of the PRO research, and this assists researchers to report their results more accurately and to a certain degree use this instrument to evaluate the quality of the research methods.

Matching the Grade 8 TIMSS Item Pool to the Ontario Curriculum.

ERIC Educational Resources Information Center

Lawson, Alexandra; Bordignon, Catherine; Nagy, Philip

2002-01-01

Studied the match between the Ontario (Canada) eighth grade curriculum for 1997 and the item pool of the Third International Mathematics and Science Study (TIMSS) and analyzed the matching process itself. Findings show that the 1997 curriculum is a better match to the TIMSS item pool, achieving the better match by enlarging the curriculum and…

Activity-based funding of hospitals and its impact on mortality, readmission, discharge destination, severity of illness, and volume of care: a systematic review and meta-analysis.

PubMed

Palmer, Karen S; Agoritsas, Thomas; Martin, Danielle; Scott, Taryn; Mulla, Sohail M; Miller, Ashley P; Agarwal, Arnav; Bresnahan, Andrew; Hazzan, Afeez Abiola; Jeffery, Rebecca A; Merglen, Arnaud; Negm, Ahmed; Siemieniuk, Reed A; Bhatnagar, Neera; Dhalla, Irfan A; Lavis, John N; You, John J; Duckett, Stephen J; Guyatt, Gordon H

2014-01-01

Activity-based funding (ABF) of hospitals is a policy intervention intended to re-shape incentives across health systems through the use of diagnosis-related groups. Many countries are adopting or actively promoting ABF. We assessed the effect of ABF on key measures potentially affecting patients and health care systems: mortality (acute and post-acute care); readmission rates; discharge rate to post-acute care following hospitalization; severity of illness; volume of care. We undertook a systematic review and meta-analysis of the worldwide evidence produced since 1980. We included all studies reporting original quantitative data comparing the impact of ABF versus alternative funding systems in acute care settings, regardless of language. We searched 9 electronic databases (OVID MEDLINE, EMBASE, OVID Healthstar, CINAHL, Cochrane CENTRAL, Health Technology Assessment, NHS Economic Evaluation Database, Cochrane Database of Systematic Reviews, and Business Source), hand-searched reference lists, and consulted with experts. Paired reviewers independently screened for eligibility, abstracted data, and assessed study credibility according to a pre-defined scoring system, resolving conflicts by discussion or adjudication. Of 16,565 unique citations, 50 US studies and 15 studies from 9 other countries proved eligible (i.e. Australia, Austria, England, Germany, Israel, Italy, Scotland, Sweden, Switzerland). We found consistent and robust differences between ABF and no-ABF in discharge to post-acute care, showing a 24% increase with ABF (pooled relative risk  = 1.24, 95% CI 1.18-1.31). Results also suggested a possible increase in readmission with ABF, and an apparent increase in severity of illness, perhaps reflecting differences in diagnostic coding. Although we found no consistent, systematic differences in mortality rates and volume of care, results varied widely across studies, some suggesting appreciable benefits from ABF, and others suggesting deleterious consequences. Transitioning to ABF is associated with important policy- and clinically-relevant changes. Evidence suggests substantial increases in admissions to post-acute care following hospitalization, with implications for system capacity and equitable access to care. High variability in results of other outcomes leaves the impact in particular settings uncertain, and may not allow a jurisdiction to predict if ABF would be harmless. Decision-makers considering ABF should plan for likely increases in post-acute care admissions, and be aware of the large uncertainty around impacts on other critical outcomes.

Effects of diabetes definition on global surveillance of diabetes prevalence and diagnosis: a pooled analysis of 96 population-based studies with 331 288 participants

PubMed Central

2015-01-01

Summary Background Diabetes has been defined on the basis of different biomarkers, including fasting plasma glucose (FPG), 2-h plasma glucose in an oral glucose tolerance test (2hOGTT), and HbA1c. We assessed the effect of different diagnostic definitions on both the population prevalence of diabetes and the classification of previously undiagnosed individuals as having diabetes versus not having diabetes in a pooled analysis of data from population-based health examination surveys in different regions. Methods We used data from 96 population-based health examination surveys that had measured at least two of the biomarkers used for defining diabetes. Diabetes was defined using HbA1c (HbA1c ≥6·5% or history of diabetes diagnosis or using insulin or oral hypoglycaemic drugs) compared with either FPG only or FPG-or-2hOGTT definitions (FPG ≥7·0 mmol/L or 2hOGTT ≥11·1 mmol/L or history of diabetes or using insulin or oral hypoglycaemic drugs). We calculated diabetes prevalence, taking into account complex survey design and survey sample weights. We compared the prevalences of diabetes using different definitions graphically and by regression analyses. We calculated sensitivity and specificity of diabetes diagnosis based on HbA1c compared with diagnosis based on glucose among previously undiagnosed individuals (ie, excluding those with history of diabetes or using insulin or oral hypoglycaemic drugs). We calculated sensitivity and specificity in each survey, and then pooled results using a random-effects model. We assessed the sources of heterogeneity of sensitivity by meta-regressions for study characteristics selected a priori. Findings Population prevalence of diabetes based on FPG-or-2hOGTT was correlated with prevalence based on FPG alone (r=0·98), but was higher by 2–6 percentage points at different prevalence levels. Prevalence based on HbA1c was lower than prevalence based on FPG in 42·8% of age–sex–survey groups and higher in another 41·6%; in the other 15·6%, the two definitions provided similar prevalence estimates. The variation across studies in the relation between glucose-based and HbA1c-based prevalences was partly related to participants' age, followed by natural logarithm of per person gross domestic product, the year of survey, mean BMI, and whether the survey population was national, subnational, or from specific communities. Diabetes defined as HbA1c 6·5% or more had a pooled sensitivity of 52·8% (95% CI 51·3–54·3%) and a pooled specificity of 99·74% (99·71–99·78%) compared with FPG 7·0 mmol/L or more for diagnosing previously undiagnosed participants; sensitivity compared with diabetes defined based on FPG-or-2hOGTT was 30·5% (28·7–32·3%). None of the preselected study-level characteristics explained the heterogeneity in the sensitivity of HbA1c versus FPG. Interpretation Different biomarkers and definitions for diabetes can provide different estimates of population prevalence of diabetes, and differentially identify people without previous diagnosis as having diabetes. Using an HbA1c-based definition alone in health surveys will not identify a substantial proportion of previously undiagnosed people who would be considered as having diabetes using a glucose-based test. Funding Wellcome Trust, US National Institutes of Health. PMID:26109024

Lip and tooth injuries at public swimming pools in Austria.

PubMed

Lechner, Katharina; Connert, Thomas; Kühl, Sebastian; Filippi, Andreas

2017-06-01

There is an increased risk of orofacial injuries in swimming pool facilities. Nevertheless, only a few studies have addressed this issue. The aim of this study was to identify the frequency of lip and tooth injuries at public swimming pools in Austria. A further aim was to examine which gender and age groups were affected, where and why these injuries occurred, and whether pool attendants had sufficient knowledge of dental first-aid measures. A total of 764 pool attendants in Austria were contacted by telephone and 689 participated in the study (90.2%). The attendants were interviewed retrospectively about accident occurrences in 2014 by a standardized questionnaire. Responses to the provision of first aid and choice of storage medium for avulsed teeth were subsequently evaluated. The frequency of lip injuries was 19.0%, and tooth injuries were 11.3%. Male bathers (P < .05) and children under 12 years (P < .001) most frequently suffered injuries. The waterslide was the most common accident site. The most common cause of lip injuries was slipping on wet surfaces (39.0%), and for tooth injuries it was collisions with other persons or objects (each 28.1%). The pool attendants' responses were predominantly good or sufficient on first aid, with the exception of what storage medium to choose. Tooth rescue boxes were available in only 8.6% of all pool facilities. Orofacial injuries are a frequently occurring problem in swimming pool facilities. The pool attendants' knowledge on first-aid care of tooth injuries could still be improved. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Financing institutional long-term care for the elderly in China: a policy evaluation of new models.

PubMed

Yang, Wei; Jingwei He, Alex; Fang, Lijie; Mossialos, Elias

2016-12-01

A rapid ageing population coupled with changes in family structure has brought about profound implications to social policy in China. Although the past decade has seen a steady increase in public funding to long-term care (LTC), the narrow financing base and vast population have created significant unmet demand, calling for reforms in financing. This paper focuses on the financing of institutional LTC care by examining new models that have emerged from local policy experiments against two policy goals: equity and efficiency. Three emerging models are explored: Social Health Insurance (SHI) in Shanghai, LTC Nursing Insurance (LTCNI) in Qingdao and a means-tested model in Nanjing. A focused systematic narrative review of academic and grey literature is conducted to identify and assess these models, supplemented with qualitative interviews with government officials from relevant departments, care home staff and service users. This paper argues that, although SHI appears to be a convenient solution to fund LTC, this model has led to systematic bias in affordable access among participants of different insurance schemes, and has created a powerful incentive for the over-provision of unnecessary services. The means-tested method has been remarkably constrained by narrow eligibility and insufficiency of funding resources. The LTCNI model is by far the most desirable policy option among the three studied here, but the narrow definition of eligibility has substantively excluded a large proportion of elders in need from access to care, which needs to be addressed in future reforms. This paper proposes three lines of LTC financing reforms for policy-makers: (1) the establishment of a prepaid financing mechanism pooled specifically for LTC costs; (2) the incorporation of more stringent eligibility rules and needs assessment; and (3) reforming the dominant fee-for-service methods in paying LTC service providers. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Strengthening programs in science, engineering and mathematics. Third annual progress report

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

Sandhu, S.S.

1997-09-30

The Division of Natural Sciences and Mathematics at Claflin College consists of the Departments of Biology, Chemistry, Computer Science, Physics, Engineering and Mathematics. It offers a variety of major and minor academic programs designed to meet the mission and objectives of the college. The division`s pursuit to achieve excellence in science education is adversely impacted by the poor academic preparation of entering students and the lack of equipment, facilities and research participation, required to impart adequate academic training and laboratory skills to the students. Funds were received from the US Department of Energy to improve the divisional facilities and laboratorymore » equipment and establish mechanism at pre-college and college levels to increase (1) the pool of high school students who will enroll in Science and Mathematics courses (2) the pool of well qualified college freshmen who will seek careers in Science, Engineering and Mathematics (3) the graduation rate in Science,engineering and Mathematics at the undergraduate level and (4) the pool of well-qualified students who can successfully compete to enter the graduate schools of their choice in the fields of science, engineering, and mathematics. The strategies that were used to achieve the mentioned objectives include: (1) Improved Mentoring and Advisement, (2) Summer Science Camp for 7th and 8th graders, (3) Summer Research Internships for Claflin SEM Seniors, (4) Summer Internships for Rising High School Seniors, (5) Development of Mathematical Skills at Pre-college/Post-secondary Levels, (6) Expansion of Undergraduate Seminars, (7) Exposure of Undergraduates to Guest Speakers/Roll Models, (8) Visitations by Undergraduate Students to Graduate Schools, and (9) Expanded Academic Program in Environmental Chemistry.« less

Reserve growth in oil pools of Alberta: Model and forecast

USGS Publications Warehouse

Verma, M.; Cook, T.

2010-01-01

Reserve growth is recognized as a major component of additions to reserves in most oil provinces around the world, particularly in mature provinces. It takes place as a result of the discovery of new pools/reservoirs and extensions of known pools within existing fields, improved knowledge of reservoirs over time leading to a change in estimates of original oil-in-place, and improvement in recovery factor through the application of new technology, such as enhanced oil recovery methods, horizontal/multilateral drilling, and 4D seismic. A reserve growth study was conducted on oil pools in Alberta, Canada, with the following objectives: 1) evaluate historical oil reserve data in order to assess the potential for future reserve growth; 2) develop reserve growth models/ functions to help forecast hydrocarbon volumes; 3) study reserve growth sensitivity to various parameters (for example, pool size, porosity, and oil gravity); and 4) compare reserve growth in oil pools and fields in Alberta with those from other large petroleum provinces around the world. The reported known recoverable oil exclusive of Athabasca oil sands in Alberta increased from 4.5 billion barrels of oil (BBO) in 1960 to 17 BBO in 2005. Some of the pools that were included in the existing database were excluded from the present study for lack of adequate data. Therefore, the known recoverable oil increased from 4.2 to 13.9 BBO over the period from 1960 through 2005, with new discoveries contributing 3.7 BBO and reserve growth adding 6 BBO. This reserve growth took place mostly in pools with more than 125,000 barrels of known recoverable oil. Pools with light oil accounted for most of the total known oil volume, therefore reflecting the overall pool growth. Smaller pools, in contrast, shrank in their total recoverable volumes over the years. Pools with heavy oil (gravity less than 20o API) make up only a small share (3.8 percent) of the total recoverable oil; they showed a 23-fold growth compared to about 3.5-fold growth in pools with medium oil and 2.2-fold growth in pools with light oil over a fifty-year period. The analysis indicates that pools with high porosity reservoirs (greater than 30 percent porosity) grew more than pools with lower porosity reservoirs which could possibly be attributed to permeability differences between the two types. Reserve growth models for Alberta, Canada, show the growth at field level is almost twice as much as at pool level, possibly because the analysis has evaluated fields with two or more pools with different discovery years. Based on the models, the growth in oil volumes in Alberta pools over the next five-year period (2006-2010) is expected to be about 454 million barrels of oil. Over a twenty-five year period, the cumulative reserve growth in Alberta oil pools has been only 2-fold compared to a 4- to- 5-fold increase in other petroleum producing areas such as Saskatchewan, Volga-Ural, U.S. onshore fields, and U.S. Gulf of Mexico. However, the growth at the field level compares well with that of U.S. onshore fields. In other petroleum provinces, the reserves are reported at field levels rather than at pool levels, the latter basically being the equivalent of individual reservoirs. ?? 2010 by the Canadian Society of Petroleum Geologists.

Observations of Cold Pool Properties during GoAmazon2014/5

NASA Astrophysics Data System (ADS)

Mayne, S. L.; Schumacher, C.; MacDonald, L.; Turner, D. D.

2017-12-01

Convectively generated cold pools are instrumental in both the development of the sub-cloud layer and the organization of deep convection. Despite this, analyses of cold pools in the tropics are constrained by a lack of observational data; insight into the phenomena therefore relies heavily on numerical models. GoAmazon2014/5, a 2-year DOE-sponsored field campaign centered on Manacapuru, Brazil in the central Amazon, provides a unique opportunity to characterize tropical cold pools and allows for the comparison of observational data with theoretical results from model cold pool simulations and parameterizations. This investigation analyzes radar, disdrometer, and profiler measurements at the DOE mobile facility site to study tropical cold pool characteristics. The Brazilian military (SIPAM) operational S-band radar in Manaus is used to provide a broad context of convective systems, while measurements from Parsivel disdrometers are used to assess drop-size distributions (DSDs) at the surface. A unique aspect of this research is the use of the Atmospheric Emitted Radiance Interferometer (AERI) instrument, which utilizes down-welling IR measurements to obtain vertical profiles of thermodynamic quantities such as temperature and water vapor in the lowest few km of the atmosphere. Combined with surface observations and sounding data, these datasets will result in a thorough investigation of the horizontal and vertical characteristics of cold pools over the tropical rain forest. Preliminary analyses of 20 events reveal a mean cold pool height of 220 m and a mean radius of approximately 8.5 km. The average cold pool experienced a temperature (specific humidity) decrease of approximately 1 K (0.4 g/kg) at the surface. The temperature decrease is consistent with modeling studies and limited observations from previous studies over the tropics. The small decrease in specific humidity is attributed to the high moisture content within the cold pools. AERI retrievals of potential temperature and specific humidity profiles show promising similarities with theoretical results produced using the cold pool parameterization presented by Del Genio et al. (2015); however, results are sensitive to both the mass of air injected into the cold pool after its formation, and the thermodynamic characteristics of the downdraft.

Between-Habitat Variation of Benthic Cover, Reef Fish Assemblage and Feeding Pressure on the Benthos at the Only Atoll in South Atlantic: Rocas Atoll, NE Brazil

PubMed Central

Longo, G. O.; Morais, R. A.; Martins, C. D. L.; Mendes, T. C.; Aued, A. W.; Cândido, D. V.; de Oliveira, J. C.; Nunes, L. T.; Fontoura, L.; Sissini, M. N.; Teschima, M. M.; Silva, M. B.; Ramlov, F.; Gouvea, L. P.; Ferreira, C. E. L.; Segal, B.; Horta, P. A.; Floeter, S. R.

2015-01-01

The Southwestern Atlantic harbors unique and relatively understudied reef systems, including the only atoll in South Atlantic: Rocas atoll. Located 230 km off the NE Brazilian coast, Rocas is formed by coralline red algae and vermetid mollusks, and is potentially one of the most “pristine” areas in Southwestern Atlantic. We provide the first comprehensive and integrative description of the fish and benthic communities inhabiting different shallow reef habitats of Rocas. We studied two contrasting tide pool habitats: open pools, which communicate with the open ocean even during low tides, thus more exposed to wave action; and closed pools, which remain isolated during low tide and are comparatively less exposed. Reef fish assemblages, benthic cover, algal turfs and fish feeding pressure on the benthos remarkably varied between open and closed pools. The planktivore Thalassoma noronhanum was the most abundant fish species in both habitats. In terms of biomass, the lemon shark Negaprion brevirostris and the omnivore Melichtys niger were dominant in open pools, while herbivorous fishes (mainly Acanthurus spp.) prevailed in closed pools. Overall benthic cover was dominated by algal turfs, composed of articulated calcareous algae in open pools and non-calcified algae in closed pools. Feeding pressure was dominated by acanthurids and was 10-fold lower in open pools than in closed pools. Besides different wave exposure conditions, such pattern could also be related to the presence of sharks in open pools, prompting herbivorous fish to feed more in closed pools. This might indirectly affect the structure of reef fish assemblages and benthic communities. The macroalgae Digenea simplex, which is uncommon in closed pools and abundant in the reef flat, was highly preferred in herbivory assays, indicating that herbivory by fishes might be shaping this distribution pattern. The variations in benthic and reef fish communities, and feeding pressure on the benthos between open and closed pools suggest that the dynamics in open pools is mostly driven by physical factors and the tolerance of organisms to harsh conditions, while in closed pools direct and indirect effects of species interactions also play an important role. Understanding the mechanisms shaping biological communities and how they scale-up to ecosystem functioning is particularly important on isolated near-pristine systems where natural processes can still be studied under limited human impact. PMID:26061735

Between-Habitat Variation of Benthic Cover, Reef Fish Assemblage and Feeding Pressure on the Benthos at the Only Atoll in South Atlantic: Rocas Atoll, NE Brazil.

PubMed

Longo, G O; Morais, R A; Martins, C D L; Mendes, T C; Aued, A W; Cândido, D V; de Oliveira, J C; Nunes, L T; Fontoura, L; Sissini, M N; Teschima, M M; Silva, M B; Ramlov, F; Gouvea, L P; Ferreira, C E L; Segal, B; Horta, P A; Floeter, S R

2015-01-01

The Southwestern Atlantic harbors unique and relatively understudied reef systems, including the only atoll in South Atlantic: Rocas atoll. Located 230 km off the NE Brazilian coast, Rocas is formed by coralline red algae and vermetid mollusks, and is potentially one of the most "pristine" areas in Southwestern Atlantic. We provide the first comprehensive and integrative description of the fish and benthic communities inhabiting different shallow reef habitats of Rocas. We studied two contrasting tide pool habitats: open pools, which communicate with the open ocean even during low tides, thus more exposed to wave action; and closed pools, which remain isolated during low tide and are comparatively less exposed. Reef fish assemblages, benthic cover, algal turfs and fish feeding pressure on the benthos remarkably varied between open and closed pools. The planktivore Thalassoma noronhanum was the most abundant fish species in both habitats. In terms of biomass, the lemon shark Negaprion brevirostris and the omnivore Melichtys niger were dominant in open pools, while herbivorous fishes (mainly Acanthurus spp.) prevailed in closed pools. Overall benthic cover was dominated by algal turfs, composed of articulated calcareous algae in open pools and non-calcified algae in closed pools. Feeding pressure was dominated by acanthurids and was 10-fold lower in open pools than in closed pools. Besides different wave exposure conditions, such pattern could also be related to the presence of sharks in open pools, prompting herbivorous fish to feed more in closed pools. This might indirectly affect the structure of reef fish assemblages and benthic communities. The macroalgae Digenea simplex, which is uncommon in closed pools and abundant in the reef flat, was highly preferred in herbivory assays, indicating that herbivory by fishes might be shaping this distribution pattern. The variations in benthic and reef fish communities, and feeding pressure on the benthos between open and closed pools suggest that the dynamics in open pools is mostly driven by physical factors and the tolerance of organisms to harsh conditions, while in closed pools direct and indirect effects of species interactions also play an important role. Understanding the mechanisms shaping biological communities and how they scale-up to ecosystem functioning is particularly important on isolated near-pristine systems where natural processes can still be studied under limited human impact.

Experimental study of solute transport in pool-pipe system and its significance on karst hydrogeology

NASA Astrophysics Data System (ADS)

Zhao, X.; Chang, Y.; Peng, F.; Wu, J.

2016-12-01

Study of solute transport in karst conduit is of great significance for prediction and prevention of groundwater pollution in southwest karst region. Solute transport in karst conduit is strongly influenced by pools which often develop along karst conduit. In order to investigate the effect of transient storage within pools on solute transport in the conduit, a pool-pipe system was built in the laboratory and some tracer tests were performed in various flow conditions to characterize the solute transport in different pool-pipe structures. The Qtracer2 program was used to obtain solute transport parameters. We used retardation coefficient R to characterize the difference between the 1-D analytical solution of the classical advection-dispersion equation and experimental results. The experimental results reveal that the concentration peak decreases with the number of pools whereas the dispersion coefficient and dispersivity increase gradually. Adding transient storage increases retardation as tailing of the breakthrough curve(BTC) is growing with the number of pools. This demonstrates that transient storage within pools is transformed to retardation. The symmetrical pool has longer tails compared to the asymmetrical pool. The concentration peak lag behind significantly due to the asymmetrical pool. A decrease in dispersivity and tailing of the BTC is observed in all pipes with the increase of flow velocities. The 1-D analytical solution of the classical advection-dispersion equation is well fitted to BTC of a single pipe in maximum flow velocity but is poorly fitted to other BTCs with appreciable tails. Therefore, it requires an appropriate model to explain tailing of the BTC. The conclusion has important significance for understanding of solute transport process in karst conduit. Future work will focus on using the appropriate model to explain tailing of the BTC.

Effect of Holder pasteurization on macronutrients and immunoglobulin profile of pooled donor human milk.

PubMed

Adhisivam, B; Vishnu Bhat, B; Rao, Krishna; Kingsley, S M; Plakkal, Nishad; Palanivel, C

2018-03-27

The objective of this study was to study the effect of Holder pasteurization on macronutrients and immunoglobulin profile of pooled donor human milk. This descriptive study was conducted in a Human Milk Bank of a tertiary care teaching institute in south India. Thirty random paired pooled donor human milk samples (before and after pasteurization) were analyzed for macronutrients (protein, fat, carbohydrates) using infrared spectroscopy. Similarly, immunoglobulin profile (IgA and IgG) before and after pasteurization was quantified using ELISA. The mean values of protein, fat, and carbohydrates in pooled donor milk pre-pasteurization were 1.6, 3.6, and 6.1 g/dl compared with post-pasteurization values 1.4, 2.7, and 5.9 g/dl, respectively. Pasteurization reduced protein, fat, and energy content of pooled donor milk by 12.5%, 25%, and 16%, respectively. However, carbohydrates were not significantly reduced. Pasteurization decreased IgA by 30% and IgG by 60%. Holder pasteurization of pooled donor human milk decreases protein, fat, and energy content and also reduces the levels of IgA and IgG.

Study on Dynamic Development of Three-dimensional Weld Pool Surface in Stationary GTAW

NASA Astrophysics Data System (ADS)

Huang, Jiankang; He, Jing; He, Xiaoying; Shi, Yu; Fan, Ding

2018-04-01

The weld pool contains abundant information about the welding process. In particular, the type of the weld pool surface shape, i. e., convex or concave, is determined by the weld penetration. To detect it, an innovative laser-vision-based sensing method is employed to observe the weld pool surface of the gas tungsten arc welding (GTAW). A low-power laser dots pattern is projected onto the entire weld pool surface. Its reflection is intercepted by a screen and captured by a camera. Then the dynamic development process of the weld pool surface can be detected. By observing and analyzing, the change of the reflected laser dots reflection pattern, for shape of the weld pool surface shape, was found to closely correlate to the penetration of weld pool in the welding process. A mathematical model was proposed to correlate the incident ray, reflected ray, screen and surface of weld pool based on structured laser specular reflection. The dynamic variation of the weld pool surface and its corresponding dots laser pattern were simulated and analyzed. By combining the experimental data and the mathematical analysis, the results show that the pattern of the reflected laser dots pattern is closely correlated to the development of weld pool, such as the weld penetration. The concavity of the pool surface was found to increase rapidly after the surface shape was changed from convex to concave during the stationary GTAW process.

Characterization of dopamine releasable and reserve pools in Drosophila larvae using ATP/P2X2-mediated stimulation

PubMed Central

Xiao, Ning; Venton, B. Jill

2015-01-01

Dopaminergic signaling pathways are conserved between mammals and Drosophila, but the factors important for maintaining the functional pool of synaptic dopamine are not fully understood in Drosophila. In this study, we characterized the releasable and reserve dopamine pools in Drosophila larvae using ATP/ P2X2-mediated stimulation. Dopamine release was stable with stimulations performed at least every 5 min but decayed with stimulations performed 2 min apart or less, indicating the replenishment of the releasable pool occurred on a time scale between 2 and 5 min. Dopamine synthesis or uptake were pharmacologically inhibited with 3-iodotyrosine and cocaine, respectively, to evaluate their contributions to maintaining the releasable dopamine pool. We found that both synthesis and uptake were needed to maintain the releasable dopamine pool, with synthesis playing a major part in long-term replenishment and uptake being more important for short-term replenishment. These effects of synthesis and uptake on different time scales in Drosophila are analogous to mammals. However, unlike in mammals, cocaine did not activate a reserve pool of dopamine in Drosophila when using P2X2 stimulations. Our study shows that both synthesis and uptake replenish the releasable pool, providing a better understanding of dopamine regulation in Drosophila. PMID:25951875

Study on water evaporation rate from indoor swimming pools

NASA Astrophysics Data System (ADS)

Rzeźnik, Ilona

2017-11-01

The air relative humidity in closed spaces of indoor swimming pools influences significantly on users thermal comfort and the stability of the building structure, so its preservation on suitable level is very important. For this purpose, buildings are equipped with HVAC systems which provide adequate level of humidity. The selection of devices and their technical parameters is made using the mathematical models of water evaporation rate in the unoccupied and occupied indoor swimming pool. In the literature, there are many papers describing this phenomena but the results differ from each other. The aim of the study was the experimental verification of published models of evaporation rate in the pool. The tests carried out on a laboratory scale, using model of indoor swimming pool, measuring 99cm/68cm/22cm. The model was equipped with water spray installation with six nozzles to simulate conditions during the use of the swimming pool. The measurements were made for conditions of sports pools (water temperature 24°C) and recreational swimming pool (water temperature 34°C). According to the recommendations the air temperature was about 2°C higher than water temperature, and the relative humidity ranged from 40% to 55%. Models Shah and Biasin & Krumm were characterized by the best fit to the results of measurements on a laboratory scale.

Gender Differences in HIV Risk Behaviors Among Persons Involved in the U.S. Criminal Justice System and Living with HIV or at Risk for HIV: A "Seek, Test, Treat, and Retain" Harmonization Consortium.

PubMed

Loeliger, Kelsey B; Biggs, Mary L; Young, Rebekah; Seal, David W; Beckwith, Curt G; Kuo, Irene; Gordon, Michael S; Altice, Frederick L; Ouellet, Lawrence J; Cunningham, William E; Young, Jeremy D; Springer, Sandra A

2017-10-01

The U.S. female criminal justice (CJ) population is rapidly growing, yet large-scale studies exploring gender-specific HIV risk behaviors in the CJ population are lacking. This analysis uses baseline data on adults with a CJ history from eight U.S. studies in an NIH-funded "Seek, Test, Treat, Retain" harmonization consortium. Data were collected using a standardized HIV risk behavior assessment tool and pooled across studies to describe participants' characteristics and risk behaviors. Multilevel mixed-effects logistic regression models were used to test for gender-based behavior differences. Among 784 HIV-positive (21.4% female) and 5521 HIV-negative (8.5% female) participants, HIV-positive women had higher odds than HIV-positive men of engaging in condomless sexual intercourse (AOR 1.84 [1.16-2.95]) with potentially sero-discordant partners (AOR 2.40 [1.41-4.09]) and of sharing injection equipment (AOR 3.36 [1.31-8.63]). HIV risk reduction interventions targeting CJ-involved women with HIV are urgently needed as this population may represent an under-recognized potential source of HIV transmission.

Whole-island carbon stocks in the tropical Pacific: implications for mangrove conservation and upland restoration.

PubMed

Donato, D C; Kauffman, J B; Mackenzie, R A; Ainsworth, A; Pfleeger, A Z

2012-04-30

Management of forest carbon (C) stocks is an increasingly prominent land-use issue. Knowledge of carbon storage in tropical forests is improving, but regional variations are still poorly understood, and this constrains forest management and conservation efforts associated with carbon valuation mechanisms (e.g., carbon markets). This deficiency is especially pronounced in tropical islands and low-lying coastal areas where climate change impacts are expected to be among the most severe. This study presents the first field estimate of island-wide carbon storage in ecosystems of Oceania, with special attention to the regional role of coastal mangroves, which occur on islands and coastal zones throughout the tropics. On two island groups of Micronesia (Yap and Palau), we sampled all above- and belowground C pools, including soil and vegetation, in 24 sites distributed evenly among the three major vegetation structural types: mangroves, upland forests, and open savannas (generally on degraded lands formerly forested). Total C stocks were estimated to be 3.9 and 15.2 Tg C on Yap and Palau, respectively. Mangroves contained by far the largest per-hectare C pools (830-1218 Mg C ha(-1)), with deep organic-rich soils alone storing more C (631-754 Mg C ha(-1)) than all pools combined in upland systems. Despite covering just 12-13% of land area, mangroves accounted for 24-34% of total island C stocks. Savannas (156-203 Mg C ha(-1)) contained significantly lower C stocks than upland forests (375-437 Mg C ha(-1)), suggesting that reforesting savannas where appropriate has high potential for carbon-based funding to aid restoration objectives. For mangroves, these results demonstrate the key role of these systems within the broader context of C storage in island and coastal landscapes. Sustainable management of mangrove forests and their large C stocks is of high importance at the regional scale, and climate change mitigation programs such as REDD+ could play a large role in avoiding deforestation of mangroves where this is a management objective. Copyright © 2011 Elsevier Ltd. All rights reserved.

Palonosetron versus older 5-HT3 receptor antagonists for nausea prevention in patients receiving chemotherapy: a multistudy analysis.

PubMed

Morrow, Gary R; Schwartzberg, Lee; Barbour, Sally Y; Ballinari, Gianluca; Thorn, Michael D; Cox, David

2014-07-01

No clinical standard currently exists for the optimal management of nausea induced by emetogenic chemotherapy, 7particularly delayed nausea. To compare the effcacy and safety of palonosetron with older 5-HT3 receptor antagonists (RAs) in preventing chemotherapy-induced nausea. Data were pooled from 4 similarly designed multicenter, randomized, double-blind, clinical trials that compared single intravenous doses of palonosetron 0.25 mg or 0.75 mg with ondansetron 32 mg, dolasetron 100 mg, or granisetron 40 μg/kg, administered 30 minutes before moderately emetogenic chemotherapy (MEC) or highly emetogenic chemotherapy (HEC). Pooled data within each chemotherapy category (MEC: n = 1,132; HEC: n = 1,781) were analyzed by a logistic regression model. Nausea endpoints were complete control rates (ie, no more than mild nausea, no vomiting, and no rescue medication), nausea-free rates, nausea severity, and requirement for rescue antiemetic/antinausea medication over 5 days following chemotherapy. Pooled safety data were summarized descriptively. Numerically more palonosetron-treated patients were nausea-free on each day, and fewer had moderate-severe nausea. Similarly, usage of rescue medication was less frequent among palonosetron-treated patients. Complete control rates for palonosetron and older 5-HT3 RAs in the acute phase were 66% vs 63%, 52% vs 42% in the delayed phase (24-120 hours), and 46% vs 37% in the overall phase. The incidence of adverse events was similar for palonosetron and older 5-HT3 RAs. This post hoc analysis summarized data for palonosetron and several other 5-HT3 RAs but was not powered for statistical comparisons between individual agents. Because nausea is inherently subjective, the reliability of assessments of some aspects (eg, severity) may be infuenced by interindividual variability. Palonosetron may be more effective than older 5-HT3 RAs in preventing nausea, with comparable tolerability. Dr Schwartzberg is a consultant to and Dr Cox an employee at Esai. Mr Ballinari is a member of staff at and Dr Thorn consults for Helsinn Healthcare SA. Funding to support this study and the preparation of this manuscript was provided by Eisai Inc. 2014 FrontlineMedical Communications.

Redefining "Medical Care."

PubMed

Roth, Lauren R

President Donald J. Trump has said he will repeal the Affordable Care Act (ACA) and replace it with health savings accounts (HSAs). Conservatives have long preferred individual accounts to meet social welfare needs instead of more traditional entitlement programs. The types of "medical care" that can be reimbursed through an HSA are listed in section 213(d) of the Internal Revenue Code (Code) and include expenses "for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body." In spite of the broad language, regulations and court interpretations have narrowed this definition substantially. It does not include the many social factors that determine health outcomes. Though the United States spends over seventeen percent of gross domestic product (GDP) on "healthcare", the country's focus on the traditional medicalized model of health results in overall population health that is far beneath the results of other countries that spend significantly less. Precision medicine is one exceptional way in which American healthcare has focused more on individuals instead of providing broad, one-size-fits-all medical care. The precision medicine movement calls for using the genetic code of individuals to both predict future illness and to target treatments for current illnesses. Yet the definition of "medical care" under the Code remains the same for all. My proposal for precision healthcare accounts involves two steps-- the first of which requires permitting physicians to write prescriptions for a broader range of goods and services. The social determinants of health are as important to health outcomes as are surgical procedures and drugs--or perhaps more so according to many population health studies. The second step requires agencies and courts to interpret what constitutes "medical care" under the Code differently depending on the taxpayer's income level. Childhood sports programs and payments for fruits and vegetables may be covered for those in the lower income brackets who could not otherwise afford these items and would not choose to spend scarce resources on them if they could. This all assumes that the government takes funds previously used to subsidize the purchase of health insurance under the ACA (or allocates new funds) and puts the funds in individual accounts so the poor or near poor have money to pay for these expenses. Section I of this Article will explore the current definition of medical care, which excludes the social determinants of health from "healthcare" spending. I then address how precision medicine has changed the types of services and treatments that it makes sense to reimburse for each individual. If efficacy can vary from person to person based on genetic code, then it also can vary depending on environment. There is an opportunity to not only vary the types of "medical care" that can be reimbursed or deducted within the traditional range of services and drugs, but also outside of that range. Section II addresses the historical shift towards health financing through individual accounts, and specifically through HSAs. If this is the only avenue for health reform in the next few years, I advocate using it to engage in the type of experiments that are typically only possible under the cover of tax expenditures. My proposal for precision healthcare accounts moves the government to experiment with individual social spending that can lead to improved overall health outcomes. Finally, in Section III, I address two dichotomies that affect any healthcare proposal: (1) entitlement programs v. grants-in-aid, and (2) pooled insurance v. consumer-driven health plans (CDHPs). In the end, I argue that an entitlement method of funding precision HSAs along with pooled insurance subsidized by the government is the most realistic resolution to these dichotomies. Only a broad-based entitlement to funding for all healthcare expenses (medical and social) allows for significant improvements in overall population health.

Livestock Grazing as a Driver of Vernal Pool Ecohydrology

NASA Astrophysics Data System (ADS)

Michaels, J.; McCarten, N. F.

2017-12-01

Vernal pools are seasonal wetlands that host rare plant communities of high conservation priority. Plant community composition is largely driven by pool hydroperiod. A previous study found that vernal pools grazed by livestock had longer hydroperiods compared with pools excluded from grazing for 10 years, and suggests that livestock grazing can be used to protect plant diversity. It is important to assess whether observed differences are due to the grazing or due to water balance variables including upland discharge into or out of the pools since no a priori measurements were made of the hydrology prior to grazing. To address this question, in 2016 we compared 15 pools that have been grazed continuously and 15 pools that have been fenced off for over 40 years at a site in Sacramento County. We paired pools based on abiotic characteristics (size, shape, slope, soil type) to minimize natural variation. We sampled vegetation and water depth using Solinst level loggers. We found that plant diversity and average hydroperiod was significantly higher in the grazed pools. We are currently measuring groundwater connectivity and upland inputs in order to compare the relative strength of livestock grazing as a driver of hydroperiod to these other drivers.

Assessing ecological risk at a hazardous waste site containing vernal pools

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

DeLong, T.; Millard, J.; Timmer, E.

1995-12-31

An ecological risk assessment was conducted for a Superfund site in central California. As part of this assessment an evaluation of vernal pools was conducted. Vernal pools are amphibious ecosystems that support unique biotic communities. Many of the endemic species associated with vernal pools in central California are currently listed as state or Federally endangered, threatened, or rare species and include: Contra Costa goldfields (Lasthenia conjugens), vernal pool fairy shrimp (Branchinecta lynchl), vernal pool tadpole shrimp (Lepidurus packardi) and the California tiger salamander (Ambystoma tigrinum califomiense). The protection of these habitats is essential for the preservation of the special statusmore » species dependent on them for survival. As part of the risk assessment, vernal pools in the study area were identified and surveyed for special status flora and fauna for two consecutive years. Information regarding the relative quality of each pool was also collected. In order to assess potential impacts from chemical exposures to communities inhabiting these vernal pools, a weight-of-evidence approach was employed that included: evaluation of vernal pool biological composition; assessment of physical and chemical conditions; invertebrate sediment toxicity evaluations, and Frog Embryo Teratogenesis Analysis -- Xenopus (FETAX) testing.« less

Bayesian Analysis of Silica Exposure and Lung Cancer Using Human and Animal Studies.

PubMed

Bartell, Scott M; Hamra, Ghassan Badri; Steenland, Kyle

2017-03-01

Bayesian methods can be used to incorporate external information into epidemiologic exposure-response analyses of silica and lung cancer. We used data from a pooled mortality analysis of silica and lung cancer (n = 65,980), using untransformed and log-transformed cumulative exposure. Animal data came from chronic silica inhalation studies using rats. We conducted Bayesian analyses with informative priors based on the animal data and different cross-species extrapolation factors. We also conducted analyses with exposure measurement error corrections in the absence of a gold standard, assuming Berkson-type error that increased with increasing exposure. The pooled animal data exposure-response coefficient was markedly higher (log exposure) or lower (untransformed exposure) than the coefficient for the pooled human data. With 10-fold uncertainty, the animal prior had little effect on results for pooled analyses and only modest effects in some individual studies. One-fold uncertainty produced markedly different results for both pooled and individual studies. Measurement error correction had little effect in pooled analyses using log exposure. Using untransformed exposure, measurement error correction caused a 5% decrease in the exposure-response coefficient for the pooled analysis and marked changes in some individual studies. The animal prior had more impact for smaller human studies and for one-fold versus three- or 10-fold uncertainty. Adjustment for Berkson error using Bayesian methods had little effect on the exposure-response coefficient when exposure was log transformed or when the sample size was large. See video abstract at, http://links.lww.com/EDE/B160.

A study of Minnesota's high-risk health insurance pool.

PubMed

Zellner, B B; Haugen, D K; Dowd, B

1993-01-01

This is a report of a study of Minnesota's high-risk health insurance pool for "medically uninsurable" persons. The study consisted of a survey of current and past enrollees carried out in the Spring of 1990 and an analysis of the claims and membership files for 1988 and 1989. The main policy conclusion we reached is that Minnesota's high-risk pool is an adequate approach to the problem raised by risk segmentation on the basis of health status, providing that enrollment remains a small fraction of the population. The recent high, enrollment growth rates the Minnesota risk pool has experienced raise the possibility that basic structural reforms of the nongroup and small-group health insurance markets are needed.

Impacts of intensive forestry on early rotation trends in site carbon pools in the southeastern US

Treesearch

Raija Laiho; Felipe Sanchez; Allan Tiarks; Phillip M. Dougherty; Carl C. Trettin

2003-01-01

The effects of different silvicultural practices on site, especially soil, carbon (C) pools are still poorly known. We studied changes in site C pools during the first 5 years following harvesting and conversion of two extensively managed pine-hardwood stands to intensively managed loblolly pine plantations. One study site was located on the lower Atlantic Coastal...

Validation of the pooled cohort risk score in an Asian population - a retrospective cohort study.

PubMed

Chia, Yook Chin; Lim, Hooi Min; Ching, Siew Mooi

2014-11-20

The Pooled Cohort Risk Equation was introduced by the American College of Cardiology (ACC) and American Heart Association (AHA) 2013 in their Blood Cholesterol Guideline to estimate the 10-year atherosclerotic cardiovascular disease (ASCVD) risk. However, absence of Asian ethnicity in the contemporary cohorts and limited studies to examine the use of the risk score limit the applicability of the equation in an Asian population. This study examines the validity of the pooled cohort risk score in a primary care setting and compares the cardiovascular risk using both the pooled cohort risk score and the Framingham General Cardiovascular Disease (CVD) risk score. This is a 10-year retrospective cohort study of randomly selected patients aged 40-79 years. Baseline demographic data, co-morbidities and cardiovascular (CV) risk parameters were captured from patient records in 1998. Pooled cohort risk score and Framingham General CVD risk score for each patient were computed. All ASCVD events (nonfatal myocardial infarction, coronary heart disease (CHD) death, fatal and nonfatal stroke) occurring from 1998-2007 were recorded. A total of 922 patients were studied. In 1998, mean age was 57.5 ± 8.8 years with 66.7% female. There were 47% diabetic patients and 59.9% patients receiving anti-hypertensive treatment. More than 98% of patients with pooled cohort risk score ≥7.5% had FRS >10%. A total of 45 CVD events occurred, 22 (7.2%) in males and 23 (3.7%) in females. The median pooled cohort risk score for the population was 10.1 (IQR 4.7-20.6) while the actual ASCVD events that occurred was 4.9% (45/922). Our study showed moderate discrimination with AUC of 0.63. There was good calibration with Hosmer-Lemeshow test χ2 = 12.6, P = 0.12. The pooled cohort risk score appears to overestimate CV risk but this apparent over-prediction could be a result of treatment. In the absence of a validated score in an untreated population, the pooled cohort risk score appears to be appropriate for use in a primary care setting.

The Chemistry of Swimming Pool Maintenance

ERIC Educational Resources Information Center

Salter, Carl; Langhus, David L.

2007-01-01

The study of chemistry involved in the maintenance of a swimming pool provides a lot of chemical education to the students, including the demonstration of the importance of pH in water chemistry. The various chemical aspects hidden in the maintenance of the pool are being described.

Diving into Cold Pools

NASA Astrophysics Data System (ADS)

van den Heever, S. C.; Grant, L. D.; Drager, A. J.

2017-12-01

Cold pools play a significant role in convective storm initiation, organization and longevity. Given their role in convective life cycles, recent efforts have been focused on improving the representation of cold pool processes within weather forecast models, as well as on developing cold pool parameterizations in order to better represent their impacts within global climate models. Understanding the physical processes governing cold pool formation, intensity and dissipation is therefore critical to these efforts. Cold pool characteristics are influenced by numerous factors, including those associated with precipitation formation and evaporation, variations in the environmental moisture and shear, and land surface interactions. The focus of this talk will be on the manner in which the surface characteristics and associated processes impact cold pool genesis and dissipation. In particular, the results from high-resolution modeling studies focusing on the role of sensible and latent heat fluxes, soil moisture and SST will be presented. The results from a recent field campaign examining cold pools over northern Colorado will also be discussed.

A Highly Efficient Design Strategy for Regression with Outcome Pooling

PubMed Central

Mitchell, Emily M.; Lyles, Robert H.; Manatunga, Amita K.; Perkins, Neil J.; Schisterman, Enrique F.

2014-01-01

The potential for research involving biospecimens can be hindered by the prohibitive cost of performing laboratory assays on individual samples. To mitigate this cost, strategies such as randomly selecting a portion of specimens for analysis or randomly pooling specimens prior to performing laboratory assays may be employed. These techniques, while effective in reducing cost, are often accompanied by a considerable loss of statistical efficiency. We propose a novel pooling strategy based on the k-means clustering algorithm to reduce laboratory costs while maintaining a high level of statistical efficiency when predictor variables are measured on all subjects, but the outcome of interest is assessed in pools. We perform simulations motivated by the BioCycle study to compare this k-means pooling strategy with current pooling and selection techniques under simple and multiple linear regression models. While all of the methods considered produce unbiased estimates and confidence intervals with appropriate coverage, pooling under k-means clustering provides the most precise estimates, closely approximating results from the full data and losing minimal precision as the total number of pools decreases. The benefits of k-means clustering evident in the simulation study are then applied to an analysis of the BioCycle dataset. In conclusion, when the number of lab tests is limited by budget, pooling specimens based on k-means clustering prior to performing lab assays can be an effective way to save money with minimal information loss in a regression setting. PMID:25220822

A highly efficient design strategy for regression with outcome pooling.

PubMed

Mitchell, Emily M; Lyles, Robert H; Manatunga, Amita K; Perkins, Neil J; Schisterman, Enrique F

2014-12-10

The potential for research involving biospecimens can be hindered by the prohibitive cost of performing laboratory assays on individual samples. To mitigate this cost, strategies such as randomly selecting a portion of specimens for analysis or randomly pooling specimens prior to performing laboratory assays may be employed. These techniques, while effective in reducing cost, are often accompanied by a considerable loss of statistical efficiency. We propose a novel pooling strategy based on the k-means clustering algorithm to reduce laboratory costs while maintaining a high level of statistical efficiency when predictor variables are measured on all subjects, but the outcome of interest is assessed in pools. We perform simulations motivated by the BioCycle study to compare this k-means pooling strategy with current pooling and selection techniques under simple and multiple linear regression models. While all of the methods considered produce unbiased estimates and confidence intervals with appropriate coverage, pooling under k-means clustering provides the most precise estimates, closely approximating results from the full data and losing minimal precision as the total number of pools decreases. The benefits of k-means clustering evident in the simulation study are then applied to an analysis of the BioCycle dataset. In conclusion, when the number of lab tests is limited by budget, pooling specimens based on k-means clustering prior to performing lab assays can be an effective way to save money with minimal information loss in a regression setting. Copyright © 2014 John Wiley & Sons, Ltd.

Outcomes associated with 12 years of grant funding: the Pediatric Endocrinology Nursing Society grant program.

PubMed

Keil, Margaret F; Lipman, Terri H

2007-06-01

In 1990, the Pediatric Endocrinology Nursing Society (PENS) developed a grant program to provide funding to advance pediatric endocrinology nursing practice through basic and applied research. Minimal data exist regarding the effect of grant funding on professional development and research dissemination. The purpose of this study was to determine the extent that PENS' grant funding has resulted in professional presentations, publications, and further research funding. Nineteen grants that received funding were identified. Survey questions included whether the results of the PENS-funded study were presented, published, and resulted in subsequent funding from other sources. Outcome data were available for 11 of 18 grants (61%). All funded studies were presented at PENS conference; 55% were presented at other national or international conferences. Sixteen publications resulted from seven funded studies; 64% of PENS' funded studies led to additional funding, and 18% resulted in additional research studies. In summary, the research grant program of PENS funded 19 grants, which resulted in numerous publications, presentations, and, in some cases, additional research funding from other sources. Many grant recipients acknowledged that PENS was their first source of research funding and gave them the opportunity to become experienced in their role as clinical researchers.

How countries cope with competing demands and expectations: perspectives of different stakeholders on priority setting and resource allocation for health in the era of HIV and AIDS

PubMed Central

2012-01-01

Background Health systems have experienced unprecedented stress in recent years, and as yet no consensus has emerged as to how to deal with the multiple burden of disease in the context of HIV and AIDS and other competing health priorities. Priority setting is essential, yet this is a complex, multifaceted process. Drawing on a study conducted in five African countries, this paper explores different stakeholders′ perceptions of health priorities, how priorities are defined in practice, the process of resource allocation for HIV and Health and how different stakeholders perceive this. Methods A sub-analysis was conducted of selected data from a wider qualitative study that explored the interactions between health systems and HIV and AIDS responses in five sub-Saharan countries (Burkina Faso, the Democratic Republic of Congo, Ghana, Madagascar and Malawi). Key background documents were analysed and semi-structured interviews (n = 258) and focus group discussions (n = 45) were held with representatives of communities, health personnel, decision makers, civil society representatives and development partners at both national and district level. Results Health priorities were expressed either in terms of specific health problems and diseases or gaps in service delivery requiring a strengthening of the overall health system. In all five countries study respondents (with the exception of community members in Ghana) identified malaria and HIV as the two top health priorities. Community representatives were more likely to report concerns about accessibility of services and quality of care. National level respondents often referred to wider systemic challenges in relation to achieving the Millennium Development Goals (MDGs). Indeed, actual priority setting was heavily influenced by international agendas (e.g. MDGs) and by the ways in which development partners were supporting national strategic planning processes. At the same time, multi-stakeholder processes were increasingly used to identify priorities and inform sector-wide planning, whereby health service statistics were used to rank the burden of disease. However, many respondents remarked that health system challenges are not captured by such statistics. In all countries funding for health was reported to fall short of requirements and a need for further priority setting to match actual resource availability was identified. Pooled health sector funds have been established to some extent, but development partners′ lack of flexibility in the allocation of funds according to country-generated priorities was identified as a major constraint. Conclusions Although we found consensus on health priorities across all levels in the study countries, current funding falls short of addressing these identified areas. The nature of external funding, as well as programme-specific investment, was found to distort priority setting. There are signs that existing interventions have had limited effects beyond meeting the needs of disease-specific programmes. A need for more comprehensive health system strengthening (HSS) was identified, which requires a strong vision as to what the term means, coupled with a clear strategy and commitment from national and international decision makers in order to achieve stated goals. Prospective studies and action research, accompanied by pilot programmes, are recommended as deliberate strategies for HSS. PMID:23231820

How countries cope with competing demands and expectations: perspectives of different stakeholders on priority setting and resource allocation for health in the era of HIV and AIDS.

PubMed

Jenniskens, Françoise; Tiendrebeogo, Georges; Coolen, Anne; Blok, Lucie; Kouanda, Seni; Sataru, Fuseini; Ralisimalala, Andriamampianina; Mwapasa, Victor; Kiyombo, Mbela; Plummer, David

2012-12-11

Health systems have experienced unprecedented stress in recent years, and as yet no consensus has emerged as to how to deal with the multiple burden of disease in the context of HIV and AIDS and other competing health priorities. Priority setting is essential, yet this is a complex, multifaceted process. Drawing on a study conducted in five African countries, this paper explores different stakeholders' perceptions of health priorities, how priorities are defined in practice, the process of resource allocation for HIV and Health and how different stakeholders perceive this. A sub-analysis was conducted of selected data from a wider qualitative study that explored the interactions between health systems and HIV and AIDS responses in five sub-Saharan countries (Burkina Faso, the Democratic Republic of Congo, Ghana, Madagascar and Malawi). Key background documents were analysed and semi-structured interviews (n = 258) and focus group discussions (n = 45) were held with representatives of communities, health personnel, decision makers, civil society representatives and development partners at both national and district level. Health priorities were expressed either in terms of specific health problems and diseases or gaps in service delivery requiring a strengthening of the overall health system. In all five countries study respondents (with the exception of community members in Ghana) identified malaria and HIV as the two top health priorities. Community representatives were more likely to report concerns about accessibility of services and quality of care. National level respondents often referred to wider systemic challenges in relation to achieving the Millennium Development Goals (MDGs). Indeed, actual priority setting was heavily influenced by international agendas (e.g. MDGs) and by the ways in which development partners were supporting national strategic planning processes. At the same time, multi-stakeholder processes were increasingly used to identify priorities and inform sector-wide planning, whereby health service statistics were used to rank the burden of disease. However, many respondents remarked that health system challenges are not captured by such statistics.In all countries funding for health was reported to fall short of requirements and a need for further priority setting to match actual resource availability was identified. Pooled health sector funds have been established to some extent, but development partners' lack of flexibility in the allocation of funds according to country-generated priorities was identified as a major constraint. Although we found consensus on health priorities across all levels in the study countries, current funding falls short of addressing these identified areas. The nature of external funding, as well as programme-specific investment, was found to distort priority setting. There are signs that existing interventions have had limited effects beyond meeting the needs of disease-specific programmes. A need for more comprehensive health system strengthening (HSS) was identified, which requires a strong vision as to what the term means, coupled with a clear strategy and commitment from national and international decision makers in order to achieve stated goals. Prospective studies and action research, accompanied by pilot programmes, are recommended as deliberate strategies for HSS.

Tax credits and purchasing pools: will this marriage work?

PubMed

Trude, S; Ginsburg, P B

2001-04-01

Bipartisan interest is growing in Congress for using federal tax credits to help low-income families buy health insurance. Regardless of the approach taken, tax credit policies must address risk selection issues to ensure coverage for the chronically ill. Proposals that link tax credits to purchasing pools would avoid risk selection by grouping risks similar to the way large employers do. Voluntary purchasing pools have had only limited success, however. This Issue Brief discusses linking tax credits to purchasing pools. It uses information from the Center for Studying Health System Change's (HSC) site visits to 12 communities as well as other research to assess the role of purchasing pools nationwide and the key issues and implications of linking tax credits and pools.

[Comparison of simple pooling and bivariate model used in meta-analyses of diagnostic test accuracy published in Chinese journals].

PubMed

Huang, Yuan-sheng; Yang, Zhi-rong; Zhan, Si-yan

2015-06-18

To investigate the use of simple pooling and bivariate model in meta-analyses of diagnostic test accuracy (DTA) published in Chinese journals (January to November, 2014), compare the differences of results from these two models, and explore the impact of between-study variability of sensitivity and specificity on the differences. DTA meta-analyses were searched through Chinese Biomedical Literature Database (January to November, 2014). Details in models and data for fourfold table were extracted. Descriptive analysis was conducted to investigate the prevalence of the use of simple pooling method and bivariate model in the included literature. Data were re-analyzed with the two models respectively. Differences in the results were examined by Wilcoxon signed rank test. How the results differences were affected by between-study variability of sensitivity and specificity, expressed by I2, was explored. The 55 systematic reviews, containing 58 DTA meta-analyses, were included and 25 DTA meta-analyses were eligible for re-analysis. Simple pooling was used in 50 (90.9%) systematic reviews and bivariate model in 1 (1.8%). The remaining 4 (7.3%) articles used other models pooling sensitivity and specificity or pooled neither of them. Of the reviews simply pooling sensitivity and specificity, 41(82.0%) were at the risk of wrongly using Meta-disc software. The differences in medians of sensitivity and specificity between two models were both 0.011 (P<0.001, P=0.031 respectively). Greater differences could be found as I2 of sensitivity or specificity became larger, especially when I2>75%. Most DTA meta-analyses published in Chinese journals(January to November, 2014) combine the sensitivity and specificity by simple pooling. Meta-disc software can pool the sensitivity and specificity only through fixed-effect model, but a high proportion of authors think it can implement random-effect model. Simple pooling tends to underestimate the results compared with bivariate model. The greater the between-study variance is, the more likely the simple pooling has larger deviation. It is necessary to increase the knowledge level of statistical methods and software for meta-analyses of DTA data.

Genotoxic Effects in Swimmers Exposed to Disinfection By-products in Indoor Swimming Pool

EPA Science Inventory

BACKGROUND: Exposure to disinfection by-products (DBPs) in drinking water has been associated with cancer risk, and a recent study found an increased bladder cancer risk among subjects attending swimming pools. OBJECTIVES: To evaluate whether swimming in pools is associated with ...

Peatland Open-water Pool Biogeochemistry: The Influence of Hydrology and Vegetation

NASA Astrophysics Data System (ADS)

Arsenault, J.; Talbot, J.; Moore, T. R.

2017-12-01

Peatland open-water pools are net sources of carbon to the atmosphere. However, their interaction with the surrounding peat remains poorly known. In a previous study, we showed that shallow pools are richer in nutrients than deep pools. While depth was the main driver of biogeochemistry variations across time and space, analyses also showed that pool's adjacent vegetation may have an influence on water chemistry. Our goal is to understand the relationship between the biogeochemistry of open-water pools and their surroundings in a subboreal ombrotrophic peatland of southern Quebec (Canada). To assess the influence of vegetation on pool water chemistry, we compare two areas covered with different types of vegetation: a forested zone dominated by spruce trees and an open area mostly covered by Sphagnum spp. To evaluate the direction of water (in or out of the pools), we installed capacitance water level probes in transects linking pools in the two zones. Wells were also installed next to each probe to collect peat pore water samples. Samples were taken every month during summer 2017 and analyzed for dissolved organic carbon, nitrogen and phosphorus, pH and specific UV absorbance. Preliminary results show differences in peat water chemistry depending on the dominant vegetation. In both zones, water levels fluctuations are disconnected between peat and the pools, suggesting poor horizontal water movement. Pool water chemistry may be mostly influenced by the immediate surrounding vegetation than by the local vegetation pattern. Climate and land-use change may affect the vegetation structure of peatlands, thus affecting pool biogeochemistry. Considering the impact of pools on the overall peatland capacity to accumulate carbon, our results show that more focus must be placed on pools to better understand peatland stability over time.

Monitoring Physicochemical and Nutrient Dynamics Along a Development Gradient in Maine Ephemeral Wetlands

NASA Astrophysics Data System (ADS)

Podzikowski, L. Y.; Capps, K. A.; Calhoun, A.

2014-12-01

Vernal pools are ephemeral wetlands in forested landscapes that fill with snowmelt, precipitation, and/or groundwater in the spring, and characteristically dry down through the summer months. Typically, vernal pool research has focused on the population and community ecology of pool-breeding organisms (amphibians and macroinvertebrates) conducted during their relatively short breeding season. Yet, little is known about the temporal variability of biogeochemical processes within and among vernal pools in urbanizing landscapes. In this study, we monitored physicochemical characteristics and nutrient dynamics in 22 vernal pools in central Maine post thaw in 2014. Four pristine pools were sampled weekly in five locations within the pool for ambient nutrient concentrations (SRP, NH4, NOx) and at three locations for physicochemical characteristics (DO, pH, temperature, conductivity). In the remaining 18 pools, we sampled one location for nutrients and three locations for physicochemical characteristics at least monthly to estimate the influence of increasing urbanization on the physical and chemical environment. Our data suggest most pools found in urbanizing areas have higher conductivity (developed sites ranging 18.52 - 1238 μS cm-1 compared to pristine between 14.08 - 58.4 μS cm-1). Previous work suggests forested pools exhibit dystrophic conditions with high coloration from DOC limiting primary production due to increased light attenuation in pools. However, both pristine and urban pools experienced spikes in DO (>100% saturation) throughout the day, suggesting that high productivity is not a reliable indicator of the effects of urbanization on vernal pools. We argue that continued monitoring of vernal pools along a gradient of urbanization could give insight into the role of ephemeral wetlands as potential biogeochemical hotspots and may also indicate how human development may alter biogeochemical cycling in ephemeral wetlands.

Effect of the pool depth on drop impact splashing

NASA Astrophysics Data System (ADS)

Chizari, Hossain; Thoraval, Marie-Jean

2017-11-01

We investigate the effect of the pool depth on the splashing dynamics of drop impact. The splashing of a single drop impacting into a deep pool or on wet surface has been investigated for many years both numerically and experimentally. However, recent results have demonstrated the importance of the vorticity produced during the impact on the splashing behavior. More specifically, the shedding of a vortex ring inside the liquid during the impact can separate the splash jet into several parts. The shedding of the vorticity can be influenced by the proximity of the bottom of the pool, if the pool depth is small enough. We study here how the pool depth can affect the vorticity shedding and the resulting splashing jets. We perform axisymmetric numerical simulations of the impacts with the open sources codes Gerris and Basilisk, and systematically vary the impact conditions, focusing on the effect of pool depth in the splashing regimes.

Role of surface heat fluxes underneath cold pools

PubMed Central

Garelli, Alix; Park, Seung‐Bu; Nie, Ji; Torri, Giuseppe; Kuang, Zhiming

2016-01-01

Abstract The role of surface heat fluxes underneath cold pools is investigated using cloud‐resolving simulations with either interactive or horizontally homogenous surface heat fluxes over an ocean and a simplified land surface. Over the ocean, there are limited changes in the distribution of the cold pool temperature, humidity, and gust front velocity, yet interactive heat fluxes induce more cold pools, which are smaller, and convection is then less organized. Correspondingly, the updraft mass flux and lateral entrainment are modified. Over the land surface, the heat fluxes underneath cold pools drastically impact the cold pool characteristics with more numerous and smaller pools, which are warmer and more humid and accompanied by smaller gust front velocities. The interactive fluxes also modify the updraft mass flux and reduce convective organization. These results emphasize the importance of interactive surface fluxes instead of prescribed flux boundary conditions, as well as the formulation of surface heat fluxes, when studying convection. PMID:27134320

Size and characteristics of the biomedical research workforce associated with U.S. National Institutes of Health extramural grants

PubMed Central

Pool, Lindsay R.; Wagner, Robin M.; Scott, Lindsey L.; RoyChowdhury, Deepshikha; Berhane, Rediet; Wu, Charles; Pearson, Katrina; Sutton, Jennifer A.; Schaffer, Walter T.

2016-01-01

The U.S. National Institutes of Health (NIH) annually invests approximately $22 billion in biomedical research through its extramural grant programs. Since fiscal year (FY) 2010, all persons involved in research during the previous project year have been required to be listed on the annual grant progress report. These new data have enabled the production of the first-ever census of the NIH-funded extramural research workforce. Data were extracted from All Personnel Reports submitted for NIH grants funded in FY 2009, including position title, months of effort, academic degrees obtained, and personal identifiers. Data were de-duplicated to determine a unique person count. Person-years of effort (PYE) on NIH grants were computed. In FY 2009, NIH funded 50,885 grant projects, which created 313,049 full- and part-time positions spanning all job functions involved in biomedical research. These positions were staffed by 247,457 people at 2,604 institutions. These persons devoted 121,465 PYE to NIH grant-supported research. Research project grants each supported 6 full- or part-time positions, on average. Over 20% of positions were occupied by postdoctoral researchers and graduate and undergraduate students. These baseline data were used to project workforce estimates for FYs 2010–2014 and will serve as a foundation for future research.—Pool, L. R., Wagner, R. M., Scott, L. L., RoyChowdhury, D., Berhane, R., Wu, C., Pearson, K., Sutton, J. A., Schaffer, W. T. Size and characteristics of the biomedical research workforce associated with U.S. National Institutes of Health extramural grants. PMID:26625903

Whole exome sequencing in recurrent early pregnancy loss.

PubMed

Qiao, Ying; Wen, Jiadi; Tang, Flamingo; Martell, Sally; Shomer, Naomi; Leung, Peter C K; Stephenson, Mary D; Rajcan-Separovic, Evica

2016-05-01

Exome sequencing can identify genetic causes of idiopathic recurrent pregnancy loss (RPL). We identified compound heterozygous deleterious mutations affecting DYNC2H1 and ALOX15 in two out of four families with RPL. Both genes have a role in early development. Bioinformatics analysis of all genes with rare and putatively pathogenic mutations in miscarriages and couples showed enrichment in pathways relevant to pregnancy loss, including the complement and coagulation cascades pathways. Next generation sequencing (NGS) is increasingly being used to identify known and novel gene mutations in children with developmental delay and in fetuses with ultrasound-detected anomalies. In contrast, NGS is rarely used to study pregnancy loss. Chromosome microarray analysis detects putatively causative DNA copy number variants (CNVs) in ∼2% of miscarriages and CNVs of unknown significance (predominantly parental in origin) in up to 40% of miscarriages. Therefore, a large number of miscarriages still have an unknown cause. Whole exome sequencing (WES) was performed using Illumina HiSeq 2000 platform on seven euploid miscarriages from four families with RPL. Golden Helix SVS v8.1.5 was used for data assessment and inheritance analysis for deleterious DNA variants predicted to severely disrupt protein-coding genes by introducing a frameshift, loss of the stop codon, gain of the stop codon, changes in splicing or the initial codon. Webgestalt (http://bioinfo.vanderbilt.edu/webgestalt/) was used for pathway and disease association enrichment analysis of a gene pool containing putatively pathogenic variants in miscarriages and couples in comparison to control gene pools. Compound heterozygous mutations in DYNC2H1 and ALOX15 were identified in miscarriages from two families with RPL. DYNC2H1 is involved in cilia biogenesis and has been associated with fetal lethality in humans. ALOX15 is expressed in placenta and its dysregulation has been associated with inflammation, placental, dysfunction, abnormal oxidative stress response and angiogenesis. The pool of putatively pathogenic single nucleotide variants (SNVs) and small insertions and deletions (indels) detected in the miscarriages showed enrichment in 'complement and coagulation cascades pathway', and 'ciliary motility disorders'. We conclude that CNVs, individual SNVs and pool of deleterious gene mutations identified by exome sequencing could contribute to RPL. The size of our sample cohort is small. The functional effect of candidate mutations should be evaluated to determine whether the mutations are causative. This is the first study to assess whether SNVs may contribute to the pathogenesis of miscarriage. Furthermore, our findings suggest that collective effect of mutations in relevant biological pathways could be implicated in RPL. The study was funded by Canadian Institutes of Health Research (grant MOP 106467) and Michael Smith Foundation of Health Research Career Scholar salary award to ERS. © The Author 2016. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

A statistical method for the detection of variants from next-generation resequencing of DNA pools.

PubMed

Bansal, Vikas

2010-06-15

Next-generation sequencing technologies have enabled the sequencing of several human genomes in their entirety. However, the routine resequencing of complete genomes remains infeasible. The massive capacity of next-generation sequencers can be harnessed for sequencing specific genomic regions in hundreds to thousands of individuals. Sequencing-based association studies are currently limited by the low level of multiplexing offered by sequencing platforms. Pooled sequencing represents a cost-effective approach for studying rare variants in large populations. To utilize the power of DNA pooling, it is important to accurately identify sequence variants from pooled sequencing data. Detection of rare variants from pooled sequencing represents a different challenge than detection of variants from individual sequencing. We describe a novel statistical approach, CRISP [Comprehensive Read analysis for Identification of Single Nucleotide Polymorphisms (SNPs) from Pooled sequencing] that is able to identify both rare and common variants by using two approaches: (i) comparing the distribution of allele counts across multiple pools using contingency tables and (ii) evaluating the probability of observing multiple non-reference base calls due to sequencing errors alone. Information about the distribution of reads between the forward and reverse strands and the size of the pools is also incorporated within this framework to filter out false variants. Validation of CRISP on two separate pooled sequencing datasets generated using the Illumina Genome Analyzer demonstrates that it can detect 80-85% of SNPs identified using individual sequencing while achieving a low false discovery rate (3-5%). Comparison with previous methods for pooled SNP detection demonstrates the significantly lower false positive and false negative rates for CRISP. Implementation of this method is available at http://polymorphism.scripps.edu/~vbansal/software/CRISP/.

Physical and biogeochemical controls on polymictic behavior in Sierra Nevada stream pools

NASA Astrophysics Data System (ADS)

Lucas, R. G.; Conklin, M. H.; Tyler, S. W.; Suarez, F. I.; Moran, J. E.; Esser, B. K.

2011-12-01

We observed polymictic behavior in stream pools in a low gradient montane meadow in the southern Sierra Nevada mountains, California. Thermal stratification in stream pools has been observed in various environments; stratification generally persists where the buoyancy forces created by a variation in water density, as a function of water temperature, are able to overcome turbulent forces resulting from stream flow. Because the density gradient creates a relatively weak buoyancy force, low flow conditions are generally required in order to overcome the turbulent forces. In some studies, a cold water source in to the pool bottoms can help to increase the density gradient and perpetuate thermal stratification. Our study took place in Long Meadow, Sequoia National Park, California. Long Meadow lies in the Wolverton Creek watershed and is part of the Southern Sierra Critical Zone Observatory. The 1-4 m diameter and 1-2 m deep pools in our study stratified thermally during the day and mixed completely at night. The low gradient of the meadow provided low stream flows. Piezometers in the meadow indicated groundwater discharge into the meadow in the months during which stratification was observed. Radon 222 activity measured in the pools also indicated groundwater influx to the pool bottoms. We used Fluent, a computational fluid dynamics equation solver, to construct a model of one of the observed pools. Initially we attempted to model the physical mechanisms controlling thermal stratification in the pool including stream flow, groundwater discharge, solar radiation, wind speed, and air, stream and ground water temperatures. Ultimately we found the model best agreed with our observed pool temperatures when we considered the light attenuation coefficients as a function of the dissolve organic carbon (DOC) concentration. Elevated DOC concentrations are expected in low stream flow regimes associated with highly organic soils such as a montane meadow. DOC concentrations measured in samples collected from the meadow stream, pools, and ground water wells ranged from 3.09 to 5.25 mg/L. We used a power equation taken from the literature to vary the visible light attenuation with DOC values measured in the meadow system. Light attenuation coefficients determined from measured DOC concentrations ranged from 0.507 m-1 to 0.899 m-1. The results from our modeling efforts indicate that in low flow streams and rivers elevated concentrations of DOC can increase the potential for thermal stratification in stream pools.

Non-stationary Drainage Flows and Cold Pools in Gentle Terrain

NASA Astrophysics Data System (ADS)

Mahrt, L.

2015-12-01

Previous studies have concentrated on organized topography with well-defined slopes or valleys in an effort to understand the flow dynamics. However, most of the Earth's land surface consists of gentle terrain that is quasi three dimensional. Different scenarios are briefly classified. A network of measurements are analyzed to examine shallow cold pools and drainage flow down the valley which develop for weak ambient wind and relatively clear skies. However, transient modes constantly modulate or intermittently eliminate the cold pool, which makes extraction and analysis of the horizontal structure of the cold pool difficult with traditional analysis methods. Singular value decomposition successfully isolates the effects of large-scale flow from local down-valley cold air drainage within the cold pool in spite of the intermittent nature of this local flow. The traditional concept of a cold pool must be generalized to include cold pool intermittency, complex variation of temperature related to some three-dimensionality and a diffuse cold pool top. Different types of cold pools are classified in terms of the stratification and gradient of potential temperature along the slope. The strength of the cold pool is related to a forcing temperature scale proportional to the net radiative cooling divided by the wind speed above the valley. The scatter is large partly due to nonstationarity of the marginal cold pool in this shallow valley

Seasonal Patterns of the Insect Community Structure in Urban Rain Pools of Temperate Argentina

PubMed Central

Fontanarrosa, M. Soledad; Collantes, Marta B.; Bachmann, Axel O.

2009-01-01

Temporary aquatic environments are widespread in the world, and although there are considerable regional differences in their type and method of formation they have many physical, chemical and biological properties in common. With the aim to increase knowledge of urban temporary pool fauna, the objectives of this work were to assess the seasonal patterns of species composition, richness, and diversity of the aquatic insect community inhabiting rain pools in urban temperate Argentina, and to identify the environmental variables associated to these patterns. Four temporary pools of an urban green space in Buenos Aires City were studied throughout a 1-year period. Eleven flood cycles with very varied hydroperiods and dry periods, mainly associated with rainfall, were identified. Insect species richness in these temporary urban pools, 86 taxa were documented, was found to be within the range reported for wild temporary water bodies of other regions of the world. The present results provide evidence for the existence of a clear link between habitat and community variability. Hydroperiod and seasonality were the main environmental factors involved in structuring the insect communities of the studied water bodies. Urban pools in green spaces have the potential to act to its dwellers like corridors through the urban matrix. Taking into account these characteristics and their accessibility, urban temporary pools can be considered as promising habitats for the study of ecological processes involving the insect community. PMID:19611261

Building a Better Applicant Pool--A Case Study of the Use of Predictive Modeling and Market Segmentation to Build and Enroll Better Pools of Students

ERIC Educational Resources Information Center

Herridge, Bart; Heil, Robert

2003-01-01

Predictive modeling has been a popular topic in higher education for the last few years. This case study shows an example of an effective use of modeling combined with market segmentation to strategically divide large, unmanageable prospect and inquiry pools and convert them into applicants, and eventually, enrolled students. (Contains 6 tables.)

HYDROSTATIC PRESSURIZATION AND DEPLETION OF TRAPPED LUBRICANT POOL DURING CREEP CONTACT OF A RIPPLED INDENTER AGAINST A BIPHASIC ARTICULAR CARTILAGE LAYER

PubMed Central

Soltz, Michael A.; Basalo, Ines M.; Ateshian, Gerard A.

2010-01-01

This study presents an analysis of the contact of a rippled rigid impermeable indenter against a cartilage layer, which represents a first simulation of the contact of rough cartilage surfaces with lubricant entrapment. Cartilage was modeled with the biphasic theory for hydrated soft tissues, to account for fluid flow into or out of the lubricant pool. The findings of this study demonstrate that under contact creep, the trapped lubricant pool gets depleted within a time period on the order of seconds or minutes as a result of lubricant flow into the articular cartilage. Prior to depletion, hydrostatic fluid load across the contact interface may be enhanced by the presence of the trapped lubricant pool, depending on the initial geometry of the lubricant pool. According to friction models based on the biphasic nature of the tissue, this enhancement in fluid load support produces a smaller minimum friction coefficient than would otherwise be predicted without a lubricant pool. The results of this study support the hypothesis that trapped lubricant decreases the initial friction coefficient following load application, independently of squeeze-film lubrication effects. PMID:14618917

Desiccation of a pool of blood: from fluid mechanics to forensic investigations

NASA Astrophysics Data System (ADS)

Nicloux, Celine; Brutin, David

2012-11-01

The evaporation of biological fluids (with droplet configuration) has been studied since a few years due to several applications in medical fields such as medical tests, drug screening, biostabilization... The evaporation of a drop of whole blood leads to the formation of final typical pattern of cracks. Flow motion, adhesion, gelation and fracturation all occur during the evaporation of this complex matter. During the drying, a sol-gel transition develops. The evaporation of a pool of blood is studied in order to link the pattern formation and the evaporation dynamics. We intend to transfer the knowledge acquired for drops on pool to improve the forensic investigations. In this study, we focus on both pool of blood and pure water to determine the transition region from drop to pool and then to characterize the evaporation rate in the pool configuration. The spreading of blood which can be seen as a complex fluid is strongly influenced the substrate nature. The initial contact angle of blood on different substrate nature will influence the maximum thickness of the layer and then will influence the evaporation mass flux. The authors gratefully acknowledge the help and the fruitful discussions raised with A. Boccoz.

Strong influence of regional species pools on continent-wide structuring of local communities.

PubMed

Lessard, Jean-Philippe; Borregaard, Michael K; Fordyce, James A; Rahbek, Carsten; Weiser, Michael D; Dunn, Robert R; Sanders, Nathan J

2012-01-22

There is a long tradition in ecology of evaluating the relative contribution of the regional species pool and local interactions on the structure of local communities. Similarly, a growing number of studies assess the phylogenetic structure of communities, relative to that in the regional species pool, to examine the interplay between broad-scale evolutionary and fine-scale ecological processes. Finally, a renewed interest in the influence of species source pools on communities has shown that the definition of the source pool influences interpretations of patterns of community structure. We use a continent-wide dataset of local ant communities and implement ecologically explicit source pool definitions to examine the relative importance of regional species pools and local interactions for shaping community structure. Then we assess which factors underlie systematic variation in the structure of communities along climatic gradients. We find that the average phylogenetic relatedness of species in ant communities decreases from tropical to temperate regions, but the strength of this relationship depends on the level of ecological realism in the definition of source pools. We conclude that the evolution of climatic niches influences the phylogenetic structure of regional source pools and that the influence of regional source pools on local community structure is strong.

Testing Domestication Scenarios of Lima Bean (Phaseolus lunatus L.) in Mesoamerica: Insights from Genome-Wide Genetic Markers

PubMed Central

Chacón-Sánchez, María I.; Martínez-Castillo, Jaime

2017-01-01

Plant domestication can be seen as a long-term process that involves a complex interplay among demographic processes and evolutionary forces. Previous studies have suggested two domestication scenarios for Lima bean in Mesoamerica: two separate domestication events, one from gene pool MI in central-western Mexico and another one from gene pool MII in the area Guatemala-Costa Rica, or a single domestication from gene pool MI in central-western Mexico followed by post-domestication gene flow with wild populations. In this study we evaluated the genetic structure of the wild gene pool and tested these two competing domestication scenarios of Lima bean in Mesoamerica by applying an ABC approach to a set of genome-wide SNP markers. The results confirm the existence of three gene pools in wild Lima bean, two Mesoamerican gene pools (MI and MII) and the Andean gene pool (AI), and suggest the existence of another gene pool in central Colombia. The results indicate that although both domestication scenarios may be supported by genetic data, higher statistical support was given to the single domestication scenario in central-western Mexico followed by admixture with wild populations. Domestication would have involved strong founder effects reflected in loss of genetic diversity and increased LD levels in landraces. Genomic regions affected by selection were detected and these may harbor candidate genes related to domestication. PMID:28955351

Quantification of genomic relationship from DNA pooled samples

USDA-ARS?s Scientific Manuscript database

Use of DNA pooling for GWAS has been demonstrated to reduce genotypic costs up to 90% while achieving similar power to individual genotyping. Recent work has focused on use of DNA pooling to inform problems in genomic prediction. This study is designed to demonstrate the efficacy of estimating genom...

Observed Structure and Characteristics of Cold Pools over Tropical Oceans using Vector Wind Retrievals and WRF simulations

NASA Astrophysics Data System (ADS)

Garg, P.; Nesbitt, S. W.; Lang, T. J.; Chronis, T.; Thayer, J. D.; Hence, D. A.

2017-12-01

Cold pools generated in the wake of convective activity can enhance the surface sensible heat flux, latent heat flux, and also changes in evaporation out of, and fresh water flux into, the ocean. Recent studies have shown that over the open ocean, cold pool outflow boundaries and their intersections can organize and initiate a spectrum of deep convective clouds, which is a key driver of shallow and deep convection over conditionally-unstable tropical oceans. The primary goal of this study is to understand the structure and characteristics of cold pools over the tropical oceans using observations. With the idea that cold pools will have strong wind gradients at their boundaries, we use ASCAT vector wind retrievals. We identify regions of steep gradients in wind vectors as gradient features (GFs), akin to cold pools. Corresponding to these GFs, sensible and latent heat fluxes were calculated using the observed winds and background temperatures from MERRA-2 reanalysis. To evaluate the proposed technique, cold pools were observed using S-PolKa radar from the DYNAMO/AMIE field campaign in the Indian Ocean for the period of 1 October 2011 to 31 March 2012 and were compared with ASCAT GFs. To relate the thermodynamic and kinematic characteristics of observed and simulated cold pools, simulations were carried out on WRF on a 3-km domain explicitly. The areas of cold pools were identified in the models using virtual temperature (Tv), which is a direct measure of air density, while GFs were identified using model simulated winds. Quantitative measures indicate that GFs are highly correspondent with model-simulated cold pools. In global measurements of cold pools from 2007-2015, it is possible to examine the characteristics of GFs across all tropical ocean basins, and relate them to meteorological conditions, as well as the characteristics of the parent precipitation systems. Our results indicate that while there is a general relationship between the amount of precipitation and the number of cold pools, the largest cold pools exist over the Eastern Pacific basin, where the most stratiform rain is produced from oceanic MCSs. It is anticipated that improved understanding of cold pools, which are a primary triggering mechanism of oceanic shallow and deep convection, will improve prediction of this important component of the climate system.

Who pays for health care in Ghana?

PubMed Central

2011-01-01

Background Financial protection against the cost of unforeseen ill health has become a global concern as expressed in the 2005 World Health Assembly resolution (WHA58.33), which urges its member states to "plan the transition to universal coverage of their citizens". An important element of financial risk protection is to distribute health care financing fairly in relation to ability to pay. The distribution of health care financing burden across socio-economic groups has been estimated for European countries, the USA and Asia. Until recently there was no such analysis in Africa and this paper seeks to contribute to filling this gap. It presents the first comprehensive analysis of the distribution of health care financing in relation to ability to pay in Ghana. Methods Secondary data from the Ghana Living Standard Survey (GLSS) 2005/2006 were used. This was triangulated with data from the Ministry of Finance and other relevant sources, and further complemented with primary household data collected in six districts. We implored standard methodologies (including Kakwani index and test for dominance) for assessing progressivity in health care financing in this paper. Results Ghana's health care financing system is generally progressive. The progressivity of health financing is driven largely by the overall progressivity of taxes, which account for close to 50% of health care funding. The national health insurance (NHI) levy (part of VAT) is mildly progressive and formal sector NHI payroll deductions are also progressive. However, informal sector NHI contributions were found to be regressive. Out-of-pocket payments, which account for 45% of funding, are regressive form of health payment to households. Conclusion For Ghana to attain adequate financial risk protection and ultimately achieve universal coverage, it needs to extend pre-payment cover to all in the informal sector, possibly through funding their contributions entirely from tax, and address other issues affecting the expansion of the National Health Insurance. Furthermore, the pre-payment funding pool for health care needs to grow so budgetary allocation to the health sector can be enhanced. PMID:21708026

Who pays for health care in Ghana?

PubMed

Akazili, James; Gyapong, John; McIntyre, Diane

2011-06-27

Financial protection against the cost of unforeseen ill health has become a global concern as expressed in the 2005 World Health Assembly resolution (WHA58.33), which urges its member states to "plan the transition to universal coverage of their citizens". An important element of financial risk protection is to distribute health care financing fairly in relation to ability to pay. The distribution of health care financing burden across socio-economic groups has been estimated for European countries, the USA and Asia. Until recently there was no such analysis in Africa and this paper seeks to contribute to filling this gap. It presents the first comprehensive analysis of the distribution of health care financing in relation to ability to pay in Ghana. Secondary data from the Ghana Living Standard Survey (GLSS) 2005/2006 were used. This was triangulated with data from the Ministry of Finance and other relevant sources, and further complemented with primary household data collected in six districts. We implored standard methodologies (including Kakwani index and test for dominance) for assessing progressivity in health care financing in this paper. Ghana's health care financing system is generally progressive. The progressivity of health financing is driven largely by the overall progressivity of taxes, which account for close to 50% of health care funding. The national health insurance (NHI) levy (part of VAT) is mildly progressive and formal sector NHI payroll deductions are also progressive. However, informal sector NHI contributions were found to be regressive. Out-of-pocket payments, which account for 45% of funding, are regressive form of health payment to households. For Ghana to attain adequate financial risk protection and ultimately achieve universal coverage, it needs to extend pre-payment cover to all in the informal sector, possibly through funding their contributions entirely from tax, and address other issues affecting the expansion of the National Health Insurance. Furthermore, the pre-payment funding pool for health care needs to grow so budgetary allocation to the health sector can be enhanced.

Do beneficiaries' views matter in healthcare purchasing decisions? Experiences from the Nigerian tax-funded health system and the formal sector social health insurance program of the National Health Insurance Scheme.

PubMed

Ibe, Ogochukwu; Honda, Ayako; Etiaba, Enyi; Ezumah, Nkoli; Hanson, Kara; Onwujekwe, Obinna

2017-12-28

Purchasing is a health financing function that involves the transfer of pooled resources to providers on behalf of a covered population. Little attention has been paid to the extent to which the views of that population  are reflected in purchasing decisions. This article explores how purchasers in two financing mechanisms: the Formal Sector Social Health Insurance Programme (FSSHIP) operating under the Nigerian National Health Insurance Scheme (NHIS), and the tax-funded health system perform their roles in light of their responsibilities to the populations. A case study approach was adopted in which each financing mechanism is a case. Sixteen (16) in-depth interviews with purchasers and eight (8) focus group discussions with beneficiaries were held. Agency and organizational behavioural theories were used to characterise the purchaser-citizen relationships. A deductive framework approach was used to assess whether actions identified in a model of 'ideal' strategic purchasing actions were undertaken in each case. For both cases, mechanisms exist to reflect people's health needs in purchasing decisions, including quantitative and qualitative needs assessment, mechanisms to raise awareness of benefit entitlements and allow choice. However, purchasers do not use the mechanisms to effectively engage with and hold themselves accountable to the people. In the tax-funded system, weak information systems and unclear communication channels between the purchaser and citizens constrain assessment of needs; while timeliness of health information and poor engagement practices of Health Maintenance Organisations (HMOs) are the main constraints in FSSHIP. Inadequate information sharing in both mechanisms limits beneficiaries' awareness of entitlements. Although beneficiaries of FSSHIP can choose providers, lack of information on the quality of services offered by providers constrains rational decision-making and the inability to change HMOs reduces HMO responsiveness to beneficiary needs. Responsiveness and accountability to beneficiaries are undervalued by purchasers in both financing mechanisms. In the tax-funded system, civil society organisations can facilitate engagement and accountability of purchasers and the people. In FSSHIP, NHIS needs to provide stronger stewardship of HMOs to promote effective engagement with members. Furthermore, the NHIS should introduce mechanisms that allow FSSHIP members to choose their own HMO, which could encourage HMOs to be more responsive to members.

Existing Whole-House Solutions Case Study: Applying Best Practices to Florida Local Government Retrofit Programs - Central Florida

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

None

In some communities, local government and non-profit entities have funds to purchase and renovate distressed, foreclosed homes for resale in the affordable housing market. Numerous opportunities to improve whole house energy efficiency are inherent in these comprehensive renovations. BA-PIRC worked together in a multiyear field study making recommendations in individual homes, meanwhile compiling improvement costs, projected energy savings, practical challenges, and labor force factors surrounding common energy-related renovation measures. The field study, Phase 1 of this research, resulted in a set of best practices appropriate to the current labor pool and market conditions in central Florida to achieve projected annualmore » energy savings of 15%-30% and higher. This case study describes Phase 2 of the work where researchers worked with a local government partner to implement and refine the "current best practices". A simulation study was conducted to characterize savings potential under three sets of conditions representing varying replacement needs for energy-related equipment and envelope components. The three scenarios apply readily to the general remodeling industry as for renovation of foreclosed homes for the affordable housing market. The new local government partner, the City of Melbourne, implemented the best practices in a community-scale renovation program that included ten homes in 2012.« less

Species richness at the guild level: effects of species pool and local environmental conditions on stream macroinvertebrate communities.

PubMed

Grönroos, Mira; Heino, Jani

2012-05-01

1. A fundamental question in ecology is which factors determine species richness. Here, we studied the relative importance of regional species pool and local environmental characteristics in determining local species richness (LSR). Typically, this question has been studied using whole communities or a certain taxonomic group, although including species with widely varying biological traits in the same analysis may hinder the detection of ecologically meaningful patterns. 2. We studied the question above for whole stream macroinvertebrate community and within functional feeding guilds. We defined the local scale as a riffle site and the regional scale (i.e. representing the regional species pool) as a stream. Such intermediate-sized regional scale is rarely studied in this context. 3. We sampled altogether 100 sites, ten riffles (local scale) in each of ten streams (regional scale). We used the local-regional richness regression plots to study the overall effect of regional species pool on LSR. Variation partitioning was used to determine the relative importance of regional species pool and local environmental conditions for species richness. 4. The local-regional richness relationship was mainly linear, suggesting strong species pool effects. Only one guild showed some signs of curvilinearity. However, variation partitioning showed that local environmental characteristics accounted for a larger fraction of variance in LSR than regional species pool. Also, the relative importance of the fractions differed between the whole community and guilds, as well as among guilds. 5. This study indicates that the importance of the local and regional processes may vary depending on feeding guild and trophic level. We conclude that both the size of the regional species pool and local habitat characteristics are important in determining LSR of stream macroinvertebrates. Our results are in agreement with recent large-scale studies conducted in highly different study systems and complement the previous findings by showing that the interplay of regional and local factors is also important at intermediate regional scales. © 2012 The Authors. Journal of Animal Ecology © 2012 British Ecological Society.

Association between pancreatitis and subsequent risk of pancreatic cancer: a systematic review of epidemiological studies.

PubMed

Tong, Gui-Xian; Geng, Qing-Qing; Chai, Jing; Cheng, Jing; Chen, Peng-Lai; Liang, Han; Shen, Xing-Rong; Wang, De-Bin

2014-01-01

This study aimed to summarize published epidemiological evidence for the relationship between pancreatitis and subsequent risk of pancreatic cancer (PC). We searched Medline and Embase for epidemiological studies published by February 5th, 2014 examining the risk of PC in pancreatitis patients using highly inclusive algorithms. Information about first author, year of publication, country of study, recruitment period, type of pancreatitis, study design, sample size, source of controls and attained age of subjects were extracted by two researchers and Stata 11.0 was used to perform the statistical analyses and examine publication bias. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated with the random effects model. A total of 17 articles documenting 3 cohort and 14 case-control studies containing 14,667 PC cases and 17,587 pancreatitis cases were included in this study. The pooled OR between pancreatitis and PC risk was 7.05 (95%CI: 6.42-7.75). However, the pooled ORs of case-control and cohort studies were 4.62 (95%CI: 4.08-5.22) and 16.3 (95%CI: 14.3-18.6) respectively. The risk of PC was the highest in patients with chronic pancreatitis (pooled OR=10.35; 95%CI: 9.13-11.75), followed by unspecified type of pancreatitis (pooled OR=6.41; 95%CI: 4.93-8.34), both acute and chronic pancreatitis (pooled OR=6.13; 95%CI: 5.00-7.52), and acute pancreatitis (pooled OR=2.12; 95%CI: 1.59-2.83). The pooled OR of PC in pancreatitis cases diagnosed within 1 year was the highest (pooled OR=23.3; 95%CI: 14.0-38.9); and the risk in subjects diagnosed with pancreatitis for no less than 2, 5 and 10 years were 3.03 (95%CI: 2.41-3.81), 2.82 (95%CI: 2.12-3.76) and 2.25 (95%CI: 1.59-3.19) respectively. Pancreatitis, especially chronic pancreatitis, was associated with a significantly increased risk of PC; and the risk decreased with increasing duration since diagnosis of pancreatitis.

Influence of the arc plasma parameters on the weld pool profile in TIG welding

NASA Astrophysics Data System (ADS)

Toropchin, A.; Frolov, V.; Pipa, A. V.; Kozakov, R.; Uhrlandt, D.

2014-11-01

Magneto-hydrodynamic simulations of the arc and fluid simulations of the weld pool can be beneficial in the analysis and further development of arc welding processes and welding machines. However, the appropriate coupling of arc and weld pool simulations needs further improvement. The tungsten inert gas (TIG) welding process is investigated by simulations including the weld pool. Experiments with optical diagnostics are used for the validation. A coupled computational model of the arc and the weld pool is developed using the software ANSYS CFX. The weld pool model considers the forces acting on the motion of the melt inside and on the surface of the pool, such as Marangoni, drag, electromagnetic forces and buoyancy. The experimental work includes analysis of cross-sections of the workpieces, highspeed video images and spectroscopic measurements. Experiments and calculations have been performed for various currents, distances between electrode and workpiece and nozzle diameters. The studies show the significant impact of material properties like surface tension dependence on temperature as well as of the arc structure on the weld pool behaviour and finally the weld seam depth. The experimental weld pool profiles and plasma temperatures are in good agreement with computational results.

Pooling job physical exposure data from multiple independent studies in a consortium study of carpal tunnel syndrome

PubMed Central

Kapellusch, Jay M.; Garg, Arun; Bao, Stephen S.; Silverstein, Barbara A.; Burt, Susan E.; Dale, Ann Marie; Evanoff, Bradley A.; Gerr, Frederic E.; Harris-Adamson, Carisa; Hegmann, Kurt T.; Merlino, Linda A.; Rempel, David M.

2015-01-01

Pooling data from different epidemiological studies of musculoskeletal disorders (MSDs) is necessary to improve statistical power and to more precisely quantify exposure–response relationships for MSDs. The pooling process is difficult and time-consuming, and small methodological differences could lead to different exposure–response relationships. A subcommittee of a six-study research consortium studying carpal tunnel syndrome: (i) visited each study site, (ii) documented methods used to collect physical exposure data and (iii) determined compatibility of exposure variables across studies. Certain measures of force, frequency of exertion and duty cycle were collected by all studies and were largely compatible. A portion of studies had detailed data to investigate simultaneous combinations of force, frequency and duration of exertions. Limited compatibility was found for hand/wrist posture. Only two studies could calculate compatible Strain Index scores, but Threshold Limit Value for Hand Activity Level could be determined for all studies. Challenges of pooling data, resources required and recommendations for future researchers are discussed. PMID:23697792

Dynamics of Inorganic Nutrients in Intertidal Sediments: Porewater, Exchangeable, and Intracellular Pools

PubMed Central

Garcia-Robledo, Emilio; Bohorquez, Julio; Corzo, Alfonso; Jimenez-Arias, Juan L.; Papaspyrou, Sokratis

2016-01-01

The study of inorganic nutrients dynamics in shallow sediments usually focuses on two main pools: porewater (PW) nutrients and exchangeable (EX) ammonium and phosphate. Recently, it has been found that microphytobenthos (MPB) and other microorganisms can accumulate large amounts of nutrients intracellularly (IC), highlighting the biogeochemical importance of this nutrient pool. Storing nutrients could support the growth of autotrophs when nutrients are not available, and could also provide alternative electron acceptors for dissimilatory processes such as nitrate reduction. Here, we studied the magnitude and relative importance of these three nutrient pools (PW, IC, and EX) and their relation to chlorophylls (used as a proxy for MPB abundance) and organic matter (OM) contents in an intertidal mudflat of Cadiz Bay (Spain). MPB was localized in the first 4 mm of the sediment and showed a clear seasonal pattern; highest chlorophylls content was found during autumn and lowest during spring-summer. The temporal and spatial distribution of nutrients pools and MPB were largely correlated. Ammonium was higher in the IC and EX fractions, representing on average 59 and 37% of the total ammonium pool, respectively. Similarly, phosphate in the IC and EX fractions accounted on average for 40 and 31% of the total phosphate pool, respectively. Nitrate in the PW was low, suggesting low nitrification activity and rapid consumption. Nitrate accumulated in the IC pool during periods of moderate MPB abundance, being up to 66% of the total nitrate pool, whereas it decreased when chlorophyll concentration peaked likely due to a high nitrogen demand. EX-Nitrate accounted for the largest fraction of total sediment nitrate, 66% on average. The distribution of EX-Nitrate was significantly correlated with chlorophyll and OM, which probably indicates a relation of this pool to an increased availability of sites for ionic adsorption. This EX-Nitrate pool could represent an alternative nitrate source with significant concentrations available to the microbial community, deeper in the sediment below the oxic layer. PMID:27303370

Dynamics of Inorganic Nutrients in Intertidal Sediments: Porewater, Exchangeable, and Intracellular Pools.

PubMed

Garcia-Robledo, Emilio; Bohorquez, Julio; Corzo, Alfonso; Jimenez-Arias, Juan L; Papaspyrou, Sokratis

2016-01-01

The study of inorganic nutrients dynamics in shallow sediments usually focuses on two main pools: porewater (PW) nutrients and exchangeable (EX) ammonium and phosphate. Recently, it has been found that microphytobenthos (MPB) and other microorganisms can accumulate large amounts of nutrients intracellularly (IC), highlighting the biogeochemical importance of this nutrient pool. Storing nutrients could support the growth of autotrophs when nutrients are not available, and could also provide alternative electron acceptors for dissimilatory processes such as nitrate reduction. Here, we studied the magnitude and relative importance of these three nutrient pools (PW, IC, and EX) and their relation to chlorophylls (used as a proxy for MPB abundance) and organic matter (OM) contents in an intertidal mudflat of Cadiz Bay (Spain). MPB was localized in the first 4 mm of the sediment and showed a clear seasonal pattern; highest chlorophylls content was found during autumn and lowest during spring-summer. The temporal and spatial distribution of nutrients pools and MPB were largely correlated. Ammonium was higher in the IC and EX fractions, representing on average 59 and 37% of the total ammonium pool, respectively. Similarly, phosphate in the IC and EX fractions accounted on average for 40 and 31% of the total phosphate pool, respectively. Nitrate in the PW was low, suggesting low nitrification activity and rapid consumption. Nitrate accumulated in the IC pool during periods of moderate MPB abundance, being up to 66% of the total nitrate pool, whereas it decreased when chlorophyll concentration peaked likely due to a high nitrogen demand. EX-Nitrate accounted for the largest fraction of total sediment nitrate, 66% on average. The distribution of EX-Nitrate was significantly correlated with chlorophyll and OM, which probably indicates a relation of this pool to an increased availability of sites for ionic adsorption. This EX-Nitrate pool could represent an alternative nitrate source with significant concentrations available to the microbial community, deeper in the sediment below the oxic layer.

Local health departments and specific maternal and child health expenditures: relationships between spending and need.

PubMed

Bekemeier, Betty; Dunbar, Matthew; Bryan, Matthew; Morris, Michael E

2012-11-01

As a part of the Public Health Activities and Service Tracking study and in collaboration with partners in 2 Public Health Practice-Based Research Network states, we examined relationships between local health department (LHD) maternal and child health (MCH) expenditures and local needs. We used a multivariate pooled time-series design to estimate ecologic associations between expenditures in 3 MCH-specific service areas and related measures of need from 2005 to 2010 while controlling for other factors. Retrospective expenditure data from LHDs and for 3 MCH services represented annual investments in (1) Special Supplemental Nutrition for Women, Infants, and Children (WIC), (2) family planning, and (3) a composite of Maternal, Infant, Child, and Adolescent (MICA) service. Expenditure data from all LHDs in Florida and Washington were then combined with "need" and control variables. Our sample consisted of the 102 LHDs in Florida and Washington and the county (or multicounty) jurisdictions they serve. Expenditures for WIC and for our composite of MICA services were strongly associated with need among LHDs in the sample states. For WIC, this association was positive, and for MICA services, this association was negative. Family planning expenditures were weakly associated, in a positive direction. Findings demonstrate wide variations across programs and LHDs in relation to need and may underscore differences in how programs are funded. Programs with financial disbursements based on guidelines that factor in local needs may be better able to provide service as local needs grow than programs with less needs-based funding allocations.

The ICF Core Sets for hearing loss--researcher perspective. Part I: Systematic review of outcome measures identified in audiological research.

PubMed

Granberg, Sarah; Dahlström, Jennie; Möller, Claes; Kähäri, Kim; Danermark, Berth

2014-02-01

To review the literature in order to identify outcome measures used in research on adults with hearing loss (HL) as part of the ICF Core Sets development project, and to describe study and population characteristics of the reviewed studies. A systematic review methodology was applied using multiple databases. A comprehensive search was conducted and two search pools were created, pool I and pool II. The study population included adults (≥ 18 years of age) with HL and oral language as the primary mode of communication. 122 studies were included. Outcome measures were distinguished by 'instrument type', and 10 types were identified. In total, 246 (pool I) and 122 (pool II) different measures were identified, and only approximately 20% were extracted twice or more. Most measures were related to speech recognition. Fifty-one different questionnaires were identified. Many studies used small sample sizes, and the sex of participants was not revealed in several studies. The low prevalence of identified measures reflects a lack of consensus regarding the optimal outcome measures to use in audiology. Reflections and discussions are made in relation to small sample sizes and the lack of sex differentiation/descriptions within the included articles.

Physical and chemical differences between natural and artificial pools in blanket peatlands

NASA Astrophysics Data System (ADS)

Turner, Ed; Baird, Andy; Billett, Mike; Chapman, Pippa; Dinsmore, Kerry; Holden, Joseph

2014-05-01

Natural pools are common features of many northern peatlands. Numerous artificial pools are being created behind dams installed during drain-blocking, a common peatland restoration technique, significantly increasing the area of open water. Natural pools are known to be major sources of GHGs (e.g. Hamilton et al. 1994), but the reasons they are such 'hotspots' is poorly understood. We hypothesize that pools act as 'biochemical reactors' of particulate and dissolved organic carbon (POC and DOC) transported from surrounding peat that is processed into a range of products including CH4 and CO2. Therefore, understanding the processes operating in both natural and artificial pool systems is fundamental to elucidating this hypothesis. Water levels and temperature have been continuously monitored at six natural and six artificial pools within the 'Flow Country' blanket peatland in northern Scotland since May 2013. Bi-weekly sampling of waters from pools, peat matrix through-flow (via piezometers) and surface flow has been conducted for analysis of DOC, POC, DIC, CH4diss and CO2diss, together with GHG flux measurements from pool surfaces and adjacent peat. We show that, to date, pool water levels rapidly respond to rainfall, although artificial pools appear to respond with greater magnitude. For example, over the course of same rainfall event (20-23 June 2013), natural and artificial pool levels increased between 5.3 and 9.8 cm, and 12.5 and 22.6 cm respectively. Temperature measured at c. 5 cm from the base of each pool shows distinct diurnal fluctuations, which are of greater magnitude in all but one of the natural pools compared to the artificial pools: over the same period (20-23 July 2013), the maximum diurnal variation at the artificial pool site was 5.1 °C compared to 9.2 °C within the natural pools. Vegetation cover is generally higher in artificial pools and may have a moderating effect on variations in pool temperature. Results of pool-water DOC analysis from regular sampling at the study site and a wider regional survey indicate DOC concentrations are consistently higher in artificial pools. The implications of these preliminary results in relation to the carbon cycle and GHGs of blanket peatlands are briefly discussed. Hamilton, J. D., Kelly, C. A., Rudd, J. W. M., Hesslein, R. H. and Roulet, N. T. (1994) Flux to the atmosphere of CH4 and CO2 from wetland ponds on the Hudson Bay lowlands (HBLs). Journal of Geophysical Research 99, 1495-1510.

Impact of Community-Based DOT on Tuberculosis Treatment Outcomes: A Systematic Review and Meta-Analysis

PubMed Central

Zhang, HaiYang; Ehiri, John; Yang, Huan; Tang, Shenglan; Li, Ying

2016-01-01

Background Poor adherence to tuberculosis (TB) treatment can lead to prolonged infectivity and poor treatment outcomes. Directly observed treatment (DOT) seeks to improve adherence to TB treatment by observing patients while they take their anti-TB medication. Although community-based DOT (CB-DOT) programs have been widely studied and promoted, their effectiveness has been inconsistent. The aim of this study was to critical appraise and summarize evidence of the effects of CB-DOT on TB treatment outcomes. Methods Studies published up to the end of February 2015 were identified from three major international literature databases: Medline/PubMed, EBSCO, and EMBASE. Unpublished data from the grey literature were identified through Google and Google Scholar searches. Results Seventeen studies involving 12,839 pulmonary TB patients (PTB) in eight randomized controlled trials (RCTs) and nine cohort studies from 12 countries met the criteria for inclusion in this review and 14 studies were included in meta-analysis. Compared with clinic-based DOT, pooled results of RCTs for all PTB cases (including smear-negative or -positive, new or retreated TB cases) and smear-positive PTB cases indicated that CB-DOT promoted successful treatment [pooled RRs (95%CIs): 1.11 (1.02–1.19) for all PTB cases and 1.11 (1.02–1.19) for smear-positive PTB cases], and completed treatment [pooled RRs (95%CIs): 1.74(1.05, 2.90) for all PTB cases and 2.22(1.16, 4.23) for smear-positive PTB cases], reduced death [pooled RRs (95%CIs): 0.44 (0.26–0.72) for all PTB cases and 0.39 (0.23–0.66) for smear-positive PTB cases], and transfer out [pooled RRs (95%CIs): 0.37 (0.23–0.61) for all PTB cases and 0.42 (0.25–0.70) for smear-positive PTB cases]. Pooled results of all studies (RCTs and cohort studies) with all PTB cases demonstrated that CB-DOT promoted successful treatment [pooled RR (95%CI): 1.13 (1.03–1.24)] and curative treatment [pooled RR (95%CI): 1.24 (1.04–1.48)] compared with self-administered treatment. Conclusions CB-DOT did improved TB treatment outcomes according to the pooled results of included studies in this review. Studies on strategies for implementation of patient-centered and community-centered CB-DOT deserve further attention. PMID:26849656

Challenge Pools of Hepatitis C Virus Genotypes 1–6 Prototype Strains: Replication Fitness and Pathogenicity in Chimpanzees and Human Liver–Chimeric Mouse Models

PubMed Central

Bukh, Jens; Meuleman, Philip; Tellier, Raymond; Engle, Ronald E.; Feinstone, Stephen M.; Eder, Gerald; Satterfield, William C.; Govindarajan, Sugantha; Krawczynski, Krzysztof; Miller, Roger H.; Leroux-Roels, Geert; Purcell, Robert H.

2010-01-01

Chimpanzees represent the only animal model for studies of the natural history of hepatitis C virus (HCV). To generate virus stocks of important HCV variants, we infected chimpanzees with HCV strains of genotypes 1–6 and determined the infectivity titer of acute-phase plasma pools in additional animals. The courses of first- and second-passage infections were similar, with early appearance of viremia, HCV RNA titers of >104.7 IU/mL, and development of acute hepatitis; the chronicity rate was 56%. The challenge pools had titers of 103–105 chimpanzee infectious doses/mL. Human liver–chimeric mice developed high-titer infections after inoculation with the challenge viruses of genotypes 1–6. Inoculation studies with different doses of the genotype 1b pool suggested that a relatively high virus dose is required to consistently infect chimeric mice. The challenge pools represent a unique resource for studies of HCV molecular virology and for studies of pathogenesis, protective immunity, and vaccine efficacy in vivo. PMID:20353362

Information content of incubation experiments for inverse estimation of pools in the Rothamsted carbon model: a Bayesian perspective

NASA Astrophysics Data System (ADS)

Scharnagl, B.; Vrugt, J. A.; Vereecken, H.; Herbst, M.

2010-02-01

A major drawback of current soil organic carbon (SOC) models is that their conceptually defined pools do not necessarily correspond to measurable SOC fractions in real practice. This not only impairs our ability to rigorously evaluate SOC models but also makes it difficult to derive accurate initial states of the individual carbon pools. In this study, we tested the feasibility of inverse modelling for estimating pools in the Rothamsted carbon model (ROTHC) using mineralization rates observed during incubation experiments. This inverse approach may provide an alternative to existing SOC fractionation methods. To illustrate our approach, we used a time series of synthetically generated mineralization rates using the ROTHC model. We adopted a Bayesian approach using the recently developed DiffeRential Evolution Adaptive Metropolis (DREAM) algorithm to infer probability density functions of the various carbon pools at the start of incubation. The Kullback-Leibler divergence was used to quantify the information content of the mineralization rate data. Our results indicate that measured mineralization rates generally provided sufficient information to reliably estimate all carbon pools in the ROTHC model. The incubation time necessary to appropriately constrain all pools was about 900 days. The use of prior information on microbial biomass carbon significantly reduced the uncertainty of the initial carbon pools, decreasing the required incubation time to about 600 days. Simultaneous estimation of initial carbon pools and decomposition rate constants significantly increased the uncertainty of the carbon pools. This effect was most pronounced for the intermediate and slow pools. Altogether, our results demonstrate that it is particularly difficult to derive reasonable estimates of the humified organic matter pool and the inert organic matter pool from inverse modelling of mineralization rates observed during incubation experiments.

3D finite element simulation of TIG weld pool

NASA Astrophysics Data System (ADS)

Kong, X.; Asserin, O.; Gounand, S.; Gilles, P.; Bergheau, J. M.; Medale, M.

2012-07-01

The aim of this paper is to propose a three-dimensional weld pool model for the moving gas tungsten arc welding (GTAW) process, in order to understand the main factors that limit the weld quality and improve the productivity, especially with respect to the welding speed. Simulation is a very powerful tool to help in understanding the physical phenomena in the weld process. A 3D finite element model of heat and fluid flow in weld pool considering free surface of the pool and traveling speed has been developed for the GTAW process. Cast3M software is used to compute all the governing equations. The free surface of the weld pool is calculated by minimizing the total surface energy. The combined effects of surface tension gradient, buoyancy force, arc pressure, arc drag force to drive the fluid flow is included in our model. The deformation of the weld pool surface and the welding speed affect fluid flow, heat flow and thus temperature gradients and molten pool dimensions. Welding trials study is presented to compare our numerical results with macrograph of the molten pool.

Microbiological Analysis in Three Diverse Natural Geothermal Bathing Pools in Iceland

PubMed Central

Thorolfsdottir, Berglind Osk Th.; Marteinsson, Viggo Thor

2013-01-01

Natural thermal bathing pools contain geothermal water that is very popular to bathe in but the water is not sterilized, irradiated or treated in any way. Increasing tourism in Iceland will lead to increasing numbers of bath guests, which can in turn affect the microbial flora in the pools and therefore user safety. Today, there is no legislation that applies to natural geothermal pools in Iceland, as the water is not used for consumption and the pools are not defined as public swimming pools. In this study, we conducted a microbiological analysis on three popular but different natural pools in Iceland, located at Lýsuhóll, Hveravellir and Landmannalaugar. Total bacterial counts were performed by flow cytometry, and with plate count at 22 °C, 37 °C and 50 °C. The presence of viable coliforms, Enterococcus spp. and pseudomonads were investigated by growth experiments on selective media. All samples were screened for noroviruses by real time PCR. The results indicate higher fecal contamination in the geothermal pools where the geothermal water flow was low and bathing guest count was high during the day. The number of cultivated Pseudomonas spp. was high (13,000–40,000 cfu/100 mL) in the natural pools, and several strains were isolated and classified as opportunistic pathogens. Norovirus was not detected in the three pools. DNA was extracted from one-liter samples in each pool and analyzed by partial 16S rRNA gene sequencing. Microbial diversity analysis revealed different microbial communities between the pools and they were primarily composed of alpha-, beta- and gammaproteobacteria. PMID:23493033

Improvement of Anadromous Fish Habitat and Passage in Omak Creek, 2008 Annual Report : February 1, 2008 to January 31, 2009.

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

Dasher, Rhonda; Fisher, Christopher

2009-06-09

During the 2008 season, projects completed under BPA project 2000-100-00 included installation of riparian fencing, maintenance of existing riparian fencing, monitoring of at-risk culverts and installation of riparian vegetation along impacted sections of Omak Creek. Redd and snorkel surveys were conducted in Omak Creek to determine steelhead production. Canopy closure surveys were conducted to monitor riparian vegetation recovery after exclusion of cattle since 2000 from a study area commonly known as the Moomaw property. Additional redd and fry surveys were conducted above Mission Falls and in the lower portion of Stapaloop Creek to try and determine whether there has beenmore » successful passage at Mission Falls. Monitoring adult steelhead trying to navigate the falls resulted in the discovery of shallow pool depth at an upper pool that is preventing many fish from successfully navigating the entire falls. The Omak Creek Habitat and Passage Project has worked with NRCS to obtain additional funds to implement projects in 2009 that will address passage at Mission Falls, culvert replacement, as well as additional riparian planting. The Omak Creek Technical Advisory Group (TAG) is currently revising the Omak Creek Watershed Assessment. In addition, the group is revising strategy to focus efforts in targeted areas to provide a greater positive impact within the watershed. In 2008 the NRCS Riparian Technical Team was supposed to assess areas within the watershed that have unique problems and require special treatments to successfully resolve the issues involved. The technical team will be scheduled for 2009 to assist the TAG in developing strategies for these special areas.« less

Veterinary homeopathy: meta-analysis of randomised placebo-controlled trials.

PubMed

Mathie, Robert T; Clausen, Jürgen

2015-01-01

Meta-analysis of randomised controlled trials (RCTs) of veterinary homeopathy has not previously been undertaken. For all medical conditions and species collectively, we tested the hypothesis that the outcome of homeopathic intervention (treatment and/or prophylaxis, individualised and/or non-individualised) is distinguishable from corresponding intervention using placebos. All facets of the review, including literature search strategy, study eligibility, data extraction and assessment of risk of bias, were described in an earlier paper. A trial was judged to comprise reliable evidence if its risk of bias was low or was unclear in specific domains of assessment. Effect size was reported as odds ratio (OR). A trial was judged free of vested interest if it was not funded by a homeopathic pharmacy. Meta-analysis was conducted using the random-effects model, with hypothesis-driven sensitivity analysis based on risk of bias. Nine of 15 trials with extractable data displayed high risk of bias; low or unclear risk of bias was attributed to each of the remaining six trials, only two of which comprised reliable evidence without overt vested interest. For all N = 15 trials, pooled OR = 1.69 [95% confidence interval (CI), 1.12 to 2.56]; P = 0.01. For the N = 2 trials with suitably reliable evidence, pooled OR = 2.62 [95% CI, 1.13 to 6.05]; P = 0.02). Meta-analysis provides some very limited evidence that clinical intervention in animals using homeopathic medicines is distinguishable from corresponding intervention using placebos. The low number and quality of the trials hinders a more decisive conclusion. Copyright © 2014 The Faculty of Homeopathy. Published by Elsevier Ltd. All rights reserved.

Evaluation of a Urine Pooling Strategy for the Rapid and Cost-Efficient Prevalence Classification of Schistosomiasis.

PubMed

Lo, Nathan C; Coulibaly, Jean T; Bendavid, Eran; N'Goran, Eliézer K; Utzinger, Jürg; Keiser, Jennifer; Bogoch, Isaac I; Andrews, Jason R

2016-08-01

A key epidemiologic feature of schistosomiasis is its focal distribution, which has important implications for the spatial targeting of preventive chemotherapy programs. We evaluated the diagnostic accuracy of a urine pooling strategy using a point-of-care circulating cathodic antigen (POC-CCA) cassette test for detection of Schistosoma mansoni, and employed simulation modeling to test the classification accuracy and efficiency of this strategy in determining where preventive chemotherapy is needed in low-endemicity settings. We performed a cross-sectional study involving 114 children aged 6-15 years in six neighborhoods in Azaguié Ahoua, south Côte d'Ivoire to characterize the sensitivity and specificity of the POC-CCA cassette test with urine samples that were tested individually and in pools of 4, 8, and 12. We used a Bayesian latent class model to estimate test characteristics for individual POC-CCA and quadruplicate Kato-Katz thick smears on stool samples. We then developed a microsimulation model and used lot quality assurance sampling to test the performance, number of tests, and total cost per school for each pooled testing strategy to predict the binary need for school-based preventive chemotherapy using a 10% prevalence threshold for treatment. The sensitivity of the urine pooling strategy for S. mansoni diagnosis using pool sizes of 4, 8, and 12 was 85.9%, 79.5%, and 65.4%, respectively, when POC-CCA trace results were considered positive, and 61.5%, 47.4%, and 30.8% when POC-CCA trace results were considered negative. The modeled specificity ranged from 94.0-97.7% for the urine pooling strategies (when POC-CCA trace results were considered negative). The urine pooling strategy, regardless of the pool size, gave comparable and often superior classification performance to stool microscopy for the same number of tests. The urine pooling strategy with a pool size of 4 reduced the number of tests and total cost compared to classical stool microscopy. This study introduces a method for rapid and efficient S. mansoni prevalence estimation through examining pooled urine samples with POC-CCA as an alternative to widely used stool microscopy.

Evaluation of a Urine Pooling Strategy for the Rapid and Cost-Efficient Prevalence Classification of Schistosomiasis

PubMed Central

Coulibaly, Jean T.; Bendavid, Eran; N’Goran, Eliézer K.; Utzinger, Jürg; Keiser, Jennifer; Bogoch, Isaac I.; Andrews, Jason R.

2016-01-01

Background A key epidemiologic feature of schistosomiasis is its focal distribution, which has important implications for the spatial targeting of preventive chemotherapy programs. We evaluated the diagnostic accuracy of a urine pooling strategy using a point-of-care circulating cathodic antigen (POC-CCA) cassette test for detection of Schistosoma mansoni, and employed simulation modeling to test the classification accuracy and efficiency of this strategy in determining where preventive chemotherapy is needed in low-endemicity settings. Methodology We performed a cross-sectional study involving 114 children aged 6–15 years in six neighborhoods in Azaguié Ahoua, south Côte d’Ivoire to characterize the sensitivity and specificity of the POC-CCA cassette test with urine samples that were tested individually and in pools of 4, 8, and 12. We used a Bayesian latent class model to estimate test characteristics for individual POC-CCA and quadruplicate Kato-Katz thick smears on stool samples. We then developed a microsimulation model and used lot quality assurance sampling to test the performance, number of tests, and total cost per school for each pooled testing strategy to predict the binary need for school-based preventive chemotherapy using a 10% prevalence threshold for treatment. Principal Findings The sensitivity of the urine pooling strategy for S. mansoni diagnosis using pool sizes of 4, 8, and 12 was 85.9%, 79.5%, and 65.4%, respectively, when POC-CCA trace results were considered positive, and 61.5%, 47.4%, and 30.8% when POC-CCA trace results were considered negative. The modeled specificity ranged from 94.0–97.7% for the urine pooling strategies (when POC-CCA trace results were considered negative). The urine pooling strategy, regardless of the pool size, gave comparable and often superior classification performance to stool microscopy for the same number of tests. The urine pooling strategy with a pool size of 4 reduced the number of tests and total cost compared to classical stool microscopy. Conclusions/Significance This study introduces a method for rapid and efficient S. mansoni prevalence estimation through examining pooled urine samples with POC-CCA as an alternative to widely used stool microscopy. PMID:27504954

Co-circulation of West Nile virus and distinct insect-specific flaviviruses in Turkey.

PubMed

Ergünay, Koray; Litzba, Nadine; Brinkmann, Annika; Günay, Filiz; Sarıkaya, Yasemen; Kar, Sırrı; Örsten, Serra; Öter, Kerem; Domingo, Cristina; Erisoz Kasap, Özge; Özkul, Aykut; Mitchell, Luke; Nitsche, Andreas; Alten, Bülent; Linton, Yvonne-Marie

2017-03-20

Active vector surveillance provides an efficient tool for monitoring the presence or spread of emerging or re-emerging vector-borne viruses. This study was undertaken to investigate the circulation of flaviviruses. Mosquitoes were collected from 58 locations in 10 provinces across the Aegean, Thrace and Mediterranean Anatolian regions of Turkey in 2014 and 2015. Following morphological identification, mosquitoes were pooled and screened by nested and real-time PCR assays. Detected viruses were further characterised by sequencing. Positive pools were inoculated onto cell lines for virus isolation. Next generation sequencing was employed for genomic characterisation of the isolates. A total of 12,711 mosquito specimens representing 15 species were screened in 594 pools. Eleven pools (2%) were reactive in the virus screening assays. Sequencing revealed West Nile virus (WNV) in one Culex pipiens (s.l.) pool from Thrace. WNV sequence corresponded to lineage one clade 1a but clustered distinctly from the Turkish prototype isolate. In 10 pools, insect-specific flaviviruses were characterised as Culex theileri flavivirus in 5 pools of Culex theileri and one pool of Cx. pipiens (s.l.), Ochlerotatus caspius flavivirus in two pools of Aedes (Ochlerotatus) caspius, Flavivirus AV-2011 in one pool of Culiseta annulata, and an undetermined flavivirus in one pool of Uranotaenia unguiculata from the Aegean and Thrace regions. DNA forms or integration of the detected insect-specific flaviviruses were not observed. A virus strain, tentatively named as "Ochlerotatus caspius flavivirus Turkey", was isolated from an Ae. caspius pool in C6/36 cells. The viral genome comprised 10,370 nucleotides with a putative polyprotein of 3,385 amino acids that follows the canonical flavivirus polyprotein organisation. Sequence comparisons and phylogenetic analyses revealed the close relationship of this strain with Ochlerotatus caspius flavivirus from Portugal and Hanko virus from Finland. Several conserved structural and amino acid motifs were identified. We identified WNV and several distinct insect-specific flaviviruses during an extensive biosurveillance study of mosquitoes in various regions of Turkey in 2014 and 2015. Ongoing circulation of WNV is revealed, with an unprecedented genetic diversity. A probable replicating form of an insect flavivirus identified only in DNA form was detected.

Reserve Growth of Alberta Oil Pools

USGS Publications Warehouse

Verma, Mahendra K.; Cook, Troy

2008-01-01

This Open-File Report is based on a presentation delivered at the Fourth U.S. Geological Survey Workshop on Reserve Growth on March 10-11, 2008. It summarizes the results of a study of reserve growth of oil pools in Alberta Province, Canada. The study is part of a larger effort involving similar studies of fields in other important petroleum provinces around the world, with the overall objective of gaining a better understanding of reserve growth in fields with different geologic/reservoir parameters and different operating environments. The goals of the study were to: 1. Evaluate historical oil reserve data and assess reserve growth. 2. Develop reserve growth models/functions to help forecast hydrocarbon volumes. 3. Study reserve growth sensitivity to various parameters ? for example, pool size, porosity, oil gravity, and lithology. 4. Compare reserve growth in oil pools/fields of Alberta provinces with those from other large petroleum provinces.

IRT Item Parameter Scaling for Developing New Item Pools

ERIC Educational Resources Information Center

Kang, Hyeon-Ah; Lu, Ying; Chang, Hua-Hua

2017-01-01

Increasing use of item pools in large-scale educational assessments calls for an appropriate scaling procedure to achieve a common metric among field-tested items. The present study examines scaling procedures for developing a new item pool under a spiraled block linking design. The three scaling procedures are considered: (a) concurrent…

ESTIMATING THE TERRESTIAL CARBON POOLS OF THE FORMER SOVIET UNION, CONTERMINOUS U.S., AND BRAZIL

EPA Science Inventory

Terrestrial-carbon (C) pool sizes are of interest in relation to quantifying current sources and sinks of C, and evaluating the possibilities for future C sequestration or release by the biosphere. In this study, the C pools in the terrestrial ecosystems of the former Soviet Unio...

Site fidelity, size, and morphology may differ by tidal position for an intertidal fish, Bathygobius cocosensis (Perciformes-Gobiidae), in Eastern Australia

PubMed Central

Malard, Lucie A.; McGuigan, Katrina

2016-01-01

The intertidal zone is a transitional environment that undergoes daily environmental fluctuations as tides rise and fall. Relatively few fish species are adapted to endure the physiological pressures of this environment. This study focused on Bathygobius cocosensis (Gobiidae), a common intertidal fish in New South Wales, Australia. We investigated whether shore height impacted site fidelity, survival probability, fish size, and morphological traits with respect to tidal height. Mark-recapture methods were used over a five month period to determine if individuals in high shore pools had greater site fidelity; fish in high tide pools were more than twice as likely to be recaptured in their original pool than fish from low tide pools. High pool individuals were, on average, smaller with larger eyes and longer snouts relative to their size as compared to low pool individuals. We discuss several mechanisms that could cause the observed pattern in morphological variation. Ultimately, this study suggests that within species behaviour and morphology differ by tidal position for an intertidal fish. PMID:27547568

Site fidelity, size, and morphology may differ by tidal position for an intertidal fish, Bathygobius cocosensis (Perciformes-Gobiidae), in Eastern Australia.

PubMed

Malard, Lucie A; McGuigan, Katrina; Riginos, Cynthia

2016-01-01

The intertidal zone is a transitional environment that undergoes daily environmental fluctuations as tides rise and fall. Relatively few fish species are adapted to endure the physiological pressures of this environment. This study focused on Bathygobius cocosensis (Gobiidae), a common intertidal fish in New South Wales, Australia. We investigated whether shore height impacted site fidelity, survival probability, fish size, and morphological traits with respect to tidal height. Mark-recapture methods were used over a five month period to determine if individuals in high shore pools had greater site fidelity; fish in high tide pools were more than twice as likely to be recaptured in their original pool than fish from low tide pools. High pool individuals were, on average, smaller with larger eyes and longer snouts relative to their size as compared to low pool individuals. We discuss several mechanisms that could cause the observed pattern in morphological variation. Ultimately, this study suggests that within species behaviour and morphology differ by tidal position for an intertidal fish.

Assessing the Occurrence, Persistence, and Fate of Natural and Synthetic Steroid Estrogens in Vernal Pools

NASA Astrophysics Data System (ADS)

Mina, O.

2015-12-01

The presence of natural and synthetic estrogens in treated wastewater used for irrigation of agricultural fields poses a potential risk to surface water ecosystems. While a large number of recent studies have investigated the occurrence, fate, and transport of estrogens in the environment, the vast majority of these studies have focused on the fate of estrogens in streams and rivers. However, no studies have been conducted assessing the occurrence, persistence, and fate of estrogens in impacted sensitive aquatic ecosystems such as vernal pools. This is of particular importance because vernal pools serve as critical breeding habitat for amphibians, which are known to be sensitive to the presence of endocrine disrupting compounds. A spray irrigation system was implemented over 50 years ago at Penn State's "Living Filter" as an alternative to discharging treated wastewater to a high quality trout stream. This system introduces all of Penn State's treated wastewater onto approximately 250 ha of agricultural and forested land at a rate of ~5 cm/ha/week. More than a dozen vernal pools are impacted by this wastewater irrigation, with some ponds adjacent to irrigation laterals receiving direct inputs of the treated wastewater. The goal of this study was to assess the impact of these weekly irrigation activities on the occurrence, persistence, and fate of estrogens (17α- and 17β-estradiol, estrone, estriol, and ethinylestradiol) in 3 vernal pools during an 8-week field study. The spring 2015 study period coincided with wood frog breeding and metamorphosis. Irrigation wastewater was collected weekly and water samples near the sediment-water interface in each vernal pool were collected daily. Real-time monitoring stations continuously recorded the temperature, pH, redox potential, DO, EC, and water level at each pool. Nearly 100% of the daily samples (n>130) collected contained estrogens, and the concentrations were several times higher compared to the wastewater. Additionally, the data suggest transformation of estrone back to 17α- and 17β-estradiol potentially due to anaerobic conditions in the vernal pools. This unique field study suggests that more research is needed to quantify the potential impact of estrogenic activity on amphibians, particularly during the critical metamorphosis period.

Prevention of needless deaths from drowning.

PubMed

Modell, Jerome H

2010-07-01

To determine whether faulty pool maintenance and substandard lifeguard performance critically delayed retrieval and resuscitation of a significant number of pool drowning victims. One hundred and eighty drowning incidents that resulted in litigation from 1998 to 2008 were studied to determine whether faulty pool maintenance and/or substandard lifeguard performance delayed retrieval and thereby contributed to the death of these persons. A total of 180 swimming pools-commercial and private-were included. Ninety-seven of these pools were manned by lifeguards. Subjects who underwent the drowning process and suffered severe brain injury or death were reviewed to determine the rescue and resuscitation attempts by lifeguards or bystanders at the pool. One hundred and seventy-seven of the 180 persons who underwent the drowning process died. Cases were analyzed as to whether faulty pool maintenance and/or substandard lifeguard performance contributed to their demise. At fault were cloudy or dirty water; drain pipes that created underwater suction to trap victims; inadequate fencing around pools through which small children gained access; permitting small children to be at the pool without adult supervision; permitting dangerous exercises such as hyperventilation while underwater swimming, resulting in shallow water blackout; lifeguards not being attentive, being distracted by other persons, performing nonrelated chores, leaving their positions without proper relief, while failure to enter the water when told persons were submerged. Faculty pool maintenance and substandard lifeguard performance critically delayed retrieval and resuscitation of a significant number of pool drowning victims.

Subclinical Thyroid Dysfunction and the Risk for Fractures

PubMed Central

Wirth, Christina D.; Blum, Manuel R.; da Costa, Bruno R.; Baumgartner, Christine; Collet, Tinh-Hai; Medici, Marco; Peeters, Robin P.; Aujesky, Drahomir; Bauer, Douglas C.; Rodondi, Nicolas

2015-01-01

Background Data on the association between subclinical thyroid dysfunction and fractures conflict. Purpose To assess the risk for hip and nonspine fractures associated with subclinical thyroid dysfunction among prospective cohorts. Data Sources Search of MEDLINE and EMBASE (1946 to 16 March 2014) and reference lists of retrieved articles without language restriction. Study Selection Two physicians screened and identified prospective cohorts that measured thyroid function and followed participants to assess fracture outcomes. Data Extraction One reviewer extracted data using a standardized protocol, and another verified data. Both reviewers independently assessed methodological quality of the studies. Data Synthesis The 7 population-based cohorts of heterogeneous quality included 50 245 participants with 1966 hip and 3281 nonspine fractures. In random-effects models that included the 5 higher-quality studies, the pooled adjusted hazard ratios (HRs) of participants with subclinical hyperthyroidism versus euthyrodism were 1.38 (95% CI, 0.92 to 2.07) for hip fractures and 1.20 (CI, 0.83 to 1.72) for nonspine fractures without statistical heterogeneity (P = 0.82 and 0.52, respectively; I2 = 0%). Pooled estimates for the 7 cohorts were 1.26 (CI, 0.96 to 1.65) for hip fractures and 1.16 (CI, 0.95 to 1.42) for nonspine fractures. When thyroxine recipients were excluded, the HRs for participants with subclinical hyperthyroidism were 2.16 (CI, 0.87 to 5.37) for hip fractures and 1.43 (CI, 0.73 to 2.78) for nonspine fractures. For participants with subclinical hypothyroidism, HRs from higher-quality studies were 1.12 (CI, 0.83 to 1.51) for hip fractures and 1.04 (CI, 0.76 to 1.42) for nonspine fractures (P for heterogeneity = 0.69 and 0.88, respectively; I2 = 0%). Limitations Selective reporting cannot be excluded. Adjustment for potential common confounders varied and was not adequately done across all studies. Conclusion Subclinical hyperthyroidism might be associated with an increased risk for hip and nonspine fractures, but additional large, high-quality studies are needed. Primary Funding Source Swiss National Science Foundation. PMID:25089863

Methods for estimating the amount of vernal pool habitat in the northeastern United States

USGS Publications Warehouse

Van Meter, R.; Bailey, L.L.; Grant, E.H.C.

2008-01-01

The loss of small, seasonal wetlands is a major concern for a variety of state, local, and federal organizations in the northeastern U.S. Identifying and estimating the number of vernal pools within a given region is critical to developing long-term conservation and management strategies for these unique habitats and their faunal communities. We use three probabilistic sampling methods (simple random sampling, adaptive cluster sampling, and the dual frame method) to estimate the number of vernal pools on protected, forested lands. Overall, these methods yielded similar values of vernal pool abundance for each study area, and suggest that photographic interpretation alone may grossly underestimate the number of vernal pools in forested habitats. We compare the relative efficiency of each method and discuss ways of improving precision. Acknowledging that the objectives of a study or monitoring program ultimately determine which sampling designs are most appropriate, we recommend that some type of probabilistic sampling method be applied. We view the dual-frame method as an especially useful way of combining incomplete remote sensing methods, such as aerial photograph interpretation, with a probabilistic sample of the entire area of interest to provide more robust estimates of the number of vernal pools and a more representative sample of existing vernal pool habitats.

Changes in mineral-associated soil organic carbon pools across a harvested temperate forest chronosequence

NASA Astrophysics Data System (ADS)

MacIntyre, S.; Kellman, L. M.; Gabriel, C. E.; Diochon, A.

2016-12-01

Due to their substantial pool size, changes in mineral soil carbon (C) stores have the potential to generate significant changes in forest soil C budgets. Harvesting represents a significant land use disturbance that can alter soil organic carbon (SOC) stores, with a number of field studies documenting large losses of SOC following clearcut harvesting. However, little is known about how the distribution of SOC changes amongst mineral-associated pools of differing crystallinity following this disturbance. The objective of this study was to quantify changes in mineral-associated SOC pool sizes through depth and time for podzol soils (mineral soil depths of 0-5, 5-10, 10-15, 15-20, 20-35, and 35-50 cm) of a temperate red spruce harvest chronosequence (representing stand ages of 1yr, 15yr, 45yr, 80yr, and 125+yr) in Nova Scotia, Canada. Samples were subjected to a 4-step sequential chemical dissolution to selectively extract C from mineral pools of increasing crystallinity: soluble minerals (deionized water), organo-metal complexes (Na-pyrophosphate), poorly crystalline minerals (hydroxylamine), and crystalline minerals (Na-dithionite HCl). Carbon concentrations were calculated for the solutions acquired during each stage of the selective dissolution process, providing a time series of changes in mineral-associated C through depth and time following harvesting. A loss of SOC from the organo-metal complexed pool following harvesting was observed, particularly in the deeper mineral soil (20-50cm), with this pool dominating the results. In the soluble and poorly crystalline pools, losses of C were also observed from the deeper mineral soil. Of the 5 sites, the 125+yr age class had the highest concentration of SOC associated with crystalline minerals, with the 0-5cm depth stratum holding a large portion of this C. This study may be useful as a model system for understanding how harvesting disturbance alters mineral pool SOM dynamics in humid temperate forest ecosystems.

Source of funding in experimental studies of mobile phone use on health: Update of systematic review

NASA Astrophysics Data System (ADS)

van Nierop, Lotte E.; Röösli, Martin; Egger, Matthias; Huss, Anke

2010-11-01

A previous review showed that among 59 studies published in 1995-2005, industry-funded studies were least likely to report effects of controlled exposure to mobile phone radiation on health-related outcomes. We updated literature searches in 2005-2009 and extracted data on funding, conflicts of interest and results. Of 75 additional studies 12% were industry-funded, 44% had public and 19% mixed funding; funding was unclear in 25%. Previous findings were confirmed: industry-sponsored studies were least likely to report results suggesting effects. Interestingly, the proportion of studies indicating effects declined in 1995-2009, regardless of funding source. Source of funding and conflicts of interest are important in this field of research.

Comparison of individual and pooled stool samples for the assessment of intensity of Schistosoma mansoni and soil-transmitted helminth infections using the Kato-Katz technique.

PubMed

Kure, Ashenafi; Mekonnen, Zeleke; Dana, Daniel; Bajiro, Mitiku; Ayana, Mio; Vercruysse, Jozef; Levecke, Bruno

2015-09-24

Our group has recently provided a proof-of-principle for the examination of pooled stool samples using McMaster technique as a strategy for the rapid assessment of intensity of soil-transmitted helminth infections (STH, Ascaris lumbricoides, Trichuris trichiura and hookworm). In the present study we evaluated this pooling strategy for the assessment of intensity of both STH and Schistosoma mansoni infections using the Kato-Katz technique. A cross-sectional survey was conducted in 360 children aged 5-18 years from six schools in Jimma Zone (southwest Ethiopia). We performed faecal egg counts (FECs) in both individual and pooled samples (pools sizes of 5, 10 and 20) to estimate the number of eggs per gram of stool (EPG) using the Kato-Katz technique. We also assessed the time to screen both individual and pooled samples. Except for hookworms, there was a significant correlation (correlation coefficient = 0.53-0.95) between the mean of individual FECs and the FECs of pooled samples for A. lumbricoides, T. trichiura and S. mansoni, regardless of the pool size. Mean FEC were 2,596 EPG, 125 EPG, 47 EPG, and 41 EPG for A. lumbricoides, T. trichiura, S. mansoni and hookworm, respectively. There was no significant difference in FECs between the examination of individual and pooled stool samples, except for hookworms. For this STH, pools of 10 resulted in a significant underestimation of infection intensity. The total time to obtain individual FECs was 65 h 5 min. For pooled FECs, this was 19 h 12 min for pools of 5, 14 h 39 min for pools of 10 and 12 h 42 min for pools of 20. The results indicate that pooling of stool sample holds also promise as a rapid assessment of infections intensity for STH and S. mansoni using the Kato-Katz technique. In this setting, the time in the laboratory was reduced by 70 % when pools of 5 instead of individual stool samples were screened.

Healthcare financing in Syria: satisfaction with the current system and the role of national health insurance--a qualitative study of householders' views.

PubMed

Mershed, Mania; Busse, Reinhard; van Ginneken, Ewout

2012-01-01

This study aims to identify the satisfaction with the current public health system and health benefit schemes, examine willingness to participate in national health insurance and review expectations and preferences of national health insurance. To this end, qualitative semi-structured interviews were carried out with 19 Syrian householders. Our results show that a need for health reform exists and that Syrian people are willing to support a national health insurance scheme if some key issues are properly addressed. Funding of the scheme is a major concern and should take into account the ability to pay and help the poor. In addition, waiting times should be shortened and sufficient coverage guaranteed. On the whole, the people would support a national health insurance with national pooling and purchasing under a public set-up, but important concerns of such a system regarding corruption and inefficiency were voiced too. Installing a quasi non-governmental organisation as manager of the insurance system under the stewardship of the Ministry of Health could provide a compromise acceptable to the people. Copyright © 2012 John Wiley & Sons, Ltd.

Limited energy study, Buildings 750 and 798, Fort Richardson, Alaska. Final report

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

NONE

1996-02-01

The purpose of this study is to identify and evaluate Energy Conservation Opportunities (ECOs) for two motor pool facilities, Buildings 750 and 798, to determine their energy savings potential, economic feasibility, and to document results for possible future funding. Buildings 750 and 798 are heated by steam supplied from a central plant. The central plant uses natural gas as a primary fuel source to produce steam for both heating and electrical energy generation. Since power is produced on the base there is not a demand charge for electrical energy. Two ECOs examined the use of natural gas in conjunction withmore » steam as a method of heating the buildings. Annual baseline energy consumption and cost data for each building is presented. The heating system in Building 750 was found to be severely under capacity. This is the result of the disabling of the under-floor heating system and the roof top MAUs. Building 798 also has had the under-floor heating system disabled. However, baseline simulations show that the remaining system is capable of maintaining thermostat setpoints during all but the coldest days of a typical year.« less

Green Bonds and climate change: State of the art or artful dodge?

NASA Astrophysics Data System (ADS)

Queen, Irene T.

Debt-finance is a growing opportunity to fund environmental solutions. Green Bonds are being used by investors wishing to improve their Corporate Social Responsibility positions while maintaining valid returns on their investments. Based on the well-established bond-finance model, Green Bonds put money into diverse environmental projects addressing impacts from climate changes, depletion of natural resources, biodiversity loss, and pollution control. “Green” is a voluntary designation, based on a set of guidelines known as the Green Bond Principles. With varying degrees of clarity regarding their use and environmental impact and whether they are a viable solution to climate damages or merely a “greenwashed” ploy used by some issuers to appear more sustainable were questions examined as part of this research. A concise summary briefing (Appendix A), case study draft, and targeted public engagements were completed. Adaptability and responsiveness, sustainability, credibility, legitimacy, and opportunity for social transformation through the use of Green Bonds were reviewed using a case study analysis method. A unique pool of investment capital being mobilized by Green Bonds is emerging through motivated environmental investment coalitions. A review of the integrated impacts of Green Bonds as well as practical knowledge for their issuance is described here.

Modulation of mitochondrial function by endogenous Zn2+ pools

NASA Astrophysics Data System (ADS)

Sensi, Stefano L.; Ton-That, Dien; Sullivan, Patrick G.; Jonas, Elizabeth A.; Gee, Kyle R.; Kaczmarek, Leonard K.; Weiss, John H.

2003-05-01

Recent evidence suggests that intracellular Zn2+ accumulation contributes to the neuronal injury that occurs in epilepsy or ischemia in certain brain regions, including hippocampus, amygdala, and cortex. Although most attention has been given to the vesicular Zn2+ that is released into the synaptic space and may gain entry to postsynaptic neurons, recent studies have highlighted pools of intracellular Zn2+ that are mobilized in response to stimulation. One such Zn2+ pool is likely bound to cytosolic proteins, like metallothioneins. Applying imaging techniques to cultured cortical neurons, this study provides novel evidence for the presence of a mitochondrial pool distinct from the cytosolic protein or ligand-bound pool. These pools can be pharmacologically mobilized largely independently of each other, with Zn2+ release from one resulting in apparent net Zn2+ transfer to the other. Further studies found evidence for complex and potent effects of Zn2+ on isolated brain mitochondria. Submicromolar levels, comparable to those that might occur on strong mobilization of intracellular compartments, induced membrane depolarization (loss of m), increases in currents across the mitochondrial inner membrane as detected by direct patch clamp recording of mitoplasts, increased O2 consumption and decreased reactive oxygen species (ROS) generation, whereas higher levels decreased O2 consumption and increased ROS generation. Finally, strong mobilization of protein-bound Zn2+ appeared to induce partial loss of Δψm, suggesting that movement of Zn2+ between cytosolic and mitochondrial pools might be of functional significance in intact neurons.