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Sample records for premiums long-term costs

  1. 17 CFR 256.225 - Unamortized premium on long-term debt.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... COMMISSION (CONTINUED) UNIFORM SYSTEM OF ACCOUNTS FOR MUTUAL SERVICE COMPANIES AND SUBSIDIARY SERVICE COMPANIES, PUBLIC UTILITY HOLDING COMPANY ACT OF 1935 6. Long-Term Debt § 256.225 Unamortized premium on...

  2. The malpractice premium costs of obstetrics.

    PubMed

    Norton, S A

    1997-01-01

    This study examined, in 1992, the variation in the level of malpractice premiums, and the incremental malpractice premium costs associated with the practice of obstetrics for family practitioners and obstetricians. On average, in 1992 obstetricians and family practitioners providing obstetric services paid malpractice premiums of roughly $44,000 and $16,000, respectively. The incremental increase in malpractice premium costs represented roughly 70% of the premium the physicians would have paid had they not provided obstetric services. These results suggest that for both family practitioners and obstetricians, there is a considerable premium penalty associated with providing obstetric services which may have implications for women's access to obstetric services. Moreover, the results make it clear that physicians practicing in different states, and different specialists within a state, may face very different malpractice premium costs.

  3. 17 CFR 256.225 - Unamortized premium on long-term debt.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... long-term debt. (a) This account shall include the excess of the cash value of consideration received over the face value upon the issuance or assumption of long-term debt securities. (b) Amounts...

  4. Applying activity-based costing in long-term care.

    PubMed

    Wodchis, W P

    1998-01-01

    As greater numbers of the elderly use health services, and as health care costs climb, effective financial tracking is essential. Cost management in health care can benefit if costs are linked to the care activities where they are incurred. Activity-based costing (ABC) provides a useful approach. The framework aligns costs (inputs), through activities (process), to outputs and outcomes. It allocates costs based on client care needs rather than management structure. The ABC framework was tested in a residential care facility and in supportive housing apartments. The results demonstrate the feasibility and advantages of ABC for long term care agencies, including community-based care.

  5. The long-term costs of career interruptions.

    PubMed

    Ketsche, Patricia G; Branscomb, Lisette

    2003-01-01

    This article is based on a study that analyzed the long-term salary implications of career choices made by healthcare administrators. The study used a cohort of graduates from a single health administration program; these individuals had comparable levels of human capital at the outset of their careers. We estimated the effect of periods of part-time employment and job interruptions--voluntary and involuntary--on long-term salary progression. We also estimated the impact of other career choices, such as membership in a professional organization or the decision to relocate. After controlling for these choices, we estimated the residual effect of gender on salary. We found that voluntary interruptions had a greater effect on long-term salary growth than did involuntary interruptions of the same length or periods of part-time employment. Individuals evaluating options for balancing career and family constraints should understand the long-term cost of choosing a career interruption rather than part-time employment during periods of heightened responsibilities outside the workplace. Healthcare administrators should also be educated about the positive association between professional memberships and career advancement to make informed decisions about participation in such organizations. Surprisingly, after controlling for all choice variables, gender had no measurable effect on long-term salary growth. Half of those who indicated a voluntary interruption for dependent care reasons preferred part-time or flexible-hour work if it had been available. These results suggest that a pool of healthcare administrators might compete for positions if more part-time opportunities were available.

  6. Cost considerations for long-term ecological monitoring

    USGS Publications Warehouse

    Caughlan, L.; Oakley, K.L.

    2001-01-01

    For an ecological monitoring program to be successful over the long-term, the perceived benefits of the information must justify the cost. Financial limitations will always restrict the scope of a monitoring program, hence the program's focus must be carefully prioritized. Clearly identifying the costs and benefits of a program will assist in this prioritization process, but this is easier said than done. Frequently, the true costs of monitoring are not recognized and are, therefore, underestimated. Benefits are rarely evaluated, because they are difficult to quantify. The intent of this review is to assist the designers and managers of long-term ecological monitoring programs by providing a general framework for building and operating a cost-effective program. Previous considerations of monitoring costs have focused on sampling design optimization. We present cost considerations of monitoring in a broader context. We explore monitoring costs, including both budgetary costs--what dollars are spent on--and economic costs, which include opportunity costs. Often, the largest portion of a monitoring program budget is spent on data collection, and other, critical aspects of the program, such as scientific oversight, training, data management, quality assurance, and reporting, are neglected. Recognizing and budgeting for all program costs is therefore a key factor in a program's longevity. The close relationship between statistical issues and cost is discussed, highlighting the importance of sampling design, replication and power, and comparing the costs of alternative designs through pilot studies and simulation modeling. A monitoring program development process that includes explicit checkpoints for considering costs is presented. The first checkpoint occur during the setting of objectives and during sampling design optimization. The last checkpoint occurs once the basic shape of the program is known, and the costs and benefits, or alternatively the cost

  7. Taxation Categories for Long-term Care Insurance Premiums and Mortality Among Elderly Japanese: A Cohort Study

    PubMed Central

    Fujino, Yoshihisa; Tanaka, Ryuichi; Kubo, Tatsuhiko; Matsuda, Shinya

    2013-01-01

    Background This cohort study examined the association between taxation categories of long-term care insurance premiums and survival among elderly Japanese. Methods A total of 3000 participants aged 60 years or older were randomly recruited in Y City, Japan in 2002, of whom 2964 provided complete information for analysis. Information on income level, mobility status, medical status, and vital status of each participant was collected annually from 2002 to 2006. Follow-up surveys on survival were conducted until August 2007. Hazard ratios (HRs) were estimated by a Cox model, using taxation categories at baseline. In these analyses, age-adjusted and age- and mobility-adjusted models were used. Results A significantly higher mortality risk was seen only in the lowest taxation category among men: as compared with men in the second highest taxation category, the HR in the lowest category was 2.53 (95% CI, 1.26–5.08, P = 0.009). This significant association between taxation category and mortality was lost after adjustment for mobility. There was no other difference in mortality among taxation categories in men or women. Conclusions The present findings only partly supported our hypothesis that taxation category is a good indicator of socioeconomic status in examining health inequalities among elderly Japanese. PMID:23258217

  8. Fall-Related Hospitalization and Facility Costs among Residents of Institutions Providing Long-Term Care

    ERIC Educational Resources Information Center

    Carroll, Norman V.; Delafuente, Jeffrey C.; Cox, Fred M.; Narayanan, Siva

    2008-01-01

    Purpose: The purpose of this study was to estimate hospital and long-term-care costs resulting from falls in long-term-care facilities (LTCFs). Design and Methods: The study used a retrospective, pre/post with comparison group design. We used matching, based on propensity scores, to control for baseline differences between fallers and non-fallers.…

  9. Fall-Related Hospitalization and Facility Costs among Residents of Institutions Providing Long-Term Care

    ERIC Educational Resources Information Center

    Carroll, Norman V.; Delafuente, Jeffrey C.; Cox, Fred M.; Narayanan, Siva

    2008-01-01

    Purpose: The purpose of this study was to estimate hospital and long-term-care costs resulting from falls in long-term-care facilities (LTCFs). Design and Methods: The study used a retrospective, pre/post with comparison group design. We used matching, based on propensity scores, to control for baseline differences between fallers and non-fallers.…

  10. Reducing long-term remedial costs by transport modeling optimization.

    PubMed

    Becker, David; Minsker, Barbara; Greenwald, Robert; Zhang, Yan; Harre, Karla; Yager, Kathleen; Zheng, Chunmiao; Peralta, Richard

    2006-01-01

    The Department of Defense (DoD) Environmental Security Technology Certification Program and the Environmental Protection Agency sponsored a project to evaluate the benefits and utility of contaminant transport simulation-optimization algorithms against traditional (trial and error) modeling approaches. Three pump-and-treat facilities operated by the DoD were selected for inclusion in the project. Three optimization formulations were developed for each facility and solved independently by three modeling teams (two using simulation-optimization algorithms and one applying trial-and-error methods). The results clearly indicate that simulation-optimization methods are able to search a wider range of well locations and flow rates and identify better solutions than current trial-and-error approaches. The solutions found were 5% to 50% better than those obtained using trial-and-error (measured using optimal objective function values), with an average improvement of approximately 20%. This translated into potential savings ranging from 600,000 dollars to 10,000,000 dollars for the three sites. In nearly all cases, the cost savings easily outweighed the costs of the optimization. To reduce computational requirements, in some cases the simulation-optimization groups applied multiple mathematical algorithms, solved a series of modified subproblems, and/or fit "meta-models" such as neural networks or regression models to replace time-consuming simulation models in the optimization algorithm. The optimal solutions did not account for the uncertainties inherent in the modeling process. This project illustrates that transport simulation-optimization techniques are practical for real problems. However, applying the techniques in an efficient manner requires expertise and should involve iterative modification to the formulations based on interim results.

  11. Demystifying first-cost green building premiums in healthcare.

    PubMed

    Houghton, Adele; Vittori, Gail; Guenther, Robin

    2009-01-01

    This study assesses the extent of "first-cost green building construction premiums" in the healthcare sector based on data submitted by and interviews with 13 current LEED-certified and LEED-registered healthcare project teams, coupled with a literature survey of articles on the topics of actual and perceived first-cost premiums associated with green building strategies. This analysis covers both perceived and realized costs across a range of projects in this sector, leading to the following conclusions: Construction first-cost premiums may be lower than is generally perceived, and they appear to be independent of both building size and level of "green" achievement; projects are using financial incentives and philanthropy to drive higher levels of achievement; premiums are decreasing over time; and projects are benefiting from improvements in health and productivity which, although difficult to monetize, are universally valued.

  12. 42 CFR 447.78 - Aggregate limits on alternative premiums and cost sharing.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Aggregate limits on alternative premiums and cost... Provisions Alternative Premiums and Cost Sharing Under Section 1916a § 447.78 Aggregate limits on alternative premiums and cost sharing. (a) The total aggregate amount of premiums and cost sharing imposed...

  13. Cost Effectiveness of Premium Versus Regular Gasoline in MCPS Buses.

    ERIC Educational Resources Information Center

    Baacke, Clifford M.; Frankel, Steven M.

    The primary question posed in this study is whether premium or regular gasoline is more cost effective for the Montgomery County Public School (MCPS) bus fleet, as a whole, when miles-per-gallon, cost-per-gallon, and repair costs associated with mileage are considered. On average, both miles-per-gallon, and repair costs-per-mile favor premium…

  14. Can home care services achieve cost savings in long-term care for older people?

    PubMed

    Greene, V L; Ondrich, J; Laditka, S

    1998-07-01

    To determine whether efficient allocation of home care services can produce net long-term care cost savings. Hazard function analysis and nonlinear mathematical programming. Optimal allocation of home care services resulted in a 10% net reduction in overall long-term care costs for the frail older population served by the National Long-Term Care (Channeling) Demonstration, in contrast to the 12% net cost increase produced by the demonstration intervention itself. Our findings suggest that the long-sought goal of overall cost-neutrality or even cost-savings through reducing nursing home use sufficiently to more than offset home care costs is technically feasible, but requires tighter targeting of services and a more medically oriented service mix than major home care demonstrations have implemented to date.

  15. Paying for long-term care.

    PubMed Central

    Estes, C L; Bodenheimer, T

    1994-01-01

    Everyone agrees that insurance for long-term care is inadequate in the United States. Disagreement exists, however, on whether such insurance should be provided through the private or public sector. Private insurance generally uses the experience-rating principle that persons with higher risk of illness are charged higher premiums. For private insurance for long-term care, this principle creates a dilemma. Most policies will be purchased by the elderly; yet, because the elderly have a high risk of needing long-term care, only about 20% of them can afford the cost of premiums. A public-private partnership by which the government partially subsidizes private long-term-care insurance is unlikely to resolve this dilemma. Only a social insurance program for long-term care can provide universal, affordable, and equitable coverage. PMID:8128712

  16. Long-term postplacement cost comparison of AneuRx and Zenith endografts.

    PubMed

    Noll, Robert E; Tonnessen, Britt H; Kim, Jason; Money, Samuel R; Sternbergh, W Charles

    2008-11-01

    Long-term postplacement costs increase the global cost of endovascular aneurysm repair (EVAR) by 44%. Secondary procedures and endoleaks significantly increase long-term expense. This study evaluates device-specific long-term postplacement costs using two different endografts. AneuRx and Zenith endografts were used to treat 250 patients with abdominal aortic aneurysms between December 1998 and June 2006 at a single institution. A relative value unit-based hospital cost accounting system was used to calculate both direct and indirect hospital departmental costs. Institutional overhead expenses, costs of professional services, and outpatient visits were also included in cost determinations. All costs were valued in 2006 dollars. To examine long-term costs, patients with <1 year follow-up were excluded. The initial 50 EVAR patients between December 1995 and 1998 were also excluded, to limit the effect of the learning curve on postplacement cost. The cumulative 5-year postplacement costs per patient were $12,465 (AneuRx) and $10,606 (Zenith, p = 0.22). Mean durations of follow-up were 38.5 +/- 5.2 months (AneuRx) and 32.8 +/- 3.8 months (Zenith, p = 0.12). For both devices, the largest cost components were secondary procedures (59.5% AneuRx vs. 56.4% Zenith) and radiologic studies (29.2% AneuRx vs. 34.9% Zenith). Freedom from secondary procedures (80% vs. 51%, p < 0.05) and endoleaks (83% vs. 58%, p = 0.05) was higher in patients treated with Zenith vs. AneuRx endografts, respectively. There was a reduction in secondary procedures and endoleaks in patients treated with Zenith compared to AneuRx. The corresponding 15% reduction in cost, however, was not statistically significant. Additional device-related cost reductions may be possible through improvements in device and technique and alterations in surveillance imaging.

  17. Japan's universal long-term care system reform of 2005: containing costs and realizing a vision.

    PubMed

    Tsutsui, Takako; Muramatsu, Naoko

    2007-09-01

    Japan implemented a mandatory social long-term care insurance (LTCI) system in 2000, making long-term care services a universal entitlement for every senior. Although this system has grown rapidly, reflecting its popularity among seniors and their families, it faces several challenges, including skyrocketing costs. This article describes the recent reform initiated by the Japanese government to simultaneously contain costs and realize a long-term vision of creating a community-based, prevention-oriented long-term care system. The reform involves introduction of two major elements: "hotel" and meal charges for nursing home residents and new preventive benefits. They were intended to reduce economic incentives for institutionalization, dampen provider-induced demand, and prevent seniors from being dependent by intervening while their need levels are still low. The ongoing LTCI reform should be critically evaluated against the government's policy intentions as well as its effect on seniors, their families, and society. The story of this reform is instructive for other countries striving to develop coherent, politically acceptable long-term care policies.

  18. Costs of infection prevention practices in long-term care settings: A systematic review

    PubMed Central

    Cohen, Catherine C.; Choi, Yoon Jeong; Stone, Patricia W.

    2016-01-01

    The objective of this systematic review is to identify and evaluate cost estimates reported in scientific literature regarding practices to prevent infection among residents and staff of long-term care facilities. Included papers represent diverse study designs and low methodological transparency. PMID:27055307

  19. 47 CFR 52.32 - Allocation of the shared costs of long-term number portability.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ....21(h), of each regional database, as defined in § 52.21(1), shall recover the shared costs of long-term number portability attributable to that regional database from all telecommunications carriers providing telecommunications service in areas that regional database serves. Pursuant to its duties under...

  20. 47 CFR 52.32 - Allocation of the shared costs of long-term number portability.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ....21(h), of each regional database, as defined in § 52.21(1), shall recover the shared costs of long-term number portability attributable to that regional database from all telecommunications carriers providing telecommunications service in areas that regional database serves. Pursuant to its duties...

  1. 47 CFR 52.32 - Allocation of the shared costs of long-term number portability.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ....21(h), of each regional database, as defined in § 52.21(1), shall recover the shared costs of long-term number portability attributable to that regional database from all telecommunications carriers providing telecommunications service in areas that regional database serves. Pursuant to its duties...

  2. Tuberculosis screening for long-term care: a cost-effectiveness analysis.

    PubMed

    Verma, G; Chuck, A W; Jacobs, P

    2013-09-01

    Long-term care facilities in Canada, a low tuberculosis (TB) incidence country. To compare the impact and cost-effectiveness of three screening strategies for TB on entry to long-term care: no screening, screening for latent tuberculous infection (LTBI) using the tuberculin skin test (TST) or screening for active disease with a chest X-ray. Cost effectiveness analysis. With the LTBI screening strategy, the number needed to screen to prevent one active case was 1410 and the cost per case averted was Canadian $109 913. The number needed to screen to prevent one case using the active screening strategy was 1266, and the cost per case averted was $672 298. Our findings suggest that TB screening strategies on entry to long-term care are costly, with large numbers needed to screen. Screening with TST was more cost-effective than chest X-ray screening. Higher risk of reactivation of LTBI is associated with improved cost-effectiveness of screening. Short time horizons and test performance characteristics place limitations on screening programmes in this setting. Future considerations include the changing demographics of the institutionalised elderly.

  3. Gauging the Purported Costs of Public Data Archiving for Long-Term Population Studies

    PubMed Central

    Evans, Simon Robin

    2016-01-01

    It was recently proposed that long-term population studies be exempted from the expectation that authors publicly archive the primary data underlying published articles. Such studies are valuable to many areas of ecological and evolutionary biological research, and multiple risks to their viability were anticipated as a result of public data archiving (PDA), ultimately all stemming from independent reuse of archived data. However, empirical assessment was missing, making it difficult to determine whether such fears are realistic. I addressed this by surveying data packages from long-term population studies archived in the Dryad Digital Repository. I found no evidence that PDA results in reuse of data by independent parties, suggesting the purported costs of PDA for long-term population studies have been overstated. PMID:27058254

  4. Future costs for long-term care: cost projections for long-term care for older people in the United Kingdom.

    PubMed

    Karlsson, Martin; Mayhew, Les; Plumb, Robert; Rickayzen, Ben

    2006-01-01

    The purpose of this paper is to analyse the future sustainability of the UK system for provision of long-term care (LTC) due to changes in demography and health status among the older people. It considers how demand for LTC will evolve and to what extent there will be sufficient supply to meet demand. For formal care, this requires an estimate of how much the public purses, and hence taxpayers, will be burdened with LTC costs. For informal care, it involves estimating whether there will be enough carers if current patterns of provision were to continue. The results show that demand for long-term care will start to take off 10 years from now, and reach a peak somewhere after 2040. The research finds that the most significant increase will be in demand for informal care, where the number of recipients are projected to increase from 2.2 million today to 3.0 million in 2050. Relative increases will be similar in all care settings, amounting to between 30 and 50% compared with the levels today; however, the most noticeable increase will be in demand for formal home care, which is projected to be 60% above current levels by 2040. Total expenditure on formal long-term care will increase from 11 billion pounds per year today to approximately 15 billion pounds per year by 2040 (in 2001 prices). Expressed in taxation terms the effective contribution rate will increase from around 1.0% of total wages today to 1.3% in 2050. Availability of informal carers is potentially a big problem, but the extent of the problem is very sensitive to the assumptions made concerning health improvements and care-giving patterns.

  5. Medical costs attributable to child maltreatment a systematic review of short- and long-term effects.

    PubMed

    Brown, Derek S; Fang, Xiangming; Florence, Curtis S

    2011-12-01

    Child maltreatment is a serious and prevalent public health problem, which has been shown to be associated with numerous short- and long-term effects on mental and physical health. Few estimates of the medical costs of these effects have been published to date. To determine the range and quality of currently available estimates and identify the gaps and needs for future research, this article reviews research on medical costs of child maltreatment. Peer-reviewed literature on child maltreatment and medical costs was identified by searching major databases. Twelve articles on the medical costs of child maltreatment were identified. Eight studies describe short-term costs among children; four describe adult, long-term costs. Most studies used convenience samples, captured a partial share of the total costs, and did not follow best practices for econometric analysis of medical costs. Child maltreatment is associated with substantial medical costs in childhood and adulthood, but estimates vary widely because of differences in research designs, types of cost data, and study quality. Econometric estimates of the annual medical costs in adulthood range from zero to about $800. Per-episode estimates of child costs, based on mean comparisons, range from $0 to >$24,000. Copyright © 2011 American Journal of Preventive Medicine. All rights reserved.

  6. 45 CFR 152.21 - Premiums and cost-sharing.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Premiums and cost-sharing. 152.21 Section 152.21 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS PRE... are approved by the Secretary, and that reflect anticipated experience and expenses. A PCIP may not...

  7. 75 FR 30243 - Medicaid Program; Premiums and Cost Sharing

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-28

    ... Recovery Act). These provisions increase State flexibility to impose premiums and cost sharing for coverage... drugs (which are subject to a separate provision discussed below), and to adopt certain rules with... Federal Register (73 FR 9727) that proposed to implement and interpret the provisions of sections...

  8. Medicare long-term CPAP coverage policy: a cost-utility analysis.

    PubMed

    Billings, Martha E; Kapur, Vishesh K

    2013-10-15

    CPAP is an effective treatment for OSA that may reduce health care utilization and costs. Medicare currently reimburses the costs of long-term CPAP therapy only if the patient is adherent during a 90-day trial. If not, Medicare requires a repeat polysomnogram (PSG) and another trial which seems empirically not cost-effective. We modeled the cost-effectiveness of current Medicare policy compared to an alternative policy (clinic-only) without the adherence criterion and repeat PSG. Cost-utility and cost-effectiveness analysis. U.S. Medicare Population. N/A. N/A. We created a decision tree modeling (1) clinic only follow-up vs. (2) current Medicare policy. Costs were assigned based on Medicare reimbursement rates in 2012. Sensitivity analyses were conducted to test our assumptions. We estimated cumulative costs, overall adherence, and QALY gained for a 5-year time horizon from the perspective of Medicare as the payer. Current Medicare policy is more costly than the clinic-only policy but has higher net adherence and improved utility. Current Medicare policy compared to clinic-only policy costs $30,544 more per QALY. Current CMS policy promotes early identification of those more likely to adhere to CPAP therapy by requiring strict adherence standards. The policy effect is to deny coverage to those unlikely to use CPAP long-term and prevent wasted resources. Future studies are needed to measure long-term adherence in an elderly population with and without current adherence requirements to verify the cost-effectiveness of a policy change.

  9. Ballistic Missile Defense: Actions Needed to Address Implementation Issues and Estimate Long-Term Costs for European Capabilities

    DTIC Science & Technology

    2014-04-01

    BALLISTIC MISSILE DEFENSE Actions Needed to Address Implementation Issues and Estimate Long-Term Costs for...and Estimate Long-Term Costs for European Capabilities 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT...requesters April 2014 BALLISTIC MISSILE DEFENSE Actions Needed to Address Implementation Issues and Estimate Long-Term Costs for European Capabilities

  10. Long-term cost-effectiveness of disease management in systolic heart failure.

    PubMed

    Miller, George; Randolph, Stephen; Forkner, Emma; Smith, Brad; Galbreath, Autumn Dawn

    2009-01-01

    Although congestive heart failure (CHF) is a primary target for disease management programs, previous studies have generated mixed results regarding the effectiveness and cost savings of disease management when applied to CHF. We estimated the long-term impact of systolic heart failure disease management from the results of an 18-month clinical trial. We used data generated from the trial (starting population distributions, resource utilization, mortality rates, and transition probabilities) in a Markov model to project results of continuing the disease management program for the patients' lifetimes. Outputs included distribution of illness severity, mortality, resource consumption, and the cost of resources consumed. Both cost and effectiveness were discounted at a rate of 3% per year. Cost-effectiveness was computed as cost per quality-adjusted life year (QALY) gained. Model results were validated against trial data and indicated that, over their lifetimes, patients experienced a lifespan extension of 51 days. Combined discounted lifetime program and medical costs were $4850 higher in the disease management group than the control group, but the program had a favorable long-term discounted cost-effectiveness of $43,650/QALY. These results are robust to assumptions regarding mortality rates, the impact of aging on the cost of care, the discount rate, utility values, and the targeted population. Estimation of the clinical benefits and financial burden of disease management can be enhanced by model-based analyses to project costs and effectiveness. Our results suggest that disease management of heart failure patients can be cost-effective over the long term.

  11. Medicaid program; premiums and cost sharing. Final rule.

    PubMed

    2008-11-25

    This final rule implements and interprets the provisions of sections 6041, 6042, and 6043 of the Deficit Reduction Act of 2005 (DRA), and section 405(a)(1) of the Tax Relief and Health Care Act of 2006 (TRHCA). The DRA was amended by the TRHCA which revised sections 6041, 6042, and 6043 of the DRA including limitations on cost sharing for individuals with family incomes at or below 100 percent of the federal poverty line. These sections amended the Social Security Act (the Act) by adding a new section 1916A to provide State Medicaid agencies with increased flexibility to impose premium and cost sharing requirements on certain Medicaid recipients. This flexibility supplements the existing authority States have to impose premiums and cost sharing under section 1916 of the Act. The DRA provisions also specifically address cost sharing for non-preferred drugs and non-emergency care furnished in a hospital emergency department.

  12. Impact of pen utilization on insulin cost reduction in long-term care facilities.

    PubMed

    Bazalo, Gary; Weiss, Richard C; Bouchard, Jonathan R; Perry, Ronald G; Wendt, Frederick L; Jewell, James L

    2012-06-01

    To determine the impact on insulin acquisition cost of a pharmacy program to convert insulin utilization from multidose vials to pen-delivery systems for long-term care residents covered by Medicare Part A, and managed care plans. Retrospective cost comparison. Long-term care facilities. Residents covered by Medicare Part A and managed care plans. Policy to replace insulin vials with pen devices, effective July 2009. Mean insulin cost-per-patient day (total insulin purchases divided by patient admission days) and pen utilization (pen purchases as a percent of total insulin purchases). Insulin purchase data covered 2,405 admissions in 75 facilities over the 12-month period ending June 2010. Pen device purchases increased from less than 1% to almost 35% of total insulin purchases over the study period during which insulin cost per patient-day declined from $10.29 to $4.08. For Medicare Part A patients with admissions of 30 days or fewer, the most frequent visit type, mean cost per patient-day decreased from $13.73 to $9.19 as pen purchases increased from less than 1% to about 32%. For these same patients, mean cost per patient-day for admissions using only pen devices was $7.04, compared with $11.79 for admissions using only vials (P < 0.001). Significant differences in mean cost per patient-day were also found for residents covered by managed care and for longer admissions. Total insulin costs can be reduced through higher utilization of pen devices by patients in long-term care facilities.

  13. Shifting the Paradigm for Long Term Monitoring at Legacy Sites to Improve Performance while Reducing Cost

    SciTech Connect

    Eddy-Dilek, Carol A.; Looney, Brian B.; Seaman, John; Kmetz, Thomas

    2013-01-10

    A major issue facing many government and private industry sites that were previously contaminated with radioactive and chemical wastes is that often the sites cannot be cleaned up enough to permit unrestricted human access. These sites will require long-term management, in some cases indefinitely, leaving site owners with the challenge of protecting human health and environmental quality in a cost effective manner. Long-term monitoring of groundwater contamination is one of the largest projected costs in the life cycle of environmental management at the Savannah River Site (SRS), the larger DOE complex, and many large federal and private sites. Currently, most monitoring strategies are focused on laboratory measurements of contaminants measured in groundwater samples collected from wells. This approach is expensive, and provides limited and lagging information about the effectiveness of cleanup activities and the behavior of the residual contamination. Over the last twenty years, DOE and other federal agencies have made significant investments in the development of various types of sensors and strategies that would allow for remote analysis of contaminants in groundwater, but these approaches do not promise significant reductions in risk or cost. Scientists at SRS have developed a new paradigm to simultaneously improve the performance of long term monitoring systems while lowering the overall cost of monitoring. This alternative approach incorporates traditional point measurements of contaminant concentration with measurements of controlling variables including boundary conditions, master variables, and traditional plume/contaminant variables. Boundary conditions are the overall driving forces that control plume movement and therefore provide leading indication to changes in plume stability. These variables include metrics associated with meteorology, hydrology, hydrogeology, and land use. Master variables are the key variables that control the chemistry of the

  14. Long-term cost-effectiveness of single indirect restorations in selected dental practices.

    PubMed

    Kelly, P G; Smales, R J

    2004-05-22

    To determine the relative cost-effectiveness of alternative methods for restoring large tooth substance loss in adults. Long-term survival estimates and discounted costs for 245 large indirect restorations were used to calculate their incremental cost-effectiveness over 15 years when compared with direct placement Class II cusp-overlay amalgams and Class IV multisurface resin composites, placed in 100 patients from three private dental practices. The direct placement restorations were more cost-effective than the indirect restorations at all time intervals over the 15-year study period. The full gold crown and the ceramometal crown were the most cost-effective indirect posterior and anterior restorations respectively. The cast gold onlay and the porcelain jacket crown were the least cost-effective indirect posterior and anterior restorations respectively. When clinically practicable, large direct placement restorations should be placed initially in preference to indirect restorations.

  15. Long-term costs and survival of prostate cancer: a population-based study.

    PubMed

    Brodszky, Valentin; Varga, Péter; Gimesi-Országh, Judit; Fadgyas-Freyler, Petra; Boncz, Imre; Nyirády, Péter; Riesz, Péter; Baji, Petra; Péntek, Márta; Rencz, Fanni; Gulácsi, László

    2017-07-31

    There is a rising interest in measuring the societal burden of malignancies including prostate cancer. However, population-based studies reporting incidence costs of prostate cancer in the long term are lacking in Europe. The objectives of the study are to analyse the long-term costs and survival of prostate cancer patients treated by radical prostatectomy (RP) or conservative management (nRP). A retrospective claims data analysis of the National Health Insurance Found Administration of Hungary between 01.01.2002 and 31.10.2013 was carried out. Annual incidence costs related to prostate cancer and overall survival were calculated for a cohort of patients diagnosed between 2002 and 2005. Altogether 17,642 patients were selected; 2185 (12%) of them have undergone RP. The annual incidence rate ranged between 4177 and 4736 cases. Mean age of RP and nRP patients was 59.4 (SD 5.9) and 71.0 (8.4) years, respectively. The mean survival time of the RP patients was significantly longer compared to nRP patients both in the total sample (11.2 vs. 7.4 years; p < 0.001) and in the subgroup <70 years (11.3 vs. 8.8 years; p < 0.001). At the end of the 12-year follow-up, RP patients had a higher (0.83 vs. 0.68), while nRP patients had a slightly lower (0.35 vs. 38) probability of being alive compared with the age-matched general male population. The long-term cumulative costs of the RP and nRP patients amounted to €4448 and €8616. The main driver of the cost difference was the high drug costs in the nRP group. To our knowledge, this study applied the longest time-window in reporting population-based incidence costs in Europe. We found that not only RP patients lived longer but they had significantly lower total long-term costs than nRP patients. Therefore, radical prostatectomy is a cost-effective strategy in prostate cancer.

  16. Initial and Long-Term Costs of Patients Hospitalized with West Nile Virus Disease

    PubMed Central

    Staples, J. Erin; Shankar, Manjunath B.; Sejvar, James J.; Meltzer, Martin I.; Fischer, Marc

    2014-01-01

    There are no published data on the economic burden for specific West Nile virus (WNV) clinical syndromes (i.e., fever, meningitis, encephalitis, and acute flaccid paralysis [AFP]). We estimated initial hospital and lost-productivity costs from 80 patients hospitalized with WNV disease in Colorado during 2003; 38 of these patients were followed for 5 years to determine long-term medical and lost-productivity costs. Initial costs were highest for patients with AFP (median $25,117; range $5,385–$283,381) and encephalitis (median $20,105; range $3,965–$324,167). Long-term costs were highest for patients with AFP (median $22,628; range $624–$439,945) and meningitis (median $10,556; range $0–$260,748). Extrapolating from this small cohort to national surveillance data, we estimated the total cumulative costs of reported WNV hospitalized cases from 1999 through 2012 to be $778 million (95% confidence interval $673 million–$1.01 billion). These estimates can be used in assessing the cost-effectiveness of interventions to prevent WNV disease. PMID:24515937

  17. Initial and long-term costs of patients hospitalized with West Nile virus disease.

    PubMed

    Staples, J Erin; Shankar, Manjunath B; Sejvar, James J; Meltzer, Martin I; Fischer, Marc

    2014-03-01

    There are no published data on the economic burden for specific West Nile virus (WNV) clinical syndromes (i.e., fever, meningitis, encephalitis, and acute flaccid paralysis [AFP]). We estimated initial hospital and lost-productivity costs from 80 patients hospitalized with WNV disease in Colorado during 2003; 38 of these patients were followed for 5 years to determine long-term medical and lost-productivity costs. Initial costs were highest for patients with AFP (median $25,117; range $5,385-$283,381) and encephalitis (median $20,105; range $3,965-$324,167). Long-term costs were highest for patients with AFP (median $22,628; range $624-$439,945) and meningitis (median $10,556; range $0-$260,748). Extrapolating from this small cohort to national surveillance data, we estimated the total cumulative costs of reported WNV hospitalized cases from 1999 through 2012 to be $778 million (95% confidence interval $673 million-$1.01 billion). These estimates can be used in assessing the cost-effectiveness of interventions to prevent WNV disease.

  18. [Heart transplantation and long-term lvad support cost-effectiveness model].

    PubMed

    Szentmihályi, Ilona; Barabás, János Imre; Bali, Ágnes; Kapus, Gábor; Tamás, Csilla; Sax, Balázs; Németh, Endre; Pólos, Miklós; Daróczi, László; Kőszegi, Andrea; Cao, Chun; Benke, Kálmán; Kovács, Péter Barnabás; Fazekas, Levente; Szabolcs, Zoltán; Merkely, Béla; Hartyánszky, István

    2016-12-01

    Heart transplantation is a high priority project at Semmelweis University. In accordance with this, the funding of heart transplantation and mechanical circulatory support also constitutes an important issue. In this report, the authors discuss the creation of a framework with the purpose of comparing the cost-effectiveness of heart transplantation and artificial heart implantation. Our created framework includes the calculation of cost, using the direct allocation method, calculating the incremental cost-effectiveness ratio and creating a cost-effectiveness plane. Using our model, it is possible to compare the initial, perioperative and postoperative expenses of both the transplanted and the artificial heart groups. Our framework can possibly be used for the purposes of long term follow-up and with the inclusion of a sufficient number of patients, the creation of cost-effectiveness analyses and supporting strategic decision-making.

  19. Use of Pulmonary Artery Catheter in Coronary Artery Bypass Graft. Costs and Long-Term Outcomes

    PubMed Central

    Xu, Fei; Wang, Qian; Zhang, Heng; Chen, Sipeng; Ao, Hushan

    2015-01-01

    Background Pulmonary artery catheters (PAC) are used widely to monitor hemodynamics in patients undergoing coronary bypass graft (CABG) surgery. However, recent studies have raised concerns regarding both the effectiveness and safety of PAC. Therefore, our aim was to determine the effects of the use of PAC on the short- and long-term health and economic outcomes of patients undergoing CABG. Methods 1361 Chinese patients who consecutively underwent isolated, primary CABG at the Cardiovascular Institute of Fuwai Hospital from June 1, 2012 to December 31, 2012 were included in this study. Of all the patients, 453 received PAC during operation (PAC group) and 908 received no PAC therapy (control group). Short-term and long-term mortality and major complications were analyzed with multivariate regression analysis and propensity score matched-pair analysis was used to yield two well-matched groups for further comparison. Results The patients who were managed with PAC more often received intraoperative vasoactive drugs dopamine (70.9% vs. 45.5%; P<0.001) and epinephrine (7.7% vs. 2.6%; P<0.001). In addition, costs for initial hospitalization were higher for PAC patients ($14,535 vs. $13,873, respectively, p = 0.004). PAC use was neither associated with the perioperative mortality or major complications, nor was it associated with long-term mortality and major adverse cardiac and cerebrovascular events. In addition, comparison between two well-matched groups showed no significant differences either in baseline characteristics or in short-term and long-term outcomes. Conclusions There is no clear indication of any benefit or harm in managing CABG patients with PAC. However, use of PAC in CABG is more expensive. That is, PAC use increased costs without benefit and thus appears unjustified for routine use in CABG surgery. PMID:25689312

  20. Decomposing Cost Efficiency in Regional Long-term Care Provision in Japan

    PubMed Central

    Yamauchi, Yasuhiro

    2016-01-01

    Many developed countries face a growing need for long-term care provision because of population ageing. Japan is one such example, given its population's longevity and low birth rate. In this study, we examine the efficiency of Japan's regional long-term care system in FY2010 by performing a data envelopment analysis, a non-parametric frontier approach, on prefectural data and separating cost efficiency into technical, allocative, and price efficiencies under different average unit costs across regions. In doing so, we elucidate the structure of cost inefficiency by incorporating a method for restricting weight flexibility to avoid unrealistic concerns arising from zero optimal weight. The results indicate that technical inefficiency accounts for the highest share of losses, followed by price inefficiency and allocation inefficiency. Moreover, the majority of technical inefficiency losses stem from labor costs, particularly those for professional caregivers providing institutional services. We show that the largest share of allocative inefficiency losses can also be traced to labor costs for professional caregivers providing institutional services, while the labor provision of in-home care services shows an efficiency gain. However, although none of the prefectures gains efficiency by increasing the number of professional caregivers for institutional services, quite a few prefectures would gain allocative efficiency by increasing capital inputs for institutional services. These results indicate that preferred policies for promoting efficiency might vary from region to region, and thus, policy implications should be drawn with care. PMID:26493427

  1. Long-Term Outcomes and Costs of Ventricular Assist Devices Among Medicare Beneficiaries

    PubMed Central

    Hernandez, Adrian F.; Shea, Alisa M.; Milano, Carmelo A.; Rogers, Joseph G.; Hammill, Bradley G.; O’Connor, Christopher M.; Schulman, Kevin A.; Peterson, Eric D.; Curtis, Lesley H.

    2009-01-01

    Context In 2003, Medicare expanded coverage of ventricular assist devices as destination, or permanent, therapy for end-stage heart failure. Little is known about long-term outcomes and costs associated with these devices. Objective To examine acute and long-term outcomes of Medicare beneficiaries receiving ventricular assist devices alone or after open-heart surgery. Design, Setting, and Patients Analysis of all inpatient claims from the Centers for Medicare & Medicaid Services for the period 2000 through 2006. Patients were Medicare fee-for-service beneficiaries who received a ventricular assist device between February 2000 and June 2006 alone (n = 1476) or after cardiotomy in the previous 30 days (n = 1467). Main Outcome Measures Cumulative incidence of device replacement, device removal, heart transplantation, readmission, and death, accounting for censoring and competing risks. We followed patients for at least 6 months and identified factors independently associated with long-term survival. We used Medicare payments to calculate total inpatient costs and costs per day outside the hospital. Results Overall 1-year survival was 51.6% (n = 669) in the primary device group and 30.8% (n = 424) in the postcardiotomy group. Among primary device patients, 815 (55.2%) were discharged alive with a device. Of those, 450 (55.6%) were readmitted within 6 months and 504 (73.2%) were alive at 1 year. Of the 493 (33.6%) postcardiotomy patients discharged alive with a device, 237 (48.3%) were readmitted within 6 months and 355 (76.6%) were alive at 1 year. Mean 1-year Medicare payments for inpatient care for patients in the 2000–2005 cohorts were $178 714 (SD, $142 549) in the primary device group and $111 769 (SD, $95 413) in the postcardiotomy group. Conclusions Among Medicare beneficiaries receiving a ventricular assist device, early mortality, morbidity, and costs remain high. Improving patient selection and reducing perioperative mortality will be critical for improving

  2. Long-term effectiveness and cost-effectiveness of smoking cessation interventions in patients with COPD.

    PubMed

    Hoogendoorn, Martine; Feenstra, Talitha L; Hoogenveen, Rudolf T; Rutten-van Mölken, Maureen P M H

    2010-08-01

    The aim of this study was to estimate the long-term (cost-) effectiveness of smoking cessation interventions for patients with chronic obstructive pulmonary disease (COPD). A systematic review was performed of randomised controlled trials on smoking cessation interventions in patients with COPD reporting 12-month biochemical validated abstinence rates. The different interventions were grouped into four categories: usual care, minimal counselling, intensive counselling and intensive counselling + pharmacotherapy ('pharmacotherapy'). For each category the average 12-month continuous abstinence rate and intervention costs were estimated. A dynamic population model for COPD was used to project the long-term (cost-) effectiveness (25 years) of 1-year implementation of the interventions for 50% of the patients with COPD who smoked compared with usual care. Uncertainty and one-way sensitivity analyses were performed for variations in the calculation of the abstinence rates, the type of projection, intervention costs and discount rates. Nine studies were selected. The average 12-month continuous abstinence rates were estimated to be 1.4% for usual care, 2.6% for minimal counselling, 6.0% for intensive counselling and 12.3% for pharmacotherapy. Compared with usual care, the costs per quality-adjusted life year (QALY) gained for minimal counselling, intensive counselling and pharmacotherapy were euro 16 900, euro 8200 and euro 2400, respectively. The results were most sensitive to variations in the estimation of the abstinence rates and discount rates. Compared with usual care, intensive counselling and pharmacotherapy resulted in low costs per QALY gained with ratios comparable to results for smoking cessation in the general population. Compared with intensive counselling, pharmacotherapy was cost saving and dominated the other interventions.

  3. Benefit-cost aspects of long-term isolation of uranium mill tailings

    SciTech Connect

    Van Dyke, J.

    1983-11-01

    The Uranium Mill Tailings Radiation Control Act of 1978 provides for regulations for control of radon diffusion from uranium mill tailings to protect the public welfare. In developing these regulations, the Office of Nuclear Material Safety and Safeguards of the Nuclear Regulatory Commission has sought to establish the benefits and costs for alternative regulatory criteria. This report provides a perspective on some economic issues associated with long-term radiation effects from disposal of uranium mill tailings. The general problem of developing an economic rationale for regulating this activity is complicated by the very long-term and widespread effects which could result from radon gas diffusion associated with tailings piles. The economic issues are also complex because of the trade-offs between costs of disposal and intangible social values. When intergenerational implications were considered the traditional basis for discounting in a benefit-cost framework was found to shift. The appropriate rate of discount was found to depend on ethical assumptions and expectations about the relative welfare of future generations. 30 references, 1 figure, 2 tables.

  4. Long-term cost-effectiveness of providing full coverage for preventive medications after myocardial infarction.

    PubMed

    Ito, Kouta; Avorn, Jerry; Shrank, William H; Toscano, Michele; Spettel, Claire; Brennan, Troyen; Choudhry, Niteesh K

    2015-05-01

    Adherence to drugs that are prescribed after myocardial infarction remains suboptimal. Although eliminating patient cost sharing for secondary prevention increases adherence and reduces rates of major cardiovascular events, the long-term clinical and economic implications of this approach have not been adequately evaluated. We developed a Markov model simulating a hypothetical cohort of commercially insured patients who were discharged from the hospital after myocardial infarction. Patients received β-blockers, renin-angiotensin system antagonists, and statins without cost sharing (full coverage) or at the current level of insurance coverage (usual coverage). Model inputs were extracted from the Post Myocardial Infarction Free Rx Event and Economic Evaluation trial and other published literature. The main outcome was an incremental cost-effectiveness ratio as measured by cost per quality-adjusted life year gained. Patients receiving usual coverage lived an average of 9.46 quality-adjusted life years after their event and incurred costs of $171,412. Patients receiving full coverage lived an average of 9.60 quality-adjusted life years and incurred costs of $167,401. Compared with usual coverage, full coverage would result in greater quality-adjusted survival (0.14 quality-adjusted life years) and less resource use ($4011) per patient. Our results were sensitive to alterations in the risk reduction for post-myocardial infarction events from full coverage. Providing full prescription drug coverage for evidence-based pharmacotherapy to commercially insured post-myocardial infarction patients has the potential to improve health outcomes and save money from the societal perspective over the long-term. https://www.clinicaltrials.gov. Unique identifier: NCT00566774. © 2015 American Heart Association, Inc.

  5. Long-Term Care Benefits May Reduce End-of-Life Medical Care Costs

    PubMed Central

    Evered, Sharrilyn R.; Center, Bruce A.

    2014-01-01

    Abstract This study explores whether personal care services for functionally dependent or cognitively impaired individuals paid for by a long-term care (LTC) insurance policy can reduce health care utilization and costs at the end of life. This retrospective study uses propensity score matching methodology, hierarchical multiple regression, and Poisson regression to compare 830 decedents who utilized benefits from a voluntary LTC insurance plan (“claimants”) to 6860 decedents who never purchased coverage but were similar to claimants on 17 variables, including age, sex, frailty, burden of illness markers, and propensity to have needed LTC services. Claimants using LTC benefits experienced significantly lower health care costs at end of life, including 14% lower total medical costs, 13% lower pharmacy costs, 35% lower inpatient admission costs, and 16% lower outpatient visit costs. They also experienced 8% fewer inpatient admissions and 10% fewer inpatient days. The presence of dementia at the end of life moderated these effects. This study suggests that use of insurance-based LTC services measurably reduces health care expenditures at the end of life. (Population Health Management 2014;17:332–339) PMID:24784144

  6. Long-term reduction of health care costs & utilization after epilepsy surgery

    PubMed Central

    Schiltz, Nicholas K.; Kaiboriboon, Kitti; Koroukian, Siran M.; Singer, Mendel E.; Love, Thomas E.

    2015-01-01

    SUMMARY Objective To assess long-term direct medical costs, health care utilization, and mortality following resective surgery in persons with uncontrolled epilepsy. Methods Retrospective longitudinal cohort study of Medicaid beneficiaries with epilepsy from 2000 - 2008. The study population included 7,835 persons with uncontrolled focal epilepsy age 18 to 64 years, with an average follow-up time of 5 years. Of these, 135 received surgery during the study period. To account for selection bias, we used risk-set optimal pairwise matching on a time-varying propensity score, and inverse probability of treatment weighting. Repeated measures generalized linear models were used to model utilization and cost outcomes. Cox proportional hazard was used to model survival. Results The mean direct medical cost difference between the surgical group and control group was $6,806 after risk-set matching. The incidence rate ratio of inpatient, emergency room, and outpatient utilization was lower among the surgical group in both unadjusted and adjusted analyses. There was no significant difference in mortality after adjustment. Among surgical cases, mean annual costs per subject were on average $6,484 lower, and all utilization measures were lower after surgery compared to before. Significance Subjects that underwent epilepsy surgery had lower direct medical care costs and health care utilization. These findings support that epilepsy surgery yield substantial health care cost savings. PMID:26693701

  7. Long-term treatment costs for aggressive periodontitis in a German population.

    PubMed

    Schwendicke, Falk; Biffar, Anne Sophie; Graetz, Christian

    2017-09-14

    This study assessed the long-term annual costs for treating aggressive periodontitis (AgP) patients. A cohort of compliant AgP patients was retrospectively evaluated. Costs for active periodontal therapy (APT, including scaling and root planning, open flap debridement, root resections, but not pocket-elimination or regenerative surgery) and supportive periodontal therapy (SPT, including also costs for restorative, endodontic, prosthetic and surgical treatments) were estimated from a mixed payer-perspective in Germany. The impact of tooth- and patient-level factors on annual costs were assessed using mixed-modelling. 52 patients (mean [SD] age: 35.2/6.8 years), with 26.5 (4.0) teeth (38% with bone loss>50%) were treated. Mean follow-up (retention) time was 16.9 (5.4) years. Total treatment costs per patient and per tooth were 6998 (3807) and 267 (148) Euro, respectively. 87% of the costs were generated during SPT, 13% during APT. Annual patient- and tooth-level costs were 536 (209) and 20.1 (65.0) Euro, respectively. Annual tooth-level costs were significantly increased in patients aged 34 years or older, male patients, former or current smokers, teeth with furcation involvement degree II/III, and bone loss 50-70%. Annual treatment costs for treating AgP patients were similar to those found for chronic periodontitis patients. Certain parameters might predict costs. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  8. Dancing Bees Improve Colony Foraging Success as Long-Term Benefits Outweigh Short-Term Costs

    PubMed Central

    Schürch, Roger; Grüter, Christoph

    2014-01-01

    Waggle dancing bees provide nestmates with spatial information about high quality resources. Surprisingly, attempts to quantify the benefits of this encoded spatial information have failed to find positive effects on colony foraging success under many ecological circumstances. Experimental designs have often involved measuring the foraging success of colonies that were repeatedly switched between oriented dances versus disoriented dances (i.e. communicating vectors versus not communicating vectors). However, if recruited bees continue to visit profitable food sources for more than one day, this procedure would lead to confounded results because of the long-term effects of successful recruitment events. Using agent-based simulations, we found that spatial information was beneficial in almost all ecological situations. Contrary to common belief, the benefits of recruitment increased with environmental stability because benefits can accumulate over time to outweigh the short-term costs of recruitment. Furthermore, we found that in simulations mimicking previous experiments, the benefits of communication were considerably underestimated (at low food density) or not detected at all (at medium and high densities). Our results suggest that the benefits of waggle dance communication are currently underestimated and that different experimental designs, which account for potential long-term benefits, are needed to measure empirically how spatial information affects colony foraging success. PMID:25141306

  9. Cost of discarded medication in Indiana long-term care facilities.

    PubMed

    Brown, C H; Kirk, K W

    1984-04-01

    The cost of discarded medication was studied in 17 Indiana intermediate-care and skilled-nursing facilities with varying bed capacities and drug-distribution systems. During visits to each facility, one or two pharmacists collected data on patients' drug regimens and the quantities of medication dispensed and discarded over periods of one to seven months. A total of $ 5,620 worth of medication ($ 4,472 excluding topical medications) was destroyed in the facilities during the study period. The projected annual cost of discarded medication was approximately $ 15,800 ($ 12,460 excluding topical medications). In the 13 facilities using some type of unit dose drug distribution system, the mean projected annual cost of discarded medication per patient ($ 4.07) was significantly less than for the four facilities using traditional drug-distribution systems ($ 23.54). There was an inverse relationship between bed capacity and mean projected annual cost of discarded medication per patient. The use of unit dose drug distribution systems in all long-term care facilities would be expected to result in substantial savings in the costs of discarded medications.

  10. Long-term cost-effectiveness of Oncotype DX® versus current clinical practice from a Dutch cost perspective.

    PubMed

    Kip, Michelle; Monteban, Helma; Steuten, Lotte

    2015-09-01

    This study analyzes the incremental cost-effectiveness of Oncotype DX(®) testing to support adjuvant chemotherapy recommendations, versus current clinical practice, for patients with estrogen receptor-positive (ER(+)), node-negative or micrometastatic (pN1mic) early-stage breast cancer in The Netherlands. Markov model projecting distant recurrence, survival, quality-adjusted life years (QALYs) and healthcare costs over a 30-year time horizon. Oncotype DX was projected to increase QALYs by 0.11 (0.07-0.58) and costs with €1236 (range: -€142-€1236) resulting in an incremental cost-effectiveness ratio of €11,236/QALY under the most conservative scenario. Reallocation of adjuvant chemotherapy based on Oncotype DX testing is most likely a cost-effective use of scarce resources, improving long-term survival and QALYs at marginal or lower costs.

  11. Impact of road traffic injuries on disability rates and long-term care costs in Spain.

    PubMed

    Alemany, Ramon; Ayuso, Mercedes; Guillén, Montserrat

    2013-11-01

    Road traffic injuries are one of the leading causes of increasing disability-adjusted life expectancy. We analyze long-term care needs associated with motor vehicle crash-related disability in Spain and conclude that needs attributable traffic injuries are most prevalent during victims' mid-life years, they create a significant burden for both families and society as a whole given that public welfare programmes supporting these victims need to be maintained over a long time frame. High socio-economic costs of road traffic accidents (in Spain 0.04% of the GDP in 2008) are clearly indicative of the need for governments and policymakers to strengthen road accident preventive measures. Copyright © 2013 Elsevier Ltd. All rights reserved.

  12. Outcomes, cost and long term survival of patients referred to a regional weaning centre

    PubMed Central

    Pilcher, D; Bailey, M; Treacher, D; Hamid, S; Williams, A; Davidson, A

    2005-01-01

    Background: Regional weaning centres provide cost effective care for patients who have undergone prolonged mechanical ventilation. There are few published European data on outcomes in these patients. Methods: Patients admitted for weaning to the Lane Fox Respiratory Unit (LFU) between January 1997 and December 2000 were identified. The proportion weaned from mechanical ventilation, in-hospital mortality, and subsequent survival after discharge were examined. Results: A total of 153 patients had been ventilated for a median of 26 days before transfer. The daily cost per patient stay was €1350. Fifty eight patients (38%) were fully weaned, 42 (27%) died, and 53 (35%) required ventilatory support at discharge from hospital of whom 36 (24%) required only nocturnal ventilation. Univariate analysis showed increasing age (OR 1.06, p<0.001), length of ICU stay (OR 1.02, p = 0.001), APACHE II predicted risk of death score (OR 1.02, p = 0.05), and a surgical cause for admission (OR 4.04) were associated with mortality. Neuromuscular/chest wall conditions were associated with low mortality (OR 0.36) but low likelihood of weaning from ventilation (OR 0.28). Female sex (OR 2.13, p = 0.03) and COPD (OR 2.81) were associated with successful weaning. Overall survival at 3 years from admission was 47%. Long term survival was lowest in patients with COPD. Conclusions: Most patients survived to leave hospital, the majority having been liberated from ventilatory support. Survivors were younger and spent less time ventilated in the referring ICU. The underlying diagnosis determined success of weaning, hospital survival, and long term outcome. PMID:15741433

  13. Plan choice, health insurance cost and premium sharing.

    PubMed

    Kosteas, Vasilios D; Renna, Francesco

    2014-05-01

    We develop a model of premium sharing for firms that offer multiple insurance plans. We assume that firms offer one low quality plan and one high quality plan. Under the assumption of wage rigidities we found that the employee's contribution to each plan is an increasing function of that plan's premium. The effect of the other plan's premium is ambiguous. We test our hypothesis using data from the Employer Health Benefit Survey. Restricting the analysis to firms that offer both HMO and PPO plans, we measure the amount of the premium passed on to employees in response to a change in both premiums. We find evidence of large and positive effects of the increase in the plan's premium on the amount of the premium passed on to employees. The effect of the alternative plan's premium is negative but statistically significant only for the PPO plans. Copyright © 2014 Elsevier B.V. All rights reserved.

  14. Long-term socioeconomic consequences and health care costs of childhood and adolescent-onset epilepsy.

    PubMed

    Jennum, Poul; Christensen, Jakob; Ibsen, Rikke; Kjellberg, Jakob

    2016-07-01

    To estimate long-term socioeconomic consequences and health care costs of epilepsy with onset in childhood and adolescence. A historical prospective cohort study of Danish individuals with epilepsy, age up to 20 years at time of diagnosis between January 1981 and December 2012. Information about marital status, parenthood, educational level, employment status, income, use of the health care system, and cost of medicine was obtained from nationwide administrative and health registers. We identified 12,756 and 28,319 people with diagnosed with epilepsy, ages 0-5 and 6-20 years at onset, respectively. Using follow-up data for a maximum of 30 years, 1,394 of those ages 0-5 years at onset were compared with 2,897 controls persons without epilepsy, and 10,195 of those ages 6-20 years at onset were compared with 20,678 controls without epilepsy. Compared with people without the epilepsy, those with epilepsy tended to have a lower level of education, to be less likely to be married, to be more likely to live alone, and to have higher divorce and unemployment rates, lower employment rates, and people with epilepsy were more likely to receive disability pension and social security. Income was lower from employment, which in part was compensated by social security, sick pay, disability pension and unemployment benefit, sick pay (public-funded), disability pension, and other public transfers. Predicted health care costs 30 years after epilepsy onset were significantly higher among persons with epilepsy onset at 0-5 and 6-20 years, including costs for outpatient and inpatient services (hospital services), emergency room use, primary health care sector (general practice), and use of medication. The long-term negative effects on all aspects of health care and social domains, including marital status, parental socioeconomic status, educational level, employment status, and use of welfare benefits compared with controls without epilepsy calls for increased awareness on

  15. Long Term Societal Costs of Anterior Discectomy and Fusion (ACDF) versus Cervical Disc Arthroplasty (CDA) for Treatment of Cervical Radiculopathy

    PubMed Central

    Ghori, Ahmer; Konopka, Joseph F.; Cha, Thomas D.; Bono, Christopher M.

    2016-01-01

    Background Current literature suggests that anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) have comparable clinical outcomes for the treatment of cervical radiculopathy. Given similar outcomes, an understanding of differences in long-term societal costs can help guide resource utilization. The purpose of this study was to compare the relative long-term societal costs of anterior cervical discectomy and fusion (ACDF) to cervical disc arthroplasty (CDA) for the treatment of single level cervical disc disease by considering upfront surgical costs, lost productivity, and risk of subsequent revision surgery. Methods We completed an economic and decision analysis using a Markov model to evaluate the long-term societal costs of ACDF and CDA in a theoretical cohort of 45-65 year old patients with single level cervical disc disease who have failed nonoperative treatment. Results The long-term societal costs for a 45-year old patient undergoing ACDF are $31,178 while long-term costs for CDA are $24,119. Long-term costs for CDA remain less expensive throughout the modeled age range of 45 to 65 years old. Sensitivity analysis demonstrated that CDA remains less expensive than ACDF as long as annual reoperation rate remains below 10.5% annually. Conclusions Based on current data, CDA has lower long-term societal costs than ACDF for patients 45-65 years old by a substantial margin. Given reported reoperation rates of 2.5% for CDA, it is the preferred treatment for cervical radiculopathy from an economic perspective. PMID:26913221

  16. Integrated, long term, sustainable, cost effective biosolids management at a large Canadian wastewater treatment facility.

    PubMed

    Leblanc, R J; Allain, C J; Laughton, P J; Henry, J G

    2004-01-01

    The Greater Moncton Sewerage Commission's 115,000 m3/d advanced, chemically assisted primary wastewater treatment facility located in New Brunswick, Canada, has developed an integrated, long term, sustainable, cost effective programme for the management and beneficial utilization of biosolids from lime stabilized raw sludge. The paper overviews biosolids production, lime stabilization, conveyance, and odour control followed by an indepth discussion of the wastewater sludge as a resource programme, namely: composting, mine site reclamation, landfill cover, land application for agricultural use, tree farming, sod farm base as a soil enrichment, topsoil manufacturing. The paper also addresses the issues of metals, pathogens, organic compounds, the quality control program along with the regulatory requirements. Biosolids capital and operating costs are presented. Research results on removal of metals from primary sludge using a unique biological process known as BIOSOL as developed by the University of Toronto, Canada to remove metals and destroy pathogens are presented. The paper also discusses an ongoing cooperative research project with the Université de Moncton where various mixtures of plant biosolids are composted with low quality soil. Integration, approach to sustainability and "cumulative effects" as part of the overall biosolids management strategy are also discussed.

  17. Long term health care consumption and cost expenditure in systolic heart failure.

    PubMed

    Mejhert, Märit; Lindgren, Peter; Schill, Owe; Edner, Magnus; Persson, Hans; Kahan, Thomas

    2013-04-01

    The prevalence, health care consumption, and mortality increase in elderly patients with heart failure. This study aimed to analyse long term cost expenditure and predictors of health care consumption in these patients. We included 208 patients aged 60 years or older and hospitalised with heart failure (NYHA class II-IV and left ventricular systolic dysfunction); 58% were men, mean age 76 years, and mean ejection fraction 0.34. Data on all hospital admissions, discharge diagnoses, lengths of stay, and outpatient visits were collected from the National Board of Health and Welfare. We obtained data of all health care consumption for each individual. After 8-12 years of prospective follow up 72% were dead (median survival 4.6 years). Main drivers of health care expenditure were non-cardiac (40%) and cardiac (29%) hospitalizations, and visits to primary care centres (16%), and hospital outpatient clinics (15%). On average, health care expenditures were € 36,447 per patient during follow up. The average yearly cost per patient was about 5,700€, in contrast to the estimated consumption of primary and hospital care in the general population: € 1,956 in 65-74 year olds and € 2,701 in 75-84 year olds. Poor quality of life (Nottingham Health Profile) was the strongest independent predictor of total health care consumption and costs (p<0.001; by multivariate analyses). Health care costs in chronic systolic heart failure are at least two-fold higher than in the general population. Quality of life is a strong independent predictor of health care consumption. Copyright © 2012 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  18. ORTHODONTIC RETENTION. Studies of retention capacity, cost-effectiveness and long-term stability.

    PubMed

    Tynelius, Gudrun Edman

    2014-01-01

    Retention strategies, cost-effectiveness and long-term stability of treatment outcome are essential aspects of orthodontic treatment planning. The overall aim of this thesis was to compare and evaluate three different retention strategies, with special reference to short- and long-term clinical stability and cost-effectiveness. The approach was evidence-based, hence randomized controlled methodology was used in order to generate high levels of evidence. This thesis is based on four studies: Papers I and II are based on randomized controlled trials, evaluating the stability of treatment outcome after one and two years of retention, using three different retention strategies: a maxillary vacuum-formed retainer combined with a mandibular canine-to-canine retainer; a maxillary vacuum-formed retainer combined with stripping of the mandibular anterior teeth and a prefabricated positioner. Paper III presents a cost-minimization analysis of two years of retention treatment. Paper IV is based on a randomized controlled trial documenting the results five years post-retention. The following conclusions were drawn: Papers I and II. From a clinical perspective, asssessment after one year of retention disclosed that the three retention methods were successful in retaining the orthodontic treatment results. After two years of retention, all three retention methods were equally effective in controlling relapse at a clinically acceptable level. Most of the relapse occurred during the first year of retention; only minor or negligible changes were found during the second year. The subjects were grouped according to the level of compliance (excellent or good). After two years of retention there was a negative correlation between growth in body height and relapse of mandibular LII in the group of subjects with excellent compliance. The group with good compliance showed a positive correlation (Paper II, Figure 3). After two years of retention, growth in body height, initial crowding and

  19. 42 CFR 600.515 - Public schedule of enrollee premium and cost sharing.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 5 2014-10-01 2014-10-01 false Public schedule of enrollee premium and cost sharing. 600.515 Section 600.515 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... BENEFITS, PERFORMANCE STANDARDS, SERVICE DELIVERY REQUIREMENTS, PREMIUM AND COST SHARING, ALLOTMENTS,...

  20. Influence of ultra-long-term fatigue on the oxygen cost of two types of locomotion.

    PubMed

    Millet, G; Lepers, R; Lattier, G; Martin, V; Babault, N; Maffiuletti, N

    2000-11-01

    The aim of this study was to examine the effects of fatigue induced by a 65-km ultramarathon on the oxygen cost of running (Cr) and cycling (Ccycl). The day before and immediately after the race, a group of nine well-trained male subjects performed two submaximal 4-min exercise bouts: one cycling at a power corresponding to 1.5 W x kg(-1) body mass on an electromagnetically braked ergometer, and one running at 11 km x h(-1) on a flat asphalt roadway. Before oxygen cost determinations, the subjects performed 12 "ankle" jumps at a given frequency that was fixed by an electronic metronome (2.5 Hz). From the non-fatigued to the fatigued condition, there was a significant increase in minute ventilation for both running (P < 0.01) and cycling (P < 0.0001). Significant changes were also found in respiratory exchange ratio both for running (P = 0.01) and cycling (P < 0.0001). However, running and cycling differed in that Cycyc increased significantly by [mean (SD)] 24.2 (11.5)% (P < 0.001), suggesting an alteration of muscle efficiency, while Cr did not change with fatigue [186.8 (14.1) mlO2 x kg(-1) x km(-1) vs 186.8 (18.7) mlO2 x kg(-1) x km(-1)]. In addition, contact times during hopping increased significantly from 0.173 (0.019) ms to 0.194 (0.027) ms (P < 0.01). Analysis of the factors that determine Cr indicate that the subjects modified their movement pattern in order to decrease the mechanical cost of running in such long-term fatigue conditions.

  1. Do "premium" joint implants add value?: analysis of high cost joint implants in a community registry.

    PubMed

    Gioe, Terence J; Sharma, Amit; Tatman, Penny; Mehle, Susan

    2011-01-01

    Numerous joint implant options of varying cost are available to the surgeon, but it is unclear whether more costly implants add value in terms of function or longevity. We evaluated registry survival of higher-cost "premium" knee and hip components compared to lower-priced standard components. Premium TKA components were defined as mobile-bearing designs, high-flexion designs, oxidized-zirconium designs, those including moderately crosslinked polyethylene inserts, or some combination. Premium THAs included ceramic-on-ceramic, metal-on-metal, and ceramic-on-highly crosslinked polyethylene designs. We compared 3462 standard TKAs to 2806 premium TKAs and 868 standard THAs to 1311 premium THAs using standard statistical methods. The cost of the premium implants was on average approximately $1000 higher than the standard implants. There was no difference in the cumulative revision rate at 7-8 years between premium and standard TKAs or THAs. In this time frame, premium implants did not demonstrate better survival than standard implants. Revision indications for TKA did not differ, and infection and instability remained contributors. Longer followup is necessary to demonstrate whether premium implants add value in younger patient groups. Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

  2. A Long-Term Experimental Study Demonstrates the Costs of Begging That Were Not Found over the Short Term

    PubMed Central

    Soler, Manuel; Ruiz-Raya, Francisco; Carra, Laura G.; Medina-Molina, Eloy; Ibáñez-Álamo, Juan Diego; Martín-Gálvez, David

    2014-01-01

    Parent–offspring conflict theory predicts that begging behaviour could escalate continuously over evolutionary time if it is not prevented by costliness of begging displays. Three main potential physiological costs have been proposed: growth, immunological and metabolic costs. However, empirical evidence on this subject remains elusive because published results are often contradictory. In this study, we test for the existence of these three potential physiological costs of begging in house sparrow (Passer domesticus) nestlings by stimulating a group of nestlings to beg for longer and another group for shorter periods than in natural conditions. All nestlings were fed with the same quantity of food. Our study involves a long-term experimental treatment for begging studies (five consecutive days). Long-term studies frequently provide clearer results than short-term studies and, sometimes, relevant information not reported by the latter ones. Our long-term experiment shows (i) a clear effect on the immune response even since the first measurement (6 hours), but it was higher during the second (long-term) than during the first (short-term) test; (ii) evidence of a growth cost of begging in house sparrow nestlings not previously found by other studies; (iii) body condition was affected by our experimental manipulation only after 48 hour; (iv) a metabolic cost of begging never previously shown in any species, and (v) for the first time, it has shown a simultaneous effect of the three potential physiological costs of begging: immunocompetence, growth, and metabolism. This implies first, that a multilevel trade-off can occur between begging and all physiological costs and, second, that a lack of support in a short-term experiment for the existence of a tested cost of begging does not mean absence of that cost, because it can be found in a long-term experiment. PMID:25372280

  3. 5 CFR 875.303 - How are premium payment errors corrected?

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 2 2011-01-01 2011-01-01 false How are premium payment errors corrected... SERVICE REGULATIONS (CONTINUED) FEDERAL LONG TERM CARE INSURANCE PROGRAM Cost § 875.303 How are premium... and/or level of coverage, you must pay retroactive premiums to the Carrier for the amount due. If...

  4. 5 CFR 875.303 - How are premium payment errors corrected?

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 5 Administrative Personnel 2 2013-01-01 2013-01-01 false How are premium payment errors corrected... SERVICE REGULATIONS (CONTINUED) FEDERAL LONG TERM CARE INSURANCE PROGRAM Cost § 875.303 How are premium... and/or level of coverage, you must pay retroactive premiums to the Carrier for the amount due. If...

  5. 5 CFR 875.303 - How are premium payment errors corrected?

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 5 Administrative Personnel 2 2014-01-01 2014-01-01 false How are premium payment errors corrected... SERVICE REGULATIONS (CONTINUED) FEDERAL LONG TERM CARE INSURANCE PROGRAM Cost § 875.303 How are premium... and/or level of coverage, you must pay retroactive premiums to the Carrier for the amount due. If...

  6. 5 CFR 875.303 - How are premium payment errors corrected?

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 5 Administrative Personnel 2 2012-01-01 2012-01-01 false How are premium payment errors corrected... SERVICE REGULATIONS (CONTINUED) FEDERAL LONG TERM CARE INSURANCE PROGRAM Cost § 875.303 How are premium... and/or level of coverage, you must pay retroactive premiums to the Carrier for the amount due. If...

  7. Public-private solution to protection against the cost of long-term care.

    PubMed

    Ball, R M

    1990-02-01

    The demographics of our population and our current reliance on Medicaid with a means test that no one likes suggest the need for revising our financing of long-term care. Given that persons with Alzheimer's disease and related dementias are a substantial proportion of those needing long-term care, support for research to cure or control these problems should be part of a strategy for addressing the problem of long-term care. However, even if substantial progress is made there is still a need for revising our method of financing long-term care. However, other pressing societal needs, such as reducing the 2 trillion dollar federal debt, addressing the needs of the growing number of children in poverty, and caring for the more than 30 million uninsured Americans, limit the role of the federal government in financing long-term care. A proposal to provide coverage for those with functional disabilities or cognitive impairment who need chronic home care and for the initial portion of nursing home stays within a social insurance program is outlined. More extensive coverage for nursing home stays would be provided for those with community-dwelling spouses. Major financing would be provided through either a payroll tax or by a federal income tax for all age groups with supplementation from estate taxes or capital gains taxes at death. Improvement of benefits in the Medicaid program and an important role for private insurance in protecting the estates of those who become permanent nursing home residents are also suggested.

  8. A retrospective investigation of energy efficiency standards: Policies may have accelerated long term declines in appliance costs

    DOE PAGES

    Van Buskirk, R. D.; Kantner, C. L. S.; Gerke, B. F.; ...

    2014-11-14

    We perform a retrospective investigation of multi-decade trends in price and life-cycle cost (LCC) for home appliances in periods with and without energy efficiency (EE) standards and labeling polices. In contrast to the classical picture of the impact of efficiency standards, the introduction and updating of appliance standards is not associated with a long-term increase in purchase price; rather, quality-adjusted prices undergo a continued or accelerated long-term decline. In addition, long term trends in appliance LCCs—which include operating costs—consistently show an accelerated long term decline with EE policies. We also show that the incremental price of efficiency improvements has declinedmore » faster than the baseline product price for selected products. These observations are inconsistent with a view of EE standards that supposes a perfectly competitive market with static supply costs. These results suggest that EE policies may be associated with other forces at play, such as innovation and learning-by-doing in appliance production and design, that can affect long term trends in quality-adjusted prices and LCCs.« less

  9. A retrospective investigation of energy efficiency standards: policies may have accelerated long term declines in appliance costs

    NASA Astrophysics Data System (ADS)

    Van Buskirk, R. D.; Kantner, C. L. S.; Gerke, B. F.; Chu, S.

    2014-11-01

    We perform a retrospective investigation of multi-decade trends in price and life-cycle cost (LCC) for home appliances in periods with and without energy efficiency (EE) standards and labeling polices. In contrast to the classical picture of the impact of efficiency standards, the introduction and updating of appliance standards is not associated with a long-term increase in purchase price; rather, quality-adjusted prices undergo a continued or accelerated long-term decline. In addition, long term trends in appliance LCCs—which include operating costs—consistently show an accelerated long term decline with EE policies. We also show that the incremental price of efficiency improvements has declined faster than the baseline product price for selected products. These observations are inconsistent with a view of EE standards that supposes a perfectly competitive market with static supply costs. These results suggest that EE policies may be associated with other forces at play, such as innovation and learning-by-doing in appliance production and design, that can affect long term trends in quality-adjusted prices and LCCs.

  10. Long-Term Effects of Outpatient Geriatric Evaluation and Management on Health Care Utilization, Cost, and Survival

    ERIC Educational Resources Information Center

    Engelhardt, Joseph B.; Toseland, Ronald W.; Gao, Jian; Banks, Steven

    2006-01-01

    Purpose: The long-term effectiveness and efficiency of an outpatient geriatric evaluation and management (GEM) program was compared to usual primary care (UPC). Design and Method: A randomized controlled group design was used. Health care utilization, cost of care, and survival were assessed during a 48-month period among a sample of 160 male…

  11. Long-Term Effects of Outpatient Geriatric Evaluation and Management on Health Care Utilization, Cost, and Survival

    ERIC Educational Resources Information Center

    Engelhardt, Joseph B.; Toseland, Ronald W.; Gao, Jian; Banks, Steven

    2006-01-01

    Purpose: The long-term effectiveness and efficiency of an outpatient geriatric evaluation and management (GEM) program was compared to usual primary care (UPC). Design and Method: A randomized controlled group design was used. Health care utilization, cost of care, and survival were assessed during a 48-month period among a sample of 160 male…

  12. What Are the Long-Term Economic Costs of Psychological Problems during Childhood? Fact Sheet

    ERIC Educational Resources Information Center

    Steinberg, Paul

    2010-01-01

    Recent research has established evidence of a strong link between poor physical health during childhood (and even in utero) and health and economic outcomes much later in adulthood. But much less is known about the long-term economic consequences of psychological conditions experienced during childhood, although childhood psychological…

  13. What Are the Long-Term Economic Costs of Psychological Problems during Childhood? Fact Sheet

    ERIC Educational Resources Information Center

    Steinberg, Paul

    2010-01-01

    Recent research has established evidence of a strong link between poor physical health during childhood (and even in utero) and health and economic outcomes much later in adulthood. But much less is known about the long-term economic consequences of psychological conditions experienced during childhood, although childhood psychological…

  14. Positive illusions about the self: short-term benefits and long-term costs.

    PubMed

    Robins, R W; Beer, J S

    2001-02-01

    Two studies addressed parallel questions about the correlates and consequences of self-enhancement bias. Study 1 was conducted in a laboratory context and examined self-enhancing evaluations of performance in a group-interaction task. Study 2 assessed students' illusory beliefs about their academic ability when they first entered college and then followed them longitudinally to test claims about the long-term benefits of positive illusions. Both studies showed that self-enhancement bias was related to narcissism, ego involvement, self-serving attributions, and positive affect. Study 2 found that self-enhancement was associated with decreasing levels of self-esteem and well-being as well as with increasing disengagement from the academic context. Self-enhancement did not predict higher academic performance or higher graduate rates. Thus, the findings suggest that self-enhancing beliefs may be adaptive in the short term but not in the long term.

  15. Integrating acute and long-term care for high-cost populations.

    PubMed

    Master, R J; Eng, C

    2001-01-01

    The inadequacies of our fragmented acute and long-term care financing and delivery systems have been well recognized for many years. Yet over the past two decades only a very small number of "boutique" initiatives have been able to improve the financing and the delivery of care to chronically ill and disabled populations. These initiatives share most of the following characteristics: prepaid, risk-adjusted financing; integrated Medicare and Medicaid funding streams; a flexible array of acute and long-term benefits; well-organized, redesigned care delivery systems that tailor these benefits to individual need; a mission-driven philosophy; and considerable creativity in engaging government payers. The experience of these "boutiques" illustrates both the obstacles to, and the opportunity for, meaningful, widespread care delivery reform for vulnerable chronically ill populations.

  16. Effects of bystander CPR following out-of-hospital cardiac arrest on hospital costs and long-term survival.

    PubMed

    Geri, Guillaume; Fahrenbruch, Carol; Meischke, Hendrika; Painter, Ian; White, Lindsay; Rea, Thomas D; Weaver, Marcia R

    2017-06-01

    Bystander cardiopulmonary resuscitation (CPR) is associated with a greater likelihood of survival to hospital discharge after out-of-hospital cardiac arrest (OHCA). However the long-term survival benefits in relationship to cost have not been well-studied. We evaluated bystander CPR, hospital-based costs, and long-term survival following OHCA in order to assess the potential cost-effectiveness of bystander CPR. We conducted a retrospective cohort study of consecutive EMS-treated OHCA patients >=12years who arrested prior to EMS arrival and outside a nursing facility between 2001 and 2010 in greater King County, WA. Utstein-style information was obtained from the EMS registry, including 5-year survival. Costs from the OHCA hospitalization were obtained from the Washington State Comprehensive Hospital Abstract Reporting System. Cost effectiveness was based on hospital costs divided by quality-adjusted life years (QALYs) for a 5-year follow-up window. Of the 4448 eligible patients, 18.5% (n=824) were discharged alive from hospital and 12.1% (n=539) were alive at 5 years. Five-year survival was higher in patients who received bystander CPR (14.3% vs. 8.7%, p<0.001) translating to an average 0.09 QALYs associated with bystander CPR. The average (SD) total cost of the initial acute care hospitalization was USD 19,961 (40,498) for all admitted patients and USD 75,175 (52,276) for patients alive at year 5. The incremental cost-effectiveness ratio associated with bystander CPR was USD 48,044 per QALY. Based on this population-based investigation, bystander CPR was positively associated with long-term survival and appears cost-effective. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. Risk-adjusted impact of administrative costs on the distribution of terminal wealth for long-term investment.

    PubMed

    Guillén, Montserrat; Jarner, Søren Fiig; Nielsen, Jens Perch; Pérez-Marín, Ana M

    2014-01-01

    The impact of administrative costs on the distribution of terminal wealth is approximated using a simple formula applicable to many investment situations. We show that the reduction in median returns attributable to administrative fees is usually at least twice the amount of the administrative costs charged for most investment funds, when considering a risk-adjustment correction over a reasonably long-term time horizon. The example we present covers a number of standard cases and can be applied to passive investments, mutual funds, and hedge funds. Our results show investors the potential losses they face in performance due to administrative costs.

  18. Risk-Adjusted Impact of Administrative Costs on the Distribution of Terminal Wealth for Long-Term Investment

    PubMed Central

    Guillén, Montserrat; Jarner, Søren Fiig; Pérez-Marín, Ana M.

    2014-01-01

    The impact of administrative costs on the distribution of terminal wealth is approximated using a simple formula applicable to many investment situations. We show that the reduction in median returns attributable to administrative fees is usually at least twice the amount of the administrative costs charged for most investment funds, when considering a risk-adjustment correction over a reasonably long-term time horizon. The example we present covers a number of standard cases and can be applied to passive investments, mutual funds, and hedge funds. Our results show investors the potential losses they face in performance due to administrative costs. PMID:25180200

  19. Shifting the Paradigm for Long Term Monitoring at Legacy Sites to Improve Performance while Reducing Costs - 13422

    SciTech Connect

    Eddy-Dilek, Carol A; Looney, Brian B.; Gaughan, Thomas; Kmetz, Thomas; Seaman, John

    2013-07-01

    A major issue facing many government and private industry sites that were previously contaminated with radioactive and chemical wastes is that often the sites cannot be cleaned up enough to permit unrestricted human access. These sites will require long-term management, in some cases indefinitely, leaving site owners with the challenge of protecting human health and environmental quality in a cost effective manner. Long-term monitoring of groundwater contamination is one of the largest projected costs in the life cycle of environmental management at the Savannah River Site (SRS), the larger DOE complex, and many large federal and private sites. Currently, most monitoring strategies are focused on laboratory measurements of contaminants measured in groundwater samples collected from wells. This approach is expensive, and provides limited and lagging information about the effectiveness of cleanup activities and the behavior of the residual contamination. Over the last twenty years, DOE and other federal agencies have made significant investments in the development of various types of sensors and strategies that would allow for remote analysis of contaminants in groundwater, but these approaches do not promise significant reductions in risk or cost. Scientists at SRS have developed a new paradigm to simultaneously improve the performance of long term monitoring systems while lowering the overall cost of monitoring. This alternative approach incorporates traditional point measurements of contaminant concentration with measurements of controlling variables including boundary conditions, master variables, and traditional plume/contaminant variables. Boundary conditions are the overall driving forces that control plume movement and therefore provide leading indication to changes in plume stability. These variables include metrics associated with meteorology, hydrology, hydrogeology, and land use. Master variables are the key variables that control the chemistry of the

  20. Comparison of Long-term Care in Nursing Homes Versus Home Health: Costs and Outcomes in Alabama.

    PubMed

    Blackburn, Justin; Locher, Julie L; Kilgore, Meredith L

    2016-04-01

    To compare acute care outcomes and costs among nursing home residents with community-dwelling home health recipients. A matched retrospective cohort study of Alabamians aged more than or equal to 65 years admitted to a nursing home or home health between March 31, 2007 and December 31, 2008 (N = 1,291 pairs). Medicare claims were compared up to one year after admission into either setting. Death, emergency department and inpatient visits, inpatient length of stay, and acute care costs were compared using t tests. Medicaid long-term care costs were compared for a subset of matched beneficiaries. After one year, 77.7% of home health beneficiaries were alive compared with 76.2% of nursing home beneficiaries (p < .001). Home health beneficiaries averaged 0.2 hospital visits and 0.1 emergency department visits more than nursing home beneficiaries, differences that were statistically significant. Overall acute care costs were not statistically different; home health beneficiaries' costs averaged $31,423, nursing home beneficiaries' $32,239 (p = .5032). Among 426 dual-eligible pairs, Medicaid long-term care costs averaged $4,582 greater for nursing home residents (p < .001). Using data from Medicare claims, beneficiaries with similar functional status, medical diagnosis history, and demographics had similar acute care costs regardless of whether they were admitted to a nursing home or home health care. Additional research controlling for exogenous factors relating to long-term care decisions is needed. © The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  1. The Prime Diabetes Model: Novel Methods for Estimating Long-Term Clinical and Cost Outcomes in Type 1 Diabetes Mellitus.

    PubMed

    Valentine, William J; Pollock, Richard F; Saunders, Rhodri; Bae, Jay; Norrbacka, Kirsi; Boye, Kristina

    Recent publications describing long-term follow-up from landmark trials and diabetes registries represent an opportunity to revisit modeling options in type 1 diabetes mellitus (T1DM). To develop a new product-independent model capable of predicting long-term clinical and cost outcomes. After a systematic literature review to identify clinical trial and registry data, a model was developed (the PRIME Diabetes Model) to simulate T1DM progression and complication onset. The model runs as a patient-level simulation, making use of covariance matrices for cohort generation and risk factor progression, and simulating myocardial infarction, stroke, angina, heart failure, nephropathy, retinopathy, macular edema, neuropathy, amputation, hypoglycemia, ketoacidosis, mortality, and risk factor evolution. Several approaches novel to T1DM modeling were used, including patient characteristics and risk factor covariance, a glycated hemoglobin progression model derived from patient-level data, and model averaging approaches to evaluate complication risk. Validation analyses comparing modeled outcomes with published studies demonstrated that the PRIME Diabetes Model projects long-term patient outcomes consistent with those reported for a number of long-term studies. Macrovascular end points were reliably reproduced across five different populations and microvascular complication risk was accurately predicted on the basis of comparisons with landmark studies and published registry data. The PRIME Diabetes Model is product-independent, available online, and has been developed in line with good practice guidelines. Validation has indicated that outcomes from long-term studies can be reliably reproduced. The model offers new approaches to long-standing challenges in diabetes modeling and may become a valuable tool for informing health care policy. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  2. A review of methods used in long-term cost-effectiveness models of diabetes mellitus treatment.

    PubMed

    Tarride, Jean-Eric; Hopkins, Robert; Blackhouse, Gord; Bowen, James M; Bischof, Matthias; Von Keyserlingk, Camilla; O'Reilly, Daria; Xie, Feng; Goeree, Ron

    2010-01-01

    Diabetes mellitus is a major healthcare concern from both a treatment and a funding perspective. Although decision makers frequently rely on models to evaluate the long-term costs and consequences associated with diabetes interventions, no recent article has reviewed the methods used in long-term cost-effectiveness models of diabetes treatment. The following databases were searched up to April 2008 to identify published economic models evaluating treatments for diabetes mellitus: OVID MEDLINE, EMBASE and the Thomson's Biosis Previews, NHS EED via Wiley's Cochrane Library, and Wiley's HEED database. Identified articles were reviewed and grouped according to unique models. When a model was applied in different settings (e.g. country) or compared different treatment alternatives, only the original publication describing the model was included. In some cases, subsequent articles were included if they provided methodological advances from the original model. The following data were captured for each study: (i) study characteristics; (ii) model structure; (iii) long-term complications, data sources, methods reporting and model validity; (iv) utilities, data sources and methods reporting; (v) costs, data sources and methods reporting; (vi) model data requirements; and (vii) economic results including methods to deal with uncertainty. A total of 17 studies were identified, 12 of which allowed for the conduct of a cost-effectiveness analysis and a cost-utility analysis. Although most models were Markov-based microsimulations, models differed with respect to the number of diabetes-related complications included. The majority of the studies used a lifetime time horizon and a payer perspective. The DCCT for type 1 diabetes and the UKPDS for type 2 diabetes were the trial data sources most commonly cited for the efficacy data, although several non-randomized data sources were used. While the methods used to derive the efficacy data were commonly reported, less information was

  3. On the Long-Term Average Cost of CO2 Transport and Storage

    SciTech Connect

    Dooley, James J.; Dahowski, Robert T.; Davidson, Casie L.

    2008-03-03

    Paper describes general trends in the cost of CO2 transport and storage (including measurement, monitoring, and verification) and how these can be used to justify a proxy cost to cover a large number of potential CCS commercial deployment scenarios.

  4. A portable low-cost long-term live-cell imaging platform for biomedical research and education.

    PubMed

    Walzik, Maria P; Vollmar, Verena; Lachnit, Theresa; Dietz, Helmut; Haug, Susanne; Bachmann, Holger; Fath, Moritz; Aschenbrenner, Daniel; Abolpour Mofrad, Sepideh; Friedrich, Oliver; Gilbert, Daniel F

    2015-02-15

    Time-resolved visualization and analysis of slow dynamic processes in living cells has revolutionized many aspects of in vitro cellular studies. However, existing technology applied to time-resolved live-cell microscopy is often immobile, costly and requires a high level of skill to use and maintain. These factors limit its utility to field research and educational purposes. The recent availability of rapid prototyping technology makes it possible to quickly and easily engineer purpose-built alternatives to conventional research infrastructure which are low-cost and user-friendly. In this paper we describe the prototype of a fully automated low-cost, portable live-cell imaging system for time-resolved label-free visualization of dynamic processes in living cells. The device is light-weight (3.6 kg), small (22 × 22 × 22 cm) and extremely low-cost (<€1250). We demonstrate its potential for biomedical use by long-term imaging of recombinant HEK293 cells at varying culture conditions and validate its ability to generate time-resolved data of high quality allowing for analysis of time-dependent processes in living cells. While this work focuses on long-term imaging of mammalian cells, the presented technology could also be adapted for use with other biological specimen and provides a general example of rapidly prototyped low-cost biosensor technology for application in life sciences and education. Copyright © 2014 The Authors. Published by Elsevier B.V. All rights reserved.

  5. The evaluation of the National Long Term Care Demonstration. 8. The effect of channeling on health and long-term care costs.

    PubMed Central

    Thornton, C; Dunstan, S M; Kemper, P

    1988-01-01

    Expanded community care for the frail elderly has been advocated based on its potential for financial cost saving. However, the evaluation found that average costs increased: the cost of expanding publicly financed case management and formal community services beyond what already was provided was not offset by reductions in the costs for nursing home care. PMID:3130324

  6. Cost savings from home and community-based services: Arizona's capitated Medicaid long-term care program.

    PubMed

    Weissert, W G; Lesnick, T; Musliner, M; Foley, K A

    1997-12-01

    The Arizona Long-Term Care System is the first capitated, long-term care Medicaid program in the nation to operate statewide. It promotes an extensive home and community-based services program intended to lower long-term care costs by substituting home care for institutional care. Because the program is statewide, finding a suitable control group to evaluate it was a serious problem. A substitute strategy was chosen that compares actual costs incurred to an estimate of what costs would have been in the absence of home and community-based (HCB) services. To estimate the likelihood of institutionalizing clients in the absence of HCB services, coefficients for institutionalization risk factors were estimated in a logistic regression model developed using national data. These were applied to characteristics of Arizona clients. The model assigned approximately 75 percent of the program's clients to a category with traits that were determined to resemble nursing home residents' traits. A similar methodology was used to estimate lengths of nursing home stays. Lengths of stay by the program's nursing home patients were regressed on their characteristics using an event history analysis model. Coefficients for these characteristics from the regression analysis were then applied to HCB services clients to estimate how long their nursing home stays would have lasted, had they been institutionalized. These estimated nursing home stays were generally shorter than these same patients' observed home and community stays. Risk of institutionalization was then multiplied by estimated length of stay and by monthly nursing home costs to estimate what costs would have been without the HCB services option. The expected costs were compared to actual costs to judge cost savings. Home and community-based services appeared to save substantial amounts on costs of nursing home care. Estimates of savings were very robust and did not appear to be declining as the program matured. Savings

  7. Retrospective Analysis of Long-Term Outcomes After Combat Injury: A Hidden Cost of War.

    PubMed

    Stewart, Ian J; Sosnov, Jonathan A; Howard, Jeffrey T; Orman, Jean A; Fang, Raymond; Morrow, Benjamin D; Zonies, David H; Bollinger, Mary; Tuman, Caroline; Freedman, Brett A; Chung, Kevin K

    2015-12-01

    During the conflicts in Iraq and Afghanistan, 52,087 service members have been wounded in combat. The long-term sequelae of these injuries have not been carefully examined. We sought to determine the relation between markers of injury severity and the subsequent development of hypertension, coronary artery disease, diabetes mellitus, and chronic kidney disease. Retrospective cohort study of critically injured US military personnel wounded in Iraq or Afghanistan from February 1, 2002 to February 1, 2011. Patients were then followed until January 18, 2013. Chronic disease outcomes were assessed by International Classification of Diseases, 9th edition codes and causes of death were confirmed by autopsy. From 6011 admissions, records were excluded because of missing data or if they were for an individual's second admission. Patients with a disease diagnosis of interest before the injury date were also excluded, yielding a cohort of 3846 subjects for analysis. After adjustment for other factors, each 5-point increment in the injury severity score was associated with a 6%, 13%, 13%, and 15% increase in incidence rates of hypertension, coronary artery disease, diabetes mellitus, and chronic kidney disease, respectively. Acute kidney injury was associated with a 66% increase in rates of hypertension and nearly 5-fold increase in rates of chronic kidney disease. In Iraq and Afghanistan veterans, the severity of combat injury was associated with the subsequent development of hypertension, coronary artery disease, diabetes mellitus, and chronic kidney disease. © 2015 American Heart Association, Inc.

  8. Cost-efficiency in Medicaid long-term support services: the role of home and community based services.

    PubMed

    Chattopadhyay, Arpita; Fan, Yang; Chattopadhyay, Sudip

    2013-12-01

    Growth in home and community based services (HCBS) has been implicated in rising long-term care expenditure in the Medicaid program. Its efficiency impact has not been tested. Using Stochastic Frontier Analysis (SFA) and panel data methods, we evaluated the cost efficiency of long-term support services (LTSS) provided by state Medicaid agencies and examined its association with intensity of HCBS use. We compared the efficiency of state funded HCBS programs with federal waiver programs. We found substantial variation in cost efficiency of LTSS programs by states, but all showed improvement over time related to increased HCBS use. Higher participation in federal waivers programs yielded additional improvements in cost-efficiency. Results indicate that increasing HCBS services targeted at "high need" population and developmentally disabled individuals would improve efficiency in LTSS delivery. These results reveal the importance of measuring and comparing efficiencies across Medicaid funded LTSS programs, as we introduce reforms in the LTSS delivery system. We recommend that Medicaid agencies invest in the development of improved data sources for the estimation of cost efficiencies of their programs.

  9. The effect of owning private long-term care insurance policies on out-of-pocket costs.

    PubMed Central

    Rice, T; Thomas, K; Weissert, W

    1991-01-01

    This article examines the effect of owning long-term care insurance policies on the amount of out-of-pocket costs incurred by the elderly during their nursing home stays, and the importance of different policy features and restrictions. Data were drawn from the 1985 National Nursing Home Survey, and from copies of long-term care insurance policies collected from 11 leading companies during the spring and summer of 1988. The study results show a great deal of uncertainty concerning amounts the policies are likely to pay toward nursing home stays. This implies that the policies collected did not adequately fulfill one of the primary purposes of insurance: a reduction in risk and uncertainty. To examine whether rapid policy changes in recent years have made a difference, we assessed each of seven policy features and found that the two most important restrictions in long-term care insurance policies are prior hospitalization and level-of-care requirements. Recently, the National Association of Insurance Commissioners (NAIC) recommended that states prohibit the sale of policies containing these restrictions. Our findings confirm the wisdom of this recommendation. We did find, however, that two other policy restrictions--policy maximums and lack of inflation adjustment--are problematic. We recommend that the NAIC expand its model regulations to require that policy maximums be a minimum of four years, and that some form of inflation protection be incorporated into policy benefit structures. PMID:1899410

  10. Evaluation of the long-term cost-effectiveness of liraglutide therapy for patients with type 2 diabetes in France.

    PubMed

    Roussel, Ronan; Martinez, Luc; Vandebrouck, Tom; Douik, Habiba; Emiel, Patrick; Guery, Matthieu; Hunt, Barnaby; Valentine, William J

    2016-01-01

    The present study aimed to compare the projected long-term clinical and cost implications associated with liraglutide, sitagliptin and glimepiride in patients with type 2 diabetes mellitus failing to achieve glycemic control on metformin monotherapy in France. Clinical input data for the modeling analysis were taken from two randomized, controlled trials (LIRA-DPP4 and LEAD-2). Long-term (patient lifetime) projections of clinical outcomes and direct costs (2013 Euros; €) were made using a validated computer simulation model of type 2 diabetes. Costs were taken from published France-specific sources. Future costs and clinical benefits were discounted at 3% annually. Sensitivity analyses were performed. Liraglutide was associated with an increase in quality-adjusted life expectancy of 0.25 quality-adjusted life years (QALYs) and an increase in mean direct healthcare costs of €2558 per patient compared with sitagliptin. In the comparison with glimepiride, liraglutide was associated with an increase in quality-adjusted life expectancy of 0.23 QALYs and an increase in direct costs of €4695. Based on these estimates, liraglutide was associated with an incremental cost-effectiveness ratio (ICER) of €10,275 per QALY gained vs sitagliptin and €20,709 per QALY gained vs glimepiride in France. Calculated ICERs for both comparisons fell below the commonly quoted willingness-to-pay threshold of €30,000 per QALY gained. Therefore, liraglutide is likely to be cost-effective vs sitagliptin and glimepiride from a healthcare payer perspective in France.

  11. Costs of Caring for Persons with Long-Term Mental Illness in Alternative Residential Settings.

    ERIC Educational Resources Information Center

    Galster, George C.; And Others

    1994-01-01

    Costs for caring for severely mentally disabled persons receiving housing subsidies and/or case management services or who were in a state hospital were compared in two Ohio counties. Comparisons for 82 persons found differences among community-based group settings, but the state hospital costs at least 3 times higher. (SLD)

  12. Long-term costs of intimate partner violence in a sample of female HMO enrollees.

    PubMed

    Jones, Alison Snow; Dienemann, Jacqueline; Schollenberger, Janet; Kub, Joan; O'Campo, Patricia; Gielen, Andrea Carlson; Campbell, Jacquelyn C

    2006-01-01

    To compare costs associated with intimate partner violence (IPV) overall and for selected physical health problems in a non-poor, privately insured sample. We compared 185 women aged 21-55 who were physically and/or sexually abused between 1989 and 1997 and enrolled in a multisite metropolitan health maintenance organization (HMO) to 198 never abused women enrolled in the same plan who had been matched using propensity score stratification. Costs associated with HMO visits, hospital stays, referrals, and emergency room (ER) visits, prescriptions, and radiology are based on the Medicare Resource-Based Relative Value System, expressed in 2005 dollars. Average health care costs for women who reported physical, sexual, and/or emotional abuse exceeded those of never abused women by $1,700 over the 3-year study period. Women who reported abuse within 12 months of interview had higher average costs, as did women who reported physical abuse; however, sexual or emotional abuse and previous abuse also elevated costs. Costs associated with neurologic symptoms, injuries, mental health care, and unclassified symptoms account for most of these differences. IPV elevates health care costs, not only among women currently experiencing abuse, but also among women for whom the abuse has ceased. Efforts to control health care costs should focus on early detection and prevention of IPV.

  13. Reproductive Flexibility: Genetic Variation, Genetic Costs and Long-Term Evolution in a Collembola

    PubMed Central

    Tully, Thomas; Ferrière, Régis

    2008-01-01

    In a variable yet predictable world, organisms may use environmental cues to make adaptive adjustments to their phenotype. Such phenotypic flexibility is expected commonly to evolve in life history traits, which are closely tied to Darwinian fitness. Yet adaptive life history flexibility remains poorly documented. Here we introduce the collembolan Folsomia candida, a soil-dweller, parthenogenetic (all-female) microarthropod, as a model organism to study the phenotypic expression, genetic variation, fitness consequences and long-term evolution of life history flexibility. We demonstrate that collembola have a remarkable adaptive ability for adjusting their reproductive phenotype: when transferred from harsh to good conditions (in terms of food ration and crowding), a mother can fine-tune the number and the size of her eggs from one clutch to the next. The comparative analysis of eleven clonal populations of worldwide origins reveals (i) genetic variation in mean egg size under both good and bad conditions; (ii) no genetic variation in egg size flexibility, consistent with convergent evolution to a common physiological limit; (iii) genetic variation of both mean reproductive investment and reproductive investment flexibility, associated with a reversal of the genetic correlation between egg size and clutch size between environmental conditions ; (iv) a negative genetic correlation between reproductive investment flexibility and adult lifespan. Phylogenetic reconstruction shows that two life history strategies, called HIFLEX and LOFLEX, evolved early in evolutionary history. HIFLEX includes six of our 11 clones, and is characterized by large mean egg size and reproductive investment, high reproductive investment flexibility, and low adult survival. LOFLEX (the other five clones) has small mean egg size and low reproductive investment, low reproductive investment flexibility, and high adult survival. The divergence of HIFLEX and LOFLEX could represent different

  14. Cost analysis of long-term outcomes of an urban mental health court.

    PubMed

    Kubiak, Sheryl; Roddy, Juliette; Comartin, Erin; Tillander, Elizabeth

    2015-10-01

    Multiple studies have demonstrated decreased recidivism and increased treatment engagement for individuals with serious mental illness involved in Mental Health Courts (MHC). However, the limited availability of social and fiscal resources requires an analysis of the relationship between a program's effectiveness and its costs. Outcome costs associated with a sample of 105 participants discharged for more than 1 year - and grouped by completion status - were compared to an eligible sample not enrolled (n=45). Transactional costs analysis (TCA) was used to calculate outcomes associated with treatment, arrest, and confinement in the 12-month post-MHC. Total outcome costs for the Successful Group ($16,964) significantly differed from the Unsuccessful ($32,258) and Compare Groups ($39,870). Costs associated with the higher number of arrests for those in the Compare Group created the largest differences. Total cost savings between Successful and Compare (M=$22,906) equated to $916,240 and savings between Unsuccessful and Compare (M=$7612) were $494,708. The total combined cost savings for participants in the 12-month post-MHC period was $1,411,020. While it is important to understand that MHCs and the individuals that they serve vary and these results are for a felony-level court, policy makers and researchers can use these results to guide their decision-making.

  15. Summary of the cost analysis report for the long-term management of depleted uranium hexafluoride

    SciTech Connect

    Dubrin, J.W.; Rahm-Crites, L.

    1997-09-01

    This report is a summary of the Cost Analysis Report which provides comparative cost data for the management strategy alternatives. The PEIS and the Cost Analysis Report will help DOE select a management strategy. The Record of Decision, expected in 1998, will complete the first part of the Depleted Uranium Hexafluoride Management Program. The second part of the Program will look at specific sites and technologies for carrying out the selected strategy. The Cost Analysis Report estimates the primary capital and operating costs for the different alternatives. It reflects the costs of technology development construction of facilities, operation, and decontamination and decommissioning. It also includes potential revenues from the sale of by-products such as anhydrous hydrogen fluoride (ABF). These estimates are based on early designs. They are intended to help in comparing alternatives, rather than to indicate absolute costs for project budgets or bidding purposes. More detailed estimates and specific funding sources will be considered in part two of the Depleted Uranium Hexafluoride Management Program.

  16. Long-term health care costs for prostate cancer patients on androgen deprivation therapy

    PubMed Central

    Krahn, M.D.; Bremner, K.E.; Luo, J.; Tomlinson, G.; Alibhai, S.M.H.

    2016-01-01

    Background Comparing relative costs for androgen deprivation therapy (adt) protocols in prostate cancer (pca) requires an examination of all health care resources, not only those specific to pca. The objective of the present study was to use administrative data to estimate total health care costs in a population-based cohort of pca patients. Methods Patients in Ontario with pca who started 90 days or more of adt at age 66 years or older during 1995–2005 were selected from cancer registry and health care administrative databases. We classified patients (n = 21,818) by regimen (medical castration, orchiectomy, anti-androgen monotherapy, medical castration with anti-androgen, orchiectomy with anti-androgen) and indication (neoadjuvant, adjuvant, metastatic disease, biochemical recurrence, primary nonmetastatic). Using nonparametric regression methods, with inverse probability weighting to adjust for censoring, and bootstrapping, we computed mean 1-year, 5-year, and 10-year longitudinal total direct medical costs (2009 Canadian dollars). Results Mean first-year costs were highest for metastatic disease, ranging from $24,400 for orchiectomy to $32,120 for anti-androgen monotherapy. Mean first-year costs for all other indications were less than $20,000. Mean 5-year and 10-year costs were lowest for neoadjuvant treatment: approximately $43,000 and $81,000 respectively, with differences of less than $4,000 between regimens. Annual costs were highest in the first year of adt. Orchiectomy was the least costly regimen for most time periods, but was limited to primary and metastatic indications. Outpatient drugs, including pharmacologic adt, accounted for 17%–65% of total first-year costs. Conclusions Compared with combined therapies, the adt monotherapies, particularly orchiectomy when clinically feasible, are more economical. Our methods exemplified the use of algorithms to elucidate clinical information from administrative data. Our approach can be adapted for other

  17. Long-term impact of war on healthcare costs: an eight-country study.

    PubMed

    Sabes-Figuera, Ramon; McCrone, Paul; Bogic, Marija; Ajdukovic, Dean; Franciskovic, Tanja; Colombini, Niccolò; Kucukalic, Abdulah; Lecic-Tosevski, Dusica; Morina, Nexhmedin; Popovski, Mihajlo; Schützwohl, Matthias; Priebe, Stefan

    2012-01-01

    Exposure to war can negatively affect health and may impact on healthcare costs. Estimating these costs and identifying their predictors is important for appropriate service planning. We aimed to measure use of health services in an adult population who had experienced war in the former-Yugoslavia on average 8 years previously, and to identify characteristics associated with the use and costs of healthcare. War-affected community samples in Bosnia-Herzegovina, Croatia, Kosovo, FYR Macedonia, and Serbia were recruited through a random walk technique. Refugees in Germany, Italy and the UK were contacted through registers, organisations and networking. Current service use was measured for the previous three months and combined with unit costs for each country for the year 2006/7. A two-part approach was used, to identify predictors of service use with a multiple logistic regression model and predictors of cost with a generalised linear regression model. 3,313 participants were interviewed in Balkan countries and 854 refugees in Western European countries. In the Balkan countries, traumatic events and mental health status were related to greater service use while in Western countries these associations were not found. Participants in Balkan countries with post traumatic stress disorder (PTSD) had costs that were 63% higher (p = 0.005) than those without PTSD. Distress experienced during the most traumatic war event was associated with higher costs (p = 0.013). In Western European countries costs were 76% higher if non-PTSD anxiety disorders were present (0.027) and 63% higher for mood disorders (p = 0.006). War experiences and their effects on mental health are associated with increased health care costs even many years later, especially for those who stayed in the area of conflict. Focussing on the mental health impact of war is important for many reasons including those of an economic nature.

  18. Development of a cost-effective and flexible vibration DAQ system for long-term continuous structural health monitoring

    NASA Astrophysics Data System (ADS)

    Nguyen, Theanh; Chan, Tommy H. T.; Thambiratnam, David P.; King, Les

    2015-12-01

    In the structural health monitoring (SHM) field, long-term continuous vibration-based monitoring is becoming increasingly popular as this could keep track of the health status of structures during their service lives. However, implementing such a system is not always feasible due to on-going conflicts between budget constraints and the need of sophisticated systems to monitor real-world structures under their demanding in-service conditions. To address this problem, this paper presents a comprehensive development of a cost-effective and flexible vibration DAQ system for long-term continuous SHM of a newly constructed institutional complex with a special focus on the main building. First, selections of sensor type and sensor positions are scrutinized to overcome adversities such as low-frequency and low-level vibration measurements. In order to economically tackle the sparse measurement problem, a cost-optimized Ethernet-based peripheral DAQ model is first adopted to form the system skeleton. A combination of a high-resolution timing coordination method based on the TCP/IP command communication medium and a periodic system resynchronization strategy is then proposed to synchronize data from multiple distributed DAQ units. The results of both experimental evaluations and experimental-numerical verifications show that the proposed DAQ system in general and the data synchronization solution in particular work well and they can provide a promising cost-effective and flexible alternative for use in real-world SHM projects. Finally, the paper demonstrates simple but effective ways to make use of the developed monitoring system for long-term continuous structural health evaluation as well as to use the instrumented building herein as a multi-purpose benchmark structure for studying not only practical SHM problems but also synchronization related issues.

  19. 5 CFR 894.402 - Do the premiums I pay reflect the cost of providing benefits?

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 2 2011-01-01 2011-01-01 false Do the premiums I pay reflect the cost of providing benefits? 894.402 Section 894.402 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES DENTAL AND VISION INSURANCE PROGRAM Cost...

  20. 5 CFR 894.402 - Do the premiums I pay reflect the cost of providing benefits?

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 5 Administrative Personnel 2 2013-01-01 2013-01-01 false Do the premiums I pay reflect the cost of providing benefits? 894.402 Section 894.402 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES DENTAL AND VISION INSURANCE PROGRAM Cost...

  1. 5 CFR 894.402 - Do the premiums I pay reflect the cost of providing benefits?

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 5 Administrative Personnel 2 2012-01-01 2012-01-01 false Do the premiums I pay reflect the cost of providing benefits? 894.402 Section 894.402 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES DENTAL AND VISION INSURANCE PROGRAM Cost...

  2. 5 CFR 894.402 - Do the premiums I pay reflect the cost of providing benefits?

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 5 Administrative Personnel 2 2014-01-01 2014-01-01 false Do the premiums I pay reflect the cost of providing benefits? 894.402 Section 894.402 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES DENTAL AND VISION INSURANCE PROGRAM Cost...

  3. Doctors commitment and long-term effectiveness for cost containment policies: lesson learned from biosimilar drugs

    PubMed Central

    Menditto, Enrica; Orlando, Valentina; Coretti, Silvia; Putignano, Daria; Fiorentino, Denise; Ruggeri, Matteo

    2015-01-01

    Background Agency is a pervasive feature of the health care market, with doctors acting as agents for both patients and the health care system. In a context of scarce resources, doctors are required to take opportunity cost into account when prescribing treatments, while cost containment policies cannot overlook their active role in determining health care resource allocation. This paper addresses this issue, investigating the effects of cost containment measures in the market of biosimilar drugs that represent a viable and cost-saving strategy for the reduction of health care expenditure. The analysis focuses on a particular region in Italy, where several timely policies to incentivize biosimilar prescribing were launched. Methods Drugs were identified by the anatomical therapeutic chemical classification system. Information about biosimilar drugs and their originator biological products was extracted from the IMS Health regional database. Drug consumption was expressed in terms of counting units, while expenditure was evaluated in Euro (€). The market penetration of biosimilars was analyzed by year and quarterly. Results In the Campania region of Italy, the effects of cost containment policies, launched between 2009 and 2013, showed the prescription of biosimilars strongly increasing in 2010 until prescribing levels reached and exceeded the market share of the reference biological products in 2012. After a slight reduction, a plateau was observed at the beginning of 2013. At the same time, the use of the originator products had been decreasing until the first quarter of 2011. However, after a 1-year plateau, this trend was reversed, with a new increase in the consumption of the originators observed. Conclusion Results show that the cost containment policies, applied to cut health expenditure “to cure and not to care”, did not produce the cultural change necessary to make these policies effective in the long run. Therefore, top-down policies for cost

  4. 5 CFR 875.301 - Is there a Government contribution toward premiums?

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... premiums? 875.301 Section 875.301 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL LONG TERM CARE INSURANCE PROGRAM Cost § 875.301 Is there a... term care insurance....

  5. 5 CFR 875.301 - Is there a Government contribution toward premiums?

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... premiums? 875.301 Section 875.301 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL LONG TERM CARE INSURANCE PROGRAM Cost § 875.301 Is there a... term care insurance....

  6. 5 CFR 875.301 - Is there a Government contribution toward premiums?

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... premiums? 875.301 Section 875.301 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL LONG TERM CARE INSURANCE PROGRAM Cost § 875.301 Is there a... term care insurance....

  7. 5 CFR 875.301 - Is there a Government contribution toward premiums?

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... premiums? 875.301 Section 875.301 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL LONG TERM CARE INSURANCE PROGRAM Cost § 875.301 Is there a... term care insurance....

  8. 5 CFR 875.301 - Is there a Government contribution toward premiums?

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... premiums? 875.301 Section 875.301 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL LONG TERM CARE INSURANCE PROGRAM Cost § 875.301 Is there a... term care insurance....

  9. Long-Term Costs of Ischemic Stroke and Major Bleeding Events among Medicare Patients with Nonvalvular Atrial Fibrillation

    PubMed Central

    Mercaldi, Catherine J.; Siu, Kimberly; Sander, Stephen D.; Walker, David R.; Wu, You; Li, Qian; Wu, Ning

    2012-01-01

    Purpose. Acute healthcare utilization of stroke and bleeding has been previously examined among patients with nonvalvular atrial fibrillation (NVAF). The long-term cost of such outcomes over several years is not well understood. Methods. Using 1999–2009 Medicare medical and enrollment data, we identified incident NVAF patients without history of stroke or bleeding. Patients were followed from the first occurrence of ischemic stroke, major bleeding, or intracranial hemorrhage (ICH) resulting in hospitalization. Those with events were matched with 1–5 NVAF patients without events. Total incremental costs of events were calculated as the difference between costs for patients with events and matched controls for up to 3 years. Results. Among the 25,465 patients who experienced events, 94.5% were successfully matched. In the first year after event, average incremental costs were $32,900 for ischemic stroke, $23,414 for major bleeding, and $47,640 for ICH. At 3 years after these events, costs remained elevated by $3,156–$5,400 per annum. Conclusion. While the costs of stroke and bleeding among patients with NVAF are most dramatic in the first year, utilization remained elevated at 3 years. Cost consequences extend beyond the initial year after these events and should be accounted for when assessing the cost-effectiveness of treatment regimens for stroke prevention. PMID:23082276

  10. Evaluation of a Low-cost and Low-noise Active Dry Electrode for Long-term Biopotential Recording.

    PubMed

    Pourahmad, Ali; Mahnam, Amin

    2016-01-01

    Wet Ag/AgCl electrodes, although very popular in clinical diagnosis, are not appropriate for expanding applications of wearable biopotential recording systems which are used repetitively and for a long time. Here, the development of a low-cost and low-noise active dry electrode is presented. The performance of the new electrodes was assessed for recording electrocardiogram (ECG) and electroencephalogram (EEG) in comparison with that of typical gel-based electrodes in a series of long-term recording experiments. The ECG signal recorded by these electrodes was well comparable with usual Ag/AgCl electrodes with a correlation up to 99.5% and mean power line noise below 6.0 μVRMS. The active electrodes were also used to measure alpha wave and steady state visual evoked potential by recording EEG. The recorded signals were comparable in quality with signals recorded by standard gel electrodes, suggesting that the designed electrodes can be employed in EEG-based rehabilitation systems and brain-computer interface applications. The mean power line noise in EEG signals recorded by the active electrodes (1.3 μVRMS) was statistically lower than when conventional gold cup electrodes were used (2.0 μVRMS) with a significant level of 0.05, and the new electrodes appeared to be more resistant to the electromagnetic interferences. These results suggest that the developed low-cost electrodes can be used to develop wearable monitoring systems for long-term biopotential recording.

  11. Cost estimate report for the long-term management of depleted uranium hexafluoride : storage of depleted uranium metal.

    SciTech Connect

    Folga, S.M.; Kier, P.H.; Thimmapuram, P.R.

    2001-01-24

    This report contains a cost analysis of the long-term storage of depleted uranium in the form of uranium metal. Three options are considered for storage of the depleted uranium. These options are aboveground buildings, partly underground vaults, and mined cavities. Three cases are presented. In the first case, all the depleted uranium metal that would be produced from the conversion of depleted uranium hexafluoride (UF{sub 6}) generated by the US Department of Energy (DOE) prior to July 1993 would be stored at the storage facility (100% Case). In the second case, half the depleted uranium metal would be stored at this storage facility (50% Case). In the third case, one-quarter of the depleted uranium metal would be stored at the storage facility (25% Case). The technical basis for the cost analysis presented in this report is principally found in the companion report, ANL/EAD/TM-100, ''Engineering Analysis Report for the Long-Term Management of Depleted Uranium Hexafluoride: Storage of Depleted Uranium Metal'', prepared by Argonne National Laboratory.

  12. Cost and Performance Report for Adaptive Long-Term Monitoring at Environmental Restoration Sites (ER-0629)

    DTIC Science & Technology

    2009-10-01

    Tracker Plot with “Out-of-Bounds” Value that is a Potential Concern Figure 6-1 Conceptual Example to Illustrate Temporal Interpolation Issue Figure 6...representation of the plumes with Model Builder.  Sampling Optimizer provided useful trade-off curves of sampling cost versus the interpolation ...The software interpolates spatially but does not perform interpolations in time. The software would be improved if there was a feature to optionally

  13. Developments toward a low-cost approach for long-term, unattended vapor intrusion monitoring.

    PubMed

    Patel, Sanjay V; Tolley, William K

    2014-08-07

    There are over 450 000 sites contaminated by chemicals in the US. This large number of contaminated sites and the speed of subsurface migration of chemicals pose considerable risk to nearby residences and commercial buildings. The high costs for monitoring around these sites stem from the labor involved in placing and replacing the passive sorbent vapor samplers and the resultant laboratory analysis. This monitoring produces sparse data sets that do not track temporal changes well. To substantially reduce costs and better track exposures, less costly, unattended systems for monitoring soil gases and vapor intrusion into homes and businesses are desirable to aid in the remediation of contaminated sites. This paper describes progress toward the development of an inexpensive system specifically for monitoring vapor intrusion; the system can operate repeatedly without user intervention with low detection limits (1 × 10(-9), or 1 part-per-billion). Targeted analytes include chlorinated hydrocarbons (dichloroethylene, trichloroethane, trichloroethylene, and perchloroethylene) and benzene. The system consists of a trap-and-purge preconcentrator for vapor collection in conjunction with a compact gas chromatography instrument to separate individual compounds. Chemical detection is accomplished with an array of chemicapacitors and a metal-oxide semiconductor combustibles sensor. Both the preconcentrator and the chromatography column are resistively heated. All components are compatible with ambient air, which serves as the carrier gas for the gas chromatography and detectors.

  14. Developments toward a Low-Cost Approach for Long-Term, Unattended Vapor Intrusion Monitoring

    PubMed Central

    Tolley, William K.

    2014-01-01

    There are over 450,000 sites contaminated by chemicals in the US. This large number of contaminated sites and the speed of subsurface migration of chemicals pose considerable risk to nearby residences and commercial buildings. The high costs for monitoring around these site stem from the labor involved in placing and replacing the passive sorbent vapor samplers and the resultant laboratory analysis. This monitoring produces sparse data sets that do not track temporal changes well. To substantially reduce costs and better track exposures, less costly, unattended systems for monitoring soil gases and vapor intrusion into homes and businesses are desirable to aid in the remediation of contaminated sites. This paper describes progress toward the development of an inexpensive system specifically for monitoring vapor intrusion; the system can operate repeatedly without user intervention with low detection limits (1 × 10−9, or 1 part-per-billion). Targeted analytes include chlorinated hydrocarbons (dichloroethylene, trichloroethane, trichloroethylene, and perchloroethylene) and benzene. The system consists of a trap-and-purge preconcentrator for vapor collection in conjunction with a compact gas chromatography instrument to separate individual compounds. Chemical detection is accomplished with an array of chemicapacitors and a metal-oxide semiconductor combustibles sensor. Both the preconcentrator and the chromatography column are resistively heated. All components are compatible with ambient air, which serves as the carrier gas for the gas chromatography and detectors. PMID:24903107

  15. [Basic principles of cost-benefit analysis in long-term treatment of risk factors].

    PubMed

    Szucs, T D; Gutzwiller, F

    1998-12-05

    Health care decision makers are increasingly forced to identify and implement the options for potential spendings and savings. Historically, preventive measures for cardiovascular diseases have been scrutinised a great deal. The main reason for this was that substantial financial investments would have to be undertaken long before the clinical benefits were apparent. In the past, most economic evaluations of lipid lowering therapy have been based on models combining logistic regression risk functions from epidemiological cohort studies, such as the Framingham study, with the extent of cholesterol reduction. Recently, however, data from the large controlled outcome studies (4S, CARE, LIPID, WOSCOPS) have been reported which allow a direct estimate of the economic benefits of cholesterol reduction in primary and secondary prevention. The economic evaluation of such therapies can be performed in several ways, from relatively easy cost-consequence analyses to more complex cost-effectiveness analysis. Initial economic analyses of the trials are already available. There are, however, still considerable practical and methodological issues which have to be taken into account in assessing lipid lowering drugs. Available pharmaco-economic data on lipid lowering therapies suggest that statins are a cost-effective option in primary and secondary coronary prevention.

  16. Evidence for the long term cost effectiveness of home care reablement programs

    PubMed Central

    Lewin, Gill F; Alfonso, Helman S; Alan, Janine J

    2013-01-01

    Background The objectives of this study were to determine whether older individuals who participated in a reablement (restorative) program rather than immediately receiving conventional home care services had a reduced need for ongoing support and lower home care costs over the next 57 months (nearly 5 years). Materials and methods Data linkage was used to examine retrospectively the service records of older individuals who had received a reablement service versus a conventional home care service to ascertain their use of home care services over time. Results Individuals who had received a reablement service were less likely to use a personal care service throughout the follow-up period or any other type of home care over the next 3 years. This reduced use of home care services was associated with median cost savings per person of approximately AU $12,500 over nearly 5 years. Conclusion The inclusion of reablement as the starting point for individuals referred for home care within Australia’s reformed aged care system could increase the system’s cost effectiveness and ensure that all older Australians have the opportunity to maximize their independence as they age. PMID:24124354

  17. Long-term cost-effectiveness of home versus clinic-based management of chronic heart failure: the WHICH? study.

    PubMed

    Maru, Shoko; Byrnes, Joshua M; Carrington, Melinda J; Stewart, Simon; Scuffham, Paul A

    2017-04-01

    The cost-effectiveness of a heart failure management intervention can be further informed by incorporating the expected benefits and costs of future survival. This study compared the long-term costs per quality-adjusted life year (QALY) gained from home-based (HBI) vs specialist clinic-based intervention (CBI) among elderly patients (mean age = 71 years) with heart failure discharged home (mean intervention duration = 12 months). Cost-utility analysis was conducted from a government-funded health system perspective. A Markov cohort model was used to simulate disease progression over 15 years based on initial data from a randomized clinical trial (the WHICH? study). Time-dependent hazard functions were modeled using the Weibull function, and this was compared against an alternative model where the hazard was assumed to be constant over time. Deterministic and probabilistic sensitivity analyses were conducted to identify the key drivers of cost-effectiveness and quantify uncertainty in the results. During the trial, mortality was the highest within 30 days of discharge and decreased thereafter in both groups, although the declining rate of mortality was slower in CBI than HBI. At 15 years (extrapolated), HBI was associated with slightly better health outcomes (mean of 0.59 QALYs gained) and mean additional costs of AU$13,876 per patient. The incremental cost-utility ratio and the incremental net monetary benefit (vs CBI) were AU$23,352 per QALY gained and AU$15,835, respectively. The uncertainty was driven by variability in the costs and probabilities of readmissions. Probabilistic sensitivity analysis showed HBI had a 68% probability of being cost-effective at a willingness-to-pay threshold of AU$50,000 per QALY. Compared with CBI (outpatient specialized HF clinic-based intervention), HBI (home-based predominantly, but not exclusively) could potentially be cost-effective over the long-term in elderly patients with heart failure at a willingness-to-pay threshold of

  18. The evolution of genomic imprinting: costs, benefits and long-term consequences.

    PubMed

    Holman, Luke; Kokko, Hanna

    2014-08-01

    Genomic imprinting refers to a pattern of gene expression in which a specific parent's allele is either under-expressed or completely silenced. Imprinting is an evolutionary conundrum because it appears to incur the costs of diploidy (e.g. presenting a larger target than haploidy to mutations) while foregoing its benefits (protection from harmful recessive mutations). Here, we critically evaluate previously proposed evolutionary benefits of imprinting and suggest some additional ones. We discuss whether each benefit is capable of explaining both the origin and maintenance of imprinting, and examine how the different benefits interact. We then outline the many costs of imprinting. Simple models show that circulating deleterious recessives can prevent the initial spread of imprinting, even if imprinting would be evolutionarily stable if it could persist long enough to purge these. We also show that imprinting can raise or lower the mutation load, depending on the selective regime and the degree of dominance. We finish by discussing the population-level consequences of imprinting, which can be both positive and negative. Imprinting offers many insights into evolutionary conflict, the interaction between individual- and population-level fitness effects, and the 'gene's-eye view' of evolution.

  19. Long-Term Cost-Effectiveness of Insulin Glargine Versus Neutral Protamine Hagedorn Insulin for Type 2 Diabetes in Thailand.

    PubMed

    Permsuwan, Unchalee; Chaiyakunapruk, Nathorn; Dilokthornsakul, Piyameth; Thavorn, Kednapa; Saokaew, Surasak

    2016-06-01

    Even though Insulin glargine (IGlar) has been available and used in other countries for more than a decade, it has not been adopted into Thai national formulary. This study aimed to evaluate the long-term cost effectiveness of IGlar versus neutral protamine Hagedorn (NPH) insulin in type 2 diabetes from the perspective of Thai Health Care System. A validated computer simulation model (the IMS CORE Diabetes Model) was used to estimate the long-term projection of costs and clinical outcomes. The model was populated with published characteristics of Thai patients with type 2 diabetes. Baseline risk factors were obtained from Thai cohort studies, while relative risk reduction was derived from a meta-analysis study conducted by the Canadian Agency for Drugs and Technology in Health. Only direct costs were taken into account. Costs of diabetes management and complications were obtained from hospital databases in Thailand. Both costs and outcomes were discounted at 3 % per annum and presented in US dollars in terms of 2014 dollar value. Incremental cost-effectiveness ratio (ICER) was calculated. One-way and probabilistic sensitivity analyses were also performed. IGlar is associated with a slight gain in quality-adjusted life years (0.488 QALYs), an additional life expectancy (0.677 life years), and an incremental cost of THB119,543 (US$3522.19) compared with NPH insulin. The ICERs were THB244,915/QALY (US$7216.12/QALY) and THB176,525/life-year gained (LYG) (US$5201.09/LYG). The ICER was sensitive to discount rates and IGlar cost. At the acceptable willingness to pay of THB160,000/QALY (US$4714.20/QALY), the probability that IGlar was cost effective was less than 20 %. Compared to treatment with NPH insulin, treatment with IGlar in type 2 diabetes patients who had uncontrolled blood glucose with oral anti-diabetic drugs did not represent good value for money at the acceptable threshold in Thailand.

  20. Cost-Effectiveness of Nutrition Intervention in Long-Term Care.

    PubMed

    Simmons, Sandra F; Keeler, Emmett; An, Ruopeng; Liu, Xulei; Shotwell, Matthew S; Kuertz, Brittany; Silver, Heidi J; Schnelle, John F

    2015-11-01

    To determine the cost-effectiveness of two nutrition interventions on food, beverage, and supplement intake and body weight. Randomized, controlled trial. Five skilled nursing home facilities. Long-stay residents with orders for nutrition supplementation (N = 154). Participants were randomized into a usual care control group, an oral liquid nutrition supplement (ONS) intervention group, or a snack intervention group. Research staff provided ONS, according to orders or a variety of snack foods and beverages twice per day between meals, 5 days per week for 24 weeks and assistance to promote consumption. Research staff independently weighed residents at baseline and monthly during the 24-week intervention. Resident food, beverage and supplement intake and the amount of staff time spent providing assistance were assessed for 2 days at baseline and 2 days per month during the intervention using standardized observation and weighed intake procedures. The ONS intervention group took in an average of 265 calories more per day and the snack intervention group an average of 303 calories more per day than the control group. Staff time required to provide each intervention averaged 11 and 14 minutes per person per offer for ONS and snacks, respectively, and 3 minutes for usual care. Both interventions were cost-effective in increasing caloric intake, but neither intervention had a significant effect on body weight, despite positive trends. Oral liquid nutrition supplements and snack offers were efficacious in promoting caloric intake when coupled with assistance to promote consumption and a variety of options, but neither intervention resulted in significant weight gain. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.

  1. 45 CFR 800.106 - Cost-sharing limits, advance payments of premium tax credits, and cost-sharing reductions.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 3 2014-10-01 2014-10-01 false Cost-sharing limits, advance payments of premium tax credits, and cost-sharing reductions. 800.106 Section 800.106 Public Welfare Regulations Relating to Public Welfare (Continued) OFFICE OF PERSONNEL MANAGEMENT MULTI-STATE PLAN PROGRAM...

  2. 45 CFR 800.106 - Cost-sharing limits, advance payments of premium tax credits, and cost-sharing reductions.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 3 2013-10-01 2013-10-01 false Cost-sharing limits, advance payments of premium tax credits, and cost-sharing reductions. 800.106 Section 800.106 Public Welfare Regulations Relating to Public Welfare (Continued) OFFICE OF PERSONNEL MANAGEMENT MULTI-STATE PLAN PROGRAM...

  3. Nutritional analysis of a long-term care menu before and after an increase in the raw food cost allowance.

    PubMed

    Wright-Thompson, Ashley; Piché, Leonard

    2011-01-01

    Regular, nontherapeutic menus were compared before and after an increase in the Ontario long-term care (LTC) raw food cost allowance (RFCA). The purpose was to determine whether any significant nutritional differences existed between the old and new menus and whether they met target values for adequacy, according to the Dietary Reference Intake (DRI) nutrient recommendations or other target values relevant to Ministry of Health and Long-Term Care standards. A southeastern Ontario LTC facility fall/winter 2006/2007 menu and fall/winter 2007/2008 menu were used for nutrient analysis with ESHA Food Processor SQL 10.1.0. Each menu was compared with target values based on Canada's Food Guide (CFG) for 1992 and 2007, and with DRI nutrient recommendations. The 2007/2008 menu provided significantly more servings of vegetables and fruit, meeting the 2007 CFG recommendations, and significantly greater amounts of some nutrients (e.g., vitamin C, protein, magnesium, potassium, fibre, and total water). It also came closer to meeting DRI target recommendations. While some improvements have been made to the menu in this specific facility, further improvements, possibly through supplementation, must be made to ensure nutritional adequacy for all residents.

  4. Cost tradeoffs in consequence management at nuclear power plants: A risk based approach to setting optimal long-term interdiction limits for regulatory analyses

    SciTech Connect

    Mubayi, V.

    1995-05-01

    The consequences of severe accidents at nuclear power plants can be limited by various protective actions, including emergency responses and long-term measures, to reduce exposures of affected populations. Each of these protective actions involve costs to society. The costs of the long-term protective actions depend on the criterion adopted for the allowable level of long-term exposure. This criterion, called the ``long term interdiction limit,`` is expressed in terms of the projected dose to an individual over a certain time period from the long-term exposure pathways. The two measures of offsite consequences, latent cancers and costs, are inversely related and the choice of an interdiction limit is, in effect, a trade-off between these two measures. By monetizing the health effects (through ascribing a monetary value to life lost), the costs of the two consequence measures vary with the interdiction limit, the health effect costs increasing as the limit is relaxed and the protective action costs decreasing. The minimum of the total cost curve can be used to calculate an optimal long term interdiction limit. The calculation of such an optimal limit is presented for each of five US nuclear power plants which were analyzed for severe accident risk in the NUREG-1150 program by the Nuclear Regulatory Commission.

  5. Computerized physician order entry with clinical decision support in long-term care facilities: costs and benefits to stakeholders.

    PubMed

    Subramanian, Sujha; Hoover, Sonja; Gilman, Boyd; Field, Terry S; Mutter, Ryan; Gurwitz, Jerry H

    2007-09-01

    Nursing homes are the setting of care for growing numbers of our nation's older people, and adverse drug events are an increasingly recognized safety and quality concern in this population. Health information technology, including computerized physician/provider order entry (CPOE) with clinical decision support (CDS), has been proposed as an important systems-based approach for reducing medication errors and preventable drug-related injuries. This article describes the costs and benefits of CPOE with CDS for the various stakeholders involved in long-term care (LTC), including nurses, physicians, the pharmacy, the laboratory, the payer (e.g., the insurer), nursing home residents, and the LTC facility. Critical barriers to adoption of these systems are discussed, primarily from an economic perspective. The analysis suggests that multiple stakeholders will incur the costs related to implementation of CPOE with CDS in the LTC setting, but the costs incurred by each may not be aligned with the benefits, which may present a major barrier to broad adoption. Physicians and LTC facilities are likely to bear a large burden of the costs, whereas residents and payers will enjoy a large portion of the benefits. Consideration of these costs and benefits suggests that financial incentives to physicians and facilities may be necessary to encourage and accelerate widespread use of these systems in the LTC setting.

  6. 5 CFR 894.402 - Do the premiums I pay reflect the cost of providing benefits?

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Do the premiums I pay reflect the cost of providing benefits? 894.402 Section 894.402 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES DENTAL AND VISION INSURANCE PROGRAM...

  7. Influence of transportation cost on long-term retention in clinic for HIV patients in rural Haiti.

    PubMed

    Sowah, Leonard A; Turenne, Franck V; Buchwald, Ulrike K; Delva, Guesly; Mesidor, Romaine N; Dessaigne, Camille G; Previl, Harold; Patel, Devang; Edozien, Anthony; Redfield, Robert R; Amoroso, Anthony

    2014-12-01

    With improved access to antiretroviral therapy in resource-constrained settings, long-term retention in HIV clinics has become an important means of reducing costs and improving outcomes. Published data on retention in HIV clinics beyond 24 months are, however, limited. In our clinic in rural Haiti, we hypothesized that individuals residing in locations with higher transportation costs to clinic would have poorer retention than those who had lower costs. We used a retrospective cohort design to evaluate potential predictors of HIV clinic retention. Patient information was abstracted from the electronic medical records. Cox proportional hazards regression was used to identify independent predictors of 4-year clinic retention. There were 410 patients in our cohort, 266 (64.9%) females and 144 (35.1%) males. Forty-five (11%) patients lived in locations with transportation costs >$2. Males were 1.5 times more likely to live in municipalities with transportation costs to clinic of >$2. Multivariate analysis suggested that age <30 years, male gender, and transportation cost were independent predictors of loss to follow-up (LTFU): risk ratio of 2.98, 95% confidence interval (CI): 1.73 to 4.96, P < 0.001; 1.71, CI: 1.08 to 2.70, P = 0.02; and 1.91, CI: 1.08 to 3.36, P = 0.02, respectively. Patients with transportation costs greater than $2 were 1.9 times more likely to be lost to care compared with those who paid less for transportation. HIV treatment programs in resource-constrained settings may need to pay closer attention to issues related to transportation cost to improve patient retention.

  8. Medical Care Costs Associated With Long-term Weight Maintenance Versus Weight Gain Among Patients With Type 2 Diabetes.

    PubMed

    Nichols, Gregory A; Bell, Kelly; Kimes, Teresa M; O'Keeffe-Rosetti, Maureen

    2016-11-01

    Weight loss is recommended for overweight patients with diabetes but avoidance of weight gain may be a more realistic goal. We calculated the 4-year economic impact of maintaining body weight versus gaining weight. Among 8,154 patients with type 2 diabetes, we calculated weight change as the difference between the first body weight measure in 2010 and the last measure in 2013 and calculated mean glycated hemoglobin (A1C) from all measurements from 2010 to 2013. We created four analysis groups: weight change <5% and A1C <7%; weight gain ≥5% and A1C <7%; weight change <5% and A1C ≥7%; and weight gain ≥5% and A1C ≥7%. We compared change in medical costs between 2010 and 2013, adjusted for demographic and clinical characteristics. Patients who maintained weight within 5% of baseline experienced a reduction in costs of about $400 regardless of A1C. In contrast, patients who gained ≥5% of baseline weight and had mean A1C ≥7% had an increase in costs of $1,473 (P < 0.001). Those who gained >5% of their baseline weight with mean A1C <7% had a modest increase in costs ($387, NS). Patients who gained at least 5% of their baseline body weight and did not maintain A1C <7% over 4 years experienced a 14% increase in medical costs, whereas those who maintained good glycemic control had a mean cost increase of 3.3%. However, patients who maintained weight within 5% of baseline had costs that were ∼5% lower than baseline. Avoidance of weight gain may reduce costs in the long-term. © 2016 by the American Diabetes Association.

  9. Long-term implications of sustained wind power growth in the United States: Direct electric system impacts and costs

    SciTech Connect

    Lantz, Eric; Mai, Trieu; Wiser, Ryan H.; Krishnan, Venkat

    2016-10-01

    This paper evaluates potential changes in the power system associated with sustained growth in wind generation in the United States to 35% of end-use demand by 2050; Wiser et al. (2016) evaluate societal benefits and other impacts for this same scenario. Under reference or central conditions, the analysis finds cumulative wind capacity of 404 gigawatts (GW) would be required to reach this level and drive 2050 incremental electricity rate and cumulative electric sector savings of 2% and 3% respectively, relative to a scenario with no new wind capacity additions. Greater savings are estimated under higher fossil fuel costs or with greater advancements in wind technologies. Conversely, incremental costs are found when fossil fuel costs are lower than central assumptions or wind technology improvements are more-limited. Through 2030, the primary generation sources displaced by new wind capacity include natural gas and coal-fired generation. By 2050, wind could displace other renewables. Incremental new transmission infrastructure totaling 29 million megawatt-miles is estimated to be needed by 2050. In conjunction with related societal benefits, this work demonstrates that 35% wind energy by 2050 is plausible, could support enduring benefits, and could result in long-term consumer savings, if nearer-term (pre-2030) cost barriers are overcome; at the same time, these opportunities are not anticipated to be realized in their full form under 'business-as-usual' conditions.

  10. Covering bariatric surgery has minimal effect on insurance premium costs within the Affordable Care Act.

    PubMed

    English, Wayne; Williams, Brandon; Scott, John; Morton, John

    2016-06-01

    Currently, of the 51 state health exchanges operating under the Affordable Care Act, only 23 include benchmark plans that cover bariatric surgery coverage. Bariatric surgery coverage is not considered an essential health benefit in 28 state exchanges, and this lack of coverage has a discriminatory and detrimental impact on millions of Americans participating in state exchanges that do not provide bariatric surgery coverage. We examined 3 state exchanges in which a portion of their plans provided coverage for bariatric surgery to determine if bariatric surgery coverage is correlated with premium costs. State health exchanges; United States. Data from the 2015 state exchange plans were analyzed using information from the Centers for Medicare & Medicaid Services' Individual Market Landscape file and Benefits and Cost Sharing public use files. Only 3 states (Oklahoma, Oregon, and Virginia) in the analysis have 1 or more rating regions in which a portion of the plans cover bariatric surgery. In Oklahoma and Oregon, the average monthly premiums for all bronze, silver, and gold coverage levels are higher for plans covering bariatric surgery. Only 1 of these states included platinum plans that cover bariatric surgery. The average difference in premiums was between $1 to $45 higher in Oklahoma, and $18 to $32 higher in Oregon. Conversely, in Virginia, the average monthly premiums are between $2 and $21 lower for each level for plans covering bariatric surgery. Monthly premiums for plans covering versus not covering bariatric surgery ranged from 6% lower to 15% higher in the same geographic rating region. Across all 3 states in the sample, the average monthly premiums do not differ consistently on the basis of whether the state exchange plans cover bariatric surgery. Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  11. The long-term impact of employment on mental health service use and costs for persons with severe mental illness.

    PubMed

    Bush, Philip W; Drake, Robert E; Xie, Haiyi; McHugo, Gregory J; Haslett, William R

    2009-08-01

    Stable employment promotes recovery for persons with severe mental illness by enhancing income and quality of life, but its impact on mental health costs has been unclear. This study examined service cost over ten years among participants in a co-occurring disorders study. Latent-class growth analysis of competitive employment identified trajectory groups. The authors calculated annual costs of outpatient services and institutional stays for 187 participants and examined group differences in ten-year utilization and cost. A steady-work group (N=51) included individuals whose work hours increased rapidly and then stabilized to average 5,060 hours per person over ten years. A late-work group (N=57) and a no-work group (N=79) did not differ significantly in utilization or cost outcomes, so they were combined into a minimum-work group (N=136). More education, a bipolar disorder diagnosis (versus schizophrenia or schizoaffective disorder), work in the past year, and lower scores on the expanded Brief Psychiatric Rating Scale predicted membership in the steady-work group. These variables were controlled for in the outcomes analysis. Use of outpatient services for the steady-work group declined at a significantly greater rate than it did for the minimum-work group, while institutional (hospital, jail, or prison) stays declined for both groups without a significant difference. The average cost per participant for outpatient services and institutional stays for the minimum-work group exceeded that of the steady-work group by $166,350 over ten years. Highly significant reductions in service use were associated with steady employment. Given supported employment's well-established contributions to recovery, evidence of long-term reductions in the cost of mental health services should lead policy makers and insurers to promote wider implementation.

  12. [Prophylactic long-term therapy of affective disorders with lithium, valproic acid and carbamazepine--effectiveness and cost-effectiveness].

    PubMed

    Roick, C; Ahrens, B; Becker, T

    2001-07-01

    Affective disorders have a substantial public health impact due to morbidity, mortality, quality of life impairment and economic implications. There has been renewed debate of the efficacy and effectiveness of Lithium in long-term treatment of affective disorders. In the present paper current literature is discussed with a focus on the routine use of Lithium (effectiveness) and on cost aspects. Recent reviews have confirmed the prophylactic efficacy of Lithium in bipolar affective disorders. However, there is some evidence that effectiveness studies do not hold what efficacy research would promise. Non-compliance is likely to be a major reason for this. Lithium response rates have declined in recent studies. This may be related to diagnostic change (broader concept of affective disorders) and more widespread Lithium use. Non-compliance in patients taking Lithium is a primary factor in relapse with substantial cost effects (due to inpatient care). Current studies compare Lithium with Valproic acid/divalproex, and find cost advantages for the latter possibly due to better compliance. A special suicide-preventive effect has only been proven for Lithium. To ensure the full prophylactic potential of Lithium compliance needs to be improved. Future studies will compare Lithium with Valproic acid/divalproex, Carbamazepine and new treatment strategies more detailed.

  13. Long-term clinical impact and cost-effectiveness of obeticholic acid for the treatment of primary biliary cholangitis.

    PubMed

    Samur, Sumeyye; Klebanoff, Matthew; Banken, Reiner; Pratt, Daniel S; Chapman, Rick; Ollendorf, Daniel A; Loos, Anne M; Corey, Kathleen; Hur, Chin; Chhatwal, Jagpreet

    2017-03-01

    Primary biliary cholangitis (PBC) is a chronic, progressive autoimmune liver disease that mainly affects middle-aged women. Obeticholic acid (OCA), which was recently approved by the Food and Drug Administration for PBC treatment, has demonstrated positive effects on biochemical markers of liver function. Our objective was to evaluate the long-term clinical impact and cost-effectiveness of OCA as a second-line treatment for PBC in combination with ursodeoxycholic acid (UDCA) in adults with an inadequate response to UDCA. We developed a mathematical model to simulate the lifetime course of PBC patients treated with OCA+UDCA versus UDCA alone. Efficacy data were derived from the phase 3 PBC OCA International Study of Efficacy trial, and the natural history of PBC was informed by published clinical studies. Model outcomes were validated using the PBC Global Study. We found that in comparison with UDCA, OCA+UDCA could decrease the 15-year cumulative incidences of decompensated cirrhosis from 12.2% to 4.5%, hepatocellular carcinoma from 9.1% to 4.0%, liver transplants from 4.5% to 1.2%, and liver-related deaths from 16.2% to 5.7% and increase 15-year transplant-free survival from 61.1% to 72.9%. The lifetime cost of PBC treatment would increase from $63,000 to $902,000 (1,330% increment). The discounted quality-adjusted life years with UDCA and OCA+UDCA were 10.74 and 11.78, respectively, and the corresponding costs were $142,300 and $633,900, resulting in an incremental cost-effectiveness ratio of $473,400/quality-adjusted life year gained. The results were most sensitive to the cost of OCA.

  14. Long-term mental health resource utilization and cost of care following group psychoeducation or unstructured group support for bipolar disorders: a cost-benefit analysis.

    PubMed

    Scott, Jan; Colom, Francesc; Popova, Ekaterina; Benabarre, Antonio; Cruz, Nuria; Valenti, Marc; Goikolea, José M; Sánchez-Moreno, Jose; Asenjo, Miguel A; Vieta, Eduard

    2009-03-01

    To explore the short- and long-term mental health resource utilization and cost of care in a sample of 120 individuals with bipolar disorders who participated in a randomized controlled efficacy trial of group psychoeducation versus unstructured group support. Prospective, independent monitoring of DSM-IV bipolar disorder type I or II patients aged 18 to 65 years was conducted during the intervention phase (6 months) and follow-up phase (5-year postintervention) of a randomized controlled trial reporting clinical outcomes and inpatient and outpatient mental health service utilization, with estimation of cost of treatment per patient. The study was conducted from October 1997 through October 2006. Compared with individuals with bipolar disorder receiving the control intervention, psychoeducated patients had twice as many planned outpatient appointments, but the estimated mean cost of emergency consultation utilization was significantly less. There were trends for psychoeducated patients to opt for self-funded psychotherapy after completing group psychoeducation and to utilize more medications. However, inpatient care accounted for 40% estimated total cost in the control group but only about 15% in the psychoeducation group. This study demonstrates the importance of taking a long-term overview of the cost versus benefits of adjunctive psychological therapy in bipolar disorders. If viewed only in the short-term, the psychoeducation group used more mental health care resources without clear additional health gain. However, extended follow-up demonstrated a long-term advantage for psychoeducated individuals, such that, compared to an unstructured support group intervention, group psychoeducation is less costly and more effective. ©Copyright 2009 Physicians Postgraduate Press, Inc.

  15. Development of More Cost-Effective Methods for Long-Term Monitoring of Soil Vapor Intrusion to Indoor Air Using Quantitative Passive Diffusive-Adsorptive Sampling Techniques

    DTIC Science & Technology

    2015-05-01

    ER-200830) Development of More Cost-Effective Methods for Long-Term Monitoring of Soil Vapor Intrusion to Indoor Air Using...Methods for Long-Term Monitoring of Soil Vapor Intrusion to Indoor Air Using Quantitative Passive Diffusive-Adsorptive Sampling Techniques W912HQ-08-C...volatile organic compounds (VOCs) at sites with potential human health risks. These risks were attributable to subsurface vapor intrusion to indoor air by

  16. 41 CFR 301-11.15 - What expenses may be considered part of the daily lodging cost when I rent on a long-term basis?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 41 Public Contracts and Property Management 4 2012-07-01 2012-07-01 false What expenses may be considered part of the daily lodging cost when I rent on a long-term basis? 301-11.15 Section 301-11.15...., stove, refrigerator, chairs, tables, bed, sofa, television, or vacuum cleaner); (b) Cost of...

  17. Evaluating the long-term performance of low-cost adsorbents using small-scale adsorption column experiments.

    PubMed

    Callery, O; Healy, M G; Rognard, F; Barthelemy, L; Brennan, R B

    2016-09-15

    This study investigated a novel method of predicting the long-term phosphorus removal performance of large-scale adsorption filters, using data derived from short-term, small-scale column experiments. The filter media investigated were low-cost adsorbents such as aluminum sulfate drinking water treatment residual, ferric sulfate drinking water treatment residual, and fine and coarse crushed concretes. Small-bore adsorption columns were loaded with synthetic wastewater, and treated column effluent volume was plotted against the mass of phosphorus adsorbed per unit mass of filter media. It was observed that the curve described by the data strongly resembled that of a standard adsorption isotherm created from batch adsorption data. Consequently, it was hypothesized that an equation following the form of the Freundlich isotherm would describe the relationship between filter loading and media saturation. Moreover, the relationship between filter loading and effluent concentration could also be derived from this equation. The proposed model was demonstrated to accurately predict the performance of large-scale adsorption filters over a period of up to three months with a very high degree of accuracy. Furthermore, the coefficients necessary to produce said model could be determined from just 24 h of small-scale experimental data. Copyright © 2016. Published by Elsevier Ltd.

  18. Medicaid program; premiums and cost sharing. Final rule with comment period.

    PubMed

    2010-05-28

    This final rule revises the November 25, 2008 final rule entitled, "Medicaid Programs; Premiums and Cost Sharing (73 FR 71828)," to address public comments received during reopened comment periods, and to reflect relevant statutory changes made in section 5006(a) of the American Recovery and Reinvestment Act of 2009 (the Recovery Act). This revised final rule implements and interprets section 1916A of the Social Security Act (the Act), which was added by sections 6041, 6042, and 6043 of the Deficit Reduction Act of 2005 (DRA), amended by section 405(a)(1) of the Tax Relief and Health Care Act of 2006 (TRHCA) and further amended by section 5006(a) of the American Recovery and Reinvestment Act of 2009 (the Recovery Act). These provisions increase State flexibility to impose premiums and cost sharing for coverage of certain individuals whose family income exceeds specified levels. This revised rule also provides a further opportunity for public comment on revisions made to implement and interpret section 5006(a) of the Recovery Act. The Recovery Act prohibits States from charging premiums and cost sharing under Medicaid to Indians furnished items or services directly by the Indian Health Service, Indian Tribes, Tribal Organizations, or Urban Indian Organizations or through referral under contract health services.

  19. Medical students on long-term regional and rural placements: what is the financial cost to supervisors?

    PubMed

    Hudson, Judith N; Weston, Kathryn M; Farmer, Elizabeth A

    2012-01-01

    Medical student education is perceived as utilising significant amounts of preceptors' time, negatively impacting on clinical productivity. Most studies have examined short-term student rotations in urban settings, limiting their generalisability to other settings and educational models. To test Worley and Kitto's hypothetical model which proposed a 'turning point' when students become financially beneficial, this study triangulated practice financial data with the perspectives of clinical supervisors before and after regional/rural longitudinal integrated community-based placements. Gross practice financial data were compared before and during the year-long placement. Interview data pre- and post-placement were analysed by two researchers who concurred on emergent themes and categories. This study suggested a financial 'turning point' of 1-2 months when the student became beneficial to the practice. Most preceptors (66%) perceived the longitudinal placement as financially neutral or favourable. Nineteen per cent of supervisors reported a negative financial impact, some attributing this to reduced patient throughput, inadequacy of the government teaching subsidy and/or time spent on assessment preparation. Other supervisors were unconcerned about costs, perceiving that minor financial loss was outweighed by personal satisfaction. CONCLUISONS: Senior students learning in long-term clerkships are legitimate members of regional/rural communities of practice. These students can be cost-neutral or have a small positive financial impact on the practice within a few months. Further financial impact research should include consideration of different models of supervisor teaching subsidies. The ultimate financial benefit of a model may lie in the recruitment and retention of much-needed regional and rural practitioners.

  20. State trends in premiums and deductibles, 2003-2011: eroding protection and rising costs underscore need for action.

    PubMed

    Schoen, Cathy; Lippa, Jacob; Collins, Sara; Radley, David

    2012-12-01

    Rapidly rising health insurance premiums and higher cost-sharing continue to strain the budgets of U.S. working families and employers. Analysis of state trends in private employer-based health insurance from 2003 to 2011 reveals that premiums for family coverage increased 62 percent across states--rising far faster than income for middle- and low-income families. At the same time, deductibles more than doubled in large and small firms. Workers are thus paying more but getting less-protective benefits. If trends continue at their historical rate, the average premium for family coverage will reach nearly $25,000 by 2020. The Affordable Care Act's reforms should begin to moderate costs while improving coverage. But with private insurance costs projected to increase faster than incomes over the next decade, further efforts are needed. If annual premium growth slowed by one percentage point, by 2020 employers and families would save $2,029 annually for family coverage.

  1. Analysis of costs to dispense prescriptions in independently owned, closed-door long-term care pharmacies.

    PubMed

    Carroll, Norman V; Rupp, Michael T; Holdford, David A

    2014-03-01

    The need for accurate calculation of long-term care (LTC) pharmacies' costs to dispense (CTD) has become more important as payers have moved toward reimbursement models based on pharmacies' actual acquisition cost for drug products and the Centers for Medicare Medicaid Services (CMS) has implemented requirements that LTC pharmacies must dispense prescriptions for certain branded drugs in 14-day-or-less quantities. To (a) calculate the average cost that the typical independently owned, closed-door LTC pharmacy currently incurs to dispense and deliver a prescription to the resident of a client LTC facility and (b) estimate how CMS-mandated changes to a 14-day-or-less dispensing cycle would affect the typical LTC pharmacy's average CTD. The data requirements and measurement model were developed by academic researchers in consultation with an industry advisory committee of independent LTC pharmacy owners. A survey instrument was constructed to collect financial and operating data required to calculate the CTD. Surveys were distributed via 3 dissemination channels to approximately 1,000 independently owned, closed-door LTC pharmacies. The National Community Pharmacists Association mailed surveys to their LTC members; 3 major national wholesalers distributed surveys to their LTC customers through their newsletters; and 3 LTC group purchasing organizations distributed the surveys to their members through emails, newsletters, mailings, and/or regional meetings. Each pharmacy's CTD was calculated by dividing total LTC dispensing-related 
costs by the total number of prescriptions dispensed. Dispensing-related costs included costs incurred to physically dispense and deliver prescriptions (e.g., dispensing pharmacists' and technicians' salaries and costs of medication containers) and costs incurred to support the dispensing function (e.g., salaries of delivery and medical records personnel). A model based on dispensing-related fixed, variable, and semivariable costs was

  2. Cost-Effectiveness of a Long-Term Internet-Delivered Worksite Health Promotion Programme on Physical Activity and Nutrition: A Cluster Randomized Controlled Trial

    ERIC Educational Resources Information Center

    Robroek, Suzan J. W.; Polinder, Suzanne; Bredt, Folef J.; Burdorf, Alex

    2012-01-01

    This study aims to evaluate the cost-effectiveness of a long-term workplace health promotion programme on physical activity (PA) and nutrition. In total, 924 participants enrolled in a 2-year cluster randomized controlled trial, with departments (n = 74) within companies (n = 6) as the unit of randomization. The intervention was compared with a…

  3. Cost-Effectiveness of a Long-Term Internet-Delivered Worksite Health Promotion Programme on Physical Activity and Nutrition: A Cluster Randomized Controlled Trial

    ERIC Educational Resources Information Center

    Robroek, Suzan J. W.; Polinder, Suzanne; Bredt, Folef J.; Burdorf, Alex

    2012-01-01

    This study aims to evaluate the cost-effectiveness of a long-term workplace health promotion programme on physical activity (PA) and nutrition. In total, 924 participants enrolled in a 2-year cluster randomized controlled trial, with departments (n = 74) within companies (n = 6) as the unit of randomization. The intervention was compared with a…

  4. Long term costs and effects of reducing the number of twin pregnancies in IVF by single embryo transfer: the TwinSing study

    PubMed Central

    2010-01-01

    Background Pregnancies induced by in vitro fertilisation (IVF) often result in twin gestations, which are associated with both maternal and perinatal complications. An effective way to reduce the number of IVF twin pregnancies is to decrease the number of embryos transferred from two to one. The interpretation of current studies is limited because they used live birth as outcome measure and because they applied limited time horizons. So far, research on long-term outcomes of IVF twins and singletons is scarce and inconclusive. The objective of this study is to investigate the short (1-year) and long-term (5 and 18-year) costs and health outcomes of IVF singleton and twin children and to consider these in estimating the cost-effectiveness of single embryo transfer compared with double embryo transfer, from a societal and a healthcare perspective. Methods/Design A multi-centre cohort study will be performed, in which IVF singletons and IVF twin children born between 2003 and 2005 of whom parents received IVF treatment in one of the five participating Dutch IVF centres, will be compared. Data collection will focus on children at risk of health problems and children in whom health problems actually occurred. First year of life data will be collected in approximately 1,278 children (619 singletons and 659 twin children). Data up to the fifth year of life will be collected in approximately 488 children (200 singletons and 288 twin children). Outcome measures are health status, health-related quality of life and costs. Data will be obtained from hospital information systems, a parent questionnaire and existing registries. Furthermore, a prognostic model will be developed that reflects the short and long-term costs and health outcomes of IVF singleton and twin children. This model will be linked to a Markov model of the short-term cost-effectiveness of single embryo transfer strategies versus double embryo transfer strategies to enable the calculation of the long-term cost

  5. Long term costs and effects of reducing the number of twin pregnancies in IVF by single embryo transfer: the TwinSing study.

    PubMed

    van Heesch, Mirjam M J; Bonsel, Gouke J; Dumoulin, John C M; Evers, Johannes L H; van der Hoeven, Mark Ahbm; Severens, Johan L; Dykgraaf, Ramon H M; van der Veen, Fulco; Tonch, Nino; Nelen, Willianne L D M; van Zonneveld, Piet; van Goudoever, Johannes B; Tamminga, Pieter; Steiner, Katerina; Koopman-Esseboom, Corine; van Beijsterveldt, Catharina E M; Boomsma, Dorret I; Snellen, Diana; Dirksen, Carmen D

    2010-10-20

    Pregnancies induced by in vitro fertilisation (IVF) often result in twin gestations, which are associated with both maternal and perinatal complications. An effective way to reduce the number of IVF twin pregnancies is to decrease the number of embryos transferred from two to one. The interpretation of current studies is limited because they used live birth as outcome measure and because they applied limited time horizons. So far, research on long-term outcomes of IVF twins and singletons is scarce and inconclusive. The objective of this study is to investigate the short (1-year) and long-term (5 and 18-year) costs and health outcomes of IVF singleton and twin children and to consider these in estimating the cost-effectiveness of single embryo transfer compared with double embryo transfer, from a societal and a healthcare perspective. A multi-centre cohort study will be performed, in which IVF singletons and IVF twin children born between 2003 and 2005 of whom parents received IVF treatment in one of the five participating Dutch IVF centres, will be compared. Data collection will focus on children at risk of health problems and children in whom health problems actually occurred. First year of life data will be collected in approximately 1,278 children (619 singletons and 659 twin children). Data up to the fifth year of life will be collected in approximately 488 children (200 singletons and 288 twin children). Outcome measures are health status, health-related quality of life and costs. Data will be obtained from hospital information systems, a parent questionnaire and existing registries. Furthermore, a prognostic model will be developed that reflects the short and long-term costs and health outcomes of IVF singleton and twin children. This model will be linked to a Markov model of the short-term cost-effectiveness of single embryo transfer strategies versus double embryo transfer strategies to enable the calculation of the long-term cost-effectiveness. This is

  6. Compensation benefits in a population-based cohort of men and women on long-term disability after musculoskeletal injuries: costs, course, predictors.

    PubMed

    Lederer, Valérie; Rivard, Michèle

    2014-11-01

    The aim of this study is to assess costs, duration and predictors of prolonged compensation benefits by gender in a population characterised by long-term compensation benefits for traumatic or non-traumatic musculoskeletal injuries (MSIs). This study examined 3 years of data from a register-based provincial cohort including all new allowed long-term claims (≥3 months of wage replacement benefits) related to neck/shoulder/back/trunk/upper-limb MSIs in Quebec, Canada, from 2001 to 2003 (13,073 men and 9032 women). Main outcomes were compensation duration and costs. Analyses were carried out separately for men and women to investigate gender differences. An extended Cox model with Heaviside functions of time was used to account for covariates with time-varying effects. Male workers experienced a longer compensation benefit duration and higher median costs. At the end of follow-up, 3 years postinjury, 12.3% of men and 7.3% of women were still receiving compensation benefits. Effects of certain predictors (e.g., income, injury site or industry) differed markedly between men and women. Age and claim history had time-varying effects in the men's and women's models, respectively. Knowing costs, duration and predictors of long-term compensation claims by gender can help employers, decision makers and rehabilitation specialists to identify at-risk workers and industries to engage them in early intervention and prevention programmes. Tailoring parts of long-term disability prevention and management efforts to men's and women's specific needs, barriers and vulnerable subgroups, could reduce time on benefits among both male and female long-term claimants. 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.

  7. Raising premiums and other costs for Oregon health plan enrollees drove many to drop out.

    PubMed

    Wright, Bill J; Carlson, Matthew J; Allen, Heidi; Holmgren, Alyssa L; Rustvold, D Leif

    2010-12-01

    The Oregon Health Plan was created to be a sustainable program that could weather budgetary storms without having to cut enrollees from Medicaid. A 2003 redesign of the program increased premiums, raised cost sharing, and imposed rigid premium payment deadlines for members in the "Standard" version of the program but not for members of the "Plus" version. This paper adds two years of longitudinal data to a previous study on the impacts of these changes. It shows that the redesign was a key factor driving a 77 percent disenrollment rate in the Standard program, from a high of 104,000 enrollees in February 2003 to just 24,000 by the end of the study period, November 2005. Those who were in the Standard plan when the reduced benefits and higher member costs went into effect were also nearly twice as likely to have unmet health care needs compared to those in the Plus plan. These changes underscore that in a period of economic downturn, policy makers must understand the impact of increased cost sharing on vulnerable populations.

  8. Improving quality of care in people with Type 2 diabetes through the Associazione Medici Diabetologi-annals initiative: a long-term cost-effectiveness analysis.

    PubMed

    Giorda, C B; Nicolucci, A; Pellegrini, F; Kristiansen, C K; Hunt, B; Valentine, W J; Vespasiani, G

    2014-05-01

    The Associazione Medici Diabetologi-annals initiative is a physician-led quality-of-care improvement scheme that has been shown to improve HbA1c concentration, blood pressure, lipid profiles and BMI in enrolled people with Type 2 diabetes. The present analysis investigated the long-term cost-effectiveness of enrolling people with Type 2 diabetes in the Associazione Medici Diabetologi-annals initiative compared with conventional management. Long-term projections of clinical outcomes and direct costs (in 2010 Euros) were made using a published and validated model of Type 2 diabetes in people with Type 2 diabetes who were either enrolled in the Associazione Medici Diabetologi-annals initiative or who were receiving conventional management. Treatment effects were based on mean changes from baseline seen at 5 years after enrolment in the scheme. Costs and clinical outcomes were discounted at 3% per annum. The Associazione Medici Diabetologi-annals initiative was associated with improvements in mean discounted life expectancy and quality-adjusted life expectancy of 0.55 years (95% CI 0.54-0.57) years and 0.48 quality-adjusted life years (95% CI 0.46-0.49), respectively, compared with conventional management. Whilst treatment costs were higher in the Associazione Medici Diabetologi-annals arm, this was offset by savings as a result of the reduced incidence and treatment of diabetes-related complications. The Associazione Medici Diabetologi-annals initiative was found to be cost-saving over patient lifetimes compared with conventional management [€ 37,289 (95% CI 37,205-37,372) vs € 41,075 (95% CI 40,956-41,155)]. Long-term projections indicate that the physician-led Associazione Medici Diabetologi-annals initiative represents a cost-saving method of improving long-term clinical outcomes compared with conventional management of people with Type 2 diabetes in Italy. © 2013 The Authors. Diabetic Medicine © 2013 Diabetes UK.

  9. Excess costs of dementia disorders and the role of age and gender - an analysis of German health and long-term care insurance claims data.

    PubMed

    Schwarzkopf, Larissa; Menn, Petra; Leidl, Reiner; Wunder, Sonja; Mehlig, Hilmar; Marx, Peter; Graessel, Elmar; Holle, Rolf

    2012-06-19

    Demographic ageing is associated with an increasing number of dementia patients, who reportedly incur higher costs of care than individuals without dementia. Regarding Germany, evidence on these excess costs is scarce. Adopting a payer perspective, our study aimed to quantify the additional yearly expenditures per dementia patient for various health and long-term care services. Additionally, we sought to identify gender-specific cost patterns and to describe age-dependent cost profiles. The analyses used 2006 claims data from the AOK Bavaria Statutory Health Insurance fund of 9,147 dementia patients and 29,741 age- and gender-matched control subjects. Cost predictions based on two-part regression models adjusted for age and gender and excess costs of dementia care refer to the difference in model-estimated means between both groups. Corresponding analyses were performed stratified for gender. Finally, a potentially non-linear association between age and costs was investigated within a generalized additive model. Yearly spending within the social security system was circa €12,300 per dementia patient and circa €4,000 per non-demented control subject. About two-thirds of the additional expenditure for dementia patients occurred in the long-term care sector. Within our study sample, male and female dementia patients incurred comparable total costs. However, women accounted for significantly lower health and significantly higher long-term care expenditures. Long-term care spending increased in older age, whereupon health care spending decreased. Thus, at more advanced ages, women incurred greater costs than men of the same age. Dementia poses a substantial additional burden to the German social security system, with the long-term care sector being more seriously challenged than the health care sector. Our results suggest that female dementia patients need to be seen as a key target group for health services research in an ageing society. It seems clear that

  10. Excess costs of dementia disorders and the role of age and gender - an analysis of German health and long-term care insurance claims data

    PubMed Central

    2012-01-01

    Background Demographic ageing is associated with an increasing number of dementia patients, who reportedly incur higher costs of care than individuals without dementia. Regarding Germany, evidence on these excess costs is scarce. Adopting a payer perspective, our study aimed to quantify the additional yearly expenditures per dementia patient for various health and long-term care services. Additionally, we sought to identify gender-specific cost patterns and to describe age-dependent cost profiles. Methods The analyses used 2006 claims data from the AOK Bavaria Statutory Health Insurance fund of 9,147 dementia patients and 29,741 age- and gender-matched control subjects. Cost predictions based on two-part regression models adjusted for age and gender and excess costs of dementia care refer to the difference in model-estimated means between both groups. Corresponding analyses were performed stratified for gender. Finally, a potentially non-linear association between age and costs was investigated within a generalized additive model. Results Yearly spending within the social security system was circa €12,300 per dementia patient and circa €4,000 per non-demented control subject. About two-thirds of the additional expenditure for dementia patients occurred in the long-term care sector. Within our study sample, male and female dementia patients incurred comparable total costs. However, women accounted for significantly lower health and significantly higher long-term care expenditures. Long-term care spending increased in older age, whereupon health care spending decreased. Thus, at more advanced ages, women incurred greater costs than men of the same age. Conclusions Dementia poses a substantial additional burden to the German social security system, with the long-term care sector being more seriously challenged than the health care sector. Our results suggest that female dementia patients need to be seen as a key target group for health services research in an

  11. Long-Term Care

    MedlinePlus

    ... this page please turn Javascript on. Long-Term Care What Is Long-Term Care? Long-term care involves a variety of services ... the Escape (Esc) button on your keyboard.) Most Care Provided at Home Long-term care is provided ...

  12. Cost-effectiveness of embryo transfer strategies: a decision analytic model using long-term costs and consequences of singletons and multiples born as a consequence of IVF.

    PubMed

    van Heesch, M M J; van Asselt, A D I; Evers, J L H; van der Hoeven, M A H B M; Dumoulin, J C M; van Beijsterveldt, C E M; Bonsel, G J; Dykgraaf, R H M; van Goudoever, J B; Koopman-Esseboom, C; Nelen, W L D M; Steiner, K; Tamminga, P; Tonch, N; Torrance, H L; Dirksen, C D

    2016-11-01

    What is the cost-effectiveness of elective single embryo transfer (eSET) versus double embryo transfer (DET) strategies from a societal perspective, when applying a time horizon of 1, 5 and 18 years? From a short-term perspective (1 year) it is cost-effective to replace DET with single embryo transfer; however when intermediate- (5 years) and long-term (18 years) costs and consequences are incorporated, DET becomes the most cost-effective strategy, given a ceiling ratio of €20 000 per quality-adjusted life years (QALY) gained. According to previous cost-effectiveness research into embryo transfer strategies, DET is considered cost-effective if society is willing to pay around €20 000 for an extra live birth. However, interpretation of those studies is complicated, as those studies fail to incorporate long-term costs and outcomes and used live birth as a measure of effectiveness instead of QALYs. With this outcome, both multiple and singletons were valued as one live birth, whereas costs of all children of a multiple were incorporated. A Markov model (cycle length: 1 year; time horizon: 1, 5 and 18 years) was developed comparing a maximum of: (i) three cycles of eSET in all patients; (ii) four cycles of eSET in all patients; (iii) five cycles of eSET in all patients; (iv) three cycles of standard treatment policy (STP), i.e. eSET in women <38 years with a good quality embryo, and DET in all other women; and (v) three cycles of DET in all patients. Expected life years (LYs), child QALYs and costs were estimated for all comparators. Input parameters were derived from a retrospective cohort study, in which hospital resource data were collected (n=580) and a parental questionnaire was sent out (431 respondents). Probabilistic sensitivity analysis (5000 iterations) was performed. With a time horizon of 18 years, DETx3 is most effective (0.54 live births, 10.2 LYs and 9.8 QALYs) and expensive (€37 871) per couple starting IVF. Three cycles of eSET are least

  13. Applying quality assurance in real time to compliant long-term periodontal maintenance patients utilizing cost-effectiveness and cost utility.

    PubMed

    Fardal, Øystein; Grytten, Jostein

    2014-06-01

    Little work has been done on quality assurance of long-term maintenance of periodontal therapy A quality assurance model was applied to 80 patients (50 females, 30 males) with an average age of 64.3 years (SD. 8.83, range 45-91) and with 21.6 (SD. 2.65, range 16-26) maintenance years. The main elements were patients' expectations, objectives and patient-based outcomes, human and financial costs and treatment deviations. For cost-effectiveness, this group was compared with a control group of 25 patients with an average of 9.96 years not complying with maintenance therapy. The patients' main expectations and reasons for seeking treatment were to save teeth and a desire for better oral health. The patients had a total tooth-year loss of 3.3%. 81.3% reported improved oral health. Total treatment discounted cost was €5842. The cost of buying an extra tooth year was €20.2. Patients reported anxiety of 4.6 (SD10.5, range 0-47) and discomfort of 11.8 (SD13.2 range 0-70) for the maintenance visits on the Visual Analogue Scale (VAS). Treatment deviations showed 3.8% extreme downhill patients, 6.3% with poor oral hygiene, 3.8% reported a worsening of their oral health, 3.8% had high anxiety whereas 5.0% experienced a high level of discomfort. It is possible to apply a number of elements of a quality assurance measure to a patient population of compliant maintenance patients in real time. The results obtained compare well with previous internal and external studies. This model should be useful to patients and practitioners as well as for larger population-based studies. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  14. A prospective study on the cost-effective utilization of long-term inpatient video-EEG monitoring in a developing country.

    PubMed

    Chemmanam, Thomas; Radhakrishnan, Ashalatha; Sarma, Sankara P; Radhakrishnan, Kurupath

    2009-04-01

    To investigate diagnostic value, therapeutic benefit and cost-effective utilization of video-EEG monitoring (VEM) in a comprehensive epilepsy program in a developing country. The authors prospectively recruited all patients who underwent long-term (> or =3 hours) inpatient VEM during a 10-month period. The cohort was followed to gather information about the proportion of patients in whom long-term management was altered by VEM and resultant impact on direct health care costs. Out of 143 study subjects (median age 22 years), 102 (71.3%) were referred for presurgical evaluation. The median duration of VEM was 61 hours, and median number of events recorded per patient was 3. Video-EEG monitoring helped to clarify the epilepsy syndromic diagnosis in 123 of 132 (93.2%) patients referred with the diagnosis of epileptic seizures. Video-EEG monitoring confirmed coexistent complex partial seizures in 4 of 11 (36.4%) patients with a referral diagnosis of psychogenic nonepileptic events. During mean follow-up period of 2.2 years, 48 patients (33.6%) underwent epilepsy surgery. A significant decrease in antiepileptic drug polytherapy, and minimization in recurring direct medical and nonmedical costs occurred. In addition to immediate diagnostic usefulness, VEM contributes significantly to long-term therapeutic and economic benefits for patients with difficult to diagnose and treat paroxysmal events.

  15. Using home equity to finance long-term care.

    PubMed

    Jacobs, B; Weissert, W

    1987-01-01

    A majority of elderly Americans have the bulk of their assets tied up in the houses they own. Reverse mortgages could tap this home equity, providing loan disbursements without requiring older homeowners to make monthly payments on principal and interest. In this paper we analyze the potential of using home equity to finance long-term care of the elderly, including payments for home care and for long-term care insurance. We first estimate each homeowner's risk of need for care (and risk of institutionalization) and then calculate the degree to which home equity could be used to cover the costs of home care (or of insurance premiums). Special emphasis is placed on those in the highest risk group and on those with the lowest incomes, who often turn out to be the same people.

  16. Long-term efficacy of an extracorporeal membrane oxygenation simulation with a novel, low-cost vascular model "Endo-Circuit".

    PubMed

    Endo, Tomoyuki; Kagaya, Yutaka; Arata, Yutaro; Imai, Hiroyuki

    2017-01-01

    This study investigated the long-term efficacy of a half-day extracorporeal membrane oxygenation simulation and low-cost vascular model for practitioner knowledge, skills, and attitudes in clinical settings and also assessed the usefulness of the vascular model. We included participants who attended a half-day extracorporeal membrane oxygenation simulation focused on the veno-arterial method between April 2013 and January 2016 at Tohoku University Simulation Center (Sendai, Japan). A survey questionnaire form was sent to each participant in March 2016. Ninety-six survey respondents engaged in real extracorporeal membrane oxygenation practice after the simulation were eligible for this study, and their answers were analyzed for differences between doctors and nurses. The survey asked questions regarding occupation, workplace, course date, years of experience, extracorporeal membrane oxygenation practice before simulation, problems and fears before the simulation, usefulness of reference materials, long-term efficacy of the simulation for practice, usefulness of the vascular model, and intensive care data review. Among all eligible answers, every average self-reported score (ranging from 0 to 10) of the long-term efficacy for extracorporeal membrane oxygenation practice was above 4. Nurses reported experiencing fears more frequently than doctors before the simulation. The usefulness of an original low-cost vascular model was evaluated at a median score of 7. A half-day extracorporeal membrane oxygenation simulation with an original low-cost vascular model had long-term positive efficacy for knowledge, skills, and attitudes of practitioners who engaged in real practice after the simulation, and the practitioners considered the model to be useful for them.

  17. Home non-invasive mechanical ventilation and long-term oxygen therapy in stable hypercapnic chronic obstructive pulmonary disease patients: comparison of costs.

    PubMed

    Clini, Enrico M; Magni, Giovanna; Crisafulli, Ernesto; Viaggi, Stefano; Ambrosino, Nicolino

    2009-01-01

    A cost analysis of nocturnal non-invasive ventilation (NNV) in stable chronic obstructive pulmonary disease (COPD) patients would be helpful in decision making, when the balance between the increased demand and the availability of resources should be checked. Based on data from the Italian trial in stable hypercapnic COPD patients, this study compares the cost of care associated with the use of NNV when added to the usual long-term oxygen therapy (LTOT) with the cost of care of LTOT regimen alone. Cost was calculated in 77 of 90 patients included into that trial. Analysis included drug therapy, hospitalisations due to acute exacerbation, oxygen and ventilator equipment. An estimation of charges was made according to the national sources of cost for drugs and hospital admissions and the actualised reimbursement for the home care provided to both oxygen and ventilator users. The cost/day comparison was made between the individual patients in the 2 groups (NNV + LTOT, n = 35; LTOT, n = 42). The mean cost of drugs and oxygen was similar in both groups, whereas the cost of hospitalisation tended to be lower in NNV + LTOT compared to LTOT alone (8.25 +/-10.29 vs. 12.50 +/- 20.28 EUR/patient/day, p < 0.05). Inclusion of the ventilator equipment increased the total cost to 23.73 EUR/day in the NNV + LTOT compared to 21.42 EUR/day in the LTOT group (not significant). The present report suggests that long-term management with addition of non-invasive ventilation does not increase costs compared with the usual LTOT regimen: the hospital-related costs were reduced when using the ventilator in these hypercapnic COPD patients. (c) 2008 S. Karger AG, Basel.

  18. Modeling Costs and Impacts of Introducing Early Infant Male Circumcision for Long-Term Sustainability of the Voluntary Medical Male Circumcision Program.

    PubMed

    Njeuhmeli, Emmanuel; Stegman, Peter; Kripke, Katharine; Mugurungi, Owen; Ncube, Gertrude; Xaba, Sinokuthemba; Hatzold, Karin; Christensen, Alice; Stover, John

    2016-01-01

    Voluntary medical male circumcision (VMMC) has been shown to be an effective prevention strategy against HIV infection in males [1-3]. Since 2007, the President's Emergency Plan for AIDS Relief (PEPFAR) has supported VMMC programs in 14 priority countries in Africa. Today several of these countries are preparing to transition their VMMC programs from a scale-up and expansion phase to a maintenance phase. As they do so, they must consider the best approaches to sustain high levels of male circumcision in the population. The two alternatives under consideration are circumcising adolescents 10-14 years old over the long term or integrating early infant male circumcision (EIMC) into maternal and child health programs. The paper presents an analysis, using the Decision Makers Program Planning Tool, Version 2.0 (DMPPT 2.0), of the estimated cost and impact of introducing EIMC into existing VMMC programs in several countries in eastern and southern Africa. Limited cost data exist for the implementation of EIMC, but preliminary studies, such as the one detailed in Mangenah, et al. [4-5], suggest that the cost of EIMC may be less than that of adolescent and adult male circumcision. If this is the case, then adding EIMC to the VMMC program will increase the number of circumcisions that need to be performed but will not increase the total cost of the program over the long term. In addition, we found that a delayed or slow start-up of EIMC would not substantially reduce the impact of adding it to the program or increase cumulative long-term costs, which should make introduction of EIMC more feasible and attractive to countries contemplating such a program innovation.

  19. Modeling Costs and Impacts of Introducing Early Infant Male Circumcision for Long-Term Sustainability of the Voluntary Medical Male Circumcision Program

    PubMed Central

    Stegman, Peter; Kripke, Katharine; Mugurungi, Owen; Ncube, Gertrude; Xaba, Sinokuthemba; Hatzold, Karin; Christensen, Alice; Stover, John

    2016-01-01

    Voluntary medical male circumcision (VMMC) has been shown to be an effective prevention strategy against HIV infection in males [1–3]. Since 2007, the President’s Emergency Plan for AIDS Relief (PEPFAR) has supported VMMC programs in 14 priority countries in Africa. Today several of these countries are preparing to transition their VMMC programs from a scale-up and expansion phase to a maintenance phase. As they do so, they must consider the best approaches to sustain high levels of male circumcision in the population. The two alternatives under consideration are circumcising adolescents 10–14 years old over the long term or integrating early infant male circumcision (EIMC) into maternal and child health programs. The paper presents an analysis, using the Decision Makers Program Planning Tool, Version 2.0 (DMPPT 2.0), of the estimated cost and impact of introducing EIMC into existing VMMC programs in several countries in eastern and southern Africa. Limited cost data exist for the implementation of EIMC, but preliminary studies, such as the one detailed in Mangenah, et al. [4–5], suggest that the cost of EIMC may be less than that of adolescent and adult male circumcision. If this is the case, then adding EIMC to the VMMC program will increase the number of circumcisions that need to be performed but will not increase the total cost of the program over the long term. In addition, we found that a delayed or slow start-up of EIMC would not substantially reduce the impact of adding it to the program or increase cumulative long-term costs, which should make introduction of EIMC more feasible and attractive to countries contemplating such a program innovation. PMID:27410233

  20. Long-term medical management of primary open-angle glaucoma and ocular hypertension in the UK: optimizing cost-effectiveness and clinic resources by minimizing therapy switches.

    PubMed

    Orme, Michelle; Collins, Sarah; Loftus, Jane

    2012-09-01

    The objective was to assess the long-term economic consequences of the medical management of glaucoma in the UK. The economic evaluation was conducted using the results from a 10-year Markov model based around 3 key triggers for a switch in medical therapy for glaucoma, namely: lack of tolerance (using hyperemia as a proxy); intraocular pressure (IOP) not meeting treatment benchmark; and glaucoma progression. Clinical data from a comprehensive systematic literature review and meta-analysis were used. Direct costs associated with glaucoma treatment are considered (at 2008/9 prices) from the perspective of the UK NHS as payer (outpatient/secondary care setting). Using this model, the economic consequences of 3 prostaglandin-based treatment sequences were compared. Drug acquisition costs account for around 8% to 13% of the total cost of glaucoma and, if ophthalmologist visits are included, amount to approximately £0.80 to £0.90 per day of medical therapy. The total long-term costs of all prostaglandin strategies are similar because of a shift in resources: increased drug costs are offset by fewer clinic visits to instigate treatment switches, and by avoiding surgery or costs associated with managing low vision. Under the latanoprost-based strategy, patients would have longer intervals between the need to switch therapies, which is largely due to a reduction in hyperemia, seen as a proxy for tolerance. This leads to a delay in glaucoma progression of 12 to 13 months. For every 1000 clinic appointments, 719 patients can be managed for 1 year with a latanoprost-based strategy compared with 586 or 568 with a bimatoprost or travoprost-based strategy. Drug acquisition costs are not a key driver of the total cost of glaucoma management and the cost of medical therapy is offset by avoiding the cost of managing low vision. Economic models of glaucoma should include the long-term consequences of treatment as these will affect cost-effectiveness. This analysis supports the

  1. Cost-Effectiveness of Cranberry Capsules to Prevent Urinary Tract Infection in Long-Term Care Facilities: Economic Evaluation with a Randomized Controlled Trial

    PubMed Central

    van den Hout, Wilbert B; Caljouw, Monique A A; Putter, Hein; Cools, Herman J M; Gussekloo, Jacobijn

    2014-01-01

    Objectives To investigate whether the preventive use of cranberry capsules in long-term care facility (LTCF) residents is cost-effective depending on urinary tract infection (UTI) risk. Design Economic evaluation with a randomized controlled trial. Setting Long-term care facilities. Participants LTCF residents (N = 928, 703 female, median age 84), stratified according to UTI risk. Measurements UTI incidence (clinically or strictly defined), survival, quality of life, quality-adjusted life years (QALYs), and costs. Results In the weeks after a clinical UTI, participants showed a significant but moderate deterioration in quality of life, survival, care dependency, and costs. In high-UTI-risk participants, cranberry costs were estimated at €439 per year (1.00 euro = 1.37 U.S. dollar), which is €3,800 per prevented clinically defined UTI (95% confidence interval = €1,300–infinity). Using the strict UTI definition, the use of cranberry increased costs without preventing UTIs. Taking cranberry capsules had a 22% probability of being cost-effective compared with placebo (at a willingness to pay of €40,000 per QALY). In low-UTI-risk participants, use of cranberry capsules was only 3% likely to be cost-effective. Conclusion In high-UTI-risk residents, taking cranberry capsules may be effective in preventing UTIs but is not likely to be cost-effective in the investigated dosage, frequency, and setting. In low-UTI-risk LTCF residents, taking cranberry capsules twice daily is neither effective nor cost-effective. PMID:25180379

  2. Impact of Physician-Coordinated Intensive Follow-Up on Long-Term Medical Costs in Patients with Unstable Angina Undergoing Percutaneous Coronary Intervention

    PubMed Central

    Jia, Jing-Jing; Dong, Ping-Shuan; Du, Lai-Jing; Li, Zhi-Guo; Lai, Li-Hong; Yang, Xu-Ming; Wang, Shao-Xin; Yang, Xi-Shan; Li, Zhi-Juan; Shang, Xi-Yan; Fan, Xi-Mei

    2017-01-01

    Background To investigate the impact of professional physician-coordinated intensive follow-up on long-term expenditures after percutaneous coronary intervention (PCI) in unstable angina (UA) patients. Methods In this study, there were 669 UA patients who underwent successful PCI and followed up for 3 years, then divided into the intensive follow-up group (N = 337), and the usual follow-up group (N = 332). Patients were provided with detailed discharge information and individualized follow-up schedules. The intensive group received the extra follow-up times and medical consultations, and all patients were followed up for approximately 3 years. Results At the 3-year mark after PCI, the cumulative major adverse cardiac events (MACE), recurrence of myocardial ischemia, cardiac death, all-cause death and revascularization in the intensive group were lower than in the usual group. Additionally, the proportion of good medication adherence was significantly higher than in the usual group (56.4% vs. 46.1%, p < 0.001). The hospitalization daytime, total hospitalization cost and total medical cost in the intensive group were lower. Multiple linear regression showed that diabetes, hypertension, intensive follow-up and good medication adherence were associated with emergency and regular clinical cost (p < 0.05), the re-hospitalization cost (p < 0.05) and the total medical cost (p < 0.05) of patient care. Intensive follow-up and good adherence were negatively correlated with the cost of re-hospitalization (standardized coefficients = -0.132, -0.128, p < 0.05) and total medical costs (standardized coefficients = -0.072, -0.086, p < 0.05). Conclusions Intensive follow-up can reduce MACE, improve medication adherence and save long-term total medical costs, just by increasing the emergency and regular clinical visits cost in UA patients after PCI. PMID:28344421

  3. Variations in county-level costs between traditional medicare and medicare advantage have implications for premium support.

    PubMed

    Biles, Brian; Casillas, Giselle; Guterman, Stuart

    2015-01-01

    Concern about the future growth of Medicare spending has led some in Congress and elsewhere to promote converting Medicare to a "premium support" system. Under premium support, Medicare would provide a "defined contribution" to each Medicare beneficiary to purchase either a Medicare Advantage (MA)-type private health plan or the traditional Medicare public plan. To better understand the implications of such a shift, we compared the average costs per beneficiary of providing Medicare benefits at the county level for traditional Medicare and four types of MA plans. We found that the relative costs of Medicare Advantage and traditional Medicare varied greatly by MA plan type and by geographic location. The costs of health maintenance organization-type plans averaged 7 percent less than those of traditional Medicare, but the costs of the more loosely structured preferred provider organization and private fee-for-service plans averaged 12-18 percent more than those of traditional Medicare. In some counties MA plan costs averaged 28 percent less than costs in traditional Medicare, while in other counties MA plan costs averaged 26 percent more than traditional Medicare costs. Enactment of a Medicare premium-support proposal could trigger cost increases for beneficiaries participating in Medicare Advantage as well as those in traditional Medicare.

  4. Estimating long-term clinical effectiveness and cost-effectiveness of HPV 16/18 vaccine in China.

    PubMed

    Zhang, Qian; Liu, Yi-Jun; Hu, Shang-Ying; Zhao, Fang-Hui

    2016-11-04

    Human papillomavirus (HPV) 16 and 18 are the two most common HPV oncogenic types that can be prevented by vaccination. This study aimed at assessing the cost-effectiveness of 3 doses of the bivalent HPV vaccine in rural and urban settings in China. A Markov model was adapted to reflect the lifetime of a modelled 100,000 12-year-old girls cohort in rural and urban settings in China. Input parameters were obtained from published literature, official reports and a two-round expert review panel. Clinical and economic outcomes of vaccination at age 12 with screening was compared to screening only. In the base case analysis, a 3 % discount rate, the vaccine cost of 247 CNY (US$ 39, PAHO vaccine cost in 2013), two rounds of screening in a life time and 70 % coverage for both screening and vaccination were used. One-way, two-way and probabilistic sensitivity analyses were performed. We used different thresholds of cost-effectiveness to reflect the diversity of economic development in China. Vaccination in addition to screening could prevent 60 % more cervical cancer cases and deaths than screening only. The incremental cost effectiveness ratio varied largely when changing cost of vaccination and discount in one way analysis. Vaccination was very cost-effective when the vaccine cost ranged 87-630 CNY (US$ 13.8-100) in rural and 87-750 CNY (US$ 13.8-119) in urban; and remained cost-effective when the vaccine cost ranged 630-1,700 CNY (US$ 100-270) in rural and 750-1,900 CNY (US$ 119-302) in urban in two way analysis. Probabilistic sensitivity analyses showed that model results were robust. In both rural and urban, the vaccination cost and discounting are important factors determining the cost-effectiveness of HPV vaccination; policy makers in China should take these into account when making a decision on the introduction of HPV vaccine. In areas with a high burden of cervical cancer and limited screening activities, HPV vaccination should be prioritized. However, the vaccine

  5. Long term healthcare costs of infants who survived neonatal necrotizing enterocolitis: a retrospective longitudinal study among infants enrolled in Texas Medicaid.

    PubMed

    Ganapathy, Vaidyanathan; Hay, Joel W; Kim, Jae H; Lee, Martin L; Rechtman, David J

    2013-08-20

    Infants who survive advanced necrotizing enterocolitis (NEC) at the time of birth are at increased risk of having poor long term physiological and neurodevelopmental growth. The economic implications of the long term morbidity in these children have not been studied to date. This paper compares the long term healthcare costs beyond the initial hospitalization period incurred by medical and surgical NEC survivors with that of matched controls without a diagnosis of NEC during birth hospitalization. The longitudinal healthcare utilization claim files of infants born between January 2002 and December 2003 and enrolled in the Texas Medicaid fee-for-service program were used for this research. Propensity scoring was used to match infants diagnosed with NEC during birth hospitalization to infants without a diagnosis of NEC on the basis of gender, race, prematurity, extremely low birth weight status and presence of any major birth defects. The Medicaid paid all-inclusive healthcare costs for the period from 6 months to 3 years of age among children in the medical NEC, surgical NEC and matched control groups were evaluated descriptively, and in a generalized linear regression framework in order to model the impact of NEC over time and by birth weight. Two hundred fifty NEC survivors (73 with surgical NEC) and 2,909 matched controls were available for follow-up. Medical NEC infants incurred significantly higher healthcare costs than matched controls between 6-12 months of age (mean incremental cost = US$ 5,112 per infant). No significant difference in healthcare costs between medical NEC infants and matched controls was seen after 12 months. Surgical NEC survivors incurred healthcare costs that were consistently higher than that of matched controls through 36 months of age. The mean incremental healthcare costs of surgical NEC infants compared to matched controls between 6-12, 12-24 and 24-36 months of age were US$ 18,274, 14,067 (p < 0.01) and 8,501 (p = 0.06) per infant

  6. Can biochar serve as a toop to reduce soil GHG costs of agricultural production in the long term?

    NASA Astrophysics Data System (ADS)

    Kammann, Claudia; Finke, Christoph; Schröder, Matthias; Schmidt, Hans-Peter; Lima, Amanda; Teixeira, Wenceslau; Clough, Tim; Müller, Christoph

    2013-04-01

    With a growing world population and growing demands for bioenergy there is an urgent need to improve the greenhouse gas (GHG) emission-to-yield ratio of agricultural production. 'Young, production-fresh biochar has repeatedly been observed to reduce N2O emissions in a variety of agricultural soils, but it is unknown how long initial N2O-reducing effects will persist. Biochar-amended soils may even develop a potential for higher N2O emissions decades after Biochar application due to the formation of higher soil organic matter stocks when mineral N is applied. Unfortunately the longest-running field trials are not older than a few years, thus our ability for predictions is rather limited. To investigate the long-term effect that Biochar addition to soils may have on soil GHG emissions we conducted three different laboratory incubation studies with potential 'long-term analogs' that may offer insights: (I) N-rich Biochar-manure compost, versus pure manure-compost, or manure-compost were the same amount of untreated, fresh Biochar was added; (II) temperate soil from a 100-year old charcoal making (kiln) site in Germany compared to the original adjacent forest soil; and (III) two tropical Terra preta soils (secondary forest and cultivation) compared to their respective adjacent ferralsols. None of the studies indicated that old, "aged" Biochar in soils or substrates will increase the risk for N2O losses. The Biochar-compost (I) still had significantly reduced N2O emissions, or was the same as the control. However, its biological activity (respiration) was significantly increased (122% of ctrl). In contrast, the fresh Biochar addition significantly reduced N2O emissions to 39% of the control, accompanied by significantly reduced respiration rates (50% of ctrl.). The kiln-area soil (II), compared to the corresponding adjacent forest soil (both at 60% of their respective WHCmax), did not exhibit higher N2O emissions after N-fertilization over the course of one month. The

  7. Strategies for inhibitor treatment and costs in the short and long term: a critical evaluation of recent clinical studies.

    PubMed

    Baghaipour, Mohammad Reza; Steen Carlsson, Katarina

    2015-02-01

    One important complication of patients with severe haemophilia A is the formation of inhibitory antibodies to factor VIII (FVIII). Immune tolerance induction (ITI) is the treatment of choice for patients with inhibitors, but this approach is successful in about 60% of patients. Treatment of acute bleeding in patients with inhibitors is one of the greatest challenges in haemophilia management and is costly. Bypassing agents are the mainstay of treatment in these patients. The aims of this study were to review the most recent publications concerning the costs of inhibitor treatment. We conducted a literature review using PubMed which yielded 63 papers analysing the costs of inhibitor management of which 12 were suitable for our study. Four of eight studies supported the use of activated prothrombin complex concentrate (aPCC) with lower costs, but the remaining four studies showed that recombinant factor VIIa (rFVIIa) had a lower average treatment cost. Of four ITI studies, two supported lifelong cost-effectiveness of ITI vs. bypassing agents and the remaining two papers showed a high cost of inhibitor treatment. Dosages, time between onset of bleeding and treatment, patient characteristics and the price of drugs are some of the important issues that should be considered for further studies.

  8. Long-term calorie restriction decreases metabolic cost of movement and prevents decrease of physical activity during aging in the rhesus monkeys

    PubMed Central

    Yamada, Yosuke; Colman, Ricki J; Kemnitz, Joseph W.; Baum, Scott T.; Anderson, Rozalyn M.; Weindruch, Richard; Schoeller, Dale A.

    2013-01-01

    Background Short-term (<1 year) calorie restriction (CR) has been reported to decrease physical activity and metabolic rate in humans and non-human primate models; however, studies examining the very long-term (>10 year) effect of CR on these parameters are lacking. Objective The objective of this study was to examine metabolic and behavioral adaptations to long-term CR longitudinally in rhesus macaques. Design Eighteen (10 male, 8 female) control (C) and 24 (14 male, 10 female) age matched CR rhesus monkeys between 19.6 and 31.9 years old were examined after 13 and 18 years of moderate adult-onset CR. Energy expenditure (EE) was examined by doubly labeled water (DLW; TEE) and respiratory chamber (24hrEE). Physical activity was assessed both by metabolic equivalent (MET) in a respiratory chamber and by an accelerometer. Metabolic cost of movements during 24h were also calculated. Age and fat-free mass were included as covariates. Results Adjusted total and 24hr EE were not different between C and CR. Sleeping metabolic rate was significantly lower, and physical activity level was higher in CR than in C independent from the CR-induced changes in body composition. The duration of physical activity above 1.6 METs was significantly higher in CR than in C, and CR had significantly higher accelerometer activity counts than C. Metabolic cost of movements during 24h were significantly lower in CR than in C. The accelerometer activity counts were significantly decreased after seven years in C animals, but not in CR animals. Conclusions The results suggest that long-term CR decreases basal metabolic rate, but maintains higher physical activity with lower metabolic cost of movements compared with C. PMID:23954367

  9. Cost-effectiveness and budget impact analyses of a long-term hypertension detection and control program for stroke prevention.

    PubMed

    Yamagishi, Kazumasa; Sato, Shinichi; Kitamura, Akihiko; Kiyama, Masahiko; Okada, Takeo; Tanigawa, Takeshi; Ohira, Tetsuya; Imano, Hironori; Kondo, Masahide; Okubo, Ichiro; Ishikawa, Yoshinori; Shimamoto, Takashi; Iso, Hiroyasu

    2012-09-01

    The nation-wide, community-based intensive hypertension detection and control program, as well as universal health insurance coverage, may well be contributing factors for helping Japan rank near the top among countries with the longest life expectancy. We sought to examine the cost-effectiveness of such a community-based intervention program, as no evidence has been available for this issue. The hypertension detection and control program was initiated in 1963 in full intervention and minimal intervention communities in Akita, Japan. We performed comparative cost-effectiveness and budget-impact analyses for the period 1964-1987 of the costs of public health services and treatment of patients with hypertension and stroke on the one hand, and incidence of stroke on the other in the full intervention and minimal intervention communities. The program provided in the full intervention community was found to be cost saving 13 years after the beginning of program in addition to the fact of effectiveness that; the prevalence and incidence of stroke were consistently lower in the full intervention community than in the minimal intervention community throughout the same period. The incremental cost was minus 28,358 yen per capita over 24 years. The community-based intensive hypertension detection and control program was found to be both effective and cost saving. The national government's policy to support this program may have contributed in part to the substantial decline in stroke incidence and mortality, which was largely responsible for the increase in Japanese life expectancy.

  10. Medical costs of war in 2035: long-term care challenges for veterans of Iraq and Afghanistan.

    PubMed

    Geiling, James; Rosen, Joseph M; Edwards, Ryan D

    2012-11-01

    War-related medical costs for U.S. veterans of Iraq and Afghanistan may be enormous because of differences between these wars and previous conflicts: (1) Many veterans survive injuries that would have killed them in past wars, and (2) improvised explosive device attacks have caused "polytraumatic" injuries (multiple amputations; brain injury; severe facial trauma or blindness) that require decades of costly rehabilitation. In 2035, today's veterans will be middle-aged, with health issues like those seen in aging Vietnam veterans, complicated by comorbidities of posttraumatic stress disorder, traumatic brain injury, and polytrauma. This article cites emerging knowledge about best practices that have demonstrated cost-effectiveness in mitigating the medical costs of war. We propose that clinicians employ early interventions (trauma care, physical therapy, early post-traumatic stress disorder diagnosis) and preventive health programs (smoking cessation, alcohol-abuse counseling, weight control, stress reduction) to treat primary medical conditions now so that we can avoid treating costly secondary and tertiary complications in 2035. (We should help an amputee reduce his cholesterol and maintain his weight at age 30, rather than treating his heart disease or diabetes at age 50.) Appropriate early interventions for primary illness should preserve veterans' functional status, ensure quality clinical care, and reduce the potentially enormous cost burden of their future health care.

  11. A cost-benefit analysis of long-term management options for forests following contamination with 137Cs.

    PubMed

    Shaw, G; Robinson, C; Holm, E; Frissel, M J; Crick, M

    2001-01-01

    This paper provides a description of a cost-benefit analysis applied to determine the cost effectiveness, or otherwise, of nine management strategies potentially applicable to forests contaminated with 137Cs. The management strategies were considered singly and in a number of likely combinations. A management strategy was considered to be cost-effective if it resulted in a lower overall monetary detriment than was incurred if use of the contaminated forest was continued on a 'business as usual' basis. Only the banning of mushroom collection and restriction of public access proved to be cost-effective management strategies on the basis of this definition. However, even these strategies only proved cost-effective at high levels of 137Cs contamination, at which net savings in detriment in the form of public dose were achieved. Cost-effective savings of doses to forest workers were never achieved at any of the contamination levels considered in this study. It is suggested that novel alternative uses of contaminated forests are required which could provide added value to the standing crop in return for small increases in public and worker doses. One such use might be biofuel production.

  12. Long-Term Secondary Care Costs of Endometrial Cancer: A Prospective Cohort Study Nested within the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS)

    PubMed Central

    Karpinskyj, Chloe; Miners, Alec; Taylor, Julie; Manchanda, Ranjit; Iyer, Rema; Griffin, Michelle; Ryan, Andy; Jacobs, Ian; Menon, Usha; Legood, Rosa

    2016-01-01

    Background There is limited evidence on the costs of Endometrial Cancer (EC) by stage of disease. We estimated the long-term secondary care costs of EC according to stage at diagnosis in an English population-based cohort. Methods Women participating in UKCTOCS and diagnosed with EC following enrolment (2001–2005) and prior to 31st Dec 2009 were identified to have EC through multiple sources. Survival was calculated through data linkage to death registry. Costs estimates were derived from hospital records accessed from Hospital Episode Statistics (HES) with additional patient level covariates derived from case notes and patient questionnaires. Missing and censored data was imputed using Multiple Imputation. Regression analysis of cost and survival was undertaken. Results 491 of 641 women with EC were included. Five year total costs were strongly dependent on stage, ranging from £9,475 (diagnosis at stage IA/IB) to £26,080 (diagnosis at stage III). Stage, grade and BMI were the strongest predictors of costs. The majority of costs for stage I/II EC were incurred in the first six months after diagnosis while for stage III / IV considerable costs accrued after the first six months. Conclusions In addition to survival advantages, there are significant cost savings if patients with EC are detected earlier. PMID:27829038

  13. Long-Term Secondary Care Costs of Endometrial Cancer: A Prospective Cohort Study Nested within the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS).

    PubMed

    Pennington, Mark; Gentry-Maharaj, Aleksandra; Karpinskyj, Chloe; Miners, Alec; Taylor, Julie; Manchanda, Ranjit; Iyer, Rema; Griffin, Michelle; Ryan, Andy; Jacobs, Ian; Menon, Usha; Legood, Rosa

    2016-01-01

    There is limited evidence on the costs of Endometrial Cancer (EC) by stage of disease. We estimated the long-term secondary care costs of EC according to stage at diagnosis in an English population-based cohort. Women participating in UKCTOCS and diagnosed with EC following enrolment (2001-2005) and prior to 31st Dec 2009 were identified to have EC through multiple sources. Survival was calculated through data linkage to death registry. Costs estimates were derived from hospital records accessed from Hospital Episode Statistics (HES) with additional patient level covariates derived from case notes and patient questionnaires. Missing and censored data was imputed using Multiple Imputation. Regression analysis of cost and survival was undertaken. 491 of 641 women with EC were included. Five year total costs were strongly dependent on stage, ranging from £9,475 (diagnosis at stage IA/IB) to £26,080 (diagnosis at stage III). Stage, grade and BMI were the strongest predictors of costs. The majority of costs for stage I/II EC were incurred in the first six months after diagnosis while for stage III / IV considerable costs accrued after the first six months. In addition to survival advantages, there are significant cost savings if patients with EC are detected earlier.

  14. Economic analysis including long-term risks and costs of alternative diagnostic strategies to evaluate patients with chest pain

    PubMed Central

    Bedetti, Gigliola; Pasanisi, Emilio Maria; Pizzi, Carmine; Turchetti, Giuseppe; Loré, Cosimo

    2008-01-01

    Background Diagnosis costs for cardiovascular disease waste a large amount of healthcare resources. The aim of the study is to evaluate the clinical and economic outcomes of alternative diagnostic strategies in low risk chest pain patients. Methods We evaluated direct and indirect downstream costs of 6 strategies: coronary angiography (CA) after positive troponin I or T (cTn-I or cTnT) (strategy 1); after positive exercise electrocardiography (ex-ECG) (strategy 2); after positive exercise echocardiography (ex-Echo) (strategy 3); after positive pharmacologic stress echocardiography (PhSE) (strategy 4); after positive myocardial exercise stress single-photon emission computed tomography with technetium Tc 99m sestamibi (ex-SPECT-Tc) (strategy 5) and direct CA (strategy 6). Results The predictive accuracy in correctly identifying the patients was 83,1% for cTn-I, 87% for cTn-T, 85,1% for ex-ECG, 93,4% for ex-Echo, 98,5% for PhSE, 89,4% for ex-SPECT-Tc and 18,7% for CA. The cost per patient correctly identified results $2.051 for cTn-I, $2.086 for cTn-T, $1.890 for ex-ECG, $803 for ex-Echo, $533 for PhSE, $1.521 for ex-SPECT-Tc ($1.634 including cost of extra risk of cancer) and $29.673 for CA ($29.999 including cost of extra risk of cancer). The average relative cost-effectiveness of cardiac imaging compared with the PhSE equal to 1 (as a cost comparator), the relative cost of ex-Echo is 1.5×, of a ex-SPECT-Tc is 3.1×, of a ex-ECG is 3.5×, of cTnI is ×3.8, of cTnT is ×3.9 and of a CA is 56.3×. Conclusion Stress echocardiography based strategies are cost-effective versus alternative imaging strategies and the risk and cost of radiation exposure is void. PMID:18510723

  15. Adherence clubs for long-term provision of antiretroviral therapy: cost-effectiveness and access analysis from Khayelitsha, South Africa.

    PubMed

    Bango, Funeka; Ashmore, John; Wilkinson, Lynne; van Cutsem, Gilles; Cleary, Susan

    2016-09-01

    As the scale of the South African HIV epidemic calls for innovative models of care that improve accessibility for patients while overcoming chronic human resource shortages, we (i) assess the cost-effectiveness of lay health worker-led group adherence clubs, in comparison with a nurse-driven 'standard of care' and (ii) describe and evaluate the associated patient cost and accessibility differences. Our cost-effectiveness analysis compares an 'adherence club' innovation to conventional nurse-driven care within a busy primary healthcare setting in Khayelitsha, South Africa. In each alternative, we calculate provider costs and estimate rates of retention in care and viral suppression as key measures of programme effectiveness. All results are presented on an annual or per patient-year basis. In the same setting, a smaller sample of patients was interviewed to understand the direct and indirect non-healthcare cost and access implications of the alternatives. Access was measured using McIntyre and colleagues' 2009 framework. Adherence clubs were the more cost-effective model of care, with a cost per patient-year of $300 vs. $374 and retention in care at 1 year of 98.03% (95% CI 97.67-98.33) for clubs vs. 95.49% (95% CI 95.01-95.94) for standard of care. Viral suppression in clubs was 99.06% (95% CI 98.82-99.27) for clubs vs. 97.20% (95% CI 96.81-97.56) for standard of care. When interviewed, club patients reported fewer missed visits, shorter waiting times and higher acceptability of services compared to standard of care. Adherence clubs offer the potential to enhance healthcare efficiency and patient accessibility. Their scale-up should be supported. © 2016 John Wiley & Sons Ltd.

  16. Increased healthcare utilization costs following initiation of insulin treatment in type 2 diabetes: A long-term follow-up in clinical practice.

    PubMed

    Kalkan, Almina; Bodegard, Johan; Sundström, Johan; Svennblad, Bodil; Östgren, Carl Johan; Nilsson, Peter Nilsson; Johansson, Gunnar; Ekman, Mattias

    2017-04-01

    To compare long-term changes in healthcare utilization and costs for type 2 diabetes patients before and after insulin initiation, as well as healthcare costs after insulin versus non-insulin anti-diabetic (NIAD) initiation. Patients newly initiated on insulin (n=2823) were identified in primary health care records from 84 Swedish primary care centers, between 1999 to 2009. First, healthcare costs per patient were evaluated for primary care, hospitalizations and secondary outpatient care, before and up to seven years after insulin initiation. Second, patients prescribed insulin in second line were matched to patients prescribed NIAD in second line, and the healthcare costs of the matched groups were compared. The total mean annual healthcare cost increased from €1656 per patient 2 years before insulin initiation to €3814 seven years after insulin initiation. The total cumulative mean healthcare cost per patient at year 5 after second-line treatment was €13,823 in the insulin group compared to €9989 in the NIAD group. Initiation of insulin in type 2 diabetes patients was followed by increased healthcare costs. The increases in costs were larger than those seen in a matched patient population initiated on NIAD treatment in second-line. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  17. 47 CFR 52.33 - Recovery of carrier-specific costs directly related to providing long-term number portability.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... network elements under section 251. (iv) The incumbent local exchange carrier shall levelize the monthly... statistical areas or with an adjacent number portability-capable local exchange carrier may assess each end...) Incumbent local exchange carriers may recover their carrier-specific costs directly related to...

  18. Managing Threat, Cost, and Incentive to Kill: The Short- and Long-Term Effects of Intervention in Mass Killings

    ERIC Educational Resources Information Center

    Kathman, Jacob D.; Wood, Reed M.

    2011-01-01

    How do third-party interventions affect the severity of mass killings? The authors theorize that episodes of mass killing are the consequence of two factors: (1) the threat perceptions of the perpetrators and (2) the cost of implementing genocidal policies relative to other alternatives. To reduce genocidal hostilities, interveners must address…

  19. A Benefit-Cost Analysis of a Long-Term Intervention on Social and Emotional Learning in Compulsory School

    ERIC Educational Resources Information Center

    Klapp, Alli; Belfield, Clive; Bowden, Brooks; Levin, Henry; Shand, Robert; Zander, Sabine

    2017-01-01

    There is growing evidence that social and emotional skills can be taught to students in school and teaching these skills can have a positive effect on later outcomes, such as better mental health and less drug use. This paper presents a benefit-cost analysis of a longitudinal social and emotional learning intervention in Sweden, using data for 663…

  20. Managing Threat, Cost, and Incentive to Kill: The Short- and Long-Term Effects of Intervention in Mass Killings

    ERIC Educational Resources Information Center

    Kathman, Jacob D.; Wood, Reed M.

    2011-01-01

    How do third-party interventions affect the severity of mass killings? The authors theorize that episodes of mass killing are the consequence of two factors: (1) the threat perceptions of the perpetrators and (2) the cost of implementing genocidal policies relative to other alternatives. To reduce genocidal hostilities, interveners must address…

  1. Consumers Buy Lower-Cost Plans On Covered California, Suggesting Exposure To Premium Increases Is Less Than Commonly Reported.

    PubMed

    Gabel, Jon R; Arnold, Daniel R; Fulton, Brent D; Stromberg, Sam T; Green, Matthew; Whitmore, Heidi; Scheffler, Richard M

    2017-01-01

    With the notable exception of California, states have not made enrollment data for their Affordable Care Act (ACA) Marketplace plans publicly available. Researchers thus have tracked premium trends by calculating changes in the average price for plans offered (a straight average across plans) rather than for plans purchased (a weighted average). Using publicly available enrollment data for Covered California, we found that the average purchased price for all plans was 11.6 percent less than the average offered price in 2014, 13.2 percent less in 2015, and 15.2 percent less in 2016. Premium growth measured by plans purchased was roughly 2 percentage points less than when measured by plans offered in 2014-15 and 2015-16. We observed shifts in consumer choices toward less costly plans, both between and within tiers, and we estimate that a $100 increase in a plan's net annual premium reduces its probability of selection. These findings suggest that the Marketplaces are helping consumers moderate premium cost growth. Project HOPE—The People-to-People Health Foundation, Inc.

  2. The performance and long-term stability of low-cost separators in single-chamber bottle-type microbial fuel cells.

    PubMed

    Kondaveeti, Sanath; Kakarla, Ramesh; Kim, Hong Suck; Kim, Byung-Goon; Min, Booki

    2017-03-21

    This study evaluates long-term stability of low-cost separators in single-chamber bottle-type microbial fuel cells with domestic wastewater. Low-cost separators tested in this study were nonwoven fabrics (NWF) of polypropylene (PP80, PP100), textile fabrics of polyphenylene sulfide (PPS), sulfonated polyphenylene sulfide (SPPS), and cellulose esters. NWF PP80 separator generated the highest power density of 280 mW/m(2), which was higher than with ion-exchange membranes (cation exchange membrane; CEM = 271 mW/m(2), cation exchange membrane; CMI = 196 mW/m(2), Nafion = 260 mW/m(2)). MFC operations with other size-selective separators such as SPPS, PPS, and cellulose esters exhibited power densities of 261, 231, and 250 mW/m(2), respectively. During a 280-day operation, initial power density of PP80 (278 mW/m(2)) was decreased to 257 mW/m(2), but this decrease was smaller than with others (Nafion: 265-230 mW/m(2); PP100: 220-126 mW/m(2)). The anode potential of around -430 mV did not change much with all separators in the long-term operation, but the initial cathode potential gradually decreased. Fouling analysis suggested that the presence of carbonaceous substance on Nafion and PP80 after 280 days of operation and Nafion was subject to be more biofouling.

  3. Comparison of pressure ulcer treatments in long-term care facilities: clinical outcomes and impact on cost.

    PubMed

    Narayanan, Siva; Van Vleet, John; Strunk, Billy; Ross, Robert N; Gray, Mikel

    2005-01-01

    This study compared clinical outcomes and nursing labor costs associated with (a) balsam Peru, hydrogenated castor oil, and trypsin (BCT) ointment; (b) BCT + Other; and (c) Other treatments in 2014 wound episodes occurring in 861 patients (mean 2.34 wounds/patient). Treatment with BCT ointment or BCT + Other was associated with a higher healing rate (P < .05). No Stage 1 or 2 ulcer treated with BCT ointment progressed, compared with 13.8% treated with BCT + Other and 13.4% treated with Other. The reported mean duration of treatment and time to heal were shorter for ulcers treated with BCT ointment, but differences did not reach significance, possibly because of the variability in reported treatment times. Mean daily nursing labor costs were lower for treatment with BCT than Other ($50.8 vs $61.7, P < .05). These data suggest that treatment of Stage 1 or 2 ulcers with BCT may be associated with shorter treatment time and time to heal and a potential reduction in treatment-related nursing labor costs.

  4. Preschool hyperactivity is associated with long-term economic burden: evidence from a longitudinal health economic analysis of costs incurred across childhood, adolescence and young adulthood.

    PubMed

    Chorozoglou, Maria; Smith, Elizabeth; Koerting, Johanna; Thompson, Margaret J; Sayal, Kapil; Sonuga-Barke, Edmund J S

    2015-09-01

    Preschool hyperactivity is an early risk factor for adult mental health problems and criminality. Little is known about; (a) the patterns of long-term service costs associated with this behavioural marker in the general population and (b) the specific factors predicting hyperactivity-related costs. We undertook a prospective study investigating associations between preschool hyperactivity and average individual annual service costs up to late adolescent and young adulthood. One-hundred and seventy individuals rated as hyperactive by their parents and 88 nonhyperactive controls were identified from a community sample of 4,215 three years olds. Baseline information about behaviour/emotional problems and background characteristics were collected. At follow-up (when individuals were aged between 14 and 25 years) information was obtained on service use, and associated costs since the age of three. Based on this information we calculated the average cost per annum incurred by each individual. Compared to controls, preschoolers with hyperactivity had 17.6 times higher average costs per annum across domains (apart from nonmental health costs). These were £562 for each hyperactive individual compared with £30 for controls. Average annual costs decreased as a function of age, with higher costs incurred at younger ages. The effects of hyperactivity remained significant when other baseline factors were added to the model. Effects were fully mediated by later psychiatric morbidity. When the hyperactive group were examined separately, costs were consistently predicted by male gender and, for some cost codes, by conduct problems. Preventative approaches targeting early hyperactivity may be of value. Services should be targeted towards high-risk individuals with careful consideration given to the cost-to-benefit trade-off of early intervention strategies. © 2015 The Authors. Journal of Child Psychology and Psychiatry published by John Wiley & Sons Ltd on behalf of Association

  5. Long-term Effect of Home Nursing Intervention on Cost and Healthcare Utilization for Patients with Chronic Obstructive Pulmonary Disease: A Retrospective Observational Study.

    PubMed

    Matsumura, Takuro; Takarada, Kana; Oki, Yutaro; Fujimoto, Yukari; Kaneko, Hiromi; Ohira, Mineko; Ishikawa, Akira

    2015-01-01

    The present study aimed to examine the long-term effects of a home nursing intervention on healthcare utilization and costs among patients with chronic obstructive pulmonary disease (COPD). A 3-year retrospective study. Eleven COPD patients who had received home nursing intervention after hospital discharge were enrolled. We retrospectively investigated their healthcare utilization and costs for 1 year before the intervention and during 2 years of the intervention. The number and length of hospitalizations decreased gradually from the pre-intervention period through the second year. The number of hospital and home nursing visits increased from the pre-intervention period through the first and second years. The hospitalization costs were decreased by approximately half from the pre-intervention period through the first year and from the first year through the second year. The total medical cost did not change significantly. Our home nursing intervention decreased the number and length of hospitalizations and the hospitalization costs; however, it did not affect the total medical cost. It is possible that the continuation of home nursing interventions may decrease the number of hospitalizations, number of home nursing visits, and the total medical cost by maintaining the health condition of patients. © 2014 Association of Rehabilitation Nurses.

  6. JNK1 ablation in mice confers long-term metabolic protection from diet-induced obesity at the cost of moderate skin oxidative damage.

    PubMed

    Becattini, Barbara; Zani, Fabio; Breasson, Ludovic; Sardi, Claudia; D'Agostino, Vito Giuseppe; Choo, Min-Kyung; Provenzani, Alessandro; Park, Jin Mo; Solinas, Giovanni

    2016-09-01

    Obesity and insulin resistance are associated with oxidative stress, which may be implicated in the progression of obesity-related diseases. The kinase JNK1 has emerged as a promising drug target for the treatment of obesity and type 2 diabetes. JNK1 is also a key mediator of the oxidative stress response, which can promote cell death or survival, depending on the magnitude and context of its activation. In this article, we describe a study in which the long-term effects of JNK1 inactivation on glucose homeostasis and oxidative stress in obese mice were investigated for the first time. Mice lacking JNK1 (JNK1(-/-)) were fed an obesogenic high-fat diet (HFD) for a long period. JNK1(-/-) mice fed an HFD for the long term had reduced expression of antioxidant genes in their skin, more skin oxidative damage, and increased epidermal thickness and inflammation compared with the effects in control wild-type mice. However, we also observed that the protection from obesity, adipose tissue inflammation, steatosis, and insulin resistance, conferred by JNK1 ablation, was sustained over a long period and was paralleled by decreased oxidative damage in fat and liver. We conclude that compounds targeting JNK1 activity in brain and adipose tissue, which do not accumulate in the skin, may be safer and most effective.-Becattini, B., Zani, F., Breasson, L., Sardi, C., D'Agostino, V. G., Choo, M.-K., Provenzani, A., Park, J. M., Solinas, G. JNK1 ablation in mice confers long-term metabolic protection from diet-induced obesity at the cost of moderate skin oxidative damage. © FASEB.

  7. Cost-effectiveness of proton pump inhibitor cotherapy in patients taking long-term, low-dose aspirin for secondary cardiovascular prevention.

    PubMed

    Saini, Sameer D; Schoenfeld, Philip; Fendrick, A Mark; Scheiman, James

    2008-08-11

    Patients with coronary heart disease (CHD) require long-term therapy with low-dose aspirin (ASA). Although these patients are at increased risk for upper gastrointestinal bleeding (UGIB) and proton pump inhibitor (PPI) cotherapy may reduce such risk, it is not known whether lifelong PPI cotherapy is cost-effective. A Markov model was developed to compare lifelong therapy with ASA alone vs therapy with ASA plus PPI in patients with CHD who are at least 50 years old. Base-case assumptions were (1) starting age, 65 years (range, 50-80 years); (2) UGIB risk category, average risk (range, average to 8-fold increased risk); (3) PPI effectiveness (66% (range, 25%-75%); and (4) annual PPI cost, $250 (range, $250-$1400). In the base-case analysis, ASA plus PPI resulted in fewer lifetime UGIB events (3.1% vs 9.5%) and UGIB-related deaths (0.4% vs 1.4%). At over-the-counter (OTC) PPI cost, ASA plus PPI was cost-effective, with an incremental cost-effectiveness ratio (ICER) of $40,090 per life-year saved (LYS). Varying PPI effectiveness from 75% to 25% resulted in ICERs of $35,315 to $94,578 per LYS. Varying the starting age of the cohort from 80 to 50 years resulted in ICERs of $16,887 to $79,955 per LYS. At prescription PPI cost, the ICER for average-risk patients was over $100,000 per LYS across all modeled age groups and assumptions of PPI effectiveness, but the ICER for high-risk patients was $10,433 to $51,505 per LYS. At OTC cost, PPI cotherapy is cost-effective in average-risk patients taking low-dose ASA for secondary prevention. At prescription cost, cotherapy is cost-effective for high-risk patients only.

  8. A Low-cost data-logging platform for long-term field sensor deployment in caves

    NASA Astrophysics Data System (ADS)

    Cruz, M. A.; Myre, J. M.; Covington, M. D.

    2014-12-01

    Active karst systems are notoriously inhospitable environments for humans and equipment. Caves require equipment to cope with high humidity, high velocity flows, submersion, sediment loads, and harassment from local fauna. Equipment taken into caves is often considered "consumable" due to the extreme nature of cave environments and the difficulty of transport. Further, because many interesting monitoring locations within caves can be considered remote, it is ideal for electronic monitoring platforms to require minimal maintenance of parts and power supplies. To partially address the challenge of scientifically monitoring such environments, we have developed an arduino based platform for environmental monitoring of cave systems. The arduino is a general purpose open source microcontroller that is easily programmed with only a basic knowledge of the C programming language. The arduino is capable of controlling digital and analog electronics in a modular fashion. Using this capability, we have created a platform for monitoring CO2 levels in cave systems that costs one-tenth of a comparable commercial system while using a fraction of the power. The modular nature of the arduino system allows the incorporation of additional environmental sensors in the future.

  9. Long-Term Realism and Cost-Effectiveness: Primary Prevention in Combatting Cancer and Associated Inequalities Worldwide

    PubMed Central

    Bray, Freddie; Jemal, Ahmedin; Torre, Lindsey A.; Forman, David; Vineis, Paolo

    2015-01-01

    The global figure of 14 million new cancer cases in 2012 is projected to rise to almost 22 million by 2030, with the burden in low- and middle-income countries (LMICs) shifting from 59% to 65% of all cancer cases worldwide over this time. While the overheads of cancer care are set to rapidly increase in all countries worldwide irrespective of income, the limited resources to treat and manage the growing number of cancer patients in LMICs threaten national economic development. Current data collated in the recent second edition of The Cancer Atlas by the American Cancer Society and International Agency for Research on Cancer show that a substantial proportion of cancers are preventable and that prevention is cost-effective. Therefore, cancer control strategies within countries must prioritize primary and secondary prevention, alongside cancer management and palliative care and integrate these measures into existing health care plans. There are many examples of the effectiveness of prevention in terms of declining cancer rates and major risk factors, including an 80% decrease in liver cancer incidence rates among children and young adults following universal infant hepatitis B vaccination in Taiwan and a 46% reduction in smoking prevalence in Brazil after the implementation of a more aggressive tobacco control program beginning in 1989. Prevention can bring rich dividends in net savings but actions must be promoted and implemented. The successful approaches to combatting certain infectious diseases provide a model for implementing cancer prevention, particularly in LMICs, via the utilization of existing infrastructures for multiple purposes. PMID:26424777

  10. Long-term stability in biomass and production of terpene indole alkaloids by hairy root culture of Rauvolfia serpentina and cost approximation to endorse commercial realism.

    PubMed

    Pandey, Pallavi; Kaur, Ranjeet; Singh, Sailendra; Chattopadhyay, Sunil Kumar; Srivastava, Santosh Kumar; Banerjee, Suchitra

    2014-07-01

    The effect of 6 years of cultivation and use of table-sugar (TS) on the biomass/terpene alkaloid productivities and rol gene expression were studied in a hairy root (HR) clone of Rauvolfia serpentina. The media cost could be reduced >94 % by replacing sucrose (SUC) with TS—an unexplored avenue for HR cultivation. The overall productivities increased over long-term cultivation with sugar proving superior to SUC for biomass (24.4 ± 2.11 g/l DW after 40 days to 17.31 % higher) and reserpine (0.094 ± 0.008 % DW after 60 days to 193.8 % more) production. The latter however revealed comparatively better yields concerning ajmaline (0.507 ± 0.048 % DW after 60 days to 61.98 % higher) and yohimbine (0.628 ± 0.062 % DW after 60 days to 38.32 % higher), respectively. PCR amplification of rol genes confirmed long-term expression stability.

  11. Long-term Cost-Effectiveness of Diagnostic Tests for Assessing Stable Chest Pain: Modeled Analysis of Anatomical and Functional Strategies.

    PubMed

    Bertoldi, Eduardo G; Stella, Steffan F; Rohde, Luis E; Polanczyk, Carisi A

    2016-05-01

    Several tests exist for diagnosing coronary artery disease, with varying accuracy and cost. We sought to provide cost-effectiveness information to aid physicians and decision-makers in selecting the most appropriate testing strategy. We used the state-transitions (Markov) model from the Brazilian public health system perspective with a lifetime horizon. Diagnostic strategies were based on exercise electrocardiography (Ex-ECG), stress echocardiography (ECHO), single-photon emission computed tomography (SPECT), computed tomography coronary angiography (CTA), or stress cardiac magnetic resonance imaging (C-MRI) as the initial test. Systematic review provided input data for test accuracy and long-term prognosis. Cost data were derived from the Brazilian public health system. Diagnostic test strategy had a small but measurable impact in quality-adjusted life-years gained. Switching from Ex-ECG to CTA-based strategies improved outcomes at an incremental cost-effectiveness ratio of 3100 international dollars per quality-adjusted life-year. ECHO-based strategies resulted in cost and effectiveness almost identical to CTA, and SPECT-based strategies were dominated because of their much higher cost. Strategies based on stress C-MRI were most effective, but the incremental cost-effectiveness ratio vs CTA was higher than the proposed willingness-to-pay threshold. Invasive strategies were dominant in the high pretest probability setting. Sensitivity analysis showed that results were sensitive to costs of CTA, ECHO, and C-MRI. Coronary CT is cost-effective for the diagnosis of coronary artery disease and should be included in the Brazilian public health system. Stress ECHO has a similar performance and is an acceptable alternative for most patients, but invasive strategies should be reserved for patients at high risk. © 2016 Wiley Periodicals, Inc.

  12. Knee Joint Distraction Compared to Total Knee Arthroplasty for Treatment of End Stage Osteoarthritis: Simulating Long-Term Outcomes and Cost-Effectiveness

    PubMed Central

    van der Woude, J. A. D.; Nair, S. C.; Custers, R. J. H.; van Laar, J. M.; Kuchuck, N. O.; Lafeber, F. P. J. G.; Welsing, P. M. J.

    2016-01-01

    Objective In end-stage knee osteoarthritis the treatment of choice is total knee arthroplasty (TKA). An alternative treatment is knee joint distraction (KJD), suggested to postpone TKA. Several studies reported significant and prolonged clinical improvement of KJD. To make an appropriate decision regarding the position of this treatment, a cost-effectiveness and cost-utility analysis from healthcare perspective for different age and gender categories was performed. Methods A treatment strategy starting with TKA and a strategy starting with KJD for patients of different age and gender was simulated. To extrapolate outcomes to long-term health and economic outcomes a Markov (Health state) model was used. The number of surgeries, QALYs, and treatment costs per strategy were calculated. Costs-effectiveness is expressed using the cost-effectiveness plane and cost-effectiveness acceptability curves. Results Starting with KJD the number of knee replacing procedures could be reduced, most clearly in the younger age categories; especially revision surgery. This resulted in the KJD strategy being dominant (more effective with cost-savings) in about 80% of simulations (with only inferiority in about 1%) in these age categories when compared to TKA. At a willingness to pay of 20.000 Euro per QALY gained, the probability of starting with KJD to be cost-effective compared to starting with a TKA was already found to be over 75% for all age categories and over 90–95% for the younger age categories. Conclusion A treatment strategy starting with knee joint distraction for knee osteoarthritis has a large potential for being a cost-effective intervention, especially for the relatively young patient. PMID:27171268

  13. Medicaid program; premiums and cost sharing. Final rule; delay of effective date and reopening of comment period.

    PubMed

    2009-03-27

    This action temporarily delays the effective date of the November 25, 2008 final rule entitled, Medicaid Program; Premiums and Cost Sharing" (73 FR 71828) until December 31, 2009. In addition, this action reopens the comment period on the policies set out in the November 25, 2008 final rule, and specifically solicits comments on the effect of certain provisions of the American Recovery and Reinvestment Act of 2009.

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

    PubMed

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

    2016-05-01

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

  15. Long-term Cost-effectiveness of Two GLP-1 Receptor Agonists for the Treatment of Type 2 Diabetes Mellitus in the Italian Setting: Liraglutide Versus Lixisenatide.

    PubMed

    Hunt, Barnaby; Kragh, Nana; McConnachie, Ceilidh C; Valentine, William J; Rossi, Maria C; Montagnoli, Roberta

    2017-07-01

    Maintaining glycemic control is the key treatment target for patients with type 2 diabetes mellitus. In addition, the glucagon-like peptide-1 (GLP-1) receptor agonists may be associated with other favorable treatment characteristics, such as reduction in body weight and reduced risk of hypoglycemia compared with traditional diabetes interventions. The aim of the present analysis was to compare the long-term cost-effectiveness of 2 GLP-1 receptor agonists, liraglutide 1.8 mg and lixisenatide 20 μg (both administered once daily), in the treatment of patients with type 2 diabetes failing to achieve glycemic control with metformin monotherapy in the Italian setting. The IMS CORE Diabetes Model was used to project long-term clinical outcomes and subsequent costs (in 2015 Euros [€]) associated with liraglutide 1.8 mg versus lixisenatide 20 μg treatment in a cohort with baseline characteristics derived from the open-label LIRA-LIXI trial (Efficacy and Safety of Liraglutide Versus Lixisenatide as Add-on to Metformin in Subjects With Type 2 Diabetes; NCT01973231) over patient lifetimes from the perspective of a health care payer. Efficacy data were taken from the 26-week end points of the same trial, including changes in glycated hemoglobin, body mass index, serum lipid levels, and hypoglycemic event rates. Outcomes projected included life expectancy, quality-adjusted life expectancy, cumulative incidence and time to onset of diabetes-related complications, and direct medical costs. Outcomes were discounted at 3% annually, and sensitivity analyses were performed. Liraglutide 1.8 mg was associated with improved discounted life expectancy (14.07 vs 13.96 years) and quality-adjusted life expectancy (9.18 vs 9.06 quality-adjusted life years [QALYs]) compared with lixisenatide 20 μg. These improvements were mostly attributable to a greater reduction in glycated hemoglobin level with liraglutide 1.8 mg versus lixisenatide 20 μg, leading to reduced incidence and

  16. Longitudinal Changes in the Government-Certified Index Stage and Requisite Costs for Long-Term Care Insurance System among the Community-Dwelling Demented Elderly in Japan

    PubMed Central

    Nakamura, Shiori; Iwamoto, Makoto; Tsuno, Norifumi; Shigeta, Masahiro; Nakayama, Kazuhiko

    2013-01-01

    Background. A new public long-term care (LTC) insurance was launched in 2000 in Japan. However, there have been few studies involving factors that increase LTC costs of demented subjects; no follow-up studies involving the Government-Certified Index (GCI) and requisite costs related to the causes of dementia. Method. An epidemiological survey was conducted in a rural area in Japan in 1999, and 271 subjects were diagnosed as dementia patients. Age, sex, mini-mental state examination, clinical dementia rating, activity of daily living, causes of dementia, and coexisting physical disease were confirmed. After the LTC insurance has been launched, we tracked the GCI stages and payment amounts every month for 8 years. Result. 209 subjects were certified to be eligible for LTC insurance; however, 13 did not receive any payment. Only 49 out of 209 were alive after the follow-up period. The most common cause of dementia was Alzheimer's disease (AD), followed by vascular dementia (VaD). There was no significant difference between the mortality rates of the two groups. VaD subjects required higher costs than AD subjects in the total certified period and in GCI stage 5. Conclusion. Our results indicate that causes of dementia can have an impact on the requisite costs for the LTC insurance. PMID:23533944

  17. Longitudinal Changes in the Government-Certified Index Stage and Requisite Costs for Long-Term Care Insurance System among the Community-Dwelling Demented Elderly in Japan.

    PubMed

    Shinagawa, Shunichiro; Nakamura, Shiori; Iwamoto, Makoto; Tsuno, Norifumi; Shigeta, Masahiro; Nakayama, Kazuhiko

    2013-01-01

    Background. A new public long-term care (LTC) insurance was launched in 2000 in Japan. However, there have been few studies involving factors that increase LTC costs of demented subjects; no follow-up studies involving the Government-Certified Index (GCI) and requisite costs related to the causes of dementia. Method. An epidemiological survey was conducted in a rural area in Japan in 1999, and 271 subjects were diagnosed as dementia patients. Age, sex, mini-mental state examination, clinical dementia rating, activity of daily living, causes of dementia, and coexisting physical disease were confirmed. After the LTC insurance has been launched, we tracked the GCI stages and payment amounts every month for 8 years. Result. 209 subjects were certified to be eligible for LTC insurance; however, 13 did not receive any payment. Only 49 out of 209 were alive after the follow-up period. The most common cause of dementia was Alzheimer's disease (AD), followed by vascular dementia (VaD). There was no significant difference between the mortality rates of the two groups. VaD subjects required higher costs than AD subjects in the total certified period and in GCI stage 5. Conclusion. Our results indicate that causes of dementia can have an impact on the requisite costs for the LTC insurance.

  18. Long Term Prognosis

    MedlinePlus

    ... TERM PROGNOSIS The long-term outlook of pediatric cardiomyopathy continues to be unpredictable because it occurs with ... a child also depends on the type of cardiomyopathy and the stage the disease is first diagnosed. ...

  19. 5 CFR 875.302 - What are the options for making premium payments?

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 5 Administrative Personnel 2 2012-01-01 2012-01-01 false What are the options for making premium payments? 875.302 Section 875.302 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL LONG TERM CARE INSURANCE PROGRAM Cost § 875.302 What are...

  20. 5 CFR 875.302 - What are the options for making premium payments?

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 2 2011-01-01 2011-01-01 false What are the options for making premium payments? 875.302 Section 875.302 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL LONG TERM CARE INSURANCE PROGRAM Cost § 875.302 What are...

  1. 5 CFR 875.302 - What are the options for making premium payments?

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 5 Administrative Personnel 2 2014-01-01 2014-01-01 false What are the options for making premium payments? 875.302 Section 875.302 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL LONG TERM CARE INSURANCE PROGRAM Cost § 875.302 What are...

  2. 5 CFR 875.302 - What are the options for making premium payments?

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 5 Administrative Personnel 2 2013-01-01 2013-01-01 false What are the options for making premium payments? 875.302 Section 875.302 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL LONG TERM CARE INSURANCE PROGRAM Cost § 875.302 What are...

  3. 5 CFR 875.302 - What are the options for making premium payments?

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false What are the options for making premium payments? 875.302 Section 875.302 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL LONG TERM CARE INSURANCE PROGRAM Cost § 875.302 What are...

  4. Partnership long-term care insurance: lessons for CLASS program development.

    PubMed

    Meiners, Mark R

    2012-01-01

    The Community Living Assistance Services and Supports (CLASS) Act was a voluntary public insurance strategy intended to help people pay for long-term care. CLASS was passed as part of health reform to overcome aspects of private long-term care insurance market failure but came under close scrutiny from both its supporters and its detractors. Experience with the long-term care insurance market and State Partnership Programs provide insights about how to make CLASS fiscally viable. A CLASS program that offered one set of options to cover front-end risk (e.g., 1 to 3 years) and another set to cover catastrophic risk (after a high deductible) could have been offered as an alternative to the basic CLASS "long and lean" benefit model with all enrollees joined into a single risk pool. This would have broadened the risk pool and lowered premium costs under the program.

  5. Healthcare Resource Use and Costs in Long-Term Survivors of Acute Respiratory Distress Syndrome: A 5-Year Longitudinal Cohort Study.

    PubMed

    Ruhl, A Parker; Huang, Minxuan; Colantuoni, Elizabeth; Lord, Robert K; Dinglas, Victor D; Chong, Alexandra; Sepulveda, Kristin A; Mendez-Tellez, Pedro A; Shanholtz, Carl B; Steinwachs, Donald M; Pronovost, Peter J; Needham, Dale M

    2017-02-01

    To evaluate the time-varying relationship of annual physical, psychiatric, and quality of life status with subsequent inpatient healthcare resource use and estimated costs. Five-year longitudinal cohort study. Thirteen ICUs at four teaching hospitals. One hundred thirty-eight patients surviving greater than or equal to 2 years after acute respiratory distress syndrome. None. Postdischarge inpatient resource use data (e.g., hospitalizations, skilled nursing, and rehabilitation facility stays) were collected via a retrospective structured interview at 2 years, with prospective collection every 4 months thereafter, until 5 years postacute respiratory distress syndrome. Adjusted odds ratios for hospitalization and relative medians for estimated episode of care costs were calculated using marginal longitudinal two-part regression. The median (interquartile range) number of inpatient admission hospitalizations was 4 (2-8), with 114 patients (83%) reporting greater than or equal to one hospital readmission. The median (interquartile range) estimated total inpatient postdischarge costs over 5 years were $58,500 ($19,700-157,800; 90th percentile, $328,083). Better annual physical and quality of life status, but not psychiatric status, were associated with fewer subsequent hospitalizations and lower follow-up costs. For example, greater grip strength (per 6 kg) had an odds ratio (95% CI) of 0.85 (0.73-1.00) for inpatient admission, with 23% lower relative median costs, 0.77 (0.69-0.87). In a multisite cohort of long-term acute respiratory distress syndrome survivors, better annual physical and quality of life status, but not psychiatric status, were associated with fewer hospitalizations and lower healthcare costs.

  6. Long-Term Effectiveness and Cost-Effectiveness of Metformin Combined with Liraglutide or Exenatide for Type 2 Diabetes Mellitus Based on the CORE Diabetes Model Study.

    PubMed

    Zhang, Xuesong; Liu, Sisi; Li, Yukun; Wang, Yan; Tian, Meimei; Liu, Guoqiang

    2016-01-01

    Type 2 diabetes mellitus (T2DM) is associated with β cell impairment. Agonists of the glucagon-like peptide 1 (GLP-1) receptor (such as liraglutide and exenatide) can increase the number of pancreatic β cells and improve cell function. These drugs contribute to the long-term control of T2DM. To evaluate the cost-effectiveness of metformin combined with liraglutide or exenatide in Chinese patient with T2DM. Patients with T2DM from the Third Hospital of Hebei Medical University were treated with oral metformin combined with liraglutide (0.6 mg/day, could be increased by 0.6 mg weekly until 1.2 or 1.8 mg) or exenatide (5 μg bid for four weeks, increased to 10 μg bid). The computer simulation model CORE was used to calculate the 30-year expected life expectancy, quality-adjusted life years (QALY), direct costs, HbA1c levels, body mass index (BMI), and the incidence of cardiovascular, renal, and ocular complications of T2DM. Patients were followed up for 52 weeks. Medication costs were calculated according to retail prices in China. A 3% annual discount was adopted in this study. The 30-year simulation showed that the total direct medical costs were lower using liraglutide compared to exenatide by 2130 RMB/QALY yearly, while the expected life expectancy and QALY were increased by 0.471 years and 0.388, respectively, using liraglutide with an incremental cost-effectiveness of -11,550 RMB/QALYs. Liraglutide 1.2 mg/day was superior to exenatide 10 μg bid with respect to cost-effectiveness in Chinese patients with T2DM.

  7. New drugs for osteoporosis. Comparison of the costs and required returns with those of other drugs intended for long-term use.

    PubMed

    Edwards, M

    1999-03-01

    Specific regulatory guidelines dictate that developing a new drug for osteoporosis will be significantly more expensive and take at least 2 years longer in comparison with other long-term therapies developed using the International Committee on Harmonisation (ICH) general guidelines. Assuming similar attrition rates, the minimal additional uncapitalised cost is $US86 million for nonestrogen osteoporosis compounds following a minimum programme designed to gain indications for both treatment and prevention. The excess expenditure is created by the size requirements for phase III fracture trials in both the European Union (EU)/US and Japan. The after-tax cash flows to the point of launch discounted at 11% are $US102 million greater, reflecting the additional effect of delayed time to market. Assuming similar lifecycles, the peak sales required to return the investment on an osteoporosis drug will be a minimum of $US95 million greater per launched compound. Many ongoing osteoporosis programmes are substantially larger than the theoretical minimum. The costs of substantially increasing the sample size in phase III trials mean that blockbuster revenues will be required to break even. However, the potential cost of a delayed launch because of fracture efficacy being incompletely proved is so substantial that fracture trials need to be powered conservatively to decrease the chances of this eventuality.

  8. How the ACA's Health Insurance Expansions Have Affected Out-of-Pocket Cost-Sharing and Spending on Premiums.

    PubMed

    Glied, Sherry; Solís-Román, Claudia; Parikh, Shivani

    2016-09-01

    One important benefit gained by the millions of Americans with health insurance through the Affordable Care Act (ACA) is protection from high out-of-pocket health spending. While Medicaid unambiguously reduces out-of-pocket premium and medical costs for low-income people, it is less certain that marketplace coverage and other types of insurance purchased to comply with the law's individual mandate also protect from high health spending. Goal: To compare out-of-pocket spending in 2014 to spending in 2013; assess how this spending changed in states where many people enrolled in the marketplaces relative to states where few people enrolled; and project the decline in the percentage of people paying high amounts out-of-pocket. Methods: Linear regression models were used to estimate whether people under age 65 spent above certain thresholds. Key findings and conclusions: The probability of incurring high out-of-pocket costs and premium expenses declined as marketplace enrollment increased. The percentage reductions were greatest among those with incomes between 250 percent and 399 percent of poverty, those who were eligible for premium subsidies, and those who previously were uninsured or had very limited nongroup coverage. These effects appear largely attributable to marketplace enrollment rather than to other ACA provisions or to economic trends.

  9. Cost-effectiveness of cervical spine clearance interventions with litigation and long-term-care implications in obtunded adult patients following blunt injury.

    PubMed

    Ertel, Audrey E; Robinson, Bryce R H; Eckman, Mark H

    2016-11-01

    Recent guidelines from the Eastern Association for the Surgery of Trauma conditionally recommend cervical collar removal after a negative cervical computed tomography in obtunded adult blunt trauma patients. Although the rates of missed injury are extremely low, the impact of chronic care costs and litigation upon decision making remains unclear. We hypothesize that the cost-effectiveness of strategies that include additional imaging may contradict current guidelines. A cost-effectiveness analysis was performed for a base-case 40-year-old, obtunded man with a negative computed tomography. Strategies compared included adjunct imaging with cervical magnetic resonance imaging (MRI), collar maintenance for 6 weeks, or removal. Data on the probability for long-term collar complications, spine injury, imaging costs, complications associated with MRI, acute and chronic care, and litigation were obtained from published and Medicare data. Outcomes were expressed as 2014 US dollars and quality-adjusted life-years. Collar removal was more effective and less costly than collar use or MRI (19.99 vs. 19.35 vs. 18.70 quality-adjusted life-years; $675,359 vs. $685,546 vs. $685,848) in the base-case analysis. When the probability of missed cervical injury was greater than 0.04 adjunct imaging with MRI dominated, however, collar removal remained cost-effective until the probability of missed injury exceeded 0.113 at which point collar removal exceeded the $50,000 threshold. Collar removal remained the most cost-effective approach until the probability of complications from collar use was reduced to less than 0.009, at which point collar maintenance became the most cost-effective strategy. Early collar removal dominates all strategies until the risk of complications from MRI positioning is reduced to 0.03 and remained cost-effective even when the probability of complication was reduced to 0. Early collar removal in obtunded adult blunt trauma patients appears to be the most effective

  10. Construction Performance Optimization toward Green Building Premium Cost Based on Greenship Rating Tools Assessment with Value Engineering Method

    NASA Astrophysics Data System (ADS)

    Latief, Yusuf; Berawi, Mohammed Ali; Basten, Van; Riswanto; Budiman, Rachmat

    2017-07-01

    Green building concept becomes important in current building life cycle to mitigate environment issues. The purpose of this paper is to optimize building construction performance towards green building premium cost, achieving green building rating tools with optimizing life cycle cost. Therefore, this study helps building stakeholder determining building fixture to achieve green building certification target. Empirically the paper collects data of green building in the Indonesian construction industry such as green building fixture, initial cost, operational and maintenance cost, and certification score achievement. After that, using value engineering method optimized green building fixture based on building function and cost aspects. Findings indicate that construction performance optimization affected green building achievement with increasing energy and water efficiency factors and life cycle cost effectively especially chosen green building fixture.

  11. Long-term clinical benefit and cost-effectiveness of an 8-week multimodal knee osteoarthritis management program incorporating intra-articular sodium hyaluronate (Hyalgan(®)) injections.

    PubMed

    Miller, Larry E; Sloniewsky, Michael J; Gibbons, Thomas E; Johnston, Janice G; Vosler, Kent D; Nasir, Saad

    2017-01-01

    Given the poor long-term effectiveness of focused nonsurgical knee osteoarthritis (OA) treatments, alternative therapies are needed for patients who have unsuccessfully exhausted nonsurgical options. A telephone interview was conducted in patients who participated in a single 8-week multimodal knee OA treatment program (mean follow-up: 3.7 years, range: 2.7-4.9 years). The program consisted of five intra-articular knee injections of sodium hyaluronate (Hyalgan(®)), with each injection given 1 week apart, structured physical therapy, knee bracing, and patient education. Clinical outcomes included knee pain severity, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) subscores, current medication use, and history of total knee arthroplasty. Base-case, subgroup, and sensitivity analyses were conducted to determine the incremental cost-effectiveness ratio (ICER) of the treatment program with comparisons made to historical literature controls undergoing usual care. A total of 218 patients (54%) provided long-term follow-up data. Knee pain severity decreased 60% and WOMAC subscores decreased 33%-42% compared to baseline (all p<0.001). Total knee arthroplasty was performed in 22.8% (81/356) of knees during followup. The treatment program was highly cost-effective compared to usual care with a base-case ICER of $6,000 per quality-adjusted life year (QALY). Results of subgroup analyses, one-way deterministic sensitivity analyses, and second-order probabilistic sensitivity analyses resulted in ICERs ranging from $3,996 to $10,493 per QALY. The percentage of simulations with an ICER below willingness-to-pay limits was 97.2%, 98.9%, and 99.4% for the $50,000, $100,000, and $150,000 per QALY thresholds, respectively. Participation in a single 8-week knee OA treatment program, which included one cycle of five intra-articular knee injections of sodium hyaluronate given at weekly intervals, is highly cost-effective and provides clinically meaningful reductions

  12. Long-term cost reduction of routine medications following a residential programme combining physical activity and nutrition in the treatment of type 2 diabetes: a prospective cohort study.

    PubMed

    Lanhers, Charlotte; Walther, Guillaume; Chapier, Robert; Lesourd, Bruno; Naughton, Geraldine; Pereira, Bruno; Duclos, Martine; Vinet, Agnès; Obert, Philippe; Courteix, Daniel; Dutheil, Frédéric

    2017-04-16

    To demonstrate that lifestyle modifications will reduce the cost of routine medications in individuals with type 2 diabetes (T2D), through a mechanism involving glycaemic control. A within-trial cost-medication analysis with a 1-year time horizon. Controlled environment within the spa resort of Chatel-Guyon, France. Twenty-nine participants (aged 50-70 years) with T2D. A 1-year follow-up intervention, beginning with a 3-week residential programme combining high exercise volume (15-20 hours/week), restrictive diet (-500 kcal/day) and education. Participants continued their routine medication, independently managed by their general practitioner. Number of medications, number of pills, cost of medications and health-related outcomes. Twenty-six participants completed the 1-year intervention. At 1 year, 14 patients out of 26 (54%) stopped/decreased their medications whereas only 5 (19%) increased or introduced new drugs (χ(2)=6.3, p=0.02). The number of pills per day decreased by 1.3±0.3 at 12 months (p<0.001). The annual cost of medications for T2D were lower at 1 year (€135.1±43.9) versus baseline (€212.6±35.8) (p=0.03). The regression coefficients on costs of routine medication were 0.507 (95% CI 0.056 to 0.959, p=0.027) for HbA1c and 0.156 (95% CI -0.010 to 0.322, p=0.06) for blood glucose levels. Diabetics patients with HbA1c >6.5% in the highest (last) quartile doubled their routine medication costs (66% vs 33%, p=0.037). Individuals with T2D reduced routine medication costs following a long-term lifestyle intervention that started with a 3-week residential programme. Combining high exercise volume, restrictive diet and education effectively supported the health of T2D. The main factor explaining reduced medication costs was better glycaemic control, independent of weight changes. Despite limitations precluding generalisability, cost-effective results of reduced medication should contribute to the evidence base required to promote lifestyle

  13. Medicare program; prospective payment system for long-term care hospitals RY 2009: annual payment rate updates, policy changes, and clarifications; and electronic submission of cost reports: revision to effective date of cost reporting period. Final rule.

    PubMed

    2008-05-09

    This final rule updates the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs). We are also consolidating the annual July 1 update for payment rates and the October 1 update for Medicare severity long-term care diagnosis-related group (MS-LTC-DRG) weights to a single rulemaking cycle that coincides with the Federal fiscal year (FFY). In addition, we are clarifying various policy issues. This final rule also finalizes the provisions from the Electronic Submission of Cost Reports: Revision to Effective Date of Cost Reporting Period interim final rule with comment period that was published in the May 27, 2005 Federal Register which revises the existing effective date by which all organ procurement organizations (OPOs), rural health clinics (RHCs), Federally qualified health centers (FQHCs), and community mental health centers (CMHCs) are required to submit their Medicare cost reports in a standardized electronic format from cost reporting periods ending on or after December 31, 2004 to cost reporting periods ending on or after March 31, 2005. This final rule does not affect the current cost reporting requirement for hospices and end-stage renal disease (ESRD) facilities. Hospices and ESRD facilities are required to continue to submit cost reports under the Medicare regulations in a standardized electronic format for cost reporting periods ending on or after December 31, 2004.

  14. Locked into Copenhagen pledges - Implications of short-term emission targets for the cost and feasibility of long-term climate goals

    SciTech Connect

    Riahi, Keywan; Kriegler, Elmar; Johnson, Nils; Bertram, Christoph; den Elzen, Michel; Eom, Jiyong; Schaeffer, Michiel; Edmonds, James A.; Isaac, Morna; Krey, Volker; Longden, Thomas; Luderer, Gunnar; Mejean, Aurelie; McCollum, David; Mima, Silvana; Turton, Hal; Van Vuuren, Detlef; Wada, Kenichi; Bosetti, Valentina; Capros, Pantelis; Criqui, Patrick; Hamdi-Cherif, Meriem; Kainuma, M.; Edenhofer, Ottmar

    2015-01-01

    This paper provides an overview of the AMPERE intermodeling comparison with focus on the implications of near-term policies for the costs and attainability of long-term climate objectives. Ten modeling teams participated in the project to explore the consequences of global emissions following the proposed policy stringency of the national pledges from the Copenhagen Accord and Cancún Agreements to 2030. Specific features compared to earlier assessments are the explicit consideration of near-term 2030 emissions targets as well as the systematic sensitivity analysis for the availability and potential of mitigation technologies. Our estimates show that a 2030 mitigation effort comparable to the pledges would result in a further "lock-in" of the energy system into fossil fuels and thus impede the required energy transformation to reach low greenhouse-gas stabilization levels (450ppm CO2e). Major implications include significant increases in mitigation costs, increased risk that low stabilization targets become unattainable, and reduced chances of staying below the proposed temperature change target of 2C. With respect to technologies, we find that following the pledge pathways to 2030 would narrow policy choices, and increases the risks that some currently optional technologies, such as nuclear or carbon capture and storage (CCS), will become "a must" by 2030.

  15. 42 CFR 447.56 - Limitations on premiums and cost sharing.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Indian who is eligible to receive or has received an item or service furnished by an Indian health care provider or through referral under contract health services is exempt from premiums. Indians who are currently receiving or have ever received an item or service furnished by an Indian health care provider...

  16. State trends in premiums and deductibles, 2003-2009: how building on the Affordable Care Act will help stem the tide of rising costs and eroding benefits.

    PubMed

    Schoen, Cathy; Stremikis, Kristof; How, Sabrina K H; Collins, Sara R

    2010-12-01

    Rapidly rising health insurance costs have strained U.S. families and employers in recent years. This issue brief examines data for all states on changes in private employer premiums and deductibles for 2003 and 2009. The analysis finds that premiums for businesses and their employees increased 41 percent across states from 2003 to 2009, while per-person deductibles jumped 77 percent in large as well as small firms. If these trends continue at the rate prior to enactment of the Affordable Care Act, the average premium for family coverage will rise 79 percent by 2020, to more than $23,000. The authors describe how health reform offers the potential to reduce insurance cost growth while improving value and protection. If reforms succeed in slowing premium growth by 1 percentage point annually in all states, by 2020 employers and families together will save $2,323 annually for family coverage, compared with projected trends.

  17. Transitions from private to public health coverage among children: estimating effects on out-of-pocket medical costs and health insurance premium costs.

    PubMed

    Shaefer, H Luke; Grogan, Colleen M; Pollack, Harold A

    2011-06-01

    To assess the effects of transitions from private to public health insurance by children on out-of-pocket medical expenditures and health insurance premium costs. Data are drawn from the 1996 and 2001 panels of the Survey of Income and Program Participation. We construct a nationally representative, longitudinal sample of children, ages 0-18, and their families for the period 1998-2003, a period in which states raised public health insurance eligibility rates for children. We exploit the Survey of Income and Program Participation's longitudinal design to identify children in our sample who transition from private to public health insurance. We then use a bootstrapped instrumental variable approach to estimate the effects of these transitions on out-of-pocket expenditures and health insurance premium costs. Children who transition from private to public coverage are relatively low-income, are disproportionately likely to live in single-mother households, and are more likely to be Black or of Hispanic origin. Child health status is highly predictive of transitions. We estimate that these transitions provide a cash-equivalent transfer of nearly U.S.$1,500 annually for families in the form of reduced out-of-pocket and health insurance premium costs. Transitions from private to public health coverage by children can bring important social benefits to vulnerable families. This suggests that instead of being a net societal cost, such transitions may provide an important social benefit. © Health Research and Educational Trust.

  18. Outcomes, cost comparison, and patient satisfaction during long-term central venous access in cancer patients: Experience from a Tertiary Care Cancer Institute in South India

    PubMed Central

    Babu, K. Govind; Suresh Babu, M. C.; Lokanatha, D.; Bhat, Gita R.

    2016-01-01

    Introduction: Prolonged treatment, frequent administration of chemotherapy, antibiotics and blood products in cancer patients requires long term venous access. Central venous catheters (CVC) inserted into the subclavian vein or internal jugular vein, peripherally inserted central venous catheters (PICC) and chemoport (CP) are the commonly used central venous access devices (CVAD). Aim: This study was envisaged to review our experience of CVADs over a one year period and analyze the outcome with regard to catheter life, reasons for removal, complications, patient satisfaction and cost comparison between the CVAD types in the Indian setting. Settings and Design: This was a prospective, observational study carried out in a tertiary care cancer institute. Materials and Methods: 180 CVADs placed in patients with hematological malignancies and solid tumors from January 2014 to December 2014 were included. Statistical Analysis Used: Data was analyzed using descriptive statistics, Mann Whitney U test. P <0.05 was taken as statistically significant. Results: 180 CVADs were placed in 160 patients. The median catheter indwelling period was 76 days (16 days to 313 days) for CVC, 59 days (20days – 313 days) for PICC and 137 days (70 days – 258 days) for CP. 66 out of 160 patients developed complications (41.2%). 108 complication events were noted in 66 patients. There were 40 episodes of CRBSI. Out of the 68 mechanical complications, 37 were encountered during insertion of the CVAD and 31 were during the catheter indwelling period. Out of 160 patients, 138 (86.25%) were satisfied with the CVAD. The cost incurred for CVC/PICC (INR 4,480) was lower than that for CP (INR 24,150) and it was statistically significant (P < 0.0001). Our patients were highly satisfied with the CVAD. Conclusion: Use of CVC and PICC is a safe, reliable and cost saving way of administration of chemotherapy in developing countries. The incidence of complications and catheter loss was acceptable. Our

  19. Long-term room-temperature hydrazine/air fuel cells based on low-cost nanotextured Cu-Ni catalysts

    NASA Astrophysics Data System (ADS)

    Filanovsky, Boris; Granot, Eran; Presman, Igor; Kuras, Iliya; Patolsky, Fernando

    2014-01-01

    We present here a long-term room-temperature (RT) direct-liquid hydrazine/air fuel cell device. This hydrazine/air fuel cell is based on low-cost easily-prepared nanotextured Cu-Ni anodes as the hydrazine (Hz) catalyst, combined with a commercial anion-exchange membrane film and a commercial air cathode. In addition, our hydrazine/air fuel cell consists on an improved novel design that results in remarkably high mechanical and chemical stabilities for long periods of operation. This hydrazine/air fuel cell can operates continuously for about ∼2000 h (limited mainly by cathode and membrane deterioration) with continuous fuel supply, and supplies about 0.58 V at 1 A (14.3 mA cm-2, with a discharge efficiency of about 70% (drift is less than 0.01% h-1), and appears to be suitable for mass production. The use of optimally-combined multi-metal electrodes suggests the possibility to create novel catalysts of improved electrochemical efficiency and stability. Our fuel cell devices can find broad applications in different civilian and military field mobile and stationary uses, for instance, in future fuel-cell operated vehicles and stationary back-up power electrical stations.

  20. Utilizing time-driven activity-based costing to understand the short- and long-term costs of treating localized, low-risk prostate cancer.

    PubMed

    Laviana, Aaron A; Ilg, Annette M; Veruttipong, Darlene; Tan, Hung-Jui; Burke, Michael A; Niedzwiecki, Douglas R; Kupelian, Patrick A; King, Chris R; Steinberg, Michael L; Kundavaram, Chandan R; Kamrava, Mitchell; Kaplan, Alan L; Moriarity, Andrew K; Hsu, William; Margolis, Daniel J A; Hu, Jim C; Saigal, Christopher S

    2016-02-01

    Given the costs of delivering care for men with prostate cancer remain poorly described, this article reports the results of time-driven activity-based costing (TDABC) for competing treatments of low-risk prostate cancer. Process maps were developed for each phase of care from the initial urologic visit through 12 years of follow-up for robotic-assisted laparoscopic prostatectomy (RALP), cryotherapy, high-dose rate (HDR) and low-dose rate (LDR) brachytherapy, intensity-modulated radiation therapy (IMRT), stereotactic body radiation therapy (SBRT), and active surveillance (AS). The last modality incorporated both traditional transrectal ultrasound (TRUS) biopsy and multiparametric-MRI/TRUS fusion biopsy. The costs of materials, equipment, personnel, and space were calculated per unit of time and based on the relative proportion of capacity used. TDABC for each treatment was defined as the sum of its resources. Substantial cost variation was observed at 5 years, with costs ranging from $7,298 for AS to $23,565 for IMRT, and they remained consistent through 12 years of follow-up. LDR brachytherapy ($8,978) was notably cheaper than HDR brachytherapy ($11,448), and SBRT ($11,665) was notably cheaper than IMRT, with the cost savings attributable to shorter procedure times and fewer visits required for treatment. Both equipment costs and an inpatient stay ($2,306) contributed to the high cost of RALP ($16,946). Cryotherapy ($11,215) was more costly than LDR brachytherapy, largely because of increased single-use equipment costs ($6,292 vs $1,921). AS reached cost equivalence with LDR brachytherapy after 7 years of follow-up. The use of TDABC is feasible for analyzing cancer services and provides insights into cost-reduction tactics in an era focused on emphasizing value. By detailing all steps from diagnosis and treatment through 12 years of follow-up for low-risk prostate cancer, this study has demonstrated significant cost variation between competing treatments. © 2015

  1. Medicaid program; premiums and cost sharing. Final rule; delay of effective data and reopening of comment period.

    PubMed

    2009-01-27

    In accordance with the memorandum of January 20, 2009, from the Assistant to the President and Chief of Staff, entitled "Regulatory Review Plan," this action temporarily delays for 60 days the effective date of the final rule entitled "Medicaid Program; Premiums and Cost Sharing" (73 FR 71828). The temporary 60-day delay in effective date is necessary to give Department officials the opportunity for further review and consideration of new regulations. In addition, this action reopens the comment period on the policies set out in the November 25, 2008 final rule.

  2. Cost-Effectiveness of Long-Term Ticagrelor in Patients With Prior Myocardial Infarction: Results From the PEGASUS-TIMI 54 Trial.

    PubMed

    Magnuson, Elizabeth A; Li, Haiyan; Wang, Kaijun; Vilain, Katherine; Shafiq, Ali; Bonaca, Marc P; Bhatt, Deepak L; Cohen, Marc; Steg, Philippe Gabriel; Storey, Robert F; Braunwald, Eugene; Sabatine, Marc S; Cohen, David J

    2017-08-01

    gained), and patients with peripheral artery disease (ICER = $13,427/QALY gained). For patients with a history of MI >1 year previously, long-term treatment with ticagrelor 60 mg + low-dose ASA yields a cost-effectiveness ratio suggesting intermediate value based on current guidelines. Ticagrelor appears to provide higher value for patients in several recognized high-risk subgroups. (Prevention of Cardiovascular Events [e.g., Death From Heart or Vascular Disease, Heart Attack, or Stroke] in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin [PEGASUS]; NCT01225562). Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  3. Long-term healthcare costs and functional outcomes associated with lack of remission in schizophrenia: a post-hoc analysis of a prospective observational study

    PubMed Central

    2012-01-01

    Background Little is known about the long-term outcomes for patients with schizophrenia who fail to achieve symptomatic remission. This post-hoc analysis of a 3-year study compared the costs of mental health services and functional outcomes between individuals with schizophrenia who met or did not meet cross-sectional symptom remission at study enrollment. Methods This post-hoc analysis used data from a large, 3-year prospective, non-interventional observational study of individuals treated for schizophrenia in the United States conducted between July 1997 and September 2003. At study enrollment, individuals were classified as non-remitted or remitted using the Schizophrenia Working Group Definition of symptom remission (8 core symptoms rated as mild or less). Mental health service use was measured using medical records. Costs were based on the sites’ medical information systems. Functional outcomes were measured with multiple patient-reported measures and the clinician-rated Quality of Life Scale (QLS). Symptoms were measured using the Positive and Negative Syndrome Scale (PANSS). Outcomes for non-remitted and remitted patients were compared over time using mixed effects models for repeated measures or generalized estimating equations after adjusting for multiple baseline characteristics. Results At enrollment, most of the 2,284 study participants (76.1%) did not meet remission criteria. Non-remitted patients had significantly higher PANSS total scores at baseline, a lower likelihood of being Caucasian, a higher likelihood of hospitalization in the previous year, and a greater likelihood of a substance use diagnosis (all p < 0.05). Total mental health costs were significantly higher for non-remitted patients over the 3-year study (p = 0.008). Non-remitted patients were significantly more likely to be victims of crime, exhibit violent behavior, require emergency services, and lack paid employment during the 3-year study (all p < 0.05). Non-remitted patients also

  4. PGE(1) treatment of severe intermittent claudication (short-term versus long-term, associated with exercise)--efficacy and costs in a 20-week, randomized trial.

    PubMed

    Belcaro, G; Nicolaides, A N; Agus, G; Cesarone, M R; Geroulakos, G; Pellegrini, L; De Sanctis, M T; Incandela, L; Ricci, A; Mondani, P; De Angelis, R; Ippolito, E; Barsotti, A; Vasdekis, S; Ledda, A; Christopoulos, D; Errichi, B M; Helmis, H; Cornelli, U; Ramaswami, G; Dugall, M; Bucci, M; Martines, G; Ferrari, P G; Corsi, M; Di Francescantonio, D

    2000-08-01

    The efficacy, safety, and cost of prostaglandin E1 (PGE1) in the treatment of severe intermittent claudication was studied comparing a long-term treatment protocol (LTP) with a short-term treatment protocol (STP) in a randomized 20-week study. The study included 980 patients (883 completed the study) with an average total walking distance of 85.5 +/-10 m (range 22-119). Phase 1 was a 2-week run-in phase (no treatment) for both protocols. In LTP, phase 2 was the main treatment phase. In the LTP, treatment was performed with 2-hour infusions (60 microg PGE1, 5 days each week for 4 weeks. In phase 3 (4-week interval period) PGE1 was administered twice a week (same dosage). In phase 4 (monitoring lasting 3 months, from week 9 to 20) no drugs were used. In STP phase 2 treatment was performed in 2 days by a 2-hour infusion (first day: morning 20 microg, afternoon 40 microg; second day morning and afternoon 60 microg). The reduced dosage was used only at the first cycle (week 0) to evaluate tolerability or side effects. Full dosage (60 microg bid) was used for all other cycles. The same cycle was repeated at the beginning of weeks 4, 8, and 12. The observation period was between weeks 12 and 20. A treadmill test was performed at inclusion, at the beginning of each phase, and at the end of 20th week. A similar progressive physical training plan (based on walking) and a reduction in risk factors levels plan was used in both groups. Intention-to-treat analysis indicated an increase in walking distance, which improved at 4 weeks and at 20 weeks in the STP more than in the LTP group. At 4 weeks the variation (increase) in pain-free walking (PFWD) was 167.8% (of the initial value) in the LTP group and 185% in the STP group (p<0.05). At 4 weeks the variation (increase) in total walking distance (TWD) was 227.6% of the initial value in the LTP group and 289% in the STP group (p<0.05). At 20 weeks the increase in PFWD was 496% of the initial value in the LTP group vs 643% in the

  5. Decision-analytic modeling to evaluate the long-term effectiveness and cost-effectiveness of HPV-DNA testing in primary cervical cancer screening in Germany.

    PubMed

    Sroczynski, Gaby; Schnell-Inderst, Petra; Mühlberger, Nikolai; Lang, Katharina; Aidelsburger, Pamela; Wasem, Jürgen; Mittendorf, Thomas; Engel, Jutta; Hillemanns, Peter; Petry, Karl Ulrich; Krämer, Alexander; Siebert, Uwe

    2010-04-27

    Persistent infections with high-risk types of human papillomavirus (HPV) are associated with the development of cervical neoplasia. Compared to cytology HPV testing is more sensitive in detecting high-grade cervical cancer precursors, but with lower specificity. HPV based primary screening for cervical cancer is currently discussed in Germany. Decisions should be based on a systematic evaluation of the long-term effectiveness and cost-effectiveness of HPV based primary screening. What is the long-term clinical effectiveness (reduction in lifetime risk of cervical cancer and death due to cervical cancer, life years gained) of HPV testing and what is the cost-effectiveness in Euro per life year gained (LYG) of including HPV testing in primary cervical cancer screening in the German health care context? How can the screening program be improved with respect to test combination, age at start and end of screening and screening interval and which recommendations should be made for the German health care context? A previously published and validated decision-analytic model for the German health care context was extended and adapted to the natural history of HPV infection and cervical cancer in order to evaluate different screening strategies that differ by screening interval, and tests, including cytology alone, HPV testing alone or in combination with cytology, and HPV testing with cytology triage for HPV-positive women. German clinical, epidemiological and economic data were used. In the absence of individual data, screening adherence was modelled independently from screening history. Test accuracy data were retrieved from international meta-analyses. Predicted outcomes included reduction in lifetime-risk for cervical cancer cases and deaths, life expectancy, lifetime costs, and discounted incremental cost-effectiveness ratios (ICER). The perspective of the third party payer and 3% annual discount rate were adopted. Extensive sensitivity analyses were performed in order

  6. Overseas Contingency Operations: OMB and DOD Should Revise the Criteria for Determining Eligible Costs and Identify the Costs Likely to Endure Long Term

    DTIC Science & Technology

    2017-01-01

    Abbreviations DOD Department of Defense FASAB Federal Accounting Standards Advisory Board GWOT Global War...guidance and the OMB’s criteria, developed in collaboration with DOD, to GAO’s Standards for Internal Control in the Federal Government that relate to...related actions with cost- estimating practices in the Handbook of Federal Accounting Standards and Standards for Internal Control in the Federal

  7. Long-term use and cost-effectiveness of secondary prevention drugs for heart disease in Western Australian seniors (WAMACH): a study protocol.

    PubMed

    Gunnell, Anthony S; Knuiman, Matthew W; Geelhoed, Elizabeth; Hobbs, Michael S T; Katzenellenbogen, Judith M; Hung, Joseph; Rankin, Jamie M; Nedkoff, Lee; Briffa, Thomas G; Ortiz, Michael; Gillies, Malcolm; Cordingley, Anne; Messer, Mitch; Gardner, Christian; Lopez, Derrick; Atkins, Emily; Mai, Qun; Sanfilippo, Frank M

    2014-09-18

    Secondary prevention drugs for cardiac disease have been demonstrated by clinical trials to be effective in reducing future cardiovascular and mortality events (WAMACH is the Western Australian Medication Adherence and Costs in Heart disease study). Hence, most countries have adopted health policies and guidelines for the use of these drugs, and included them in government subsidised drug lists to encourage their use. However, suboptimal prescribing and non-adherence to these drugs remains a universal problem. Our study will investigate trends in dispensing patterns of drugs for secondary prevention of cardiovascular events and will also identify factors influencing these patterns. It will also assess the clinical and economic consequences of non-adherence and the cost-effectiveness of using these drugs. This population-based cohort study will use longitudinal data on almost 40,000 people aged 65 years or older who were hospitalised in Western Australia between 2003 and 2008 for coronary heart disease, heart failure or atrial fibrillation. Linking of several State and Federal government administrative data sets will provide person-based information on drugs dispensed precardiac and postcardiac event, reasons for hospital admission, emergency department visits, mortality and medical visits. Dispensed drug trends will be described, drug adherence measured and their association with future all-cause/cardiovascular events will be estimated. The cost-effectiveness of these long-term therapies for cardiac disease and the impact of adherence will be evaluated. Human Research Ethics Committee (HREC) approvals have been obtained from the Department of Health (Western Australian #2011/62 and Federal) and the University of Western Australia (RA/4/1/1130), in addition to HREC approvals from all participating hospitals. Findings will be published in peer-reviewed medical journals and presented at local, national and international conferences. Results will also be disseminated

  8. Effectiveness and cost-effectiveness of a telehealth intervention to support the management of long-term conditions: study protocol for two linked randomized controlled trials

    PubMed Central

    2014-01-01

    Background As the population ages, more people are suffering from long-term health conditions (LTCs). Health services around the world are exploring new ways of supporting people with LTCs and there is great interest in the use of telehealth: technologies such as the Internet, telephone and home self-monitoring. Methods/Design This study aims to evaluate the effectiveness and cost-effectiveness of a telehealth intervention delivered by NHS Direct to support patients with LTCs. Two randomized controlled trials will be conducted in parallel, recruiting patients with two exemplar LTCs: depression or raised cardiovascular disease (CVD) risk. A total of 1,200 patients will be recruited from approximately 42 general practices near Bristol, Sheffield and Southampton, UK. Participants will be randomly allocated to either usual care (control group) or usual care plus the NHS Direct Healthlines Service (intervention group). The intervention is based on a conceptual model incorporating promotion of self-management, optimisation of treatment, coordination of care and engagement of patients and general practitioners. Participants will be provided with tailored help, combining telephone advice from health information advisors with support to use a range of online resources. Participants will access the service for 12 months. Outcomes will be collected at baseline, four, eight and 12 months for the depression trial and baseline, six and 12 months for the CVD risk trial. The primary outcome will be the proportion of patients responding to treatment, defined in the depression trial as a PHQ-9 score <10 and an absolute reduction in PHQ-9 ≥5 after 4 months, and in the CVD risk trial as maintenance or reduction of 10-year CVD risk after 12 months. The study will also assess whether the intervention is cost-effective from the perspective of the NHS and personal social services. An embedded qualitative interview study will explore healthcare professionals’ and patients’ views of

  9. Long-term impact of self-financed rotavirus vaccines on rotavirus-associated hospitalizations and costs in the Valencia Region, Spain.

    PubMed

    Orrico-Sanchez, Alejandro; López-Lacort, Mónica; Pérez-Vilar, Silvia; Díez-Domingo, Javier

    2017-04-11

    Rotavirus vaccines are available in Spain from 2007. They are recommended by the Spanish Pediatric Association, but not funded by the National Health System (NHS) and its coverage rate reached 40-50%. The hospitalization rate reduction of rotavirus caused gastroenteritis (RVAGE) directly attributable to vaccination remains unclear due to the large differences described in published studies, ranging from 14 to 44.5% in children <5 years of age, even with similar vaccination coverage. These results could be partly explained by variability in hospitalization policies, different study designs and the timeframe of observation. In addition, the direct economic impact of the reduction of hospitalizations has never been estimated. Therefore, there is a need to analyze the long-term impact of rotavirus vaccines on RVAGE and all cause gastroenteritis (AGE) hospitalizations and the national health system associated costs, minimizing potential confounders or biases. A population-based, ecological study using the hospital discharge registry's Minimum Basic Data Set (MBDS) and the vaccine register (SIV) was performed, among Valencia Region's children <5 years old, during 2002 - 2015. RVAGE and AGE hospitalization risk was analyzed by vaccine coverage and adjusted by the total hospitalization rate for all causes to avoid external biases. The impact of AGE-associated health care utilization in prevaccine (2003-2006) versus postvaccine (2008-2014) years was also assessed. After vaccines licensure, the incidence of RVAGE-associated hospitalizations decreased markedly. A general vaccine coverage-related reduction in RVAGE or AGE-hospitalizations risk was observed in all age groups. Compared with unvaccinated children, RVAGE hospitalization risk decreased by 67% (95% CI: 55-67), 71% (95% CI: 58-81) and 68% (95% CI: 18-92) in children 0, 1 and 4 years of age, respectively, with a vaccination coverage between 40 and 42%. Overall, the hospital related costs were reduced around EUR 6

  10. The Long-Term Safety, Public Health Impact, and Cost-Effectiveness of Routine Vaccination with a Recombinant, Live-Attenuated Dengue Vaccine (Dengvaxia): A Model Comparison Study

    PubMed Central

    Longini, Ira; Lourenco, Jose; Pearson, Carl A. B.; Reiner, Robert C.; Mier-y-Terán-Romero, Luis; Vannice, Kirsten

    2016-01-01

    Background Large Phase III trials across Asia and Latin America have recently demonstrated the efficacy of a recombinant, live-attenuated dengue vaccine (Dengvaxia) over the first 25 mo following vaccination. Subsequent data collected in the longer-term follow-up phase, however, have raised concerns about a potential increase in hospitalization risk of subsequent dengue infections, in particular among young, dengue-naïve vaccinees. We here report predictions from eight independent modelling groups on the long-term safety, public health impact, and cost-effectiveness of routine vaccination with Dengvaxia in a range of transmission settings, as characterised by seroprevalence levels among 9-y-olds (SP9). These predictions were conducted for the World Health Organization to inform their recommendations on optimal use of this vaccine. Methods and Findings The models adopted, with small variations, a parsimonious vaccine mode of action that was able to reproduce quantitative features of the observed trial data. The adopted mode of action assumed that vaccination, similarly to natural infection, induces transient, heterologous protection and, further, establishes a long-lasting immunogenic memory, which determines disease severity of subsequent infections. The default vaccination policy considered was routine vaccination of 9-y-old children in a three-dose schedule at 80% coverage. The outcomes examined were the impact of vaccination on infections, symptomatic dengue, hospitalised dengue, deaths, and cost-effectiveness over a 30-y postvaccination period. Case definitions were chosen in accordance with the Phase III trials. All models predicted that in settings with moderate to high dengue endemicity (SP9 ≥ 50%), the default vaccination policy would reduce the burden of dengue disease for the population by 6%–25% (all simulations: –3%–34%) and in high-transmission settings (SP9 ≥ 70%) by 13%–25% (all simulations: 10%– 34%). These endemicity levels are

  11. The Long-Term Safety, Public Health Impact, and Cost-Effectiveness of Routine Vaccination with a Recombinant, Live-Attenuated Dengue Vaccine (Dengvaxia): A Model Comparison Study.

    PubMed

    Flasche, Stefan; Jit, Mark; Rodríguez-Barraquer, Isabel; Coudeville, Laurent; Recker, Mario; Koelle, Katia; Milne, George; Hladish, Thomas J; Perkins, T Alex; Cummings, Derek A T; Dorigatti, Ilaria; Laydon, Daniel J; España, Guido; Kelso, Joel; Longini, Ira; Lourenco, Jose; Pearson, Carl A B; Reiner, Robert C; Mier-Y-Terán-Romero, Luis; Vannice, Kirsten; Ferguson, Neil

    2016-11-01

    Large Phase III trials across Asia and Latin America have recently demonstrated the efficacy of a recombinant, live-attenuated dengue vaccine (Dengvaxia) over the first 25 mo following vaccination. Subsequent data collected in the longer-term follow-up phase, however, have raised concerns about a potential increase in hospitalization risk of subsequent dengue infections, in particular among young, dengue-naïve vaccinees. We here report predictions from eight independent modelling groups on the long-term safety, public health impact, and cost-effectiveness of routine vaccination with Dengvaxia in a range of transmission settings, as characterised by seroprevalence levels among 9-y-olds (SP9). These predictions were conducted for the World Health Organization to inform their recommendations on optimal use of this vaccine. The models adopted, with small variations, a parsimonious vaccine mode of action that was able to reproduce quantitative features of the observed trial data. The adopted mode of action assumed that vaccination, similarly to natural infection, induces transient, heterologous protection and, further, establishes a long-lasting immunogenic memory, which determines disease severity of subsequent infections. The default vaccination policy considered was routine vaccination of 9-y-old children in a three-dose schedule at 80% coverage. The outcomes examined were the impact of vaccination on infections, symptomatic dengue, hospitalised dengue, deaths, and cost-effectiveness over a 30-y postvaccination period. Case definitions were chosen in accordance with the Phase III trials. All models predicted that in settings with moderate to high dengue endemicity (SP9 ≥ 50%), the default vaccination policy would reduce the burden of dengue disease for the population by 6%-25% (all simulations: -3%-34%) and in high-transmission settings (SP9 ≥ 70%) by 13%-25% (all simulations: 10%- 34%). These endemicity levels are representative of the participating sites in

  12. Long-term costs of inflated self-estimate on academic performance among adolescent students: a case of second-language achievements.

    PubMed

    Yang, Mu-Li; Chuang, Hsueh-Hua; Chiou, Wen-Bin

    2009-12-01

    Past studies suggest that the adaptive or maladaptive consequences of inflated self-estimate, one form of positive illusions, require further investigation. 308 freshmen at a junior college (164 women, 144 men; M age = 19.8 yr., SD = 1.1) participated in a longitudinal study during a 2-yr. period. There were three assessments of short- and long-term effects of overly positive self-estimates on second-language achievement. Students' overestimation of subsequent performance appears to be associated with lower achievement. Those students with apparently inflated self-estimates performed marginally better on the first assessment but worse in the second and final assessments. Students with more accurate self-estimates showed improvement on all assessments. The findings suggested that overinflated self-estimates, i.e., positive illusions, among adolescent students might lead to a lower achievement over the long-term.

  13. Long-term testing

    SciTech Connect

    Ferber, M.; Graves, G.A. Jr.

    1994-12-31

    Land-based gas turbines are significantly different from automotive gas turbines in that they are designed to operate for 50,000 h or greater (compared to 5,000--10,000 h). The primary goal of this research is to determine the long-term survivability of ceramic materials for industrial gas turbine applications. Research activities in this program focus on the evaluation of the static tensile creep and stress rupture (SR) behavior of three commercially available structural ceramics which have been identified by the gas turbine manufacturers as leading candidates for use in industrial gas turbines. For each material investigated, a minimum of three temperatures and four stresses will be used to establish the stress and temperature sensitivities of the creep and SR behavior. Because existing data for many candidate structural ceramics are limited to testing times less than 2,000 h, this program will focus on extending these data to times on the order of 10,000 h, which represents the lower limit of operating time anticipated for ceramic blades and vanes in gas turbine engines. A secondary goal of the program will be to investigate the possibility of enhancing life prediction estimates by combining interrupted tensile SR tests and tensile dynamic fatigue tests in which tensile strength is measured as a function of stressing rate. The third goal of this program will be to investigate the effects of water vapor upon the SR behavior of the three structural ceramics chosen for the static tensile studies by measuring the flexural strength as a function of stressing rate at three temperatures.

  14. Long-term cost-effectiveness of collaborative care (vs usual care) for people with depression and comorbid diabetes or cardiovascular disease: a Markov model informed by the COINCIDE randomised controlled trial

    PubMed Central

    Camacho, Elizabeth M; Ntais, Dionysios; Coventry, Peter; Bower, Peter; Lovell, Karina; Chew-Graham, Carolyn; Baguley, Clare; Gask, Linda; Dickens, Chris; Davies, Linda M

    2016-01-01

    Objectives To evaluate the long-term cost-effectiveness of collaborative care (vs usual care) for treating depression in patients with diabetes and/or coronary heart disease (CHD). Setting 36 primary care general practices in North West England. Participants 387 participants completed baseline assessment (collaborative care: 191; usual care: 196) and full or partial 4-month follow-up data were captured for 350 (collaborative care: 170; usual care: 180). 62% of participants were male, 14% were non-white. Participants were aged ≥18 years, listed on a Quality and Outcomes Framework register for CHD and/or type 1 or 2 diabetes mellitus, with persistent depressive symptoms. Patients with psychosis or type I/II bipolar disorder, actively suicidal, in receipt of services for substance misuse, or already in receipt of psychological therapy for depression were excluded. Intervention Collaborative care consisted of evidence-based low-intensity psychological treatments, delivered over 3 months and case management by a practice nurse and a Psychological Well Being Practitioner. Outcome measures As planned, the primary measure of cost-effectiveness was the incremental cost-effectiveness ratio (cost per quality-adjusted life year (QALY)). A Markov model was constructed to extrapolate the trial results from short-term to long-term (24 months). Results The mean cost per participant of collaborative care was £317 (95% CI 284 to 350). Over 24 months, it was estimated that collaborative care was associated with greater healthcare usage costs (net cost £674 (95% CI −30 953 to 38 853)) and QALYs (net QALY gain 0.04 (95% CI −0.46 to 0.54)) than usual care, resulting in a cost per QALY gained of £16 123, and a likelihood of being cost-effective of 0.54 (willingness to pay threshold of £20 000). Conclusions Collaborative care is a potentially cost-effective long-term treatment for depression in patients with comorbid physical and mental illness. The estimated

  15. Long-term cost-effectiveness of collaborative care (vs usual care) for people with depression and comorbid diabetes or cardiovascular disease: a Markov model informed by the COINCIDE randomised controlled trial.

    PubMed

    Camacho, Elizabeth M; Ntais, Dionysios; Coventry, Peter; Bower, Peter; Lovell, Karina; Chew-Graham, Carolyn; Baguley, Clare; Gask, Linda; Dickens, Chris; Davies, Linda M

    2016-10-07

    To evaluate the long-term cost-effectiveness of collaborative care (vs usual care) for treating depression in patients with diabetes and/or coronary heart disease (CHD). 36 primary care general practices in North West England. 387 participants completed baseline assessment (collaborative care: 191; usual care: 196) and full or partial 4-month follow-up data were captured for 350 (collaborative care: 170; usual care: 180). 62% of participants were male, 14% were non-white. Participants were aged ≥18 years, listed on a Quality and Outcomes Framework register for CHD and/or type 1 or 2 diabetes mellitus, with persistent depressive symptoms. Patients with psychosis or type I/II bipolar disorder, actively suicidal, in receipt of services for substance misuse, or already in receipt of psychological therapy for depression were excluded. Collaborative care consisted of evidence-based low-intensity psychological treatments, delivered over 3 months and case management by a practice nurse and a Psychological Well Being Practitioner. As planned, the primary measure of cost-effectiveness was the incremental cost-effectiveness ratio (cost per quality-adjusted life year (QALY)). A Markov model was constructed to extrapolate the trial results from short-term to long-term (24 months). The mean cost per participant of collaborative care was £317 (95% CI 284 to 350). Over 24 months, it was estimated that collaborative care was associated with greater healthcare usage costs (net cost £674 (95% CI -30 953 to 38 853)) and QALYs (net QALY gain 0.04 (95% CI -0.46 to 0.54)) than usual care, resulting in a cost per QALY gained of £16 123, and a likelihood of being cost-effective of 0.54 (willingness to pay threshold of £20 000). Collaborative care is a potentially cost-effective long-term treatment for depression in patients with comorbid physical and mental illness. The estimated cost per QALY gained was below the threshold recommended by English decision

  16. Individual decision making in the non-purchase of long-term care insurance.

    PubMed

    Curry, Leslie A; Robison, Julie; Shugrue, Noreen; Keenan, Patricia; Kapp, Marshall B

    2009-08-01

    Although prior research suggests that economic, behavioral, and psychosocial factors influence decisions not to purchase long-term care insurance, few studies have examined the interplay among these factors in depth and from the consumer's point of view. This study was intended to further illuminate these considerations, generate hypotheses about non-purchasing decisions, and inform the design of policies that are responsive to concerns and preferences of potential purchasers. Qualitative study using 32 in-depth interviews and 6 focus groups, following a grounded theory approach. Five themes characterize decisions not to purchase long-term care insurance: (a) the determination that a policy is "too costly" reflects highly individualized and complex trade-offs not solely economic in nature, (b) non-purchasers are skeptical about the viability and integrity of private insurance companies and seek an unbiased source of information, (c) family dynamics play an important role in insurance decisions, (d) contemplating personal risk for long-term care triggers psychological responses that have implications for decision making, and (e) non-purchasers feel inadequately informed and overwhelmed by the process of deciding whether to purchase long-term care insurance. States are seeking to offset escalating Medicaid long-term care expenditures through a variety of policy mechanisms, including stimulating individual purchase of long-term care insurance. Findings suggest that economic incentives such as lowering premiums will be necessary but not sufficient to attract appropriate candidates. Attention to behavioral and psychosocial factors is essential to designing incentives that are responsive to concerns and preferences of potential purchasers.

  17. 46 CFR Sec. 3 - Premiums.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 8 2011-10-01 2011-10-01 false Premiums. Sec. 3 Section 3 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION A-NATIONAL SHIPPING AUTHORITY BONDING OF SHIP'S PERSONNEL Sec. 3 Premiums. The bonds provided for shall be furnished without cost to the National Shipping Authority,...

  18. 46 CFR Sec. 3 - Premiums.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 8 2010-10-01 2010-10-01 false Premiums. Sec. 3 Section 3 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION A-NATIONAL SHIPPING AUTHORITY BONDING OF SHIP'S PERSONNEL Sec. 3 Premiums. The bonds provided for shall be furnished without cost to the National Shipping Authority, but...

  19. 46 CFR Sec. 3 - Premiums.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 8 2013-10-01 2013-10-01 false Premiums. Sec. 3 Section 3 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION A-NATIONAL SHIPPING AUTHORITY BONDING OF SHIP'S PERSONNEL Sec. 3 Premiums. The bonds provided for shall be furnished without cost to the National Shipping Authority, but...

  20. A cluster randomised controlled trial of the clinical and cost-effectiveness of a 'whole systems' model of self-management support for the management of long- term conditions in primary care: trial protocol

    PubMed Central

    2012-01-01

    Background Patients with long-term conditions are increasingly the focus of quality improvement activities in health services to reduce the impact of these conditions on quality of life and to reduce the burden on care utilisation. There is significant interest in the potential for self-management support to improve health and reduce utilisation in these patient populations, but little consensus concerning the optimal model that would best provide such support. We describe the implementation and evaluation of self-management support through an evidence-based 'whole systems' model involving patient support, training for primary care teams, and service re-organisation, all integrated into routine delivery within primary care. Methods The evaluation involves a large-scale, multi-site study of the implementation, effectiveness, and cost-effectiveness of this model of self-management support using a cluster randomised controlled trial in patients with three long-term conditions of diabetes, chronic obstructive pulmonary disease (COPD), and irritable bowel syndrome (IBS). The outcome measures include healthcare utilisation and quality of life. We describe the methods of the cluster randomised trial. Discussion If the 'whole systems' model proves effective and cost-effective, it will provide decision-makers with a model for the delivery of self-management support for populations with long-term conditions that can be implemented widely to maximise 'reach' across the wider patient population. Trial registration number ISRCTN: ISRCTN90940049 PMID:22280501

  1. Long-term contraceptives.

    PubMed

    Brown, Audrey

    2010-10-01

    To avoid unintended pregnancy, women in the UK need to consistently use reliable contraception for over 30 years. The long-acting reversible contraceptive methods compromise the progestogen-only implant, the progestogen-only injectable contraceptive, the copper-bearing intra-uterine device and the levonorgestrel-releasing intra-uterine system. These methods of contraception are highly reliable in pregnancy prevention, and are amongst the medically safest methods for users. Despite this, these long-acting methods are used by less than 10% of the UK population. National guidance has advised that increasing uptake of these long-acting methods will reduce the unplanned pregnancy rate. In addition, these methods are more cost effective than the oral contraceptive even at 1 year of use. Obstetricians and gynaecologists frequently come into contact with women requiring contraceptive advice, and should have a sound knowledge of the long-acting methods.

  2. Long-term environmental stewardship.

    SciTech Connect

    Nagy, Michael David

    2010-08-01

    The purpose of this Supplemental Information Source Document is to effectively describe Long-Term Environmental Stewardship (LTES) at Sandia National Laboratories/New Mexico (SNL/NM). More specifically, this document describes the LTES and Long-Term Stewardship (LTS) Programs, distinguishes between the LTES and LTS Programs, and summarizes the current status of the Environmental Restoration (ER) Project.

  3. Long-term urethral catheterisation.

    PubMed

    Turner, Bruce; Dickens, Nicola

    This article discusses long-term urethral catheterisation, focusing on the relevant anatomy and physiology, indications for the procedure, catheter selection and catheter care. It is important that nurses have a good working knowledge of long-term catheterisation as the need for this intervention will increase with the rise in chronic health conditions and the ageing population.

  4. Presynaptic long-term plasticity

    PubMed Central

    Yang, Ying; Calakos, Nicole

    2013-01-01

    Long-term synaptic plasticity is a major cellular substrate for learning, memory, and behavioral adaptation. Although early examples of long-term synaptic plasticity described a mechanism by which postsynaptic signal transduction was potentiated, it is now apparent that there is a vast array of mechanisms for long-term synaptic plasticity that involve modifications to either or both the presynaptic terminal and postsynaptic site. In this article, we discuss current and evolving approaches to identify presynaptic mechanisms as well as discuss their limitations. We next provide examples of the diverse circuits in which presynaptic forms of long-term synaptic plasticity have been described and discuss the potential contribution this form of plasticity might add to circuit function. Finally, we examine the present evidence for the molecular pathways and cellular events underlying presynaptic long-term synaptic plasticity. PMID:24146648

  5. Valuing a long-term care facility.

    PubMed

    Mellen, C M

    1992-10-01

    The business valuation industry generally uses at least one of three basic approaches to value a long-term care facility: the cost approach, sales comparison approach, or income approach. The approach that is chosen and the resulting weight that is applied to it depend largely on the circumstances involved. Because a long-term care facility is a business enterprise, more weight usually is given to the income approach which factors into the estimate of value both the tangible and intangible assets of the facility.

  6. [Concept for a health care economic evaluation of short- and long-term costs and effectiveness parameters of an expanded ambulatory psychosomatic rehabilitation program].

    PubMed

    Albrecht, M; Krauth, C; Rieger, J; Lamprecht, F; Kersting, A; Schwartz, F W

    2000-03-01

    There are only few ambulatory rehabilitation concepts for mothers with psychosomatic disorders (prevalence 5%). Also, only little is known about the evaluation of these programmes. This study compares the socioeconomic evaluations of an ambulatory rehabilitation programme with a post-assistance programme and one without a post-assistance programme. The superior programme should be determined by weighing all relevant costs and benefits. The intensive phase of the ambulatory rehabilitation programme consists of an eight-week treatment with group, single, body and art therapy. The post-assistance programme spans a period of nine-months with 36 sessions of psychoanalytic group therapy. The evaluation of both programme alternatives is made by with the evaluation tool of socioeconomic analyses. For consideration and pricing of costs all direct medical costs, direct non-medical costs and indirect costs are being monitored. Outcomes assessment is realised by cost-effectiveness analysis, cost-utility analysis and cost-benefit analysis. Utilisation of the health care system is being assessed with questionnaires. Measurements are being performed at the beginning and the end of the rehabilitation programme and three, six, nine and twelve months later. Mothers with children aged six years and younger and suffering from various psychosomatic disorders were included in this study. The costs identified for the rehabilitation programme are DM 5571.10 (intensive care and post-assistance programme) and DM 1512.40 (intensive care) per patient. Further progress of the study will show if future cost will differ between the two alternatives. For the comparison of both alternatives all costs will be linked with outcomes. It remains to be seen that additional costs of the post-assistance programme will be compensated with positive outcomes. A sensitivity analysis will show if variation of assumptions will influence the cost-benefit-ratio of the different alternatives.

  7. Why make premium diesel?

    SciTech Connect

    Pipenger, G.G.

    1997-01-01

    In the last issue of Hart`s Fuel Technology & Management (Vol. 6, No. 6, pp. 62-64), a discussion of the evolution of premium diesel fuels in the US and Europe was begun. Cetane and ignition improvers were discussed. In this concluding article, different additive components such as fuel stabilizers, corrosion inhibitors and lubricity additives are reviewed--all of which are key components of any top-quality diesel fuel today. An excerpt from {open_quotes}The Making of Premium Diesel,{close_quotes} which categorizes (costs, benefits, dosage rates) the additives necessary to improve diesel quality is presented.

  8. Long Term Surface Salinity Measurements

    NASA Technical Reports Server (NTRS)

    Schmitt, Raymond W.; Brown, Neil L.

    2005-01-01

    Our long-term goal is to establish a reliable system for monitoring surface salinity around the global ocean. Salinity is a strong indicator of the freshwater cycle and has a great influence on upper ocean stratification. Global salinity measurements have potential to improve climate forecasts if an observation system can be developed. This project is developing a new internal field conductivity cell that can be protected from biological fouling for two years. Combined with a temperature sensor, this foul-proof cell can be deployed widely on surface drifters. A reliable in-situ network of surface salinity sensors will be an important adjunct to the salinity sensing satellite AQUARIUS to be deployed by NASA in 2009. A new internal-field conductivity cell has been developed by N Brown, along with new electronics. This sensor system has been combined with a temperature sensor to make a conductivity - temperature (UT) sensor suitable for deployment on drifters. The basic sensor concepts have been proven on a high resolution CTD. A simpler (lower cost) circuit has been built for this application. A protection mechanism for the conductivity cell that includes antifouling protection has also been designed and built. Mr. A.Walsh of our commercial partner E-Paint has designed and delivered time-release formulations of antifoulants for our application. Mr. G. Williams of partner Clearwater Instrumentation advised on power and communication issues and supplied surface drifters for testing.

  9. Cost effectiveness of interferon-gamma release assay for tuberculosis screening using three months of rifapentine and isoniazid among long-term expatriates from low to high incidence countries.

    PubMed

    Kowada, Akiko

    Long-term expatriates from low to high tuberculosis (TB) incidence countries get high rates of active TB and latent TB infection (LTBI). TB screening for expatriates is important for occupational health. Interferon-gamma release assays are more accurate than tuberculin skin test (TST). Rifapentine plus isoniazid for 3 months (3HP) is as effective as 9 months of isoniazid (9H) with a higher treatment-completion rate. Decision trees and Markov models were constructed using a societal perspective on a lifetime horizon. The target population was a hypothetical cohort of 30 year-old expatriates. Seven strategies; TST with 3HP or 9H, QuantiFERON(®)-TB Gold In-Tube (QFT) with 3HP or 9H, T-SPOT(®).TB (TSPOT) with 3HP or 9H and chest X-ray examination (CXR) were modeled. The main outcome measure of effectiveness was quality-adjusted life-years (QALYs) gained. QFT with 3HP yielded the greatest benefits with the lowest cost ($US 674.8; 25.95660 QALYs [year 2012 values]). CXR was the least cost-effective ($US 13,666.8; 24.62917 QALYs). Cost-effectiveness was sensitive to adherence rate of 3HP and QFT specificity, but not to BCG vaccination rate. Entry LTBI screening using QFT treated with 3HP is recommended on the basis of cost effectiveness among long-term expatriates from low to high incidence countries. Copyright © 2016 Elsevier Ltd. All rights reserved.

  10. A new, low cost, locking plate for the long-term fixation of a critical size bone defect in the ratfemur: in vivo performance, biomechanical and finite element analysis.

    PubMed

    Mataliotakis, George I; Tsouknidas, Alexander; Panteliou, Sofia; Vekris, Marios D; Mitsionis, Grigorios I; Agathopoulos, Simeon; Beris, Alexander E

    2015-01-01

    The optimum fixation device for the critical size bone defect is not established yet. A reliable, feasible and low-cost fixation device for the long-term maintenance of a critical bone defect. A custom-made plate made of poly-methyl-methacrylate was used for the fixation of a critical defect of rats' femurs. The screws were securely fixing both on the plate and the bone. A three point bending test, aimed to resemble the in vivo loading pattern, a Finite Element Analysis and a 24-week in vivo monitoring of the integrity of the plate fixation were utilized. The plate has linear and reproducible behavior. It presents no discontinuities in the stress field of the fixation. Its properties are attributed to the material and the locking principle. It fails beyond the level of magnitude of the normal ambulatory loads. In vivo, 100% of the plates maintained the bone defect intact up to 12 weeks and 85% of them at 24 weeks. This novel locking plate shows optimal biomechanical performance and reliability with high long-term in vivo survival rate. It is fully implantable, inexpensive and easily manufactured. It can be qualified for long term critical defect fixation in bone regeneration studies.

  11. The Long-Term Effectiveness of Reading Recovery and the Cost-Efficiency of Reading Recovery Relative to the Learning Disabled Classification Rate

    ERIC Educational Resources Information Center

    Galluzzo, Charles A.

    2010-01-01

    There is a great deal of research supporting Reading Recovery as a successful reading intervention program that assists below level first graders readers in closing the gap in reading at the same level of their average peers. There is a lack of research that analyses the cost-effectiveness of the Reading Recovery program compared to the cost in…

  12. The Long-Term Effectiveness of Reading Recovery and the Cost-Efficiency of Reading Recovery Relative to the Learning Disabled Classification Rate

    ERIC Educational Resources Information Center

    Galluzzo, Charles A.

    2010-01-01

    There is a great deal of research supporting Reading Recovery as a successful reading intervention program that assists below level first graders readers in closing the gap in reading at the same level of their average peers. There is a lack of research that analyses the cost-effectiveness of the Reading Recovery program compared to the cost in…

  13. Short- and long-term effects of gestational diabetes mellitus on healthcare cost: a cross-sectional comparative study in the ATLANTIC DIP cohort.

    PubMed

    Danyliv, A; Gillespie, P; O'Neill, C; Noctor, E; O'Dea, A; Tierney, M; McGuire, B; Glynn, L G; Dunne, F

    2015-04-01

    This paper examines the association between gestational diabetes mellitus and costs of care during pregnancy and 2-5 years post pregnancy. Healthcare utilization during pregnancy was measured for a sample of 658 women drawn from the Atlantic Diabetes in Pregnancy (ATLANTIC DIP) network. Healthcare utilization 2-5 years post pregnancy was assessed for a subsample of 348 women via a postal questionnaire. A vector of unit costs was applied to healthcare activity to calculate the costs of care at both time points. Differences in cost for women with gestational diabetes mellitus compared with those with normal glucose tolerance during the pregnancy were examined using univariate and multivariate regression analyses. Gestational diabetes mellitus was independently associated with an additional €817.60 during pregnancy (€1192.1 in the gestational diabetes mellitus group, €511.6 in the normal glucose tolerance group), in the form of additional delivery and neonatal care costs, and an additional €680.50 in annual healthcare costs 2-5 years after the index pregnancy (€6252.4 in the gestational diabetes mellitus group, €5434.8 in the normal glucose tolerance group). These results suggest that gestational diabetes mellitus is associated with increased costs of care during and post pregnancy. They provide indication of the associated cost that can be avoided or reduced by the screening, prevention and management of gestational diabetes mellitus in pregnancy. These estimates are useful for further studies that examine the cost and cost-effectiveness of such programmes. © 2014 The Authors. Diabetic Medicine © 2014 Diabetes UK.

  14. Cost-Effectiveness of Long-Term Every Three-Year Versus Annual Postoperative Surveillance for Low-Risk Papillary Thyroid Cancer.

    PubMed

    Wu, James X; Beni, Catherine E; Zanocco, Kyle A; Sturgeon, Cord; Yeh, Michael W

    2015-07-01

    Patients with low-risk papillary thyroid cancer (PTC) who demonstrate an excellent response to initial therapy have a 2% recurrence rate and 100% disease-specific survival within 10 years. Thus, annual surveillance may be excessive. We hypothesized that less frequent postoperative surveillance in these patients is cost effective. A Markov discrete time state transition model was created to compare postoperative surveillance tapered to 3-year intervals after 5 years of annual surveillance versus conventional annual surveillance in low-risk PTC patients with negative neck ultrasound and stimulated thyroglobulin less than 2 ng/mL 1 year postoperatively. Outcome probabilities, utilities, and costs were determined via literature review, the Medicare Physician Fee Schedule, and Healthcare Cost and Utilization Project data. Sensitivity analyses were performed to assess areas of uncertainty. The cost of annual surveillance was $5,239 per patient and yielded 22.49 quality-adjusted life-years (QALYs). The 3-year strategy cost $2,601 less, but also yielded 0.01 less QALYs. Thus, the incremental cost per QALY of annual surveillance was $260,100. Probabilistic sensitivity analysis demonstrated that less frequent surveillance was more cost effective in 99.98% of 10,000 simulated patients. One-way sensitivity analysis revealed that annual surveillance would be cost effective if the total cost of neck ultrasound could be reduced to $23 or less. Extending postoperative surveillance to 3-year intervals after 5 years of annual surveillance in patients with low-risk PTC with excellent response to therapy is more cost effective than annual surveillance.

  15. An economic model demonstrating the long-term cost benefits of incorporating fertility control into wild horse (Equus caballus) management programs on public lands in the United States.

    PubMed

    de Seve, Charles W; Griffin, Stephanie L Boyles

    2013-12-01

    In recent years, the Bureau of Land Management's (BLM) Wild Horse and Burro Management program costs have increased dramatically due to a rise in the number of animals removed from public lands coupled with significantly decreased adoption rates. To assist with development and implementation of effective, cost-containing management programs, a robust economic model to project the costs and optimize outcomes of various management scenarios was created. For example, preliminary demonstration model runs show that by gradually replacing "removal-only" programs with contraception-and-removal programs on one hypothetical Herd Management Area (HMA), the BLM could save about US$8 million over 12 years while maintaining an area target population of 874 horses. Because the BLM estimates that more than 38,000 wild horses roam on 179 HMAs in the United States, the use of this economic model could result in a cost-savings of tens of millions of dollars if applied broadly across all HMAs.

  16. A modeling framework for optimal long-term care insurance purchase decisions in retirement planning.

    PubMed

    Gupta, Aparna; Li, Lepeng

    2004-05-01

    The level of need and costs of obtaining long-term care (LTC) during retired life require that planning for it is an integral part of retirement planning. In this paper, we divide retirement planning into two phases, pre-retirement and post-retirement. On the basis of four interrelated models for health evolution, wealth evolution, LTC insurance premium and coverage, and LTC cost structure, a framework for optimal LTC insurance purchase decisions in the pre-retirement phase is developed. Optimal decisions are obtained by developing a trade-off between post-retirement LTC costs and LTC insurance premiums and coverage. Two-way branching models are used to model stochastic health events and asset returns. The resulting optimization problem is formulated as a dynamic programming problem. We compare the optimal decision under two insurance purchase scenarios: one assumes that insurance is purchased for good and other assumes it may be purchased, relinquished and re-purchased. Sensitivity analysis is performed for the retirement age.

  17. Costs and resource use following defunctioning stoma in low anterior resection for cancer - A long-term analysis of a randomized multicenter trial.

    PubMed

    Floodeen, H; Hallböök, O; Hagberg, L A; Matthiessen, P

    2017-02-01

    Defunctioning stoma in low anterior resection (LAR) for rectal cancer can prevent major complications, but overall cost-effectiveness for the healthcare provider is unknown. This study compared inpatient healthcare resources and costs within 5 years of LAR between two randomized groups of patients undergoing LAR with and without defunctioning stoma. Five-year follow-up of a randomized, multicenter trial on LAR (NCT 00636948) with (stoma; n = 116) or without (no stoma; n = 118) defunctioning stoma comparing inpatient healthcare resources and costs. Unplanned stoma formation, days with stoma, length of hospital stay, reoperations, and total associated inpatient costs were analyzed. Average costs were € 21.663 per patient with defunctioning stoma and € 15.922 per patient without defunctioning stoma within 5 years of LAR, resulting in an average cost-saving of € 5.741. There was no difference between groups regarding the total number of days with any stoma (stoma = 33 398 vs. no stoma = 34 068). The total number of unplanned reoperations were 70 (no stoma) and 32 (stoma); p < 0.001. In the group randomized to no stoma at LAR, 30.5% (36/118) required an unplanned stoma later. Randomization to defunctioning stoma in LAR was more expensive than no stoma, despite the cost-savings associated with a reduced frequency of anastomotic leakage. Both groups required the same total number of days with a stoma within five years of LAR. Copyright © 2016 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

  18. Long-Term Cost-Effectiveness of Upper Airway Stimulation for the Treatment of Obstructive Sleep Apnea: A Model-Based Projection Based on the STAR Trial.

    PubMed

    Pietzsch, Jan B; Liu, Shan; Garner, Abigail M; Kezirian, Eric J; Strollo, Patrick J

    2015-05-01

    Upper airway stimulation (UAS) is a new approach to treat moderate-to-severe obstructive sleep apnea. Recently, 12-month data from the Stimulation Treatment for Apnea Reduction (STAR) trial were reported, evaluating the effectiveness of UAS in patients intolerant or non-adherent to continuous positive airway pressure therapy. Our objective was to assess the cost-effectiveness of UAS from a U.S. payer perspective. A 5-state Markov model was used to predict cardiovascular endpoints (myocardial infarction [MI], stroke, hypertension), motor vehicle collisions (MVC), mortality, quality-adjusted life years (QALYs), and costs. We computed 10-year relative event risks and the lifetime incremental cost-effectiveness ratio (ICER) in $/QALY, comparing UAS therapy to no treatment under the assumption that the STAR trial-observed reduction in mean apnea-hypopnea index from 32.0 to 15.3 events/h was maintained. Costs and effects were discounted at 3% per year. U.S. healthcare system; third-party payer perspective. 83% male cohort with mean age of 54.5 years. UAS vs. no treatment. UAS substantially reduced event probabilities over 10 years (relative risks: MI 0.63; stroke 0.75; MVC 0.34), and was projected to add 1.09 QALYs over the patient's lifetime. Costs were estimated to increase by $42,953, resulting in a lifetime ICER of $39,471/QALY. Relative to the acknowledged willingness-to-pay threshold of $50,000-$100,000/QALY, our results indicate upper airway stimulation is a cost-effective therapy in the U.S. healthcare system. © 2015 Associated Professional Sleep Societies, LLC.

  19. Workers' decisions to take-up offered health insurance coverage: assessing the importance of out-of-pocket premium costs.

    PubMed

    Cooper, Philip F; Vistnes, Jessica

    2003-07-01

    Many proposed policy initiatives involve subsidies directed toward encouraging employers to offer coverage and toward workers to encourage enrollment in offered plans. Given that insurance coverage reflects employers' decisions to offer coverage, eligibility requirements for such coverage, and employees' take-up decisions, all three elements are important when considering mechanisms to decrease the number of uninsured individuals. In this study, we examine the relationship between workers' decisions to take-up offers of health insurance and annual out-of-pocket contributions, total premiums, and employer and workforce characteristics. We model the take-up decision using cross-sectional data from approximately 18,000 establishments per year from the 1997 to 1999 Medical Expenditure Panel Survey - Insurance Component. We find that workers are less likely to enroll in coverage as single employee contributions increase. Our results for family contributions are much smaller than for single contributions and are not statistically significant in all years. Our simulation results suggest that reducing employee contribution levels for single coverage from existing levels in 1999 to zero would yield an increase in take-up rates of roughly 6% points in establishments that had required a positive level of contributions. Our results also indicate that of the 13.8 million private sector workers who decline coverage from their employers, 2.5 million would potentially enroll in employer-sponsored coverage if the cost of single coverage were to fall to zero. Reducing employee contributions will increase take-up rates; however, even when employees pay nothing for their coverage, some employees elect not to enroll.

  20. 41 CFR 301-11.15 - What expenses may be considered part of the daily lodging cost when I rent on a long-term basis?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 41 Public Contracts and Property Management 4 2010-07-01 2010-07-01 false What expenses may be... Public Contracts and Property Management Federal Travel Regulation System TEMPORARY DUTY (TDY) TRAVEL... the price of a hotel/motel room in the area concerned, the cost of special user fees (e.g., cable TV...

  1. AB055. Long term NIV

    PubMed Central

    Siopi, Dimitra

    2016-01-01

    role of long term NIV remains controversial in patients with chronic hypercapnic respiratory failure attributed to COPD. This happens because RCTs haven’t been able to prove benefits in survival, although the settings used in those trials seem to be insufficient to correct hypercapnia. According to more recent data higher pressure (high-intensity NIV) with the goal of achieving normocapnia can improve exercise tolerance, quality of life and survival. Obesity hypoventilation syndrome on the other hand is gradually receiving clinical interest and is recognized as a significant cause of morbidity and mortality, with a beneficial role of NIV in improving survival, hospitalizations and health related quality of life, thus reducing healthcare cost. Despite the improved awareness of the medical world dealing with the obesity epidemic, the syndrome is still under-diagnosed. Any medical specialty should perceive the value of controlling those patients in order to offer the optimal type of mechanical ventilation, depending on the underlying type of the respiratory disorder (obstructive episodes or pure hypoventilation). Patients with congestive heart failure can suffer from central sleep apnoea, OSA and Cheyne-Stokes respiration with a negative impact in their clinical outcome. CPAP therapy is indicated in resolving obstructive apnea, but is ineffective in case of central sleep apnea or Cheyne-Stokes breathing. The initial enthusiasm for assisted servo ventilation (ASV) use in this group of patients was not confirmed by a multicentre RCT (which showed increased mortality) and this type of ventilation is no longer recommended in heart failure patients with CSA and ejection fraction <45%. Scarce data exist regarding long-term NIV in patients with Cystic Fibrosis, bronchiectasis and interstitial lung diseases .It seems though that with careful patient selection NIV can play an important role in the management of those patients, even serving as a bridge to transplantation

  2. Long-term impact of a chronic disease management program on hospital utilization and cost in an Australian population with heart disease or diabetes.

    PubMed

    Hamar, G Brent; Rula, Elizabeth Y; Coberley, Carter; Pope, James E; Larkin, Shaun

    2015-04-22

    To evaluate the longitudinal value of a chronic disease management program, My Health Guardian (MHG), in reducing hospital utilization and costs over 4 years. The MHG program provides individualized support via telephonic nurse outreach and online tools for self-management, behavior change and well-being. In follow up to an initial 18-month analysis of MHG, the current study evaluated program impact over 4 years. A matched-cohort analysis retrospectively compared MHG participants with heart disease or diabetes (treatment, N = 4,948) to non-participants (comparison, N = 28,520) on utilization rates (hospital admission, readmission, total bed days) and hospital claims cost savings. Outcomes were evaluated using regression analyses, controlling for remaining demographic, disease, and pre-program admissions or cost differences between the study groups. Over the 4 year period, program participation resulted in significant reductions in hospital admissions (-11.4%, P < 0.0001), readmissions (-36.7%, P < 0.0001), and bed days (-17.2%, P < 0.0001). The effect size increased over time for admissions and bed days. The relative odds of any admission and readmission over the 4 years were 27% and 45% lower, respectively, in the treatment group. Cumulative program savings from reduced hospital claims was $3,549 over 4-years; savings values for each program year were significant and increased with time (P = 0.003 to P < 0.0001). Savings calculations did not adjust for pooled costs (and savings) in Australia's risk equalization system for private insurers. Results confirm and extend prior program outcomes and support the longitudinal value of the MHG program in reducing hospital utilization and costs for individuals with heart disease or diabetes and demonstrate the increasing program effect with continued participation over time.

  3. Long-term socio-economic consequences and health care costs of poliomyelitis: a historical cohort study involving 3606 polio patients.

    PubMed

    Nielsen, Nete Munk; Kay, Lise; Wanscher, Benedikte; Ibsen, Rikke; Kjellberg, Jakob; Jennum, Poul

    2016-06-01

    Worldwide 10-20 million individuals are living with disabilities after acute poliomyelitis. However, very little is known about the socio-economic consequences and health care costs of poliomyelitis. We carried out a historical register-based study including 3606 individuals hospitalised for poliomyelitis in Copenhagen, Denmark 1940-1954, and 13,795 age and gender-matched Danes. Participants were followed from 1980 until 2012, and family, socio-economic conditions and health care costs were evaluated in different age groups using chi-squared tests, boot-strapped t tests or hazard ratios (HR) calculated in Cox-regression models. The analyses were performed separately for paralytic and non-paralytic polio survivors and their controls, respectively. Compared with controls a higher percentage of paralytic polio survivors remained childless, whereas no difference was observed for non-paralytic polio survivors. The educational level among paralytic as well as non-paralytic polio survivors was higher than that among their controls, employment rate at the ages of 40, 50 and 60 years was slightly lower, whereas total income in the age intervals of 31-40, 41-50 and 51-60 years were similar to controls. Paralytic and non-paralytic polio survivors had a 2.5 [HR = 2.52 (95 % confidence interval (CI); 2.29-2.77)] and 1.4 [HR = 1.35 (95 % CI; 1.23-1.49)]-fold higher risk, respectively, of receiving disability pension compared with controls. Personal health care costs were considerably higher in all age groups in both groups of polio survivors. Individuals with a history of poliomyelitis are well educated, have a slightly lower employment rate, an income similar to controls, but a considerably higher cost in the health care system.

  4. European long-term care programs: lessons for community living assistance services and supports?

    PubMed

    Nadash, Pamela; Doty, Pamela; Mahoney, Kevin J; Von Schwanenflugel, Matthias

    2012-02-01

    To uncover lessons from abroad for Community Living Assistance Services and Supports (CLASS), a federally run voluntary public long-term care (LTC) insurance program created under the Accountable Care Act of 2010. Program administrators and policy researchers from Austria, England, France, Germany, and the Netherlands. Qualitative methods focused on key parameters of cash for care: how programs set benefit levels; project expenditures; control administrative costs; regulate the use of benefits; and protect workers. Structured discussions were conducted during an international conference of LTC experts, followed by personal meetings and individual correspondence. Germany's self-financing mandate and tight targeting of benefits have resulted in a solvent program with low premiums. Black markets for care are likely in the absence of regulation; France addresses this via a unique system ensuing legal payment of workers. Programs in the five countries studied have lessons, both positive and negative, relevant to CLASS design. © Health Research and Educational Trust.

  5. Titanium for long-term tritium storage

    SciTech Connect

    Heung, L.K.

    1994-12-01

    Due to the reduction of nuclear weapon stockpile, there will be an excess of tritium returned from the field. The excess tritium needs to be stored for future use, which might be several years away. A safe and cost effective means for long term storage of tritium is needed. Storing tritium in a solid metal tritide is preferred to storing tritium as a gas, because a metal tritide can store tritium in a compact form and the stored tritium will not be released until heat is applied to increase its temperature to several hundred degrees centigrade. Storing tritium as a tritide is safer and more cost effective than as a gas. Several candidate metal hydride materials have been evaluated for long term tritium storage. They include uranium, La-Ni-Al alloys, zirconium and titanium. The criteria used include material cost, radioactivity, stability to air, storage capacity, storage pressure, loading and unloading conditions, and helium retention. Titanium has the best combination of properties and is recommended for long term tritium storage.

  6. Adaptive Long-Term Monitoring at Environmental Restoration Sites

    DTIC Science & Technology

    2009-11-01

    bounds value that is a potential concern. .............. 27 Figure 6. Conceptual example to illustrate temporal interpolation issue...Force Base HMSI Hazard Management Systems, Inc. IDW inverse distance weighting LTM long term monitoring LTMO long-term monitoring...provided the best representation of the plumes with Model Builder. • SO provided useful trade-off curves of sampling cost versus the interpolation

  7. 47 CFR 54.303 - Long term support.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... base-level of Long Term Support for 1998, the Administrator shall calculate the difference between the.... (2) To calculate Long Term Support for calendar year 1998, the Administrator shall adjust the base...; and (4) The line port costs in excess of basic analog service pursuant to § 69.130 of this...

  8. 47 CFR 54.303 - Long term support.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... base-level of Long Term Support for 1998, the Administrator shall calculate the difference between the.... (2) To calculate Long Term Support for calendar year 1998, the Administrator shall adjust the base...; and (4) The line port costs in excess of basic analog service pursuant to § 69.130 of this...

  9. Workshop on long-term contraceptives.

    PubMed

    1996-01-01

    The National Population Council Secretariat (NPCS) of Ghana held a three-day workshop on long-term contraceptives in 1996 in collaboration with the Ministry of Health, the Association of Voluntary Surgical Contraception, and the Johns Hopkins Population Communication Services. The session was funded by USAID. The executive director of NPCS, Dr. Richard Turkson, said that the slow rate of contraceptive acceptance was an obstacle to population control despite political concern that rapid population growth exerted an adverse impact on the economy. Only 10% of married women were using long-term or permanent methods of contraception. The hope was voiced that the participants would devise practical and cost-effective education, information, and communication (IEC) strategies to boost the demand for long-term contraceptive methods among sexually active people in Ghana. It was essential that these strategies and activities were based on a realist assessment of the demographic and social situation of the country. The examination of case studies in cultures similar to Ghana would also offer valuable lessons. The factors that hinder the acceptance of long-term methods include misconceptions, myths, and false rumors rooted in a general lack of knowledge among the people. Participants were urged to come up with strategies to counter these problems, and service providers were encouraged to improve their knowledge about contraceptive methods and counseling skills. Male involvement in contraception was also advocated. Statistics show that most Ghanians practicing contraception were using short-term methods such as foaming tablets, pills, and condoms. However, it is necessary to shift to long-term methods such as injectables, implants, and sterilization in order to achieve significant reductions in fertility.

  10. Long-term parenteral nutrition

    PubMed Central

    Ladefoged, Karin; Jarnum, Stig

    1978-01-01

    Nineteen patients (11 women and eight men) aged 20-68 received long-term parenteral nutrition, mostly at home, for six to 63 months (mean 19 months). Indications for LTPN were extensive, active Crohn's disease in three patients, intestinocutaneous fistulas in three, and short-bowel syndrome in the remaining 13 patients. Subclavian or intra-atrial (Broviac) catheters were most commonly used, for which the average life was four and seven months respectively. Complications of long-term parenteral nutrition included pneumothorax in four out of 48 subclavian vein punctures. Catheter-induced thrombosis of central veins was shown by phlebography 17 times in nine patients, and eight episodes of total occlusion occurred. Two of these patients had pulmonary infarction. Nineteen episodes of catheter sepsis occurred in 11 patients, but only one was fatal. Complications related to intestinal disease included intra-abdominal abscesses and intestinal fistulas, and disturbances of liver function. Five patients died, though in only two was death related to long-term parenteral nutrition. One of these patients died from catheter sepsis, the other had subdural haematoma possibly caused by anticoagulant treatment. Eight of the 14 surviving patients still needed parenteral nutrition. All received a disability pension, but six had an acceptable quality of life with almost normal social activities. Despite problems such as difficulties in maintaining standardised infusion programmes, it was concluded that long-term parenteral nutrition at home is practicable and consistent with an acceptable quality of life. ImagesFIG 2 PMID:98199

  11. In-lake measures for phosphorus control: The most feasible and cost-effective solution for long-term management of water quality in urban lakes.

    PubMed

    Huser, Brian J; Futter, Martyn; Lee, Jeff T; Perniel, Mike

    2016-06-15

    Both in-lake and catchment measures designed to reduce phosphorus (P) loading were implemented as part of a 12.3 million USD restoration project for the Minneapolis Chain of lakes in Minnesota (USA). Treatment wetlands, 'in-pipe' measures, and in-lake aluminum sulfate (alum) treatment were applied to restore water quality in the four urban lakes. Different alum dosing methods led to between 4 and 20+ (modeled) years of water quality improvements in these lakes after treatment and only one of the four lakes continues to meet water quality goals approximately 25 years after the project started. Due to limited space and poor performance, reduction of total external loads was low (1-13%) for three lakes. Changes to internal P sediment release rates after application of alum correlated well with epilimnetic total P (TP) concentrations in these lakes, indicating that improvements in water quality were mainly driven by reduced internal loading via in-lake measures. Substantial reductions to external P loading were only achieved at Cedar Lake (49%) via conversion of an existing natural area to a treatment wetland, but even Cedar Lake is no longer meeting management goals. When expressed in terms of dollars spent per unit P removed, in lake alum treatment was on average 50 times more effective than in-catchment measures. The results of this study indicate that substantial external nutrient reductions may not be adequate to sustainably maintain water quality in urban lakes and that continued in-lake management of P accumulated in lake sediment will not only be necessary, but will also be more cost efficient relative to in-catchment measures.

  12. Long-Term and Sustained Therapeutic Results of a Specific Promonocyte Cell Formulation in Refractory Angina: ReACT(®) (Refractory Angina Cell Therapy) Clinical Update and Cost-Effective Analysis.

    PubMed

    Hossne, Nelson Americo; Cruz, Eduardo; Buffolo, Enio; Coimbra, Anna Carolina Teixeira de Siqueira Mac Dowell; Machado, Janaina; Goldenberg, Regina Coeli Dos Santos; Regazzi, Germana; Azevedo, Silvia; Invitti, Adriana Luckow; Rodrigues Branco, João Nelson; Rodrigues de Oliveira, José Salvador; Stolf, Noedir Antonio Groppo; Miller, Leslie W; Sanberg, Paul R

    2015-01-01

    Mononuclear stem cells have been studied for their potential in myocardial ischemia. In our previous published article, ReACT(®) phase I/II clinical trial, our results suggest that a certain cell population, promonocytes, directly correlated with the perceived angiogenesis in refractory angina patients. This study is ReACT's clinical update, assessing long-term sustained efficacy. The ReACT phase IIA/B noncontrolled, open-label, clinical trial enrolled 14 patients with refractory angina and viable ischemic myocardium, without ventricular dysfunction, who were not suitable for myocardial revascularization. The procedure consisted of direct myocardial injection of a specific mononuclear cell formulation, with a certain percentage of promonocytes, in a single series of multiple injections (24-90; 0.2 ml each) into specific areas of the left ventricle. Primary endpoints were Canadian Cardiovascular Society Angina Classification (CCSAC) improvement at the 12-month follow-up and ischemic area reduction (scintigraphic analysis) at the 12-month follow-up, in correlation with ReACT's formulation. A recovery index (for patients with more than 1 year follow-up) was created to evaluate CCSAC over time, until April 2011. Almost all patients presented progressive improvement in CCSAC beginning 3 months (p=0.002) postprocedure, which was sustained at the 12-month follow-up (p=0.002), as well as objective myocardium ischemic area reduction at 6 months (decrease of 15%, p<0.024) and 12 months (decrease of 100%, p<0.004) The recovery index (n=10) showed that the patients were graded less than CCSAC 4 for 73.9 ± 24.2% over a median follow-up time of 46.8 months. After characterization, ReACT's promonocyte concentration suggested a positive correlation with CCSAC improvement (r=-0.575, p=0.082). Quality of life (SF-36 questionnaire) improved significantly in almost all domains. Cost-effectiveness analysis showed decrease in angina-related direct costs. Refractory angina patients

  13. The (cost-)effectiveness of an individually tailored long-term worksite health promotion programme on physical activity and nutrition: design of a pragmatic cluster randomised controlled trial.

    PubMed

    Robroek, Suzan J W; Bredt, Folef J; Burdorf, Alex

    2007-09-21

    Cardiovascular disease is the leading cause of disability and mortality in most Western countries. The prevalence of several risk factors, most notably low physical activity and poor nutrition, is very high. Therefore, lifestyle behaviour changes are of great importance. The worksite offers an efficient structure to reach large groups and to make use of a natural social network. This study investigates a worksite health promotion programme with individually tailored advice in physical activity and nutrition and individual counselling to increase compliance with lifestyle recommendations and sustainability of a healthy lifestyle. The study is a pragmatic cluster randomised controlled trial with the worksite as the unit of randomisation. All workers will receive a standard worksite health promotion program. Additionally, the intervention group will receive access to an individual Health Portal consisting of four critical features: a computer-tailored advice, a monitoring function, a personal coach, and opportunities to contact professionals at request. Participants are employees working for companies in the Netherlands, being literate enough to read and understand simple Internet-based messages in the Dutch language.A questionnaire to assess primary outcomes (compliance with national recommendations on physical activity and on fruit and vegetable intake) will take place at baseline and after 12 and 24 months. This questionnaire also assesses secondary outcomes including fat intake, self-efficacy and self-perceived barriers on physical activity and fruit and vegetable intake. Other secondary outcomes, including a cardiovascular risk profile and physical fitness, will be measured at baseline and after 24 months. Apart from the effect evaluation, a process evaluation will be carried out to gain insight into participation and adherence to the worksite health promotion programme. A cost-effectiveness analysis and sensitivity analysis will be carried out as well. The

  14. Long-term data archiving

    SciTech Connect

    Moore, David Steven

    2009-01-01

    Long term data archiving has much value for chemists, not only to retain access to research and product development records, but also to enable new developments and new discoveries. There are some recent regulatory requirements (e.g., FDA 21 CFR Part 11), but good science and good business both benefit regardless. A particular example of the benefits of and need for long term data archiving is the management of data from spectroscopic laboratory instruments. The sheer amount of spectroscopic data is increasing at a scary rate, and the pressures to archive come from the expense to create the data (or recreate it if it is lost) as well as its high information content. The goal of long-term data archiving is to save and organize instrument data files as well as any needed meta data (such as sample ID, LIMS information, operator, date, time, instrument conditions, sample type, excitation details, environmental parameters, etc.). This editorial explores the issues involved in long-term data archiving using the example of Raman spectral databases. There are at present several such databases, including common data format libraries and proprietary libraries. However, such databases and libraries should ultimately satisfy stringent criteria for long term data archiving, including readability for long times into the future, robustness to changes in computer hardware and operating systems, and use of public domain data formats. The latter criterion implies the data format should be platform independent and the tools to create the data format should be easily and publicly obtainable or developable. Several examples of attempts at spectral libraries exist, such as the ASTM ANDI format, and the JCAMP-DX format. On the other hand, proprietary library spectra can be exchanged and manipulated using proprietary tools. As the above examples have deficiencies according to the three long term data archiving criteria, Extensible Markup Language (XML; a product of the World Wide Web

  15. A comparison of long-term cost and clinical outcomes between the two-stage sequence expander/prosthesis and autologous deep inferior epigastric flap methods for breast reconstruction in a public hospital.

    PubMed

    Lagares-Borrego, A; Gacto-Sanchez, P; Infante-Cossio, P; Barrera-Pulido, F; Sicilia-Castro, D; Gomez-Cia, T

    2016-02-01

    Postmastectomy breast reconstruction involves the use of large amounts of hospital resources. This study provides comparative data on the clinical results and long-term economic costs of two methods of breast reconstruction in a public hospital. A prospective cohort study was performed to evaluate the costs incurred by delayed unilateral breast reconstruction performed using either the two-stage sequence expander/prosthesis (E-P) or autologous deep inferior epigastric flap (DIEP) method during 2005-2013 in 134 patients. The major evaluated variables included previous clinical records, history of radiotherapy, and number of surgical procedures. Total costs accounted for both direct intra- and extra-hospital costs derived from the initial reconstruction and those resulting from associated reoperations due to aesthetic retouches and/or complications. Patients undergoing E-P reconstruction required a higher number of surgery sessions to complete the reconstruction (3.07 vs. 2.32, p < 0.001) and showed higher rates of surgery-related complications (40.29% vs. 32.82%). No statistically significant differences were found between the two surgical methods in terms of total costs (€18857.77 DIEP vs. €20502.08 E-P; p = 0.89). In the E-P cohort, active smoking and history of radiotherapy were statistically significant risk factors of complications. In the DIEP group, only active smoking was significantly associated with complications. Compared to the E-P method, breast reconstruction using the DIEP method is more cost-effective and involves fewer serious complications that result in reconstruction failure or undesirable aesthetic results. E-P reconstruction presents a higher number of complications that may cause surgical failure or poor outcomes. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  16. Long-term care: a substantive factor in financial planning.

    PubMed

    Willis, D A

    2000-01-01

    More than 50 percent of women will enter a nursing home at some point in their lives. About one-third of men living to age 65 will also need nursing home care. Planning for long-term care is even more important since Medicare covers very little of the cost of such care. The Indiana Partnership Plan is one program designed to help fund the long-term care costs while allowing individuals protect other financial assets.

  17. A systematic review of the effectiveness of strategies for reducing fracture risk in children with juvenile idiopathic arthritis with additional data on long-term risk of fracture and cost of disease management.

    PubMed

    Thornton, J; Ashcroft, D; O'Neill, T; Elliott, R; Adams, J; Roberts, C; Rooney, M; Symmons, D

    2008-03-01

    To review outcome measures and treatment costs in children with juvenile idiopathic arthritis (JIA) and low bone mineral density (BMD) and/or fragility fractures. To review evidence for effectiveness and safety of bisphosphonates and calcium and/or vitamin D in these children. To assess long-term bone health in adults with JIA. Major databases were searched up to July 2005 for effectiveness studies and up to January 2005 for costs. A structured search strategy was conducted. For the evaluation of long-term bone health, outcome data were derived from two cohorts of adult patients with JIA. As there were few published cost data, an ongoing UK longitudinal study (CAPS) provided background data on the cost of managing JIA. Sixteen studies (78 children with JIA) were included. At baseline, the children had BMD below the expected values for age- and sex-matched children; treatment with bisphosphonates increased BMD with mean percentage increases in spine BMD varying from 4.5 to 19.1%. None of the studies with control groups compared results between the intervention and control groups, they only compared each group with its own baseline. Overall, studies were heterogeneous in design, of variable quality and with no consistency in methods of assessing and reporting outcomes. Hence, data could not be combined or an effect size calculated. A further 43 papers were included in the safety review; side-effects were generally transient. Two studies assessed treatment with calcium and/or vitamin D; BMD was increased from 0.75 to 0.830 g/cm2 after 6 months and BMD Z-score from -2.8 to -2.3 after 6 months and -2.4 after 1 year. There are relatively few long-term studies on the occurrence of low BMD and fragility fractures in children with JIA, with most studies only following children for 1 or 2 years. However, the long- and short-term data indicate that children with JIA have a lower BMD and more fractures than children without JIA. There are very few data on long-term bone health

  18. Long-Term Effect of Participation in an Early Exercise and Education Program on Clinical Outcomes and Cost Implications, in Patients with TIA and Minor, Non-Disabling Stroke.

    PubMed

    Faulkner, James; Stoner, Lee; Lanford, Jeremy; Jolliffe, Evan; Mitchelmore, Andrew; Lambrick, Danielle

    2017-06-01

    Participation in exercise and education programs following transient ischemic attack (TIA) or minor stroke may decrease cardiovascular disease risk. The purpose of this study was to assess the long-term effect (3.5 years) of an exercise and education program administered soon after TIA or minor stroke diagnosis on clinical outcome measures (stroke classification and number, patient deaths, hospital/emergency department admission) and cost implications obtained from standard hospital records. Hospital records were screened for 60 adults (male, n = 31; 71 ± 10 years), diagnosed with TIA or non-disabling stroke, who had previously been randomised and completed either an 8-week exercise and education program, or usual care control. Follow-up clinical outcomes and cost implications were obtained 3.5 ± 0.3 years post-exercise. Participants randomised to the exercise and education program had significantly fewer recurrent stroke/TIAs (n = 3 vs. n = 13, Cohen's d = 0.79) than the control group (P ≤ 0.003). Similar finding were reported for patient deaths (n = 0 vs. n = 4, d = 0.53), and hospital admissions (n = 48 vs. n = 102, d = 0.54), although these findings were only approaching statistical significance. The relative risk (mean; 95%CI) of death, stroke/TIAs and hospital admissions were 0.11 (0.01 to 1.98), 0.23 (0.07 to 0.72) and 0.79 (0.57 to 1.09), respectively. Hospital admission costs were significantly lower for the exercise group ($9041 ± 15,080 NZD [~$6000 ± 10,000 USD]) than the control group ($21,750 ± 22,973 NZD [~$14,000 ± 15,000 USD]) during the follow-up period (P < 0.05, d = 0.69). The present study demonstrates the long-term patient benefit and economic importance of providing secondary prevention, exercise and education programs for patients with TIA and minor stroke. URL: http://www.anzctr.org.au/ ; Trial Registration Number: ACTRN12611000630910.

  19. Cost-effectiveness of different interferon beta products for relapsing-remitting and secondary progressive multiple sclerosis: Decision analysis based on long-term clinical data and switchable treatments

    PubMed Central

    2013-01-01

    Background Multiple sclerosis (MS) is a highly debilitating immune mediated disorder and the second most common cause of neurological disability in young and middle-aged adults. Iran is amongst high MS prevalence countries (50/100,000). Economic burden of MS is a topic of important deliberation in economic evaluations study. Therefore determining of cost-effectiveness interferon beta (INF β) and their copied biopharmaceuticals (CBPs) and biosimilars products is significant issue for assessment of affordability in Lower-middle-income countries (LMICs). Methods A literature-based Markov model was developed to assess the cost-effectiveness of three INF βs products compared with placebo for managing a hypothetical cohort of patients diagnosed with relapsing remitting MS (RRMS) in Iran from a societal perspective. Health states were based on the Kurtzke Expanded Disability Status Scale (EDSS). Disease progression transition probabilities for symptom management and INF β therapies were obtained from natural history studies and multicenter randomized controlled trials and their long term follow up for RRMS and secondary progressive MS (SPMS). A cross sectional study has been developed to evaluate cost and utility. Transitions among health states occurred in 2-years cycles for fifteen cycles and switching to other therapies was allowed. Calculations of costs and utilities were established by attachment of decision trees to the overall model. The incremental cost effectiveness ratio (ICER) of cost/quality adjusted life year (QALY) for all available INF β products (brands, biosimilars and CBPs) were considered. Both costs and utilities were discounted. Sensitivity analyses were done to assess robustness of model. Results ICER for Avonex, Rebif and Betaferon was 18712, 11832, 15768 US Dollars ($) respectively when utility attained from literature review has been considered. ICER for available CBPs and biosimilars in Iran was $847, $6964 and $11913. Conclusions The Markov

  20. A perspective on long-term care for the elderly

    PubMed Central

    Scanlon, William J.

    1988-01-01

    Long-term care represents a significant burden to the approximately 7 million elderly in need, their families, and the Medicaid program. Concerns exist about access, quality, cost, and the distribution of the burden of care. In this article each area is discussed, highlighting the principal issues, identifying the unique aspects that pertain to long-term care, and exploring the implications for research and policy development. Future trends, especially the growth of the elderly population, are expected to affect significantly the provision of long-term care. The considerable uncertainty about how these trends may impact on long-term care is described, and the critical role social choice will play in shaping the future long-term care system is emphasized. PMID:10312975

  1. Understanding the factors behind the decision to purchase varying coverage amounts of long-term care insurance.

    PubMed

    Kumar, N; Cohen, M A; Bishop, C E; Wallack, S S

    1995-02-01

    This article examines the factors related to an individual's decision to purchase a given amount of long-term care insurance coverage. DATA SOURCE AND STUDY SETTING: Primary data analyses were conducted on an estimation sample of 6,545 individuals who had purchased long-term care (LTC) insurance policies in late 1990 and early 1991, and 1,248 individuals who had been approached by agents but chose not to buy such insurance. Companies contributing the two samples represented 45 percent of total sales during the study year. A two-stage logit-OLS (ordinary least squares) choice-based sampling model was used to examine the relationship between the expected value of purchased coverage and explanatory variables that included: demographic traits, attitudes, risk premium, nursing home bed supply, and Medicaid program configurations. Mail surveys were used to collect information about individuals' reasons for purchase, attitudes about long-term care, and demographic characteristics. Through an identification code, information on the policy designs chosen by these individuals was linked to each of the returned mail surveys. The response rate to the survey was about 60 percent. The model explains about 47 percent of the variance in the dependent variable-expected value of policy coverage. Important variables negatively associated with the dependent variable include advancing age, being married, and having less than a college education. Variables positively related include being male, having more income, and having increasing expected LTC costs. Medicaid program configuration also influences the level of benefits purchased: state reimbursement rates and the presence of comprehensive estate recovery programs are both positively related to the expected value of purchased benefits. Finally, as the difference between the premium charged and the actuarially fair premium increases, individuals buy less coverage. An important finding with implications for policymakers is that changes

  2. Long-term oxygen therapy.

    PubMed

    Christopher, Kent L; Porte, Phillip

    2011-02-01

    This article provides an overview of the status of long-term oxygen therapy (LTOT). In the United States, payment cutbacks are occurring as a result of congressionally mandated competitive bidding and capped rental programs. These Medicare programs are discussed. These legislative and regulatory changes may result in reduced patient access to appropriate oxygen-delivery systems that meet medical needs, including optimal ambulation. Prescribing LTOT is addressed in this article, as is the need for adequate patient education. The importance of appropriate monitoring and reassessment is presented. The use of an LTOT collaborative care model is discussed. Although the new intermittent flow oxygen-delivery systems have potential benefits, there is consensus that each patient should be tested on the specific device because of variability in delivery and patient response. Feasible locations for patient education and monitoring are identified.

  3. 49 CFR 260.15 - Credit risk premium.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 4 2013-10-01 2013-10-01 false Credit risk premium. 260.15 Section 260.15... REHABILITATION AND IMPROVEMENT FINANCING PROGRAM Overview § 260.15 Credit risk premium. (a) Where available... pay to the Administrator a Credit Risk Premium adequate to cover that portion of the subsidy cost...

  4. 49 CFR 260.15 - Credit risk premium.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 4 2010-10-01 2010-10-01 false Credit risk premium. 260.15 Section 260.15... REHABILITATION AND IMPROVEMENT FINANCING PROGRAM Overview § 260.15 Credit risk premium. (a) Where available... pay to the Administrator a Credit Risk Premium adequate to cover that portion of the subsidy cost...

  5. [An evaluation of net carbon sink effect and cost/benefits of a rice-rape rotation ecosystem under long-term fertilization from Tai Lake region of China].

    PubMed

    Li, Jie-Jing; Pan, Gen-Xing; Zhang, Xu-Hui; Fei, Qing-Hua; Li, Zhi-Peng; Zhou, Ping; Zheng, Ju-Feng; Qiu, Duo-Sheng

    2009-07-01

    Taking a long-term fertilized rice-rape rotation system in Taihu Lake as test objective, its annual C balance and economic benefit were estimated, based on the measurement of past years grain yield, litter C content, and field CO2 emission as well as the investigation of material and management inputs. The calculated annual C sink under different fertilizations ranged from 0.9 t C x hm(-2) x a(-1) to 7.5 t C x hm(-2) x a(-1), and the net C sink effect under combined inorganic/organic fertilization was three folds as that under chemical fertilization. The C cost of material input ranged from 0.37 t C x hm(-2) x a(-1) to 1.13 t C x hm(-2) x a(-1), and that of management input ranged from 1.69 t C x hm(-2) x a(-1) to 1.83 t C x hm(-2) x a(-1). The annual economic benefit ranged from 5.8 x 10(3) CNY x hm(-2) x a(-1) to 16.5 x 10(3) CNY x hm(-2) x a(-1), and was 2.1 times higher under combined fertilization than under chemical fertilization. Comparing with that under chemical fertilization, the marginal cost for per ton C sink under combined inorganic/organic fertilization was estimated as 217.1 CNY x t(-1) C, very close to the C price of 20 Euro x t(-1) C in the EU. In sum, under combined inorganic/organic fertilization, this rice paddy ecosystem could not only have higher productivity, but also present greater net C sink effect and higher economic benefit, compared with under chemical fertilizer fertilization.

  6. Asthma Medicines: Long-Term Control

    MedlinePlus

    ... Size Email Print Share Asthma Medicines: Long-term Control Page Content Article Body Corticosteroids Synthetic versions of ... form, they are used exclusively for long-term control; they are not very effective for acute symptoms. ...

  7. Consumer Direction in Long-Term Care.

    ERIC Educational Resources Information Center

    Generations, 2000

    2000-01-01

    Issue includes 17 theme articles on long-term care, covering legal issues, federal role, state programs, demonstration programs, family caregivers, home health care, home care workers, culturally appropriate long-term care, financial support, and cognitive impairments. (SK)

  8. Stapedectomy - long-term report.

    PubMed

    Shea, J J

    1982-01-01

    The long-term results with large fenestra stapedectomy with vein graft and Teflon piston are compared with results with the small fenestra stapedectomy with teflon piston directly into the vestibule. There were 1,943 operations in the former group and 2,155 in the latter when compared in 1970. One hundred consecutive patients from the beginning of each group with follow-up to present were compared. Results were generally the same with no great change in 15 and 20 years as compared to those at 5 years. The complication of perilymph fistula was caused by creating an opening in the footplate much larger than the prosthesis and was eliminated by interposing a living oval window seal if the opening was much larger than the prosthesis and a flap of lining membrane from the promontory when it was not. Other factors that influence a good result are discussed, including the type and the diameter of the piston used, the type of living oval window seal and the method of attachment to the incus. The small fenestra operation was found to be superior to the large, not only for the hearing gain achieved, but the case of performance and the freedom from complications due to migration of the prosthesis and/or the oval window seal. At present we have done about all that can be done for the conductive components. What remains is the sensorineural component which our studies indicate may be due to an autoimmune response.

  9. Long-term corrosion studies

    SciTech Connect

    Gdowski, G.

    1998-05-29

    The scope of this activity is to assess the long-term corrosion properties of metallic materials under consideration for fabricating waste package containers. Three classes of metals are to be assessed: corrosion resistant, intermediate corrosion resistant, and corrosion allowance. Corrosion properties to be evaluated are general, pitting and crevice corrosion, stress-corrosion cracking, and galvanic corrosion. The performance of these materials will be investigated under conditions that are considered relevant to the potential emplacement site. Testing in four aqueous solutions, and vapor phases above them, and at two temperatures are planned for this activity. (The environmental conditions, test metals, and matrix are described in detail in Section 3.0.) The purpose and objective of this activity is to obtain the kinetic and mechanistic information on degradation of metallic alloys currently being considered for waste package containers. This information will be used to provide assistance to (1) waste package design (metal barrier selection) (E-20-90 to E-20-92), (2) waste package performance assessment activities (SIP-PA-2), (3) model development (E-20-75 to E-20-89). and (4) repository license application.

  10. Long-Term Planning in Higher Education.

    ERIC Educational Resources Information Center

    United Nations Educational, Scientific and Cultural Organization, Bangkok (Thailand). Principal Regional Office for Asia and the Pacific.

    This report presents the concepts and issues discussed at a Regional Symposium on Long-term Planning in Higher Education held in Dhaka, Bangladesh, September 21-30, 1986. Chapter 1 explores some fundamental issues about the rationale for the objectives of long-term planning. It defines long-term planning in higher education, considers its…

  11. Long Term TOA - M Data and Information

    Atmospheric Science Data Center

    2015-06-30

    A Long-Term TOA and Constrained Surface Radiation Budget Project A Long-Term TOA and Constrained Surface Readiation Budget Dataset Using Merged CERES, ... and apply the knowledge to existing data to develop long-term (nearly 30 years) consistent and calibrated data product (TOA irradiances ...

  12. Equity of access under Korean national long-term care insurance: implications for long-term care reform.

    PubMed

    Park, Ju Moon

    2015-09-15

    The national long-term care insurance was implemented in July 2008. Few studies have been conducted with representative national survey data since the long-term care insurance was introduced. Therefore, this study examines the extent to which equity in the use of long-term care has been achieved in Korea. The Aday-Andersen model was used as a conceptual model, based on the Korean Health Panel Study which was conducted in 2011. Descriptive and logistic regression analysis was performed to examine the relationship between the dependent and independent variables and the relative importance of factors as predictors of utilization. The results of this study indicated that those who rated his or her health to be fair, good, and very good, had no limited activities, were disabled, and had insurance coverage were more likely to use long-term care services, respectively. Their decision to use long-term care was primarily affected by need (health status, limited activity, disability) and enabling (insurance coverage) factors. The findings also indicated that the introduction of a national long-term care insurance program did not yield a fully equitable distribution of services. Long-term care reforms in Korea should continue to concentrate on expanding insurance coverage and reducing the inequities reflected in disparities in consumer cost-sharing and associated patterns of utilization across plans. The subsequent impact on managed care and expenditures need to be more fully understood.

  13. The market for long-term care services.

    PubMed

    Grabowski, David C

    2008-01-01

    Although a large literature has established the importance of market and regulatory forces within the long-term care sector, current research in this field is limited by a series of data, measurement, and methodological issues. This paper provides a comprehensive review of these issues with an emphasis on identifying initiatives that will increase the volume and quality of long-term care research. Recommendations include: the construction of standard measures of long-term care market boundaries, the broader dissemination of market and regulatory data, the linkage of survey-based data with market measures, the encouragement of further market-based studies of noninstitutional long-term care settings, and the standardization of Medicaid cost data.

  14. Advanced long term cryogenic storage systems

    NASA Technical Reports Server (NTRS)

    Brown, Norman S.

    1987-01-01

    Long term, cryogenic fluid storage facilities will be required to support future space programs such as the space-based Orbital Transfer Vehicle (OTV), Telescopes, and Laser Systems. An orbital liquid oxygen/liquid hydrogen storage system with an initial capacity of approximately 200,000 lb will be required. The storage facility tank design must have the capability of fluid acquisition in microgravity and limit cryogen boiloff due to environmental heating. Cryogenic boiloff management features, minimizing Earth-to-orbit transportation costs, will include advanced thick multilayer insulation/integrated vapor cooled shield concepts, low conductance support structures, and refrigeration/reliquefaction systems. Contracted study efforts are under way to develop storage system designs, technology plans, test article hardware designs, and develop plans for ground/flight testing.

  15. Surgeons' Perspectives on Premium Implants in Total Joint Arthroplasty.

    PubMed

    Wasterlain, Amy S; Bello, Ricardo J; Vigdorchik, Jonathan; Schwarzkopf, Ran; Long, William J

    2017-06-29

    Declining total joint arthroplasty reimbursement and rising implant prices have led many hospitals to restrict access to newer, more expensive total joint arthroplasty implants. The authors sought to understand arthroplasty surgeons' perspectives on implants regarding innovation, product launch, costs, and cost-containment strategies including surgeon gain-sharing and patient cost-sharing. Members of the International Congress for Joint Reconstruction were surveyed regarding attitudes about implant technology and costs. Descriptive and univariate analyses were performed. A total of 126 surgeons responded from all 5 regions of the United States. Although 76.9% believed new products advance technology in orthopedics, most (66.7%) supported informing patients that new implants lack long-term clinical data and restricting new implants to a small number of investigators prior to widespread market launch. The survey revealed that 66.7% would forgo gain-sharing incentives in exchange for more freedom to choose implants. Further, 76.9% believed that patients should be allowed to pay incremental costs for "premium" implants. Surgeons who believed that premium products advance orthopedic technology were more willing to forgo gain-sharing (P=.040). Surgeons with higher surgical volume (P=.007), those who believed implant companies should be allowed to charge more for new technology (P<.001), and those who supported discussing costs with patients (P=.004) were more supportive of patient cost-sharing. Most arthroplasty surgeons believe technological innovation advances the field but support discussing the "unproven" nature of new implants with patients. Many surgeons support alternative payment models permitting surgeons and patients to retain implant selection autonomy. Most respondents prioritized patient beneficence and surgeon autonomy above personal financial gain. [Orthopedics. 201x; xx(x):xx-xx.]. Copyright 2017, SLACK Incorporated.

  16. LONG-TERM MONITORING SENSOR NETWORK

    SciTech Connect

    Stephen P. Farrington; John W. Haas; Neal Van Wyck

    2003-10-16

    Long-term monitoring (LTM) associated with subsurface contamination sites is a key element of Long Term Stewardship and Legacy Management across the Department of Energy (DOE) complex. However, both within the DOE and elsewhere, LTM is an expensive endeavor, often exceeding the costs of the remediation phase of a clean-up project. The primary contributors to LTM costs are associated with labor. Sample collection, storage, preparation, analysis, and reporting can add a significant financial burden to project expense when extended over many years. Development of unattended, in situ monitoring networks capable of providing quantitative data satisfactory to regulatory concerns has the potential to significantly reduce LTM costs. But survival and dependable operation in a difficult environment is a common obstacle to widespread use across the DOE complex or elsewhere. Deploying almost any sensor in the subsurface for extended periods of time will expose it to chemical and microbial degradation. Over the time-scales required for in situ LTM, even the most advanced sensor systems may be rendered useless. Frequent replacement or servicing (cleaning) of sensors is expensive and labor intensive, offsetting most, if not all, of the cost savings realized with unattended, in situ sensors. To enable facile, remote monitoring of contaminants and other subsurface parameters over prolonged periods, Applied Research Associates, Inc has been working to develop an advanced LTM sensor network consisting of three key elements: (1) an anti-fouling sensor chamber that can accommodate a variety of chemical and physical measurement devices based on electrochemical, optical and other techniques; (2) two rapid, cost effective, and gentle means of emplacing sensor packages either at precise locations directly in the subsurface or in pre-existing monitoring wells; and (3) a web browser-based data acquisition and control system (WebDACS) utilizing field-networked microprocessor-controlled smart

  17. Economic efficiency, IRPs and long term contracts

    SciTech Connect

    Sutherland, R.J.

    1993-04-30

    There is no market failure that warrants utility regulation of the construction of new generating plants, the supply of energy efficiency or the purchase of fuel under contract. The natural monopoly problem applies to the distribution of electricity and gas, not to generation, energy conservation, or gas purchases. Utility regulation magnifies a market failure, which is the principal agent problem. Regulatory allowance of utilities signing long term fixed price contracts and undertaking conservation measures result in costs and risks being shifted to ratepayers that would not occur under competitive market conditions. Economic efficiency would be enhanced if cost of service regulation of electric and gas utilities were replaced by a competitive market process for the construction of new power plants, utility conservation programs and contracts to purchase fuel. Conservation measures could be supplied by energy service companies. Gas merchants could provide gas and energy conservation directly to ultimate customers, if they had access to LDC pipelines. With a competitive market established to sell gas and energy services, contracts and conservation measures would not require cost-of- service regulation.

  18. Private Financing Options for Long-term Care

    PubMed Central

    Brody, Barbara L.; Simon, Harold J.; Smallwood, Dennis E.

    1987-01-01

    Private financing for long-term care now comes almost exclusively from out-of-pocket payments. Long-term-care costs quickly impoverish most elderly, resulting in Medicaid dependency. The consequences are profound for the western Sun Belt with its rapidly growing elderly population. Key private financing options are long-term-care individual retirement accounts (LTC/IRAs), home equity conversion, social-health maintenance organizations and long-term-care insurance. Study of data from the past half century suggests that the LTC/IRA approach would prove unsatisfactory for the purpose despite the intuitive appeal of this mechanism. Experience with home equity conversions is still very limited, and unresolved questions limit this approach to the role of a reserve option for now. While promising, social-health maintenance organizations are still in the experimental stages and not yet commercially available. Long-term-care insurance is currently sold on a thin market and emphasizes nursing home coverage. New approaches to private financing through long-term-care insurance seem to offer the best approach for immediate implementation. PMID:3118576

  19. Long-term solar-terrestrial observations

    NASA Technical Reports Server (NTRS)

    1988-01-01

    The results of an 18-month study of the requirements for long-term monitoring and archiving of solar-terrestrial data is presented. The value of long-term solar-terrestrial observations is discussed together with parameters, associated measurements, and observational problem areas in each of the solar-terrestrial links (the sun, the interplanetary medium, the magnetosphere, and the thermosphere-ionosphere). Some recommendations are offered for coordinated planning for long-term solar-terrestrial observations.

  20. LONG TERM IN SITU DISPOSAL ENGINEERING STUDY

    SciTech Connect

    ADAMS; CARLSON; BROCKMAN

    2003-07-23

    Patent application pulled per Ken Norris (FH General Counsel). The objective of this study is to devise methods, produce conceptual designs, examine and select alternatives, and estimate costs for the demonstration of long-term (300-year) in situ disposal of an existing waste disposal site. The demonstration site selected is the 216-A-24 Crib near the 200 East Area. The site contains a fission product inventory and has experienced plant, animal, and inadvertent than intrusion. Of the potential intrusive events and transport pathways at the site, potential human intrusion has been given primary consideration in barrier design. Intrusion by wind, plants, and animals has been given secondary consideration. Groundwater modeling for a number of barrier configurations has been carried out to help select a barrier that will minimize water infiltration and waste/water contact time. The estimated effective lifetime and cost of 20 barrier schemes, using a variety of materials, have been evaluated. The schemes studied include single component surface barriers, multicomponent barriers, and massively injected grout barriers. Five barriers with high estimated effective lifetimes and relatively low costs have been selected for detailed evaluation. They are basalt riprap barriers, massive soil barriers, salt basin barriers, multi-component fine/coarse barriers, and cemented basalt barriers. A variety of materials and configurations for marking the site have also been considered. A decision analysis was completed to select a barrier scheme for demonstration. The analysis indicated that the basalt riprap alternative would be the preferred choice for a full-scale demonstration. The recommended approach is to demonstrate the basalt riprap barrier at the 216-A-24 Crib as soon as possible. Methods and costs of assessing effectiveness of the demonstration are also described. Preliminary design modifications and costs for applying the five selected barrier schemes to other site types are

  1. Health Insurance Marketplaces: Premium Trends in Rural Areas.

    PubMed

    Barker, Abigail R; Kemper, Leah M; McBride, Timothy D; Meuller, Keith J

    2016-05-01

    Since 2014, when the Health Insurance Marketplaces (HIMs) authorized by the Patient Protection and Affordable Care Act (ACA) were implemented, considerable premium changes have been observed in the marketplaces across the 50 states and the District of Columbia. This policy brief assesses the changes in average HIM plan premiums from 2014 to 2016, before accounting for subsidies, with an emphasis on the widening variation across rural and urban places. Since this brief focuses on premiums without accounting for subsidies, this is not intended to be an analysis of the "affordability" of ACA premiums, as that would require assessment of premiums, cost-sharing adjustments, and other factors.

  2. [Perspectives in long-term care insurance].

    PubMed

    Pick, P

    2007-03-01

    Twelve years after its introduction, long-term care insurance is back on the agenda and up for political reform. This paper shows why long-term care insurance needs to be reformed. The two central aspects on which reform projects focus are addressed: firstly, the structural improvement of nursing care and long-term care insurance and, secondly, the creation of a sustained financing. The principal conclusion is that, while there is a broad consensus about the structural improvement of long-term care insurance, opinions differ widely in the matter of its sustained financing. As a consequence, a coherent financing concept has yet to emerge.

  3. Comparison of long-term care in an acute care institution and in a long-term care institution.

    PubMed

    Friedman, R; Kalant, N

    1998-11-03

    Acute care hospitals in Quebec are required to reserve 10% of their beds for patients receiving long-term care while awaiting transfer to a long-term care facility. It is widely believed that this is inefficient because it is more costly to provide long-term care in an acute care hospital than in one dedicated to long-term care. The purpose of this study was to compare the quality and cost of long-term care in an acute care hospital and in a long-term care facility. A concurrent cross-sectional study was conducted of 101 patients at the acute care hospital and 102 patients at the long-term care hospital. The 2 groups were closely matched in terms of age, sex, nursing care requirements and major diagnoses. Several indicators were used to assess the quality of care: the number of medical specialist consultations, drugs, biochemical tests and radiographic examinations; the number of adverse events (reportable incidents, nosocomial infections and pressure ulcers); and anthropometric and biochemical indicators of nutritional status. Costs were determined for nursing personnel, drugs and biochemical tests. A longitudinal study was conducted of 45 patients who had been receiving long-term care at the acute care hospital for at least 5 months and were then transferred to the long-term care facility where they remained for at least 6 months. For each patient, the number of adverse events, the number of medical specialist consultations and the changes in activities of daily living status were assessed at the 2 institutions. In the concurrent study, no differences in the number of adverse events were observed; however, patients at the acute care hospital received more drugs (5.9 v. 4.7 for each patient, p < 0.01) and underwent more tests (299 v. 79 laboratory units/year for each patient, p < 0.001) and radiographic examinations (64 v. 46 per 1000 patient-weeks, p < 0.05). At both institutions, 36% of the patients showed anthropometric and biochemical evidence of protein

  4. Comparison of long-term care in an acute care institution and in a long-term care institution

    PubMed Central

    Friedman, R; Kalant, N

    1998-01-01

    BACKGROUND: Acute care hospitals in Quebec are required to reserve 10% of their beds for patients receiving long-term care while awaiting transfer to a long-term care facility. It is widely believed that this is inefficient because it is more costly to provide long-term care in an acute care hospital than in one dedicated to long-term care. The purpose of this study was to compare the quality and cost of long-term care in an acute care hospital and in a long-term care facility. METHODS: A concurrent cross-sectional study was conducted of 101 patients at the acute care hospital and 102 patients at the long-term care hospital. The 2 groups were closely matched in terms of age, sex, nursing care requirements and major diagnoses. Several indicators were used to assess the quality of care: the number of medical specialist consultations, drugs, biochemical tests and radiographic examinations; the number of adverse events (reportable incidents, nosocomial infections and pressure ulcers); and anthropometric and biochemical indicators of nutritional status. Costs were determined for nursing personnel, drugs and biochemical tests. A longitudinal study was conducted of 45 patients who had been receiving long-term care at the acute care hospital for at least 5 months and were then transferred to the long-term care facility where they remained for at least 6 months. For each patient, the number of adverse events, the number of medical specialist consultations and the changes in activities of daily living status were assessed at the 2 institutions. RESULTS: In the concurrent study, no differences in the number of adverse events were observed; however, patients at the acute care hospital received more drugs (5.9 v. 4.7 for each patient, p < 0.01) and underwent more tests (299 v. 79 laboratory units/year for each patient, p < 0.001) and radiographic examinations (64 v. 46 per 1000 patient-weeks, p < 0.05). At both institutions, 36% of the patients showed anthropometric and

  5. 42 CFR 447.72 - Alternative premium and cost sharing exemptions and protections for individuals with family...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... drugs cannot exceed the nominal amount as defined in § 447.54. (2) Cost sharing for non-emergency... child covered under a Medicaid expansion program for whom enhanced match is claimed under title XXI of...

  6. Specialty drug coupons lower out-of-pocket costs and may improve adherence at the risk of increasing premiums.

    PubMed

    Starner, Catherine I; Alexander, G Caleb; Bowen, Kevin; Qiu, Yang; Wickersham, Peter J; Gleason, Patrick P

    2014-10-01

    Expenditures for specialty drugs account for more than 25 percent of total US drug spending and have been increasing at more than 13 percent annually. We examined insurers' role in maintaining the affordability and accessibility of specialty drugs while maximizing their value. We conducted two analyses: one using an administrative claims database with information on more than ten million commercially insured patients and another using the same database combined with the drug prescription records from a specialty pharmacy. First, we examined the prevalence of specialty drug coupons and the degree to which these reduced patients' out-of-pocket costs, focusing on 264,801 prescriptions. Second, we quantified the association between the magnitude of out-of-pocket costs for specialty drugs and patients' abandonment of their new or restarted therapy, focusing on a group of nearly 16,000 patients. We found that drug coupons accounted for $21.2 million of patients' $35.3 million annual out-of-pocket costs. In the vast majority of cases, coupons reduced monthly cost sharing to less than $250, a point at which patients were far less likely to abandon therapy with biologic anti-inflammatory drugs or with drugs for multiple sclerosis. However, by reducing cost sharing, coupons may also circumvent efforts to encourage patients to use the most cost-effective drugs. Project HOPE—The People-to-People Health Foundation, Inc.

  7. Going Solar Yields Long-Term Economical, Educational Benefits

    ERIC Educational Resources Information Center

    von Moos, Brian

    2009-01-01

    Going solar is not an easy decision, but a long-term investment with a potentially substantial up-front cost. While some schools have enough capital in reserve, can raise bond money, or can solicit sufficient donations, many schools rely on creative financial programs to make a solar energy system economically feasible. Thinking about going solar…

  8. Environmental Factors in Suicide in Long Term-Care Facilities.

    ERIC Educational Resources Information Center

    Osgood, Nancy J.

    1992-01-01

    Explored environmental factors related to suicide in 463 long-term care facilities. Staff turnover, size, auspices, and per diem cost related to suicidal behavior and deaths from suicide. More suicides occurred in larger facilities and facilities with higher staff turnover. Religious or "other" facilities experienced more suicidal deaths than…

  9. A computer program for evaluating long-term forestry investments.

    Treesearch

    Dennis L. Schweitzer; Allen L. Lundgren; Robert F. Wambach

    1967-01-01

    Describes a computer program, written in FORTRAN, which has been developed to assist in evaluating long-term forestry investments. A series of discount rates are used to calculate the internal rate of return and discounted costs, incomes, and net worth for any investments specified by the user. The features of the program are illustrated and discussed in detail, and...

  10. Virtual Models of Long-Term Care

    ERIC Educational Resources Information Center

    Phenice, Lillian A.; Griffore, Robert J.

    2012-01-01

    Nursing homes, assisted living facilities and home-care organizations, use web sites to describe their services to potential consumers. This virtual ethnographic study developed models representing how potential consumers may understand this information using data from web sites of 69 long-term-care providers. The content of long-term-care web…

  11. Virtual Models of Long-Term Care

    ERIC Educational Resources Information Center

    Phenice, Lillian A.; Griffore, Robert J.

    2012-01-01

    Nursing homes, assisted living facilities and home-care organizations, use web sites to describe their services to potential consumers. This virtual ethnographic study developed models representing how potential consumers may understand this information using data from web sites of 69 long-term-care providers. The content of long-term-care web…

  12. Long Term Preservation of Digital Information.

    ERIC Educational Resources Information Center

    Lorie, Raymond A.

    The preservation of digital data for the long term presents a variety of challenges from technical to social and organizational. The technical challenge is to ensure that the information, generated today, can survive long term changes in storage media, devices, and data formats. This paper presents a novel approach to the problem. It distinguishes…

  13. Long-Term Nutrition: A Clinician's Guide to Successful Long-Term Enteral Access in Adults.

    PubMed

    Bechtold, Matthew L; Mir, Fazia A; Boumitri, Christine; Palmer, Lena B; Evans, David C; Kiraly, Laszlo N; Nguyen, Douglas L

    2016-09-22

    Long-term nutrition support requires long-term enteral access. To ensure the success of long-term enteral access, many factors need to be taken into consideration. This article represents a guide to placing and maintaining access in patients requiring long-term nutrition and addresses many of the common questions regarding long-term enteral access, such as indications, types of access, feeding after access placed, and recognition and treatment of potential complications. This guide will help the clinician establish and maintain access to maximize nutrition in patients requiring long-term nutrition.

  14. Long-Term Care Insurance: Coverage Varies Widely in a Developing Market. Report to the Chairman, Subcommittee on Health and Long-Term Care, Select Committeee on Aging, House of Representatives.

    ERIC Educational Resources Information Center

    General Accounting Office, Washington, DC. Div. of Human Resources.

    In response to a request by Congressman Claude Pepper, the General Accounting Office (GAO) conducted a study to examine the private long-term care insurance market. The GAO analyzed the premiums, benefits, and limitations of 33 policies offered by 25 insurers in 1986. The GAO assessed the potential for abuse in this market by surveying state…

  15. Robotics for Long-Term Monitoring

    SciTech Connect

    Shahin, Sarkis; Duran, Celso

    2002-07-01

    While long-term monitoring and stewardship means many things to many people, DOE has defined it as The physical controls, institutions, information, and other mechanisms needed to ensure protection of people and the environment at sites where DOE has completed or plans to complete cleanup (e.g., landfill closures, remedial actions, and facility stabilization). Across the United States, there are thousands of contaminated sites with multiple contaminants released from multiple sources where contaminants have transported and commingled. The U.S. government and U.S. industry are responsible for most of the contamination and are landowners of many of these contaminated properties. These sites must be surveyed periodically for various criteria including structural deterioration, water intrusion, integrity of storage containers, atmospheric conditions, and hazardous substance release. The surveys, however, are intrusive, time-consuming, and expensive and expose survey personnel to radioactive contamination. In long-term monitoring, there's a need for an automated system that will gather and report data from sensors without costly human labor. In most cases, a SCADA (Supervisory Control and Data Acquisition) unit is used to collect and report data from a remote location. A SCADA unit consists of an embedded computer with data acquisition capabilities. The unit can be configured with various sensors placed in different areas of the site to be monitored. A system of this type is static, i.e., the sensors, once placed, cannot be moved to other locations within the site. For those applications where the number of sampling locations would require too many sensors, or where exact location of future problems is unknown, a mobile sensing platform is an ideal solution. In many facilities that undergo regular inspections, the number of video cameras and air monitors required to eliminate the need for human inspections is very large and far too costly. HCET's remote harsh

  16. Premium cost optimization of operational and maintenance of green building in Indonesia using life cycle assessment method

    NASA Astrophysics Data System (ADS)

    Latief, Yusuf; Berawi, Mohammed Ali; Basten, Van; Budiman, Rachmat; Riswanto

    2017-06-01

    Building has a big impact on the environmental developments. There are three general motives in building, namely the economy, society, and environment. Total completed building construction in Indonesia increased by 116% during 2009 to 2011. It made the energy consumption increased by 11% within the last three years. In fact, 70% of energy consumption is used for electricity needs on commercial buildings which leads to an increase of greenhouse gas emissions by 25%. Green Building cycle costs is known as highly building upfront cost in Indonesia. The purpose of optimization in this research improves building performance with some of green concept alternatives. Research methodology is mixed method of qualitative and quantitative approaches through questionnaire surveys and case study. Assessing the successful of optimization functions in the existing green building is based on the operational and maintenance phase with the Life Cycle Assessment Method. Choosing optimization results were based on the largest efficiency of building life cycle and the most effective cost to refund.

  17. 45 CFR 156.440 - Plans eligible for advance payments of the premium tax credit and cost-sharing reductions.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... tax credit and cost-sharing reductions. 156.440 Section 156.440 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Health Insurance...

  18. Long-term care: The public role and private initiatives

    PubMed Central

    Burke, Thomas R.

    1988-01-01

    The ongoing effort of the U.S. Department of Health and Human Services to identify private financing mechanisms that can effectively assist the rapidly growing population of older persons in paying for long-term care expenses is discussed in this article. The focus on private strategies stems from the recognition that Federal and State sectors already pay almost one-half of all long-term care expenses, the proclivity of liberalized financing structures to raise total costs, and the tendency of public financing to dampen choice, flexibility, and access to care. In view of the improved economic situation of most older persons in our Nation today, the potential for market development of private financing options is thought to be excellent, particularly the market for long-term care insurance. PMID:10312961

  19. Long-term adequacy of metal resources

    USGS Publications Warehouse

    Singer, D.A.

    1977-01-01

    Although the earth's crust contains vast quantities of metals, extraction technologies and associated costs are inextricably bound to three fundamental geological factors - the amount of metal available in the earth's crust in each range of grades, the mineralogical form and chemical state of the metal, and the spatial distribution of the metal. The energy required to recover a given amount of metal increases substantially as grade declines. Most metal is produced from sulphide or oxide minerals, whereas most metal in the crust may be locked in the structures of the more refractory silicates. Recovery from silicate minerals could require orders of magnitude more energy than that used at present as also could exploitation of small, widely scattered or thin, deeply buried deposits. Although specific information on the fundamental factors is not available, each factor must in turn tend to further restrict exploitation. Independence of average grade and tonnage for many deposit types further reduces the availability of rock as a source of metal. In the long term, effects of these factors will be large increases in price for many metals. ?? 1977.

  20. Hospital diversification into long-term care.

    PubMed

    Shah, A; Fennell, M; Mor, V

    2001-01-01

    In the 1990s, acute care hospitals in the United States encountered an unstable operating environment created by a series of transformations in the health care delivery system and long-term-care market. Confronted with an array of economic pressures and demographic changes, hospitals were motivated to engage in long-term-care diversification, such as establishing a long-term-care unit or providing home health services, as a means of entering new markets and ensuring financial stability. This article examines the organizational, market, and community factors associated with this strategic activity among a national sample of urban and rural hospitals.

  1. Long Term Effects of Food Poisoning

    MedlinePlus

    ... develop chronic arthritis. Brain and nerve damage A Listeria infection can lead to meningitis, an inflammation of ... brain. If a newborn infant is infected with Listeria , long-term consequences may include mental retardation, seizures, ...

  2. Mental Health in Long Term Care Settings.

    ERIC Educational Resources Information Center

    Shore, Herbert

    1978-01-01

    There are many ways in which long-term care facilities attempt to cope with the mental health problems of the elderly. The author reviews five factors crucial to effective care for the aged in these facilities. (Author/RK)

  3. Roadmap to Long-Term Monitoring Optimization

    EPA Pesticide Factsheets

    This roadmap focuses on optimization of established long-term monitoring programs for groundwater. Tools and techniques discussed concentrate on methods for optimizing the monitoring frequency and spatial (three-dimensional) distribution of wells ...

  4. Long-term-care legal update.

    PubMed

    Fiesta, J

    1998-04-01

    As more nurses move from the acute care setting to long-term-care and home health care, different practice issues arise. To maximize liability protection, nurses must understand the legal issues unique to each delivery system.

  5. Evidence-based long term care design.

    PubMed

    Calkins, Margaret P

    2009-01-01

    Research on the impact of the built environment in long-term care settings continues to grow. This article focuses on work conducted and published since 2000, when an earlier review on research on dementia and design was published. The vast majority of research that addressed neurological conditions in residents in long-term care settings (assisted living and nursing homes) relates to Alzheimer's disease and related dementias.

  6. Long Term Outcomes after Pediatric Liver Transplantation

    PubMed Central

    2013-01-01

    Long term outcomes after liver transplantation are major determinants of quality of life and of the value of this heroic treatment. As short term outcomes are excellent, our community is turning to take a harder look at long term outcomes. The purpose of this paper is to review these outcomes, and highlight proposed treatments, as well as pressing topics needing to be studied. A systemic review of the English literature was carried in PubMed, covering all papers addressing long term outcomes in pediatric liver transplant from 2000-2013. Late outcomes after pediatric liver transplant affect the liver graft in the form of chronic liver dysfunction. The causes include rejection particularly humoral rejection, but also de novo autoimmune hepatitis, and recurrent disease. The metabolic syndrome is a major factor in long term cardiovascular complication risk. Secondary infections, kidney dysfunction and malignancy remain a reality of those patients. There is growing evidence of late cognitive and executive function delays affecting daily life productivity as well as likely adherence. Finally, despite a good health status, quality of life measures are comparable to those of children with chronic diseases. Long term outcomes are the new frontier in pediatric liver transplantation. Much is needed to improve graft survival, but also to avoid systemic morbidities from long term immunosuppression. Quality of life is a new inclusive measure that will require interventions and innovative approaches respectful not only on the patients but also of their social circle. PMID:24511516

  7. Employee responses to health insurance premium increases.

    PubMed

    Goldman, Dana P; Leibowitz, Arleen A; Robalino, David A

    2004-01-01

    To determine the sensitivity of employees' health insurance decisions--including the decision to not choose health maintenance organization or fee-for-service coverage--during periods of rapidly escalating healthcare costs. A retrospective cohort study of employee plan choices at a single large firm with a "cafeteria-style" benefits plan wherein employees paid all the additional cost of purchasing more generous insurance. We modeled the probability that an employee would drop coverage or switch plans in response to employee premium increases using data from a single large US company with employees across 47 states during the 3-year period of 1989 through 1991, a time of large premium increases within and across plans. Premium increases induced substantial plan switching. Single employees were more likely to respond to premium increases by dropping coverage, whereas families tended to switch to another plan. Premium increases of 10% induced 7% of single employees to drop or severely cut back on coverage; 13% to switch to another plan; and 80% to remain in their existing plan. Similar figures for those with family coverage were 11%, 12%, and 77%, respectively. Simulation results that control for known covariates show similar increases. When faced with a dramatic increase in premiums--on the order of 20%--nearly one fifth of the single employees dropped coverage compared with 10% of those with family coverage. Employee coverage decisions are sensitive to rapidly increasing premiums, and single employees may be likely to drop coverage. This finding suggests that sustained premium increases could induce substantial increases in the number of uninsured individuals.

  8. Long-term symptom relief after septoplasty.

    PubMed

    Sundh, Carolina; Sunnergren, Ola

    2015-10-01

    The results for long-term symptom relief after septoplasty are contradictory in reviewed publications but the findings suggest that results are unsatisfactory. In this study, we analyzed and compared short- and long-term symptom relief after septoplasty and factors possibly associated with symptom relief. 111 patients that underwent septoplasty between 2008 and 2010 were included in the study. Medical charts were reviewed for preoperative characteristics and assessments. Data on short-term symptom relief (6 months) were retrieved from the Swedish National Quality Registry for Septoplasty; data on long-term symptom relief (34-70 months) were collected through a questionnaire. Upon the 34-70 month follow-up, 53% of the patients reported that symptoms either remained or had worsened and 83% reported nasal obstruction. Degree of symptom relief was significantly higher among patients not reporting nasal obstruction than among patients reporting nasal obstruction at long-term follow-up. The proportion of patients that reported "my symptoms are gone" declined from 53% after 6 months to 18% after 34-70 months. None of the factors taken into consideration, age at surgery, gender, follow-up time, primary operation/reoperation, history of nasal trauma, self-reported allergy, rhinometric obstruction, or same sided rhinometric, clinical and subjective nasal obstruction were associated with symptom relief. The long-term results after septoplasty are unsatisfactory. A majority of patients report that their symptoms remain after septoplasty.

  9. The aging network and managed long-term care.

    PubMed

    Polivka, Larry; Zayac, Helen

    2008-10-01

    Since the early 1980s, service providers and area agencies on aging, that is, the aging network, have developed a number of strengths as they built a community-based long-term-care system in most states. Many area agencies and providers now have the capacity to assess the needs of older persons, identify appropriate services, and administer cost-effective community programs while operating within fixed, capped budgets. They have also been able to identify and maintain roles for informal caregivers, draw on community resources through donations and the use of volunteers, and create substantial political support. In this article we argue that the aging network should draw on these strengths to develop integrated long-term-care systems designed to shift the balance of state long-term-care systems from institutional to home- and community-based services. We also argue that the nonprofit aging network, because it is made up of area agencies on aging and service providers, provides a potentially more effective framework for the integration of long-term-care resources than do proprietary managed care organizations.

  10. Health reform: setting the agenda for long term care.

    PubMed

    Hatch, O G; Wofford, H; Willging, P R; Pomeroy, E

    1993-06-01

    The White House Task Force on National Health Care Reform, headed by First Lady Hillary Rodham Clinton, is expected to release its prescription for health care reform this month. From the outset, Clinton's mandate was clear: to provide universal coverage while reining in costs for delivering quality health care. Before President Clinton was even sworn into office, he had outlined the major principles that would shape the health reform debate. Global budgeting would establish limits on all health care expenditures, thereby containing health costs. Under a system of managed competition, employers would form health alliances for consumers to negotiate for cost-effective health care at the community level. So far, a basic approach to health care reform has emerged. A key element is universal coverage--with an emphasis on acute, preventive, and mental health care. Other likely pieces are employer-employee contributions to health care plans, laws that guarantee continued coverage if an individual changes jobs or becomes ill, and health insurance alliances that would help assure individual access to low-cost health care. What still is not clear is the extent to which long term care will be included in the basic benefits package. A confidential report circulated by the task force last month includes four options for long term care: incremental Medicaid reform; a new federal/state program to replace Medicaid; a social insurance program for home and community-based services; or full social insurance for long term care. Some work group members have identified an additional option: prefunded long term care insurance.(ABSTRACT TRUNCATED AT 250 WORDS)

  11. Long-term outcomes of autoimmune pancreatitis

    PubMed Central

    Ikeura, Tsukasa; Miyoshi, Hideaki; Shimatani, Masaaki; Uchida, Kazushige; Takaoka, Makoto; Okazaki, Kazuichi

    2016-01-01

    Autoimmune pancreatitis (AIP) has been considered a favorable-prognosis disease; however, currently, there is limited information on natural course of AIP during long-term follow-up. Recently published studies regarding the long-term outcomes of AIP has demonstrated the developments of pancreatic stone formation, exocrine insufficiency, and endocrine insufficiency are observed in 5%-41%, 34%-82%, and 38%-57% of patients having the disease. Furthermore, the incidence rate of developing pancreatic cancer ranges from 0% to 4.8% during the long-term follow-up. The event of death from AIP-related complications other than accompanying cancer is likely to be rare. During follow-up of AIP patients, careful surveillance for not only relapse of the disease but also development of complications at regular intervals is needed. PMID:27678359

  12. The Pupil Premium: Next Steps

    ERIC Educational Resources Information Center

    Sutton Trust, 2015

    2015-01-01

    The pupil premium was introduced by the Coalition government in April 2011 to provide additional funding for disadvantaged pupils. The main difference between the premium and previous funding for disadvantaged pupils is that the premium is linked to individual pupils. On July 1, 2015, The Pupil Premium Summit organized by the Education Endowment…

  13. The Pupil Premium: Next Steps

    ERIC Educational Resources Information Center

    Sutton Trust, 2015

    2015-01-01

    The pupil premium was introduced by the Coalition government in April 2011 to provide additional funding for disadvantaged pupils. The main difference between the premium and previous funding for disadvantaged pupils is that the premium is linked to individual pupils. On July 1, 2015, The Pupil Premium Summit organized by the Education Endowment…

  14. Helping consumers to select an appropriate long-term care insurance policy.

    PubMed

    Firman, J P

    1992-01-01

    Consumers who purchase long term care insurance policies can get good value for their money but there are several residual risks. Advisers have an important responsibility to make sure that their clients fully understand these risks. We recommend that consumers who are appropriate candidates for long term care insurance take into account the following guidelines: Make sure that a policy is bought from a well-known, financially secure company that has an A.M. Best Company rating of A or A+ or at least an A rating from Standard & Poor's. Avoid companies that have a history of consumer complaints, post-claims underwriting, high agent commissions, high lapse rates, or abuses in the Medigap market. Buy a policy with level premiums but understand that in the absence of explicit rate guarantees, premiums may be increased in the future. Seek policies that are guaranteed renewable, explicitly ensure fair access to policy upgrades, provide protection in case of late premium payments, and guarantee protection from potential changes in government benefits.

  15. Keratoprosthesis: a long-term review.

    PubMed Central

    Barnham, J. J.; Roper-Hall, M. J.

    1983-01-01

    A keratoprosthesis (KP), is an artificial cornea which is inserted into an opacified cornea in an attempt to restore useful vision or, less commonly, to make the eye comfortable in painful keratopathy. Results o a retrospective study of 35 patients, with 55 KP insertions, are reviewed with regard to visual acuity, length of time vision is maintained, retention time, and complication. Overall there were a number of long-term real successes, eith retention of the KP and maintenance of improved vision in eyes not amenable to conventional treatment. Careful long-term follow-up was needed, with further surgical procedures often being necessary. Images PMID:6860613

  16. Long-term Outcomes after Severe Shock

    PubMed Central

    Pratt, Cristina M.; Hirshberg, Eliotte L.; Jones, Jason P.; Kuttler, Kathryn G.; Lanspa, Michael J.; Wilson, Emily L.; Hopkins, Ramona O.; Brown, Samuel M.

    2014-01-01

    Background Severe shock is a life-threatening condition with very high short-term mortality. Whether the long-term outcomes among survivors of severe shock are similar to long-term outcomes of other critical illness survivors is unknown. We therefore sought to assess long-term survival and functional outcomes among 90-day survivors of severe shock and determine whether clinical predictors were associated with outcomes. Methods Seventy-six patients who were alive 90 days after severe shock (received ≥1 mcg/kg/min of norepinephrine equivalent) were eligible for the study. We measured three-year survival and long-term functional outcomes using the Medical Outcomes Study 36-Item Short-Form Health Survey, the EuroQOL 5-D-3L, the Hospital Anxiety and Depression Scale, the Impact of Event Scale-Revised and an employment instrument. We also assessed the relationship between in-hospital predictors and long-term outcomes. Results The mean long-term survival was 5.1 years: 82% (62/76) of patients survived, of whom 49 were eligible for follow-up. Patients who died were older than patients who survived. Thirty-six patients completed a telephone interview a mean of five years after hospital admission. The patients’ Physical Functioning scores were below US population norms (p<0.001), whereas mental health scores were similar to population norms. Nineteen percent of the patients had symptoms of depression, 39% had symptoms of anxiety and 8% had symptoms of posttraumatic stress disorder. Thirty-six percent were disabled, and 17% were working full time. Conclusions Early survivors of severe shock had a high three-year survival rate. Patients’ long term physical and psychological outcomes were similar to those reported for cohorts of less severely ill ICU survivors. Anxiety and depression were relatively common, but only a few patients had symptoms of posttraumatic stress disorder. This study supports the observation that acute illness severity does not determine long-term

  17. [Fetal pain: immediate and long term consequences].

    PubMed

    Houfflin Debarge, Véronique; Dutriez, Isabelle; Pusniak, Benoit; Delarue, Eléonore; Storme, Laurent

    2010-06-01

    Several situations are potentially painful for fetuses, such as malformations and invasive procedures. Nociceptive pathways are known to be functional at 26 weeks. Even if it is not possible to evaluate the fetal experience of pain, it is essential to examine its immediate and long-term consequences. As early as the beginning of the second trimester, hemodynamic and hormonal responses are observed following fetal nociceptive stimulation, In experimental studies, long-term changes have been noted in the corticotrop axis, subsequent responses to pain, and behavior after perinatal nociceptive stimulation.

  18. Long-term outcomes after severe shock.

    PubMed

    Pratt, Cristina M; Hirshberg, Eliotte L; Jones, Jason P; Kuttler, Kathryn G; Lanspa, Michael J; Wilson, Emily L; Hopkins, Ramona O; Brown, Samuel M

    2015-02-01

    Severe shock is a life-threatening condition with very high short-term mortality. Whether the long-term outcomes among survivors of severe shock are similar to long-term outcomes of other critical illness survivors is unknown. We therefore sought to assess long-term survival and functional outcomes among 90-day survivors of severe shock and determine whether clinical predictors were associated with outcomes. Seventy-six patients who were alive 90 days after severe shock (received ≥1 μg/kg per minute of norepinephrine equivalent) were eligible for the study. We measured 3-year survival and long-term functional outcomes using the Medical Outcomes Study 36-Item Short-Form Health Survey, the EuroQOL 5-D-3L, the Hospital Anxiety and Depression Scale, the Impact of Event Scale-Revised, and an employment instrument. We also assessed the relationship between in-hospital predictors and long-term outcomes. The mean long-term survival was 5.1 years; 82% (62 of 76) of patients survived, of whom 49 were eligible for follow-up. Patients who died were older than patients who survived. Thirty-six patients completed a telephone interview a mean of 5 years after hospital admission. The patients' Physical Functioning scores were below U.S. population norms (P < 0.001), whereas mental health scores were similar to population norms. Nineteen percent of the patients had symptoms of depression, 39% had symptoms of anxiety, and 8% had symptoms of posttraumatic stress disorder. Thirty-six percent were disabled, and 17% were working full-time. Early survivors of severe shock had a high 3-year survival rate. Patients' long-term physical and psychological outcomes were similar to those reported for cohorts of less severely ill intensive care unit survivors. Anxiety and depression were relatively common, but only a few patients had symptoms of posttraumatic stress disorder. This study supports the observation that acute illness severity does not determine long-term outcomes. Even extremely

  19. Multi-objective, multi-level, multi-dimensional least-cost planning for long-term electric power generation development in the least-developing countries: A case study of Sudan

    NASA Astrophysics Data System (ADS)

    Elhag, Hussein Adam

    This research argues that the United States' version of the Ḻeast-C&barbelow;ost P&barbelow;lanning (LCP) for electric power long-term development is insufficient to fully accommodate the problems associated with planning for this sub-sector in the Ḻeast-Ḏeveloping C&barbelow;ountries (LDC's). This insufficiency is due to diverse and often conflicting objectives among these countries' national and socio-economic development priorities. It then suggests a modified LCP framework, to be based on multi-objective decision-making process, to integrate the objectives of the electric power sub-sector with those of broad social and national economic development concerns. This modified approach has termed by this research as the M&barbelow;ulti-O&barbelow;bjective Ḻeast-C&barbelow;ost P&barbelow;lanning (MOLCP). The solution of this model was based on the analysis of two other models, which are supportive and created specifically for the analysis of this research, and based on valid weighting methods. The first is the P&barbelow;rioritization Ḏecision-M&barbelow;aking model (PDM) which was actually based on the Analytical Hierarchy Process technique. The function of this model is to allocate the limited domestic energy resources among all energy-consuming sectors on the basis of the availability or scarcity of other energy substitutes for primary energy sources mainly used in each sector. The outcome of this model determines the type and amount of fuels that would be available for each sector, including electric power generation. This, in turn, would indeed determine the type of generating technologies that might be introduced in the long-term power development. In the second model, nine objectives, subsuming twenty seven associated attributes, are evaluated by means of the M&barbelow;ulti-O&barbelow;bjective M&barbelow;ulti-Ḏimensional Ḏecision-M&barbelow;aking model (MOMDM). Since not all the objectives enjoy the same load of importance to the planning

  20. Managed Care and Long-Term Services for People with Mental Retardation. ARC Q&A.

    ERIC Educational Resources Information Center

    Arc, Arlington, TX.

    This fact sheet uses a question-and-answer format to summarize issues related to managed care and long-term services for people with mental retardation. Questions and answers address the following topics: the evolving concept of "managed care"; the application of managed care to provide cost-efficient long-term services for people with mental…

  1. Long-Term Memory and Learning

    ERIC Educational Resources Information Center

    Crossland, John

    2011-01-01

    The English National Curriculum Programmes of Study emphasise the importance of knowledge, understanding and skills, and teachers are well versed in structuring learning in those terms. Research outcomes into how long-term memory is stored and retrieved provide support for structuring learning in this way. Four further messages are added to the…

  2. Long-Term Memory and Learning

    ERIC Educational Resources Information Center

    Crossland, John

    2011-01-01

    The English National Curriculum Programmes of Study emphasise the importance of knowledge, understanding and skills, and teachers are well versed in structuring learning in those terms. Research outcomes into how long-term memory is stored and retrieved provide support for structuring learning in this way. Four further messages are added to the…

  3. Professionalism in Long-Term Care Settings

    ERIC Educational Resources Information Center

    Lubinski, Rosemary

    2006-01-01

    Speech-language pathologists who serve elders in a variety of long-term care settings have a variety of professional skills and responsibilities. Fundamental to quality service is knowledge of aging and communication changes and disorders associated with this process, institutional alternatives, and the changing nature of today's elders in…

  4. Long-Term Impacts of Educational Interventions

    ERIC Educational Resources Information Center

    Deming, David James

    2010-01-01

    The school accountability movement has led to a marked increase in the use of standardized test scores to measure school and teacher productivity, yet little is known about the correlation between test score gains and improvements in long-term outcomes. In the first chapter of my dissertation, I study the impact of a school choice policy in…

  5. Long-term studies of dopamine agonists.

    PubMed

    Hubble, Jean P

    2002-02-26

    Dopamine agonists have long been used as adjunctive therapy for the treatment of Parkinson's disease (PD). In more recent years these drugs have also been proved safe and effective as initial therapy in lieu of levodopa in the treatment of PD. Long-term levodopa therapy is associated with motor complications, including fluctuating response patterns and dyskinesia. By initially introducing a dopamine agonist as symptomatic drug therapy, it may be possible to postpone the use of levodopa and delay or prevent the development of motor complications. Recently, four clinical trials have explored this hypothesis by comparing the long-term response and side effects of levodopa with dopamine agonist therapy. The drugs studied have included ropinirole, pramipexole, cabergoline, and pergolide. In each of these projects, the occurrence of motor complications, such as wearing off and dyskinesia, was significantly less in the subjects assigned to initiation of therapy with a dopamine agonist. The addition of levodopa could be postponed by many months or even several years. Therefore, these long-term studies of dopamine agonists support the initiation of a dopamine agonist instead of levodopa in an effort to postpone levodopa-related motor complications. This therapeutic approach may be particularly appropriate in PD patients with a long treatment horizon on the basis of age and general good health. The extension phase of the long-term study comparing pramipexole with levodopa is ongoing, and follow-up information may help to establish the value of this treatment strategy.

  6. Long Term Care Aide. Course Outline.

    ERIC Educational Resources Information Center

    Wilbee, Judy

    This course outline is intended to assist the instructor in the development of a curriculum for a long-term care aide program by specifying one component of the curriculum--the objectives. These objectives, or competencies expected as outcomes for student performance on completion of the program, describe the capabilities an individual must…

  7. Long-term lysimeter data on evapotranspiration

    USDA-ARS?s Scientific Manuscript database

    Long term crop evapotranspiration (ET) data measured using large weighing lysimeters have only been gathered in a few places in the world, yet are of great importance for ground truthing of many models of plant water use, mesoscale climate, remote sensing estimation of ET, climate change and climate...

  8. Who Recommends Long-Term Care Matters

    ERIC Educational Resources Information Center

    Kane, Robert L.; Bershadsky, Boris; Bershadsky, Julie

    2006-01-01

    Purpose: Making good consumer decisions requires having good information. This study compared long-term-care recommendations among various types of health professionals. Design and Methods: We gave randomly varied scenarios to a convenience national sample of 211 professionals from varying disciplines and work locations. For each scenario, we…

  9. Professionalism in Long-Term Care Settings

    ERIC Educational Resources Information Center

    Lubinski, Rosemary

    2006-01-01

    Speech-language pathologists who serve elders in a variety of long-term care settings have a variety of professional skills and responsibilities. Fundamental to quality service is knowledge of aging and communication changes and disorders associated with this process, institutional alternatives, and the changing nature of today's elders in…

  10. Evaluating Long-Term Disability Insurance Plans.

    ERIC Educational Resources Information Center

    Powell, Jan

    1992-01-01

    This report analyzes the factors involved in reviewing benefits and services of employer-sponsored group long-term disability plans for higher education institutions. Opening sections describe the evolution of disability insurance and its shape today. Further sections looks at the complex nature of "value" within a plan, relationship…

  11. LONG TERM HYDROLOGICAL IMPACT ASSESSMENT (LTHIA)

    EPA Science Inventory

    LTHIA is a universal Urban Sprawl analysis tool that is available to all at no charge through the Internet. It estimates impacts on runoff, recharge and nonpoint source pollution resulting from past or proposed land use changes. It gives long-term average annual runoff for a lan...

  12. Long-Term Stability of Tutor Performance.

    ERIC Educational Resources Information Center

    Dolmans, Diana H. J. M.; And Others

    1996-01-01

    Examined the extent to which tutor ratings remained stable in the long term by evaluating 291 ratings of 140 tutors at Maastricht University in the Netherlands between 1992 and 1995. The results indicated that, if the aggregated score and overall judgement are used to interpret the precision of individual scores, four and two occasions,…

  13. Urethroplasty for hypospadias: long-term results.

    PubMed

    Glassman, C N; Machlus, B J; Kelalis, P P

    1980-06-01

    A retrospective study of patients who had undergone multi-staged hypospadias repair at the Mayo Clinic was undertaken to identify long-term problems associated with this surgery. Patients were queried concerning their satisfaction with quality of urinary stream; penile erection and ejaculation; sexual function and fertility; and cosmetic appearance.

  14. LONG TERM HYDROLOGICAL IMPACT ASSESSMENT (LTHIA)

    EPA Science Inventory

    LTHIA is a universal Urban Sprawl analysis tool that is available to all at no charge through the Internet. It estimates impacts on runoff, recharge and nonpoint source pollution resulting from past or proposed land use changes. It gives long-term average annual runoff for a lan...

  15. Very Long Term Memory for Tacit Knowledge.

    ERIC Educational Resources Information Center

    Allen, Rhianon; Reber, Arthur S.

    1980-01-01

    Very long-term memory for abstract materials was examined for subjects who had served in a synthetic grammar learning experiment two years earlier. Knowledge of these grammars was retained. The form and structure of knowledge and the manner in which it is put to use remained similar to the original. (Author/RD)

  16. Long-term opioid therapy reconsidered.

    PubMed

    Von Korff, Michael; Kolodny, Andrew; Deyo, Richard A; Chou, Roger

    2011-09-06

    In the past 20 years, primary care physicians have greatly increased prescribing of long-term opioid therapy. However, the rise in opioid prescribing has outpaced the evidence regarding this practice. Increased opioid availability has been accompanied by an epidemic of opioid abuse and overdose. The rate of opioid addiction among patients receiving long-term opioid therapy remains unclear, but research suggests that opioid misuse is not rare. Recent studies report increased risks for serious adverse events, including fractures, cardiovascular events, and bowel obstruction, although further research on medical risks is needed. New data indicate that opioid-related risks may increase with dose. From a societal perspective, higher-dose regimens account for the majority of opioids dispensed, so cautious dosing may reduce both diversion potential and patient risks for adverse effects. Limiting long-term opioid therapy to patients for whom it provides decisive benefits could also reduce risks. Given the warning signs and knowledge gaps, greater caution and selectivity are needed in prescribing long-term opioid therapy. Until stronger evidence becomes available, clinicians should err on the side of caution when considering this treatment.

  17. Long-term fixed income market structure

    NASA Astrophysics Data System (ADS)

    Grilli, Luca

    2004-02-01

    Long-term fixed income market securities present a strong positive correlation in daily returns. By using a metrical approach and considering “modified” time series, I show how it is possible to show a more complex structure which depends strictly on the maturity date.

  18. Long-term function after restorative proctocolectomy.

    PubMed

    Wheeler, J M D; Banerjee, A; Ahuja, N; Jewell, D P; Mortensen, N J McC

    2005-05-01

    Early functional outcome after restorative proctocolectomy and formation of an ileoanal pouch is known to be good, but there are minimal data on the long-term function of the pouch. The aim of this study was to look at the long-term functional outcome in patients who had undergone restorative proctocolectomy and formation of an ileoanal pouch. A total of 151 consecutive patients (96 males, 55 females) who underwent ileoanal pouch surgery between April 1983 and May 1993 were identified. Functional outcomes from the previous 12 months were appraised by a standardized questionnaire. The median age at surgery was 31 years (range, 6-63 years), with a median follow-up of 142 months (range, 100-221 months). Eighteen patients have had their pouches excised, with another patient being defunctioned. Therefore 19 patients (13 percent) had suffered pouch failure. Altogether, 115 patients were available for follow-up, and 98 patients (85 percent) returned questionnaires. The median pouch-emptying frequency was five times (range, 1-17) during the day and one time (range, 0-6) at night. A total of 74 percent of patients had perfect continence during the day. Most of the patients had no life-style restrictions related to the pouch, and 98 percent of patients would recommend a pouch to others. Long-term functional outcome after ileoanal pouch surgery is good in most patients. For patients requiring proctocolectomy, ileoanal pouch surgery can now be recommended as an excellent long-term option.

  19. Long-Term Impacts of Educational Interventions

    ERIC Educational Resources Information Center

    Deming, David James

    2010-01-01

    The school accountability movement has led to a marked increase in the use of standardized test scores to measure school and teacher productivity, yet little is known about the correlation between test score gains and improvements in long-term outcomes. In the first chapter of my dissertation, I study the impact of a school choice policy in…

  20. Long-Term Stability of Tutor Performance.

    ERIC Educational Resources Information Center

    Dolmans, Diana H. J. M.; And Others

    1996-01-01

    Examined the extent to which tutor ratings remained stable in the long term by evaluating 291 ratings of 140 tutors at Maastricht University in the Netherlands between 1992 and 1995. The results indicated that, if the aggregated score and overall judgement are used to interpret the precision of individual scores, four and two occasions,…

  1. Who Recommends Long-Term Care Matters

    ERIC Educational Resources Information Center

    Kane, Robert L.; Bershadsky, Boris; Bershadsky, Julie

    2006-01-01

    Purpose: Making good consumer decisions requires having good information. This study compared long-term-care recommendations among various types of health professionals. Design and Methods: We gave randomly varied scenarios to a convenience national sample of 211 professionals from varying disciplines and work locations. For each scenario, we…

  2. Long-term disability in anxiety disorders.

    PubMed

    Hendriks, Sanne M; Spijker, Jan; Licht, Carmilla M M; Hardeveld, Florian; de Graaf, Ron; Batelaan, Neeltje M; Penninx, Brenda W J H; Beekman, Aartjan T F

    2016-07-19

    This longitudinal study aims to investigate differences in long-term disability between social anxiety disorder (SAD), panic disorder with agoraphobia (PDA), panic disorder without agoraphobia (PD), generalized anxiety disorder (GAD) and multiple anxiety disorders (multiple AD), focusing on the effects of different course trajectories (remission, recurrence and chronic course) and specific symptom dimensions (anxiety arousal and avoidance behaviour). Data were used from participants with no psychiatric diagnosis (healthy controls, n = 647) or with a current anxiety disorder (SAD, n = 191; PDA, n = 90; PD, n = 84; GAD, n = 110; multiple AD, n = 480). Severity of anxiety arousal and avoidance behaviour symptoms was measured using the Beck Anxiety Inventory and the Fear Questionnaire. The World Health Organization Disability Assessment Schedule II was used to measure disability. Long-term disability was most prevalent in participants with SAD and multiple AD, and lowest in PDA and PD. GAD had an intermediate position. Anxiety arousal and avoidance behaviour were associated with more long-term disability in anxiety disorders than course trajectories. Various anxiety disorders have different disability levels over 4 years of time, therefore diagnostic distinction is important for treatment focus. Anxiety arousal and avoidance behaviour are major predictors for long-term disability in anxiety disorders.

  3. Long-Term Stability of Social Participation

    ERIC Educational Resources Information Center

    Hyyppa, Markku T.; Maki, Juhani; Alanen, Erkki; Impivaara, Olli; Aromaa, Arpo

    2008-01-01

    The long-term stability of social participation was investigated in a representative urban population of 415 men and 579 women who had taken part in the nationwide Mini-Finland Health Survey in the years 1978-1980 and were re-examined 20 years later. Stability was assessed by means of the following tracking coefficients: kappa, proportion of…

  4. Long-Term Care Research and Policy

    ERIC Educational Resources Information Center

    Kemper, Peter

    2003-01-01

    This article provides a framework for understanding how long-term care (LTC) research contributes to policy, develops a typology of research contributions to policy with examples of each type, and suggests ways to ensure that contributions continue in the future. The article draws on in-depth interviews with LTC experts working at the interface…

  5. The long term characteristics of greenschist

    NASA Astrophysics Data System (ADS)

    Jang, Bo-An

    2016-04-01

    The greenschist in the Jinping II Hydropower Station in southwest China exhibits continuous creep behaviour because of the geological conditions in the region. This phenomenon illustrates the time-dependent deformation and progressive damage that occurs after excavation. In this study, the responses of greenschist to stress over time were determined in a series of laboratory tests on samples collected from the access tunnel walls at the construction site. The results showed that the greenschist presented time-dependent behaviour under long-term loading. The samples generally experienced two stages: transient creep and steady creep, but no accelerating creep. The periods of transient creep and steady creep increased with increasing stress levels. The long-term strength of the greenschist was identified based on the variation of creep strain and creep rate. The ratio of long-term strength to conventional strength was around 80% and did not vary much with confining pressures. A quantitative method for predicting the failure period of greenschist, based on analysis of the stress-strain curve, is presented and implemented. At a confining pressure of 40 MPa, greenschist was predicted to fail in 5000 days under a stress of 290 MPa and to fail in 85 days under the stress of 320 MPa, indicating that the long-term strength identified by the creep rate and creep strain is a reliable estimate.

  6. The Present, Mid-Term, and Long-Term Supply Curves for Tellurium; and Updates in the Results from NREL's CdTe PV Module Manufacturing Cost Model (Presentation)

    SciTech Connect

    Woodhouse, M.; Goodrich, A.; Redlinger, M.; Lokanc, M.; Eggert, R.

    2013-09-01

    For those PV technologies that rely upon Te, In, and Ga, first-order observations and calculations hint that there may be resource constraints that could inhibit their successful deployment at a SunShot level. These are only first-order approximations, however, and the possibility for an expansion in global Te, In, and Ga supplies needs to be considered in the event that there are upward revisions in their demand and prices.In this study, we examine the current, mid-term, and long-term prospects of Tellurium (Te) for use in PV. We find that the current global supply base of Te would support <10 GW of annual traditional CdTe PV manufacturing production. But as for the possibility that the supply base for Te might be expanded, after compiling several preliminary cumulative availability curves we find that there may be significant upside potential in the supply base for this element - principally vis a vis increasing demand and higher prices. Primarily by reducing the Tellurium intensity in manufacturing and by increasing the recovery efficiency of Te in Cu refining processes, we calculate that it may prove affordable to PV manufacturers to expand the supply base for Te such that 100 GW, or greater, of annual CdTe PV production is possible in the 2030 - 2050 timeframe.

  7. Long-term biological investigations in space.

    PubMed

    Lotz, R G; Fuchs, H; Bertsche, U

    1975-01-01

    Missions in space within the next two decades will be of longer duration than those carried out up to the present time, and the effects of such long-term flights on biological organisms are unknown. Results of biological experiments that have been performed to date cannot be extrapolated to results in future flights because of the unknown influence of adaptation over a long period of time. Prior experiments with Axolotl, fishes, and vertebrates by our research team (in part with sounding rockets) showed that these specimens did not appear to be suitable for long-term missions on which minimization of expense, technique, and energy is required. Subsequent investigations have shown the suitability of the leech (Hirudo medicinalis), which consumes blood of mammals up to ten times its own weight (1 g) and can live more than 2 years without further food supply. Emphasis in the experiments with Hirudo medicinalis is placed on metabolic rhythm and motility. Resorption and diffusion in tissue, development, and growth under long-term effects of cosmic proton radiation and zero-gravity are other focal points. The constancy of cellular life in the mature animals is a point in favor of these specimens. We have also taken into account the synergistic effects of the space environment on the problems just mentioned. The life-support system constructed for the leech has been tested successfully in four sounding rocket flights and, on that basis, has been prepared for a long-term mission. Long-term investigations out of the terrestrial biosphere will provide us with information concerning the degree of adaptation of certain physiological and biochemical functions and as to what extent biological readjustment or repair processes can occur under the specific stress conditions of space flight.

  8. Long-Term Hearing Results After Ossiculoplasty.

    PubMed

    Cox, Matthew D; Trinidade, Aaron; Russell, James Shep; Dornhoffer, John L

    2017-04-01

    To determine if the OOPS index is predictive of long-term hearing results after ossiculoplasty. Case series with retrospective chart review. Tertiary care otology practice. Adult and pediatric patients (3-88 years of age). Ossiculoplasty with cartilage tympanoplasty, with or without mastoidectomy. Primary outcome measures included short-term hearing results (pure-tone average air-bone gap [PTA-ABG] measured between 60 days and 1 year after surgery), long-term hearing results (PTA-ABG measured ≥5 years after surgery), and the rate of successful ABG closure to ≤20 dB. Secondary measures included the need for revision surgery, delayed tympanic membrane graft failure, worsening conductive hearing loss (after an initially satisfactory hearing result), and recurrence of cholesteatoma. There was no significant difference between adults and children for short-term hearing results (average post-op PTA-ABG was 18.9 dB vs. 19.8 dB, respectively; p = 0.544), long-term hearing results (average final PTA-ABG was 19.3 dB vs. 19.4 dB, respectively; p = 0.922), or rate of ABG closure to less than 20 dB (63.1% vs. 58.0%, p = 0.282). Spearman's rank-order correlation (ρ) identified a strong positive correlation between OOPS index score and average post-operative PTA-ABG (ρ = 0.983; p < 0.001; 2-tailed), as well as average long-term PTA-ABG (ρ = 0.950, p < 0.001; 2-tailed). The OOPS index makes it possible to accurately prognosticate hearing outcomes in adult and pediatric patients undergoing ossiculoplasty in both the short term and the long term.

  9. An analysis of the short- and long-term cost-effectiveness of starting biphasic insulin aspart 30 in insulin-naïve people with poorly controlled type 2 diabetes.

    PubMed

    Shafie, Asrul Akmal; Gupta, Vishal; Baabbad, Ranya; Hammerby, Eva; Home, Philip

    2014-11-01

    This study aimed to assess the cost-effectiveness of starting insulin therapy with biphasic insulin aspart 30 (BIAsp 30) in people with type 2 diabetes inadequately controlled on oral glucose-lowering drugs in Saudi Arabia, India, Indonesia, and Algeria. The IMS CORE Diabetes Model was used to evaluate economic outcomes associated with starting BIAsp 30, using baseline characteristics and treatment outcomes from the A(1)chieve study. Time horizons of 1 and 30 years were applied, with country-specific costs for complications, therapies, and background mortality. Incremental cost-effectiveness ratios (ICERs) are expressed as cost per quality-adjusted life-year (QALY) in local currencies, USD, and fractions of local GDP per capita (GDPc). Cost-effectiveness was pre-defined using the World Health Organization definition of <3.0 times GDPc. Comprehensive sensitivity analyses were performed. In the primary 30-year analyses, starting BIAsp 30 was associated with a projected increase in life expectancy of >1 year and was highly cost-effective, with ICERs of -0.03 (Saudi Arabia), 0.25 (India), 0.48 (India), 0.47 (Indonesia), and 0.46 (Algeria) GDPc/QALY. The relative risk of developing selected complications was reduced in all countries. Sensitivity analyses including cost of self-monitoring, treatment costs, and deterioration of glucose control with time showed the results to be robust. In a 1-year analysis, ICER per QALY gained was still cost-effective or highly cost-effective. Starting BIAsp 30 in people with type 2 diabetes in the A(1)chieve study was found to be cost-effective across all country settings at 1- and 30-year time horizons, and usefully increased predicted life expectancy. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  10. Long Term Stability of Coriolis Flow Meters: DESY experience

    NASA Astrophysics Data System (ADS)

    Boeckmann, T.; Bozhko, Y.; Escherich, K.; Petersen, B.; Putselyk, S.; Schnautz, T.; Sellmann, D.; Zhirnov, A.

    2017-02-01

    The measurement of coolant flow is important operational parameter for reliable operation of cryogenic system with superconducting magnets or cavities as well as for the system diagnostics in case of non-steady-state operation, e.g. during cool-down/warm-up or other transients. Proper flowmeter is chosen according to the different parameters, e.g. turn-down, operating temperature range, leak-tightness, pressure losses, long-term stability, etc. For helium cryogenics, the Venturi tube or Orifice, as well as Coriolis flow meters are often applied. For the present time, the orifices are usually used due to their simplicity and low costs, however, low turn-down range, large pressure drop, restriction of flow area, susceptibility to thermoacoustic oscillations limit their useful operation range. Operational characteristics of Venturi tubes is substantially improved in comparison to orifices, however, relative high costs and susceptibility to thermoacoustic oscillations still limit their application to special cases. The Coriolis flow meters do not have typical drawbacks of Venturi tube and orifices, however long-term stability over many years was not demonstrated yet. This paper describes the long-term behaviour of Coriolis flow meters after many years of operation at AMTF and XMTS facilities.

  11. Structure of dialysis membranes and long-term clinical outcome.

    PubMed

    Bonomini, V; Coli, L; Scolari, M P; Stefoni, S

    1995-01-01

    The present comparative evaluation aims at establishing whether the basic structure of dialysis membrane is able to predict long-term clinical outcome. From a population of 1,256 patients on renal dialysis treatment, treated by the Institute of Nephrology and Dialysis of the St. Orsola University Hospital of Bologna from 1963 to 1993, 122 patients were retrospectively selected for the present study. Patients were divided into two different groups according to the kind of dialysis membrane used--cellulose-based (64 patients) and synthetic-based (58 patients) membranes. The parameters considered were: intradialytic biology, long-term biocompatibility, survival and morbidity, and cost/benefit. The results obtained demonstrate that cellulosic membranes can be said to cause a greater acute intradialytic biological response than synthetics, though not to a significant degree. There are, however, no significant differences in the biological changes from group to group. Nonsignificant differences were noted in long-term survival general morbidity. In terms of sheer cost, synthetic membrane treatment is anything up to 200% dearer than cellulosic.

  12. Archiving Primary Data: Solutions for Long-Term Studies.

    PubMed

    Mills, James A; Teplitsky, Céline; Arroyo, Beatriz; Charmantier, Anne; Becker, Peter H; Birkhead, Tim R; Bize, Pierre; Blumstein, Daniel T; Bonenfant, Christophe; Boutin, Stan; Bushuev, Andrey; Cam, Emmanuelle; Cockburn, Andrew; Côté, Steeve D; Coulson, John C; Daunt, Francis; Dingemanse, Niels J; Doligez, Blandine; Drummond, Hugh; Espie, Richard H M; Festa-Bianchet, Marco; Frentiu, Francesca; Fitzpatrick, John W; Furness, Robert W; Garant, Dany; Gauthier, Gilles; Grant, Peter R; Griesser, Michael; Gustafsson, Lars; Hansson, Bengt; Harris, Michael P; Jiguet, Frédéric; Kjellander, Petter; Korpimäki, Erkki; Krebs, Charles J; Lens, Luc; Linnell, John D C; Low, Matthew; McAdam, Andrew; Margalida, Antoni; Merilä, Juha; Møller, Anders P; Nakagawa, Shinichi; Nilsson, Jan-Åke; Nisbet, Ian C T; van Noordwijk, Arie J; Oro, Daniel; Pärt, Tomas; Pelletier, Fanie; Potti, Jaime; Pujol, Benoit; Réale, Denis; Rockwell, Robert F; Ropert-Coudert, Yan; Roulin, Alexandre; Sedinger, James S; Swenson, Jon E; Thébaud, Christophe; Visser, Marcel E; Wanless, Sarah; Westneat, David F; Wilson, Alastair J; Zedrosser, Andreas

    2015-10-01

    The recent trend for journals to require open access to primary data included in publications has been embraced by many biologists, but has caused apprehension amongst researchers engaged in long-term ecological and evolutionary studies. A worldwide survey of 73 principal investigators (Pls) with long-term studies revealed positive attitudes towards sharing data with the agreement or involvement of the PI, and 93% of PIs have historically shared data. Only 8% were in favor of uncontrolled, open access to primary data while 63% expressed serious concern. We present here their viewpoint on an issue that can have non-trivial scientific consequences. We discuss potential costs of public data archiving and provide possible solutions to meet the needs of journals and researchers. Copyright © 2015 Elsevier Ltd. All rights reserved.

  13. 19. Generic services for the long-term care patient.

    PubMed

    Pfeiffer, E

    1976-05-01

    The purpose of multidimensional functional assessment of the long-term care patient or client is to identify the relevant set of services or service package. This necessitates defining the universe of services independently of existing service providers and settings, which vary considerably in scope and type of activities. A list of 24 generic services developed by the Duke Center for the Study of Aging and Human Development has proved useful in assigning patients to the appropriate providers. It is also a means of describing accurately the service capacity of a given program or institution, as well as the precise nature of the intervention, or set of services, in studies of impact or outcome. Planners and evaluators can use the list to cost existing programs and to plan new ones more responsive to the requirements of long-term care patients and clients.

  14. Cost Effectiveness of Support for People Starting a New Medication for a Long-Term Condition Through Community Pharmacies: An Economic Evaluation of the New Medicine Service (NMS) Compared with Normal Practice.

    PubMed

    Elliott, Rachel A; Tanajewski, Lukasz; Gkountouras, Georgios; Avery, Anthony J; Barber, Nick; Mehta, Rajnikant; Boyd, Matthew J; Latif, Asam; Chuter, Antony; Waring, Justin

    2017-08-03

    The English community pharmacy New Medicine Service (NMS) significantly increases patient adherence to medicines, compared with normal practice. We examined the cost effectiveness of NMS compared with normal practice by combining adherence improvement and intervention costs with the effect of increased adherence on patient outcomes and healthcare costs. We developed Markov models for diseases targeted by the NMS (hypertension, type 2 diabetes mellitus, chronic obstructive pulmonary disease, asthma and antiplatelet regimens) to assess the impact of patients' non-adherence. Clinical event probability, treatment pathway, resource use and costs were extracted from literature and costing tariffs. Incremental costs and outcomes associated with each disease were incorporated additively into a composite probabilistic model and combined with adherence rates and intervention costs from the trial. Costs per extra quality-adjusted life-year (QALY) were calculated from the perspective of NHS England, using a lifetime horizon. NMS generated a mean of 0.05 (95% CI 0.00-0.13) more QALYs per patient, at a mean reduced cost of -£144 (95% CI -769 to 73). The NMS dominates normal practice with a probability of 0.78 [incremental cost-effectiveness ratio (ICER) -£3166 per QALY]. NMS has a 96.7% probability of cost effectiveness compared with normal practice at a willingness to pay of £20,000 per QALY. Sensitivity analysis demonstrated that targeting each disease with NMS has a probability over 0.90 of cost effectiveness compared with normal practice at a willingness to pay of £20,000 per QALY. Our study suggests that the NMS increased patient medicine adherence compared with normal practice, which translated into increased health gain at reduced overall cost. ClinicalTrials.gov Trial reference number NCT01635361 ( http://clinicaltrials.gov/ct2/show/NCT01635361 ). Current Controlled trials: Trial reference number ISRCTN 23560818 ( http://www.controlled-trials.com/ISRCTN23560818

  15. Is the current standard of care leading to cost-effective outcomes for patients with type 2 diabetes requiring insulin? A long-term health economic analysis for the UK.

    PubMed

    Valentine, W J; Curtis, B H; Pollock, R F; Van Brunt, K; Paczkowski, R; Brändle, M; Boye, K S; Kendall, D M

    2015-07-01

    The aim of the analysis was to investigate whether insulin intensification, based on the use of intensive insulin regimens as recommended by the current standard of care in routine clinical practice, would be cost-effective for patients with type 2 diabetes in the UK. Clinical data were derived from a retrospective analysis of 3185 patients with type 2 diabetes on basal insulin in The Health Improvement Network (THIN) general practice database. In total, 48% (614 patients) intensified insulin therapy, defined by adding bolus or premix insulin to a basal regimen, which was associated with a reduction in HbA1c and an increase in body mass index. Projections of clinical outcomes and costs (2011 GBP) over patients' lifetimes were made using a recently validated type 2 diabetes model. Immediate insulin intensification was associated with improvements in life expectancy, quality-adjusted life expectancy and time to onset of complications versus no intensification or delaying intensification by 2, 4, 6, or 8 years. Direct costs were higher with the insulin intensification strategy (due to the acquisition costs of insulin). Incremental cost-effectiveness ratios for insulin intensification were GBP 32,560, GBP 35,187, GBP 40,006, GBP 48,187 and GBP 55,431 per QALY gained versus delaying intensification 2, 4, 6 and 8 years, and no intensification, respectively. Although associated with improved clinical outcomes, insulin intensification as practiced in the UK has a relatively high cost per QALY and may not lead to cost-effective outcomes for patients with type 2 diabetes as currently defined by UK cost-effectiveness thresholds. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  16. The Long-Term Cost to the UK NHS and Social Services of Different Durations of IV Thiamine (Vitamin B1) for Chronic Alcohol Misusers with Symptoms of Wernicke's Encephalopathy Presenting at the Emergency Department.

    PubMed

    Wilson, Edward C F; Stanley, George; Mirza, Zulfiquar

    2016-04-01

    Wernicke's encephalopathy (WE) is an acute neuropsychiatric condition caused by depleted intracellular thiamine, most commonly arising in chronic alcohol misusers, who may present to emergency departments (EDs) for a variety of reasons. Guidelines recommend a minimum 5-day course of intravenous (IV) thiamine in at-risk patients unless WE can be excluded. To estimate the cost impact on the UK public sector (NHS and social services) of a 5-day course of IV thiamine, vs a 2- and 10-day course, in harmful or dependent drinkers presenting to EDs. A Markov chain model compared expected prognosis of patients under alternative admission strategies over 35 years. Model inputs were derived from a prospective cohort study, expert opinion via structured elicitation and NHS costing databases. Costs (2012/2013 price year) were discounted at 3.5 %. Increasing treatment from 2 to 5 days increased acute care costs but reduced the probability of disease progression and thus reduced the expected net costs by GBP87,000 per patient (95 % confidence interval GBP19,300 to GBP172,300) over 35 years. Increasing length of stay to optimize IV thiamine replacement will place additional strain on acute care but has potential UK public sector cost savings. Social services and the NHS should explore collaborations to realise both the health benefits to patients and savings to the public purse.

  17. Long-term consequences of foodborne infections.

    PubMed

    Batz, Michael B; Henke, Evan; Kowalcyk, Barbara

    2013-09-01

    Foodborne infections with Campylobacter, E. coli O157:H7, Listeria monocytogenes, Salmonella, Shigella, Toxoplasma gondii, and other pathogens can result in long-term sequelae to numerous organ systems. These include irritable bowel syndrome, inflammatory bowel disease, reactive arthritis, hemolytic uremic syndrome, chronic kidney disease, Guillain-Barré Syndrome, neurological disorders from acquired and congenital listeriosis and toxoplasmosis, and cognitive and developmental deficits due to diarrheal malnutrition or severe acute illness. A full understanding of the long-term sequelae of foodborne infection is important both for individual patient management by clinicians, as well as to inform food safety and public health decision making. Copyright © 2013 Elsevier Inc. All rights reserved.

  18. Case presentation: long-term treatment.

    PubMed

    Glucksman, Myron L

    2013-01-01

    The long-term (14 years) psychodynamic psychotherapy and pharmacotherapy of a depressed, suicidal, self-mutilating female patient is described. Her diagnoses included Chronic Posttraumatic Stress Disorder, Borderline Personality Disorder, and Recurrent Major Depression. Treatment was punctuated with repeated hospitalizations for self-mutilation (cutting) and suicidal ideation. A major determinant for her psychopathology was sexual abuse by her father from ages 6 to 14. This resulted in feelings of guilt and rage that she repressed and acted out through self-mutilating and suicidal behavior. A prolonged negative transference gradually became ambivalent, then positive. This was associated with her internalization of the healing qualities of the therapeutic relationship. She also gained insight into the reasons for her need to punish herself. Her initial self-representation as unworthy and bad was transformed into perceiving herself as a worthwhile, loving person. This case illustrates the role of long-term treatment for a complex, life-threatening, psychiatric disorder.

  19. Modeling long-term collider performance

    SciTech Connect

    Ritson, D. Superconducting Super Collider Lab., Dallas, TX )

    1991-07-01

    A model for the SSC arcs is described with multipole lattice field errors agglomerated into 32 lattice points, and with first order lattice errors and modulation provided by discrete transfer elements. Numerical solutions for long term dynamic aperture studies are obtained by multipole kick-drift tracking. The CPU time required to track through one turn is minimal, and comparable to that required to implement a one-turn fifth-order Taylor series map. Comparisons with tracking results using a fine grained representation of the lattice are made, and found to be satisfactory. The effects of tune modulation are studied and can substantially degrade long-term dynamic aperture. The effects of small relativistic momentum corrections, usually neglected for the large momenta at the SSC, are shown to have negligible influence on tracking results. 5 refs., 7 figs.

  20. [Ambulatory long-term EEG monitors].

    PubMed

    John, K; Komärek, V; Lehovský, M

    1990-06-01

    Ambulatory EEG monitoring is indicated in patients with attacks of uncertain origin. The method is useful to distinguish non-epileptic and epileptic attacks and to differentiate the kind of epileptic seizures which is important for the choice of antiepileptic drugs and for prognosis. It is necessary to describe in detail behaviour and seizures of patient during monitoring. EEG long term monitoring is only useful if attacks were seen frequently, at least once or twice a week.

  1. LOP - Long-Term Orbit Predictor

    NASA Technical Reports Server (NTRS)

    Kwok, Johnny H.

    1992-01-01

    Long-Term Orbit Preditor (LOP) trajectory-propagation computer program is useful tool in analysis of lifetime of orbiting spacecraft. Suitable for studying planetary-orbit missions with reconnaissance (flyby) and exploratory (mapping) trajectories. Includes sample data for study of drift cycle of geosynchronous station, strategy for radar mapping of Venus, frozen orbit about Mars, and orbit characterized by repeating ground trace. Executed faster than such programs based on Cowell's method. Written in FORTRAN 77.

  2. Long term economic relationships from cointegration maps

    NASA Astrophysics Data System (ADS)

    Vicente, Renato; Pereira, Carlos de B.; Leite, Vitor B. P.; Caticha, Nestor

    2007-07-01

    We employ the Bayesian framework to define a cointegration measure aimed to represent long term relationships between time series. For visualization of these relationships we introduce a dissimilarity matrix and a map based on the sorting points into neighborhoods (SPIN) technique, which has been previously used to analyze large data sets from DNA arrays. We exemplify the technique in three data sets: US interest rates (USIR), monthly inflation rates and gross domestic product (GDP) growth rates.

  3. Long-term sequelae of electrical injury

    PubMed Central

    Wesner, Marni L.; Hickie, John

    2013-01-01

    Abstract Objective To summarize the current evidence-based knowledge about the long-term sequelae of injuries from electrical current. Quality of evidence MEDLINE was searched for English-language articles published in the past 20 years using the following search terms: electrical, injuries, wound, trauma, accident, sequelae, long-term, follow-up, and aftereffects. For obvious reasons, it is unethical to randomly study electrical injury in controlled clinical trials. By necessity, this topic is addressed in less-rigorous observational and retrospective work and case studies. Therefore, the strength of the literature pertaining to the long-term sequelae of electrical injury is impaired by the necessity of retrospective methods and case studies that typically describe small cohorts. Main message There are 2 possible consequences of electrical injury: the person either survives or dies. For those who survive electrical injury, the immediate consequences are usually obvious and often require extensive medical intervention. The long-term sequelae of the electrical injury might be more subtle, pervasive, and less well defined, but can include neurologic, psychological, and physical symptoms. In the field of compensation medicine, determining causation and attributing outcome to an injury that might not result in objective clinical findings becomes a considerable challenge. Conclusion The appearance of these consequences of electrical injury might be substantially delayed, with onset 1 to 5 or more years after the electrical injury. This poses a problem for patients and health care workers, making it hard to ascribe symptoms to a remote injury when they might not arise until well after the incident event. PMID:24029506

  4. Breakthroughs in long term care design.

    PubMed

    Hiatt, L

    1991-01-01

    In summary, here is what design is trying to accomplish in long term care facilities: Functional access; Privacy as entitlement; Sensory optimization to improve vision and hearing; Reduced walking and wheeling distances that still allow people to be mobile; Effective or functional placement of space and equipment; The option of smaller scale, so neither residents nor staff feel like they are hanging out with a unit full of, perhaps 68, people all the time; Flexibility and adaptability

  5. Long-term course of opioid addiction.

    PubMed

    Hser, Yih-Ing; Evans, Elizabeth; Grella, Christine; Ling, Walter; Anglin, Douglas

    2015-01-01

    Opioid addiction is associated with excess mortality, morbidities, and other adverse conditions. Guided by a life-course framework, we review the literature on the long-term course of opioid addiction in terms of use trajectories, transitions, and turning points, as well as other factors that facilitate recovery from addiction. Most long-term follow-up studies are based on heroin addicts recruited from treatment settings (mostly methadone maintenance treatment), many of whom are referred by the criminal justice system. Cumulative evidence indicates that opioid addiction is a chronic disorder with frequent relapses. Longer treatment retention is associated with a greater likelihood of abstinence, whereas incarceration is negatively related to subsequent abstinence. Over the long term, the mortality rate of opioid addicts (overdose being the most common cause) is about 6 to 20 times greater than that of the general population; among those who remain alive, the prevalence of stable abstinence from opioid use is low (less than 30% after 10-30 years of observation), and many continue to use alcohol and other drugs after ceasing to use opioids. Histories of sexual or physical abuse and comorbid mental disorders are associated with the persistence of opioid use, whereas family and social support, as well as employment, facilitates recovery. Maintaining opioid abstinence for at least five years substantially increases the likelihood of future stable abstinence. Recent advances in pharmacological treatment options (buprenorphine and naltrexone) include depot formulations offering longer duration of medication; their impact on the long-term course of opioid addiction remains to be assessed.

  6. Infective endocarditis: determinants of long term outcome

    PubMed Central

    Netzer, R O M; Altwegg, S C; Zollinger, E; Täuber, M; Carrel, T; Seiler, C

    2002-01-01

    Objective: To evaluate predictors of long term prognosis in infective endocarditis. Design: Retrospective cohort study. Setting: Tertiary care centre. Patients: 212 consecutive patients with infective endocarditis between 1980 and 1995 Main outcome measures: Overall and cardiac mortality; event-free survival; and the following events: recurrence, need for late valve surgery, bleeding and embolic complications, cerebral dysfunction, congestive heart failure. Results: During a mean follow up period of 89 months (range 1–244 months), 56% of patients died. In 180 hospital survivors, overall and cardiac mortality amounted to 45% and 24%, respectively. By multivariate analysis, early surgical treatment, infection by streptococci, age < 55 years, absence of congestive heart failure, and > 6 symptoms or signs of endocarditis during active infection were predictive of improved overall long term survival. Independent determinants of event-free survival were infection by streptococci and age < 55 years. Event-free survival was 17% at the end of follow up both in medically–surgically treated patients and in medically treated patients. Conclusions: Long term survival following infective endocarditis is 50% after 10 years and is predicted by early surgical treatment, age < 55 years, lack of congestive heart failure, and the initial presence of more symptoms of endocarditis. PMID:12067947

  7. Long-term OH variability of Miras

    NASA Astrophysics Data System (ADS)

    Etoka, S.; Le Squeren, A. M.

    2000-10-01

    We present here the results and interpretation of a long-term OH variability program conducted with the French {Nançay} Radiotelescope from 1980 to 1995. It concerns seven Mira stars: R Aql, RS Vir, S CrB, R LMi, RR Aql, U Her and UX Cyg. This study deals with the three OH maser lines observed in the Miras at 1612, 1665 and 1667 MHz. These OH variable stars have periods ranging from 290 to 580 days. The study presents the first insight of the long-term temporal behaviour of OH integrated flux variations as well as spectral component variations. The main aims are to determine the temporal behaviour of the OH maser emission and the longevity and variability of the spectral components. We find that the shapes of the OH curve are closer to the IR than the optical shapes and that the emissions at 1665 and 1667 MHz have a very similar behaviour while the emission at 1612 MHz behaves differently. The 1612 MHz emission shows smoother temporal variations and greater component longevity than the main line emission, leading to the conclusion that the 1612 MHz emission is coming from an outer part of the circumstellar shell and is more saturated than the main line emission. The study also shows the existence of inhomogeneities, especially differences between the front and back parts of the shell can be seen, and that OH variability curves undergo long term variations over several cycles.

  8. Electrodes for long-term esophageal electrocardiography.

    PubMed

    Niederhauser, Thomas; Haeberlin, Andreas; Marisa, Thanks; Jungo, Michael; Goette, Josef; Jacomet, Marcel; Abacherli, Roger; Vogel, Rolf

    2013-09-01

    The emerging application of long-term and high-quality ECG recording requires alternative electrodes to improve the signal quality and recording capability of surface skin electrodes. The esophageal ECG has the potential to overcome these limitations but necessitates novel recorder and lead designs. The electrode material is of particular interest, since the material has to ensure conflicting requirements like excellent biopotential recording properties and inertness. To this end, novel electrode materials like PEDOT and silver-PDMS as well as established electrode materials such as stainless steel, platinum, gold, iridium oxide, titanium nitride, and glassy carbon were investigated by long-term electrochemical impedance spectroscopy and model-based signal analysis using the derived in vitro interfacial properties in conjunction with a dedicated ECG amplifier. The results of this novel approach show that titanium nitride and iridium oxide featuring microstructured surfaces did not degrade when exposed to artificial acidic saliva. These materials provide low electrode potential drifts and insignificant signal distortion superior to surface skin electrodes making them compatible with accepted standards for ambulatory ECG. They are superior to the noble and polarizable metals such as platinum, silver, and gold that induced more signal distortions and are superior to esophageal stainless steel electrodes that corrode in artificial saliva. The study provides rigorous criteria for the selection of electrode materials for prolonged ECG recording by combining long-term in vitro electrode material properties with ECG signal quality assessment.

  9. Long-term prophylaxis in bipolar disorder.

    PubMed

    Taylor, Matthew J; Goodwin, Guy M

    2006-01-01

    Bipolar disorder is a major cause of disability, and the prevention of relapse is a key management goal. Pharmacological interventions, effectively delivered through enhanced clinical care, are central to long-term management. This article summarises the available evidence for a range of pharmacological options, and provides guidance on common issues in clinical management in line with current practice guidelines. The use of medications for long-term prophylaxis should be considered in all patients meeting criteria for bipolar I disorder. Increasing high-quality evidence from randomised trials informs management decisions relating to both novel agents, such as lamotrigine and olanzapine, and longer-established therapies, such as lithium and valproate, in monotherapy. Medications taken long-term in bipolar disorder differ in the extent to which they protect against manic and depressive relapse. Consequently, the emerging challenge is to understand how combination treatments can enhance efficacy and effectiveness based on data from controlled trials rather than random polypharmacy. Clinical care can be enhanced with effective education about the illness, and the use of strategies to improve treatment adherence and the recognition and management of stressors or prodromal symptoms. Where available, a range of specific psychological interventions can be effective as an adjunct to medication. When discontinuation of prophylaxis is necessary, gradual tapering of dose over weeks or months is recommended.

  10. Long term therapy of generalized anxiety disorder.

    PubMed

    Rouillon, Frédéric

    2004-04-01

    Generalized anxiety disorder (GAD) is a common (lifetime prevalence: 5.1%), recurrent condition, which often heralds other psychiatric disorders, notably depression. As by definition it is a disorder progressing over months, treatment should be designed on a long term basis. And yet, few studies have been conducted beyond the classical 6-8 weeks characterizing the acute treatment phase. This is especially true of anxiolytics, but also of antidepressants, with the exception of paroxetine and venlafaxine, which are the only drugs approved in this indication in Western countries. The efficacy of psychotherapy, notably relaxation and cognitive-behavioral therapy, is established in the treatment of GAD, but its preferred indications and possible combination with antidepressants are still to be specified. Long term, not to say very long term studies of GAD, as well as depression, will still be required in the future to improve its management and specify therapeutic modalities (combination treatment, optimal duration, continuous or intermittent therapy, choice of psychotherapeutic techniques or agents, em leader ). Early and adequately prolonged treatment should not only result in more numerous remission periods, but also in decreased frequency of co-morbidities whether depressive, addictive, or of another nature, and should also reduce the social impact of GAD.

  11. The marriage premium and compensating wage differentials.

    PubMed

    Reed, W R; Harford, K

    1989-12-01

    This paper proposes and tests an alternative explanation of the marriage premium that relies upon differences in workers' tastes and compensating wage differentials. A key assumption is that marital status proxies for the consumption of family goods, such as children, and that these are costly. Workers whose greater demands for family goods are taste- generated and shown to choose jobs that offer greater wage, and less non-pecuniary compensation. This creates an observed wage premium that has nothing to do with differences in workers' productivities. Supporting empirical evidence for this hypothesis is presented, including a reevaluation of previous studies.

  12. Long-Term Monitoring Research Needs: A DOE Perspective

    NASA Astrophysics Data System (ADS)

    Moore, B.; Davis, C. B.

    2002-05-01

    The U.S. Department of Energy's Office of Environmental Management is responsible for dealing with the nation's legacy of Cold War radioactive and hazardous waste and contamination. Major efforts are underway to deal with this legacy; these are expected to last up to decades and cost up to billions of dollars at some sites. At all sites, however, active remediation must eventually cease; if hazards then remain, the site must enter into a long-term stewardship mode. In this talk we discuss aspects of long-term monitoring pertinent to DOE sites, focusing on challenges to be faced, specific goals or targets to be met, and research needs to be addressed in order to enable DOE to meet its long-term stewardship obligations. DOE LTM research needs fall into three major categories: doing what we can do now much more efficiently; doing things we cannot do now; and proving the validity of our monitoring programs. Given the enormity of the DOE obligations, it will be highly desirable to develop much more efficient monitoring paradigms. Doing so will demand developing autonomous, remote monitoring networks of in situ sensors capable of replacing (or at least supplementing to a large extent) conventional groundwater and soil gas sampling and analysis programs. The challenges involved range from basic science (e.g., inventing in situ sensors for TCE that do not demand routine maintenance) to engineering (attaining superior reliability in data reporting in remote networks) to ergonomics (developing decent ways of selecting and presenting the "right" information from the monitoring network) to regulatory affairs (presenting convincing evidence that the more efficient systems actually provide superior monitoring). We explore these challenges in some detail, focusing on the "long" in long-term monitoring as it applies to DOE sites. Monitoring system performance validation and, ultimately, regulator and stakeholder acceptance of site closure and long-term stewardship plans depend

  13. 47 CFR 32.4300 - Other long-term liabilities and deferred credits.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... benefits, deferred compensation costs and other long-term liabilities not provided for elsewhere. Subsidiary records shall be maintained to identify the nature of these items. (b) This account shall include...

  14. 47 CFR 32.4300 - Other long-term liabilities and deferred credits.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... benefits, deferred compensation costs and other long-term liabilities not provided for elsewhere. Subsidiary records shall be maintained to identify the nature of these items. (b) This account shall include...

  15. 47 CFR 32.4300 - Other long-term liabilities and deferred credits.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... benefits, deferred compensation costs and other long-term liabilities not provided for elsewhere. Subsidiary records shall be maintained to identify the nature of these items. (b) This account shall include...

  16. 47 CFR 32.4300 - Other long-term liabilities and deferred credits.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... benefits, deferred compensation costs and other long-term liabilities not provided for elsewhere. Subsidiary records shall be maintained to identify the nature of these items. (b) This account shall include...

  17. Long-term views on hydro O M

    SciTech Connect

    Hocker, C. )

    1991-06-01

    Like the proverbial iceberg, at least 90 percent of the effort, costs, and headaches of owning a hydroelectric plant is usually hidden from view in the unglamorous, but essential, category of operations and maintenance (O M). While the processing of planning, designing, and constructing a plant may command more attention and excitement, and the economic benefits of ownership may be more satisfying, the day-in, day-out work of O M is a key component in the long-term success of a hydro plant. With project lives of between 50 and 100 years, running a hydro plant can be an extremely long-lived venture requiring an equally long-term approach to O M. Hydro O M experts in the US and Canada generally agree that successful O M requires a long-term view. Representatives of government agencies, investor-owned utilities, and private non-utility hydro owners contacted for this article all share similar perspectives, experiences, and methods for dealing with O M problems.

  18. Results of a Survey of Long-Term Archiving Implementations

    NASA Astrophysics Data System (ADS)

    Gurman, Joseph B.; Spencer, Jennifer L.

    2015-04-01

    NASA’s Heliophysics Data Management Policy calls for discipline-specific “final archives,” which will be responsible for the long-term archiving and service of Heliophysics mission data. Long-term archival functions, such as periodic revalidation of the data and migration to newer storage media when appropriate, have never been part of the Solar Data Analysis Center core capabilities. We also recognize that the largest space solar physics data set, the SDO AIA and HMI data at the Stanford Joint Science and Operations Center (JSOC), will eventually need preservation and long-term access, as will the potentially much larger data archive of DKIST observations. We have carried out a study of data archiving best practices in other disciplines and organizations, including NASA’s Space Physics Data Facility (SPDF), the National Institute of Standards and Technology (NIST), and private industry, and report on the lessons learned and possible cost models. We seek input from the broader solar physics community on the relative value of various levels of preservation effort.

  19. Long-term nuclear waste management: Present status and alternatives

    NASA Astrophysics Data System (ADS)

    Schapira, J. P.

    1989-08-01

    Long-term nuclear waste management deals with the final and irreversible stage of waste disposal, on surface and in deep geological formations (according to the waste type), when institutional surveillance is over. There are presently two main options available to deal with the wastes generated by spent nuclear fuel unloaded from reactors and containing most of the radiotoxicity produced all along the nuclear fuel cycle. Since the end of Word War II, spent-fuel reprocessing technology has gone through three different stages, ending up with considerable technical achievements and large investments (construction of large facilities, UP3 in France and THORP in the UK). However, having to face spent-fuel risings and lack of reprocessing capacities, since the mid-seventies some countries are considering the possibility of direct spent-fuel disposal without reprocessing. These two options are discussed in terms of long-term waste management. Because of the types of waste conditioning and packaging adopted with present reprocessing technology, in that case long-term safety, after a few centuries, relies completely on the geological barriers. On the other hand, long-term safety with the second option is based essentially on the retention properties of uranium oxide with respect to actinides. Finally, alternatives such as chemical partitioning of minor actinides followed by their transmutation, either in reactors or using high-energy particle accelerators, are under discussion. Apart from the standard reprocessing (after a cooling period of 3-5 years), all the other options called for a long period (50 years) of interim storage, preventing the adoption of irreversible, costly and not well proved waste management solutions, and leaving time to develop and assess these alternative methods.

  20. The Impact of the ACA on Premiums: Evidence from the Self-Employed.

    PubMed

    Heim, Bradley T; Hunter, Gillian; Lurie, Ithai Z; Ramnath, Shanthi P

    2015-10-01

    This article examines the impact of the Affordable Care Act on premiums by studying a segment of the nongroup market, the self-employed. Because self-employed health insurance premiums are deductible, tax data contain comprehensive individual-level information on the premiums paid by this group prior to the establishment of health insurance exchanges. We compare these prior premiums to reference silver premiums available on the exchanges and find that exchange premiums are 4.2 percent higher on average among the entire sample but 42.3 percent lower on average after taxes and subsidies. We also examine which type of exchange coverage would cost less than the individual's prior health insurance premiums and find that almost 60 percent of families could purchase bronze plans for less than their prior premiums, though only about a quarter could purchase platinum plans. After taxes and subsidies, the fractions increase to over 85 percent for bronze plans and over half for platinum plans.

  1. Timber beams subjected to long - term loading

    NASA Astrophysics Data System (ADS)

    Sógel, K.

    2010-09-01

    Wood is a significant structural material, which is often used for timber bearing structures. Elements of timber structures must especially satisfy safety requirements, which are expressed by the ultimate limit states in the established standards. The structure must also satisfy the serviceability limit states. Local and global deformations make it impossible for the structure to serve the purpose it was designed for. It is important to take the deflections and their possible increase into account in the design to provide a structure which can be used during the whole period of service. Based on earlier examinations, it is known that a timber element over the course of long-term loading shows creep behavior. The structure of wood is able to adapt to the conditions of the surrounding environment. The properties of wood are especially affected by the relative humidity of the air and then by the type, intensity and duration of the loading. The most important factors affecting the serviceability of timber structures are volume changes caused by humidity and additional deflections caused by the effects of long-term loading. These phenomena emphasize the importance of serviceability limit states for timber structures. The paper deals with a long-term experimental investigation of timber girders that are currently often used. The aim was to obtain the deflection curves and mark the time dependence and the final deflections. The paper will also define the approximations for simulating the time-dependent deflections and obtain the creep coefficients for calculating the final deflections of the girders investigated.

  2. Long-Term Recency in Anterograde Amnesia

    PubMed Central

    Talmi, Deborah; Caplan, Jeremy B.; Richards, Brian; Moscovitch, Morris

    2015-01-01

    Amnesia is usually described as an impairment of a long-term memory (LTM) despite an intact short-term memory (STM). The intact recency effect in amnesia had supported this view. Although dual-store models of memory have been challenged by single-store models based on interference theory, this had relatively little influence on our understanding and treatment of amnesia, perhaps because the debate has centred on experiments in the neurologically intact population. Here we tested a key prediction of single-store models for free recall in amnesia: that people with amnesia will exhibit a memory advantage for the most recent items even when all items are stored in and retrieved from LTM, an effect called long-term recency. People with amnesia and matched controls studied, and then free-recalled, word lists with a distractor task following each word, including the last (continual distractor task, CDFR). This condition was compared to an Immediate Free Recall (IFR, no distractors) and a Delayed Free Recall (DFR, end-of-list distractor only) condition. People with amnesia demonstrated the full long-term recency pattern: the recency effect was attenuated in DFR and returned in CDFR. The advantage of recency over midlist items in CDFR was comparable to that of controls, confirming a key prediction of single-store models. Memory deficits appeared only after the first word recalled in each list, suggesting the impairment in amnesia may emerge only as the participant’s recall sequence develops, perhaps due to increased susceptibility to output interference. Our findings suggest that interference mechanisms are preserved in amnesia despite the overall impairment to LTM, and challenge strict dual-store models of memory and their dominance in explaining amnesia. We discuss the implication of our findings for rehabilitation. PMID:26046770

  3. Long-Term Recency in Anterograde Amnesia.

    PubMed

    Talmi, Deborah; Caplan, Jeremy B; Richards, Brian; Moscovitch, Morris

    2015-01-01

    Amnesia is usually described as an impairment of a long-term memory (LTM) despite an intact short-term memory (STM). The intact recency effect in amnesia had supported this view. Although dual-store models of memory have been challenged by single-store models based on interference theory, this had relatively little influence on our understanding and treatment of amnesia, perhaps because the debate has centred on experiments in the neurologically intact population. Here we tested a key prediction of single-store models for free recall in amnesia: that people with amnesia will exhibit a memory advantage for the most recent items even when all items are stored in and retrieved from LTM, an effect called long-term recency. People with amnesia and matched controls studied, and then free-recalled, word lists with a distractor task following each word, including the last (continual distractor task, CDFR). This condition was compared to an Immediate Free Recall (IFR, no distractors) and a Delayed Free Recall (DFR, end-of-list distractor only) condition. People with amnesia demonstrated the full long-term recency pattern: the recency effect was attenuated in DFR and returned in CDFR. The advantage of recency over midlist items in CDFR was comparable to that of controls, confirming a key prediction of single-store models. Memory deficits appeared only after the first word recalled in each list, suggesting the impairment in amnesia may emerge only as the participant's recall sequence develops, perhaps due to increased susceptibility to output interference. Our findings suggest that interference mechanisms are preserved in amnesia despite the overall impairment to LTM, and challenge strict dual-store models of memory and their dominance in explaining amnesia. We discuss the implication of our findings for rehabilitation.

  4. Long-term management of prolactinomas.

    PubMed

    Schlechte, Janet A

    2007-08-01

    Prolactinomas are a frequent cause of gonadal dysfunction and infertility, especially in young women. The regulation of prolactin secretion and the efficacy of dopamine agonists in the therapy of prolactinomas are well established. The current challenges in management of prolactinomas are related to follow-up after successful therapy. Issues and questions to be addressed in this approach to long-term management of prolactinomas include the frequency of radiographic monitoring, effect of pregnancy and menopause, safety of estrogen in women taking oral contraceptives, and the potential for discontinuation of dopamine agonist therapy.

  5. Human Behaviour in Long-Term Missions

    NASA Technical Reports Server (NTRS)

    1997-01-01

    In this session, Session WP1, the discussion focuses on the following topics: Psychological Support for International Space Station Mission; Psycho-social Training for Man in Space; Study of the Physiological Adaptation of the Crew During A 135-Day Space Simulation; Interpersonal Relationships in Space Simulation, The Long-Term Bed Rest in Head-Down Tilt Position; Psychological Adaptation in Groups of Varying Sizes and Environments; Deviance Among Expeditioners, Defining the Off-Nominal Act in Space and Polar Field Analogs; Getting Effective Sleep in the Space-Station Environment; Human Sleep and Circadian Rhythms are Altered During Spaceflight; and Methodological Approach to Study of Cosmonauts Errors and Its Instrumental Support.

  6. Long-Term Wind Power Variability

    SciTech Connect

    Wan, Y. H.

    2012-01-01

    The National Renewable Energy Laboratory started collecting wind power data from large commercial wind power plants (WPPs) in southwest Minnesota with dedicated dataloggers and communication links in the spring of 2000. Over the years, additional WPPs in other areas were added to and removed from the data collection effort. The longest data stream of actual wind plant output is more than 10 years. The resulting data have been used to analyze wind power fluctuations, frequency distribution of changes, the effects of spatial diversity, and wind power ancillary services. This report uses the multi-year wind power data to examine long-term wind power variability.

  7. Transverse dimension and long-term stability.

    PubMed

    Vanarsdall, R L

    1999-09-01

    This article emphasizes the critical importance of the skeletal differential between the width of the maxilla and the width of the mandible. Undiagnosed transverse discrepancy leads to adverse periodontal response, unstable dental camouflage, and less than optimal dentofacial esthetics. Hundreds of adult retreatment patients corrected for significant maxillary transverse deficiency using surgically assisted maxillary expansion (similar to osseous distraction) has produced excellent stability. Eliciting tooth movement for children (orthopedics, lip bumper, Cetlin plate) in all three planes of space by muscles, eruption, and growth, develops the broader arch form (without the mechanical forces of fixed or removable appliances) and has also demonstrated impressive long term stability.

  8. Terminating a long-term clinical trial.

    PubMed

    Klimt, C R; Canner, P L

    1979-05-01

    Long-term trials often include more than one active treatment group. These may be discontinued independently if found ineffective or possibly harmful. Certain subgroups of patients may be discovered, in the course of a clinical trial, who do not respond satisfactorily and are, therefore, excluded during the course of a trial. Yet anouther kind of termination comes when we have a therapeutic breakthrough or when hope has to be abandoned for demonstrating beneficial effects for one, several, or all treatments included in a trial. Examples from the authors' experience are presented, as are successful and unsuccessful techniques in managing terminations of various types.

  9. Terminating a long-term clinical trial.

    PubMed

    Klimt, C R

    1981-05-01

    Long-term clinical trials often include more than one active treatment group. These may be discontinued independently if found to be ineffective or possibly harmful. Certain subgroups of patients may be discovered, in the course of a clinical trial, who do not respond satisfactorily and are, therefore, excluded during the course of a trial. Yet another kind of termination comes when we have a therapeutic breakthrough or when hope has to be abandoned for demonstrating beneficial effects for one, several, or all treatments included in a trial. Examples from the authors' experience are presented, as are successful and unsuccessful techniques in managing terminations of various types.

  10. A long-term climatology of medicanes

    NASA Astrophysics Data System (ADS)

    Cavicchia, Leone; von Storch, Hans; Gualdi, Silvio

    2014-09-01

    Medicanes, intense and destructive mesoscale cyclones exhibiting several similarities with tropical hurricanes, are known to struck occasionally the Mediterranean Sea. Thanks to a high-resolution dynamical downscaling effort, we are able to study for the first time the long-term climatology of those rare storms in a systematic way. The distribution of medicanes frequency in space and time is discussed, and the environmental factors responsible for their formation are investigated. We find that medicanes develop in those areas of the Mediterranean region where intrusions of cold air in the upper troposphere can produce configurations of thermodynamical disequilibrium of the atmosphere similar to those associated with the formation of tropical cyclones.

  11. Performance considerations in long-term spaceflight

    NASA Technical Reports Server (NTRS)

    Akins, F. R.

    1979-01-01

    Maintenance of skilled performance during extended space flight is of critical importance to both the health and safety of crew members and to the overall success of mission goals. An examination of long term effects and performance requirements is therefore a factor of immense importance to the planning of future missions. Factors that were investigated include: definition of performance categories to be investigated; methods for assessing and predicting performance levels; in-flight factors which can affect performance; and factors pertinent to the maintenance of skilled performance.

  12. A Long-Term Experimental Case Study of the Ecological Effectiveness and Cost Effectiveness of Invasive Plant Management in Achieving Conservation Goals: Bitou Bush Control in Booderee National Park in Eastern Australia

    PubMed Central

    Lindenmayer, David B.; Wood, Jeff; MacGregor, Christopher; Buckley, Yvonne M.; Dexter, Nicholas; Fortescue, Martin; Hobbs, Richard J.; Catford, Jane A.

    2015-01-01

    Invasive plant management is often justified in terms of conservation goals, yet progress is rarely assessed against these broader goals, instead focussing on short-term reductions of the invader as a measure of success. Key questions commonly remain unanswered including whether invader removal reverses invader impacts and whether management itself has negative ecosystem impacts. We addressed these knowledge gaps using a seven year experimental investigation of Bitou Bush, Chrysanthemoides monilifera subsp. rotundata. Our case study took advantage of the realities of applied management interventions for Bitou Bush to assess whether it is a driver or passenger of environmental change, and quantified conservation benefits relative to management costs of different treatment regimes. Among treatments examined, spraying with herbicide followed by burning and subsequent re-spraying (spray-fire-spray) proved the most effective for reducing the number of individuals and cover of Bitou Bush. Other treatment regimes (e.g. fire followed by spraying, or two fires in succession) were less effective or even exacerbated Bitou Bush invasion. The spray-fire-spray regime did not increase susceptibility of treated areas to re-invasion by Bitou Bush or other exotic species. This regime significantly reduced plant species richness and cover, but these effects were short-lived. The spray-fire-spray regime was the most cost-effective approach to controlling a highly invasive species and facilitating restoration of native plant species richness to levels characteristic of uninvaded sites. We provide a decision tree to guide management, where recommended actions depend on the outcome of post-treatment monitoring and performance against objectives. Critical to success is avoiding partial treatments and treatment sequences that may exacerbate invasive species impacts. We also show the value of taking advantage of unplanned events, such as wildfires, to achieve management objectives at

  13. Policies of price regulators in periods of high or increasing costs and their potential long-term effect on investment: The case of the electric utility industry in the 1970s and 1980s

    NASA Astrophysics Data System (ADS)

    Hardarson, Pall

    This study presents and estimates a model of electric utility regulation during periods of high or rising costs. Regulators are viewed as utility maximizers, whose utility function is influenced by political pressure from consumers and the regulated firms. The model can also be interpreted as a reduced form bargaining model. Although regulators have frequently been modeled in the theoretical literature on regulation as having a well defined utility function, this is, to my knowledge, the first empirical study of electric utility regulation that takes this approach. This study also uses a far larger data set than previous studies on electric utility regulation. It is found that policies like those carried out by price regulators during the 1970s and 1980s can potentially lead to serious underinvestment. This underinvestment result applies to all states in my sample. The underinvestment bias, however, is likely to be mitigated if high cost periods are short in duration. Based on the estimation results of this study, states are ranked according to the regulatory climate for the regulated firms. Regulatory policies between states differed significantly. Policies like those in states with the least favorable regulatory climate appear likely to frequently jeopardize utilities' financial position during high cost periods, whereas policies in states with average to good regulatory climate (relative to my sample) are much less likely to do so. This study also examines the effect on regulatory policies of a few political variables commonly included in studies of electric utility regulators. The effect of these variables is found to be negligible. This result, as well as the underinvestment result and the ranking of states according to regulatory climate, is in general agreement with previous empirical work.

  14. A long-term experimental case study of the ecological effectiveness and cost effectiveness of invasive plant management in achieving conservation goals: bitou bush control in booderee national park in eastern australia.

    PubMed

    Lindenmayer, David B; Wood, Jeff; MacGregor, Christopher; Buckley, Yvonne M; Dexter, Nicholas; Fortescue, Martin; Hobbs, Richard J; Catford, Jane A

    2015-01-01

    Invasive plant management is often justified in terms of conservation goals, yet progress is rarely assessed against these broader goals, instead focussing on short-term reductions of the invader as a measure of success. Key questions commonly remain unanswered including whether invader removal reverses invader impacts and whether management itself has negative ecosystem impacts. We addressed these knowledge gaps using a seven year experimental investigation of Bitou Bush, Chrysanthemoides monilifera subsp. rotundata. Our case study took advantage of the realities of applied management interventions for Bitou Bush to assess whether it is a driver or passenger of environmental change, and quantified conservation benefits relative to management costs of different treatment regimes. Among treatments examined, spraying with herbicide followed by burning and subsequent re-spraying (spray-fire-spray) proved the most effective for reducing the number of individuals and cover of Bitou Bush. Other treatment regimes (e.g. fire followed by spraying, or two fires in succession) were less effective or even exacerbated Bitou Bush invasion. The spray-fire-spray regime did not increase susceptibility of treated areas to re-invasion by Bitou Bush or other exotic species. This regime significantly reduced plant species richness and cover, but these effects were short-lived. The spray-fire-spray regime was the most cost-effective approach to controlling a highly invasive species and facilitating restoration of native plant species richness to levels characteristic of uninvaded sites. We provide a decision tree to guide management, where recommended actions depend on the outcome of post-treatment monitoring and performance against objectives. Critical to success is avoiding partial treatments and treatment sequences that may exacerbate invasive species impacts. We also show the value of taking advantage of unplanned events, such as wildfires, to achieve management objectives at

  15. Japanese public long-term care insured: preferences for future long-term care facilities, including relocation, waiting times, and individualized care.

    PubMed

    Sawamura, Kanae; Sano, Hiroshi; Nakanishi, Miharu

    2015-04-01

    Expenditures on long-term care insurance (LTCI) in Japan have been increasing with the aging of the population, which has led to an increase in premiums. To optimize resource allocation, we aim to clarify the priorities of the functions of long-term care facilities from the viewpoint of future beneficiaries. The present study was conducted using a cross-sectional study design. We conducted a mail-in survey targeting 2400 adults aged 50-65 in 8 cities in Japan, and 371 persons responded. Conjoint analysis was applied to measure participants' preferences for long-term care facility services. Participants read 1 of 2 vignettes of an 80-year-old person with either dementia or a fracture, and were asked to envision it as a possible future scenario for themselves. Participants then completed 8 or 9 tasks to select suitable long-term care facilities for the person described. The questionnaire also contained common questions on participants' personal profiles: age, gender, family situation, education, approximate yearly family income, experience as a family caregiver, dwelling status, present health status, and possibility of requiring long-term care services in the future. The results focused mainly on (1) possibilities of individual choice for daily schedules/meals; (2) availability of regular care staff; (3) room; (4) main daily interactions; (5) necessity of relocation associated with medical deterioration; 6) Waiting time; 7) distance from present residence; and (8) monthly fees. Necessity of relocation associated with medical deterioration was consistently given the greatest importance. Participants with experience as a family caregiver showed significantly greater preference for individualized care and communication. The option of avoiding relocation was highly valued by participants compared with private rooms and individualized care. The present situation of high demand for intensive care homes for the elderly, provoked by anxiety about future residence, will not

  16. Long-Term Care Policy: Singapore's Experience.

    PubMed

    Chin, Chee Wei Winston; Phua, Kai-Hong

    2016-01-01

    Singapore, like many developed countries, is facing the challenge of a rapidly aging population and the increasing need to provide long-term care (LTC) services for elderly in the community. The Singapore government's philosophy on care for the elderly is that the family should be the first line of support, and it has relied on voluntary welfare organizations (VWOs) or charities for the bulk of LTC service provision. For LTC financing, it has emphasized the principles of co-payment and targeting of state support to the low-income population through means-tested government subsidies. It has also instituted ElderShield, a national severe disability insurance scheme. This paper discusses some of the challenges facing LTC policy in Singapore, particularly the presence of perverse financial incentives for hospitalization, the pitfalls of over-reliance on VWOs, and the challenges facing informal family caregivers. It discusses the role of private LTC insurance in LTC financing, bearing in mind demand- and supply-side failures that have plagued the private LTC insurance market. It suggests the need for more standardized needs assessment and portable LTC benefits, with reference to the Japanese Long-Term Care Insurance program, and also discusses the need to provide more support to informal family caregivers.

  17. Sleep facilitates long-term face adaptation

    PubMed Central

    Ditye, Thomas; Javadi, Amir Homayoun; Carbon, Claus-Christian; Walsh, Vincent

    2013-01-01

    Adaptation is an automatic neural mechanism supporting the optimization of visual processing on the basis of previous experiences. While the short-term effects of adaptation on behaviour and physiology have been studied extensively, perceptual long-term changes associated with adaptation are still poorly understood. Here, we show that the integration of adaptation-dependent long-term shifts in neural function is facilitated by sleep. Perceptual shifts induced by adaptation to a distorted image of a famous person were larger in a group of participants who had slept (experiment 1) or merely napped for 90 min (experiment 2) during the interval between adaptation and test compared with controls who stayed awake. Participants' individual rapid eye movement sleep duration predicted the size of post-sleep behavioural adaptation effects. Our data suggest that sleep prevented decay of adaptation in a way that is qualitatively different from the effects of reduced visual interference known as ‘storage’. In the light of the well-established link between sleep and memory consolidation, our findings link the perceptual mechanisms of sensory adaptation—which are usually not considered to play a relevant role in mnemonic processes—with learning and memory, and at the same time reveal a new function of sleep in cognition. PMID:23986109

  18. Craniopharyngioma in Children: Long-term Outcomes

    PubMed Central

    STEINBOK, Paul

    2015-01-01

    The survival rate for childhood craniopharyngioma has been improving, with more long-term survivors. Unfortunately it is rare for the patient to be normal, either from the disease itself or from the effects of treatment. Long-term survivors of childhood craniopharyngioma suffer a number of impairments, which include visual loss, endocrinopathy, hypothalamic dysfunction, cerebrovascular problems, neurologic and neurocognitive dysfunction. Pituitary insufficiency is present in almost 100%. Visual and hypothalamic dysfunction is common. There is a high risk of metabolic syndrome and increased risk of cerebrovascular disease, including stroke and Moyamoya syndrome. Cognitive, psychosocial, and emotional problems are prevalent. Finally, there is a higher risk of premature death among survivors of craniopharyngioma, and often this is not from tumor recurrence. It is important to consider craniopharyngioma as a chronic disease. There is no perfect treatment. The treatment has to be tailored to the individual patient to minimize dysfunction caused by tumor and treatments. So “cure” of the tumor does not mean a normal patient. The management of the patient and family needs multidisciplinary evaluation and should involve ophthalmology, endocrinology, neurosurgery, oncology, and psychology. Furthermore, it is also important to address emotional issues and social integration. PMID:26345668

  19. Long-term Trend of Sunspot Numbers

    NASA Astrophysics Data System (ADS)

    Gao, P. X.

    2016-10-01

    Using the Hilbert-Huang Transform method, we investigate the long-term trend of yearly mean total sunspot numbers in the time interval of 1700-2015, which come from the World Data Center—the sunspot Index and long-term solar observations. The main findings of this study are summarized below. (1) From the adaptive trend, which is extracted from the yearly mean total sunspot numbers, we can find that the value gradually increases during the time period 1700-1975, then decreases gradually from 1975 to 2015. (2) The Centennial Gleissberg Cycle is extracted from the yearly mean total sunspot numbers and confirms that a new grand minimum is in progress; the Dalton Minimum, the Gleissberg Minimum, and low level of solar activity during solar cycle 24 (the part of the new grand minimum) all can be understood as minima of the Centennial Gleissberg Cycle. (3) Based on the adaptive (overall) trend, and the 100-year and longer timescale trend of yearly mean total sunspot numbers, we can infer that the level of solar activity during the new grand minimum may be close to that during the Gleissberg Minimum, slightly higher than that during the Dalton Minimum, and significantly higher than that during the Maunder Minimum. Our results do not support the suggestion that a new grand minimum, somewhat resembling the Maunder Minimum, is in progress.

  20. Sleep facilitates long-term face adaptation.

    PubMed

    Ditye, Thomas; Javadi, Amir Homayoun; Carbon, Claus-Christian; Walsh, Vincent

    2013-10-22

    Adaptation is an automatic neural mechanism supporting the optimization of visual processing on the basis of previous experiences. While the short-term effects of adaptation on behaviour and physiology have been studied extensively, perceptual long-term changes associated with adaptation are still poorly understood. Here, we show that the integration of adaptation-dependent long-term shifts in neural function is facilitated by sleep. Perceptual shifts induced by adaptation to a distorted image of a famous person were larger in a group of participants who had slept (experiment 1) or merely napped for 90 min (experiment 2) during the interval between adaptation and test compared with controls who stayed awake. Participants' individual rapid eye movement sleep duration predicted the size of post-sleep behavioural adaptation effects. Our data suggest that sleep prevented decay of adaptation in a way that is qualitatively different from the effects of reduced visual interference known as 'storage'. In the light of the well-established link between sleep and memory consolidation, our findings link the perceptual mechanisms of sensory adaptation--which are usually not considered to play a relevant role in mnemonic processes--with learning and memory, and at the same time reveal a new function of sleep in cognition.

  1. Clinical review: Long-term noninvasive ventilation

    PubMed Central

    Robert, Dominique; Argaud, Laurent

    2007-01-01

    Noninvasive positive ventilation has undergone a remarkable evolution over the past decades and is assuming an important role in the management of both acute and chronic respiratory failure. Long-term ventilatory support should be considered a standard of care to treat selected patients following an intensive care unit (ICU) stay. In this setting, appropriate use of noninvasive ventilation can be expected to improve patient outcomes, reduce ICU admission, enhance patient comfort, and increase the efficiency of health care resource utilization. Current literature indicates that noninvasive ventilation improves and stabilizes the clinical course of many patients with chronic ventilatory failure. Noninvasive ventilation also permits long-term mechanical ventilation to be an acceptable option for patients who otherwise would not have been treated if tracheostomy were the only alternative. Nevertheless, these results appear to be better in patients with neuromuscular/-parietal disorders than in chronic obstructive pulmonary disease. This clinical review will address the use of noninvasive ventilation (not including continuous positive airway pressure) mainly in diseases responsible for chronic hypoventilation (that is, restrictive disorders, including neuromuscular disease and lung disease) and incidentally in others such as obstructive sleep apnea or problems of central drive. PMID:17419882

  2. Long term changes in the polar vortices

    NASA Astrophysics Data System (ADS)

    Braathen, Geir O.

    2015-04-01

    As the amount of halogens in the stratosphere is slowly declining and the ozone layer slowly recovers it is of interest to see how the meteorological conditions in the vortex develop over the long term since such changes might alter the foreseen ozone recovery. In conjunction with the publication of the WMO Antarctic and Arctic Ozone Bulletins, WMO has acquired the ERA Interim global reanalysis data set for several meteorological parameters. This data set goes from 1979 - present. These long time series of data can be used for several useful studies of the long term development of the polar vortices. Several "environmental indicators" for vortex change have been calculated, and a climatology, as well as trends, for these parameters will be presented. These indicators can act as yardsticks and will be useful for understanding past and future changes in the polar vortices and how these changes affect polar ozone depletion. Examples of indicators are: vortex mean temperature, vortex minimum temperature, vortex mean PV, vortex "importance" (PV*area), vortex break-up time, mean and maximum wind speed. Data for both the north and south polar vortices have been analysed at several isentropic levels from 350 to 850 K. A possible link between changes in PV and sudden stratospheric warmings will be investigated, and the results presented.

  3. Long-term Caspian Sea level change

    NASA Astrophysics Data System (ADS)

    Chen, J. L.; Pekker, T.; Wilson, C. R.; Tapley, B. D.; Kostianoy, A. G.; Cretaux, J.-F.; Safarov, E. S.

    2017-07-01

    Caspian Sea level (CSL) has undergone substantial fluctuations during the past several hundred years. The causes over the entire historical period are uncertain, but we investigate here large changes seen in the past several decades. We use climate model-predicted precipitation (P), evaporation (E), and observed river runoff (R) to reconstruct long-term CSL changes for 1979-2015 and show that PER (P-E + R) flux predictions agree very well with observed CSL changes. The observed rapid CSL increase (about 12.74 cm/yr) and significant drop ( -6.72 cm/yr) during the periods 1979-1995 and 1996-2015 are well accounted for by integrated PER flux predictions of +12.38 and -6.79 cm/yr, respectively. We show that increased evaporation rates over the Caspian Sea play a dominant role in reversing the increasing trend in CSL during the past 37 years. The current long-term decline in CSL is expected to continue into the foreseeable future, under global warming scenarios.

  4. Long term efficacy of a pen injector.

    PubMed

    Dinneen, S F; Cronin, C C; O'Sullivan, D J

    1991-09-01

    We assessed the long term efficacy of Novopen as a form of insulin administration. Records were obtained on 48 patients who were treated with Novopen between January '86 and October '88. Six patients were excluded due to insufficient data. The study group of 42 patients comprised 22 females and 20 males of average age 33 years (range 17-66). Mean Hb.A1 rose from 10.6% to 12.1% after Novopen therapy, a rise of 14.1%. This rise is both clinically and statistically significant (p less than 0.001; 99% confidence limits 0.59-2.78). Increases in weight and insulin dose were also noted, but did not reach statistical significance. The majority of patients felt Novopen was superior to twice daily insulin in terms of ease of administration (81%) and flexibility of lifestyle (95%), and all who were using Novopen wished to continue with it. More than 50% of patients admitted to altering their dietary habits while using Novopen. Despite continuing patient satisfaction with this form of insulin administration, its long-term use may be associated with sub-optimal metabolic control.

  5. Climate Predictability and Long Term Memory

    NASA Astrophysics Data System (ADS)

    Zhu, X.; Blender, R.; Fraedrich, K.; Liu, Z.

    2010-09-01

    The benefit of climate Long Term Memory (LTM) for long term prediction is assessed using data from a millennium control simulation with the atmosphere ocean general circulation model ECHAM5/MPIOM. The forecast skills are evaluated for surface temperature time series at individual grid points. LTM is characterised by the Hurst exponent in the power-law scaling of the fluctuation function which is determined by detrended fluctuation analysis (DFA). LTM with a Hurst exponent close to 0.9 occurs mainly in high latitude oceans, which are also characterized by high potential predictability. Climate predictability is diagnosed in terms of potentially predictable variance fractions. Explicit prediction experiments for various time steps are conducted on a grid point basis using an auto-correlation (AR1) predictor: in regions with LTM, prediction skills are beyond that expected from red noise persistence; exceptions occur in some areas in the southern oceans and over the northern hemisphere continents. Extending the predictability analysis to the fully forced simulation shows large improvement in prediction skills.

  6. Long-term phenotypic evolution of bacteria.

    PubMed

    Plata, Germán; Henry, Christopher S; Vitkup, Dennis

    2015-01-15

    For many decades comparative analyses of protein sequences and structures have been used to investigate fundamental principles of molecular evolution. In contrast, relatively little is known about the long-term evolution of species' phenotypic and genetic properties. This represents an important gap in our understanding of evolution, as exactly these proprieties play key roles in natural selection and adaptation to diverse environments. Here we perform a comparative analysis of bacterial growth and gene deletion phenotypes using hundreds of genome-scale metabolic models. Overall, bacterial phenotypic evolution can be described by a two-stage process with a rapid initial phenotypic diversification followed by a slow long-term exponential divergence. The observed average divergence trend, with approximately similar fractions of phenotypic properties changing per unit time, continues for billions of years. We experimentally confirm the predicted divergence trend using the phenotypic profiles of 40 diverse bacterial species across more than 60 growth conditions. Our analysis suggests that, at long evolutionary distances, gene essentiality is significantly more conserved than the ability to utilize different nutrients, while synthetic lethality is significantly less conserved. We also find that although a rapid phenotypic evolution is sometimes observed within the same species, a transition from high to low phenotypic similarity occurs primarily at the genus level.

  7. Long term perfusion system supporting adipogenesis

    PubMed Central

    Abbott, Rosalyn D.; Raja, Waseem K.; Wang, Rebecca Y.; Stinson, Jordan A.; Glettig, Dean L.; Burke, Kelly A.; Kaplan, David L.

    2015-01-01

    Adipose tissue engineered models are needed to enhance our understanding of disease mechanisms and for soft tissue regenerative strategies. Perfusion systems generate more physiologically relevant and sustainable adipose tissue models, however adipocytes have unique properties that make culturing them in a perfusion environment challenging. In this paper we describe the methods involved in the development of two perfusion culture systems (2D and 3D) to test their applicability for long term in vitro adipogenic cultures. It was hypothesized that a silk protein biomaterial scaffold would provide a 3D framework, in combination with perfusion flow, to generate a more physiologically relevant sustainable adipose tissue engineered model than 2D cell culture. Consistent with other studies evaluating 2D and 3D culture systems for adipogenesis we found that both systems successfully model adipogensis, however 3D culture systems were more robust, providing the mechanical structure required to contain the large, fragile adipocytes that were lost in 2D perfused culture systems. 3D perfusion also stimulated greater lipogenesis and lipolysis and resulted in decreased secretion of LDH compared to 2D perfusion. Regardless of culture configuration (2D or 3D) greater glycerol was secreted with the increased nutritional supply provided by perfusion of fresh media. These results are promising for adipose tissue engineering applications including long term cultures for studying disease mechanisms and regenerative approaches, where both acute (days to weeks) and chronic (weeks to months) cultivation are critical for useful insight. PMID:25843606

  8. Long-term experience with indapamide.

    PubMed

    Beling, S; Vukovich, R A; Neiss, E S; Zisblatt, M; Webb, E; Losi, M

    1983-07-01

    Indapamide, 2.5 mg administered once daily for periods up to 36 months, was found to be safe and effective for the long-term control of mild to moderate hypertension. The effects of hydrochlorothiazide, 50 mg, and indapamide, 2.5 mg, were studied in two randomized, double-blind, multicenter trials. Data from the two multicenter trials (20 study sites) were pooled for purposes of comparison. Significant reductions in systolic and diastolic blood pressure, with patients in both supine and standing positions, occurred in both groups within the first 8 weeks of treatment. This effect was maintained throughout the active treatment period. Success, as determined by the therapeutic success rate (percentage of patients with decreases of standing phase V diastolic blood pressure of at least 10 mm Hg or to below 90 mm Hg), occurred in 53% of the patients given hydrochlorothiazide and in 56% of the indapamide-treated patients. During the study period, the nature, frequency, and severity of adverse reactions were similar for both groups. There was no clinically significant difference between the treatment groups for the laboratory assessments. Patients who completed the multicenter trials were eligible for participation in an ongoing long-term extension study of the safety of indapamide. Data are available for periods up to 36 months and demonstrate neither augmentation of clinical or laboratory adverse effects nor any potentially harmful indicators that could be attributed to prolonged treatment.

  9. Long Term Changes in the Polar Vortices

    NASA Astrophysics Data System (ADS)

    Braathen, Geir O.

    2016-04-01

    As the amount of halogens in the stratosphere is slowly declining and the ozone layer slowly recovers it is of interest to see how the meteorological conditions in the vortex develop over the long term since such changes might alter the foreseen ozone recovery. In conjunction with the publication of the WMO Antarctic and Arctic Ozone Bulletins, WMO has acquired the ERA Interim global reanalysis data set for several meteorological parameters. This data set goes from 1979 - present. These long time series of data can be used for several useful studies of the long term development of the polar vortices. Several "environmental indicators" for vortex change have been calculated, and a climatology, as well as trends, for these parameters will be presented. These indicators can act as yardsticks and will be useful for understanding past and future changes in the polar vortices and how these changes affect polar ozone depletion. Examples of indicators are: vortex mean temperature, vortex minimum temperature, vortex mean PV, vortex "importance" (PV*area), vortex break-up time, mean and maximum wind speed. Data for both the north and south polar vortices have been analysed at several isentropic levels from 350 to 850 K. A possible link between changes in PV and sudden stratospheric warmings will be investigated, and the results presented. The unusual meteorological conditions of the 2015 south polar vortex and the 2010/11 and 2015/16 north polar vortices will be compared to other recent years.

  10. Long term effects of Escherichia coli mastitis.

    PubMed

    Blum, Shlomo E; Heller, Elimelech D; Leitner, Gabriel

    2014-07-01

    Escherichia coli is one of the most frequently diagnosed causes of bovine mastitis, and is typically associated with acute, clinical mastitis. The objective of the present study was to evaluate the long term effects of intramammary infections by E. coli on milk yield and quality, especially milk coagulation. Twenty-four Israeli Holstein cows diagnosed with clinical mastitis due to intramammary infection by E. coli were used in this study. Mean lactation number, days in milk (DIM) and daily milk yield (DMY) at the time of infection was 3.3 ± 1.3, 131.7 days ± 78.6 and 45.7 L ± 8.4, respectively. DMY, milk constituents, somatic cells count (SCC), differential leukocytes count and coagulation parameters were subsequently assessed. Two patterns of inflammation were identified: 'short inflammation', characterized by <15% decrease in DMY and <30 days until return to normal (n = 5), and 'long inflammation', characterized by >15% decrease in DMY and >30 days to reach a new maximum DMY (n = 19). The estimated mean loss of marketable milk during the study was 200 L/cow for 'short inflammation' cases, and 1,500 L/cow for 'long inflammation' ones. Significant differences between 'short' and 'long inflammation' effects were found in almost all parameters studied. Long-term detrimental effects on milk quality were found regardless of clinical or bacteriological cure of affected glands.

  11. Long-Term Memory and the Control of Attentional Control

    PubMed Central

    Mayr, Ulrich; Kuhns, David; Hubbard, Jason

    2014-01-01

    Task-switch costs and in particular the switch-cost asymmetry (i.e., the larger costs of switching to a dominant than a non-dominant task) are usually explained in terms of trial-to-trial carry-over of task-specific control settings. Here we argue that task switches are just one example of situations that trigger a transition from working-memory maintenance to updating, thereby opening working memory to interference from long-term memory. We used a new paradigm that requires selecting a spatial location either on the basis of a central cue (i.e., endogenous control of attention) or a peripheral, sudden onset (i.e., exogenous control of attention). We found a strong cost asymmetry that occurred even after short interruptions of otherwise single-task blocks (Exp. 1-3), but that was much stronger when participants had experienced the competing task under conditions of conflict (Exp. 1-2). Experiment 3 showed that the asymmetric costs were due to interruptions per se, rather than to associative interference tied to specific interruption activities. Experiment 4 generalized the basic pattern across interruptions varying in length or control demands and Experiment 5 across primary tasks with response-selection conflict rather than attentional conflict. Combined, the results support a model in which costs of selecting control settings arise when (a) potentially interfering memory traces have been encoded in long-term memory and (b) working-memory is forced from a maintenance mode into an updating mode (e.g., through task interruptions), thereby allowing unwanted retrieval of the encoded memory traces. PMID:24650696

  12. Three large-scale changes to the Medicare program could curb its costs but also reduce enrollment

    PubMed Central

    Eibner, Christine; Goldman, Dana P.; Sullivan, Jeffrey; Garber, Alan M.

    2013-01-01

    Medicare spending accounts for a substantial fraction of Federal spending, and significant program changes may be necessary for long-run fiscal balance. We used a microsimulation approach to estimate how benefit changes to Medicare–including Part A, for hospital care, premiums, premium support credits, and changing the eligibility age–affect long-term Medicare spending and enrollment. All policies considered reduce spending, with reductions ranging from 2.4 to 24 percent between 2012 and 2036. However, the policies also reduce coverage among the elderly. To achieve significant costs savings without causing substantial uninsurance among seniors, benefits changes would likely need to occur in combination with other options. PMID:23650322

  13. Long-term priming of visual search prevails against the passage of time and counteracting instructions.

    PubMed

    Kruijne, Wouter; Meeter, Martijn

    2016-08-01

    Studies on intertrial priming have shown that in visual search experiments, the preceding trial automatically affects search performance: facilitating it when the target features repeat and giving rise to switch costs when they change-so-called (short-term) intertrial priming. These effects also occur at longer time scales: When 1 of 2 possible target colors is more frequent during an experiment block, this results in a prolonged and persistent facilitation for the color that was biased, long after the frequency bias is gone-so-called long-term priming. In this study, we explore the robustness of such long-term priming. In Experiment 1, participants were fully informed of the bias and instructed to prioritize the other unbiased color. Despite these instructions, long-term priming of the biased color persisted in this block, suggesting that guidance by long-term priming is an implicit effect. In Experiment 2, long-term priming was built up in 1 experimental session and was then assessed in a second session a week later. Long-term priming persisted across this week, emphasizing that long-term priming is truly a phenomenon of long-term memory. The results support the view that priming results from the automatic and implicit retrieval of memory traces of past trials. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  14. Managing soils for long-term productivity

    PubMed Central

    Syers, J. K.

    1997-01-01

    Meeting the goal of long-term agricultural productivity requires that soil degradation be halted and reversed. Soil fertility decline is a key factor in soil degradation and is probably the major cause of declining crop yields. There is evidence that the contribution of declining soil fertility to soil degradation has been underestimated.
    Sensitivity to soil degradation is implicit in the assessment of the sustainability of land management practices, with wide recognition of the fact that soils vary in their ability to resist change and recover subsequent to stress. The concept of resilience in relation to sustainability requires further elaboration and evaluation.
    In the context of soil degradation, a decline in soil fertility is primarily interpreted as the depletion of organic matter and plant nutrients. Despite a higher turnover rate of organic matter in the tropics there is no intrinsic difference between the organic matter content of soils from tropical and temperate regions. The level of organic matter in a soil is closely related to the above and below ground inputs. In the absence of adequate organic material inputs and where cultivation is continuous, soil organic matter declines progressively. Maintaining the quantity and quality of soil organic matter should be a guiding principle in developing management practices.
    Soil microbial biomass serves as an important reservoir of nitrogen (N), phosphorus (P) and sulphur (S), and regulates the cycling of organic matter and nutrients. Because of its high turnover rate, microbial biomass reacts quickly to changes in management and is a sensitive indicator for monitoring and predicting changes in soil organic matter. Modelling techniques have been reasonably successful in predicting changes in soil organic matter with different organic material inputs, but there is little information from the tropics.
    Nutrient depletion through harvested crop components and residue removal, and by leaching and soil

  15. Multiobjective long-term planning of biopharmaceutical manufacturing facilities.

    PubMed

    Lakhdar, K; Savery, J; Papageorgiou, L G; Farid, S S

    2007-01-01

    Biopharmaceutical companies with large portfolios of clinical and commercial products typically need to allocate production across several multiproduct facilities, including third party contract manufacturers. This poses several capacity planning challenges which are further complicated by the need to satisfy different stakeholders often with conflicting objectives. This work addresses the question of how a biopharmaceutical manufacturer can make better long-term capacity planning decisions given multiple strategic criteria such as cost, risk, customer service level, and capacity utilization targets. A long-term planning model that allows for multiple facilities and accounts for multiple objectives via goal programming is developed. An industrial case study based on a large scale biopharmaceutical manufacturer is used to illustrate the functionality of the model. A single objective model is used to identify how best to use existing capacity so as to maximize profits for different demand scenarios. Mitigating risk due to unforeseen circumstances by including a dual facility constraint is shown to be a reasonable strategy at base case demand levels but unacceptable if demands are 150% higher than expected. The capacity analysis identifies where existing capacity fails to meet demands given the constraints. A multiobjective model is used to demonstrate how key performance measures change given different decision making policies where different weights are assigned to cost, customer service level, and utilization targets. The analysis demonstrates that a high profit can still be achieved while meeting key targets more closely. The sensitivity of the optimal solution to different limits on the targets is illustrated.

  16. Long-term care insurance demand limited by beliefs about needs, concerns about insurers, and care available from family.

    PubMed

    Brown, Jeffrey R; Goda, Gopi Shah; McGarry, Kathleen

    2012-06-01

    In spite of the high costs and major financial risks involved in long-term care, the majority of older Americans do not own long-term care insurance. We conducted a survey designed to learn more about the role of the following four broad factors in affecting the demand for long-term care insurance: preferences and beliefs, such as notions about the likelihood that one will become disabled; substitutes for insurance, such as savings that could be spent on long-term care; substitutes for formal care, such as care provided by family members; and features of the private market, such as concerns about the high costs of coverage. We found evidence that each of these factors was important in explaining low demand for long-term care insurance. For example, people who believed they might need long-term care were more likely to purchase long-term care coverage. People who had alternative ways to pay for care, such as through savings, or those who could use unpaid care from family members, were less likely to purchase insurance. Features of the private market, such as people's lack of trust in insurers and the high cost of coverage, made people less likely to buy long-term care insurance. We conclude that policy interventions designed to address only one factor limiting the purchase of long-term care insurance are unlikely to dramatically increase demand for long-term care insurance.

  17. 42 CFR 447.64 - Alternative premiums, enrollment fees, or similar fees: State plan requirements.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... cost sharing for the remainder of the family's current monthly or quarterly cap period. (e) The process... SERVICES Payments: General Provisions Alternative Premiums and Cost Sharing Under Section 1916a § 447.64... subject to premiums or cost sharing for specific items or services; and (2) If the State adopts...

  18. Neurotoxicity testing during long-term studies.

    PubMed

    Ivens, I

    1990-01-01

    Several tests and methods for the investigation of neurotoxicity were performed with female Wistar rats for up to 187 days. The methods were validated by testing 10 rats treated with beta,beta'-iminodipropionitrile (IDPN) and 10 control rats. Cage side observation of the animals revealed signs of altered behavior and motor dysfunction of the IDPN-treated rats. Results of a neuromuscular screen indicated changes in gait, righting reflex, grip strength and performance of the negative geotropism test. Investigation of the animals in activity monitors and on the accelerating rotarod showed changes of several parameters. The motor nerve conduction velocity, measured 6 months after the first treatment, was reduced by 6.7 meters per second in the IDPN group compared to controls. From the results of the tests it can be concluded that the methods chosen can be used during long-term studies but may be most useful for animals not older than 12 months.

  19. Long term cryogenic storage facility systems study

    NASA Technical Reports Server (NTRS)

    Schuster, John R.

    1987-01-01

    The Long Term Cryogenic Storage Facility Systems Study (LTCSFSS) is a Phase A study of a large capacity propellant depot for the space based, cryogenic orbital transfer vehicle. The study is being performed for Marshall Space Flight Center by General Dynamics Space Systems Division and has five principal objectives: (1) Definition of preliminary concept designs for four storage facility concepts; (2) Selection of preferred concepts through the application of trade studies to candidate propellant management system components; (3) Preparation of a conceptual design for an orbital storage facility; (4) Development of supporting research and technology requirements; and (5) Development of a test program to demonstrate facility performance. The initial study has been completed, and continuation activities are just getting under way to provide greater detail in key areas and accommodate changes in study guidelines and assumptions.

  20. Reducing long-term reservoir performance uncertainty

    SciTech Connect

    Lippmann, M.J.

    1988-04-01

    Reservoir performance is one of the key issues that have to be addressed before going ahead with the development of a geothermal field. In order to select the type and size of the power plant and design other surface installations, it is necessary to know the characteristics of the production wells and of the produced fluids, and to predict the changes over a 10--30 year period. This is not a straightforward task, as in most cases the calculations have to be made on the basis of data collected before significant fluid volumes have been extracted from the reservoir. The paper describes the methodology used in predicting the long-term performance of hydrothermal systems, as well as DOE/GTD-sponsored research aimed at reducing the uncertainties associated with these predictions. 27 refs., 1 fig.

  1. Long-term monitoring for closed sites

    SciTech Connect

    Golchert, N.W.; Sedlet, J.; Veluri, V.R.

    1985-01-01

    A procedure is presented for planning and implementing a long-term environmental monitoring program for closed low-level radioactive waste disposal sites. The initial task in this procedure is to collect the available information on the legal/regulatory requirements, site and area characteristics, source term, pathway analysis, and prior monitoring results. This information is coupled with parameters such as half-life and retardation factors to develop a monitoring program. As examples, programs are presented for a site that has had little or no waste migration, and for sites where waste has been moved by suface water, by ground water, and by air. Sampling techniques and practices are discussed relative to how a current program would be structured and projections are made on techniques and practices expected to be available in the future. 8 refs., 2 figs.

  2. Emotional behavior in long-term marriage.

    PubMed

    Carstensen, L L; Gottman, J M; Levenson, R W

    1995-03-01

    In exploring the emotional climate of long-term marriages, this study used an observational coding system to identify specific emotional behaviors expressed by middle-aged and older spouses during discussions of a marital problem. One hundred and fifty-six couples differing in age and marital satisfaction were studied. Emotional behaviors expressed by couples differed as a function of age, gender, and marital satisfaction. In older couples, the resolution of conflict was less emotionally negative and more affectionate than in middle-aged marriages. Differences between husbands and wives and between happy and unhappy marriages were also found. Wives were more affectively negative than husbands, whereas husbands were more defensive than wives, and unhappy marriages involved greater exchange of negative affect than happy marriages.

  3. Long Term Hydrological (Radiological) Site Monitoring Data

    EPA Pesticide Factsheets

    Quality Data Asset includes all current and historical data on the quality of water with regard to the presence of water pollutants of all kinds regulated by the Clean Water Act. Under the new Interagency Agreement with the Department of Energy (DOE), the Radiation & Indoor Environments National Laboratory (R&IE), Office of Radiation and Indoor Air (ORIA), EPA, located in Las Vegas, NV, conducts a Long-Term Hydrological Monitoring Program (LTHMP) providing laboratory sampling/analysis and Quality Assurance and Control to measure radioactivity concentrations in the water sources near the sites of former underground nuclear explosions. The results of the LTHMP provide assurance that radioactive material from the tests have not migrated into water supplies.

  4. Long-term U. S. energy outlook

    SciTech Connect

    Friesen, G.

    1984-01-01

    Each year Chase Econometrics offers its clients a brief summary of the assumptions underlying the long-term energy forecast for the U.S. To illustrate the uncertainty involved in forecasting for the period to the year 2000, they choose to compare forecasts with some recent projections prepared by the Department of Energy's Office of Policy, Planning and Analysis for the annual National Energy Policy Plan supplement. Particular emphasis is placed on Scenario B, which is the mid-range reference case. As the introduction to the supplement emphasizes, the NEPP projections should not be considered a statement of the policy goals of the Reagan Administration. They represent an analysis of the possible evolution of U.S. energy markets, given current information and existing policies. The purpose of providing Scenario B as a reference case as well as Scenarios A and C as alternate cases is to show the sensitivity of oil price projections to small swings in energy demand.

  5. Long term performance of radon mitigation systems

    SciTech Connect

    Prill, R.; Fisk, W.J.

    2002-03-01

    Researchers installed radon mitigation systems in 12 houses in Spokane, Washington and Coeur d'Alene, Idaho during the heating season 1985--1986 and continued to monitor indoor radon quarterly and annually for ten years. The mitigation systems included active sub-slab ventilation, basement over-pressurization, and crawlspace isolation and ventilation. The occupants reported various operational problems with these early mitigation systems. The long-term radon measurements were essential to track the effectiveness of the mitigation systems over time. All 12 homes were visited during the second year of the study, while a second set 5 homes was visited during the fifth year to determine the cause(s) of increased radon in the homes. During these visits, the mitigation systems were inspected and measurements of system performance were made. Maintenance and modifications were performed to improve system performance in these homes.

  6. Withdrawal from long-term benzodiazepine treatment.

    PubMed Central

    Petursson, H; Lader, M H

    1981-01-01

    Long-term, normal-dose benzodiazepine treatment was discontinued in 16 patients who were suspected of being dependent on their medication. The withdrawal was gradual, placebo-controlled, and double-blind. All the patients experienced some form of withdrawal reaction, which ranged from anxiety and dysphoria to moderate affective and perceptual changes. Symptom ratings rose as the drugs were discontinued, but usually subsided to prewithdrawal levels over the next two to four weeks. Other features of the withdrawal included disturbance of sleep and appetite and noticeable weight loss. Electroencephalography showed appreciable reduction in fast-wave activity as the drugs were withdrawn, and an improvement in psychological performance was recorded by the Digit Symbol Substitution Test. Because of the risk of dependence on benzodiazepines these agents should probably not be given as regular daily treatment for chronic anxiety. PMID:6114776

  7. [Enteral nutrition through long-term jejunostomy].

    PubMed

    Fernández, T; Neira, P; Enríquez, C

    2008-01-01

    We present the case of a female patient suffering a peritonitis episode after subtotal gastrectomy due to gastric neoplasm in relation to lesser curvature necrosis extending to the anterior esophageal wall. This an uncommon andsevere complication that made mandatory further aggressive surgery: transection of the abdominal esophagus, transection of the gastric stump, and cervical esophagostomy with creation of a jejunostomy with a needle catheter for feeding. This digestive tube access technique is generally used during major abdominal post-surgery until oral intake is reestablished. Our patient has been 187 days with this therapy since reconstruction of the GI tract was ruled out due to tumoral infiltration of the colon and tumor recurrence at the gastrohepatic omentum. To date, there has been no complication from permanence and/or long-term use of this technique.

  8. [Childhood liver transplantation. Long-term results].

    PubMed

    Jara, Paloma; Hierro, Loreto

    2010-05-01

    Liver transplantation allows long-term survival (10 years or more) in 75% of children receiving transplants before 2000. The risk of mortality after the first year is 4-10% in the next 10-20 years. Chronic rejection affects 6%. The need for late retransplantation is 3-5%. However, the follow-up of these patients involves the management of diverse problems in the graft (immunological, biliary, vascular) and others related to the use of immunosuppressants (renal dysfunction, lymphoproliferative syndrome). The transition from pediatric to adult care generates special needs. Adolescence and young adulthood are associated with a lack of compliance. Adult specialists should be aware of the special features of the original diagnosis and the surgical techniques used in childhood transplantation. Final quality of life is good overall but is lower than that in healthy young persons.

  9. Long-term leaching of photovoltaic modules

    NASA Astrophysics Data System (ADS)

    Nover, Jessica; Zapf-Gottwick, Renate; Feifel, Carolin; Koch, Michael; Metzger, Jörg W.; Werner, Jürgen H.

    2017-08-01

    Some photovoltaic module technologies use toxic materials. We report long-term leaching on photovoltaic module pieces of 5 × 5 cm2 size. The pieces are cut out from modules of the four major commercial photovoltaic technologies: crystalline and amorphous silicon, cadmium telluride as well as from copper indium gallium diselenide. To simulate different environmental conditions, leaching occurs at room temperature in three different water-based solutions with pH 3, 7, and 11. No agitation is performed to simulate more representative field conditions. After 360 days, about 1.4% of lead from crystalline silicon module pieces and 62% of cadmium from cadmium telluride module pieces are leached out in acidic solutions. The leaching depends heavily on the pH and the redox potential of the aqueous solutions and it increases with time. The leaching behavior is predictable by thermodynamic stability considerations. These predictions are in good agreement with the experimental results.

  10. Technology for long-term care.

    PubMed

    Tak, Sunghee H; Benefield, Lazelle E; Mahoney, Diane Feeney

    2010-01-01

    Severe staff shortages in long-term care (LTC) make it difficult to meet the demands of the growing aging population. Further, technology-savvy Baby Boomers are expected to reshape the current institutional environments toward gaining more freedom and control in their care and lives. Voices from business, academia, research, advocacy organizations, and government bodies suggest that innovative technological approaches are the linchpin that may prepare society to cope with these projected demands. In this article, we review the current state of aging-related technology, identify potential areas for efficacy testing on improving the quality of life of LTC residents in future research, and discuss barriers to implementation of LTC technology. Finally, we present a vision of future technology use that could transform current care practices.

  11. Radiation risk during long-term spaceflight.

    PubMed

    Petrov, V M

    2002-01-01

    Cosmonauts' exposure to cosmic rays during long-term spaceflight can cause unfavorable effects in health and risk for the crew members' lives. All unfavorable effects induced by exposure should be taken into consideration for the risk estimation. They should include both the acute deterministic effects and delayed effects called stochastic. On the ground the limitation of unfavorable consequences of acute exposure is achieved by means of establishing dose limits. But in space applications this approach can't be acceptable. Establishing a fixed dose limit is adequate to introducing indefinite reserve coefficient and therefore ineffective usage of spacecraft resource. The method of radiation risk calculation caused by acute and delayed effects of cosmonauts' exposure is discussed and substantiated in the report. Peculiarities of the impact of permanent radiation sources (galactic cosmic rays and trapped radiation) and the variable one (solar cosmic rays) are taken into consideration. c2002 COSPAR. Published by Elsevier Science Ltd. All rights reserved.

  12. Long-term control of root growth

    SciTech Connect

    Burton, F.G.; Cataldo, D.A.; Cline, J.F.; Skiens, W.E.

    1992-05-26

    A method and system for long-term control of root growth without killing the plants bearing those roots involves incorporating a 2,6-dinitroaniline in a polymer and disposing the polymer in an area in which root control is desired. This results in controlled release of the substituted aniline herbicide over a period of many years. Herbicides of this class have the property of preventing root elongation without translocating into other parts of the plant. The herbicide may be encapsulated in the polymer or mixed with it. The polymer-herbicide mixture may be formed into pellets, sheets, pipe gaskets, pipes for carrying water, or various other forms. The invention may be applied to other protection of buried hazardous wastes, protection of underground pipes, prevention of root intrusion beneath slabs, the dwarfing of trees or shrubs and other applications. The preferred herbicide is 4-difluoromethyl-N,N-dipropyl-2,6-dinitro-aniline, commonly known as trifluralin. 7 figs.

  13. Long-term control of root growth

    DOEpatents

    Burton, Frederick G.; Cataldo, Dominic A.; Cline, John F.; Skiens, W. Eugene

    1992-05-26

    A method and system for long-term control of root growth without killing the plants bearing those roots involves incorporating a 2,6-dinitroaniline in a polymer and disposing the polymer in an area in which root control is desired. This results in controlled release of the substituted aniline herbicide over a period of many years. Herbicides of this class have the property of preventing root elongation without translocating into other parts of the plant. The herbicide may be encapsulated in the polymer or mixed with it. The polymer-herbicide mixture may be formed into pellets, sheets, pipe gaskets, pipes for carrying water, or various other forms. The invention may be applied to other protection of buried hazardous wastes, protection of underground pipes, prevention of root intrusion beneath slabs, the dwarfing of trees or shrubs and other applications. The preferred herbicide is 4-difluoromethyl-N,N-dipropyl-2,6-dinitro-aniline, commonly known as trifluralin.

  14. Long-term dynamics of Typha populations

    USGS Publications Warehouse

    Grace, J.B.; Wetzel, R.G.

    1998-01-01

    The zonation of Typha populations in an experimental pond in Michigan was re-examined 15 years after the original sampling to gain insight into the long-term dynamics. Current distributions of Typha populations were also examined in additional experimental ponds at the site that have been maintained for 23 years. The zonation between T. latifolia and T. angustifolia in the previously studied pond 15 years after the initial sampling revealed that the density and distribution of shoots had not changed significantly. Thus, it appears that previously reported results (based on 7- year old populations) have remained consistent over time. Additional insight into the interaction between these two taxa was sought by comparing mixed and monoculture stands in five experimental ponds that have remained undisturbed for their 23-year history. The maximum depth of T. latifolia, the shallow- water species, was not significantly reduced when growing in the presence of the more flood tolerant T. angustifolia. In contrast, the minimum depth of T. angustifolia was reduced from 0 to 37 cm when in the presence of T. latifolia. When total populations were compared between monoculture and mixed stands, the average density of T. angustifolia shoots was 59.4 percent lower in mixed stands while the density of T. latifolia was 32 percent lower, with T. angustifolia most affected at shallow depths (reduced by 92 percent) and T. latifolia most affected at the deepest depths (reduced by 60 percent). These long-term observations indicate that competitive displacement between Typha taxa has remained stable over time.

  15. Reconstructing the long-term aa index

    NASA Astrophysics Data System (ADS)

    Clilverd, Mark A.; Clarke, Ellen; Ulich, Thomas; Linthe, Joachim; Rishbeth, Henry

    2005-07-01

    The robustness of the aa geomagnetic index is of critical importance to the debate about the previously reported doubling of the solar coronal magnetic field in the last 100 years, inferred from an increasing trend in this index. To test the trend in aa, we have reconstructed the aa index using two long-running European stations (Sodankylä from 1914 and Niemegk from 1890) to provide data for the northern component of the index that are independent of data from the UK observatories used in the "official" aa index. Both the fully "reconstructed" aa series, based on Sodankylä (67°N, L = 5.2 RE) and Niemegk (52°N, L = 2.3 RE) data in combination with the official aa Southern Hemisphere data, confirm the increasing trend in the index. The Niemegk-based index shows little solar cycle variation in its deviation from the official index, probably because of the midlatitude location of the station. The high-latitude station, Sodankylä, is more affected by active geomagnetic conditions during solar maximum because of the proximity of the auroral oval to the station. Nevertheless, its index also clearly confirms the increasing trend in the aa index and hence supports the idea of a long-term increase in solar coronal magnetic field strength. As an added test, we reconstructed the aa index from a single site using data from two long-running UK stations, Eskdalemuir and Lerwick, applying a technique known as interhourly variation (IHV) proposed by Svalgaard et al. (2004). The resulting series is designed to be primarily sensitive to solar wind conditions. Both the reconstructed aaIHV also showed an increasing trend with time and high consistency with the official aa index. Overall, we conclude that the robustness of the trend in the aa index supports the idea of a long-term increase in solar coronal magnetic field strength.

  16. Posterior urethral valves: long-term outcome.

    PubMed

    Caione, Paolo; Nappo, Simona Gerocarni

    2011-10-01

    Posterior urethral valves represent the most common cause of bladder outlet obstruction in infancy that impairs renal and bladder function. Long-term outcome of patients with previous PUV is evaluated. Patients over 18 years of age, treated from 1982 to 1995 before the age of 3 years were considered. Previous surgery, renal function, bladder activity, urinary incontinence, and fertility/sexual activity were evaluated. Clinical interview, creatinine clearance, uroflowmetry with ultrasound post-void urine residue, and self-administered questionnaire were recorded. Out of 45 identified records, 24 patients (53.3%) accepted to be enrolled (age 18-34 years, mean 23 years). The mean follow-up was 19.5 years (16-30 years). Out of the 21 excluded patients, 20 did not reply to the clinical interview and 1 died at age of 6 years. All the 24 patients had early endoscopic section of PUV; nine also received transient ureterocutaneostomy or vesicostomy. Ureteroneocystostomy was performed in five patients and ureterocystoplasty with unilateral nephrectomy in two. At follow-up chronic renal failure was detected in 13 patients (54.1%) and 9 (37.5%) had arterial hypertension. End-stage renal disease developed in five patients (20.8%): three had successful renal transplantation and two were in dialysis. Lower urinary tract symptoms were present in seven patients (29.1%). No significant fertility deficit and sexual dysfunction were observed in 23 patients, while 1 patient was azoospermic. No paternity was reported so far. Long-term outcome of patients with previously treated PUV is mandatory. Kidney, bladder, and sexual functions should be monitored till adulthood to verify any modified behaviour.

  17. Long term results of pneumatic retinopexy

    PubMed Central

    Ellakwa, Amin F

    2012-01-01

    Background Rhegmatogenous retinal detachment is a commonly encountered retinal problem where rapid treatment can prevent irreversible vision loss. Pneumatic retinopexy (PR) is a simple, minimally invasive procedure for retinal reattachment. Purpose This study aimed to assess the long-term anatomical and functional outcome of pneumatic retinopexy in primary rhegmatogenous retinal detachment. Patients and methods A prospective interventional study was performed. Subjects with rhegmatogenous retinal detachment who underwent pneumatic retinopexy from May 2006 to May 2007 at Menoufiya University Hospital were included in this study with at least 3 years follow-up. Results A total of 40 cases were included in the study. The mean age of patients was 44.25 ± 10.85 years. Reattachment of the retina was achieved in 100% of cases. In 75% of cases, the primary intervention was successful. However, the retina redetached in 20% of these during the first 6 months, requiring reinjection or another procedure. Three years after the first intervention, follow-up measurement of the mean visual acuity of the eyes without reoperation was 0.40 ± 0.21 while the mean visual acuity of the eyes which needed additional operations was 0.22 ± 0.13. Conclusion Sixty percent of the cases obtained long-term retinal reattachment with a single operation success (SOS), with good visual recovery and less morbidity than other more invasive procedures like scleral buckling or pars plana vitrectomy, translating to higher productivity for the patient. This procedure, being quicker than the alternatives, also saves the surgeon’s time, making PR a good choice for managing primary rhegmatogenous retinal detachment in developing countries. PMID:22275808

  18. Managing Records for the Long Term - 12363

    SciTech Connect

    Montgomery, John V.; Gueretta, Jeanie

    2012-07-01

    The U.S. Department of Energy (DOE) is responsible for managing vast amounts of information documenting historical and current operations. This information is critical to the operations of the DOE Office of Legacy Management. Managing legacy records and information is challenging in terms of accessibility and changing technology. The Office of Legacy Management is meeting these challenges by making records and information management an organizational priority. The Office of Legacy Management mission is to manage DOE post-closure responsibilities at former Cold War weapons sites to ensure the future protection of human health and the environment. These responsibilities include environmental stewardship and long-term preservation and management of operational and environmental cleanup records associated with each site. A primary organizational goal for the Office of Legacy Management is to 'Preserve, Protect, and Share Records and Information'. Managing records for long-term preservation is an important responsibility. Adequate and dedicated resources and management support are required to perform this responsibility successfully. Records tell the story of an organization and may be required to defend an organization in court, provide historical information, identify lessons learned, or provide valuable information for researchers. Loss of records or the inability to retrieve records because of poor records management processes can have serious consequences and even lead to an organisation's downfall. Organizations must invest time and resources to establish a good records management program because of its significance to the organization as a whole. The Office of Legacy Management will continue to research and apply innovative ways of doing business to ensure that the organization stays at the forefront of effective records and information management. DOE is committed to preserving records that document our nation's Cold War legacy, and the Office of Legacy

  19. Dynamics of long-term genomic selection

    PubMed Central

    2010-01-01

    Background Simulation and empirical studies of genomic selection (GS) show accuracies sufficient to generate rapid gains in early selection cycles. Beyond those cycles, allele frequency changes, recombination, and inbreeding make analytical prediction of gain impossible. The impacts of GS on long-term gain should be studied prior to its implementation. Methods A simulation case-study of this issue was done for barley, an inbred crop. On the basis of marker data on 192 breeding lines from an elite six-row spring barley program, stochastic simulation was used to explore the effects of large or small initial training populations with heritabilities of 0.2 or 0.5, applying GS before or after phenotyping, and applying additional weight on low-frequency favorable marker alleles. Genomic predictions were from ridge regression or a Bayesian analysis. Results Assuming that applying GS prior to phenotyping shortened breeding cycle time by 50%, this practice strongly increased early selection gains but also caused the loss of many favorable QTL alleles, leading to loss of genetic variance, loss of GS accuracy, and a low selection plateau. Placing additional weight on low-frequency favorable marker alleles, however, allowed GS to increase their frequency earlier on, causing an initial increase in genetic variance. This dynamic led to higher long-term gain while mitigating losses in short-term gain. Weighted GS also increased the maintenance of marker polymorphism, ensuring that QTL-marker linkage disequilibrium was higher than in unweighted GS. Conclusions Losing favorable alleles that are in weak linkage disequilibrium with markers is perhaps inevitable when using GS. Placing additional weight on low-frequency favorable alleles, however, may reduce the rate of loss of such alleles to below that of phenotypic selection. Applying such weights at the beginning of GS implementation is important. PMID:20712894

  20. The Starkey project: long-term research for long-term management solutions.

    Treesearch

    Thomas M. Quigley; Michael J. Wisdom

    2004-01-01

    The Starkey Project is a unique, long-term research program designed to study the effects of key resource uses of national forests on mule deer (Odocoileus hemionus) and elk (Cervus elaphus) habitats and populations located at the Starkey Experimental Forest and Range (Starkey). The purpose of the project was to fill knowledge...

  1. Automated Long - Term Scheduling for the SOFIA Airborne Observatory

    NASA Technical Reports Server (NTRS)

    Civeit, Thomas

    2013-01-01

    The NASA Stratospheric Observatory for Infrared Astronomy (SOFIA) is a joint US/German project to develop and operate a gyro-stabilized 2.5-meter telescope in a Boeing 747SP. SOFIA's first science observations were made in December 2010. During 2011, SOFIA accomplished 30 flights in the "Early Science" program as well as a deployment to Germany. The new observing period, known as Cycle 1, is scheduled to begin in 2012. It includes 46 science flights grouped in four multi-week observing campaigns spread through a 13-month span. Automation of the flight scheduling process offers a major challenge to the SOFIA mission operations. First because it is needed to mitigate its relatively high cost per unit observing time compared to space-borne missions. Second because automated scheduling techniques available for ground-based and space-based telescopes are inappropriate for an airborne observatory. Although serious attempts have been made in the past to solve part of the problem, until recently mission operations staff was still manually scheduling flights. We present in this paper a new automated solution for generating SOFIA long-term schedules that will be used in operations from the Cycle 1 observing period. We describe the constraints that should be satisfied to solve the SOFIA scheduling problem in the context of real operations. We establish key formulas required to efficiently calculate the aircraft course over ground when evaluating flight schedules. We describe the foundations of the SOFIA long-term scheduler, the constraint representation, and the random search based algorithm that generates observation and instrument schedules. Finally, we report on how the new long-term scheduler has been used in operations to date.

  2. 17 CFR 256.224 - Other long-term debt.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... SYSTEM OF ACCOUNTS FOR MUTUAL SERVICE COMPANIES AND SUBSIDIARY SERVICE COMPANIES, PUBLIC UTILITY HOLDING COMPANY ACT OF 1935 6. Long-Term Debt § 256.224 Other long-term debt. This account shall include all long...

  3. 17 CFR 256.224 - Other long-term debt.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... SYSTEM OF ACCOUNTS FOR MUTUAL SERVICE COMPANIES AND SUBSIDIARY SERVICE COMPANIES, PUBLIC UTILITY HOLDING COMPANY ACT OF 1935 6. Long-Term Debt § 256.224 Other long-term debt. This account shall include all long...

  4. Treatment for childhood cancer -- long-term risks

    MedlinePlus

    ... ency/patientinstructions/000849.htm Treatment for childhood cancer - long-term risks To use the sharing features on this ... has. Being aware of your child's risk of long-term health problems can help you follow-up with ...

  5. 22 CFR 228.12 - Long-term leases.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... SERVICES FINANCED BY USAID Conditions Governing Source and Nationality of Commodity Procurement Transactions for USAID Financing § 228.12 Long-term leases. Any commodity obtained under a long-term lease...

  6. 22 CFR 228.18 - Long-term leases.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... USAID Conditions Governing Source and Nationality of Commodity and Service Procurement Transactions for USAID Financing § 228.18 Long-term leases. Any commodity obtained under a long-term lease agreement as...

  7. 22 CFR 228.18 - Long-term leases.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... USAID Conditions Governing Source and Nationality of Commodity and Service Procurement Transactions for USAID Financing § 228.18 Long-term leases. Any commodity obtained under a long-term lease agreement as...

  8. 22 CFR 228.18 - Long-term leases.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... USAID Conditions Governing Source and Nationality of Commodity and Service Procurement Transactions for USAID Financing § 228.18 Long-term leases. Any commodity obtained under a long-term lease agreement as...

  9. 22 CFR 228.12 - Long-term leases.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... SERVICES FINANCED BY USAID Conditions Governing Source and Nationality of Commodity Procurement Transactions for USAID Financing § 228.12 Long-term leases. Any commodity obtained under a long-term lease...

  10. Long-term Changes in Tropospheric Ozone

    NASA Astrophysics Data System (ADS)

    Oltmans, S.; Lefohn, A.; Galbally, I.; Scheel, E.; Bodeker, G.; Brunke, E.; Claude, H.; Tarasick, D.; Simmonds, P.; Anlauf, K.; Schmidlin, F.; Akagi, K.; Redondas, A.

    2006-05-01

    Tropospheric ozone measurements from a selected network of surface and ozonesonde sites are used to give a broad geographic picture of long-term variations. The picture of long-term tropospheric ozone changes is a varied one in terms of both the sign and magnitude of trends and in the possible causes for the changes. At mid latitudes of the S.H. three time series of ~20 years in length agree in showing increases that are strongest in the austral spring (August-October). Profile measurements show this increase extending through the mid troposphere but not into the highest levels of the troposphere. In the N.H. in the Arctic a period of declining ozone in the troposphere through the 1980s into the mid 1990s has reversed and the overall change is small. The decadal-scale variations in the troposphere in this region are related in part to changes in the lowermost stratosphere. At mid latitudes in the N.H., continental Europe and Japan showed significant increases in the 1970s and 1980s. Over North America rises in the 1970s are less than those seen in Europe and Japan, suggesting significant regional differences. In all three of these mid latitude, continental regions tropospheric ozone amounts appear to have leveled off or in some cases declined in the more recent decades. Over the North Atlantic three widely separated sites show significant increases since the late 1990s that may have peaked in recent years. In the N.H. tropics both the surface record and the ozonesondes in Hawaii show a significant increase in the autumn months in the most recent decade compared to earlier periods that drives the overall increase seen in the 30 year record. This appears to be related to a shift in the transport pattern during this season with more frequent flow from higher latitudes in the latest decade. The pattern of change, with the largest increases in the N.H. coming prior to the mid 1980s, suggests that increased positive radiative forcing due to tropospheric ozone was felt

  11. Evaluating Long-Term Care Through the Humanbecoming Lens.

    PubMed

    Hart, Judith D

    2015-10-01

    The author describes evaluating long-term care from the humanbecoming perspective. Three core ideas are presented related to dignity and living quality, and how the humanbecoming perspective can be incorporated into long-term care evaluations that make a difference to the residents, caregivers, management, and to the outcomes of long-term care. This approach from the humanbecoming perspective can enrich evaluative information, influence long-term care outcomes, and ensure human dignity for all concerned.

  12. 42 CFR 422.262 - Beneficiary premiums.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... an MA plan (other than a MSA plan) is the sum of the MA monthly basic beneficiary premium (if any... beneficiary premium (if any). (2) Special rule for MSA plans. For an individual enrolled in an MSA plan... premium, the MA monthly prescription drug premium, and the monthly MSA premium of an MA organization...

  13. 42 CFR 422.262 - Beneficiary premiums.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... an MA plan (other than a MSA plan) is the sum of the MA monthly basic beneficiary premium (if any... beneficiary premium (if any). (2) Special rule for MSA plans. For an individual enrolled in an MSA plan... premium, the MA monthly prescription drug premium, and the monthly MSA premium of an MA organization may...

  14. 42 CFR 422.262 - Beneficiary premiums.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... an MA plan (other than a MSA plan) is the sum of the MA monthly basic beneficiary premium (if any... beneficiary premium (if any). (2) Special rule for MSA plans. For an individual enrolled in an MSA plan... premium, the MA monthly prescription drug premium, and the monthly MSA premium of an MA organization may...

  15. 42 CFR 422.262 - Beneficiary premiums.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... an MA plan (other than a MSA plan) is the sum of the MA monthly basic beneficiary premium (if any... beneficiary premium (if any). (2) Special rule for MSA plans. For an individual enrolled in an MSA plan... premium, the MA monthly prescription drug premium, and the monthly MSA premium of an MA organization may...

  16. 42 CFR 422.262 - Beneficiary premiums.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... an MA plan (other than a MSA plan) is the sum of the MA monthly basic beneficiary premium (if any... beneficiary premium (if any). (2) Special rule for MSA plans. For an individual enrolled in an MSA plan... premium, the MA monthly prescription drug premium, and the monthly MSA premium of an MA organization may...

  17. Long-term global nuclear energy and fuel cycle strategies

    SciTech Connect

    Krakowski, R.A.

    1997-09-24

    The Global Nuclear Vision Project is examining, using scenario building techniques, a range of long-term nuclear energy futures. The exploration and assessment of optimal nuclear fuel-cycle and material strategies is an essential element of the study. To this end, an established global E{sup 3} (energy/economics/environmental) model has been adopted and modified with a simplified, but comprehensive and multi-regional, nuclear energy module. Consistent nuclear energy scenarios are constructed using this multi-regional E{sup 3} model, wherein future demands for nuclear power are projected in price competition with other energy sources under a wide range of long-term demographic (population, workforce size and productivity), economic (price-, population-, and income-determined demand for energy services, price- and population-modified GNP, resource depletion, world-market fossil energy prices), policy (taxes, tariffs, sanctions), and top-level technological (energy intensity and end-use efficiency improvements) drivers. Using the framework provided by the global E{sup 3} model, the impacts of both external and internal drivers are investigated. The ability to connect external and internal drivers through this modeling framework allows the study of impacts and tradeoffs between fossil- versus nuclear-fuel burning, that includes interactions between cost, environmental, proliferation, resource, and policy issues.

  18. Adapting Advances in Remediation Science to Long-Term Surveillance

    SciTech Connect

    Peterson, Dave

    2006-03-01

    Several facets of groundwater remediation stand to gain from the advances made during recent years in disciplines that contribute to remediation science. Engineered remedies designed to aggressively remove subsurface contamination should benefit from this progress, and more passive cleanup methods and the long-term monitoring of such passive approaches may benefit equally well if not more. The U.S. Department of Energy Office of Legacy Management (LM) has adopted a strategic plan that is designed to take advantage of technological improvements in the monitoring and assessment of both active and passive groundwater remedies. Flexible adaptation of new technologies, as they become available, to long-term surveillance at LM sites is expected to reduce site stewardship costs while ensuring the future protection of human health and the environment. Some of the technologies are expected to come from government initiatives that focus on the needs of subsurface monitoring. Additional progress in monitoring science will likely result from continual improvements in our understanding of contaminant fate-and-transport processes in the groundwater and the vadose zone.

  19. ABO-incompatible kidney transplantation: long-term outcomes.

    PubMed

    Tanabe, Kazunari; Ishida, Hideki; Inui, Masashi; Okumi, Masayoshi; Shirakawa, Hiroki; Shimizu, Tomokazu; Omoto, Kazuya; Kondo, Tsunenori

    2013-01-01

    In the past 20 years, over 2,000 cases of ABO-incompatible living kidney transplantation (ABO-ILKT) have been performed in Japan, expanding the donor pool and overcoming the serious shortage of organ donors. Overall long-term outcomes (>20 years) have been excellent and almost identical to the outcomes of ABO-compatible living kidney transplantation (ABO-CLKT). In the last decade, ABO-ILKT has become accepted as a therapeutic alternative for end-stage renal failure. Recently, approximately 30% of all living donor kidney transplantations in Japan have been ABO-ILKT. In the 1990s, desensitization included preoperative plasmapheresis, splenectomy, and heavy immunosuppression that caused surgical and medical stress on patients and a higher cost than that needed for ABO-CLKT for the preoperative conditioning. However, since 2000, rituximab has replaced splenectomy making ABO-ILKT much easier. It is also less stressful for patients. In the last decade, outcomes have improved significantly and 5- and 10-year graft survival have reached 95% and 90%, respectively-identical to, or even better than outcomes of ABO-CLKT. Our current preconditioning includes plasmapheresis 0-2 times, rituximab injection, and regular immunosuppression. Neither intravenous immunoglobulin nor prophylactic plasmapheresis is used after transplantation. ABO-ILKT is a standard option for kidney transplantation requiring minimal preconditioning and regular immunosuppression after transplantation. It now provides an excellent long-term (>20 years) outcome.

  20. [Long-term care services in Spain: an overview].

    PubMed

    Casado-Marín, David

    2006-03-01

    To date, both in Spain and virtually all the other European Union (EU) countries, dependency has been seen to be a fundamentally private problem to be dealt with by the family concerned. In this way, whether through informal carers or contracted professionals, in the domestic environment or in care homes, it is the dependent person themselves and their families who currently bear the majority of the costs. In light of this, current concern lies in the social change that is coming on, mainly the accelerated aging process and the increased participation of middle-aged women in the labour market, which heighten the need for collective organisation of that which until now has been resolved within family circles. In this context, at the same time that the Government announces to issue a <Long Term Care Law> by the end of 2005, our paper briefly analyzes what we consider the four crucial issues in this area: the current scope of dependency problems and its possible future evolution, the characteristics of the current spanish long-term care system and its main problems; the role that health services should have in the dependency issue; and finally, the benefits and drawbacks of the main alternatives that the Administration could manage in case it intends to increase its involvement in this field.

  1. Non-intrusive long-term monitoring approaches

    SciTech Connect

    Smathers, D.; Mangan, D.

    1998-08-01

    In order to promote internatinal confidence that the US and Russia are disarming per their commitments under Article 6 of the Non-Proliferation Treaty, an international verification regime may be applied to US and Russian excess fissile materials. Initially, it is envisioned that this verification regime would be applied at storage facilities; however, it should be anticipated that the verificatino regime would continue throughout any material disposition activities, should such activities be pursued. once the materials are accepted into the verification regime, it is assumed that long term monitoring will be used to maintain continuity of knowledge. The requirements for long term storage monitoring include unattended operation for extended periods of time, minimal intrusiveness on the host nation`s safety and security activities, data collection incorporating data authentication, and monitoring redundancy to allow resolution of anomalies and to continue coverage in the event of equipment failures. Additional requirements include effective data review and analysis processes, operation during storage facility loading, procedure for removal of inventory items for safety-related surveillance, and low cost, reliable equipment. A monitoring system might include both continuous monitoring of storagecontainers and continuous area monitoring. These would be complemented with periodic on-site inspections. A fissile material storage facility is not a static operation. The initial studies have shown there are a number of volid reasions why a host nation may need them to remove material from the storage facility. A practical monitoring system must be able to accommodate necessary material movements.

  2. Long-term Variability of Beach Cusps

    NASA Astrophysics Data System (ADS)

    Pianca, C.; Holman, R. A.; Siegle, E.

    2016-02-01

    The most curious morphological features observed on beaches are the cusps. Due to their rhythmic spacing, beach cusps have attracted many observers and many, often contradictory, theories as to their form. Moreover, most of the research about beach cusps has focused on their formation. Few had available long time series to study such things as the variability of alongshore and cross-shore position and spacing on the cusp field, the presence, longevity and interactions between higher and lower sets of cusps, and the processes by which cusp fields extend, shrink or change length scale. The purpose of this work is to use long-term data sets of video images from two study sites, an intermediate (Duck, USA, 26 years) and a reflective beach (Massaguaçu, Brazil, 3 years), to investigate the temporal and spatial changes of cusps conditions. Time-evolving shoreline data were first extracted using an algorithm called ASLIM (Pianca et al 2015). Cusps were then identified based on the band-passed variability of time exposure image data about this shoreline as a function of elevation relative to MSL. The identified beaches cusps will be analyzed for cusp spacing, positions (upper or lower cusps), alongshore variability, merging events, percentage of cusp events, patterns of the events and time scales of variability. Finally, the relationship of these characteristics to environmental conditions (wave, tides, beach conditions) will be studied.

  3. Long term results of childhood dysphonia treatment.

    PubMed

    Mackiewicz-Nartowicz, Hanna; Sinkiewicz, Anna; Bielecka, Arleta; Owczarzak, Hanna; Mackiewicz-Milewska, Magdalena; Winiarski, Piotr

    2014-05-01

    The aim of this study was to assess the long term results of treatment and rehabilitation of childhood dysphonia. This study included a group of adolescents (n=29) aged from 15 to 20 who were treated due to pediatric hyperfunctional dysphonia and soft vocal fold nodules during their pre-mutational period (i.e. between 5 and 12 years of age). The pre-mutational therapy was comprised of proper breathing pattern training, voice exercises and psychological counseling. Laryngostroboscopic examination and perceptual analysis of voice were performed in each patient before treatment and one to four years after mutation was complete. The laryngostroboscopic findings, i.e. symmetry, amplitude, mucosal wave and vocal fold closure, were graded with NAPZ scale, and the GRBAS scale was used for the perceptual voice analysis. Complete regression of the childhood dysphonia was observed in all male patients (n=14). Voice disorders regressed completely also in 8 out of 15 girls, but symptoms of dysphonia documented on perceptual scale persisted in the remaining seven patients. Complex voice therapy implemented in adolescence should be considered as either the treatment or preventive measure of persistent voice strain, especially in girls. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  4. Long-term corrosion testing pan.

    SciTech Connect

    Wall, Frederick Douglas; Brown, Neil R.

    2008-08-01

    This document describes the testing and facility requirements to support the Yucca Mountain Project long-term corrosion testing needs. The purpose of this document is to describe a corrosion testing program that will (a) reduce model uncertainty and variability, (b) reduce the reliance upon overly conservative assumptions, and (c) improve model defensibility. Test matrices were developed for 17 topical areas (tasks): each matrix corresponds to a specific test activity that is a subset of the total work performed in a task. A future document will identify which of these activities are considered to be performance confirmation activities. Detailed matrices are provided for FY08, FY09 and FY10 and rough order estimates are provided for FY11-17. Criteria for the selection of appropriate test facilities were developed through a meeting of Lead Lab and DOE personnel on October 16-17, 2007. These criteria were applied to the testing activities and recommendations were made for the facility types appropriate to carry out each activity. The facility requirements for each activity were assessed and activities were identified that can not be performed with currently available facilities. Based on this assessment, a total of approximately 10,000 square feet of facility space is recommended to meet all future testing needs, given that all testing is consolidated to a single location. This report is a revision to SAND2007-7027 to address DOE comments and add a series of tests to address NWTRB recommendations.

  5. Long-term data storage in diamond.

    PubMed

    Dhomkar, Siddharth; Henshaw, Jacob; Jayakumar, Harishankar; Meriles, Carlos A

    2016-10-01

    The negatively charged nitrogen vacancy (NV(-)) center in diamond is the focus of widespread attention for applications ranging from quantum information processing to nanoscale metrology. Although most work so far has focused on the NV(-) optical and spin properties, control of the charge state promises complementary opportunities. One intriguing possibility is the long-term storage of information, a notion we hereby introduce using NV-rich, type 1b diamond. As a proof of principle, we use multicolor optical microscopy to read, write, and reset arbitrary data sets with two-dimensional (2D) binary bit density comparable to present digital-video-disk (DVD) technology. Leveraging on the singular dynamics of NV(-) ionization, we encode information on different planes of the diamond crystal with no cross-talk, hence extending the storage capacity to three dimensions. Furthermore, we correlate the center's charge state and the nuclear spin polarization of the nitrogen host and show that the latter is robust to a cycle of NV(-) ionization and recharge. In combination with super-resolution microscopy techniques, these observations provide a route toward subdiffraction NV charge control, a regime where the storage capacity could exceed present technologies.

  6. Long-term physiological consequences of pneumonectomy.

    PubMed

    Deslauriers, Jean; Ugalde, Paula; Miro, Santiago; Deslauriers, Deborah R; Ferland, Sylvie; Bergeron, Sébastien; Lacasse, Yves; Provencher, Steeve

    2011-01-01

    Ever since the first successful pneumonectomy for lung cancer was performed in 1933, a number of largely historical reports have attempted to look at the physiological consequences of this operation in order to define patient long-term functional status. The pertinence of these contributions is, however, limited because most were performed in patients who had their pneumonectomy for benign diseases or were carried out in small and heterogeneous populations. Thus, several surgical myths and beliefs such as phrenic nerve interruption at the time of operation might be desirable, marked hyperinflation of the residual lung is associated with reduced lung function, and patients develop pulmonary hypertension over time and have poor exercise tolerance have persisted over the years. Our findings based on a study of 100 patients evaluated 5 or more years after surgery (mean follow-up time, 9.1 ± 2.8 years [5.0-14.7 years]) show that most patients can adjust to living with only one lung and are thus able to live a near-normal life. Although diaphragmatic paralysis is characterized by significant alterations in respiratory function, hyperinflation of the residual lung is beneficial. Copyright © 2011 Elsevier Inc. All rights reserved.

  7. Long-term predictions using natural analogues

    SciTech Connect

    Ewing, R.C.

    1995-09-01

    One of the unique and scientifically most challenging aspects of nuclear waste isolation is the extrapolation of short-term laboratory data (hours to years) to the long time periods (10{sup 3}-10{sup 5} years) required by regulatory agencies for performance assessment. The direct validation of these extrapolations is not possible, but methods must be developed to demonstrate compliance with government regulations and to satisfy the lay public that there is a demonstrable and reasonable basis for accepting the long-term extrapolations. Natural systems (e.g., {open_quotes}natural analogues{close_quotes}) provide perhaps the only means of partial {open_quotes}validation,{close_quotes} as well as data that may be used directly in the models that are used in the extrapolation. Natural systems provide data on very large spatial (nm to km) and temporal (10{sup 3}-10{sup 8} years) scales and in highly complex terranes in which unknown synergisms may affect radionuclide migration. This paper reviews the application (and most importantly, the limitations) of data from natural analogue systems to the {open_quotes}validation{close_quotes} of performance assessments.

  8. Long-term corrosion testing plan.

    SciTech Connect

    Wall, Frederick Douglas; Brown, Neil R.

    2009-02-01

    This document describes the testing and facility requirements to support the Yucca Mountain Project long-term corrosion testing program. The purpose of this document is to describe a corrosion testing program that will (a) reduce model uncertainty and variability, (b) reduce the reliance upon overly conservative assumptions, and (c) improve model defensibility. Test matrices were developed for 17 topical areas (tasks): each matrix corresponds to a specific test activity that is a subset of the total work performed in a task. A future document will identify which of these activities are considered to be performance confirmation activities. Detailed matrices are provided for FY08, FY09 and FY10 and rough order estimates are provided for FY11-17. Criteria for the selection of appropriate test facilities were developed through a meeting of Lead Lab and DOE personnel on October 16-17, 2007. These criteria were applied to the testing activities and recommendations were made for the facility types appropriate to carry out each activity. The facility requirements for each activity were assessed and activities were identified that can not be performed with currently available facilities. Based on this assessment, a total of approximately 10,000 square feet of facility space is recommended to accommodate all future testing, given that all testing is consolidated to a single location. This report is a revision to SAND2008-4922 to address DOE comments.

  9. Long-term treatment outcome in acromegaly.

    PubMed

    Holdaway, I M; Rajasoorya, C R; Gamble, G D; Stewart, A W

    2003-08-01

    A number of groups have developed guidelines to indicate whether an individual with acromegaly has been cured by treatment. However, studies to date do not provide a robust definition of biochemical remission of the disorder based on correlation with long-term outcome. Available data suggest that those with a random serum growth hormone (GH) level of <2.5 microg/l, or a glucose-suppressed GH level of <1 microg/l following treatment have mortality figures indistinguishable from the general population. However, the confidence limits for these mortality estimates are quite wide. It remains possible that growth hormone levels lower than 1 microg/l for random samples, or even lower when using ultrasensitive GH assays, may indicate superior outcome, but this remains to be confirmed. There are limited data relating serum insulin-like growth factor-I (IGF-I) levels to outcome, although normalisation of serum IGF-I clearly improves outcome compared with continued elevation of measurements after treatment. Current evidence suggests that a post-treatment random serum GH <2.5 microg/l and a normal serum IGF-I value defines biochemical cure. Available data suggest that achieving similar growth hormone levels after treatment also reduces the prevalence of chronic complications of the disorder, which is subsequently reflected in improved mortality.

  10. Dental hygienists and long-term care.

    PubMed

    Ablah, C R; Pickard, R B

    1998-01-01

    This study examined the willingness of dental hygienists to work in long-term care (LTC) facilities providing oral health care to the elderly. In August 1995, a mail survey of all 839 licensed and practicing dental hygienists in Kansas was conducted. Respondents were asked about their reasons for choosing dental hygiene as a career, perceptions of the adequacy of their education, satisfaction with their work, interest in working with elderly patients, and whether general supervision would influence their willingness to practice in LTC settings. Response rate was 69 percent, with 582 usable questionnaires returned. Data were analyzed using descriptive statistics and chi-square tests of significance. The results showed an overwhelming majority (94 percent) of respondents would be willing to work, at least on occasion, in a LTC facility. However, few were interested in full-time geriatric practice. Those indicating a willingness to practice regularly with the elderly, at least part time, were typically less experienced in their field and more likely to perceive their education as having adequately prepared them to care for older patients. The findings demonstrate dental hygienists' willingness to provide dental care for older adults. To optimize this resource, appropriate education is needed so that students and current practitioners master the distinctive skills necessary to care for this population.

  11. Long-Term Consequences of Neonatal Injury

    PubMed Central

    Beggs, Simon

    2015-01-01

    The maturation of the central nervous system’s (CNS’s) sensory connectivity is driven by modality-specific sensory input in early life. For the somatosensory system, this input is the physical, tactile interaction with the environment. Nociceptive circuitry is functioning at the time of birth; however, there is still considerable organization and refinement of this circuitry that occurs postnatally, before full discrimination of tactile and noxious input is possible. This fine-tuning involves separation of tactile and nociceptive afferent input to the spinal cord’s dorsal horn and the maturation of local and descending inhibitory circuitry. Disruption of that input in early postnatal life (for example, by tissue injury or other noxious stimulus), can have a profound influence on subsequent development, and consequently the mature functioning of pain systems. In this review, the impact of neonatal surgical incision on nociceptive circuitry is discussed in terms of the underlying developmental neurobiology. The changes are complex, occurring at multiple anatomical sites within the CNS, and including both neuronal and glial cell populations. The altered sensory input from neonatal injury selectively modulates neuronal excitability within the spinal cord, disrupts inhibitory control, and primes the immune system, all of which contribute to the adverse long-term consequences of early pain exposure. PMID:26174217

  12. Intermediate- and long-term earthquake prediction.

    PubMed

    Sykes, L R

    1996-04-30

    Progress in long- and intermediate-term earthquake prediction is reviewed emphasizing results from California. Earthquake prediction as a scientific discipline is still in its infancy. Probabilistic estimates that segments of several faults in California will be the sites of large shocks in the next 30 years are now generally accepted and widely used. Several examples are presented of changes in rates of moderate-size earthquakes and seismic moment release on time scales of a few to 30 years that occurred prior to large shocks. A distinction is made between large earthquakes that rupture the entire downdip width of the outer brittle part of the earth's crust and small shocks that do not. Large events occur quasi-periodically in time along a fault segment and happen much more often than predicted from the rates of small shocks along that segment. I am moderately optimistic about improving predictions of large events for time scales of a few to 30 years although little work of that type is currently underway in the United States. Precursory effects, like the changes in stress they reflect, should be examined from a tensorial rather than a scalar perspective. A broad pattern of increased numbers of moderate-size shocks in southern California since 1986 resembles the pattern in the 25 years before the great 1906 earthquake. Since it may be a long-term precursor to a great event on the southern San Andreas fault, that area deserves detailed intensified study.

  13. Intermediate- and long-term earthquake prediction.

    PubMed Central

    Sykes, L R

    1996-01-01

    Progress in long- and intermediate-term earthquake prediction is reviewed emphasizing results from California. Earthquake prediction as a scientific discipline is still in its infancy. Probabilistic estimates that segments of several faults in California will be the sites of large shocks in the next 30 years are now generally accepted and widely used. Several examples are presented of changes in rates of moderate-size earthquakes and seismic moment release on time scales of a few to 30 years that occurred prior to large shocks. A distinction is made between large earthquakes that rupture the entire downdip width of the outer brittle part of the earth's crust and small shocks that do not. Large events occur quasi-periodically in time along a fault segment and happen much more often than predicted from the rates of small shocks along that segment. I am moderately optimistic about improving predictions of large events for time scales of a few to 30 years although little work of that type is currently underway in the United States. Precursory effects, like the changes in stress they reflect, should be examined from a tensorial rather than a scalar perspective. A broad pattern of increased numbers of moderate-size shocks in southern California since 1986 resembles the pattern in the 25 years before the great 1906 earthquake. Since it may be a long-term precursor to a great event on the southern San Andreas fault, that area deserves detailed intensified study. Images Fig. 1 PMID:11607658

  14. Transuranic waste: long-term planning

    SciTech Connect

    Young, K.C.

    1985-07-01

    Societal concerns for the safe handling and disposal of toxic waste are behind many of the regulations and the control measures in effect today. Transuranic waste, a specific category of toxic (radioactive) waste, serves as a good example of how regulations and controls impact changes in waste processing - and vice versa. As problems would arise with waste processing, changes would be instituted. These changes improved techniques for handling and disposal of transuranic waste, reduced the risk of breached containment, and were usually linked with regulatory changes. Today, however, we face a greater public awareness of and concern for toxic waste control; thus, we must anticipate potential problems and work on resolving them before they can become real problems. System safety analyses are valuable aids in long-term planning for operations involving transuranic as well as other toxic materials. Examples of specific system safety analytical methods demonstrate how problems can be anticipated and resolution initiated in a timely manner having minimal impacts upon allocation of resource and operational goals. 7 refs., 1 fig.

  15. The long-term variability of Vega

    NASA Astrophysics Data System (ADS)

    Butkovskaya, V.; Plachinda, S.; Valyavin, G.; Baklanova, D.; Lee, B.-C.

    2011-12-01

    Over the time of 60 years Vega (α Lyrae = HD 172167, A0V) has been generally accepted as a standard star in the near-infrared, optical, and ultraviolet regions. But is the spectrophotometric standard Vega really non-variable star? Researchers give very different answers to this question. We aim to search a periodicity in our results of spectropolarimetric study of Vega, namely periodic variations in equivalent width of the spectral lines and longitudinal magnetic field measurements. High-accuracy spectropolarimetric observations of Vega have been performed during 26 nights from 1997 to 2010 using the Coudé spectrograph of the 2.6-m Shain reflector at the Crimean Astrophysical Observatory (CrAO, Ukraine) and during 4 nights in 2007 and 2008 using the echelle spectrograph BOES at the Bohyunsan Optical Astronomy Observatory (BOAO, South Korea). The long-term (year-to-year) variability of Vega was confirmed. It was concluded that this variability does not have magnetic nature. The paper is dedicated to the memory of V.P. Merezhin.

  16. Long-Term Soft Denture Lining Materials

    PubMed Central

    Chladek, Grzegorz; Żmudzki, Jarosław; Kasperski, Jacek

    2014-01-01

    Long-term soft denture lining (LTSDL) materials are used to alleviate the trauma associated with wearing complete dentures. Despite their established clinical efficacy, the use of LTSDLs has been limited due to the unfavorable effects of the oral environment on some of their mechanical and performance characteristics. The unresolved issue of LTSDL colonization by Candida albicans is particularly problematic. Silicone-based LTSDL (SLTSDL) materials, which are characterized by more stable hardness, sorption and solubility than acrylic-based LTSDLs (ALTSDLs), are currently the most commonly used LTSDLs. However, SLTSDLs are more prone to debonding from the denture base. Moreover, due to their limitations, the available methods for determining bond strength do not fully reflect the actual stability of these materials under clinical conditions. SLTSDL materials exhibit favorable viscoelastic properties compared with ALTSDLs. Furthermore, all of the lining materials exhibit an aging solution-specific tendency toward discoloration, and the available cleansers are not fully effective and can alter the mechanical properties of LTSDLs. Future studies are needed to improve the microbiological resistance of LTSDLs, as well as some of their performance characteristics. PMID:28788163

  17. Long-term data storage in diamond

    PubMed Central

    Dhomkar, Siddharth; Henshaw, Jacob; Jayakumar, Harishankar; Meriles, Carlos A.

    2016-01-01

    The negatively charged nitrogen vacancy (NV−) center in diamond is the focus of widespread attention for applications ranging from quantum information processing to nanoscale metrology. Although most work so far has focused on the NV− optical and spin properties, control of the charge state promises complementary opportunities. One intriguing possibility is the long-term storage of information, a notion we hereby introduce using NV-rich, type 1b diamond. As a proof of principle, we use multicolor optical microscopy to read, write, and reset arbitrary data sets with two-dimensional (2D) binary bit density comparable to present digital-video-disk (DVD) technology. Leveraging on the singular dynamics of NV− ionization, we encode information on different planes of the diamond crystal with no cross-talk, hence extending the storage capacity to three dimensions. Furthermore, we correlate the center’s charge state and the nuclear spin polarization of the nitrogen host and show that the latter is robust to a cycle of NV− ionization and recharge. In combination with super-resolution microscopy techniques, these observations provide a route toward subdiffraction NV charge control, a regime where the storage capacity could exceed present technologies. PMID:27819045

  18. Long-term potentiation: peeling the onion.

    PubMed

    Nicoll, Roger A; Roche, Katherine W

    2013-11-01

    Since the discovery of long-term potentiation (LTP), thousands of papers have been published on this phenomenon. With this massive amount of information, it is often difficult, especially for someone not directly involved in the field, not to be overwhelmed. The goal of this review is to peel away as many layers as possible, and probe the core properties of LTP. We would argue that the many dozens of proteins that have been implicated in the phenomenon are not essential, but rather modulate, often in indirect ways, the threshold and/or magnitude of LTP. What is required is NMDA receptor activation followed by CaMKII activation. The consequence of CaMKII activation is the rapid recruitment of AMPA receptors to the synapse. This recruitment is independent of AMPA receptor subunit type, but absolutely requires an adequate pool of surface receptors. An important unresolved issue is how exactly CaMKII activation leads to modifications in the PSD to allow rapid enrichment. This article is part of the Special Issue entitled 'Glutamate Receptor-Dependent Synaptic Plasticity'.

  19. Neurological long term consequences of deep diving.

    PubMed Central

    Todnem, K; Nyland, H; Skeidsvoll, H; Svihus, R; Rinck, P; Kambestad, B K; Riise, T; Aarli, J A

    1991-01-01

    Forty commercial saturation divers, mean age 34.9 (range 24-49) years, were examined one to seven years after their last deep dive (190-500 metres of seawater). Four had by then lost their divers' licence because of neurological problems. Twenty seven (68%) had been selected by neurological examination and electroencephalography before the deep dives. The control group consisted of 100 men, mean age 34.0 (range 22-48) years. The divers reported significantly more symptoms from the nervous system. Concentration difficulties and paraesthesia in feet and hands were common. They had more abnormal neurological findings by neurological examination compatible with dysfunction in the lumbar spinal cord or roots. They also had a larger proportion of abnormal electroencephalograms than the controls. The neurological symptoms and findings were highly significantly correlated with exposure to deep diving (depth included), but even more significantly correlated to air and saturation diving and prevalence of decompression sickness. Visual evoked potentials, brainstem auditory evoked potentials, and magnetic resonance imaging of the brain did not show more abnormal findings in the divers. Four (10%) divers had had episodes of cerebral dysfunction during or after the dives; two had had seizures, one had had transitory cerebral ischaemia and one had had transitory global amnesia. It is concluded that deep diving may have a long term effect on the nervous system of the divers. PMID:2025592

  20. Long-term in vivo pineal microdialysis.

    PubMed

    Sun, Xing; Liu, Tiecheng; Deng, Jie; Borjigin, Jimo

    2003-09-01

    This study describes the development of a new technique for long-term measurement of daily 5-hydroxytryptamine (5-HT) and melatonin contents in the pineal gland of freely moving rats. The technique features a number of novel improvements over previous protocols. It allows visualization of the pineal gland for accurate targeting of the guide cannula, which minimizes bleeding; incurs no direct injury to the surrounding brain tissues; and causes no interference with the sympathetic innervation from the superior cervical ganglia. Robust releases of melatonin and indole precursors were continuously monitored quantitatively and reproducibly for more than 2 wk in the same animal. In addition, effects of pharmacological agents on in vivo pineal circadian rhythms can be studied reproducibly over time, and gene expression profiles can be correlated with physiological consequences in single animals. Using these approaches, it is found that beta-adrenergic activation leads to decreased release of 5-HT, and that increased cAMP signaling in vivo results in activation of N-acetyltransferase gene induction and melatonin production. These studies will enhance the understanding of signaling pathways that regulate pineal 5-HT and melatonin synthesis and secretion.