The Third Rail of Family Systems: Sibling Relationships, Mental and Behavioral Health, and Preventive Intervention in Childhood and Adolescence

ERIC Educational Resources Information Center

Feinberg, Mark E.; Solmeyer, Anna R.; McHale, Susan M.

2012-01-01

Sibling relationships are an important context for development, but are often ignored in research and preventive interventions with youth and families. In childhood and adolescence, siblings spend considerable time together, and siblings' characteristics and sibling dynamics substantially influence developmental trajectories and outcomes. This…

Studies in Intelligence. Volume 53, Number 3, September 2009

DTIC Science & Technology

2009-09-01

picture includes a vision of an Air America aircraft. My first tour out of pilot training was in III Corps where I flew O-1 Bird Dogs for the 25th...surveillance”—a nov- el but inaccurate thought. Holzman spends considerable time regurgitating the Church Committee hearings and Angleton’s role in the

Education Affects Attitudes of Physical Therapy Providers toward People with Dementia

ERIC Educational Resources Information Center

Staples, William H.; Killian, Clyde B.

2012-01-01

A survey was sent to every skilled nursing home (N = 495) in Indiana regarding the demographics, education, and whether the severity of dementia impacts the attitudes of people in physical therapy practice. Physical therapists (PTs) and physical therapist assistants (PTAs) practicing in nursing homes spend considerable time (44.0%) working with…

Library Space Redesign and Student Computing

ERIC Educational Resources Information Center

Teleha, John C.; Sims, Iyanna; Spruill, Octavious; Bowen, Arneice; Russell, Tiffany; Exner, Nina

2017-01-01

Academic libraries are spending considerable time and study on redesigning spaces. The use of technology is often an important part of these redesigned spaces. The space redesign goals at F. D. Bluford Library focus on creating open, activity-promoting, colorful spaces that are designed to be attractive to students. The goals also focus on…

Strategies for Engaging FCS Learners in a Large-Format Classroom: Embedded Videos

ERIC Educational Resources Information Center

Leslie, Catherine Amoroso

2014-01-01

This article presents a method for utilizing technology to increase student engagement in large classroom formats. In their lives outside the classroom, students spend considerable time interfacing with media, and they are receptive to information conveyed in electronic formats. Research has shown that multimedia is an effective learning resource;…

Adapting Team-Based Learning for Application in the Basic Electric Circuit Theory Sequence

ERIC Educational Resources Information Center

O'Connell, Robert M.

2015-01-01

Team-based learning (TBL) is a form of student-centered active learning in which students independently study new conceptual material before it is treated in the classroom, and then subsequently spend considerable classroom time working in groups on increasingly challenging problems and applications based on that new material. TBL provides…

Homeland Security: Compendium of Recommendations Relevant to House Committee Organization and Analysis of Considerations for the House, and 109th and 110th Congresses: Epilogue

DTIC Science & Technology

2007-03-02

strong indication that existing committees are capable of action. A third consideration in creating a homeland security committee is whether such a...current House committee system. Ranking Member Dingell of the Energy and Commerce Committee indicated that his experience with committees sharing oversight...Schlesinger reported spending half of his time as secretary of energy on Capitol Hill, “dealing with one problem or another.” He indicated the number of

Bioethics and "Rightness".

PubMed

Frank, Arthur W

2017-03-01

If bioethics seeks to affect what people do and don't do as they respond to the practical issues that confront them, then it is useful to take seriously people's sense of rightness. Rightness emerges from the fabric of a life-including the economy of its geography, the events of its times, its popular culture-to be what the sociologist Pierre Bourdieu calls a predisposition. It is the product of a way of life and presupposes continuing to live that way. Rightness is local and communal, holding in relationship those who share the same predisposing sense of how to experience. Rightness is an embodied way of evaluating what is known to matter and choosing among possible responses. Bioethics spends considerable time on what people should do and on the arguments that support recommended actions. It might spend more time on what shapes people's sense of the rightness of what they feel called to do. © 2017 The Hastings Center.

Examination of Work Environment Factors Relating to Burnout Syndrome of Early Childhood Educators in Greece

ERIC Educational Resources Information Center

Rentzou, Konstantina

2012-01-01

Early childhood education is a profession which requires the professional staff to spend considerable time in intense involvement with other people. The pressure from the demands this profession has can create a sense of physical and emotional exhaustion that often leads to burnout. Thus, previous research has linked perceptions of the work…

Conceptual and Methodological Considerations for Assessment and Prevention of Adolescent Dating Violence and Stalking at School

ERIC Educational Resources Information Center

Theriot, Matthew T.

2008-01-01

Although research has highlighted that dating violence is a serious and pervasive problem in many adolescent relationships, the prevalence and characteristics of such violence at schools is not fully understood. Yet, adolescents spend a great deal of time at school, and schools facilitate their relationships by providing numerous opportunities for…

Barriers to Care of Inner-City Children with Asthma: School Nurse Perspective

ERIC Educational Resources Information Center

Forbis, Shalini; Rammel, Jennifer; Huffman, Belinda; Taylor, Roberta

2006-01-01

School nurses spend considerable time caring for the needs of children with asthma and thus can offer valuable insights into barriers to asthma care within the school setting. Investigators conducted focus groups with school nurses in Dayton Public Schools to evaluate barriers to asthma care for children in an urban school system. The school…

Parental Mediation of Television Viewing and Videogaming of Adolescents with Autism Spectrum Disorder and Their Siblings

ERIC Educational Resources Information Center

Kuo, Melissa H.; Magill-Evans, Joyce; Zwaigenbaum, Lonnie

2015-01-01

Adolescents with autism spectrum disorder spend considerable time in media activities. Parents play an important role in shaping adolescents' responses to media. This study explored the mediation strategies that parents of adolescents with autism spectrum disorder used to manage television and video game use, factors associated with their use of…

Elaboration and Organization Strategies Used by Prospective Class Teachers While Studying Social Studies Education Textbooks

ERIC Educational Resources Information Center

Tay, Bayram

2013-01-01

Problem Statement: Students spend a considerable amount of their time studying from textbooks, which play an important role in their learning activities. The strategies students use to learn work as guides, requiring them to mentally process, make sense of and internalize information offered to them during the instructional process. Of these,…

Reducing Infant Mortality. KIDS COUNT Indicator Brief

ERIC Educational Resources Information Center

Shore, Rima; Shore, Barbara

2009-01-01

Despite the wide range of expertise that has been brought to bear on reducing infant mortality across the nation, the first year of life remains a time of considerable risk for many babies. Although the U.S. spends more on health care than any other country, its infant mortality rate remains higher than that of most other industrialized nations.…

In the Beginning of the Middle: Curriculum Considerations for Middle School General Music

ERIC Educational Resources Information Center

Giebelhausen, Robin

2015-01-01

Middle school general music is an experience that numerous music educators feel underprepared to teach. Because many undergraduate programs spend little time on this teaching scenario and because the challenges of middle school general music are different from those of elementary general music or middle school ensembles, teachers often lack the…

The Child and Adult Care Food Program and the Nutrition of Preschoolers

ERIC Educational Resources Information Center

Korenman, Sanders; Abner, Kristin S.; Kaestner, Robert; Gordon, Rachel A.

2013-01-01

Children spend a considerable amount of time in preschools and child care centers. As a result, these settings may have an influence on their diet, weight, and food security, and are potentially important contexts for interventions to address nutritional health. The Child and Adult Care Food Program (CACFP) is one such intervention. No national…

Cyber Bullying Victimization of Elementary School Students and Their Reflections on the Victimization

ERIC Educational Resources Information Center

Sezer, Merve; Sahin, Ismail; Akturk, Ahmet Oguz

2013-01-01

With the use of developing technology, mostly in communication and entertainment, students spend considerable time on the Internet. In addition to the advantages provided by the Internet, social isolation brings problems such as addiction. This is one of the problems of the virtual violence. Cyber bullying is the common name of the intensities…

Behaviour of Turkish Elementary School Principals in the Change Process: An Analysis of the Perceptions of Both Teachers and School Principals

ERIC Educational Resources Information Center

Gokce, Feyyat

2009-01-01

Technological and economic changes affect societies, and consequently bring about change in education. Elementary school principals in Turkey spend considerable time and effort managing change in their schools. This study contributes to the better management of Turkish elementary schools by determining the behavior of elementary school principals…

Online Advertising: Examining the Content and Messages within Websites Targeted at Children

ERIC Educational Resources Information Center

Kervin, Lisa; Jones, Sandra C.; Mantei, Jessica

2012-01-01

It is recognised that from a young age children spend considerable portions of their leisure time on the Internet. In Australia a number of child-targeted magazines have associated websites, which have high and ever-increasing readership. We do not yet know the impact of this medium upon children. Overt advertising is evident on webpages, but so…

45 CFR 1201.9 - Considerations in determining whether the Corporation will comply with a demand or request.

Code of Federal Regulations, 2010 CFR

2010-10-01

... determining whether the Corporation will comply with a demand or request. (a) In deciding whether to comply... discovery or the rules of procedure governing the case or matter in which the demand arose; (2) Whether... conduct of official business; (5) The need to avoid spending the time and money of the United States for...

22 CFR 172.8 - Considerations in determining whether the Department will comply with a demand or request.

Code of Federal Regulations, 2010 CFR

2010-04-01

... in determining whether the Department will comply with a demand or request. (a) In deciding whether... applicable rules of discovery or the rules of procedure governing the case or matter in which the demand... for the conduct of official business; (5) The need to avoid spending the time and money of the United...

The Role of Mental Health Professionals Contributes to Mental Health Promotion and Prevention: Innovative Programmes in Serbia

ERIC Educational Resources Information Center

Milovancevic, Milica Pejovic; Jovicic, Milica

2013-01-01

It has been estimated that 9 to 13% of children and adolescents have a mental disorder that causes significant functioning impairment and that only one fifth of those who need mental health services actually receive them. The majority of children and adolescents are enrolled in schools, where they spend a considerable amount of time, and this is…

Social-Emotional Needs: A School-Based Approach to Preventing Suicide among Students with Gifts and Talents

ERIC Educational Resources Information Center

Cross, Tracy L.

2012-01-01

This article provides a succinct primer on some of the basic constructs that adults need to know to help keep students with gifts and talents from completing suicide. It focuses on the school as the primary context to look out for potentially suicidal gifted students. This makes sense, as students spend a considerable amount of time in school,…

Effects of radiotransmitter necklaces on behaviors of adult male western burrowing owls

USGS Publications Warehouse

Chipman, E.D.; McIntyre, N.E.; Ray, J.D.; Wallace, M.C.; Boal, C.W.

2007-01-01

We studied the behavioral effects of necklace-style radiotransmitters on breeding male western burrowing owls (Athene cunicularia hypugaea) in 2 areas of northwestern Texas, USA, in 2004 and 2005. We tested the hypothesis that transmittered owls would spend time interacting with their necklaces and as a result spend less time in vigilance and resting activities than would nontransmittered owls. Nontransmittered owls (n = 6) spent significantly more time being vigilant (P = 0.007) than did transmittered owls (n = 3) in 2004, who spent significant amounts of time interacting with their necklaces. In 2005, behaviors of transmittered owls (n = 8) were significantly different (P < 0.001) from control individuals (n = 4), but behaviors did not vary consistently by treatment period (prenecklace vs. necklace vs. postnecklace periods). Behavioral activity budgets varied considerably among individuals. Although the owls spent a significant amount of time interacting with their necklaces, they appeared to habituate to the presence of the transmitters within a relatively short period (<1 week), and necklaces did not affect survivorship or fitness in the short-term.

US Spending on Personal Health Care and Public Health, 1996-2013.

PubMed

Dieleman, Joseph L; Baral, Ranju; Birger, Maxwell; Bui, Anthony L; Bulchis, Anne; Chapin, Abigail; Hamavid, Hannah; Horst, Cody; Johnson, Elizabeth K; Joseph, Jonathan; Lavado, Rouselle; Lomsadze, Liya; Reynolds, Alex; Squires, Ellen; Campbell, Madeline; DeCenso, Brendan; Dicker, Daniel; Flaxman, Abraham D; Gabert, Rose; Highfill, Tina; Naghavi, Mohsen; Nightingale, Noelle; Templin, Tara; Tobias, Martin I; Vos, Theo; Murray, Christopher J L

2016-12-27

US health care spending has continued to increase, and now accounts for more than 17% of the US economy. Despite the size and growth of this spending, little is known about how spending on each condition varies by age and across time. To systematically and comprehensively estimate US spending on personal health care and public health, according to condition, age and sex group, and type of care. Government budgets, insurance claims, facility surveys, household surveys, and official US records from 1996 through 2013 were collected and combined. In total, 183 sources of data were used to estimate spending for 155 conditions (including cancer, which was disaggregated into 29 conditions). For each record, spending was extracted, along with the age and sex of the patient, and the type of care. Spending was adjusted to reflect the health condition treated, rather than the primary diagnosis. Encounter with US health care system. National spending estimates stratified by condition, age and sex group, and type of care. From 1996 through 2013, $30.1 trillion of personal health care spending was disaggregated by 155 conditions, age and sex group, and type of care. Among these 155 conditions, diabetes had the highest health care spending in 2013, with an estimated $101.4 billion (uncertainty interval [UI], $96.7 billion-$106.5 billion) in spending, including 57.6% (UI, 53.8%-62.1%) spent on pharmaceuticals and 23.5% (UI, 21.7%-25.7%) spent on ambulatory care. Ischemic heart disease accounted for the second-highest amount of health care spending in 2013, with estimated spending of $88.1 billion (UI, $82.7 billion-$92.9 billion), and low back and neck pain accounted for the third-highest amount, with estimated health care spending of $87.6 billion (UI, $67.5 billion-$94.1 billion). The conditions with the highest spending levels varied by age, sex, type of care, and year. Personal health care spending increased for 143 of the 155 conditions from 1996 through 2013. Spending on low back and neck pain and on diabetes increased the most over the 18 years, by an estimated $57.2 billion (UI, $47.4 billion-$64.4 billion) and $64.4 billion (UI, $57.8 billion-$70.7 billion), respectively. From 1996 through 2013, spending on emergency care and retail pharmaceuticals increased at the fastest rates (6.4% [UI, 6.4%-6.4%] and 5.6% [UI, 5.6%-5.6%] annual growth rate, respectively), which were higher than annual rates for spending on inpatient care (2.8% [UI, 2.8%-2.8%] and nursing facility care (2.5% [UI, 2.5%-2.5%]). Modeled estimates of US spending on personal health care and public health showed substantial increases from 1996 through 2013; with spending on diabetes, ischemic heart disease, and low back and neck pain accounting for the highest amounts of spending by disease category. The rate of change in annual spending varied considerably among different conditions and types of care. This information may have implications for efforts to control US health care spending.

US Spending on Personal Health Care and Public Health, 1996–2013

PubMed Central

Dieleman, Joseph L.; Baral, Ranju; Birger, Maxwell; Bui, Anthony L.; Bulchis, Anne; Chapin, Abigail; Hamavid, Hannah; Horst, Cody; Johnson, Elizabeth K.; Joseph, Jonathan; Lavado, Rouselle; Lomsadze, Liya; Reynolds, Alex; Squires, Ellen; Campbell, Madeline; DeCenso, Brendan; Dicker, Daniel; Flaxman, Abraham D.; Gabert, Rose; Highfill, Tina; Naghavi, Mohsen; Nightingale, Noelle; Templin, Tara; Tobias, Martin I.; Vos, Theo; Murray, Christopher J. L.

2017-01-01

IMPORTANCE US health care spending has continued to increase, and now accounts for more than 17% of the US economy. Despite the size and growth of this spending, little is known about how spending on each condition varies by age and across time. OBJECTIVE To systematically and comprehensively estimate US spending on personal health care and public health, according to condition, age and sex group, and type of care. DESIGN AND SETTING Government budgets, insurance claims, facility surveys, household surveys, and official US records from 1996 through 2013 were collected and combined. In total, 183 sources of data were used to estimate spending for 155 conditions (including cancer, which was disaggregated into 29 conditions). For each record, spending was extracted, along with the age and sex of the patient, and the type of care. Spending was adjusted to reflect the health condition treated, rather than the primary diagnosis. EXPOSURES Encounter with US health care system. MAIN OUTCOMES AND MEASURES National spending estimates stratified by condition, age and sex group, and type of care. RESULTS From 1996 through 2013, $30.1 trillion of personal health care spending was disaggregated by 155 conditions, age and sex group, and type of care. Among these 155 conditions, diabetes had the highest health care spending in 2013, with an estimated $101.4 billion (uncertainty interval [UI], $96.7 billion–$106.5 billion) in spending, including 57.6% (UI, 53.8%–62.1%) spent on pharmaceuticals and 23.5% (UI, 21.7%–25.7%) spent on ambulatory care. Ischemic heart disease accounted for the second-highest amount of health care spending in 2013, with estimated spending of $88.1 billion (UI, $82.7 billion–$92.9 billion), and low back and neck pain accounted for the third-highest amount, with estimated health care spending of $87.6 billion (UI, $67.5 billion–$94.1 billion). The conditions with the highest spending levels varied by age, sex, type of care, and year. Personal health care spending increased for 143 of the 155 conditions from 1996 through 2013. Spending on low back and neck pain and on diabetes increased the most over the 18 years, by an estimated $57.2 billion (UI, $47.4 billion–$64.4 billion) and $64.4 billion (UI, $57.8 billion–$70.7 billion), respectively. From 1996 through 2013, spending on emergency care and retail pharmaceuticals increased at the fastest rates (6.4% [UI, 6.4%–6.4%] and 5.6% [UI, 5.6%–5.6%] annual growth rate, respectively), which were higher than annual rates for spending on inpatient care (2.8% [UI, 2.8%–2.8%] and nursing facility care (2.5% [UI, 2.5%–2.5%]). CONCLUSIONS AND RELEVANCE Modeled estimates of US spending on personal health care and public health showed substantial increases from 1996 through 2013; with spending on diabetes, ischemic heart disease, and low back and neck pain accounting for the highest amounts of spending by disease category. The rate of change in annual spending varied considerably among different conditions and types of care. This information may have implications for efforts to control US health care spending. PMID:28027366

Does tax-based health financing offer protection from financial catastrophe? Findings from a household economic impact survey of ischaemic heart disease in Malaysia.

PubMed

Sukeri, Surianti; Mirzaei, Masoud; Jan, Stephen

2017-01-01

Malaysia is an upper-middle income country with a tax-based health financing system. Health care is relatively affordable, and safety nets are provided for the needy. The objectives of this study were to determine the out-of-pocket health spending, proportion of catastrophic health spending (out-of-pocket spending >40% of non-food expenditure), economic hardship and financial coping strategies among patients with ischaemic heart disease (IHD) in Malaysia under the present health financing system. A cross-sectional study was conducted at the National Heart Institute of Malaysia involving 503 patients who were hospitalized during the year prior to the survey. The mean annual out-of-pocket health spending for IHD was MYR3045 (at the time US$761). Almost 16% (79/503) suffered from catastrophic health spending (out-of-pocket health spending ≥40% of household non-food expenditures), 29.2% (147/503) were unable to pay for medical bills, 25.0% (126/503) withdrew savings to help meet living expenses, 16.5% (83/503) reduced their monthly food consumption, 12.5% (63/503) were unable to pay utility bills and 9.0% (45/503) borrowed money to help meet living expenses. Overall, the economic impact of IHD on patients in Malaysia was considerable and the prospect of economic hardship likely to persist over the years due to the long-standing nature of IHD. The findings highlight the need to evaluate the present health financing system in Malaysia and to expand its safety net coverage for vulnerable patients. © The Author 2016. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Ethical considerations in the orthopaedic relationship with industry.

PubMed

Sarmiento, A

2007-06-01

Members of the medical profession spend a long time and financial resources acquiring the knowledge necessary for the discharge of their responsibilities; therefore, they should be appropriately compensated for the services they provide. However, it has become obvious, at least in the United States, that excessive emphasis on profit making is fostering the transformation of the medical profession into strictly a business. This transformation is spawning ethical infractions, which are becoming increasingly apparent.

Species Profiles: Life Histories and Environmental Requirements of Coastal Fishes and Invertebrates (Pacific Northwest), Chum Salmon

DTIC Science & Technology

1988-03-01

respect, they are considerably unlike (J. Ames, 1984, WDF; pers. comm.). In sockeye, Oncorhynchus nerka , coho, Southern British Columbia, the average...NOMENCLATURE/TAXONOMY/RANGE MORPHOLOGY/IDENTIFICATION AIDS Scientific name.. Oncorhynchus keta Dorsal fin 10-13 rays; adipose . (Walbaum 1792) (Figure 1) fin... Oncorhynchus gorbuscha, spend minimal salmon that spawn in large river 1, time rearing in freshwater. In this systems is sometimes twice that long f

Public health spending in 2008: on the challenge of integrating PHSSR data sets and the need for harmonization.

PubMed

Leider, Jonathon P; Sellers, Katie; Shah, Gulzar; Pearsol, Jim; Jarris, Paul E

2012-01-01

In recent years, state and local public health department budgets have been cut, sometimes drastically. However, there is no systematic tracking of governmental public health spending that would allow researchers to assess these cuts in comparison with governmental public health spending as a whole. Furthermore, attempts to quantify the impact of public health spending are limited by the lack of good data on public health spending on state and local public health services combined. The objective of this article is to integrate self-reported state and local health department (LHD) survey data from 2 major national organizations to create state-level estimates of governmental public health spending. To create integrated estimates, we selected 1388 LHDs and 46 states that had reported requisite financial information. To account for the nonrespondent LHDs, estimates of the spending were developed by using appropriate statistical weights. Finally, funds from federal pass-through and state sources were estimated for LHDs and subtracted from the total spending by the state health agency to avoid counting these dollars in both state and local figures. On average, states spend $106 per capita on traditional public health at the state and local level, with an average of 42% of spending occurring at the local level. Considerable variation exists in state and local public health funding. The results of this analysis show a relatively low level of public health funding compared with state Medicaid spending and health care more broadly.

News Media and Strategic Communications Industry, Industry Study, Spring 2008

DTIC Science & Technology

2008-01-01

through iTunes , CBS is extending the reach of broadcast news to a wider, younger audience.29 Cable Television Current Conditions Cable... sales channel.”50 In the three largest advertising markets – U.S., Japan and the U.K. – consumers now spend 21.9% of their media time online.51...the areas of auto sales and employment, is putting particular pressure on the newspaper industry’s classified revenues. However, as a considerable

Urinary tract infections cranberry juice, underwear, and probiotics in the 21st century.

PubMed

Miller, Jane L; Krieger, John N

2002-08-01

There is a substantial gap between the viewpoint of urologists and the rest of society regarding UTIs. Urologists spend little time and effort thinking about UTIs. In contrast, UTIs are a major issue for many women. There is substantial concern about "natural compounds" and probiotics that allow women to take charge of their health care. It is easy to understand this concern because UTIs are common, costly, and cause considerable morbidity.

Place of death among older Americans: does state spending on home- and community-based services promote home death?

PubMed

Muramatsu, Naoko; Hoyem, Ruby L; Yin, Hongjun; Campbell, Richard T

2008-08-01

The majority of Americans die in institutions although most prefer to die at home. States vary greatly in their proportion of home deaths. Although individuals' circumstances largely determine where they die, health policies may affect the range of options available to them. To examine whether states' spending on home- and community-based services (HCBS) affects place of death, taking into consideration county health care resources and individuals' family, sociodemographic, and health factors. Using exit interview data from respondents in the Health and Retirement Study born in 1923 or earlier who died between 1993 and 2002 (N = 3362), we conducted discrete-time survival analysis of the risk of end-of-life nursing home relocation to examine whether states' HCBS spending would delay or prevent end-of-life nursing home admission. Then we ran logistic regression analysis to investigate the HCBS effects on place of death separately for those who relocated to a nursing home and those who remained in the community. Living in a state with higher HCBS spending was associated with lower risk of end-of-life nursing home relocation, especially among people who had Medicaid. However, state HCBS support was not directly associated with place of death. States' generosity for HCBS increases the chance of dying at home via lowering the risk of end-of-life nursing home relocation. State-to-state variation in HCBS spending may partly explain variation in home deaths. Our findings add to the emerging encouraging evidence for continued efforts to enhance support for HCBS.

Rising Use Of Observation Care Among The Commercially Insured May Lead to Total And Out-Of-Pocket Cost Savings.

PubMed

Adrion, Emily R; Kocher, Keith E; Nallamothu, Brahmajee K; Ryan, Andrew M

2017-12-01

Proponents of hospital-based observation care argue that it has the potential to reduce health care spending and lengths-of-stay, compared to short-stay inpatient hospitalizations. However, critics have raised concerns about the out-of-pocket spending associated with observation care. Recent reports of high out-of-pocket spending among Medicare beneficiaries have received considerable media attention and have prompted direct policy changes. Despite the potential for changed policies to indirectly affect non-Medicare patients, little is known about the use of, and spending associated with, observation care among commercially insured populations. Using multipayer commercial claims for the period 2009-13, we evaluated utilization and spending among patients admitted for six conditions that are commonly managed with either observation care or short-stay hospitalizations. In our study period, the use of observation care increased relative to that of short-stay hospitalizations. Total and out-of-pocket spending were substantially lower for observation care, though both grew rapidly-and at rates much higher than spending in the inpatient setting-over the study period. Despite this growth, spending on observation care is unlikely to exceed spending for short-stay hospitalizations. As observation care attracts greater attention, policy makers should be aware that Medicare policies that disincentivize observation may have unintended financial impacts on non-Medicare populations, where observation care may be cost saving.

Health spending trends in the 1980's: Adjusting to financial incentives

PubMed Central

Arnett, Ross H.; Cowell, Carol S.; Davidoff, Lawrence M.; Freeland, Mark S.

1985-01-01

Health expenditure growth is projected to moderate considerably during 1983-90, reaching $660 billion in 1990 and consuming over 11 percent of the gross national product. During 1973-83, spending for health care more than tripled, increasing from $103 billion to $355 billion and moving from 7.8 percent to 10.8 percent of the gross national product. Government spending for health care is projected to reach $284 billion by 1990, with the Federal Government paying 73 percent. The Medicare Prospective Payment System, private sector initiatives, and State and local government actions are providing incentives to substantially increase competition and cost effectiveness in health care provision. PMID:10311158

11 critical questions to ask when buying a physician practice.

PubMed

Jessee, William F

2012-07-01

Answering probing questions in advance of a practice purchase can help hospital and health system leaders make informed decisions. The questions are intended to stimulate careful consideration before entering into a practice acquisition; no single piece of information or answer should be considered definitive in the final decision-making process. Success depends on having a clear game plan and spending time ensuring that all players-board, management, physician leaders, and the physicians who will be employees--understand and support the plan.

A Qualitative Study of Georgian Youth Who Are on the Street or Institutionalized

PubMed Central

Murray, Laura K.; Singh, Namrita S.; Surkan, Pamela J.; Semrau, Katherine; Bass, Judy; Bolton, Paul

2012-01-01

Street children, or children who live and/or spend time on the streets, are a vulnerable group of considerable concern to the global public health community. This paper describes the results of two linked qualitative studies conducted with children living or spending time on the street and in orphanages in and around urban areas in the Republic of Georgia between 2005 and 2006. The studies examined perceived causes of children going to the street, as well as indicators of healthy functioning and psychosocial problems among these children. Results on causes indicated a range of “push” factors leading children to the street and “pull” factors that keep children living on the street. Findings also showed a range of internalizing and externalizing mental health symptoms among children on the street and within orphanages. Some differences in responses were found between children living on the street and in institutions. It is important to understand the perspectives of these vulnerable populations to guide decisions on appropriate interventions that address their primary problems. PMID:23227056

Spending more money, saving more lives? The relationship between avoidable mortality and healthcare spending in 14 countries.

PubMed

Heijink, Richard; Koolman, Xander; Westert, Gert P

2013-06-01

Healthcare expenditures rise as a share of GDP in most countries, raising questions regarding the value of further spending increases. Against this backdrop, we assessed the value of healthcare spending growth in 14 western countries between 1996 and 2006. We estimated macro-level health production functions using avoidable mortality as outcome measure. Avoidable mortality comprises deaths from certain conditions "that should not occur in the presence of timely and effective healthcare". We investigated the relationship between total avoidable mortality and healthcare spending using descriptive analyses and multiple regression models, focussing on within-country variation and growth rates. We aimed to take into account the role of potential confounders and dynamic effects such as time lags. Additionally, we explored a method to estimate macro-level cost-effectiveness. We found an average yearly avoidable mortality decline of 2.6-5.3% across countries. Simultaneously, healthcare spending rose between 1.9 and 5.9% per year. Most countries with above-average spending growth demonstrated above-average reductions in avoidable mortality. The regression models showed a significant association between contemporaneous and lagged healthcare spending and avoidable mortality. The time-trend, representing an exogenous shift of the health production function, reduced the impact of healthcare spending. After controlling for this time-trend and other confounders, i.e. demographic and socioeconomic variables, a statistically significant relationship between healthcare spending and avoidable mortality remained. We tentatively conclude that macro-level healthcare spending increases provided value for money, at least for the disease groups, countries and years included in this study.

The Great Recession and Health Spending among Uninsured U.S. Immigrants: Implications for the Affordable Care Act Implementation

PubMed Central

Bustamante, Arturo Vargas; Chen, Jie

2014-01-01

Objective We study the association between the timing of the Great Recession (GR) and health spending among uninsured adults distinguishing by citizenship/nativity status and time of U.S. residence. Data Source Uninsured U.S. citizens and noncitizens from the 2005–2006 and 2008–2009 Medical Expenditure Panel Survey. Study Design The probability of reporting any health spending and the natural logarithm of health spending are our main dependent variables. We compare health spending across population categories before/during the GR. Subsequently, we implement two-part regression analyses of total and specific health-spending measures. We predict average health spending before/during the GR with a smearing estimation. Principal Findings The probability of reporting any spending diminished for recent immigrants compared to citizens during the GR. For those with any spending, recent immigrants reported higher spending during the GR (27 percent). Average reductions in total spending were driven by the decline in the share of the population reporting any spending among citizens and noncitizens. Conclusions Our study findings suggest that recent immigrants could be forgoing essential care, which later translates into higher spending. It portrays the vulnerability of a population that would remain exposed to income shocks, even after the Affordable Care Act (ACA) implementation. PMID:24962550

[Comparison of physical activity and favourite ways of spending free time in preschool girls and boys from the Mazowsze region].

PubMed

Merkiel, Sylwia; Chalcarz, Wojciech; Deptuła, Monika

2011-01-01

The aim of this study was to compare physical activity of preschool girls and boys from the Mazowsze region and their favourite ways of spending free time. The studied population included 131 children aged 3 to 7 years. Parents filled in questionnaires about their children's physical activity and favourite ways of spending free time, as well as about general information on the children and their families. Gender had statistically significant influence on the children's birth weight, attending karate outside the preschool and on riding a bicycle, playing with a ball and playing with a dog as favourite ways of spending free time during sunny weather as well as playing on a computer and playing with dolls as favourite ways of spending free time during rainy weather. Gender had little influence on the studied preschoolers' physical activity. However favourite ways of spending free time turned out to be significantly different according to gender. Physical activity level in both girls and boys was low, similarly to their peers from the previous studies.

Perceived Impact on Student Engagement When Learning Middle School Science in an Outdoor Setting

ERIC Educational Resources Information Center

Abbatiello, James

2014-01-01

Human beings have an innate need to spend time outside, but in recent years children are spending less time outdoors. It is possible that this decline in time spent outdoors could have a negative impact on child development. Science teachers can combat the decline in the amount of time children spend outside by taking their science classes…

[The mean timing of periodontic care rendering].

PubMed

Zorina, O A; Abaev, Z M; Domashev, D I; Boriskina, O A

2012-01-01

The time-studies demonstrated that the periodontologist spend 30.3 +/- 2.6 minutes on the primary ambulatory visit of patient and 16.4 +/- 0.9 minutes on the revisit of patient (non-registering time spending on preventive and curative activities). Time spending on curative preventive activities in each group of patients with periodontal diseases depended on both the severity of inflammatory destructive processes in periodontium and therapy stage.

Seeking beauty: understanding the psychology behind orthognathic surgery.

PubMed

Oluwajana, F

2015-12-01

Orthognathic surgery to correct serious skeletal discrepancies of the jaw improves both function and appearance, but patients should spend a lot of time thinking about, discussing, and planning operations that have such a considerable impact. The drive to improve appearance by such radical means is based on social and personal reasons, and this must be understood before treatment is considered. In this paper, we will review studies on the psychology of orthognathic surgery. Copyright © 2015 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

The workplace and alcohol problem prevention.

PubMed

Roman, Paul M; Blum, Terry C

2002-01-01

Workplace programs to prevent and reduce alcohol-related problems among employees have considerable potential. For example, because employees spend a lot of time at work, coworkers and supervisors may have the opportunity to notice a developing alcohol problem. In addition, employers can use their influence to motivate employees to get help for an alcohol problem. Many employers offer employee assistance programs (EAPs) as well as educational programs to reduce employees' alcohol problems. However, several risk factors for alcohol problems exist in the workplace domain. Further research is needed to develop strategies to reduce these risk factors.

Remote sensing of reconnection via ARTEMIS dual-spacecraft observations

NASA Astrophysics Data System (ADS)

Kiehas, Stefan; Angelopoulos, Vassilis; Runov, Andrei; Li, Shan-Shan

2013-04-01

Each month the two ARTEMIS probes spend about four days in the Earth's magnetotail near lunar orbit. Due to the near-equatorial orbit, the probes spend a considerable time near and inside the plasma sheet. This allows us to investigate large-scale effects of reconnection, such as flux ropes and high-speed flows, utilizing dual-probe observations on a regular basis. On August 31, 2012 around 03:00 UT, the ARTEMIS probes were separated by only 350 km in X_GSW and 0.6 (1) RE in Y_GSW (Z_GSW), where GSW denotes the Geocentric Solar Wind coordinate system, which x-axis is antiparallel to the solar wind flow direction. The two probes observe several TCRs and flux ropes. The inter-spacecraft separation allows us to determine the size of these structures to be not more than 6 RE in z. Counterstreaming beams observed by both probes indicate the simultaneous activity of two X-lines, earthward and tailward of the probes, respectively.

Variation in Physician Practice Styles within and across Emergency Departments

PubMed Central

Van Parys, Jessica

2016-01-01

Despite the significant responsibility that physicians have in healthcare delivery, we know surprisingly little about why physician practice styles vary within or across institutions. Estimating variation in physician practice styles is complicated by the fact that patients are rarely randomly assigned to physicians. This paper uses the quasi-random assignment of patients to physicians in emergency departments (EDs) to show how physicians vary in their treatment of patients with minor injuries. The results reveal a considerable degree of variation in practice styles within EDs; physicians at the 75th percentile of the spending distribution spend 20% more than physicians at the 25th percentile. Observable physician characteristics do not explain much of the variation across physicians, but there is a significant degree of sorting between physicians and EDs over time, with high-cost physicians sorting into high-cost EDs as they gain experience. The results may shed light on why some EDs remain persistently higher-cost than others. PMID:27517464

Time spent by people managing chronic obstructive pulmonary disease indicates biographical disruption

PubMed Central

Jowsey, Tanisha; Yen, Laurann E; Bagheri, Nasser; McRae, Ian S

2014-01-01

Since Bury’s 1982 proposal that chronic illness creates biographical disruption for those who are living with it, there has been no effort to quantitatively measure such disruption. “Biographical disruption” refers to the substantial and directive influence that chronic illness can have over the course of a person’s life. Qualitative research and time use studies have demonstrated that people with chronic illnesses spend considerable amounts of time managing their health, and that these demands may change over time. This study was designed to measure the time that older people with chronic illnesses spend on selected health practices as one indicator of biographical disruption. We look specifically at the time use of people with chronic obstructive pulmonary disease (COPD). As part of a larger time use survey, a recall questionnaire was mailed to 3,100 members of Lung Foundation Australia in 2011. A total of 681 responses were received (22.0% response rate), 611 of which were from people with COPD. Descriptive analyses were undertaken on the amount of time spent on selected health-related activities including personal care, nonclinical health-related care, and activity relating to health services. Almost all people with COPD report spending some time each day on personal or home-based health-related tasks, with a median time of 15 minutes per day spent on these activities. At the median, people also report spending about 30 minutes per day exercising, 2.2 hours per month (the equivalent of 4.4 minutes per day) on nonclinical health-related activities, and 4.1 hours per month (equivalent to 8.2 minutes per day) on clinical activities. Excluding exercise, the median total time spent on health-related activities was 17.8 hours per month (or 35.6 minutes per day). For people in the top 10% of time use, the total amount of time was more than 64.6 hours per month (or 2.2 hours per day) excluding exercise, and 104 hours per month (or 3.5 hours per day) including exercise. The amount of time spent on health-related activity, such as engaging in personal care tasks, may be regular and predictable. The execution of these tasks generally takes relatively small amounts of time, and might be incorporated into daily life (biography) without causing significant disruption. Other activities may require large blocks of time, and they may be disruptive in a practical way that almost inevitably disrupts biography. The amount of time required does not appear to alter in relation to the time since diagnosis. The scale of time needed to manage one’s health could easily be interpreted as disruptive, and for some people, even overwhelming. PMID:24477271

Single European currency and Monetary Union. Macroeconomic implications for pharmaceutical spending.

PubMed

Kanavos, P

1998-01-01

This article examines the potential implications of introducing a single currency among the Member States of the European Union for national pharmaceutical prices and spending. In doing so, it provides a brief account of the direct effects of introducing a single currency on pharmaceutical business. These are static in nature and include the elimination of exchange rate volatility and transaction costs, increased price transparency and limited potential for parallel trade. It subsequently analyses the potential medium and long term macroeconomic policy choices facing the Member States and their impact on pharmaceutical spending following the introduction of a single currency. These include policy directions in order to meet the Maastricht convergence criteria in the run-up to forming an Economic and Monetary Union (EMU) and the implications of EMU on national macroeconomic policy thereafter. This article argues that the necessity for tight fiscal policies across the EU and, in particular, in those Member States facing high budget deficits and overall debt levels, will continue to exert considerable downward pressure on pharmaceutical spending.

Health care spending accounts: a flexible solution for Canadian employers.

PubMed

Smithies, R; Steeves, L

1996-01-01

Flexible benefits plans have grown more slowly in Canada than in the United States, largely because of certain legal and regulatory considerations. Health care spending accounts (HCSAs) provide a cost-effective way for Canadian employers to address the health care benefit needs of a diverse workforce. A flexible health care spending account is a versatile and cost-effective instrument that can be used by Canadian employers that wish to provide a full range of health care benefits to employees. The health care alternatives available through an HCSA can provide employees with an opportunity to customize and optimize their benefits program. Regulatory requirements that an HCSA must meet in order to qualify for available tax advantages are discussed, as are the range of health care services that may be covered.

Geographic variation in public health spending: correlates and consequences.

PubMed

Mays, Glen P; Smith, Sharla A

2009-10-01

To examine the extent of variation in public health agency spending levels across communities and over time, and to identify institutional and community correlates of this variation. Three cross-sectional surveys of the nation's 2,900 local public health agencies conducted by the National Association of County and City Health Officials in 1993, 1997, and 2005, linked with contemporaneous information on population demographics, socioeconomic characteristics, and health resources. A longitudinal cohort design was used to analyze community-level variation and change in per-capita public health agency spending between 1993 and 2005. Multivariate regression models for panel data were used to estimate associations between spending, institutional characteristics, health resources, and population characteristics. The top 20 percent of communities had public health agency spending levels >13 times higher than communities in the lowest quintile, and most of this variation persisted after adjusting for differences in demographics and service mix. Local boards of health and decentralized state-local administrative structures were associated with higher spending levels and lower risks of spending reductions. Local public health agency spending was inversely associated with local-area medical spending. The mechanisms that determine funding flows to local agencies may place some communities at a disadvantage in securing resources for public health activities.

When Kids Want Too Much: Curing a Case of the "Gimmies."

ERIC Educational Resources Information Center

Villaire, Ted

2001-01-01

Asserts that as parents spend less time with their children and try to assuage their guilt by buying children things, the many effects of materialism must be prevented. Children need help understanding that spending time with friends and family is more rewarding than spending money. They need to be taught the strategies of media literacy while…

Proceedings of the Annual DTIC (Defense Technical Information Center) Users Conference Held at Alexandria, Virginia on 24-26 October 1984

DTIC Science & Technology

1984-10-26

conference packet and I would urge all of you to take a hard look at it and give us your ideas about the future in which we will be working. One of...scientist or engineer goes to the fiche and or the hard copy, spends a considerable amount of time researching—up to 3 or U hours—those hard copy...34 telecommuting ," meaning people do not necessarily have to go from one place to another but all ■we need is for the information to flow from one

'The right direction'. Primary-care docs see promise in CMS' proposed pay for non face-to-face work.

PubMed

Robeznieks, Andis

2013-07-15

The CMS has proposed paying physicians for managing patients apart from face-to-face office visits. Among the details under consideration are requiring practices to use an electronic health-record system that supports access to care, care coordination, care management and communications. "It's a step in the right direction. The devil will be in the details and, if the burden of documentation is so high, people may choose not to spend their time doing it," says Dr. Matt Handley, physician and medical director for quality at the Group Health Cooperative.

Modifying Endowment Spending Rules: Is it the Cure for Overspending?

ERIC Educational Resources Information Center

Kaufman, Roger T.; Woglom, Geoffrey

2005-01-01

In this article we analyze the dynamics of endowment spending and real endowment values using rules that tie endowment spending to inflation. Numerical examples demonstrate that under a pure inflation rule, spending rates tend to drift away over time from the appropriate rate, leading to either rising or falling real endowment values. Under a…

Heterogeneity in spending change at retirement

PubMed Central

Hurd, Michael D.; Rohwedder, Susann

2014-01-01

The simple one-good model of life-cycle consumption requires that consumption be continuous over retirement; yet prior research based on partial measures of consumption or on synthetic panels indicates that spending drops at retirement, a result that has been called the retirement-consumption puzzle. Using panel data on total spending, nondurable spending and food spending, we find that spending declines at small rates at retirement, rates that could be explained by mechanisms such as the cessation of work-related expenses, unexpected retirement due to a health shock or by the substitution of time for spending. We find substantial heterogeneity in spending change at retirement: in the upper half of the wealth distribution spending increased. In the low-wealth population where spending did decline at higher rates, the main explanation for the decline appears to be early retirement due to poor health, possibly augmented by a short planning horizon by a minority of the population. PMID:24524026

Harnessing naturally occurring data to measure the response of spending to income

PubMed Central

Gelman, Michael; Kariv, Shachar; Shapiro, Matthew D.; Silverman, Dan; Tadelis, Steven

2016-01-01

This paper presents a new data infrastructure for measuring economic activity. The infrastructure records transactions and account balances, yielding measurements with scope and accuracy that have little precedent in economics. The data are drawn from a diverse population that overrepresents males and younger adults but contains large numbers of underrepresented groups. The data infrastructure permits evaluation of a benchmark theory in economics that predicts that individuals should use a combination of cash management, saving, and borrowing to make the timing of income irrelevant for the timing of spending. As in previous studies and in contrast to the predictions of the theory, there is a response of spending to the arrival of anticipated income. The data also show, however, that this apparent excess sensitivity of spending results largely from the coincident timing of regular income and regular spending. The remaining excess sensitivity is concentrated among individuals with less liquidity. PMID:25013075

Survey of core medical trainees in the United Kingdom 2013 - inconsistencies in training experience and competing with service demands.

PubMed

Tasker, Fiona; Newbery, Nina; Burr, Bill; Goddard, Andrew F

2014-04-01

There is currently considerable concern about the attractiveness of hospital medicine as a career and experiences in core medical training (CMT) are a key determinant of whether trainees continue in the medical specialties. Little is understood about the quality and impact of the current CMT programme and this survey was designed to assess this. Three key themes emerged. Firstly, the demands of providing service have led to considerable loss of training opportunities, particularly in outpatients and formal teaching sessions. Trainees spend a lot of this service time doing menial tasks and over 90% report that service takes up 80-100% of their time. Secondly, clinical and educational supervision is variable, with trainees sometimes getting little consultant feedback on their clinical performance. Finally, 44% of trainees report that CMT has not prepared them to be a medical registrar and many trainees are put off acute medical specialties by their experiences in CMT.

Impact of State Public Health Spending on Disease Incidence in the United States from 1980 to 2009.

PubMed

Verma, Reetu; Clark, Samantha; Leider, Jonathon; Bishai, David

2017-02-01

To understand the relationship between state-level spending by public health departments and the incidence of three vaccine preventable diseases (VPDs): mumps, pertussis, and rubella in the United States from 1980 to 2009. This study uses state-level public health spending data from The Census Bureau and annual mumps, pertussis, and rubella incidence counts from the University of Pittsburgh's project Tycho. Ordinary least squares (OLS), fixed effects, and random effects regression models were tested, with results indicating that a fixed effects model would be most appropriate model for this analysis. Model output suggests a statistically significant, negative relationship between public health spending and mumps and rubella incidence. Lagging outcome variables indicate that public health spending actually has the greatest impact on VPD incidence in subsequent years, rather than the year in which the spending occurred. Results were robust to models with lagged spending variables, national time trends, and state time trends, as well as models with and without Medicaid and hospital spending. Our analysis indicates that there is evidence of a significant, negative relationship between a state's public health spending and the incidence of two VPDs, mumps and rubella, in the United States. © Health Research and Educational Trust.

Parents’ time with a partner in a cross-national context: A comparison of the United States, Spain, and France

PubMed Central

Roman, Joan Garcia; Flood, Sarah M.; Genadek, Katie R.

2017-01-01

BACKGROUND Time shared with a partner is an indicator of marital well-being and couples want to spend time together. However, time with a partner depends on work and family arrangements as well as the policies, norms, and values that prevail in society. Contrary to time spent with children, couples’ shared time in cross-national context is relatively unstudied. Previous studies from specific countries show that dual-earner couples spend less time together and that parents spend less time alone together. OBJECTIVE The aim of our study is to investigate partnered parents’ shared time across countries to understand how social conditions, cultural norms, and policy contexts are related to the amount and nature of couples’ shared time. Specifically, we compare time with a partner in the US, France, and Spain. METHODS We use data from national time use surveys conducted in the US, France, and Spain. We leverage information about with whom activities are done to examine three types of time shared with a partner for parents with children under age 10: total time with a partner indicates the minutes per day spent in the presence of a partner; exclusive time corresponds to the minutes per day spent alone with a partner when no one else is present; and family time indicates the minutes per day spent with a partner and a child at the same time. RESULTS Our results show that American couples spend the least time together, and Spanish couples spend the most time together. Parents in France spend the most time alone together. The most striking difference across countries is in time with a partner and children, which is much higher among Spanish families. CONCLUSION Paid work constraints explain a small part of the differences in couples’ shared time that we observe between countries. Differences in couples’ shared time across countries seem to be related to social norms surrounding family and general time use. PMID:29416440

National health spending trends in 1996. National Health Accounts Team.

PubMed

Levit, K R; Lazenby, H C; Braden, B R

1998-01-01

The National Health Accounts, produced annually by the Health Care Financing Administration's Office of the Actuary, present estimates for 1960-1996 of nationwide spending for health care and the sources funding that care. This year's estimates set two records: Spending topped $1 trillion for the first time, and expenditure growth slowed to the lowest rate seen in thirty-seven years of measuring health care spending--4.4 percent. The combination of decelerating health spending and a growing economy has kept national health spending as a share of the nation's gross domestic product unchanged for the fourth consecutive year.

Social and Economic Characteristics of Street Youth by Gender and Level of Street Involvement in Eldoret, Kenya

PubMed Central

Sorber, Rebecca; Winston, Susanna; Koech, Julius; Ayuku, David; Hu, Liangyuan; Hogan, Joseph; Braitstein, Paula

2014-01-01

Background Street-connected youth are a neglected and vulnerable population, particularly in resource-constrained settings. The development of interventions and supports for this population requires insight into how they live. This study describes the social and economic characteristics of a convenience sample of street youth (SY) in Eldoret, Kenya. Methods Participants were eligible if they were aged 12–21, living in Eldoret, spending days only (part-time), or nights and days on the street (full-time) and able and willing to consent or assent. Data were collected using a standardized interview conducted in English or Kiswahili. Binary dependent variables were having been arrested and/or jailed, and first priority for spending money (food vs. other). Nominal categorical dependent variables included major source of support, and major reason for being street-involved. Multivariable analysis used logistic regression models to examine the association of gender and level of street-involvement with social and economic factors of interest adjusting for age and length of time on the street. Data were analyzed using SAS 9.3. Results Of the 200 SY enrolled, 41% were female, mean age of 16.3 years; 71% were on the street full-time, and 29% part-time. Compared with part-time SY, full-time SY were more likely to have been arrested (Adjusted Odds Ratio [AOR]: 2.33, 95% Confidence Interval [95%CI]:1.01–5.35), name food as their first spending priority (AOR: 2.57, 95%CI:1.03–6.45), have left home due to violence (AOR: 5.54, 95%CI: 1.67–18.34), and more likely to report friends on the street as a major source of support (AOR: 3.59, 95% CI: 1.01–12.82). Compared with females, males were more likely to have ever been arrested (AOR: 2.66, 95%CI:1.14–6.18), and to have ever been jailed (AOR: 3.22, 95%CI:1.47–7.02). Conclusions These results suggest a high degree of heterogeneity and vulnerability among SY in this setting. There is an urgent need for interventions taking into consideration these characteristics. PMID:24827584

2017 National Park visitor spending effects : Economic contributions to local communities, states, and the Nation

USGS Publications Warehouse

Cullinane Thomas, Catherine M.; Koontz, Lynne; Cornachione, Egan

2018-01-01

The National Park Service (NPS) manages the Nation’s most iconic destinations that attract millions of visitors from across the Nation and around the world. Trip-related spending by NPS visitors generates and supports a considerable amount of economic activity within park gateway communities. This economic effects analysis measures how NPS visitor spending cycles through local economies, generating business sales and supporting jobs and income. In 2017, the National Park System received an estimated 331 million recreation visits. Visitors to National Parks spent an estimated \\$18.2 billion in local gateway regions (defined as communities within 60 miles of a park). The contribution of this spending to the national economy was 306 thousand jobs, \\$11.9 billion in labor income, \\$20.3 billion in value added, and \\$35.8 billion in economic output. The lodging sector saw the highest direct contributions with \\$5.5 billion in economic output directly contributed to local gateway economies nationally. The sector with the next greatest direct contributions was the restaurants and bars sector, with \\$3.7 billion in economic output directly contributed to local gateway economies nationally. Results from the Visitor Spending Effects report series are available online via an interactive tool. Users can view year-by-year trend data and explore current year visitor spending, jobs, labor income, value added, and economic output effects by sector for national, state, and local economies. This interactive tool is available at https://www.nps.gov/subjects/socialscience/vse.htm.

2016 National Park visitor spending effects: Economic contributions to local communities, states, and the Nation

USGS Publications Warehouse

Cullinane Thomas, Catherine; Koontz, Lynne

2017-01-01

The National Park Service (NPS) manages the Nation’s most iconic destinations that attract millions of visitors from across the Nation and around the world. Trip-related spending by NPS visitors generates and supports a considerable amount of economic activity within park gateway communities. This economic effects analysis measures how NPS visitor spending cycles through local economies, generating business sales and supporting jobs and income.In 2016, the National Park System received an estimated 330,971,689 recreation visits. Visitors to National Parks spent an estimated \\$18.4 billion in local gateway regions (defined as communities within 60 miles of a park). The contribution of this spending to the national economy was 318 thousand jobs, \\$12.0 billion in labor income, \\$19.9 billion in value added, and \\$34.9 billion in economic output. The lodging sector saw the highest direct contributions with \\$5.7 billion in economic output directly contributed to local gateway economies nationally. The sector with the next greatest direct contributions was the restaurants and bars sector, with \\$3.7 billion in economic output directly contributed to local gateway economies nationally.Results from the Visitor Spending Effects report series are available online via an interactive tool. Users can view year-by-year trend data and explore current year visitor spending, jobs, labor income, value added, and economic output effects by sector for national, state, and local economies. This interactive tool is available at https://www.nps.gov/subjects/socialscience/vse.htm.

Federal Funding Insulated State Budgets From Increased Spending Related To Medicaid Expansion.

PubMed

Sommers, Benjamin D; Gruber, Jonathan

2017-05-01

As states weigh whether to expand Medicaid under the Affordable Care Act (ACA) and Medicaid reform remains a priority for some federal lawmakers, fiscal considerations loom large. As part of the ACA's expansion of eligibility for Medicaid, the federal government paid for 100 percent of the costs for newly eligible Medicaid enrollees for the period 2014-16. In 2017 states will pay some of the costs for new enrollees, with each participating state's share rising to 10 percent by 2020. States continue to pay their traditional Medicaid share (roughly 25-50 percent, depending on the state) for previously eligible enrollees. We used data for fiscal years 2010-15 from the National Association of State Budget Officers and a difference-in-differences framework to assess the effects of the expansion's first two fiscal years. We found that the expansion led to an 11.7 percent increase in overall spending on Medicaid, which was accompanied by a 12.2 percent increase in spending from federal funds. There were no significant increases in spending from state funds as a result of the expansion, nor any significant reductions in spending on education or other programs. States' advance budget projections were also reasonably accurate in the aggregate, with no significant differences between the projected levels of federal, state, and Medicaid spending and the actual expenses as measured at the end of the fiscal year. Project HOPE—The People-to-People Health Foundation, Inc.

2015 National Park visitor spending effects: Economic contributions to local communities, states, and the nation

USGS Publications Warehouse

Cullinane Thomas, Catherine M.; Koontz, Lynne

2016-01-01

The National Park Service (NPS) manages the Nation’s most iconic destinations that attract millions of visitors from across the Nation and around the world. Trip-related spending by NPS visitors generates and supports a considerable amount of economic activity within park gateway communities. This economic effects analysis measures how NPS visitor spending cycles through local economies, generating business sales and supporting jobs and income.In 2015, the National Park System received over 307.2 million recreation visits. NPS visitors spent \\$16.9 billion in local gateway regions (defined as communities within 60 miles of a park). The contribution of this spending to the national economy was 295 thousand jobs, \\$11.1 billion in labor income, \\$18.4 billion in value added, and \\$32.0 billion in economic output. The lodging sector saw the highest direct contributions with \\$5.2 billion in economic output directly contributed to local gateway economies nationally. The sector with the next greatest direct contributions was the restaurants and bar sector, with \\$3.4 billion in economic output directly contributed to local gateway economies nationally.Results from the Visitor Spending Effects report series are available online via an interactive tool. Users can view year-by-year trend data and explore current year visitor spending, jobs, labor income, value added, and economic output effects by sector for national, state, and local economies. This interactive tool is available at http://go.nps.gov/vse.

Microeconomics. Harnessing naturally occurring data to measure the response of spending to income.

PubMed

Gelman, Michael; Kariv, Shachar; Shapiro, Matthew D; Silverman, Dan; Tadelis, Steven

2014-07-11

This paper presents a new data infrastructure for measuring economic activity. The infrastructure records transactions and account balances, yielding measurements with scope and accuracy that have little precedent in economics. The data are drawn from a diverse population that overrepresents males and younger adults but contains large numbers of underrepresented groups. The data infrastructure permits evaluation of a benchmark theory in economics that predicts that individuals should use a combination of cash management, saving, and borrowing to make the timing of income irrelevant for the timing of spending. As in previous studies and in contrast to the predictions of the theory, there is a response of spending to the arrival of anticipated income. The data also show, however, that this apparent excess sensitivity of spending results largely from the coincident timing of regular income and regular spending. The remaining excess sensitivity is concentrated among individuals with less liquidity. Copyright © 2014, American Association for the Advancement of Science.

All in a day's work: an observational study to quantify how and with whom doctors on hospital wards spend their time.

PubMed

Westbrook, Johanna I; Ampt, Amanda; Kearney, Leanne; Rob, Marilyn I

2008-05-05

To quantify time doctors in hospital wards spend on specific work tasks, and with health professionals and patients. Observational time and motion study. 400-bed teaching hospital in Sydney. 19 doctors (seven registrars, five residents, seven interns) in four wards were observed between 08:30 and 19:00 for a total of 151 hours between July and December 2006. Proportions of time in categories of work; proportions of tasks performed with health professionals and patients; proportions of tasks using specific information tools; rates of multitasking and interruptions. The greatest proportions of doctors' time were in professional communication (33%; 95% CI, 29%-38%); social activities, such as non-work communication and meal breaks (17%; 95% CI, 13%-21%), and indirect care, such as planning care (17%; 95% CI, 15%-19%). Multitasking involved 20% of time, and on average, doctors were interrupted every 21 minutes. Most tasks were completed with another doctor (56%; 95% CI, 55%-57%), while 24% (95% CI, 23%-25%) were undertaken alone and 15% (95% CI, 15%-16%) with a patient. Interns spent more time completing documentation and administrative tasks, and less time in direct care than residents and registrars. The time interns spent documenting (22%) was almost double the time they were engaged in direct patient care. Two-thirds of doctors' time was consumed by three work categories: professional communication, social activities and indirect care. Doctors on wards are interrupted at considerably lower rates than those in emergency and intensive care units. The results confirm interns' previously reported dissatisfaction with their level of administrative work and documentation.

Understanding Trends in Medicare Spending, 2007-2014.

PubMed

Keohane, Laura M; Gambrel, Robert J; Freed, Salama S; Stevenson, David; Buntin, Melinda B

2018-03-06

To analyze the sources of per-beneficiary Medicare spending growth between 2007 and 2014, including the role of demographic characteristics, attributes of Medicare coverage, and chronic conditions. Individual-level Medicare spending and enrollment data. Using an Oaxaca-Blinder decomposition model, we analyzed whether changes in price-standardized, per-beneficiary Medicare Part A and B spending reflected changes in the composition of the Medicare population or changes in relative spending levels per person. We identified a 5 percent sample of fee-for-service Medicare beneficiaries age 65 and above from years 2007 to 2014. Mean payment-adjusted Medicare per-beneficiary spending decreased by $180 between the 2007-2010 and 2011-2014 time periods. This decline was almost entirely attributable to lower spending levels for beneficiaries. Notably, declines in marginal spending levels for beneficiaries with chronic conditions were associated with a $175 reduction in per-beneficiary spending. The decline was partially offset by the increasing prevalence of certain chronic diseases. Still, we are unable to attribute a large share of the decline in spending levels to observable beneficiary characteristics or chronic conditions. Declines in spending levels for Medicare beneficiaries with chronic conditions suggest that changing patterns of care use may be moderating spending growth. © Health Research and Educational Trust.

First Births to Maltreated Adolescent Girls: Differences Associated With Spending Time in Foster Care.

PubMed

King, Bryn

2017-05-01

Few studies have examined early parenting among girls receiving child welfare services (CWS) or disentangled the relationship between maltreatment, spending time in foster care, and adolescent childbirth. Using population-based, linked administrative data, this study calculated birth rates among maltreated adolescent girls and assessed differences in birth rates associated with spending time in foster care. Of the 85,766 girls with substantiated allegations of maltreatment during adolescence, nearly 18% subsequently gave birth. Among girls who spent time in foster care, the proportion was higher (19.5%). Significant variations ( p < .001) were observed in the rate of childbirth across demographic characteristics and maltreatment experiences. When accounting for all of the covariates, spending time in foster care was associated with a modestly higher rate of a first birth (Hazard Ratio [HR] = 1.10; 95% confidence interval = [1.06, 1.14]). While age at first substantiated allegation of maltreatment and race/ethnicity were significant predictors of adolescent childbirth, specific maltreatment experiences were associated with minimal or no differences in birth rates. The findings of this study suggest that the experience of spending time in care may not be a meaningful predictor of giving birth as a teen among CWS-involved adolescent girls and highlight subgroups of this population who may be more vulnerable to early childbirth.

Effect of exercise training on sports enjoyment and leisure-time spending in adolescents with complex congenital heart disease: the moderating effect of health behavior and disease knowledge.

PubMed

Dulfer, Karolijn; Duppen, Nienke; Blom, Nico A; van Dijk, Arie P J; Helbing, Wim A; Verhulst, Frank C; Utens, Elisabeth M W J

2014-01-01

The aim of this study was to evaluate the effects of a standardized exercise program on sports enjoyment and leisure-time spending in adolescents with congenital heart disease and to know what the moderating impact of their baseline health behavior and disease knowledge is. Included were 93 patients, aged 10 to 25, with surgical repair for tetralogy of Fallot or with a Fontan circulation for single-ventricle physiology, of 5 participating centers of pediatric cardiology in The Netherlands. They were randomly allocated, stratified for age, gender, and type of congenital heart disease to a 12-week period with either: (1) three times per week standardized exercise training or (2) care as usual (randomization ratio 2:1). At baseline and after 12 weeks, participants completed Web-based questionnaires and were interviewed by phone. Primary analyses tested changes from baseline to follow-up in sports enjoyment and leisure-time spending in the exercise group vs. control group. Secondary analyses concerned the moderating influence of baseline health behavior and disease knowledge on changes from baseline to follow-up, and comparison with normative data. At follow-up, the exercise group reported a decrease in passive leisure-time spending (watching television and computer usage) compared with controls. Exercise training had no effect on sports enjoyment and active leisure-time spending. Disease knowledge had a moderating effect on improvement in sports enjoyment, whereas health behavior did not. Compared with normative data, patients obtained similar leisure time scores and lower frequencies as to drinking alcohol and smoking. Exercise training decreased passive, but not active, leisure-time spending. It did not influence sports enjoyment. © 2013 Wiley Periodicals, Inc.

The physician as a manager.

PubMed

McDonagh, T J

1982-02-01

The practice of occupational medicine has undergone considerable change over the last decade. Increased awareness of potential health hazards associated with the workplace and its products and wastes, the interest of society and workers in these subjects, and related governmental regulation have resulted in expanded occupational health programs within industry. The occupational physician has become a key company resource in the optimal management of the business impacts of health-related issues. Health-related matters often have noteworthy business implications, and the occupational physician needs to spend considerable time as a manager in the planning, resourcing, implementation, evaluation, and stewardship of programs. Thus he is experiencing greater demands and often is inadequately prepared for this nonclinical, nonscientific role. Therefore, the preparation of occupational physicians to assume such managerial responsibilities needs to receive high priority. The physician must be willing to accept this challenge both to ensure the program's success and to retain a leadership position in occupational health programs.

20 CFR 220.142 - General information about work activity.

Code of Federal Regulations, 2010 CFR

2010-04-01

... gainful activity. (e) Time spent in work. While the time the claimant spends in work is important, the... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false General information about work activity. 220... of whether the claimant spends more time or less time at the job than workers who are not impaired...

Micromanufacturing: Recent developments in this country and abroad

NASA Technical Reports Server (NTRS)

Warrington, Robert O.; Friedrich, Craig R.; Gao, Robert X.; Lin, Gang

1993-01-01

This paper has attempted to summarize some recent activities in this country and overseas. The effort in Louisiana is relatively new and growing. The Russian effort is not well coordinated or documented. A conference on Micro Systems Technologies is scheduled for June of 1993 in St. Petersburg, Russia. Serious consideration should be given to developing a strategy to not only participate in this meeting, but also to spend additional time in Russia assessing the technology. MEMS technologies will eventually affect virtually every aspect of our lives and, at least in the near term, mini-devices with micro-components will probably be the economic drivers for the technology.

How Do Residents Spend Their Shift Time? A Time and Motion Study With a Particular Focus on the Use of Computers

PubMed Central

Mamykina, Lena; Vawdrey, David K.; Hripcsak, George

2016-01-01

Purpose To understand how much time residents spend using computers as compared with other activities, and what residents use computers for. Method This time and motion study was conducted in June and July 2010 at NewYork-Presbyterian/Columbia University Medical Center with seven residents (first-, second-, and third-year) on the general medicine service. An experienced observer shadowed residents during a single day shift, captured all their activities using an iPad application, and took field notes. The activities were captured using a validated taxonomy of clinical activities, expanded to describe computer-based activities with a greater level of detail. Results Residents spent 364.5 minutes (50.6%) of their shift time using computers, compared with 67.8 minutes (9.4%) interacting with patients. In addition, they spent 292.3 minutes (40.6%) talking with others in person, 186.0 minutes (25.8%) handling paper notes, 79.7 minutes (11.1%) in rounds, 80.0 minutes (11.1%) walking or waiting, and 54.0 minutes (7.5%) talking on the phone. Residents spent 685 minutes (59.6%) multitasking. Computer-based documentation activities amounted to 189.9 minutes (52.1%) of all computer-based activities time, with 128.7 minutes (35.3%) spent writing notes and 27.3 minutes (7.5%) reading notes composed by others. Conclusions The study showed residents spent considerably more time interacting with computers (over 50% of their shift time), than in direct contact with patients (less than 10% of their shift time). Some of this may be due to an increasing reliance on computing systems for access to patient data, further exacerbated by inefficiencies in the design of the electronic health record. PMID:27028026

How Do Residents Spend Their Shift Time? A Time and Motion Study With a Particular Focus on the Use of Computers.

PubMed

Mamykina, Lena; Vawdrey, David K; Hripcsak, George

2016-06-01

To understand how much time residents spend using computers compared with other activities, and what residents use computers for. This time and motion study was conducted in June and July 2010 at NewYork-Presbyterian/Columbia University Medical Center with seven residents (first-, second-, and third-year) on the general medicine service. An experienced observer shadowed residents during a single day shift, captured all their activities using an iPad application, and took field notes. The activities were captured using a validated taxonomy of clinical activities, expanded to describe computer-based activities with a greater level of detail. Residents spent 364.5 minutes (50.6%) of their shift time using computers, compared with 67.8 minutes (9.4%) interacting with patients. In addition, they spent 292.3 minutes (40.6%) talking with others in person, 186.0 minutes (25.8%) handling paper notes, 79.7 minutes (11.1%) in rounds, 80.0 minutes (11.1%) walking or waiting, and 54.0 minutes (7.5%) talking on the phone. Residents spent 685 minutes (59.6%) multitasking. Computer-based documentation activities amounted to 189.9 minutes (52.1%) of all computer-based activities time, with 128.7 minutes (35.3%) spent writing notes and 27.3 minutes (7.5%) reading notes composed by others. The study showed that residents spent considerably more time interacting with computers (over 50% of their shift time) than in direct contact with patients (less than 10% of their shift time). Some of this may be due to an increasing reliance on computing systems for access to patient data, further exacerbated by inefficiencies in the design of the electronic health record.

Some Determinants of Commitment Levels in Premarital Relationships.

ERIC Educational Resources Information Center

Kramer, Robert M.; And Others

Premarital dating couples (N=61) were asked to answer questions concerning their perceived commitment to their relationship, the amount of time they spend with their partner, the amount of time they spend arguing, their partner's attractiveness, the length of their relationship, and their desire to continue the relationship. Time spent together…

Reductions in global biodiversity loss predicted from conservation spending.

PubMed

Waldron, Anthony; Miller, Daniel C; Redding, Dave; Mooers, Arne; Kuhn, Tyler S; Nibbelink, Nate; Roberts, J Timmons; Tobias, Joseph A; Gittleman, John L

2017-11-16

Halting global biodiversity loss is central to the Convention on Biological Diversity and United Nations Sustainable Development Goals, but success to date has been very limited. A critical determinant of success in achieving these goals is the financing that is committed to maintaining biodiversity; however, financing decisions are hindered by considerable uncertainty over the likely impact of any conservation investment. For greater effectiveness, we need an evidence-based model that shows how conservation spending quantitatively reduces the rate of biodiversity loss. Here we demonstrate such a model, and empirically quantify how conservation investment reduced biodiversity loss in 109 countries (signatories to the Convention on Biological Diversity and Sustainable Development Goals), by a median average of 29% per country between 1996 and 2008. We also show that biodiversity changes in signatory countries can be predicted with high accuracy, using a dual model that balances the effects of conservation investment against those of economic, agricultural and population growth (human development pressures). Decision-makers can use this model to forecast the improvement that any proposed biodiversity budget would achieve under various scenarios of human development pressure, and then compare these forecasts to any chosen policy target. We find that the impact of spending decreases as human development pressures grow, which implies that funding may need to increase over time. The model offers a flexible tool for balancing the Sustainable Development Goals of human development and maintaining biodiversity, by predicting the dynamic changes in conservation finance that will be needed as human development proceeds.

Reductions in global biodiversity loss predicted from conservation spending

NASA Astrophysics Data System (ADS)

Waldron, Anthony; Miller, Daniel C.; Redding, Dave; Mooers, Arne; Kuhn, Tyler S.; Nibbelink, Nate; Roberts, J. Timmons; Tobias, Joseph A.; Gittleman, John L.

2017-11-01

Halting global biodiversity loss is central to the Convention on Biological Diversity and United Nations Sustainable Development Goals, but success to date has been very limited. A critical determinant of success in achieving these goals is the financing that is committed to maintaining biodiversity; however, financing decisions are hindered by considerable uncertainty over the likely impact of any conservation investment. For greater effectiveness, we need an evidence-based model that shows how conservation spending quantitatively reduces the rate of biodiversity loss. Here we demonstrate such a model, and empirically quantify how conservation investment between 1996 and 2008 reduced biodiversity loss in 109 countries (signatories to the Convention on Biological Diversity and Sustainable Development Goals), by a median average of 29% per country. We also show that biodiversity changes in signatory countries can be predicted with high accuracy, using a dual model that balances the effects of conservation investment against those of economic, agricultural and population growth (human development pressures). Decision-makers can use this model to forecast the improvement that any proposed biodiversity budget would achieve under various scenarios of human development pressure, and then compare these forecasts to any chosen policy target. We find that the impact of spending decreases as human development pressures grow, which implies that funding may need to increase over time. The model offers a flexible tool for balancing the Sustainable Development Goals of human development and maintaining biodiversity, by predicting the dynamic changes in conservation finance that will be needed as human development proceeds.

Time for Each Other: Work and Family Constraints Among Couples.

PubMed

Flood, Sarah M; Genadek, Katie R

2016-02-01

Little is known about couples' shared time and how actual time spent together is associated with well-being. In this study, the authors investigated how work and family demands are related to couples' shared time (total and exclusive) and individual well-being (happiness, meaningfulness, and stress) when with one's spouse. They used individual-level data from the 2003-2010 American Time Use Survey (N = 46,883), including the 2010 Well-Being Module. The results indicated that individuals in full-time working dual-earner couples spend similar amounts of time together as individuals in traditional breadwinner-homemaker arrangements on weekdays after accounting for daily work demands. The findings also show that parents share significantly less total and exclusive spousal time together than nonparents, though there is considerable variation among parents by age of the youngest child. Of significance is that individuals experience greater happiness and meaning and less stress during time spent with a spouse opposed to time spent apart.

Check in the Mail or More in the Paycheck: Does the Effectiveness of Fiscal Stimulus Depend on How It Is Delivered?†

PubMed Central

Sahm, Claudia R.; Shapiro, Matthew D.; Slemrod, Joel

2013-01-01

Recent fiscal policies, including the 2008 stimulus payments and the 2009 Making Work Pay Tax Credit, aimed to increase household spending. This paper quantifies the spending response to these policies and examines differences in spending by whether the stimulus was delivered as a one-time payment or as a flow of payments from reduced withholding. Based on responses from a representative sample of households in the Thomson Reuters University of Michigan Surveys of Consumers, the paper finds that the reduction in withholding in 2009 boosted spending at roughly half the rate (13 percent) as the one-time payments (25 percent) in 2008. PMID:23970951

Using Bluetooth proximity sensing to determine where office workers spend time at work.

PubMed

Clark, Bronwyn K; Winkler, Elisabeth A; Brakenridge, Charlotte L; Trost, Stewart G; Healy, Genevieve N

2018-01-01

Most wearable devices that measure movement in workplaces cannot determine the context in which people spend time. This study examined the accuracy of Bluetooth sensing (10-second intervals) via the ActiGraph GT9X Link monitor to determine location in an office setting, using two simple, bespoke algorithms. For one work day (mean±SD 6.2±1.1 hours), 30 office workers (30% men, aged 38±11 years) simultaneously wore chest-mounted cameras (video recording) and Bluetooth-enabled monitors (initialised as receivers) on the wrist and thigh. Additional monitors (initialised as beacons) were placed in the entry, kitchen, photocopy room, corridors, and the wearer's office. Firstly, participant presence/absence at each location was predicted from the presence/absence of signals at that location (ignoring all other signals). Secondly, using the information gathered at multiple locations simultaneously, a simple heuristic model was used to predict at which location the participant was present. The Bluetooth-determined location for each algorithm was tested against the camera in terms of F-scores. When considering locations individually, the accuracy obtained was excellent in the office (F-score = 0.98 and 0.97 for thigh and wrist positions) but poor in other locations (F-score = 0.04 to 0.36), stemming primarily from a high false positive rate. The multi-location algorithm exhibited high accuracy for the office location (F-score = 0.97 for both wear positions). It also improved the F-scores obtained in the remaining locations, but not always to levels indicating good accuracy (e.g., F-score for photocopy room ≈0.1 in both wear positions). The Bluetooth signalling function shows promise for determining where workers spend most of their time (i.e., their office). Placing beacons in multiple locations and using a rule-based decision model improved classification accuracy; however, for workplace locations visited infrequently or with considerable movement, accuracy was below desirable levels. Further development of algorithms is warranted.

The Impact of Internet and Television Use on the Reading Habits and Practices of College Students

ERIC Educational Resources Information Center

Mokhtari, Kouider; Reichard, Carla A.; Gardner, Anne

2009-01-01

How much time do college students spend reading for recreational and academic purposes? Do Internet and television use displace or interfere with reading time? In this study, we used an innovative time-diary survey method to explore whether the time students spend on the Internet or watching television displaces time that would be spent reading…

The Timing of Maternal Work and Time with Children. Working Paper 425

ERIC Educational Resources Information Center

Stewart, Jay

2009-01-01

I use data from the American Time Use Survey to examine how maternal employment affects when during the day that mothers of pre-school-age children spend doing enriching childcare and whether they adjust their schedules to spend time with their children at more-desirable times of day. I find that employed mothers shift enriching childcare time…

Volume and intensity of Medicare physicians' services: An overview

PubMed Central

Kay, Terrence L.

1990-01-01

From 1978 to 1987, Medicare spending for physicians' services increased at annual compound rates of 16 percent, far exceeding increases expected based on inflation and increases in beneficiaries. As a result, Medicare spending for Part B physicians' services has attracted considerable attention. This article contains an overview of expenditure trends for Part B physicians' services, a summary of recent research findings on issues related to volume and intensity of physicians' services, and a discussion of options for controlling volume and intensity. The possible impact of the recently enacted relative-value-based fee schedule on volume and intensity of services is discussed briefly. PMID:10113398

Do Our Engineering Students Spend Enough Time Studying?

ERIC Educational Resources Information Center

Kolari, S.; Savander-Ranne, C.; Viskari, E.-L.

2006-01-01

In higher education one of the most important learning goals is deep understanding. Achieving this goal needs time and effort. The authors discuss their observations of student time use on the basis of several case studies which they have conducted in the field of engineering education in Finland. The time that the students spend studying is…

Children's Time Use: Labor Divisions and Schooling in Indonesia

ERIC Educational Resources Information Center

Hsin, Amy

2007-01-01

Data from the Worker and Iron Status Evaluation are used to examine gendered patterns in children's time in market and nonmarket work, schooling, and leisure in Indonesia (N = 2,929). Boys spend more time in market work; girls spend more time in nonmarket work. Work responsibilities increase with age as well as gender differentials in children's…

Regional economic analysis of current and proposed management alternatives for Rappahannock River Valley National Wildlife Refuge

USGS Publications Warehouse

Koontz, Lynne; Sexton, Natalie; Donovan, Ryan

2009-01-01

The National Wildlife Refuge System Improvement Act of 1997 requires all units of the National Wildlife Refuge System to be managed under a Comprehensive Conservation Plan. The Comprehensive Conservation Plan must describe the desired future conditions of a refuge and provide long-range guidance and management direction to achieve refuge purposes. The Rappahannock River Valley National Wildlife Refuge (refuge) is in the process of developing a range of management goals, objectives, and strategies for the Comprehensive Conservation Plan. The Comprehensive Conservation Plan for the refuge must contain an analysis of expected effects associated with current and proposed refuge management strategies. The purpose of this study was to assess the regional economic implications associated with draft Comprehensive Conservation Plan management strategies. Special interest groups and local residents often criticize a change in refuge management, especially if there is a perceived negative impact to the local economy. Having objective data on economic impacts may show that these fears are overstated. Quite often, the extent of economic benefits a refuge provides to a local community is not fully recognized, yet at the same time the effects of negative changes is overstated. Spending associated with refuge recreational activities, such as wildlife viewing and hunting, can generate considerable tourist activity for surrounding communities. Additionally, refuge personnel typically spend considerable amounts of money purchasing supplies in local stores, repairing equipment and purchasing fuel at the local service stations, and reside and spend their salaries in the local community. For refuge Comprehensive Conservation Plan planning, a regional economic assessment provides a means of estimating how current management (no action alternative) and proposed management activities (alternatives) could affect the local economy. This type of analysis provides two critical pieces of information: (1) it illustrates a refuge's contribution to the local community; and (2) it can help in determining whether local economic effects are or are not a real concern in choosing among management alternatives. It is important to note that the economic value of a refuge encompasses more than just the impacts of the regional economy. Refuges also provide substantial nonmarket values (values for items not exchanged in established markets), such as maintaining endangered species, preserving wetlands, educating future generations, and adding stability to the ecosystem. However, quantifying these types of nonmarket values was beyond the scope of this study because of time and budget constraints.

Time Investment and Time Management: An Analysis of Time Students Spend Working at Home for School

ERIC Educational Resources Information Center

Wagner, Petra; Schober, Barbara; Spiel, Christiane

2008-01-01

This paper deals with the time students spend working at home for school. In Study 1, we investigated amount and regulation of time. Study 2 serves to validate the results of Study 1 and, in addition, investigates the duration of the time units students used and their relation to scholastic success. In Study 1, the participants were 332 students…

34 CFR 75.607 - General considerations in designing facilities and carrying out construction.

Code of Federal Regulations, 2014 CFR

2014-07-01

... architecture and design and inclusion of works of art. The grantee may not spend more than one percent of the cost of the project on inclusion of works of art. (Authority: 20 U.S.C. 1221e-3 and 3474) ...

34 CFR 75.607 - General considerations in designing facilities and carrying out construction.

Code of Federal Regulations, 2012 CFR

2012-07-01

... architecture and design and inclusion of works of art. The grantee may not spend more than one percent of the cost of the project on inclusion of works of art. (Authority: 20 U.S.C. 1221e-3 and 3474) ...

34 CFR 75.607 - General considerations in designing facilities and carrying out construction.

Code of Federal Regulations, 2013 CFR

2013-07-01

... architecture and design and inclusion of works of art. The grantee may not spend more than one percent of the cost of the project on inclusion of works of art. (Authority: 20 U.S.C. 1221e-3 and 3474) ...

34 CFR 75.607 - General considerations in designing facilities and carrying out construction.

Code of Federal Regulations, 2010 CFR

2010-07-01

... architecture and design and inclusion of works of art. The grantee may not spend more than one percent of the cost of the project on inclusion of works of art. (Authority: 20 U.S.C. 1221e-3 and 3474) ...

Developing Global-Ready Graduates: The CANEU-COOP Experience

ERIC Educational Resources Information Center

McRae, Norah; Ramji, Karima; Lu, Linghong; Lesperance, Mary

2016-01-01

Post-secondary institutions spend considerable resources on programs, such as study abroad and international work-integrated learning, which involve students' participation in international experiences. One significant impetus for these programs is the hope that through exposing students to international settings these students will be better…

34 CFR 75.607 - General considerations in designing facilities and carrying out construction.

Code of Federal Regulations, 2011 CFR

2011-07-01

... architecture and design and inclusion of works of art. The grantee may not spend more than one percent of the cost of the project on inclusion of works of art. (Authority: 20 U.S.C. 1221e-3 and 3474) ...

How College Students Spend Their Time Communicating

ERIC Educational Resources Information Center

Emanuel, Richard; Adams, Jim; Baker, Kim; Daufin, E. K.; Ellington, Coke; Fitts, Elizabeth; Himsel, Jonathan; Holladay, Linda; Okeowo, David

2008-01-01

This study sought to assess how college students spend their time communicating and what impact, if any, communications devices may be having on how that time is spent. Undergraduates (N = 696) at four southeastern colleges were surveyed. Results revealed that listening comprises 55.4% of the total average communication day followed by reading…

Full-Day Kindergarten: Indicators on Children and Youth

ERIC Educational Resources Information Center

Child Trends, 2015

2015-01-01

Overall, children who spend time in full-day kindergarten programs are more likely than children who spend time in half-day kindergarten programs to devote time every day to reading, mathematics, and social studies. Research is inconclusive on longer-term impacts. Trends identified in this report include: (1) since 1977, the percentage of…

A numerical approach to controller design for the ACES facility

NASA Technical Reports Server (NTRS)

Frazier, W. Garth; Irwin, R. Dennis

1993-01-01

In recent years the employment of active control techniques for improving the performance of systems involving highly flexible structures has become a topic of considerable research interest. Most of these systems are quite complicated, using multiple actuators and sensors, and possessing high order models. The majority of analytical controller synthesis procedures capable of handling multivariable systems in a systematic way require considerable insight into the underlying mathematical theory to achieve a successful design. This insight is needed in selecting the proper weighting matrices or weighting functions to cast what is naturally a multiple constraint satisfaction problem into an unconstrained optimization problem. Although designers possessing considerable experience with these techniques have a feel for the proper choice of weights, others may spend a significant amount of time attempting to find an acceptable solution. Another disadvantage of such procedures is that the resulting controller has an order greater than or equal to that of the model used for the design. Of course, the order of these controllers can often be reduced, but again this requires a good understanding of the theory involved.

Vitamin D

MedlinePlus

... body that produces vitamin D. As many of us spend more and more time on computers and game consoles, we're not outdoors as much as we once were. And, when we do spend time in the sun, more of us are making the wise decision to use sunscreen ...

Spending on Children’s Personal Health Care in the United States, 1996–2013

PubMed Central

Bui, Anthony L.; Dieleman, Joseph L.; Hamavid, Hannah; Birger, Maxwell; Chapin, Abigail; Duber, Herbert C.; Horst, Cody; Reynolds, Alex; Squires, Ellen; Chung, Paul J.; Murray, Christopher J. L.

2017-01-01

IMPORTANCE Health care spending on children in the United States continues to rise, yet little is known about how this spending varies by condition, age and sex group, and type of care, nor how these patterns have changed over time. OBJECTIVE To provide health care spending estimates for children and adolescents 19 years and younger in the United States from 1996 through 2013, disaggregated by condition, age and sex group, and type of care. EVIDENCE REVIEW Health care spending estimates were extracted from the Institute for Health Metrics and Evaluation Disease Expenditure 2013 project database. This project, based on 183 sources of data and 2.9 billion patient records, disaggregated health care spending in the United States by condition, age and sex group, and type of care. Annual estimates were produced for each year from 1996 through 2013. Estimates were adjusted for the presence of comorbidities and are reported using inflation-adjusted 2015 US dollars. FINDINGS From 1996 to 2013, health care spending on children increased from $149.6 (uncertainty interval [UI], 144.1–155.5) billion to $233.5 (UI, 226.9–239.8) billion. In 2013, the largest health condition leading to health care spending for children was well-newborn care in the inpatient setting. Attention-deficit/hyperactivity disorder and well-dental care (including dental check-ups and orthodontia) were the second and third largest conditions, respectively. Spending per child was greatest for infants younger than 1 year, at $11 741 (UI, 10 799–12 765) in 2013. Across time, health care spending per child increased from $1915 (UI, 1845–1991) in 1996 to $2777 (UI, 2698–2851) in 2013. The greatest areas of growth in spending in absolute terms were ambulatory care among all types of care and inpatient well-newborn care, attention-deficit/hyperactivity disorder, and asthma among all conditions. CONCLUSIONS AND RELEVANCE These findings provide health policy makers and health care professionals with evidence to help guide future spending. Some conditions, such as attention-deficit/hyperactivity disorder and inpatient well-newborn care, had larger health care spending growth rates than other conditions. PMID:28027344

Pediatric Obesity: Is There Room for Active Video Games in Prevention or Management?

PubMed

Thivel, David; OʼMalley, Grace

2016-01-01

Children and adolescents spend a considerable amount of time engaged in sedentary behaviors that have been shown to favor weight gain and impaired physical fitness. Active video games have been proposed to increase physical activity levels. Although active video games may offer an interesting alternative to reducing sedentary time for children, the present commentary aimed to determine whether there is adequate evidence that compared active video gaming to real-life play and exercise. Given the dearth of data, it is not possible at present to support the use of active video games as substitutes for traditional forms of active play and health-enhancing physical activity. Further research should be encouraged and therapists should not consider active video games exclusively for intervention in children with obesity.

Quantity Time: Moving Beyond the Quality Time Myth--A Practical Guide to Spending More Time with Your Child.

ERIC Educational Resources Information Center

Kraehmer, Steffen T.

Recognizing that the development of an emotional bond between children and their parents stems from the ability to express love and the willingness to share time together, this book is designed to assist parents spend quantity time with their children and establish opportunities for appreciating each other's company. The book is based on START…

Supplemental Coverage Associated With More Rapid Spending Growth For Medicare Beneficiaries

PubMed Central

Golberstein, Ezra; Walsh, Kayo; He, Yulei; Chernew, Michael E.

2013-01-01

Lowering both Medicare spending and the rate of Medicare spending growth is important for the nation’s fiscal health. Policy makers in search of ways to achieve these reductions have looked at the role that supplemental coverage for Medicare beneficiaries plays in Medicare spending. Supplemental coverage makes health care more affordable for beneficiaries but also makes beneficiaries insensitive to the cost of their care, thereby increasing the demand for care. Ours is the first empirical study to investigate whether supplemental Medicare coverage is associated with higher rates of spending growth over time. We found that supplemental insurance coverage was associated with significantly higher rates of overall spending growth. Specifically, employer-sponsored and self-purchased supplemental coverage were associated with annual total spending growth rates of 7.17 percent and 7.18 percent, respectively, compared to 6.08 percent annual growth for beneficiaries without supplemental coverage. Results for Medicare program spending were more equivocal, however. Our results are consistent with the belief that current trends away from generous employer-sponsored supplemental coverage and efforts to restrict the generosity of supplemental coverage may slow spending growth. PMID:23650320

Trends in College Spending 1998-2008: Where Does the Money Come from? Where Does It Go? What Does It Buy? A Report of the Delta Cost Project

ERIC Educational Resources Information Center

Desrochers, Donna M.; Lenihan, Colleen M.; Wellman, Jane V.

2010-01-01

"Trends in College Spending, 1998-2008: Where does the money come from? Where does it go? What does it buy?" is the third in a series of reports on college and university spending from the Delta Cost Project. The findings presented in this report concentrate on the 1998 to 2008 time period--the last academic year for which spending data are…

Time Students Spend Working at Home for School

ERIC Educational Resources Information Center

Wagner, Petra; Schober, Barbara; Spiel, Christiane

2008-01-01

The paper presents three studies which deal with the time students spend working at home for school. In addition, the paper focuses on the distribution of time investment over the course of a week and on the relationship between academic achievement and time spent working at home for school. In sum, 824 students with an average age of 15 years…

Working on the Weekend: Fathers' Time with Family in the United Kingdom

ERIC Educational Resources Information Center

Hook, Jennifer L.

2012-01-01

Whereas most resident fathers are able to spend more time with their children on weekends than on weekdays, many fathers work on the weekends, spending less time with their children on these days. There are conflicting findings about whether fathers are able to make up for lost weekend time on weekdays. Using unique features of the United…

Household spending on health care.

PubMed

Chaplin, R; Earl, L

2000-10-01

This article examines changes in household spending on health care between 1978 and 1998. It also provides a detailed look at household spending on health care in 1998. Data on household spending are from Statistics Canada's Family Expenditure Survey for survey years between 1978 and 1996, and from the annual Survey of Household Spending for 1997 and 1998. Proportion of after-tax spending was calculated by subtracting average personal income taxes from average total expenditures and then dividing health care expenditures by this figure. Per capita spending was calculated by dividing average household spending by average household size. Constant dollar figures and adjustments for inflation were calculated using the Consumer Price Index (1998 = 100) to control for the effect of inflation over time. Almost every Canadian household (98.2%) reported health care expenditures in 1998, spending an average of close to $1,200, up from around $900 in 1978. In 1998, households dedicated a larger share of their average after-tax spending (2.9%) to health care than they did 20 years earlier (2.3%). Health insurance premiums claimed the largest share (29.8%) of average health care expenditures, followed by dental care, then prescription medications and pharmaceutical products.

New Directions for New Professionals.

ERIC Educational Resources Information Center

Dowling, Elizabeth J.; Eaker, Michelle A.

Institutions of higher education spend considerable resources in the recruiting, screening, and hiring processes, yet often pay little attention to acclimating new professionals to their surroundings. This document presents a step-by-step outline of how to orient new employees. The success of the new professional/institution relationship depends…

Working at the Weekend: Fathers' Time with Family in the United Kingdom.

PubMed

Hook, Jennifer L

2012-08-01

Whereas most resident fathers are able to spend more time with their children on weekends than on weekdays, many fathers work on the weekends spending less time with their children on these days. There are conflicting findings about whether fathers are able to make up for lost weekend time on weekdays. Using unique features of the United Kingdom's National Survey of Time Use 2000 (UKTUS) I examine the impact of fathers' weekend work on the time fathers spend with their children, family, and partners (N = 595 fathers). I find that weekend work is common among fathers and is associated with less time with children, families, and partners. Fathers do not recover lost time with children on weekdays, largely because weekend work is a symptom of overwork. Findings also reveal that even if fathers had compensatory time, they are unlikely to recover lost time spent as a family or couple.

Working at the Weekend: Fathers’ Time with Family in the United Kingdom

PubMed Central

Hook, Jennifer L.

2012-01-01

Whereas most resident fathers are able to spend more time with their children on weekends than on weekdays, many fathers work on the weekends spending less time with their children on these days. There are conflicting findings about whether fathers are able to make up for lost weekend time on weekdays. Using unique features of the United Kingdom’s National Survey of Time Use 2000 (UKTUS) I examine the impact of fathers’ weekend work on the time fathers spend with their children, family, and partners (N = 595 fathers). I find that weekend work is common among fathers and is associated with less time with children, families, and partners. Fathers do not recover lost time with children on weekdays, largely because weekend work is a symptom of overwork. Findings also reveal that even if fathers had compensatory time, they are unlikely to recover lost time spent as a family or couple. PMID:22844157

Cost analysis in a CMHC: determining the cost of staff time.

PubMed

Haring, A; Eckert, C

1979-06-01

The program evaluation and research unit of a community mental health center developed and field-tested a survey form to measure how employees spend their time. The form is divided into direct patient care activities, which include interviewing and testing, conducting therapy, and prescribing medications, and administrative or support activities, which include filling out charts, attending meetings, and training staff. All staff record daily, for one week, the hours and minutes they spend in each activity. Using that data as a base, the evaluation unit can determine the percentage of time staff spend in each activity and the cost of each activity based on staff members' paychecks.

Should Cursive Handwriting Still Be Taught in Schools? Information Capsule. Volume 0916

ERIC Educational Resources Information Center

Blazer, Christie

2010-01-01

Elementary school students spend less time learning cursive handwriting than they did in years past. The declining emphasis on cursive writing has been attributed to the increasing use of technology, the growing proportion of class time spent preparing for standardized tests, and the perception that the time students spend learning to write in…

Parents' Working Hours: Adolescent Children's Views and Experiences

ERIC Educational Resources Information Center

Lewis, Jane; Noden, Philip; Sarre, Sophie

2008-01-01

As dual-earner families have become the norm, the different kinds of "time" children spend with parents has become an important issue. We use the 2000 Time Use Survey to identify adolescent children spending time alone at home, and interviews with 50 children aged 14 and 15 to explore young people's experiences. We investigate their views on their…

Estimating Time Physicians and Other Health Care Workers Spend with Patients in an Intensive Care Unit Using a Sensor Network.

PubMed

Butler, Rachel; Monsalve, Mauricio; Thomas, Geb W; Herman, Ted; Segre, Alberto M; Polgreen, Philip M; Suneja, Manish

2018-04-09

Time and motion studies have been used to investigate how much time various health care professionals spend with patients as opposed to performing other tasks. However, the majority of such studies are done in outpatient settings, and rely on surveys (which are subject to recall bias) or human observers (which are subject to observation bias). Our goal was to accurately measure the time physicians, nurses, and critical support staff in a medical intensive care unit spend in direct patient contact, using a novel method that does not rely on self-report or human observers. We used a network of stationary and wearable mote-based sensors to electronically record location and contacts among health care workers and patients under their care in a 20-bed intensive care unit for a 10-day period covering both day and night shifts. Location and contact data were used to classify the type of task being performed by health care workers. For physicians, 14.73% (17.96%) of their time in the unit during the day shift (night shift) was spent in patient rooms, compared with 40.63% (30.09%) spent in the physician work room; the remaining 44.64% (51.95%) of their time was spent elsewhere. For nurses, 32.97% (32.85%) of their time on unit was spent in patient rooms, with an additional 11.34% (11.79%) spent just outside patient rooms. They spent 11.58% (13.16%) of their time at the nurses' station and 23.89% (24.34%) elsewhere in the unit. From a patient's perspective, we found that care times, defined as time with at least one health care worker of a designated type in their intensive care unit room, were distributed as follows: 13.11% (9.90%) with physicians, 86.14% (88.15%) with nurses, and 8.14% (7.52%) with critical support staff (eg, respiratory therapists, pharmacists). Physicians, nurses, and critical support staff spend very little of their time in direct patient contact in an intensive care unit setting, similar to reported observations in both outpatient and inpatient settings. Not surprisingly, nurses spend far more time with patients than physicians. Additionally, physicians spend more than twice as much time in the physician work room (where electronic medical record review and documentation occurs) than the time they spend with all of their patients combined. Copyright © 2018 Elsevier Inc. All rights reserved.

Feasibility of solar powered traffic signs in Houston : a step toward sustainable control devices.

DOT National Transportation Integrated Search

2012-08-01

"With the economy fluctuating all the time, the federal and some city governments at times spend more : money than they take in from taxes. It is important for these governments to find ways to reduce : spending while still providing sufficient opera...

Are Your Kids Too Tuned In?

ERIC Educational Resources Information Center

De Franco, Ellen B.

1989-01-01

Provides ideas to help parents determine whether their children are spending too much time with electronic media, noting children learn both good and bad from every device they use. Parents are encouraged to offer their children interest, support, and suggestions for alternate ways to spend their time. (SM)

National Health Expenditures, 1996

PubMed Central

Levit, Katharine R.; Lazenby, Helen C.; Braden, Bradley R.; Cowan, Cathy A.; Sensenig, Arthur L.; McDonnell, Patricia A.; Stiller, Jean M.; Won, Darleen K.; Martin, Anne B.; Sivarajan, Lekha; Donham, Carolyn S.; Long, Anna M.; Stewart, Madie W.

1997-01-01

The national health expenditures (NHE) series presented in this report for 1960-96 provides a view of the economic history of health care in the United States through spending for health care services and the sources financing that care. In 1996 NHE topped $1 trillion. At the same time, spending grew at the slowest rate, 4.4 percent, ever recorded in the current series. For the first time, this article presents estimates of Medicare managed care payments by type of service, as well as nursing home and home health spending in hospital-based facilities. PMID:10179997

Parental Control of the Time Preadolescents Spend on Social Media: Links with Preadolescents' Social Media Appearance Comparisons and Mental Health.

PubMed

Fardouly, Jasmine; Magson, Natasha R; Johnco, Carly J; Oar, Ella L; Rapee, Ronald M

2018-07-01

Time spent on social media and making online comparisons with others may influence users' mental health. This study examined links between parental control over the time their child spends on social media, preadolescents' time spent browsing social media, preadolescents' appearance comparisons on social media, and preadolescents' appearance satisfaction, depressive symptoms, and life satisfaction. Preadolescent social media users (N = 284, 49.1% female; aged 10-12) and one of their parents completed online surveys. Preadolescents, whose parents reported greater control over their child's time on social media, reported better mental health. This relationship was mediated by preadolescents spending less time browsing and making fewer appearance comparisons on social media. Parental control over time spent on social media may be associated with benefits for mental health among preadolescents.

Could Trends in Time Children Spend with Parents Help Explain the Black-White Gap in Human Capital? Evidence from the American Time Use Survey

ERIC Educational Resources Information Center

Patterson, Richard W.

2017-01-01

It is widely believed that the time children spend with parents significantly impacts human capital formation. If time varies significantly between black and white children, this may help explain the large racial gap in test scores and wages. In this study, I use data from the American Time Use Survey to examine the patterns in the time black and…

How Do Pre-Kindergarteners Spend Their Time? Gender, Ethnicity, and Income as Predictors of Experiences in Pre-Kindergarten Classrooms

ERIC Educational Resources Information Center

Early, Diane M.; Iruka, Iheoma U.; Ritchie, Sharon; Barbarin, Oscar A.; Winn, Donna-Marie C.; Crawford, Gisele M.; Frome, Pamela M.; Clifford, Richard M.; Burchinal, Margaret; Howes, Carollee; Bryant, Donna M.; Pianta, Robert C.

2010-01-01

The current paper considers how children spend their time in state-funded pre-kindergarten programs and how time use relates to ethnicity, gender, and family income, based on the assumption that how time is spent in pre-kindergarten is relevant for the programs' success in narrowing achievement gaps. Classroom observations of 2061 children in 652…

Three Centuries of American Inequality.

ERIC Educational Resources Information Center

Lindert, Peter H.; Williamson, Jeffrey G.

Income inequality in the United States displays considerable variance since the seventeenth century. There is no eternal constancy to the degree of inequality in total income, in labor earnings, or in income from conventional nonhuman wealth either before or after the effects of government taxes and spending. When all the necessary adjustments to…

The relationship between social capital and the way of spending leisure time, based on physical activities

PubMed Central

Karimian, Jahangir; Hosseini, Taghi Agha; Shekarchizadeh, Parivash; Nafchi, Sayed Morteza Mousavi

2015-01-01

Background: Today, social capital is a need in the society. Also, leisure time and physical activities are among the most important productive sources of social capital, which have been realized recently. This study aims to find the relationship between social capital and physical leisure time of the faculty members of Isfahan University of Medical Sciences. Materials and Methods: A descriptive correlation method was used in this study. Two questionnaires were used for data collection. Social capital questionnaire is based on SCAT Model. Also, leisure time questionnaire was made by the researcher for which face and content validity was verified by experts. Reliability coefficients by using Cronbach's alpha coefficients were calculated as 0.92 and 0.82, respectively. Sample population was calculated by Cochran's formula, and 150 people were selected as the sample using multiple cluster sampling by taking the sex and college into consideration as the variables. Findings: According to the findings, there was a direct relationship between a combination of social capital parameters (including commitment, attitude, trust, participation, mutual relationship, social norm, and unity) and the way of spending physical leisure time (R = 0.659, P = 0.000). Among the parameters, “commitment” was significant with a beta coefficient B = 0.293 and P = 0.044 and social norms was significant with a beta coefficient B = 0.196 and P = 0.047, but the rest of the factors were not significant. Conclusion: Playing sport and doing physical activities in the leisure time and also taking part in group activities and their membership provide a situation for people to respect the group interests through communication. Such activities can cause the level of social capital and its factors to be increased. PMID:27462621

The tell-tale look: viewing time, preferences, and prices.

PubMed

Gunia, Brian C; Murnighan, J Keith

2015-01-01

Even the simplest choices can prompt decision-makers to balance their preferences against other, more pragmatic considerations like price. Thus, discerning people's preferences from their decisions creates theoretical, empirical, and practical challenges. The current paper addresses these challenges by highlighting some specific circumstances in which the amount of time that people spend examining potential purchase items (i.e., viewing time) can in fact reveal their preferences. Our model builds from the gazing literature, in a purchasing context, to propose that the informational value of viewing time depends on prices. Consistent with the model's predictions, four studies show that when prices are absent or moderate, viewing time provides a signal that is consistent with a person's preferences and purchase intentions. When prices are extreme or consistent with a person's preferences, however, viewing time is a less reliable predictor of either. Thus, our model highlights a price-contingent "viewing bias," shedding theoretical, empirical, and practical light on the psychology of preferences and visual attention, and identifying a readily observable signal of preference.

Hospitalization for primary care susceptible conditions, health spending and Family Health Strategy: an analysis of trends.

PubMed

Morimoto, Tissiani; Costa, Juvenal Soares Dias da

2017-03-01

The goal of this study was to analyze the trend over time of hospitalizations due to conditions susceptible to primary healthcare (HCSPC), and how it relates to healthcare spending and Family Health Strategy (FHS) coverage in the city of São Leopoldo, Rio Grande do Sul State, Brazil, between 2003 and 2012. This is an ecological, time-trend study. We used secondary data available in the Unified Healthcare System Hospital Data System, the Primary Care Department and Public Health Budget Data System. The analysis compared HCSPC using three-year moving averages and Poisson regressions or negative binomials. We found no statistical significance in decreasing HCSPC indicators and primary care spending in the period analyzed. Healthcare spending, per-capita spending and FHS coverage increased significantly, but we found no correlation with HCSPC. The results show that, despite increases in the funds invested and population covered by FHS, they are still insufficient to deliver the level of care the population requires.

It's the recipient that counts: spending money on strong social ties leads to greater happiness than spending on weak social ties.

PubMed

Aknin, Lara B; Sandstrom, Gillian M; Dunn, Elizabeth W; Norton, Michael I

2011-02-10

Previous research has shown that spending money on others (prosocial spending) increases happiness. But, do the happiness gains depend on who the money is spent on? Sociologists have distinguished between strong ties with close friends and family and weak ties--relationships characterized by less frequent contact, lower emotional intensity, and limited intimacy. We randomly assigned participants to reflect on a time when they spent money on either a strong social tie or a weak social tie. Participants reported higher levels of positive affect after recalling a time they spent on a strong tie versus a weak tie. The level of intimacy in the relationship was more important than the type of relationship; there was no significant difference in positive affect after recalling spending money on a family member instead of a friend. These results add to the growing literature examining the factors that moderate the link between prosocial behaviour and happiness.

Association of Financial Integration Between Physicians and Hospitals With Commercial Health Care Prices.

PubMed

Neprash, Hannah T; Chernew, Michael E; Hicks, Andrew L; Gibson, Teresa; McWilliams, J Michael

2015-12-01

Financial integration between physicians and hospitals may help health care provider organizations meet the challenges of new payment models but also may enhance the bargaining power of provider organizations, leading to higher prices and spending in commercial health care markets. To assess the association between recent increases in physician-hospital integration and changes in spending and prices for outpatient and inpatient services. Using regression analysis, we estimated the relationship between changes in physician-hospital integration from January 1, 2008, through December 31, 2012, in 240 metropolitan statistical areas (MSAs) and concurrent changes in spending. Adjustments were made for patient, plan, and market characteristics, including physician, hospital, and insurer market concentration. The study population included a cohort of 7,391,335 nonelderly enrollees in preferred-provider organizations or point-of-service plans included in the Truven Health MarketScan Commercial Database during the study period. Data were analyzed from December 1, 2013, through July 13, 2015. Physician-hospital integration, measured using Medicare claims data as the share of physicians in an MSA who bill for outpatient services with a place-of-service code indicating employment or practice ownership by a hospital. Annual inpatient and outpatient spending per enrollee and associated use of health care services, with utilization measured by price-standardized spending (the sum of annual service counts multiplied by the national mean of allowed charges for the service). Among the 240 MSAs, physician-hospital integration increased from 2008 to 2012 by a mean of 3.3 percentage points, with considerable variation in increases across MSAs (interquartile range, 0.8-5.2 percentage points). For our study sample of 7,391,335 nonelderly enrollees, an increase in physician-hospital integration equivalent to the 75th percentile of changes experienced by MSAs was associated with a mean increase of $75 (95% CI, $38-$113) per enrollee in annual outpatient spending (P < .001) from 2008 to 2012, a 3.1% increase relative to mean outpatient spending in 2012 ($2407 [95% CI, $2400-$2414] per enrollee). This increase in outpatient spending was driven almost entirely by price increases because associated changes in utilization were minimal (corresponding change in price-standardized spending, $14 [95% CI, -$13 to $41] per enrollee; P = .32). Changes in physician-hospital integration were not associated with significant changes in inpatient spending ($22 [95% CI, -$1 to $46] per enrollee; P = .06) or utilization ($10 [95% CI, -$12 to $31] per enrollee; P = .37). Financial integration between physicians and hospitals has been associated with higher commercial prices and spending for outpatient care.

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

Goodman, Lynne S.

'Money makes the world go round', as the song says. It definitely influences decommissioning decision-making and financial assurance for future decommissioning. This paper will address two money-related decommissioning topics. The first is the evaluation of whether to continue or to halt decommissioning activities at Fermi 1. The second is maintaining adequacy of financial assurance for future decommissioning of operating plants. Decommissioning costs considerable money and costs are often higher than originally estimated. If costs increase significantly and decommissioning is not well funded, decommissioning activities may be deferred. Several decommissioning projects have been deferred when decision-makers determined future spending is preferablemore » than current spending, or when costs have risen significantly. Decommissioning activity timing is being reevaluated for the Fermi 1 project. Assumptions for waste cost-escalation significantly impact the decision being made this year on the Fermi 1 decommissioning project. They also have a major impact on the estimated costs for decommissioning currently operating plants. Adequately funding full decommissioning during plant operation will ensure that the users who receive the benefit pay the full price of the nuclear-generated electricity. Funding throughout operation also will better ensure that money is available following shutdown to allow decommissioning to be conducted without need for additional funds.« less

Economics' Fall from Grace

ERIC Educational Resources Information Center

Rudolph, Lloyd I.; Rudolph, Susanne Hoeber

2010-01-01

Not long ago, many political scientists suffered from economics envy. Some still do. They view economics as the queen of the social sciences, claiming that it is "scientific," like physics. Physicists and other natural scientists spend most of their time trying to explain phenomena, but non-behavioral micro-economists spend most of their time on…

After the Blackbird Whistles: Listening to Silence in Classrooms

ERIC Educational Resources Information Center

Schultz, Katherine

2010-01-01

Background/Context: Students spend a large part of their time in schools in silence. However, teachers tend to spend most of their time attending to student talk. Anthropological and linguistic research has contributed to an understanding of silence in particular communities, offering explanations for students' silence in school. This research…

Webinar Presentation: Environmental Exposures and Health Risks in California Child Care Facilities: First Steps to Improve Environmental Health where Children Spend Time

EPA Pesticide Factsheets

This presentation, Environmental Exposures and Health Risks in California Child Care Facilities: First Steps to Improve Environmental Health where Children Spend Time, was given at the NIEHS/EPA Children's Centers 2016 Webinar Series: Exposome.

The impact of waiting for intervention on costs and effectiveness: the case of transcatheter aortic valve replacement.

PubMed

Ribera, Aida; Slof, John; Ferreira-González, Ignacio; Serra, Vicente; García-Del Blanco, Bruno; Cascant, Purificació; Andrea, Rut; Falces, Carlos; Gutiérrez, Enrique; Del Valle-Fernández, Raquel; Morís-de laTassa, César; Mota, Pedro; Oteo, Juan Francisco; Tornos, Pilar; García-Dorado, David

2017-11-23

The economic crisis in Europe might have limited access to some innovative technologies implying an increase of waiting time. The purpose of the study is to evaluate the impact of waiting time on the costs and benefits of transcatheter aortic valve replacement (TAVR) for the treatment of severe aortic stenosis. This is a cost-utility analysis from the perspective of the Spanish National Health Service. Results of two prospective hospital registries (158 and 273 consecutive patients) were incorporated into a probabilistic Markov model to compare quality adjusted life years (QALYs) and costs for TAVR after waiting for 3-12 months, relative to immediate TAVR. We simulated a cohort of 1000 patients, male, and 80 years old; other patient profiles were assessed in sensitivity analyses. As waiting time increased, costs decreased at the expense of lower survival and loss of QALYs, leading to incremental cost-effectiveness ratios for eliminating waiting lists of about 12,500 € per QALY. In subgroup analyses prioritization of patients for whom higher benefit was expected led to a smaller loss of QALYs. Concerning budget impact, long waiting lists reduced spending considerably and permanently. A shorter waiting time is likely to be cost-effective (considering commonly accepted willingness-to-pay thresholds in Europe) relative to 3 months or longer waiting periods. If waiting lists are nevertheless seen as unavoidable due to severe but temporary budgetary restrictions, prioritizing patients for whom higher benefit is expected appears to be a way of postponing spending without utterly sacrificing patients' survival and quality of life.

Mobile technology in radiology resident education.

PubMed

Korbage, Aiham C; Bedi, Harprit S

2012-06-01

The authors hypothesized that ownership of a mobile electronic device would result in more time spent learning radiology. Current trends in radiology residents' studying habits, their use of electronic and printed radiology learning resources, and how much of the funds allotted to them are being used toward printed vs electronic education tools were assessed in this study. A survey study was conducted among radiology residents across the United States from June 13 to July 5, 2011. Program directors listed in the Association of Program Directors in Radiology e-mail list server received an e-mail asking for residents to participate in an online survey. The questionnaire consisted of 12 questions and assessed the type of institution, the levels of training of the respondents, and book funds allocated to residents. It also assessed the residents' study habits, access to portable devices, and use of printed and electronic radiology resources. Radiology residents are adopters of new technologies, with 74% owning smart phones and 37% owning tablet devices. Respondents spend nearly an equal amount of time learning radiology from printed textbooks as they do from electronic resources. Eighty-one percent of respondents believe that they would spend more time learning radiology if provided with tablet devices. There is considerable use of online and electronic resources and mobile devices among the current generation of radiology residents. Benefits, such as more study time, may be obtained by radiology programs that incorporate tablet devices into the education of their residents. Copyright © 2012 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Alaska's Dependence on State Spending. ISER Fiscal Policy Papers, No. 5.

ERIC Educational Resources Information Center

Goldsmith, Scott; And Others

Alaska will face a large fiscal gap and growing budget deficits in the near future. The timing of such fiscal gap open hinges on the joint effect of state budget growth and the oil price change. This paper explains Alaska's dependence on state spending and offers policy options addressing the fiscal gap. State spending: (1) supports nearly one in…

Variation In Health Outcomes: The Role Of Spending On Social Services, Public Health, And Health Care, 2000-09.

PubMed

Bradley, Elizabeth H; Canavan, Maureen; Rogan, Erika; Talbert-Slagle, Kristina; Ndumele, Chima; Taylor, Lauren; Curry, Leslie A

2016-05-01

Although spending rates on health care and social services vary substantially across the states, little is known about the possible association between variation in state-level health outcomes and the allocation of state spending between health care and social services. To estimate that association, we used state-level repeated measures multivariable modeling for the period 2000-09, with region and time fixed effects adjusted for total spending and state demographic and economic characteristics and with one- and two-year lags. We found that states with a higher ratio of social to health spending (calculated as the sum of social service spending and public health spending divided by the sum of Medicare spending and Medicaid spending) had significantly better subsequent health outcomes for the following seven measures: adult obesity; asthma; mentally unhealthy days; days with activity limitations; and mortality rates for lung cancer, acute myocardial infarction, and type 2 diabetes. Our study suggests that broadening the debate beyond what should be spent on health care to include what should be invested in health-not only in health care but also in social services and public health-is warranted. Project HOPE—The People-to-People Health Foundation, Inc.

Administrator Perceptions of Actual and Desired Time Spent by School Psychologists in Different Roles and Satisfaction with School Psychologists.

ERIC Educational Resources Information Center

Levinson, Edward M.; And Others

1996-01-01

Surveyed 512 elementary and secondary administrators regarding their perceptions of the time spent by school psychologists in 15 role functions and other duties. Results indicate that administrators desired school psychologists to spend less time in assessment and administrative activities than they were perceived to be spending in these areas.…

Academic Performance of College Students: Influence of Time Spent Studying and Working

ERIC Educational Resources Information Center

Nonis, Sarath A.; Hudson, Gail I.

2006-01-01

Today's college students are less prepared for college-level work than their predecessors. Once they get to college, they tend to spend fewer hours studying while spending more hours working, some even full time (D. T. Smart, C. A. Kelley, & J. S. Conant, 1999). In this study, the authors examined the effect of both time spent studying and time…

77 FR 38035 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-26

... government spending and 35.8 percent of state government spending. This comprehensive and ongoing, time series collection of local education agency finances maintains historical continuity in the state and...

Why prevention can increase health-care spending.

PubMed

Temple, Norman J

2012-10-01

This article examines the impact of disease prevention on health-care spending. The relationship between these two variables is more complex than what, at first glance, appears to be the case. Health-care spending would be reduced if more effective means could be found to prevent health problems that are expensive to treat but are generally not fatal, such as dementia, infectious diseases and accidents. The major focus here is on interventions designed to persuade people to quit smoking. Savings on health-care spending in early years after people stop smoking are counter-balanced (often exceeded) by higher spending at a later time. In addition, when people stop smoking there is a significant negative impact on government finances from the double effect of lost tax revenues combined with increased spending on pension payments. Arguments in favour of policies designed to prevent fatal disease, such as by reducing the prevalence of smoking, should be based on improvements to population health rather than on misleading claims that this will reduce spending on health care.

Spending by California’s Department of Developmental Services for Persons with Autism across Demographic and Expenditure Categories

PubMed Central

Leigh, J. Paul; Grosse, Scott D.; Cassady, Diana; Melnikow, Joy; Hertz-Picciotto, Irva

2016-01-01

Background Few autism spectrum disorder (ASD) studies have estimated non-medical costs for treatment or addressed possible differences in provision of services across gender, race-ethnic, age or demographic or expenditure categories, especially among adults. Methods The California Department of Developmental Services (CDDS) provides services to residents with developmental disabilities. CDDS provided aggregate data on primarily non-medical spending for fiscal year 2012–2013 for persons with ASD with or without intellectual disability (ID) (main sample, n = 42,274), and two sub-samples: ASD only (n = 30,164), and ASD+ID (n = 12,110). Demographic variables included sex, age and race-ethnicity. Spending categories included Employment Support, Community Care Facilities, Day Care, Transportation, and in-home and out-of-home Respite. Results Per-person spending for males and females were approximately the same: $10,488 and $10,791 for males and females for ages 3–17 and $26,491 and $26,627 for ages 18+. Among race/ethnicity categories, the ranking from highest to lowest among ages 3–17 was white non-Hispanics ($11,480), Asian non-Hispanics ($11,036), “Others” ($11,031), Hispanics ($9,571), and African-American non-Hispanics ($9,482). For ages 18+, the ranking was whites ($31,008), African-Americans ($26,831), “Others” ($25,395), Asians ($22,993), and Hispanics ($18,083). The ASD+ID sub-sample exerted disproportionate influence on findings from the main sample for persons 18+. Combining all ages, the top two expenditure categories for per-person spending were Community Care Facilities ($43,867) and Day Care ($11,244). For most adult age groups, the percentage of recipients participating were highest for Day Care (44.9% - 62.4%) and Transportation (38.6% - 50.9%). Per-person spending for Day Care, Transportation, and Employment Support was relatively low for children but relatively high for adults. Conclusion White non-Hispanics received the highest per-person spending and Hispanics among the least. Amounts within spending categories varied considerably across age groups. Our estimates may be useful as baseline measures for stakeholders preparing for increasing ASD prevalence, especially among adults. PMID:27015098

Disneyland Dads, Disneyland Moms? How Nonresident Parents Spend Time with Absent Children.

ERIC Educational Resources Information Center

Stewart, Susan D.

1999-01-01

Examines gender differences in how nonresident parents spend time with their absent children. Results suggest that nonresident mothers and fathers exhibit a similar pattern of participation in activities with their absent children. Most nonresident parents either engage in only leisure activities with their children or have no contact. (Author/MKA)

The Overdominance of Computers

ERIC Educational Resources Information Center

Monke, Lowell W.

2006-01-01

Most schools are unwilling to consider decreasing computer use at school because they fear that without screen time, students will not be prepared for the demands of a high-tech 21st century. Monke argues that having young children spend a significant amount of time on computers in school is harmful, particularly when children spend so much…

Secondary Counseling Services as Perceived by Selected Publics. RR-49.

ERIC Educational Resources Information Center

Peterson, Sarah; DeGracie, James S.

In the spring of 1983, an evaluation of the junior and senior high guidance programs in the Mesa Public Schools was conducted. Surveys were developed to solicit opinions from parents, teachers, counselors, administrators, career specialists, and students as to how counselors actually spend their time versus how they should spend their time.…

Reflection after Teaching a Lesson: Experiences of Secondary School Science Teachers

ERIC Educational Resources Information Center

Halstead, Melissa A.

2017-01-01

Secondary science teachers spend most of their time planning, collaborating, and teaching, but spend little time reflecting after teaching a single lesson. The theoretical framework of the adult learning theory and the transformative learning theory was the basis of this study. This qualitative research study was conducted to understand the…

Farmers as Consumers of Agricultural Education Services: Willingness to Pay and Spend Time

ERIC Educational Resources Information Center

Charatsari, Chrysanthi; Papadaki-Klavdianou, Afroditi; Michailidis, Anastasios

2011-01-01

This study assessed farmers' willingness to pay for and spend time attending an Agricultural Educational Program (AEP). Primary data on the demographic and socio-economic variables of farmers were collected from 355 farmers selected randomly from Northern Greece. Descriptive statistics and multivariate analysis methods were used in order to meet…

Room for Adjustment

ERIC Educational Resources Information Center

Kennedy, Mike

2006-01-01

In classrooms across the U.S., students spend untold hours sitting at desks and tables working on their lessons or listening to their teachers. That lack of movement might not have been a concern years ago, when children's time away from school typically was spent outdoors playing and exercising. However, as children spend more time in front of a…

Negotiating among Opportunity and Constraint: The Participation of Young People in Out-of-School-Time Activities. Chapin Hall Working Paper

ERIC Educational Resources Information Center

Chaskin, Robert J.; Baker, Stephen

2006-01-01

In recent years, there has been increased policy interest in the way young people spend their time out of school, and in promoting the availability of opportunities for them to spend this time in productive and developmentally supportive ways. Out-of-school opportunities (such as arts and music programs, sports teams, community service, youth …

How do working-age people with disabilities spend their time? New evidence from the American Time Use Survey.

PubMed

Anand, Priyanka; Ben-Shalom, Yonatan

2014-12-01

We use the American Time Use Survey to examine the extent to which adults with disabilities-defined using both the new six-question sequence on disability and the traditional work-limitation question-spend more time on health-related activities and less time on other activities than those without disabilities. We find that men and women who both reported a work limitation and responded "yes" to any of the questions in the six-question disability sequence spend approximately 40 to 50 more minutes per week, respectively, on health-related activities. We also find that most working-age men and women who report a disability work fewer hours per day than men and women without disabilities. The largest difference is for men and women who report both types of disability; these individuals spend, on average, 5 fewer hours per day in paid work than men and women without disabilities. On average, most of the decrease in paid work time is offset by more time spent on leisure activities (defined as activities that provide direct utility, such as entertainment, social activities, attending recreational events, and general relaxation) and sleeping, which is likely due to these being default activities for individuals whose medical issues and environment constrain them from participating in other activities.

Evolution and patterns of global health financing 1995-2014: development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries.

PubMed

2017-05-20

An adequate amount of prepaid resources for health is important to ensure access to health services and for the pursuit of universal health coverage. Previous studies on global health financing have described the relationship between economic development and health financing. In this study, we further explore global health financing trends and examine how the sources of funds used, types of services purchased, and development assistance for health disbursed change with economic development. We also identify countries that deviate from the trends. We estimated national health spending by type of care and by source, including development assistance for health, based on a diverse set of data including programme reports, budget data, national estimates, and 964 National Health Accounts. These data represent health spending for 184 countries from 1995 through 2014. We converted these data into a common inflation-adjusted and purchasing power-adjusted currency, and used non-linear regression methods to model the relationship between health financing, time, and economic development. Between 1995 and 2014, economic development was positively associated with total health spending and a shift away from a reliance on development assistance and out-of-pocket (OOP) towards government spending. The largest absolute increase in spending was in high-income countries, which increased to purchasing power-adjusted $5221 per capita based on an annual growth rate of 3·0%. The largest health spending growth rates were in upper-middle-income (5·9) and lower-middle-income groups (5·0), which both increased spending at more than 5% per year, and spent $914 and $267 per capita in 2014, respectively. Spending in low-income countries grew nearly as fast, at 4·6%, and health spending increased from $51 to $120 per capita. In 2014, 59·2% of all health spending was financed by the government, although in low-income and lower-middle-income countries, 29·1% and 58·0% of spending was OOP spending and 35·7% and 3·0% of spending was development assistance. Recent growth in development assistance for health has been tepid; between 2010 and 2016, it grew annually at 1·8%, and reached US$37·6 billion in 2016. Nonetheless, there is a great deal of variation revolving around these averages. 29 countries spend at least 50% more than expected per capita, based on their level of economic development alone, whereas 11 countries spend less than 50% their expected amount. Health spending remains disparate, with low-income and lower-middle-income countries increasing spending in absolute terms the least, and relying heavily on OOP spending and development assistance. Moreover, tremendous variation shows that neither time nor economic development guarantee adequate prepaid health resources, which are vital for the pursuit of universal health coverage. The Bill & Melinda Gates Foundation. Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Working time of neurosurgical residents in Europe--results of a multinational survey.

PubMed

Stienen, Martin N; Netuka, David; Demetriades, Andreas K; Ringel, Florian; Gautschi, Oliver P; Gempt, Jens; Kuhlen, Dominique; Schaller, Karl

2016-01-01

The introduction of the European Working Time directive 2003/88/EC has led to a reduction of the working hours with distinct impact on the clinical and surgical activity of neurosurgical residents in training. A survey was performed among European neurosurgical residents between 06/2014 and 03/2015. Multiple logistic regression was used to assess the relationship between responder-specific variables (e.g., age, gender, country, postgraduate year (PGY)) and outcome (e.g., working time). A total of 652 responses were collected, of which n = 532 responses were taken into consideration. In total, 17.5, 22.1, 29.5, 19.5, 5.9, and 5.5 % of European residents indicated to work <40, 40-50, 51-60, 61-70, 71-80, or >80 h/week, respectively. Residents from France and Turkey (OR 4.72, 95 % CI 1.29-17.17, p = 0.019) and Germany (OR 2.06, 95 % CI 1.15-3.67, p = 0.014) were more likely to work >60 h/week than residents from other European countries. In total, 29 % of European residents were satisfied with their current working time, 11.3 % indicated to prefer reduced working time. More than half (55 %) would prefer to work more hours/week if this would improve their clinical education. Residents that rated their operative exposure as insufficient were 2.3 times as likely as others to be willing to work more hours (OR 2.32, 95 % CI 1.47-3.70, p < 0.001). Less than every fifth European resident spends >50 % of his/her working time in the operating room. By contrast, 77.4 % indicate to devote >25 % of their daily working time to administrative work. For every advanced PGY, the likelihood to spend >50 % of the working time in the OR increases by 19 % (OR 1.19, 95 % CI 1.02-1.40, p = 0.024) and the likelihood to spend >50 % of the working time with administrative work decreases by 18 % (OR 0.84, 95 % CI 0.76-0.94, p = 0.002). The results of this survey on >500 European neurosurgical residents clearly prove that less than 40 % conform with the 48-h week as claimed by the WTD2003/88/EC. Still, more than half of them would chose to work even more hours/week if their clinical education were to improve; probably due to subjective impression of insufficient training.

Impact of Barcode Medication Administration Technology on How Nurses Spend Their Time On Clinical Care

PubMed Central

Poon, Eric G; Keohane, Carol; Featherstone, Erica; Hays, Brandon; Dervan, Andrew; Woolf, Seth; Hayes, Judy; Bane, Anne; Newmark, Lisa; Gandhi, Tejal K

2006-01-01

In a time-motion study conducted in a hospital that recently implemented barcode medication administration (BCMA) technology, we found that the BCMA system did not increase the amount of time nurses spend on medication administration activities, and did not compromise the amount of time nurses spent on direct care of patients. Our results should allay concerns regarding the impact of BCMA on nursing workflow. PMID:17238684

Determinants of hematology-oncology trainees' postfellowship career pathways with a focus on nonmalignant hematology

PubMed Central

Jenkins, Sarah; Mikhael, Joseph; Gitlin, Scott D.

2018-01-01

Nonmalignant hematologic conditions are extremely prevalent and contribute significantly to the global burden of disease. The US health care system may soon face a shortage of specialists in nonmalignant hematology. We sought to identify factors that lead hematology-oncology fellows to pursue (or not to pursue) careers in nonmalignant hematology. Cross-sectional, web-based survey distributed to 149 graduates of a hematology-oncology fellowship program at a large academic medical center between 1998 and 2016. Eighty-six out of 149 graduates responded (57.7%); most (59 [68.6%]) practice at an academic medical center. Respondents spend a mean of 61% of their time in clinical practice, 23.7% conducting research, 5.2% in education, and 5.2% in administration. Those in clinical practice spend a mean of 52.1% of their time in solid tumor oncology, 37.5% in hematologic malignancies, and 10% in nonmalignant hematology; only 1 spent >50% of time practicing nonmalignant hematology. Factors most significantly affecting choice of patient population included clinical experience during fellowship and intellectual stimulation of the patient population/disease type. Factors that could have most significantly influenced a decision to spend more time in nonmalignant hematology included increased exposure/access to role models and mentors and opportunities for better career growth/advancement. Fellowship graduates spend >50% of their time in clinical practice, but almost none spend a significant amount of time practicing nonmalignant hematology. Given the growing number of patients with nonmalignant hematologic conditions and a possible future provider shortage, medical trainees should be encouraged to pursue careers in nonmalignant hematology. PMID:29463548

More Freedom to Spend Less Money: What Happened when California School Districts Gained Spending Flexibility and Budgets Were Cut. Research Brief

ERIC Educational Resources Information Center

Li, Jennifer

2012-01-01

In 2009-2010, California made substantial education budget cuts at the same time that it removed its spending requirements from $4.5 billion of state money. This gave districts the flexibility to use the funds in any manner approved by the local school board. Researchers found that most of the formerly earmarked money was moved into general funds…

Taking Digital Creativity to the Art Classroom: Mystery Box Swap

ERIC Educational Resources Information Center

Shin, Ryan

2010-01-01

Today's students are the first generation to grow up with computers, cell-phones, video games, music and video players, and other digital technologies. As "digital natives", a new term coined by Prensky (2001), they spend more time reading text messaging lines than lines from books, and they spend more time on Facebook than putting their energies…

How Do Arizonans Spend their Personal Time? AZ Views, Volume 1, Issue 1

ERIC Educational Resources Information Center

Morrison Institute for Public Policy, Arizona State University, 2008

2008-01-01

When not sleeping, working, or tending to other duties, Arizonans keep busy, spending personal time on a wide array of different activities, from high culture to casual pastime. Reported data create a picture of a busy, active population sharing a lot of interests, particularly outdoor activities, while also containing discernible subgroups…

Do Traditional Fathers Always Work More? Gender Ideology, Race, and Parenthood

ERIC Educational Resources Information Center

Glauber, Rebecca; Gozjolko, Kristi L.

2011-01-01

Research has shown that men who express traditional gender ideologies spend more time in paid work when they become fathers, whereas men who express egalitarian ideologies spend less time in paid work. This study extends previous research by examining racial differences among men. We drew on data from the National Longitudinal Survey of Youth 1979…

How Newspaper Advertising Sales Managers Spend Their Time: A Pilot Study.

ERIC Educational Resources Information Center

Hudson, Jerry C.; Saathoff, Roger C.

A pilot study examined how newspaper advertising sales managers in five southwestern states spend their time during a typical work day. Of the 360 questionnaires mailed, 176 responses were received. The largest number of responses (93) came from retail sales managers of newspapers in markets with less than 50,000 population. The questionnaire…

For the Love of Reading: Engaging Students in a Lifelong Pursuit

ERIC Educational Resources Information Center

Willingham, Daniel T.

2015-01-01

This article asks American adults the question: How should teens spend their leisure time? The activity with the highest response, irrespective of race, education, and other demographic factors, was reading. Adults thought teens ought to spend about an hour and 15 minutes reading for pleasure each day. How much time do teens actually spend…

An overview of Medicare reimbursement regulations for advanced practice nurses.

PubMed

Frakes, Michael A; Evans, Tracylain

2006-01-01

The federal government spends nearly 15% of the budget on Medicare services annually, and advanced practice nurses are eligible for reimbursement from that pool. The regulations governing reimbursement are complex because of the social, political, and financial pressures involved in their development. Although economic viability and due diligence considerations make it incumbent on advanced practice nurses to understand the rules, the profession, as a whole, has knowledge deficits in this area. The essentials of regulatory development and structure are reviewed and considerations for optimizing reimbursement are described.

If slow rate of health care spending growth persists, projections may be off by $770 billion.

PubMed

Cutler, David M; Sahni, Nikhil R

2013-05-01

Despite earlier forecasts to the contrary, US health care spending growth has slowed in the past four years, continuing a trend that began in the early 2000s. In this article we attempt to identify why US health care spending growth has slowed, and we explore the spending implications if the trend continues for the next decade. We find that the 2007-09 recession, a one-time event, accounted for 37 percent of the slowdown between 2003 and 2012. A decline in private insurance coverage and cuts to some Medicare payment rates accounted for another 8 percent of the slowdown, leaving 55 percent of the spending slowdown unexplained. We conclude that a host of fundamental changes--including less rapid development of imaging technology and new pharmaceuticals, increased patient cost sharing, and greater provider efficiency--were responsible for the majority of the slowdown in spending growth. If these trends continue during 2013-22, public-sector health care spending will be as much as $770 billion less than predicted. Such lower levels of spending would have an enormous impact on the US economy and on government and household finances.

Investing in children: changes in parental spending on children, 1972-2007.

PubMed

Kornrich, Sabino; Furstenberg, Frank

2013-02-01

Parental spending on children is often presumed to be one of the main ways that parents invest in children and a main reason why children from wealthier households are advantaged. Yet, although research has tracked changes in the other main form of parental investment-namely, time-there is little research on spending. We use data from the Consumer Expenditure Survey to examine how spending changed from the early 1970s to the late 2000s, focusing particularly on inequality in parental investment in children. Parental spending increased, as did inequality of investment. We also investigate shifts in the composition of spending and linkages to children's characteristics. Investment in male and female children changed substantially: households with only female children spent significantly less than parents in households with only male children in the early 1970s; but by the 1990s, spending had equalized; and by the late 2000s, girls appeared to enjoy an advantage. Finally, the shape of parental investment over the course of children's lives changed. Prior to the 1990s, parents spent most on children in their teen years. After the 1990s, however, spending was greatest when children were under the age of 6 and in their mid-20s.

"I Wish We Had More Time to Spend Together...": The Distribution and Predictors of Perceived Family Time Pressures among Married Men and Women in the Paid Labor Force

ERIC Educational Resources Information Center

Roxburgh, Susan

2006-01-01

In this article, I examine the distribution of time pressure associated with the roles of marital partner and parent using data from a telephone survey. Results of an analysis of open-ended responses indicate that less than a quarter of respondents are satisfied with the time they spend with their children and spouses. Women are more likely to…

Time use patterns among women with rheumatoid arthritis: association with functional limitations and psychological status.

PubMed

Katz, P; Morris, A

2007-03-01

This study assessed time use patterns among 375 women with rheumatoid arthritis (RA). We hypothesized that (i) as functional limitations increased, time use imbalances would occur (i.e. time needed for obligatory activities would conflict with time needed for productive and free-time activities) and (ii) time use imbalances would be associated with psychological distress. Time use estimates were obtained from written questionnaires; other study data were collected from annual telephone interviews. Activities were categorized as obligatory, committed or discretionary, as defined by Verbrugge. Time use estimates were aggregated to define number of obligatory (e.g. self-care) activities requiring >2 h/day and a number of committed and discretionary activities in which no time was spent each day. After adjusting for age, education, marital status and pain severity, women with more functional limitations were significantly more likely to spend >2 h/day in obligatory activities. As functional limitations increased, the proportion spending no time in each committed activity and many discretionary activities increased. Spending >2 h/day in obligatory activities was not significantly associated with poor psychological status, but spending no time in a greater number of committed and discretionary activities was associated with lower life satisfaction and higher levels of depressive symptoms. Having more severe functional limitations appears to shift time use patterns towards more time spent in obligatory activities and less time spent in committed and discretionary activities. These imbalances in time use were associated with psychological distress, highlighting the need for women with RA to maintain important productive, social and discretionary activities.

The economic downturn and its lingering effects reduced medicare spending growth by $4 billion in 2009-12.

PubMed

Dranove, David; Garthwaite, Craig; Ody, Christopher

2015-08-01

Previous work has found a strong connection between the most recent economic recession and reductions in private health spending. However, the effect of economic downturns on Medicare spending is less clear. In contrast to studies involving earlier time periods, our study found that when the macroeconomy slowed during the Great Recession of 2007-09, so did Medicare spending growth. A small (14 percent) but significant share of the decline in Medicare spending growth from 2009 to 2012 relative to growth from 2004 to 2009 can be attributed to lingering effects of the recession. Absent the economic downturn, Medicare spending would have been $4 billion higher in 2009-12. A major reason for the relatively small impact of the macroeconomy is the relative lack of labor-force participation among people ages sixty-five and older. We estimate that if they had been working at the same rate as the nonelderly before the recession, the effect of the downturn on Medicare spending growth would have been twice as large. Project HOPE—The People-to-People Health Foundation, Inc.

Postnatal paternal involvement and maternal emotional disturbances: The effect of maternal employment status.

PubMed

Lin, Wan-Chien; Chang, Shin-Yow; Chen, Yi-Ting; Lee, Hsin-Chien; Chen, Yi-Hua

2017-09-01

Recently, studies have begun emphasizing paternal involvement during the perinatal period and its impact on maternal health. However, most studies have assessed maternal perception and focused on adolescents or minority groups in Western countries. Therefore, the current study investigated the association between paternal involvement and maternal postnatal depression and anxiety, along with the effects of maternal job status in the Asian society of Taiwan. This study recruited pregnant women in the first trimester of pregnancy as well as their partners on prenatal visits from July 2011 to September 2013 at four selected hospitals in metropolitan areas of Taipei, Taiwan. In total, 593 parental pairs completed the first interview and responded to the follow-up questionnaires until 6 months postpartum. Self-reported data were collected, and multiple logistic regression models were used for analyses. Lower paternal childcare and nursing frequency was independently associated with an increased risk of maternal postpartum depression (adjusted odds ratio (OR) =4.33, 95% confidence interval (CI)=1.34-13.98), particularly among unemployed mothers. Furthermore, among unemployed mothers, the risk of postnatal anxiety was 3.14 times higher in couples with fathers spending less time with the child, compared with couples with fathers spending more time (95% CI=1.10-8.98). However, no significant findings were obtained for employed mothers. The high prevalence of maternal postnatal emotional disturbances warrants continual consideration. Higher paternal involvement in childcare arrangements should be emphasized to aid in ameliorating these maternal emotional disturbances, particularly among unemployed mothers. Copyright © 2017 Elsevier B.V. All rights reserved.

Impact of oncology-related direct-to-consumer advertising: association with appropriate and inappropriate prescriptions.

PubMed

Abel, Gregory A; Chen, Kun; Taback, Nathan; Hassett, Michael J; Schrag, Deborah; Weeks, Jane C

2013-03-01

Little is known about the impact of direct-to-consumer advertising (DTCA) on appropriate versus inappropriate prescribing. Aromatase inhibitor (AI) therapy for breast cancer provides an ideal paradigm for studying this issue, because AIs have been the focus of substantial DTCA, and because they should only be used in postmenopausal women, age can serve as a simple surrogate marker of appropriateness. Data regarding national DTCA spending for the AIs were obtained from TNS Multimedia; hormonal therapy prescription data were obtained from IMS Health. Time series analyses were performed to characterize the association between monthly changes in DTCA spending for the AIs and monthly changes in the proportion of all new hormonal therapy prescriptions represented by the AIs from October 2005 to September 2007. Analyses were stratified by age, considering prescriptions for women ≤ 40 (likely premenopausal) to be inappropriate and those for women > 60 (likely postmenopausal) to be appropriate. Monthly dollars spent on AI-associated DTCA varied considerably ($118,600 to $22,019,660). Time series analysis revealed that for every million dollars spent on DTCA for the AIs, there was an associated increase 3 months later in the new AI prescription proportion of 0.15% for all ages (P < .0001) and 0.18% for those > 60 years (P < .0001), but no significant change for those ≤ 40 at any time from 0 to 6 months. DTCA for the AIs was associated with increases in appropriate prescriptions with no significant effect on inappropriate prescriptions, suggesting that DTCA may not foster inappropriate medication use for certain drug classes. Copyright © 2012 American Cancer Society.

Ways of spending leisure time by the third year-students of the Faculty of Pharmacy, Medical University of Lublin.

PubMed

Czabak-Garbacz, Róza; Skibniewska, Agnieszka; Mazurkiewicz, Piotr; Gdula, Agnieszka

2002-01-01

The aim of the study was the assessment of leisure time among third-year students from the Faculty of Pharmacy of the Medical University of Lublin. It analysed quantity of time devoted to school activity and ways of spending free time. The study involved 114 students (82 women and 32 men). The study revealed that women had less free time than men, who, most probably did not attend some lectures. The most popular activities among the questioned students were: sleeping (average 6.8 hours a day), studying (average 3.6 hours a day), listening to the radio (average 2.9 hours a day), talking with friends (average 1.9 hours a day), personal hygiene (average 1.1 hours a day), watching TV (average 1.1 hours a day), housework. Students devoted the least of their free time on active rest, for example walking (women did it more often than men) or practising sport (more popular among men). Cultural life of the students consisted only of meetings with friends and going to the cinema (women did it more often). The least popular way of spending free time was going to the theatre, opera, concerts and exhibitions. Few students spent their time working. Their number increased significantly during holidays. The way of spending free time by third-year students from the Faculty of Pharmacy (both men and women) during the day was similar, differences related only to the amount of time devoted to each activity.

Microstructure-Evolution and Reliability Assessment Tool for Lead-Free Component Insertion in Army Electronics

DTIC Science & Technology

2008-10-01

provide adequate means for thermal heat dissipation and cooling. Thus electronic packaging has four main functions [1]: • Signal distribution which... dissipation , involving structural and materials consideration. • Mechanical, chemical and electromagnetic protection of components and... nature when compared to phenomenological models. Microelectronic packaging industry spends typically several months building and reliability

Career Assessment of Ultraorthodox Jewish Men: Reliability, Validity, and Results of the Strong Interest Inventory

ERIC Educational Resources Information Center

Pirutinsky, Steven

2013-01-01

Ultraorthodox men spend years studying religion and delay entry into the workforce until their early 30s. They then face barriers such as insufficient education and work experience, religious restrictions, and a lack of career information and self-knowledge. Although there is considerable interest in assessment, no measure has been validated…

Spending Reduction Act

THOMAS, 113th Congress

Rep. Owens, William L. [D-NY-21

2013-06-04

House - 06/04/2013 Referred to the Committee on Oversight and Government Reform, and in addition to the Committee on Rules, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee... (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

Bibliographic Management Software: A Focus Group Study of the Preferences and Practices of Undergraduate Students

ERIC Educational Resources Information Center

Salem, Jamie; Fehrmann, Paul

2013-01-01

With the growing population of undergraduate students on our campus and an increased focus on their success, librarians at a large midwestern university were interested in the citation management styles of this university cohort. Our university library spends considerable resources each year to maintain and promote access to the robust…

[Partnership around difficult teenagers in Brest].

PubMed

Saint-André, Stéphane; Botbol, Michel

2013-01-01

The issues surrounding difficult teenagers results in professionals formalising a partnership. Certain areas of focus are identified such as getting to know each other better in order to understand each other better, working in a "common language", understanding professional identities, or embracing long term partnership. Pressure to assess and rationalise spending, as well as political challenges, must be taken into consideration.

Use of heavier drinking contexts among heterosexuals, homosexuals and bisexuals: results from a National Household Probability Survey.

PubMed

Trocki, Karen F; Drabble, Laurie; Midanik, Lorraine

2005-01-01

Extensive use of specific social contexts (bars and parties, for instance) by homosexuals and bisexuals is thought to be a factor in the higher rates of drinking among these groups. However, much of the empirical evidence behind these assumptions has been based on studies with methodological or sampling shortcomings. This article examines the epidemiological patterns of alcohol contexts in relation to sexual identity, using a large, national, probability population survey. We used the 2000 National Alcohol Survey for these analyses. The prevalence of spending leisure time in each of two social contexts (bars and parties) that are associated with heavier drinking is examined by sexual orientation (heterosexual, homosexual, bisexual and self-identified heterosexuals with same sex partners). In addition, we compare levels of drinking within these contexts by sexual orientation within these groups. Exclusively heterosexual women spent less time in these two contexts relative to all other groups of women. Gay men spent considerably more time in bars compared with the other groups of men. Heterosexual women who reported same sex partners drink more at bars, and bisexual women drink more alcohol at both bars and parties than exclusively heterosexual women. For men, there were no significant differences for average consumption in any of these contexts. Entry of background and demographic variables into logistic regression analyses did little to modify these associations. There is empirical evidence that some groups of homosexual and bisexual women and men spend more time than heterosexual individuals in heavier drinking contexts. The frequency of being in these two social contexts does not appear to be associated with heavier drinking within these contexts for men, but it may be related to heavier drinking in those places among some groups of women.

Passive radiation shielding considerations for the proposed space elevator

NASA Astrophysics Data System (ADS)

Jorgensen, A. M.; Patamia, S. E.; Gassend, B.

2007-02-01

The Earth's natural van Allen radiation belts present a serious hazard to space travel in general, and to travel on the space elevator in particular. The average radiation level is sufficiently high that it can cause radiation sickness, and perhaps death, for humans spending more than a brief period of time in the belts without shielding. The exact dose and the level of the related hazard depends on the type or radiation, the intensity of the radiation, the length of exposure, and on any shielding introduced. For the space elevator the radiation concern is particularly critical since it passes through the most intense regions of the radiation belts. The only humans who have ever traveled through the radiation belts have been the Apollo astronauts. They received radiation doses up to approximately 1 rem over a time interval less than an hour. A vehicle climbing the space elevator travels approximately 200 times slower than the moon rockets did, which would result in an extremely high dose up to approximately 200 rem under similar conditions, in a timespan of a few days. Technological systems on the space elevator, which spend prolonged periods of time in the radiation belts, may also be affected by the high radiation levels. In this paper we will give an overview of the radiation belts in terms relevant to space elevator studies. We will then compute the expected radiation doses, and evaluate the required level of shielding. We concentrate on passive shielding using aluminum, but also look briefly at active shielding using magnetic fields. We also look at the effect of moving the space elevator anchor point and increasing the speed of the climber. Each of these mitigation mechanisms will result in a performance decrease, cost increase, and technical complications for the space elevator.

Physical activity patterns in American high school students. Results from the 1990 Youth Risk Behavior Survey.

PubMed

Heath, G W; Pratt, M; Warren, C W; Kann, L

1994-11-01

To assess by self-reported participation in vigorous physical activity, the quantity and quality of school physical education, team sports, and television watching among 11,631 American high school students. Of all students in grades 9 through 12, 37% reported engaging in 20 minutes of vigorous physical activity three or more times per week. Participation in vigorous physical activity was higher among boys than girls (P < .01) and higher among white students than among those of other races and ethnic groups (P < .01). Overall, 43.7% of boys and 52% of girls reported that they were not enrolled in physical education classes. Of the students who reported attending physical education class during the past 2 weeks, 33.2% reported exercising 20 minutes or more in physical education class three to five times per week. In contrast, rates of participation in varsity and junior varsity sports remained constant across grade levels, but participation in recreational physical activity programs showed a lesser magnitude and also decreased with advancing grade. More than 70% of students reported spending at least 1 hour watching television each school day, and more than 35% reported watching television 3 hours or more each school day. Participation in vigorous physical activity and physical education class time devoted to physical activity are substantially below the goals set in Healthy People 2000. As students move toward graduation, we observed disturbing declines in participation in community recreation programs and overall vigorous activity. Students appear to spend considerably more time watching television than participating in physical activity. Public health efforts should focus on increasing the physical activity levels of our youth to enhance their current well-being and to reduce the risks of future chronic disease.

Good News and Bad News on Parenting

ERIC Educational Resources Information Center

Caplan, Bryan

2009-01-01

Sociologists focus on the theory that parents spend less time with their kids than they used to. But fact-checking popular perceptions about the evolution of parenting indicates that fathers spend much more time with their children than they used to (from a weekly average of 3 hours of primary child care in 1965, to seven hours in 2000.). A more…

Spending Time: The Impact of Hours Worked on Work-Family Conflict

ERIC Educational Resources Information Center

Adkins, Cheryl L.; Premeaux, Sonya F.

2012-01-01

Scholars have long assumed that as workers spend more time at work fewer hours are available for their non-work lives leading to negative effects in both domains, and most studies examining the impact of work hours on work and life domains have supported this viewpoint. However, the majority of these studies have used one-dimensional measures of…

The road against fatalities: infrastructure spending vs. regulation??

PubMed

Albalate, Daniel; Fernández, Laura; Yarygina, Anastasiya

2013-10-01

The road safety literature is typified by a high degree of compartmentalization between studies that focus on infrastructure and traffic conditions and those devoted to the evaluation of public policies and regulations. As a result, few studies adopt a unified empirical framework in their attempts at evaluating the road safety performance of public interventions, thus limiting our understanding of successful strategies in this regard. This paper considers both types of determinants in an analysis of a European country that has enjoyed considerable success in reducing road fatalities. After constructing a panel data set with road safety outcomes for all Spanish provinces between 1990 and 2009, we evaluate the role of the technical characteristics of infrastructure and recent infrastructure spending together with the main regulatory changes introduced. Our results show the importance of considering both types of determinants in a unified framework. Moreover, we highlight the importance of maintenance spending given its effectiveness in reducing fatalities and casualties in the current economic context of austerity that is having such a marked impact on investment efforts in Spain. Copyright © 2013 Elsevier Ltd. All rights reserved.

How Children Can Benefit from the Transition to Digital TV: Putting the Remote Control Back into the Hands of Parents. Policy Brief

ERIC Educational Resources Information Center

Benton Foundation, 2004

2004-01-01

Today, parents are struggling to ensure that their children have the education and skills they need to compete and win in the 21st century economy. But children spend more time watching television than any other activity except sleeping--and for many parents that is cause for concern. In fact, children spend 4 times as much time each week…

Time and costs of preparing and submitting an NIH grant application at a school of nursing.

PubMed

Kulage, Kristine M; Schnall, Rebecca; Hickey, Kathleen T; Travers, Jasmine; Zezulinski, Kerri; Torres, Franklin; Burgess, Janine; Larson, Elaine L

2015-01-01

Schools of nursing spend considerable time and finances pursuing federal research funding, yet the costs of such efforts are unknown. The purpose of this study was to determine the time and costs to a school of nursing to prepare a National Institutes of Health grant application. We prospectively recorded time and calculated costs in grant preparation undertaken by principal investigators and research administrators in one school of nursing. Principal investigators' time ranged from 69.8 to 162.3 hr, research administrators' time ranged from 33.9 to 56.4 hr, and costs ranged from $4,784 to $13,512 per grant. With funding rates of 5% to 15%, costs for one funded R01 would be $72,460 to $270,240. Grant writing activities represent a major time commitment to faculty and staff and costs to the school. To maximize potential for success, schools of nursing must provide costly resources to support its grant writing enterprise. Less costly and more efficient models of attaining research funding are needed for the sustainability of the nursing profession. Copyright © 2015 Elsevier Inc. All rights reserved.

Money Isn't Everything: Wives’ Earnings and Housework Time

PubMed Central

Killewald, Alexandra; Gough, Margaret

2010-01-01

The autonomy perspective of housework time predicts that wives’ housework time falls steadily as their earnings rise, because wives use additional financial resources to outsource or forego time in housework. We argue, however, that wives’ ability to reduce their housework varies by household task. That is, we expect that increases in wives’ earnings will allow them to forego or outsource some tasks, but not others. As a result, we hypothesize more rapid declines in wives’ housework time for low-earning wives as their earnings increase than for high-earning wives who have already stopped performing household tasks that are the easiest and cheapest to outsource or forego. Using fixed-effects models and data from the Panel Study of Income Dynamics, we find considerable support for our hypothesis. We further conclude that past evidence that wives who out-earn their husbands spend additional time in housework to compensate for their gender-deviant success in the labor market is due to the failure to account for the non-linear relationship between wives’ absolute earnings and their housework time. PMID:21278852

Decomposition of the drivers of the U.S. hospital spending growth, 2001–2009

PubMed Central

2014-01-01

Background United States health care spending rose rapidly in the 2000s, after a period of temporary slowdown in the 1990s. However, the description of the overall trend and the understanding of the underlying drivers of this trend are very limited. This study investigates how well historical hospital cost/revenue drivers explain the recent hospital spending trend in the 2000s, and how important each of these drivers is. Methods We used aggregated time series data to describe the trend in total hospital spending, price, and quantity between 2001 and 2009. We used the Oaxaca-Blinder method to investigate the relative importance of major hospital cost/spending drivers (derived from the literature) in explaining the change in hospital spending patterns between 2001 and 2007. We assembled data from Medicare Cost Reports, American Hospital Association annual surveys, Prospective Payment System (PPS) Impact Files, Medicare Provider Analysis and Review (MedPAR) Medicare claims data, InterStudy reports, National Health Expenditure data, and Area Resource Files. Results Aggregated time series trends show that high hospital spending between 2001 and 2009 appears to be driven by higher payment per unit of hospital output, not by increased utilization. Results using the Oaxaca-Blinder regression decomposition method indicate that changes in historically important spending drivers explain a limited 30% of unit-payment growth, but a higher 60% of utilization growth. Hospital staffing and labor-related costs, casemix, and demographics are the most important drivers of higher hospital revenue, utilization, and unit-payment. Technology is associated with lower utilization, higher unit payment, and limited increases in total revenue. Market competition, primarily because of increased managed care concentration, moderates total revenue growth by driving lower unit payment. Conclusions Much of the rapidly rising hospital spending growth in the 2000s in the United States is driven by factors not commonly known or well measured. Future studies need to explore new factors and dynamics that drive longer-term hospital spending growth in recent years, particularly through the channel of higher prices. PMID:24886580

Health Technology Assessment, International Reference Pricing, and Budget Control Tools from China's Perspective: What Are the Current Developments and Future Considerations?

PubMed

Koh, Liling; Glaetzer, Christoph; Chuen Li, Shu; Zhang, Meng

2016-05-01

China is investing considerably in health care reforms to address issues in its health care system. An example is access to innovative drugs, which remains challenging because it is largely dependent on patient self-pay. Recognizing this, the government has invested considerably in its basic medical insurance. As health care expenditure increases, there are growing concerns on budget control. Several health policy tools have been discussed recently such as health technology assessment, international reference pricing, and hospital budget control tools, which can be viewed as addressing the affordability concerns of the government budget. China has also listed her health outcomes goals in "Healthy China 2020" initiative. This article aimed to discuss the "fit-for-purpose" of these tools to address budget concerns and support China in reaching her health outcomes goals. The findings are informed by a panel discussion at ISPOR Asia Pacific 2014, literature review, and authors' experience. This review looks at the current developments in China and the considerations and implications for using these tools by drawing experiences from countries where they are used. These tools are generally used in countries with advanced health care systems. China's health care spending is still below that of countries with advanced health care systems and below World Health Organization recommendation. China has not yet reached the "critical mass" necessary for the effective use of these tools. As China continues its health care reforms, increase in health care spending to balance the health needs of the population would be key. Copyright © 2015. Published by Elsevier Inc.

Incidence and public health burden of sunburn among ...

EPA Pesticide Factsheets

Sunburn, a preventable skin condition, is a major risk factor for skin cancer. Severe burns can result in emergency department visits and in some cases hospitalization. Many people spend hours in direct sunlight while at the beach, which could lead to sunburn. We pooled data from 13 prospective cohorts of beachgoers in the United States (n=84,411) to describe incidence of sunburn, risk factors associated with an increased risk of sunburn, and the health burden resulting from time lost from work or school, visits to the doctor, and medication use. The incidence of sunburn in this population in the 10-12 days after the beach visit was 14% (n=9,882), excluding those with sunburn at enrollment. Sunburn incidence increased with greater time spent in the sun. Approximately 8% of beachgoers only exposed for <1 hour reported sunburn, whereas almost 20% spending ≥5 hours in the sun reported sunburn (p<0.001). Those with any water contact were also more likely to report sunburn (15% versus 11%, p<0.001). Among all participants, 66% applied sunblock. When skin type was considered, the highest incidence was noted among those who report repeated sunburns (17%) or freckles when in the sun (13%) compared to 11% who typically get dark tans. The incidence of sunburn varied considerably by age group. Children ages <1 year had the lowest incidence of sunburn (2%) whereas adults between the ages of 19-35 had the highest incidence of sunburn (18%). Preliminary analyses indicate t

Constipation-Related Health Care Utilization in Children Before and After Hospitalization for Constipation.

PubMed

Stephens, John R; Steiner, Michael J; DeJong, Neal; Rodean, Jonathan; Hall, Matt; Richardson, Troy; Berry, Jay G

2018-01-01

We studied constipation-related health care among children before and after constipation admission. Index admissions for constipation in 2010-2011 were identified in the Truven Marketscan Database, which includes children receiving Medicaid in 10 states. We measured number of and spending for outpatient constipation visits 12 months before and after index hospitalizations. We also measured spending for constipation hospitalizations and rehospitalization rate. There were 780 index constipation admissions. The median number of outpatient constipation visits was 1 (interquartile range [IQR] = 0, 3) in the 12 months before and 2 (IQR [0, 4]) after admission ( P = .001). Median outpatient spending for constipation was $110 (IQR [0, 429]) before and $132 (IQR [0, 431]) after admission ( P = .2). Median spending for index constipation admissions was $5295 (IQR [2756, 8267]); 78 children (10%) were rehospitalized for constipation within 12 months. Constipation-related health care utilization increased after constipation admission. Median spending for one constipation admission was 50 times the median spending for 12 months of outpatient constipation visits.

[The work of medical doctors on psychiatric wards: an analysis of everyday activities].

PubMed

Putzhammer, A; Senft, I; Fleischmann, H; Klein, H E; Schmauss, M; Schreiber, W; Hajak, G

2006-03-01

In Germany, the economic situation of psychiatric hospitals has markedly changed during the last years. Whilst the number of patients has steadily increased, many clinics considerably reduced the number of therapeutic staff due to an increasing lack of financial support. The German psychiatry personnel regulations act defines the number of therapeutic staff required for an adequate psychiatric treatment, but the requirements of this regulations act nowadays are widely missed in most of the German psychiatric hospitals. This severely affects the therapeutic work on psychiatric wards. This study analyses tasks and activities of medical doctors on psychiatric wards and compares the hours spent with various types of activities with the amount of time that should be spent according to the personnel regulations act. Results show that doctors spend much more time with documentation and administrative work than originally intended by the personnel regulations act. They compensate this mainly by a reduction of time spent in direct contact with the patients. In this context, the number of psychotherapy sessions as well as sessions with the patients' relatives has been considerably reduced, whereas the time spent for emergency intervention and basic treatment still corresponds to the calculations according to the personnel regulations act. All in all, the results show that a reduction of therapeutic staff in psychiatric hospitals directly leads to a change in treatment settings with a focus on less individual treatment options.

Pharmaceutical company spending on research and development and promotion in Canada, 2013-2016: a cohort analysis.

PubMed

Lexchin, Joel

2018-01-01

Competing claims are made about the amount of money that pharmaceutical companies spend on research and development (R&D) versus promotion. This study investigates this question in the Canadian context. Two methods for determining industry-wide figures for spending on promotion were employed. First, total industry spending on detailing and journal advertising for 2013-2016 was abstracted from reports from QuintilesIMS. Second, the mean total promotion spending for the years 2002-2005 was used to estimate total spending for 2013-2016. Total industry spending on R&D came from the Patented Medicine Prices Review Board (PMPRB). R&D to promotion spending using each method of determining the amount spent on promotion was compared for 2013-2016 inclusive. Data on the 50 top promoted drugs, the amounts spent, the companies marketing these products and their overall sales were abstracted from the QuintilesIMS reports. Spending on R&D and promotion as a percent of sales was compared for these companies. Industry wide, the ratio of R&D to promotion spending went from 1.43 to 2.18 when promotion was defined as the amount spent on detailing and journal advertising for the 50 most promoted drugs. Calculating total promotion spending from the mean of the 2002-2005 figures the ratio was 0.88 to 1.32 for the 50 most promoted drugs. For individual companies marketing one or more of the 50 most promoted drugs, mean R&D spending ranged from 3.7% of sales to 4.1% compared to mean promotion spending that went from 1.7 to 1.9%. The ratio of spending on R&D to promotion varied from 2.11 to 2.32. Eight to 10 companies per year spent more on promotion than on R&D. Depending on the method used to determine promotion spending, industry-wide the ratio of R&D spending to promotion ranges from 1.45 to 2.18 (sales representatives and journal advertising only) or from 0.88 to 1.32 (total promotion spending estimated based 2003-2005 data.) For the individual companies promoting one or more of the 50 most promoted drugs, 2.11 to 2.32 times more is spent on R&D compared to promotion. However these results should be interpreted cautiously because of data limitations.

Waiting can be an optimal conservation strategy, even in a crisis discipline

PubMed Central

Possingham, Hugh P.; Bode, Michael

2017-01-01

Biodiversity conservation projects confront immediate and escalating threats with limited funding. Conservation theory suggests that the best response to the species extinction crisis is to spend money as soon as it becomes available, and this is often an explicit constraint placed on funding. We use a general dynamic model of a conservation landscape to show that this decision to “front-load” project spending can be suboptimal if a delay allows managers to use resources more strategically. Our model demonstrates the existence of temporal efficiencies in conservation management, which parallel the spatial efficiencies identified by systematic conservation planning. The optimal timing of decisions balances the rate of biodiversity decline (e.g., the relaxation of extinction debts, or the progress of climate change) against the rate at which spending appreciates in value (e.g., through interest, learning, or capacity building). We contrast the benefits of acting and waiting in two ecosystems where restoration can mitigate forest bird extinction debts: South Australia’s Mount Lofty Ranges and Paraguay’s Atlantic Forest. In both cases, conservation outcomes cannot be maximized by front-loading spending, and the optimal solution recommends substantial delays before managers undertake conservation actions. Surprisingly, these delays allow superior conservation benefits to be achieved, in less time than front-loading. Our analyses provide an intuitive and mechanistic rationale for strategic delay, which contrasts with the orthodoxy of front-loaded spending for conservation actions. Our results illustrate the conservation efficiencies that could be achieved if decision makers choose when to spend their limited resources, as opposed to just where to spend them. PMID:28894004

Waiting can be an optimal conservation strategy, even in a crisis discipline.

PubMed

Iacona, Gwenllian D; Possingham, Hugh P; Bode, Michael

2017-09-26

Biodiversity conservation projects confront immediate and escalating threats with limited funding. Conservation theory suggests that the best response to the species extinction crisis is to spend money as soon as it becomes available, and this is often an explicit constraint placed on funding. We use a general dynamic model of a conservation landscape to show that this decision to "front-load" project spending can be suboptimal if a delay allows managers to use resources more strategically. Our model demonstrates the existence of temporal efficiencies in conservation management, which parallel the spatial efficiencies identified by systematic conservation planning. The optimal timing of decisions balances the rate of biodiversity decline (e.g., the relaxation of extinction debts, or the progress of climate change) against the rate at which spending appreciates in value (e.g., through interest, learning, or capacity building). We contrast the benefits of acting and waiting in two ecosystems where restoration can mitigate forest bird extinction debts: South Australia's Mount Lofty Ranges and Paraguay's Atlantic Forest. In both cases, conservation outcomes cannot be maximized by front-loading spending, and the optimal solution recommends substantial delays before managers undertake conservation actions. Surprisingly, these delays allow superior conservation benefits to be achieved, in less time than front-loading. Our analyses provide an intuitive and mechanistic rationale for strategic delay, which contrasts with the orthodoxy of front-loaded spending for conservation actions. Our results illustrate the conservation efficiencies that could be achieved if decision makers choose when to spend their limited resources, as opposed to just where to spend them.

In defense of derivations

NASA Astrophysics Data System (ADS)

Mungan, Carl E.

2016-05-01

At the 2015 AAPT Summer Meeting, I presented four derivations of the formula for motional emf. Such physics derivations involve the construction of explanatory frameworks involving diagrams and mathematical models. Although textbooks devote considerable space to such explanations, many teachers and students spend their time on worksheets, end-of-chapter problems, and the like. The book is reduced to a bank of solved (i.e., example) and unsolved (i.e., homework) questions, along with equations in colored boxes that presumably are to be used to answer those questions. Such an approach encourages fragmentation of knowledge, the view that there is only one right answer to a problem with the goal of physics being to find that answer (neatly boxed of course), and the inability to reason about even a slightly different (much less a novel) situation. If we are to develop scientific literacy, significant course time must be devoted to explaining the structure of and support for the models and equations we use.

Boom Time.

ERIC Educational Resources Information Center

Agron, Joe

1998-01-01

Examines building-cost trend data for educational facilities from the American School & University's 24th annual Official Education Construction Report for 1997. Data tables list education construction by projects completed; by projected spending; institution type; type of spending; projects projected for completion; and how construction costs…

Reference Pricing Changes The 'Choice Architecture' Of Health Care For Consumers.

PubMed

Robinson, James C; Brown, Timothy T; Whaley, Christopher

2017-03-01

Reference pricing in health insurance creates incentives for patients to select for nonemergency services providers that charge relatively low prices and still offer high quality of care. It changes the "choice architecture" by offering standard coverage if the patient chooses cost-effective providers but requires considerable consumer cost sharing if more expensive alternatives are selected. The short-term impact of reference pricing has been to shift patient volumes from hospital-based to freestanding surgical, diagnostic, imaging, and laboratory facilities. This article summarizes reference pricing's impacts to date on patient choice, provider prices, surgical complications, and employer spending and estimates its potential impacts if expanded to more services and a broader population. Reference pricing induces consumers to select lower-price alternatives for all of the forms of care studied, leading to significant reductions in prices paid and spending incurred by insurers and employers. The impact on consumer cost sharing is mixed, with some studies finding higher copayments and some lower. We conclude with a discussion of the incentives created for providers to redesign their clinical processes and for efficient providers to expand into price-sensitive markets. Over time, reference pricing may increase pressures for price competition and lead to further cost-reducing innovations in health care products and processes. Project HOPE—The People-to-People Health Foundation, Inc.

The benefits of bad economies: Business cycles and time-based work-life conflict.

PubMed

Barnes, Christopher M; Lefter, Alexandru M; Bhave, Devasheesh P; Wagner, David T

2016-04-01

Recent management research has indicated the importance of family, sleep, and recreation as nonwork activities of employees. Drawing from entrainment theory, we develop an expanded model of work-life conflict to contend that macrolevel business cycles influence the amount of time employees spend on both work and nonwork activities. Focusing solely on working adults, we test this model in a large nationally representative dataset from the Bureau of Labor Statistics that spans an 8-year period, which includes the "Great Recession" from 2007 through 2009. We find that during economic booms, employees work more and therefore spend less time with family, sleeping, and recreating. In contrast, in recessionary economies, employees spend less time working and therefore more time with family, sleeping, and recreating. Thus, we extend the theory on time-based work-to-family conflict, showing that there are potential personal and relational benefits for employees in recessionary economies. (c) 2016 APA, all rights reserved).

Issues in health care: interventional pain management at the crossroads.

PubMed

Manchikanti, Laxmaiah; Hirsch, Joshua A

2007-03-01

Emerging strategies in health care are extremely important for interventional pain physicians, as well as with the payors in various categories. While most Americans, including the US Congress and Administration, are looking for ways to provide affordable health care, the process of transformation and emerging health care strategies are troubling for physicians in general, and interventional pain physicians in particular. With the new Congress, only new issues rather than absolute solutions seem to emerge. Interventional pain physicians will continue to face the very same issues in the coming years that they have faced in previous years including increasing national health care spending, physician payment reform, ambulatory surgery center reform, and pay for performance. The national health expenditure data continue to extend the spending pattern that has characterized the 21st century, with US health spending continuing to outpace inflation and accounting for a growing share of the national economy. Health care spending in 2005 was $2.0 trillion or $6,697 per person and represented 16% of the gross domestic product. In 2005, Medicare spending reached $342 billion, while Medicaid spending was $315 billion. Physician and clinical services occupied approximately 21% of all US health care spending in 2005, reaching $421.2 billion. Overall, health spending in the US is expected to double to $4.1 trillion by 2016, then consuming 20% of the nation's gross domestic product, up from the current 16%. It is predicted that by 2016 the government will be paying 48.7% of the nation's health care bill, up from 38% in 1970 and 40% in 1990. The Medicare Physician Payment system based on the Sustainable Growth Rate (SGR) formula continues to be a major issue for physicians. The Congressional Budget Office has projected budget implications of change in the SGR mechanism, with consideration for allowing payment rates to increase by the amount of medical inflation, costing Medicare an estimated $218 billion from 2007 to 2016. Changes in the physician fee schedule in 2006 using the bottom-up methodology have resulted in significant cuts for interventional pain physicians performing procedures in an office setting. Medicaid physician payments and ambulatory surgery center payments for interventional techniques are proposed to be reduced substantially by Medicare and Medicaid, while hospital payments remain at stable levels with increases.

The Tell-Tale Look: Viewing Time, Preferences, and Prices

PubMed Central

Gunia, Brian C.; Murnighan, J. Keith

2015-01-01

Even the simplest choices can prompt decision-makers to balance their preferences against other, more pragmatic considerations like price. Thus, discerning people’s preferences from their decisions creates theoretical, empirical, and practical challenges. The current paper addresses these challenges by highlighting some specific circumstances in which the amount of time that people spend examining potential purchase items (i.e., viewing time) can in fact reveal their preferences. Our model builds from the gazing literature, in a purchasing context, to propose that the informational value of viewing time depends on prices. Consistent with the model’s predictions, four studies show that when prices are absent or moderate, viewing time provides a signal that is consistent with a person’s preferences and purchase intentions. When prices are extreme or consistent with a person’s preferences, however, viewing time is a less reliable predictor of either. Thus, our model highlights a price-contingent “viewing bias,” shedding theoretical, empirical, and practical light on the psychology of preferences and visual attention, and identifying a readily observable signal of preference. PMID:25581382

Making the Case: A Fact Sheet on Children and Youth in Out-of-School Time

ERIC Educational Resources Information Center

National Institute on Out of School Time, 2005

2005-01-01

This fact sheet resource is packed with the latest research and information on how children and youth spend their non-school hours, how they benefit from afterschool activities and much more. Sections include: (1) Children and youth today; (2) Health and well-being; (3) Children and youth spend time after school in a variety of ways; (4) Children…

Deciding when It's Time to Buy a New PC

ERIC Educational Resources Information Center

Goldsborough, Reid

2004-01-01

How to best decide when it's time to replace your PC, whether at home or at work, is always tricky. Spending on computers can make you more productive, but it's money you otherwise cannot spend, invest or save, and faster systems always await you in the future. What is clear is that the computer industry really wants you to buy, and the computer…

Reprioritizing government spending on health: pushing an elephant up the stairs?

PubMed

Tandon, Ajay; Fleisher, Lisa; Li, Rong; Yap, Wei Aun

2014-01-01

Countries vary widely with respect to the share of government spending on health, a metric that can serve as a proxy for the extent to which health is prioritized by governments. World Health Organization (WHO) data estimate that, in 2011, health's share of aggregate government expenditure averaged 12% in the 170 countries for which data were available. However, country differences were striking: ranging from a low of 1% in Myanmar to a high of 28% in Costa Rica. Some of the observed differences in health's share of government spending across countries are unsurprisingly related to differences in national income. However, significant variations exist in health's share of government spending even after controlling for national income. This paper provides a global overview of health's share of government spending and summarizes some of the key theoretical and empirical perspectives on allocation of public resources to health vis-à-vis other sectors from the perspective of reprioritization, one of the modalities for realizing fiscal space for health. The paper argues that theory and cross-country empirical analyses do not provide clear-cut explanations for the observed variations in government prioritization of health. Standard economic theory arguments that are often used to justify public financing for health are equally applicable to many other sectors including defence, education and infrastructure. To date, empirical work on prioritization has been sparse: available cross-country econometric analyses suggest that factors such as democratization, lower levels of corruption, ethnolinguistic homogeneity and more women in public office are correlated with higher shares of public spending on health; however, these findings are not robust and are sensitive to model specification. Evidence from case studies suggests that country-specific political economy considerations are key, and that results-focused reform efforts - in particular efforts to explicitly expand the breadth and depth of health coverage as opposed to efforts focused only on government budgetary benchmarking targets - are more likely to result in sustained and politically feasible prioritization of health from a fiscal space perspective.

Association between quality domains and health care spending across physician networks

PubMed Central

Rahman, Farah; Guan, Jun; Glazier, Richard H.; Brown, Adalsteinn; Bierman, Arlene S.; Croxford, Ruth; Stukel, Therese A.

2018-01-01

One of the more fundamental health policy questions is the relationship between health care quality and spending. A better understanding of these relationships is needed to inform health systems interventions aimed at increasing quality and efficiency of care. We measured 65 validated quality indicators (QI) across Ontario physician networks. QIs were aggregated into domains representing six dimensions of care: screening and prevention, evidence-based medications, hospital-community transitions (7-day post-discharge visit with a primary care physician; 30-day post-discharge visit with a primary care physician and specialist), potentially avoidable hospitalizations and emergency department (ED) visits, potentially avoidable readmissions and unplanned returns to the ED, and poor cancer end of life care. Each domain rate was computed as a weighted average of QI rates, weighting by network population at risk. We also measured overall and sector-specific per capita healthcare network spending. We evaluated the associations between domain rates, and between domain rates and spending using weighted correlations, weighting by network population at risk, using an ecological design. All indicators were measured using Ontario health administrative databases. Large variations were seen in timely hospital-community transitions and potentially avoidable hospitalizations. Networks with timely hospital-community transitions had lower rates of avoidable admissions and readmissions (r = -0.89, -0.58, respectively). Higher physician spending, especially outpatient primary care spending, was associated with lower rates of avoidable hospitalizations (r = -0.83) and higher rates of timely hospital-community transitions (r = 0.81) and moderately associated with lower readmission rates (r = -0.46). Investment in effective primary care services may help reduce burden on the acute care sector and associated expenditures. PMID:29614131

Time spent on home food preparation and indicators of healthy eating.

PubMed

Monsivais, Pablo; Aggarwal, Anju; Drewnowski, Adam

2014-12-01

The amount of time spent on food preparation and cooking may have implications for diet quality and health. However, little is known about how food-related time use relates to food consumption and spending, either at restaurants or for food consumed at home. To quantitatively assess the associations among the amount of time habitually spent on food preparation and patterns of self-reported food consumption, food spending, and frequency of restaurant use. This was a cross-sectional study of 1,319 adults in a population-based survey conducted in 2008-2009. The sample was stratified into those who spent <1 hour/day, 1-2 hours/day, and >2 hours/day on food preparation and cleanup. Descriptive statistics and multivariable regression models examined differences between time-use groups. Analyses were conducted in 2011-2013. Individuals who spent the least amount of time on food preparation tended to be working adults who placed a high priority on convenience. Greater amount of time spent on home food preparation was associated with indicators of higher diet quality, including significantly more frequent intake of vegetables, salads, fruits, and fruit juices. Spending <1 hour/day on food preparation was associated with significantly more money spent on food away from home and more frequent use of fast food restaurants compared to those who spent more time on food preparation. The findings indicate that time might be an essential ingredient in the production of healthier eating habits among adults. Further research should investigate the determinants of spending time on food preparation. Copyright © 2014 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Protection Against Wasteful Spending Act of 2014

THOMAS, 113th Congress

Rep. McKinley, David B. [R-WV-1

2014-06-23

House - 06/23/2014 Referred to the Committee on Oversight and Government Reform, and in addition to the Committee on Appropriations, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the... (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

Career Development and Promotion in an Academic Health Center.

PubMed

Christophersen, Edward R

2017-03-01

This paper examines the successive stages of the career path for psychologists who commit to spending their professional lives working in academic health centers. Key factors for success at each stage are described, as are the steps required for progressing to subsequent stages of professional development. The paper breaks new ground by including consideration of a post-retirement stage, "Professor Emeritus status."

Truth in Spending Act of 2013

THOMAS, 113th Congress

Rep. Kinzinger, Adam [R-IL-16

2013-06-26

House - 06/26/2013 Referred to the Committee on the Budget, and in addition to the Committee on Rules, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned. (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

Public Spending on Health Service and Policy Research in Canada, the United Kingdom, and the United States: A Modest Proposal

PubMed Central

Thakkar, Vidhi; Sullivan, Terrence

2017-01-01

Health services and policy research (HSPR) represent a multidisciplinary field which integrates knowledge from health economics, health policy, health technology assessment, epidemiology, political science among other fields, to evaluate decisions in health service delivery. Health service decisions are informed by evidence at the clinical, organizational, and policy level, levels with distinct, managerial drivers. HSPR has an evolving discourse spanning knowledge translation, linkage and exchange between research and decision-maker partners and more recently, implementation science and learning health systems. Local context is important for HSPR and is important in advancing health reform practice. The amounts and configuration of national investment in this field remain important considerations which reflect priority investment areas. The priorities set within this field or research may have greater or lesser effects and promise with respect to modernizing health services in pursuit of better value and better population outcomes. Within Canada an asset map for HSPR was published by the national HSPR research institute. Having estimated publicly-funded research spending in Canada, we sought identify best available comparable estimates from the United States and the United Kingdom. Investments from industry and charitable organizations were not included in these numbers. This commentary explores spending by the United States, Canada, and the United Kingdom on HSPR as a fraction of total public spending on health and the importance of these respective investments in advancing health service performance. Proposals are offered on the merits of common nomenclature and accounting for areas of investigation in pursuit of some comparable way of assessing priority HSPR investments and suggestions for earmarking such investments to total investment in health services spending. PMID:29179288

The effects of state-level expenditures for home- and community-based services on the risk of becoming a long-stay nursing home resident after hip fracture.

PubMed

Blackburn, J; Locher, J L; Morrisey, M A; Becker, D J; Kilgore, M L

2016-03-01

This study measures the effect of spending policies for long-term care services on the risk of becoming a long-stay nursing home resident after a hip fracture. Relative spending on community-based services may reduce the risk of long-term nursing home residence. Policies favoring alternative sources of care may provide opportunities for older adults to remain community-bound. This study aims to understand how long-term care policies affect outcomes by investigating the effect of state-level spending for home- and community-based services (HCBSs) on the likelihood of an individual's nursing home placement following hip fracture. This study uses data from the 5% sample of Medicare beneficiaries from 2005 to 2010 to identify incident hip fractures among dual-eligibility, community-dwelling adults aged at least 65 years. A multilevel generalized estimating equation (GEE) model estimated the association between an individual's risk of nursing home residence within 1 year and the percent of states' Medicaid long-term support service (LTSS) budget allocated to HCBS. Other covariates included expenditures for Title III services and individual demographic and health status characteristics. States vary considerably in HCBS spending, ranging from 17.7 to 83.8% of the Medicaid LTSS budget in 2009. Hip fractures were observed from claims among 7778 beneficiaries; 34% were admitted to a nursing home and 25% died within 1 year. HCBS spending was associated with a decreased risk of nursing home residence by 0.17 percentage points (p 0.056). Consistent with other studies, our findings suggest that state policies favoring an emphasis on HCBS may reduce nursing home residence among low-income older adults with hip fracture who are at high risk for institutionalization.

Using disease management and market reforms to address the adverse economic effects of drug budgets and price and reimbursement regulations in Germany.

PubMed

Schwermann, Tim; Greiner, Wolfgang; v d Schulenburg, J M Graf

2003-01-01

Germany spends the highest share (10.4%) of its gross domestic product on health care among European Union countries. The majority of this financing comes from an earmarked tax on labor earnings. Drug spending, as a share (12.7%), is relatively low, as is per-capita drug spending. Over the past decade, a number of specific budgeting initiatives were introduced to control drug spending-with some success, at least until the 11% increase in the first 6 months of 2001. This article describes and analyzes these governmental initiatives as well as other market reforms. Germany has had a "drug budget silo mentality" throughout this period. But the focus of the mentality moved rapidly from the central budget to regional budgets and to drug budgets per physician based on historical data. These amounts do not correspond to either medical necessity or economic considerations. An analysis of the health-care system as a whole shows that the efforts to constrain spending with budget in one area can lead to higher total costs. This article also considers the impact of introducing other actual or proposed reforms such as a positive list to replace the negative list, generic substitution, retail price competition among pharmacies, and E-health commerce. There is also a new national institute constructing a database of information on health technology assessments. To overcome the strong segmentation of the health system in physician, drug, and hospital budgets, we recommend using this information from proper cost-effectiveness evaluations to develop clear guidelines for disease management programs, reinforced by appropriate financial incentives.

Time well spent? Assessing nursing-supply chain activities.

PubMed

Ferenc, Jeff

2010-02-01

The amount of time nurses spend providing direct patient care seems to be continually eroding. So it's little wonder a survey conducted last year of critical care, OR nurses and nurse executives found that half of the 1600 respondents feel they spend too much time on supply chain duties. Most also said their supply chain duties impact patient safe ty and their ability to provide bedside care. Experts interviewed for this report believe it's time for supply chain leaders and nurses to develop a closer working partnership. Included are their recommendations to improve performance.

Problems associated with pooling mark-recapture data prior to estimating stopover length for migratory passerines

Treesearch

Sara R. Morris; Erica M. Turner; David A. Liebner; Amanda M. Larracuente; H. David Sheets

2005-01-01

One measure of the importance of a stopover site is the length of time that migrants spend at an area, however measuring the time birds spend at a stopover site has proven difficult. Most banding studies have presented only minimum length of stopover, based on the difference between initial capture and final recapture of birds that are captured more than once. Cormack-...

The Mental Health Parity and Addiction Equity Act Evaluation Study: Impact on Specialty Behavioral Health Care Utilization and Spending Among Carve-In Enrollees.

PubMed

Harwood, Jessica M; Azocar, Francisca; Thalmayer, Amber; Xu, Haiyong; Ong, Michael K; Tseng, Chi-Hong; Wells, Kenneth B; Friedman, Sarah; Ettner, Susan L

2017-02-01

The federal Mental Health Parity and Addiction Equity Act (MHPAEA) sought to eliminate historical disparities between insurance coverage for behavioral health (BH) treatment and coverage for medical treatment. Our objective was to evaluate MHPAEA's impact on BH expenditures and utilization among "carve-in" enrollees. We received specialty BH insurance claims and eligibility data from Optum, sampling 5,987,776 adults enrolled in self-insured plans from large employers. An interrupted time series study design with segmented regression analysis estimated monthly time trends of per-member spending and use before (2008-2009), during (2010), and after (2011-2013) MHPAEA compliance (N=179,506,951 member-month observations). Outcomes included: total, plan, patient out-of-pocket spending; outpatient utilization (assessment/diagnostic evaluation visits, medication management, individual and family psychotherapy); intermediate care utilization (structured outpatient, day treatment, residential); and inpatient utilization. MHPAEA was associated with increases in monthly per-member total spending, plan spending, assessment/diagnostic evaluation visits [respective immediate increases of: $1.05 (P=0.02); $0.88 (P=0.04); 0.00045 visits (P=0.00)], and individual psychotherapy visits [immediate increase of 0.00578 visits (P=0.00) and additional increases of 0.00017 visits/mo (P=0.03)]. MHPAEA was associated with modest increases in total and plan spending and outpatient utilization; for example, in July 2012 predicted per-enrollee plan spending was $4.92 without MHPAEA and $6.14 with MHPAEA. Efforts should focus on understanding how other barriers to BH care unaddressed by MHPAEA may affect access/utilization. Future research should evaluate effects produced by the Affordable Care Act's inclusion of BH care as an essential health benefit and expansion of MHPAEA protections to the individual and small group markets.

The daily lives of adolescents with an autism spectrum disorder

PubMed Central

Orsmond, Gael I.; Kuo, Hsin-Yu

2013-01-01

This study explores the daily lives, particularly discretionary time, of adolescents with an autism spectrum disorder (ASD). We describe the activities and activity partners of adolescents, the factors associated with their discretionary time use, and the impact of time use on their autism symptoms. Mothers of 103 adolescents with an ASD completed two 24-hour time diaries to describe their adolescent’s activity participation during the third wave of a longitudinal study. Adolescents with an ASD spent considerable time in discretionary activities, with watching television and using a computer as the most frequent activities. They most frequently spent discretionary time alone or with their mothers. They spent little time engaged in conversations or doing activities with peers. Age, gender, the presence of intellectual disability, severity of autism symptoms and maladaptive behaviors, the number of siblings, maternal education, marital status, and family income were associated with adolescent time use. Notably, greater time spent in conversation and reading predicted future decreases in severity of social impairment. The way that adolescents with an ASD spend their free time may have implications for their development and the course of their autism symptoms. PMID:21697194

Traditional Medicare Versus Private Insurance: How Spending, Volume, And Price Change At Age Sixty-Five.

PubMed

Wallace, Jacob; Song, Zirui

2016-05-01

To slow the growth of Medicare spending, some policy makers have advocated raising the Medicare eligibility age from the current sixty-five years to sixty-seven years. For the majority of affected adults, this would delay entry into Medicare and increase the time they are covered by private insurance. Despite its policy importance, little is known about how such a change would affect national health care spending, which is the sum of health care spending for all consumers and payers-including governments. We examined how spending differed between Medicare and private insurance using longitudinal data on imaging and procedures for a national cohort of individuals who switched from private insurance to Medicare at age sixty-five. Using a regression discontinuity design, we found that spending fell by $38.56 per beneficiary per quarter-or 32.4 percent-upon entry into Medicare at age sixty-five. In contrast, we found no changes in the volume of services at age sixty-five. For the previously insured, entry into Medicare led to a large drop in spending driven by lower provider prices, which may reflect Medicare's purchasing power as a large insurer. These findings imply that increasing the Medicare eligibility age may raise national health care spending by replacing Medicare coverage with private insurance, which pays higher provider prices than Medicare does. Project HOPE—The People-to-People Health Foundation, Inc.

Traditional Medicare Versus Private Insurance: How Spending, Volume, And Price Change At Age Sixty-Five

PubMed Central

Wallace, Jacob; Song, Zirui

2016-01-01

To slow the growth of Medicare spending, some policy makers have advocated raising the Medicare eligibility age from the current sixty-five years to sixty-seven years. For the majority of affected adults, this would delay entry into Medicare and increase the time they are covered by private insurance. Despite its policy importance, little is known about how such a change would affect national health care spending, which is the sum of health care spending for all consumers and payers—including governments. We examined how spending differed between Medicare and private insurance using longitudinal data on imaging and procedures for a national cohort of individuals who switched from private insurance to Medicare at age sixty-five. Using a regression discontinuity design, we found that spending fell by $38.56 per beneficiary per quarter—or 32.4 percent—upon entry into Medicare at age sixty-five. In contrast, we found no changes in the volume of services at age sixty-five. For the previously insured, entry into Medicare led to a large drop in spending driven by lower provider prices, which may reflect Medicare's purchasing power as a large insurer. These findings imply that increasing the Medicare eligibility age may raise national health care spending by replacing Medicare coverage with private insurance, which pays higher provider prices than Medicare does. PMID:27140993

Funding New Zealand's public healthcare system: time for an honest appraisal and public debate.

PubMed

Keene, Lyndon; Bagshaw, Philip; Nicholls, M Gary; Rosenberg, Bill; Frampton, Christopher M; Powell, Ian

2016-05-27

Successive New Zealand governments have claimed that the cost of funding the country's public healthcare services is excessive and unsustainable. We contest that these claims are based on a misrepresentation of healthcare spending. Using data from the New Zealand Treasury and the Organisation for Economic Cooperation and Development (OECD), we show how government spending as a whole is low compared with most other OECD countries and is falling as a proportion of GDP. New Zealand has a modest level of health spending overall, but government health spending is also falling as a proportion of GDP. Together, the data indicate the New Zealand Government can afford to spend more on healthcare. We identify compelling reasons why it should do so, including forecast growing health need, signs of increasing unmet need, and the fact that if health needs are not met the costs still have to be borne by the economy. The evidence further suggests it is economically and socially beneficial to meet health needs through a public health system. An honest appraisal and public debate is needed to determine more appropriate levels of healthcare spending.

A guide for digitising manuscript climate data

NASA Astrophysics Data System (ADS)

Brönnimann, S.; Annis, J.; Dann, W.; Ewen, T.; Grant, A. N.; Griesser, T.; Krähenmann, S.; Mohr, C.; Scherer, M.; Vogler, C.

2006-10-01

Hand-written or printed manuscript data are an important source for paleo-climatological studies, but bringing them into a suitable format can be a time consuming adventure with uncertain success. Before digitising such data (e.g., in the context a specific research project), it is worthwhile spending a few thoughts on the characteristics of the data, the scientific requirements with respect to quality and coverage, the metadata, and technical aspects such as reproduction techniques, digitising techniques, and quality control strategies. Here we briefly discuss the most important considerations according to our own experience and describe different methods for digitising numeric or text data (optical character recognition, speech recognition, and key entry). We present a tentative guide that is intended to help others compiling the necessary information and making the right decisions.

A guide for digitising manuscript climate data

NASA Astrophysics Data System (ADS)

Brönnimann, S.; Annis, J.; Dann, W.; Ewen, T.; Grant, A. N.; Griesser, T.; Krähenmann, S.; Mohr, C.; Scherer, M.; Vogler, C.

2006-05-01

Hand-written or printed manuscript data are an important source for paleo-climatological studies, but bringing them into a suitable format can be a time consuming adventure with uncertain success. Before starting the digitising work, it is worthwhile spending a few thoughts on the characteristics of the data, the scientific requirements with respect to quality and coverage, and on the different digitising techniques. Here we briefly discuss the most important considerations and report our own experience. We describe different methods for digitising numeric or text data, i.e., optical character recognition (OCR), speech recognition, and key entry. Each technique has its advantages and disadvantages that may become important for certain applications. It is therefore crucial to thoroughly investigate beforehand the characteristics of the manuscript data, define the quality targets and develop validation strategies.

Remembrance of weaning past: the seminal papers.

PubMed

Tobin, Martin J

2006-10-01

The approach to ventilator weaning has changed considerably over the past 30 years. Change has resulted from research in three areas: pathophysiology, weaning-predictor testing, and weaning techniques. Physiology research illuminated the mechanisms of weaning failure. It also uncovered markers of weaning success. Through more reliable prediction, patients whose weaning would have been tedious in the 1970s are now weaned more rapidly. The weaning story offers several lessons in metascience: importance of creativity, the asking of heretical questions, serendipity, mental-set psychology, cross-fertilization, and the hazards of precocity. Weaning research also illustrates how Kuhnian normal (me-too) science dominates any field. Making the next quantum leap in weaning will depend on spending less time on normal science and more on the raising (and testing) of maverick ideas.

Validation of an Open-Source Tool for Measuring Carotid Lumen Diameter and Intima-Media Thickness.

PubMed

Manterola, Hugo Luis; Lo Vercio, Lucas; Díaz, Alejandro; Del Fresno, Mariana; Larrabide, Ignacio

2018-05-14

In low- and middle-income regions, a relatively large number of deaths occur from cardiovascular disease or stroke. Carotid intima-media thickness (cIMT) and carotid lumen diameter (cLD) are strong indicators of cardiovascular event risk and stenosis severity, respectively. The interactive open-source software described here, Cimtool, is based on active contours for measuring these indicators in clinical practice and thus helping in preventive diagnosis and treatment. Cimtool was validated using carotid phantoms and real images obtained using ultrasound. Expert users measured cIMT and cLD in regular practice and also with Cimtool. The results obtained with Cimtool were then compared with the results for the manual approach in terms of measurement agreement, time spent on the measurements and usability. Intra-observer variability when using Cimtool was also analyzed. Statistical analysis revealed strong agreement between the manual method and Cimtool (p > 0.01 for cIMT and cLD). The correlation coefficient for both cIMT and cLD measurements was r > 0.9. Moreover, this software allowed the users to spend considerably less time on each measurement (3.5 min per study versus 50 s with Cimtool on average). An open-source, interactive, validated tool for measuring cIMT and cLD clinically was thus developed. Compared with the manual approach, Cimtool's straightforward measurement flow allows the user to spend less time per measurement and has less standard deviation. The coefficients of variation for measurements and intra-observer variability were lower than those reported for recent automated approaches, even with low-quality images. Copyright © 2018 World Federation for Ultrasound in Medicine and Biology. Published by Elsevier Inc. All rights reserved.

Dana's Minerals and How to Study Them, Fourth Edition

NASA Astrophysics Data System (ADS)

Cribb, Warner

Anyone who spends time in a geology lab, natural science museum, or rock and mineral shop can see that nature provides us with an incredible variety of minerals. Countless introductory geology students get “turned on” to the science of geology by studying minerals. Despite the development of modern instruments that enable rapid and detailed mineral, chemical, and atomic structural analysis, the study of minerals by hand sample remains one of the most popular and economical pursuits of many professional geologists, students, and amateur mineral enthusiasts.Because individuals with varying backgrounds in physical science collect and study minerals, a considerable need exists for a reference text that can be effectively used by both professionals and amateurs. Edward Salisbury Dana published the first such text, Minerals and How to Study Them, over a century ago. The third and last edition of this book was published in 1948. In the 50 years since, considerable changes have occurred in the understanding of mineral chemistry, crystallography, and microscopy. As a result, Dana's third edition is somewhat out of date, and its presentation of material is somewhat antiquated for modern-day readers.

Contaminant Control

ERIC Educational Resources Information Center

Bloech, Henning

2006-01-01

Five days a week, more than 55 million children, teachers and employees spend the majority of their waking hours in the U.S. school buildings. Besides being exposed to science, history and math, children and teachers are exposed to hundreds if not thousands of potentially hazardous chemicals and pollutants. Because children spend so much time in…

48 CFR 752.7028 - Differential and allowances.

Code of Federal Regulations, 2013 CFR

2013-10-01

... employees actually spend overseas on work under this contract. When such post differential is provided to... time such short-term employees spend at posts of duty in the Cooperating Country under this contract... stations for military or other reasons or because of imminent danger to their lives. If evacuation has been...

48 CFR 752.7028 - Differential and allowances.

Code of Federal Regulations, 2012 CFR

2012-10-01

... employees actually spend overseas on work under this contract. When such post differential is provided to... time such short-term employees spend at posts of duty in the Cooperating Country under this contract... stations for military or other reasons or because of imminent danger to their lives. If evacuation has been...

48 CFR 752.7028 - Differential and allowances.

Code of Federal Regulations, 2011 CFR

2011-10-01

... employees actually spend overseas on work under this contract. When such post differential is provided to... time such short-term employees spend at posts of duty in the Cooperating Country under this contract... stations for military or other reasons or because of imminent danger to their lives. If evacuation has been...

48 CFR 752.7028 - Differential and allowances.

Code of Federal Regulations, 2014 CFR

2014-10-01

... employees actually spend overseas on work under this contract. When such post differential is provided to... time such short-term employees spend at posts of duty in the Cooperating Country under this contract... stations for military or other reasons or because of imminent danger to their lives. If evacuation has been...

School Library Journal's Spending Survey

ERIC Educational Resources Information Center

Farmer, Lesley; Shontz, Marilyn

2009-01-01

This year's "School Library Journal's" spending survey showed that, despite the recession, the vast majority of media centers around the country have retained their credentialed media specialists. For example, almost 85% of elementary schools and more than 95% of middle and high schools have a full-time certified librarian. In addition, salaries…

Fleet of Foot: Adolescent Foot and Ankle Mobility

ERIC Educational Resources Information Center

Legacy, Kelly Bromley

2018-01-01

In today's world of advanced technologies, accessible transportation, and fingertip talking, adolescents are spending too many hours each day sedentary. The purpose of this article is to underscore the importance of foot and ankle mobility in an adolescent population that spends very little time on their feet. Physical educators and athletic…

The state of domestic affairs: Housework, gender and state-level institutional logics.

PubMed

Ruppanner, Leah; Maume, David J

2016-11-01

Multi-level cross-national research consistently shows individual housework arrangements are structured by broader contexts of equality. Across this body of research, the United States is treated as a single entity. Yet, individual-level housework time may vary by state-to-state differences in institutional market, family and legislative logics. To test these relationships, we pair individual-level data from the American Time Use Survey (2003-2012; aged 18 to 64 n = 106,190) with three state-level indices - female labor force empowerment, family traditionalism and state government liberalism. For market institutional logics, we find wives and husbands spend more but mothers less time in housework in states where women have more labor market power. For family logics, we find mothers spend more and husbands less time in housework in more traditional states. For legislative logics, we find women and husbands spend more time in housework in more liberal states. Our results highlight the importance of state-to-state institutional logics on individuals' housework time. Copyright © 2016 Elsevier Inc. All rights reserved.

Caring for the health of the public: cross sectional study of the activities of UK public health departments.

PubMed

Lawlor, D A; Morgan, K; Frankel, S

2002-03-01

The relative time spent in different areas of work in public health departments in the UK was assessed by means of a postal questionnaire. Departments spend one third of their time on population health work, this being similar to the amount of time spent on planning health services. Having a planning department in the health authority did not affect the amount of time spent in any area of work. Having a greater number of consultants in the department was associated with a tendency to spend more time on population health and being involved in training was associated with spending less time on planning. Public health departments in the UK are the only part of the health service with responsibility for the broader aspects of public health. Whilst the tensions between medical care and the wider influences upon population health may represent a false dichotomy, public health professionals must maintain a central focus of their work on the wider influences upon population health if balance is to be maintained within the National Health Service.

Induction for Radiology Patients

NASA Astrophysics Data System (ADS)

Yıldırım, Pınar; Tolun, Mehmet R.

This paper represents the implementation of an inductive learning algorithm for patients of Radiology Department in Hacettepe University hospitals to discover the relationship between patient demographics information and time that patients spend during a specific radiology exam. ILA has been used for the implementation which generates rules and the results are evaluated by evaluation metrics. According to generated rules, some patients in different age groups or birthplaces may spend more time for the same radiology exam than the others.

Explaining the increase in family financial pressures from medical bills between 2003 and 2007: do affordability thresholds change over time?

PubMed

Cunningham, Peter J

2011-06-01

This study examines whether affordability thresholds for medical care as defined by families change over time. The results from two nationally representative surveys show that while financial stress from medical bills--defined as the percent with problems paying medical bills--increased between 2003 and 2007, greater out-of-pocket spending accounted for this increase only for higher-income persons with employer-sponsored insurance coverage. Increased spending did not account for an increase in medical bill problems among lower-income persons. Moreover, the increase in medical bill problems among low-income persons occurred at relatively low levels of out-of-pocket spending rather than at higher levels. The results suggest that "affordability thresholds" for medical care as defined by individuals and families are not stable over time, especially for lower-income persons, which has implications for setting affordability standards in health reform.

Trends in Health Care Spending by the Private Sector

DTIC Science & Technology

1997-04-01

private - sector spending for health insurance increases each year has raised many questions about the meaning of the trend and its implications for the future. According to the federal government’s national health accounts (NHA), the annual growth rate of private health insurance expenditures tumbled from around 14 percent in 1990 to less than 3 percent in 1994 and 1995. Understanding the factors that contribute to that reduction is of particular concern to policymakers who are seeking ways to slow the growth of Medicare spending. At the same time that fundamental

An examination of flexible spending accounts.

PubMed

Cardon, J H; Showalter, M H

2001-11-01

This paper develops a framework for analyzing flexible spending account (FSA) participation and usage. We explore patterns of FSA usage using data from a benefits firm for 1996 including an examination of types of FSA expenditures and their timing. We estimate some simple econometric models of the participation decision and also the decision of how much to put into an FSA. Several pieces of evidence suggest that much of an FSA election amount is based on foreknowledge of expenditures. We also find that participants tend to spend their election amount early, thus obtaining an interest-free loan.

Steps toward dismantling poverty for working, poor women.

PubMed

Froehlich, Jeanette

2005-01-01

The majority of the world's poor people are women and many of them spend long hours doing paid and unpaid work. Pay inequities between men and women persist and income inequalities between the rich and poor are deepening. Working poor females, especially working poor mothers, struggle against considerable odds. This situation, and some steps that healthcare professionals can take toward dismantling poverty are addressed.

Buying time promotes happiness.

PubMed

Whillans, Ashley V; Dunn, Elizabeth W; Smeets, Paul; Bekkers, Rene; Norton, Michael I

2017-08-08

Around the world, increases in wealth have produced an unintended consequence: a rising sense of time scarcity. We provide evidence that using money to buy time can provide a buffer against this time famine, thereby promoting happiness. Using large, diverse samples from the United States, Canada, Denmark, and The Netherlands ( n = 6,271), we show that individuals who spend money on time-saving services report greater life satisfaction. A field experiment provides causal evidence that working adults report greater happiness after spending money on a time-saving purchase than on a material purchase. Together, these results suggest that using money to buy time can protect people from the detrimental effects of time pressure on life satisfaction.

Buying time promotes happiness

PubMed Central

Whillans, Ashley V.; Dunn, Elizabeth W.; Smeets, Paul; Bekkers, Rene; Norton, Michael I.

2017-01-01

Around the world, increases in wealth have produced an unintended consequence: a rising sense of time scarcity. We provide evidence that using money to buy time can provide a buffer against this time famine, thereby promoting happiness. Using large, diverse samples from the United States, Canada, Denmark, and The Netherlands (n = 6,271), we show that individuals who spend money on time-saving services report greater life satisfaction. A field experiment provides causal evidence that working adults report greater happiness after spending money on a time-saving purchase than on a material purchase. Together, these results suggest that using money to buy time can protect people from the detrimental effects of time pressure on life satisfaction. PMID:28739889

Do High Fidelity Wraparound Services for Youth with Serious Emotional Disturbances Save Money in the Long-Term?

PubMed

Snyder, Angela; Marton, James; McLaren, Susan; Feng, Bo; Zhou, Mei

2017-12-01

Treating youth with serious emotional disturbances (SED) is expensive often requiring institutional care. A significant amount of recent federal and state funding has been dedicated to expanding home and community-based services for these youth as an alternative to institutional care. High Fidelity Wraparound (Wrap) is an evolving, evidence-informed practice to help sustain community-based placements for youth with an SED through the use of intensive, customized care coordination among parents, multiple child-serving agencies, and providers. While there is growing evidence on the benefits of Wrap, few studies have examined health care spending associated with Wrap participation and none have examined spending patterns after the completion of Wrap. Merging health care spending data from multiple agencies and programs allows for a more complete picture of the health care costs of treating these youth in a system-of-care framework. (i) To compare overall health care spending for youth who transitioned from institutional care into Wrap (the treatment group) versus youth not receiving Wrap (the control group) and (ii) to compare changes in health care spending, overall and by category, for both groups before (the pre-period) and after (the post-period) Wrap participation. The treatment group (N=161) is matched to the control group (N=324) temporally based on the month the youth entered institutional care. Both total health care spending and spending by category are compared for each group pre- and post-Wrap participation. The post-period includes the time in which the youth was receiving Wrap services and one year afterwards to capture long-term cost impacts. In the year before Wrap participation, the treatment group averaged USD 8,433 in monthly health care spending versus USD 4,599 for the control group. Wrap participation led to an additional reduction of USD 1,130 in monthly health care spending as compared to the control group in the post-period. For youth participating in Wrap, these spending reductions were the result of decreases in mental health inpatient spending and general outpatient spending. Youth participating in Wrap had much higher average monthly costs than youth in the control group for the year prior to entering Wrap, suggesting that the intervention targeted youth with the highest mental health utilization and likely more complex needs. While both groups experienced reductions in spending, the treatment group experienced larger absolute reductions, but smaller relative reductions associated with participation. These differences were driven mainly by reductions in mental health inpatient spending. Larger reductions in general outpatient spending for the treatment group suggest spillover benefits in terms of physical health care spending. Further analysis is needed to assess how these spending changes impacted health outcomes. Wrap or similar programs may lead to reductions in health care spending. This is the first study to find evidence of longer-term spending reductions for up to a year after Wrap participation. Randomized trials or some other source of plausibly exogenous variation in Wrap participation is needed to further assess the causal impact of Wrap on health care spending, outcomes, or broader system-of-care spending.

Leisure time activities in teenagers in urban and rural areas.

PubMed

Borzecki, Andrzej; Nieradko, Barbara; Gnasś, Bogumiła; Sieklucka-Dziuba, Maria

2002-01-01

The work aimed to determine the leisure time activities in teenagers on weekdays, weekends, during winter and summer holidays. Vast majority of teenagers spend their leisure time resting in a passive way, i.e. watching TV or playing computer games irrespectively of the season. As a result of this, the number of kids with posture defects increase. On weekdays the country teenagers spend much more time doing outdoor sports and games than town children. They also more often help their parents and less frequently travel away from their homes than children living in towns.

Feeding methods and efficiencies of selected frugivorous birds

USGS Publications Warehouse

Foster, M.S.

1987-01-01

I report on handling methods and efficiencies of 26 species of Paraguayan birds freeding on fruits of Allophyllus edulis (Sapindaceae). A bird may swallow fruits whole (Type I: pluck and swallow feeders), hold a fruit and cut the pulp from the seed with the edge of the bill, swallowing the pulp but not the seed (Type II: cut or mash feeders), or take bites of pulp from a fruit that hangs from the tree or that is held and manipulated against a branch (Type III: push and bite feeders). In terms of absolute amount of pulp obtained from a fruit, and amount obtained per unit time. Type I species are far more efficient than Type II and III species. Bill morphology influences feeding methods but is not the only important factor. Diet breadth does not appear to be significant. Consideration of feeding efficiency relative to the needs of the birds indicates that these species need to spend relatively little time feeding to meet their estimated energetic needs, and that handling time has a relatively trivial effect on the time/energy budges of the bird species observed.

[Hygiene during leisure time among third year students from the Department of Nursing and Health Sciences].

PubMed

Czabak-Garbacz, Róza; Skibniewska, Agnieszka; Mazurkiewicz, Piotr; Wisowska, Anna

2002-01-01

The aim of the study was the assessment of hygiene of leisure time among third year students from Faculty of Nursing and Health Science of Lublin Medical Academy. It analysed passive and active ways of spending free time. The study involved 106 students (55 stationary and 51 extramural) and it was conducted by means of questionnaire. The study revealed that students prefer passive types of spending their leisure time. The most popular activity was listening to the radio, to which they devoted average 2.9 hours a day (listening to music mainly). Extramural students listened to the radio shorter than stationary ones (the difference was statistically significant). Students spent also a lot of their time watching television (average 1.5 hours a day), reading books and newspapers (average 1.85 hours a day) and doing housework, which is an active way of rest (average 2.7 hours a day), mainly preparing meals and shopping. Students devoted the least of their free time to sleep during the day in spite of the fact it is an excellent way of rest. The study found also that physical activity was not a favourite type of spending free time. Every third student did not do any sport. Stationary students did sport 4 times longer than extramural (the difference was statistically significant). Only 31% practiced taking a daily walk and only 44% of students made tourist trips. 81.9% of them went away during summer holidays, but only 31% of them during the winter break. Undoubtedly, the way of spending free time by the students under examination was not hygienic as it did not give them a sense of relaxation and rest; also the students themselves were not satisfied with it.

Cost efficiency and reimbursement of remote monitoring: a US perspective.

PubMed

Slotwiner, David; Wilkoff, Bruce

2013-06-01

Demographic and technological changes are driving increased utilization of cardiac implantable electronic devices (CIEDs) remote monitoring. In the USA, fee-for-service model of healthcare delivery, services rendered are valued based upon time, intensity, and technical or practice expense costs. As a consequence of this perspective, and to contain spending, Medicare has grouped physician services into families. Spending within each family of services must, by law, remain budget neutral. Cardiac implantable electronic devices monitoring services, remote and in-person, are grouped into one family. As the volume of services within this family increases, the individual encounters are destined to be discounted into ever decreasing portions. However, if the value of remote monitoring is demonstrated to extend beyond the previous boundaries of in-person interrogations, a rational request can be made to reconsider the relative value of remote monitoring. Outcome data supporting the value-added benefits of remote monitoring are rapidly accumulating, including (i) patient convenience, with reduced use of office services, (ii) equal safety compared with in-person evaluation, (iii) shorter detection time to actionable events (arrhythmias, cardiovascular disease progression, and device malfunction), (iv) reduced length of stay for hospitalizations, (v) reduced inappropriate shocks, (vi) increased battery longevity, and (vii) a relative reduction in the risk of death. Fully automatic wireless technology, only recently widely implemented, will add considerable clinical efficiencies and further increase the value of remote monitoring. The U.S. challenge will be to appropriately define the relative value of CIEDs remote monitoring now that outcome data have demonstrated its value extends beyond in-person interrogation.

The effect of healthcare delivery privatisation on avoidable mortality: longitudinal cross-regional results from Italy, 1993-2003.

PubMed

Quercioli, Cecilia; Messina, Gabriele; Basu, Sanjay; McKee, Martin; Nante, Nicola; Stuckler, David

2013-02-01

During the 1990s, Italy privatised a significant portion of its healthcare delivery. The authors compared the effectiveness of private and public sector healthcare delivery in reducing avoidable mortality (deaths that should not occur in the presence of effective medical care). The authors calculated the average rate of change in age-standardised avoidable mortality rates in 19 of Italy's regions from 1993 to 2003. Multivariate regression models were used to analyse the relationship between rates of change in avoidable mortality and levels of spending on public versus private healthcare delivery, controlling for potential demographic and economic confounders. Greater spending on public delivery of health services corresponded to faster reductions in avoidable mortality rates. Each €100 additional public spending per capita on NHS delivery was independently associated with a 1.47% reduction in the rate of avoidable mortality (p=0.003). In contrast, spending on private sector services had no statistically significant effect on avoidable mortality rates (p=0.557). A higher percentage of spending on private sector delivery was associated with higher rates of avoidable mortality (p=0.002). The authors found that neither public nor private sector delivery spending was significantly associated with non-avoidable mortality rates, plausibly because non-avoidable mortality is insensitive to healthcare services. Public spending was significantly associated with reductions in avoidable mortality rates over time, while greater private sector spending was not at the regional level in Italy.

"We want the world and we want it now": Materialism, time perspectives and problem spending tendency of Chinese.

PubMed

Ku, Lisbeth; Wu, Anise M S; Lao, Angie K P; Lam, Kerwin I N

2016-10-06

Chinese consumers' spending has been expanding rapidly in the past decade, and along with it household and credit card debt. The present research collected evidence to triangulate the contention that materialism is positively related with Chinese's problem spending tendency (PST), and that present-time-perspective (PTP) and future-time perspectives (FTP) interact systematically with materialism to affect PST. A survey of the general population in Macao, China (Study 1; N = 239) confirmed that materialism was positively correlated with PST. An interaction between materialism and PTP intensified the relationship, whereas an interaction with FTP weakened the relationship. Another survey with a sample of university students (Study 2; N = 223) again found positive relationships among PST, materialism, and PTP, as measured by temporal discount rate. But further exploration showed that PST was only related with temporal discounting among high materialists, but not among low materialists. Study 3 experimentally examined the causal effects of materialism and FTP on PST. When being primed of an orientation towards materialism (n = 33), the participants' planned consumption doubled that of the control group (n = 31). A FTP prime interacted with materialism prime and put a "damper" on participants' planned spending (n = 29), compared to their counterparts who were not primed of such a time perspective. © 2016 International Union of Psychological Science.

Rising Educational Expectations: Trends and Limits in Times of Economic Downturn

ERIC Educational Resources Information Center

Hart, Doug; Livingstone, D. W.

2009-01-01

Advocates for education have seized upon the current economic downturn as an opportunity to advance their cause. If governments are poised for an attempt to spend their way out of a deep recession, what better target than underfunded educational institutions, from daycare to universities? Public support for increased spending on education is…

40 CFR 35.4070 - How can my group spend TAG money?

Code of Federal Regulations, 2012 CFR

2012-07-01

... grant; and/or (3) Provide one-time health and safety training for your technical advisor to gain site... 40 Protection of Environment 1 2012-07-01 2012-07-01 false How can my group spend TAG money? 35.4070 Section 35.4070 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GRANTS AND OTHER FEDERAL...

Tough Choices in Tough Times: Debt and Medication Nonadherence

ERIC Educational Resources Information Center

Kalousova, Lucie; Burgard, Sarah A.

2014-01-01

Debt is a ubiquitous component of households' financial portfolios. Yet we have scant understanding of how household debt constrains spending on needed health care. Diverse types of debt have different financial properties and recent work has shown that they may have varying implications for spending on needed health care. In this article, we…

Current Issues in Early Childhood Education.

ERIC Educational Resources Information Center

Katz, Lilian G.

If present trends in family life and education continue into the next decade, most children under five will spend substantial proportions of their early years in various types of early childhood programs, most five- to six-year-olds will attend all-day kindergarten, and during their elementary school years they will spend much of their time before…

Problematic Internet Use and Body Mass Index in University Students

ERIC Educational Resources Information Center

Sari, Serkan Volkan; Aydin, Betül

2014-01-01

Problem Statement: Today, immobility and resulting weight gain constitutes one of the greatest problems among young people. The greatest problem for individuals spending a lot of time on the Internet is immobility. The result of this status is spending less energy than the amount required daily. Immobility is considered a cause of being…

Media and Risky Behaviors

ERIC Educational Resources Information Center

Escobar-Chaves, Soledad Liliana; Anderson, Craig A.

2008-01-01

Liliana Escobar-Chaves and Craig Anderson investigate two important trends among American youth and examine the extent to which the two trends might be related. First, the authors note that U.S. youth are spending increasing amounts of time using electronic media, with the average American youngster now spending one-third of each day with some…

38th Annual Maintenance & Operations Cost Study for Schools

ERIC Educational Resources Information Center

Agron, Joe

2009-01-01

Despite the worst economic environment in generations, spending by K-12 institutions on maintenance and operations (M&O) held its own--defying historical trends that have shown M&O spending among the most affected in times of budget tightening. This article presents data from the 38th annual Maintenance & Operations Cost Study for…

Physician pattern of patient notification of test results.

PubMed

Thiedke, Carolyn C; Hoeft, Katherine A; Pearson, William S

2005-01-01

To discover how community-based family physicians notify patients of test results and whether there are differences based on sex, length of time in practice, reimbursement status, employment status,or percentage of practice in managed care. We mailed a survey to 500 randomly selected members of the South Carolina chapter of the American Academy of Family Physicians. All analyses were preformed using SASTM version 8.2. Both descriptive and inferential statistics were used to analyze the collected data. A total of 367 physicians responded (73% response rate). The main outcome variable was the time each physician spent notifying patients of test results: a mean of 20.86 +/- 18.3 minutes per day(range 0-120 minutes/day). Women physicians and those with more than 75% managed care were significantly more likely to spend more than the median time notifying patients of test results. Physicians vary in the amount of time they spend notifying patients of their test results, with female physicians and those with more than 75% of their practice in managed care spending more time than do male physicians and physicians with less managed care.

Militarism and mortality. An international analysis of arms spending and infant death rates.

PubMed

Woolhandler, S; Himmelstein, D U

1985-06-15

Examination of data from 141 countries showed that infant mortality rates for 1979 were positively correlated with the proportion of gross national product devoted to military spending (r = 0.23, p less than 0.01) and negatively correlated with indicators of economic development, health resources, and social spending. In a multivariate analysis controlling for per caput gross national product, arms spending remained a significant positive predictor of infant mortality rate (p less than 0.0001), while the proportion of the population with access to clean water, the number of teachers per head, and caloric consumption per head were negative predictors. The multivariate model accounted for much of the observed variance in infant mortality rate (R2 = 0.78, p less than 0.0001), and showed good fit to similar data for the year 1972 (R2 = 0.80, p less than 0.0001). The model was also predictive of infant mortality rates in subgroup analysis of underdeveloped, middle developed, and developed nations. Analysis of time trends confirmed that an increase in military spending presages a poor record of improvement in infant mortality rate. These findings support the hypothesis that arms spending is causally related to infant mortality.

Financial trends of leading US oil companies: 1968-1984

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

Gal, N.; Sowell, E.

1985-01-01

There continues to be considerable official and public interest in various aspects of the financial performance of the oil industry. This paper traces the broad financial trends of a group of 21 leading US oil companies from 1968 through 1984. This is the most recent version, containing comprehensive full-year 1984 data, of a paper that has been released annually since 1979. Over time, the coverage of the paper has been expanded to provide more complete source material on financial trends and developments. Among the points illustrated by data in the paper and discussed in the text are the following. (1)more » Net income in 1984 was 14% below 1983 and 37% below the peak level reached in 1980. (2) The rate of return on stockholders' equity for the 21 oil companies was 11.1% in 1984, the lowest since 1972 and almost four percentage points below the average for non-petroleum manufacturing firms. (3) Capital expenditures rose slightly in 1984, after declining in the previous two years. The 1984 level of spending was 23% below the peak level attained in 1981. (4) Net long term debt increased substantially in 1984 as a result of a decline in net income and an increase in investment spending and in investments and advances (for subsidiaries and acquisitions). 5 figures, 6 tables.« less

Dementia and Out-of-Pocket Spending on Health Care Services

PubMed Central

Delavande, Adeline; Hurd, Michael D.; Martorell, Francisco; Langa, Kenneth M.

2014-01-01

Background High levels of out-of-pocket (OOP) spending for health care may lead patients to forego needed services and medications, as well as hamper their ability to pay for other essential goods. Dementia, because it leads to disability and the loss of independence may put patients and their families at risk for high OOP spending, especially for long-term care services. Methods We used data from the Aging, Demographics, and Memory Study, a nationally representative sub-sample (n=743) of the Health and Retirement Study, to determine whether individuals with dementia had higher self-reported OOP spending compared to those with cognitive impairment without dementia (CIND) and those with normal cognitive function. We also examined the relationship between dementia and utilization of dental care and prescription medications, two types of health care that are frequently paid for out-of-pocket. Multivariate and logistic regression models were used to adjust for the influence of potential confounders. Results After controlling for demographics and comorbidities, those with dementia had more than three times the yearly OOP spending compared to those with normal cognition ($8,216 for those with dementia vs. $2,570 for those with normal cognition, p<.01) Higher OOP spending for those with dementia was mainly driven by greater expenditures on nursing home care (p<.01). Dementia was not associated with the likelihood of visiting the dentist (p=0.76) or foregoing prescription medications due to cost (p=.34). Conclusions Dementia is associated with high levels of OOP spending, but not with the use of dental care or foregoing prescription medications, suggesting that excess OOP spending among those with dementia does not “crowd out” spending on these other health care services. PMID:23154049

Public health and the economy could be served by reallocating medical expenditures to social programs.

PubMed

Tran, Linda Diem; Zimmerman, Frederick J; Fielding, Jonathan E

2017-12-01

As much as 30% of US health care spending in the United States does not improve individual or population health. To a large extent this excess spending results from prices that are too high and from administrative waste. In the public sector, and particularly at the state level, where budget constraints are severe and reluctance to raise taxes high, this spending crowds out social, educational, and public-health investments. Over time, as spending on medical care increases, spending on improvements to the social determinants of health are starved. In California the fraction of General Fund expenditures spent on public health and social programs fell from 34.8% in fiscal year 1990 to 21.4% in fiscal year 2014, while health care increased from 14.1% to 21.3%. In spending more on healthcare and less on other efforts to improve health and health determinants, the state is missing important opportunities for health-promoting interventions with a strong financial return. Reallocating ineffective medical expenditures to proven and cost-effective public health and social programs would not be easy, but recognizing its potential for improving the public's health while saving taxpayers billions of dollars might provide political cover to those willing to engage in genuine reform. National estimates of the percent of medical spending that does not improve health suggest that approximately $5 billion of California's public budget for medical spending has no positive effect on health. Up to 10,500 premature deaths could be prevented annually by reallocating this portion of medical spending to public health. Alternatively, the same expenditure could help an additional 418,000 high school students to graduate.

Factors Associated With Increases in US Health Care Spending, 1996-2013

PubMed Central

Squires, Ellen; Bui, Anthony L.; Campbell, Madeline; Chapin, Abigail; Hamavid, Hannah; Horst, Cody; Li, Zhiyin; Matyasz, Taylor; Reynolds, Alex; Sadat, Nafis; Schneider, Matthew T.; Murray, Christopher J. L.

2017-01-01

Importance Health care spending in the United States increased substantially from 1995 to 2015 and comprised 17.8% of the economy in 2015. Understanding the relationship between known factors and spending increases over time could inform policy efforts to contain future spending growth. Objective To quantify changes in spending associated with 5 fundamental factors related to health care spending in the United States: population size, population age structure, disease prevalence or incidence, service utilization, and service price and intensity. Design and Setting Data on the 5 factors from 1996 through 2013 were extracted for 155 health conditions, 36 age and sex groups, and 6 types of care from the Global Burden of Disease 2015 study and the Institute for Health Metrics and Evaluation’s US Disease Expenditure 2013 project. Decomposition analysis was performed to estimate the association between changes in these factors and changes in health care spending and to estimate the variability across health conditions and types of care. Exposures Change in population size, population aging, disease prevalence or incidence, service utilization, or service price and intensity. Main Outcomes and Measures Change in health care spending from 1996 through 2013. Results After adjustments for price inflation, annual health care spending on inpatient, ambulatory, retail pharmaceutical, nursing facility, emergency department, and dental care increased by $933.5 billion between 1996 and 2013, from $1.2 trillion to $2.1 trillion. Increases in US population size were associated with a 23.1% (uncertainty interval [UI], 23.1%-23.1%), or $269.5 (UI, $269.0-$270.0) billion, spending increase; aging of the population was associated with an 11.6% (UI, 11.4%-11.8%), or $135.7 (UI, $133.3-$137.7) billion, spending increase. Changes in disease prevalence or incidence were associated with spending reductions of 2.4% (UI, 0.9%-3.8%), or $28.2 (UI, $10.5-$44.4) billion, whereas changes in service utilization were not associated with a statistically significant change in spending. Changes in service price and intensity were associated with a 50.0% (UI, 45.0%-55.0%), or $583.5 (UI, $525.2-$641.4) billion, spending increase. The influence of these 5 factors varied by health condition and type of care. For example, the increase in annual diabetes spending between 1996 and 2013 was $64.4 (UI, $57.9-$70.6) billion; $44.4 (UI, $38.7-$49.6) billion of this increase was pharmaceutical spending. Conclusions and Relevance Increases in US health care spending from 1996 through 2013 were largely related to increases in health care service price and intensity but were also positively associated with population growth and aging and negatively associated with disease prevalence or incidence. Understanding these factors and their variability across health conditions and types of care may inform policy efforts to contain health care spending. PMID:29114831

Attitudes of clinical faculty about career progress, career success and recognition, and commitment to academic medicine. Results of a survey.

PubMed

Buckley, L M; Sanders, K; Shih, M; Hampton, C L

2000-09-25

To assess attitudes about career progress, resources for career development, and commitment to academic medicine in physician faculty at an academic medical center who spend more than 50% of their time in clinical care. Faculty survey. Academic medical center and associated Veterans Affairs medical center. A total of 310 physician faculty responded to the survey. Half of the faculty reported spending 50% or less of their time in clinical care (mean, 31% of time) (group 1) and half reported spending more than 50% of their time in clinical care (mean, 72% of time) (group 2). Group 2 faculty had one third of the time for scholarly activities, reported slower career progress, and were less likely to be at the rank of professor (40% and 16% for groups 1 and 2, respectively; P<.001) or to be tenured (52% and 26%, respectively; P<.001) despite similar age and years on faculty. Group 2 faculty were 50% more likely to report that tenure and promotion criteria were not reviewed at their annual progress report (P =.003) and that they did not understand the criteria (P<.001). Group 2 faculty valued excellence in patient care over scholarship and national visibility. Group 2 faculty reported greater dissatisfaction with academic medicine and less commitment to a career in academic medicine. Physician faculty who spend more than 50% of their time in clinical care have less time, mentoring, and resources needed for development of an academic career. These obstacles plus differences in their attitudes about career success and recognition contribute to significant differences in promotion. These factors are associated with greater dissatisfaction with academic medicine and lower commitment to academic careers.

Introducing a checking technician allows pharmacists to spend more time on patient-focused activities.

PubMed

Napier, Patti; Norris, Pauline; Braund, Rhiannon

2018-04-01

Internationally there is an increasing focus on the clinical and cognitive services that pharmacists can provide. Lack of time has been identified as a barrier to pharmacists increasing their clinical activities. Within the pharmacy workplace there are many tasks that can only be performed by a pharmacist. The final accuracy check of a dispensed prescription is currently the sole responsibility of pharmacists in New Zealand. This takes up a significant amount of time during a pharmacist's work day. The introduction of a checking technician role has been suggested to allow pharmacists more time to do more patient focused work. To investigate the amount of time pharmacy staff spend on specific activities and to establish whether the introduction of a checking technician into twelve pilot sites increased the amount of time that the pharmacists could spend on patient focused activities. This study utilised a self-reported work sampling technique in twelve pilot sites, selected from both the hospital and community settings. Work sampling using an electronic device was conducted at two time-points (before the implementation of a Pharmacy Accuracy Checking Technician (PACT) role and when the PACT was in place). Data was collected at 10 min intervals for the period of five days, a working week. Tasks were grouped into patient focused, dispensing and personal activities. The introduction of the PACT into the pilot sites saw a mean increase of 19% in pharmacists' patient focused activities and a mean 20% decrease in dispensing activities. The introduction of a checking technician role into New Zealand pharmacies demonstrated the potential to provide pharmacists with more time to spend on patient focused activities. Copyright © 2017 Elsevier Inc. All rights reserved.

Reducing children's television-viewing time: a qualitative study of parents and their children.

PubMed

Jordan, Amy B; Hersey, James C; McDivitt, Judith A; Heitzler, Carrie D

2006-11-01

The American Academy of Pediatrics recommends that children over age 2 years spend < or = 2 hours per day with screen media, because excessive viewing has been linked to a plethora of physical, academic, and behavioral problems. The primary goal of this study was to qualitatively explore how a recommendation to limit television viewing might be received and responded to by a diverse sample of parents and their school-age children. The study collected background data about media use, gathered a household media inventory, and conducted in-depth individual and small group interviews with 180 parents and children ages 6 to 13 years old. Most of the children reported spending approximately 3 hours per day watching television. The average home in this sample had 4 television sets; nearly two thirds had a television in the child's bedroom, and nearly half had a television set in the kitchen or dining room. Although virtually all of the parents reported having guidelines for children's television viewing, few had rules restricting the time children spend watching television. Data from this exploratory study suggest several potential barriers to implementing a 2-hour limit, including: parents' need to use television as a safe and affordable distraction, parents' own heavy television viewing patterns, the role that television plays in the family's day-to-day routine, and a belief that children should spend their weekend leisure time as they wish. Interviews revealed that for many of these families there is a lack of concern that television viewing is a problem for their child, and there remains confusion about the boundaries of the recommendation of the American Academy of Pediatrics. Parents in this study expressed interest in taking steps toward reducing children's television time but also uncertainty about how to go about doing so. Results suggest possible strategies to reduce the amount of time children spend in front of the screen.

Health care spending growth: can we avoid fiscal Armageddon?

PubMed

Chernew, Michael

Both private and public payers have experienced a persistent rise in health care spending that has exceeded income growth. The issue now transcends the health care system because health care spending growth threatens the fiscal health of the nation. This paper examines the causes and consequences of health care spending growth. It notes that the determinants of spending growth may differ from the determinants of high spending at a point in time. Specifically, the evidence overwhelmingly suggests that the primary driver ofinflation-adjusted, per capita spending growth over the past decades (and thus premium growth) has been the diffusion of new medical technology. The paper argues that while new technology has provided significant clinical benefit, we can no longer afford the persistent gap between health spending and income growth. In simple terms, if the economy is growing 2%, we cannot afford persistent health care spending growth of 4%. Growth in public spending is particularly important. If not abated, high public spending will require either substantially higher taxes or debt, both of which could lead to fiscal Armageddon. Growth in private spending also threatens economic well-being by forcing more resources toward health care and away from other sectors. For example, since the cost of employer-based coverage is always borne by employees (directly or indirectly), salary increases and health care cost increases cannot continue on together. To avoid economic disaster, payers will be forced to have a greater resolve in the future. Specifically, because neither public nor private payers will be able to finance growing health care spending, the coming decade will likely experience significant changes in health care financing. Consumers may be asked to pay more out of pocket when they seek care and both public and private payers will put increasing pressure on payment rates. Furthermore, payment rates to providers are likely to rise more slowly than in the past, likely by less than inflation, and a new form of payment that bundles reimbursement across providers and services will be implemented. All stakeholders, particularly health care providers, will need to adapt to the pressure. Ideally, this will lead to more efficient care delivery that will require a partnership among major stakeholders to develop systems of managing population health in ways that promote affordable, high-quality outcomes.

Young people's time use and maternal employment in the UK.

PubMed

Mullan, Killian

2009-12-01

This paper analyses the relationship between young people's time use and maternal employment in the United Kingdom (UK). Two dimensions of young people's time use are important for understanding the impact of maternal employment. The first of these is family context. This concerns the time young people are near their parents or not. The second relates to young people's activity patterns. Combining information from both dimensions is necessary to provide a comprehensive overview of the impact of maternal employment on young people's time use. The paper demonstrates that young people's time use is associated with maternal employment both in terms of activity patterns and family context. Young people with employed mothers spend more time alone with a father, and more time with neither parent. More specifically, young people with mothers employed full time (FT) spend significantly more time watching TV than those whose mothers are not employed, especially when they are not near any parents. There is a negative association between FT maternal employment and the time young people spend in achievement-related activities, concentrated in time when alone with a mother. Unlike time in leisure activities or time watching TV, time in achievement-related activities when in the presence of a father does not increase to compensate for the loss in time spent in achievement-related activities when alone with a mother.

Policy Makers Will Need A Way To Update Bundled Payments That Reflects Highly Skewed Spending Growth Of Various Care Episodes

PubMed Central

Rosen, Allison B.; Aizcorbe, Ana; Ryu, Alexander J.; Nestoriak, Nicole; Cutler, David M.; Chernew, Michael E.

2015-01-01

Bundled payment entails paying a single price for all services delivered as part of an episode of care for a specific condition. It is seen as a promising way to slow the growth of health care spending while maintaining or improving the quality of care. To implement bundled payment, policy makers must set base payment rates for episodes of care and update the rates over time to reflect changes in the costs of delivering care and the components of care. Adopting the fee-for-service paradigm of adjusting payments with uniform update rates would be fair and accurate if costs increased at a uniform rate across episodes. But our analysis of 2003 and 2007 US commercial claims data showed spending growth to be highly skewed across episodes: 10 percent of episodes accounted for 82.5 percent of spending growth, and within-episode spending growth ranged from a decline of 75 percent to an increase of 323 percent. Given that spending growth was much faster for some episodes than for others, a situation known as skewness, policy makers should not update episode payments using uniform update rates. Rather, they should explore ways to address variations in spending growth, such as updating episode payments one by one, at least at the outset. PMID:23650329

[Colombian Health spending 1993-2003: its composition and trends].

PubMed

Barón-Leguizamón, Gilberto

2007-01-01

Analysing the magnitude, composition, evolution and trends in Colombian national spending on health, forming a proposal and making an important contribution towards knowledge re the reality of social health security. The results obtained respond to an ongoing effort to systematise and standardise the adopted methodology and update calculations and estimates for the eleven-year period during which Law 100/1993 was being reformed. Analysing the above led to identifying changes in the flow of resources and establishing objective comparisons according to current/available international standards. The project began in the Colombian Planning Department (lasting 5 years) and was then passed to the Ministry of Social Protection's Health Reform Support Programme where new institutional scope has been applied during the last four years. Perhaps the work's most important contribution consists of producing annual estimates of total public and private spending on health as a time-series, for a relatively significant period. The results confirm fulfilment of the reform's suppositions in terms of the significant amount of resources channelled to the sector, the important substitution of financing private spending for spending on health insurance, greater dynamism and the importance of public funds in financing total spending and the managing of an important segment of such resources by some of the new agents created by the reform. This contrasts with the little importance paid to spending on promotion and prevention and on public health and basic attention programmes.

The economic impact of NASA R and D spending Appendices

NASA Technical Reports Server (NTRS)

Evans, M. K.

1976-01-01

Seven appendices related to a previous report on the economic impact of NASA R and D spending were presented. They dealt with: (1) theoretical and empirical development of aggregate production functions, (2) the calculation of the time series for the rate of technological progress, (3) the calculation of the industry mix variable, (4) the estimation of distributed lags, (5) the estimation of the equations for gamma, (6) a ten-year forecast of the U.S. economy, (7) simulations of the macroeconomic model for increases in NASA R and D spending of $1.0, $.0.5, and 0.1 billions.

Inventory information approval system certification and flexible spending account purchases.

PubMed

Shuey, Brandon; Williams, La Vonn A

2010-01-01

There is no question that 2009 was a year of change within the pharmacy industry. Several new requirements were implemented, including the need for an Inventory Information Approval System for accepting flexible spending or health reimbursement account cords. Some pharmacies relied on the 90% exemption rule, which is discussed within this article, or an alternative method to avoid the expense of a point of sale. However, with flexible spending or health reimbursement account card participation expected to reach 85% in 2010, now bay be the time for compounding pharmacists to weigh the pros and cons of Inventory Information Approval System certification.

Personal and organizational influences to the use of fire and fuels research by federal agency managers

Treesearch

Vita Wright

2008-01-01

The Joint Fire Science Program (JFSP) and the National Fire Plan (NFP) spend considerable amounts of money on fire and fuels research. From Fiscal Year 1998-2006, the JFSP spent approximately $145 million, and from Fiscal Year 2001-2005, the NFP spent approximately $104 million on research. For the costs of research to be fully realized, it is critical that science...

A Profile of Women Potentially Eligible for the Displaced Homemaker Program under the Comprehensive Employment and Training Act of 1978.

ERIC Educational Resources Information Center

Shaw, Lois B.

In recent years considerable concern has been expressed for the plight of the displaced homemaker, a women who, after spending many years working in the home, must reenter the labor market to provide the primary support for a family. In 1978 Congress added to Title 3 of the Comprehensive Employment and Training Act a special program to assist…

Paying for Highways, Airways, and Waterways: How can Users be Charged?

DTIC Science & Technology

1992-05-01

publication. Robert D. Reischauer Director May 1992 Contents SUMMARY xi ONE INTRODUCTION Federal Financing of the Transportation Infrastructure 1 Economic...Federal Spending on Highways 13 Cm rent Financing Policy 13 Costs and Efficient Charges 17 Other Considerations in Adopting New User Charges 27...Conclusion 28 THREE AIRWAYS 29 Background 30 Current Financing Policy 34 The Relationship of Taxes to Costs of ATC 37 Alternative Financing Mechanisms 41

Patient out-of-pocket spending in cranial neurosurgery: single-institution analysis of 6569 consecutive cases and literature review.

PubMed

Yoon, Seungwon; Mooney, Michael A; Bohl, Michael A; Sheehy, John P; Nakaji, Peter; Little, Andrew S; Lawton, Michael T

2018-05-01

OBJECTIVE With drastic changes to the health insurance market, patient cost sharing has significantly increased in recent years. However, the patient financial burden, or out-of-pocket (OOP) costs, for surgical procedures is poorly understood. The goal of this study was to analyze patient OOP spending in cranial neurosurgery and identify drivers of OOP spending growth. METHODS For 6569 consecutive patients who underwent cranial neurosurgery from 2013 to 2016 at the authors' institution, the authors created univariate and multivariate mixed-effects models to investigate the effect of patient demographic and clinical factors on patient OOP spending. The authors examined OOP payments stratified into 10 subsets of case categories and created a generalized linear model to study the growth of OOP spending over time. RESULTS In the multivariate model, case categories (craniotomy for pain, tumor, and vascular lesions), commercial insurance, and out-of-network plans were significant predictors of higher OOP payments for patients (all p < 0.05). Patient spending varied substantially across procedure types, with patients undergoing craniotomy for pain ($1151 ± $209) having the highest mean OOP payments. On average, commercially insured patients spent nearly twice as much in OOP payments as the overall population. From 2013 to 2016, the mean patient OOP spending increased 17%, from $598 to $698 per patient encounter. Commercially insured patients experienced more significant growth in OOP spending, with a cumulative rate of growth of 42% ($991 in 2013 to $1403 in 2016). CONCLUSIONS Even after controlling for inflation, case-mix differences, and partial fiscal periods, OOP spending for cranial neurosurgery patients significantly increased from 2013 to 2016. The mean OOP spending for commercially insured neurosurgical patients exceeded $1400 in 2016, with an average annual growth rate of 13%. As patient cost sharing in health insurance plans becomes more prevalent, patients and providers must consider the potential financial burden for patients receiving specialized neurosurgical care.

The Mental Health Parity and Addiction Equity Act Evaluation Study: Impact on Specialty Behavioral Healthcare Utilization and Spending Among Carve-In Enrollees

PubMed Central

Harwood, Jessica M.; Azocar, Francisca; Thalmayer, Amber; Xu, Haiyong; Ong, Michael K.; Tseng, Chi-Hong; Wells, Kenneth B.; Friedman, Sarah; Ettner, Susan L.

2016-01-01

Objective The federal Mental Health Parity and Addiction Equity Act (MHPAEA) sought to eliminate historical disparities between insurance coverage for behavioral health (BH) treatment and coverage for medical treatment. Our objective was to evaluate MHPAEA’s impact on BH expenditures and utilization among “carve-in” enrollees. Method We received specialty BH insurance claims and eligibility data from Optum, sampling 5,987,776 adults enrolled in self-insured plans from large employers. An interrupted time series study design with segmented regression analysis estimated monthly time trends of per-member spending and use before (2008–2009), during (2010), and after (2011–2013) MHPAEA compliance (N=179,506,951 member-month observations). Outcomes included: total, plan, patient out-of-pocket spending; outpatient utilization (assessment/diagnostic evaluation visits; medication management; individual and family psychotherapy); intermediate care utilization (structured outpatient; day treatment; residential); and inpatient utilization. Results MHPAEA was associated with increases in monthly per-member total spending, plan spending, assessment/diagnostic evaluation visits (respective immediate increases of: $1.05 [p=0.02]; $0.88 [p=0.04]; 0.00045 visits [p=0.00]), and individual psychotherapy visits (immediate increase of 0.00578 visits [p=0.00] and additional increases of 0.00017 visits/month [p=0.03]). Conclusions MHPAEA was associated with modest increases in total and plan spending and outpatient utilization; e.g., in July 2012 predicted per-enrollee plan spending was $4.92 without MHPAEA and $6.14 with MHPAEA. Efforts should focus on understanding how other barriers to BH care unaddressed by MHPAEA may affect access/utilization. Future research should evaluate effects produced by the Affordable Care Act’s inclusion of BH care as an essential health benefit and expansion of MHPAEA protections to the individual and small group markets. PMID:27632769

The interplay of couple's shared time, women's intimacy, and intradyadic stress.

PubMed

Milek, Anne; Butler, Emily A; Bodenmann, Guy

2015-12-01

Theoretically, spending time together should be central for couples to build intimacy and should be associated with less relationship stress; however, few empirical studies have examined these links. The present study used 14 days of diary data from 92 women to investigate the interplay between the amount of time they spent with their partner (shared time), intimacy, and daily stress originating inside the relationship (intradyadic stress) on a within- and between-personal level. Multilevel analyses revealed moderation patterns: For example, when women spent more time with their partners than usual on a weekday with low levels of intradyadic stress, they reported higher intimacy. These associations varied substantially between women and were weaker on the weekend or on days with high levels of intradyadic stress. At the between-person level, higher average shared time appeared to buffer the negative association between intradyadic stress and intimacy. Our results suggest that daily fluctuations in intradyadic stress, intimacy, and shared time may have different implications compared with aggregated amounts of those variables. Spending more time together on a weekday with low intimacy might be linked to more intradyadic stress, but aggregated over the long run, spending more time together may provide opportunities for stress resolution and help couples to maintain their intimacy. (c) 2015 APA, all rights reserved).

Do Expenditures Other than Instructional Expenditures Affect Graduation and Persistence Rates in American Higher Education?

ERIC Educational Resources Information Center

Webber, Douglas A.; Ehrenberg, Ronald G.

2010-01-01

During the last two decades, median instructional spending per full-time equivalent (FTE) student at American 4-year colleges and universities has grown at a slower rate than median spending per FTE student in a number of other expenditure categories, including academic support, student services and research. Our paper uses institutional level…

Florida's Past and Future Roles in Education Finance Reform Litigation

ERIC Educational Resources Information Center

Bauries, Scott R.

2006-01-01

The state of Florida has since the time of "San Antonio v. Rodriguez" an education finance system called the Florida Education Finance Plan (FEFP), which makes substantial effort to equalize per-pupil spending in all of the state's school districts, while recognizing the local factors that may necessitate changes in that spending. Still,…

Divorced Parents' Qualitative and Quantitative Reports of Children's Living Arrangements

ERIC Educational Resources Information Center

Lin, I-fen; Schaeffer, Nora Cate; Seltzer, Judith A.; Tuschen, Kay L.

2004-01-01

We use data from a sample of divorced parents in Wisconsin (N=1,392) to examine how parents describe their children's living arrangements. When the children spend substantial time in both parents homes, both parents are less likely to use the phrase live with to describe living arrangements. When children spend most nights with their mother,…

Teaching about the Holocaust--A Resource Guide

ERIC Educational Resources Information Center

Russell, William Benedict, III

2005-01-01

Teaching about the Holocaust is an emotional process that can be extremely difficult, especially without the proper resources. Most teachers spend one or two class periods on the Holocaust and usually cram the lesson into a unit on World War II. As a teacher, the author understands that time is short and that it is impossible to spend the…

Tax Expert Offers Ideas for Monitoring Big Spending on College Sports

ERIC Educational Resources Information Center

Sander, Libby

2009-01-01

The federal government could take a cue from its regulation of charitable organizations in monitoring the freewheeling fiscal habits of big-time college athletics, a leading tax lawyer says. The author reports on the ideas offered by John D. Colombo, a professor at the University of Illinois College of Law, for monitoring big spending on college…

A Framework for the Design of Effective Graphics for Scientific Visualization

NASA Technical Reports Server (NTRS)

Miceli, Kristina D.

1992-01-01

This proposal presents a visualization framework, based on a data model, that supports the production of effective graphics for scientific visualization. Visual representations are effective only if they augment comprehension of the increasing amounts of data being generated by modern computer simulations. These representations are created by taking into account the goals and capabilities of the scientist, the type of data to be displayed, and software and hardware considerations. This framework is embodied in an assistant-based visualization system to guide the scientist in the visualization process. This will improve the quality of the visualizations and decrease the time the scientist is required to spend in generating the visualizations. I intend to prove that such a framework will create a more productive environment for tile analysis and interpretation of large, complex data sets.

Listening, Watching, and Reading: The Structure and Correlates of Entertainment Preferences

PubMed Central

Rentfrow, Peter J.; Goldberg, Lewis R.; Zilca, Ran

2010-01-01

People spend considerable amounts of time and money listening to music, watching TV and movies, and reading books and magazines, yet almost no attention in psychology has been devoted to understanding individual differences in preferences for such entertainment. The present research was designed to examine the structure and correlates of entertainment genre preferences. Analyses of the genre preferences of over 3,000 individuals revealed a remarkably clear factor structure. Using multiple samples, methods, and geographic regions, data converged to reveal five entertainment-preference dimensions: Communal, Aesthetic, Dark, Thrilling, and Cerebral. Preferences for these entertainment dimensions were uniquely related to demographics and personality traits. Results also indicated that personality accounted for significant proportions of variance in entertainment preferences over and above demographics. The results provide a foundation for developing and testing hypotheses about the psychology of entertainment preferences. PMID:20649744

Heliophysics Data and Modeling Research Using VSPO

NASA Technical Reports Server (NTRS)

Roberts, D. Aaron; Hesse, Michael; Cornwell, Carl

2007-01-01

The primary advantage of Virtual Observatories in scientific research is efficiency: rapid searches for and access to data in convenient forms makes it possible to explore scientific questions without spending days or weeks on ancilary tasks. The Virtual Space Physics Observatory provides a general portal to Heliophysics data for this task. Here we will illustrate the advantages of the VO approach by examining specific geomagnetically active times and tracing the activity through the Sun-Earth system. In addition to previous and additional data sources, we will demonstrate an extension of the capabilities to allow searching for model run results from the range of CCMC models. This approach allows the user to quickly compare models and observations at a qualitative level; considerably more work will be needed to develop more seamless connections to data streams and the equivalent numerical output from simulations.

Contraceptive use in a changing service environment: evidence from Indonesia during the economic crisis.

PubMed

Frankenberg, Elizabeth; Sikoki, Bondan; Suriastini, Wayan

2003-06-01

In the late 1990s, most Southeast Asian countries experienced substantial economic downturns that reduced social-sector spending and decreased individuals' spending power. Data from Indonesia were collected in 1997 (just before the crisis) and in 1998 (during the crisis) that are used in this study to examine changes in the contraceptive supply environment and in women's choices regarding contraceptive use. Despite substantial changes in providers' characteristics during the first year of the crisis, no statistically significant differences are found between 1997 and 1998 in overall levels of prevalence, in unmet need, or in method mix. Women's choices regarding source of contraceptive supplies, however, changed considerably over the period. Changes in the contraceptive supply environment are linked here to changes in women's choice of source of supply, and a number of providers' characteristics are found to be significantly associated with women's choices in this regard.

Annual Movement Patterns of Endangered Ivory Gulls: The Importance of Sea Ice

PubMed Central

Spencer, Nora C.; Gilchrist, H. Grant; Mallory, Mark L.

2014-01-01

The ivory gull (Pagophila eburnea) is an endangered seabird that spends its entire year in the Arctic environment. In the past three decades, threats from various sources have contributed to a >70% decline in Canada. To assess the annual habitat needs of this species, we attached satellite transmitters to 12 ivory gulls on Seymour Island, Nunavut in 2010, which provided up to four breeding seasons of tracking data. Analysis of migratory behaviour revealed considerable individual variation of post-breeding migratory route selection. Ivory gulls traveled a median of 74 days during post-breeding migration, but only 18 days during pre-breeding migration. In contrast to predictions, ivory gulls did not use the Greenland coast during migratory periods. Ivory gulls overwintered near the ice edge in Davis Strait, but also used the Labrador Sea in late February and March. We suggest that the timing of formation and recession and extent of sea ice plays a large role in ivory gull distribution and migratory timing. PMID:25551556

Automatic Differentiation in Quantum Chemistry with Applications to Fully Variational Hartree-Fock.

PubMed

Tamayo-Mendoza, Teresa; Kreisbeck, Christoph; Lindh, Roland; Aspuru-Guzik, Alán

2018-05-23

Automatic differentiation (AD) is a powerful tool that allows calculating derivatives of implemented algorithms with respect to all of their parameters up to machine precision, without the need to explicitly add any additional functions. Thus, AD has great potential in quantum chemistry, where gradients are omnipresent but also difficult to obtain, and researchers typically spend a considerable amount of time finding suitable analytical forms when implementing derivatives. Here, we demonstrate that AD can be used to compute gradients with respect to any parameter throughout a complete quantum chemistry method. We present DiffiQult , a Hartree-Fock implementation, entirely differentiated with the use of AD tools. DiffiQult is a software package written in plain Python with minimal deviation from standard code which illustrates the capability of AD to save human effort and time in implementations of exact gradients in quantum chemistry. We leverage the obtained gradients to optimize the parameters of one-particle basis sets in the context of the floating Gaussian framework.

Types of Family Caregiving and Daily Experiences in Midlife and Late Adulthood: The Moderating Influences of Marital Status and Age.

PubMed

Wong, Jen D; Shobo, Yetunde

2017-07-01

Guided by the life-course perspective, this study contributes to the family caregiving, aging, and disability literature by examining the daily experiences of three types of family caregivers in midlife and late adulthood. A sample of 162 caregivers from the National Survey of Midlife in the United States study completed interviews, questionnaires, and a Daily Diary Study. Multilevel models showed the patterns of daily time use did not differ by caregiver types. Caregivers of sons/daughters with developmental disabilities (DD) experienced more daily stressors than caregivers of parents with health conditions (HC) and caregivers of spouses with HC. Unmarried caregivers of sons/daughters with DD reported spending more time on daily leisure activities and exhibited greater daily stressor exposure than other family caregivers. Age did not moderate the associations between caregiver types and daily experiences. Findings highlight the important consideration of the caregivers' characteristics to better determine the quality of their daily experiences in midlife and late adulthood.

[Diagnostic use of positron emission tomography in France: from the coincidence gamma-camera to mobile hybrid PET/CT devices].

PubMed

Talbot, Jean-Noël

2010-11-01

Positron emission tomography (PET) is a well-established medical imaging method. PET is increasingly used for diagnostic purposes, especially in oncology. The most widely used radiopharmaceutical is FDG, a glucose analogue. Other radiopharmaceuticals have recently been registered or are in development. We outline technical improvements of PET machines during more than a decade of clinical use in France. Even though image quality has improved considerably and PET-CT hybrid machines have emerged, spending per examination has remained remarkably constant. Replacement and maintenance costs have remained in the range of 170-190 Euros per examination since 1997, whether early CDET gamma cameras or the latest time-of-flight PET/CT devices are used. This is mainly due to shorter acquisition times and more efficient use of FDG New reimbursement rates for PET/CT are needed in France in order to favor regular acquisition of state-of-the-art devices. One major development is the coupling of PET and MR imaging.

Automatic Differentiation in Quantum Chemistry with Applications to Fully Variational Hartree–Fock

PubMed Central

2018-01-01

Automatic differentiation (AD) is a powerful tool that allows calculating derivatives of implemented algorithms with respect to all of their parameters up to machine precision, without the need to explicitly add any additional functions. Thus, AD has great potential in quantum chemistry, where gradients are omnipresent but also difficult to obtain, and researchers typically spend a considerable amount of time finding suitable analytical forms when implementing derivatives. Here, we demonstrate that AD can be used to compute gradients with respect to any parameter throughout a complete quantum chemistry method. We present DiffiQult, a Hartree–Fock implementation, entirely differentiated with the use of AD tools. DiffiQult is a software package written in plain Python with minimal deviation from standard code which illustrates the capability of AD to save human effort and time in implementations of exact gradients in quantum chemistry. We leverage the obtained gradients to optimize the parameters of one-particle basis sets in the context of the floating Gaussian framework.

Assessing the level of public health partner spending using the funding formula analysis tool.

PubMed

Bernet, Patrick M

2012-01-01

Public health services are delivered through a variety of organizations. Traditional accounting of public health expenditures typically captures only spending by government agencies. New Hampshire collected information from public health partners, such as community centers that host smoking cessation classes or health education done by Girls, Inc. This study compares the new data to spending by government agencies, focusing on breakdowns by fund source and service categories. Expanded funds secured by these partners account for a 42% of all local public health spending, and they spent 4 times more than government agencies on promoting healthy behavior. The funding formula analysis tool revealed that these partners spent in ways that would be politically difficult to achieve. In an era of declining budgets, an understanding of public health's partners is increasingly vital.

HOW DO IMMIGRANTS SPEND THEIR TIME?

PubMed Central

Hamermesh, Daniel S.

2012-01-01

Sharp differences in time use by nativity emerge when activities are distinguished by incidence and intensity in recent U.S. data. A model with daily fixed costs for assimilating activities predicts immigrants are less likely than natives to undertake such activities on a given day; but those who do will spend relatively more time on them. Activities such as purchasing, education, and market work conform to the model. Other results suggest that fixed costs for assimilating activities are higher for immigrants with poor English proficiency or who originate in less developed countries. An analysis of comparable Australian data yields similar results. PMID:24443631

The German Environmental Survey for Children (GerES IV): reference values and distributions for time-location patterns of German children.

PubMed

Conrad, André; Seiwert, Margarete; Hünken, Andreas; Quarcoo, David; Schlaud, Martin; Groneberg, David

2013-01-01

Children's time-location patterns are important determinants of environmental exposure and other health-relevant factors. Building on data of the German Environmental Survey for Children (GerES IV), our study aimed at deriving reference values and distributions for time-location patterns of 3-14-year-old German children. We also investigated if GerES IV data are appropriate for evaluating associations with children's health determinants by linking them to data of the National Health Interview and Examination Survey for Children and Adolescents (KiGGS). Parents reported on the time their children usually spend at home, in other indoor environments, and outdoors. This information was characterized by statistical parameters, which were also calculated for different strata concerning socio-demography and the residential environment. Consequently, group differences were evaluated by t-tests and univariate ANOVA. Reference distributions were fitted to the time-location data by a Maximum Likelihood approach to make them also useable in probabilistic exposure modeling. Finally, associations between data on the children's physical activity as well as body weight and their outdoor time were investigated by bivariate correlation analysis and cross tabulation. On daily average, German children spend 15 h and 31 min at home, 4 h and 46 min in other indoor environments, and 3 h and 43 min outdoors. Time spent at home and outdoors decreases with age while time spent in other indoor environments increases. Differences in time-location patterns were also observed for the socio-economic status (SES) and immigration status. E.g., children with a high SES spend 24 min less outdoors than low SES children. Immigrants spend on daily average 20 min more at home and 15 min less outdoors than non-immigrant children. Outdoor time was associated with parameters of the residential environment like the building development. Children living in 1- or 2-family houses spend more time outdoors than children living in building blocks (3 h 48 min vs. 3 h 29 min). Physical activity correlates with outdoor time. For children with diminished age-specific outdoor time, a higher prevalence of obesity was observed (odds ratio: 3.2, 95% CI: 1.5-7.1). GerES IV provides a compilation of current time-location reference values and distributions on German children. This data hint to substantial differences in time-location patterns within the population to be considered in environmental health risk assessment. Copyright © 2012 Elsevier GmbH. All rights reserved.

Twelve years' experience with direct-to-consumer advertising of prescription drugs in Canada: a cautionary tale.

PubMed

Mintzes, Barbara; Morgan, Steve; Wright, James M

2009-05-27

Direct-to-consumer advertising (DTCA) of prescription drugs is illegal in Canada as a health protection measure, but is permitted in the United States. However, in 2000, Canadian policy was changed to allow 'reminder' advertising of prescription drugs. This is a form of advertising that states the brand name without health claims. 'Reminder' advertising is prohibited in the US for drugs that have 'black box' warnings of serious risks. This study examines spending on DTCA in Canada from 1995 to 2006, 12 years spanning this policy shift. We ask how annual per capita spending compares to that in the US, and whether drugs with Canadian or US regulatory safety warnings are advertised to the Canadian public in reminder advertising. Prescription drug advertising spending data were extracted from a data set on health sector spending in Canada obtained from a market research company, TNS Media Inc. Spending was adjusted for inflation and compared with US spending. Inflation-adjusted spending on branded DTCA in Canada grew from under CAD$2 million per year before 1999 to over $22 million in 2006. The major growth was in broadcast advertising, accounting for 83% of spending in 2006. US annual per capita spending was on average 24 times Canadian levels. Celebrex (celecoxib), which has a US black box and was subject to three safety advisories in Canada, was the most heavily advertised drug on Canadian television in 2005 and 2006. Of 8 brands with >$500,000 spending, which together accounted for 59% of branded DTCA in all media, 6 were subject to Canadian safety advisories, and 4 had US black box warnings. Branded 'reminder' advertising has grown rapidly in Canada since 2000, mainly due to a growth in television advertising. Although DTCA spending per capita is much lower in Canada than in the US, there is no evidence of safer content or product choice; many heavily-advertised drugs in Canada have been subject to safety advisories. For governments searching for compromise solutions to industry pressure for expanded advertising, Canada's experience stands as a stark warning.

Twelve Years' Experience with Direct-to-Consumer Advertising of Prescription Drugs in Canada: A Cautionary Tale

PubMed Central

Mintzes, Barbara; Morgan, Steve; Wright, James M.

2009-01-01

Background Direct-to-consumer advertising (DTCA) of prescription drugs is illegal in Canada as a health protection measure, but is permitted in the United States. However, in 2000, Canadian policy was changed to allow ‘reminder’ advertising of prescription drugs. This is a form of advertising that states the brand name without health claims. ‘Reminder’ advertising is prohibited in the US for drugs that have ‘black box’ warnings of serious risks. This study examines spending on DTCA in Canada from 1995 to 2006, 12 years spanning this policy shift. We ask how annual per capita spending compares to that in the US, and whether drugs with Canadian or US regulatory safety warnings are advertised to the Canadian public in reminder advertising. Methodology/Principal Findings Prescription drug advertising spending data were extracted from a data set on health sector spending in Canada obtained from a market research company, TNS Media Inc. Spending was adjusted for inflation and compared with US spending. Inflation-adjusted spending on branded DTCA in Canada grew from under CAD$2 million per year before 1999 to over $22 million in 2006. The major growth was in broadcast advertising, accounting for 83% of spending in 2006. US annual per capita spending was on average 24 times Canadian levels. Celebrex (celecoxib), which has a US black box and was subject to three safety advisories in Canada, was the most heavily advertised drug on Canadian television in 2005 and 2006. Of 8 brands with >$500,000 spending, which together accounted for 59% of branded DTCA in all media, 6 were subject to Canadian safety advisories, and 4 had US black box warnings. Conclusions/Significance Branded ‘reminder’ advertising has grown rapidly in Canada since 2000, mainly due to a growth in television advertising. Although DTCA spending per capita is much lower in Canada than in the US, there is no evidence of safer content or product choice; many heavily-advertised drugs in Canada have been subject to safety advisories. For governments searching for compromise solutions to industry pressure for expanded advertising, Canada's experience stands as a stark warning. PMID:19479084

Characteristics of the Unexpected Message Queue of MPI applications

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

Keller, Rainer; Graham, Richard L

2010-01-01

High Performance Computing systems are used on a regular basis to run a myriad of application codes, yet a surprising dearth of information exists with respect to communications characteristics. Even less information is available on the low-level communication libraries, such as the length of MPI Unexpected Message Queues (UMQs) and the length of time such messages spend in these queues. Such information is vital to developing appropriate strategies for handling such data at the library and system level. In this paper we present data on the communication characteristics of three applications GTC, LSMS, and S3D. We present data on themore » size of their UMQ, the time spend searching the UMQ and the length of time such messages spend in these queues. We find that for the particular inputs used, these applications have widely varying characteristics with regard to UMQ length and show patterns for specific applications which persist over various scales.« less

Screen-based sedentary behaviours among a nationally representative sample of youth: are Canadian kids couch potatoes?

PubMed

Leatherdale, S T; Ahmed, R

2011-09-01

To determine the percentage of Canadian youth meeting screen-time guidelines and to identify characteristics associated with different screen-time behaviours. Using nationally representative data collected from the 2008/2009 Youth Smoking Survey (YSS), we analyzed three screen-time behaviours, cigarette smoking, weekly spending money, self esteem, region and grade by sex, and conducted four logistic regression models to examine factors associated with more than 2 hours a day of sedentary screen time. Of 51 922 Canadian youth in grades 6 to 12, 50.9% spent more than 2 hours per day in screen-based behaviours. The average daily screen time was 7.8 (± 2.3) hours. Males and current smokers were more likely to report over 2 hours per day watching TV and videos or playing video games, whereas students in higher grades and those with weekly spending money were more likely to report playing or surfing on a computer. Youth with higher self-esteem were less likely to report spending over 2 hours per day in each of the three screen-time behaviours examined. Developing a better understanding of the factors associated with more hours of screen time is required to develop and target interventions that reduce screen-time behaviours.

Social class, gender, and time use: implications for the social determinants of body weight?

PubMed

McLaren, Lindsay; Godley, Jenny; MacNairn, Ian A S

2009-12-01

The social gradient in body weight (for example, obesity) departs from the social gradient in other health outcomes. Innovative approaches are needed to understand the observed patterns. This study examines time-use patterns by indicators of socio-economic position, and considers the implications of variations in time use for the social gradient in weight reported in other studies. The data are from respondents aged 25 to 64 to Canada's 1986 and 2005 General Social Surveys, which focused on time use. Participation in various activities was examined by sex, and by personal income and education, stratified by sex, in both years. Higher-income men and women were more likely than those of lower income to spend time in paid work, commuting and eating out, and less likely to spend time sleeping. Men and women with higher education were more likely than those with lower education to spend time in physical activity (2005 only) and reading. These time-use patterns plausibly contribute to the social gradient in obesity reported in other Canadian studies. The findings suggest that there is value in looking beyond a narrow range of health behaviours toward broader measures of daily routines to gain insight into the social determinants of weight and health.

[Anthropometric indexes of the state of nutrition and eating habits, and recreational physical activity of working physically men aged 20-60 of urban population].

PubMed

Gacek, Maria; Chrzanowska, Maria

2011-01-01

The aim of this studies was the comparison of somatic indexes and eating habits of working physically men who prefer different ways (active vs. passive) of spending their free time. The studies has been carried out on a group of 1271 people who work in HTS (steelworks) in Nowa Huta (one of Cracow's districts), including 523 men aged 20-40 (181 active and 342 non-active) and 748 men aged 40-60 (194 active and 554 non-active). Men referred to as active declared active spending of their free time and taking up recreational physical activity at lest twice a week. The presented research has not revealed statistically important differentiation of somatic parameters depending on preferred way of spending free time, or a connection between the physical activity level during free time and some eating habits indicating more rational choices, connected with the control of energy value of the diet, larger consumption of vegetables and fruit and smaller consumption of sweet products, and less frequently appearance of 'canine appetite' in the case of active men.

Public Spending on Health Service and Policy Research in Canada, the United Kingdom, and the United States: A Modest Proposal.

PubMed

Thakkar, Vidhi; Sullivan, Terrence

2017-04-10

Health services and policy research (HSPR) represent a multidisciplinary field which integrates knowledge from health economics, health policy, health technology assessment, epidemiology, political science among other fields, to evaluate decisions in health service delivery. Health service decisions are informed by evidence at the clinical, organizational, and policy level, levels with distinct, managerial drivers. HSPR has an evolving discourse spanning knowledge translation, linkage and exchange between research and decision-maker partners and more recently, implementation science and learning health systems. Local context is important for HSPR and is important in advancing health reform practice. The amounts and configuration of national investment in this field remain important considerations which reflect priority investment areas. The priorities set within this field or research may have greater or lesser effects and promise with respect to modernizing health services in pursuit of better value and better population outcomes. Within Canada an asset map for HSPR was published by the national HSPR research institute. Having estimated publicly-funded research spending in Canada, we sought identify best available comparable estimates from the United States and the United Kingdom. Investments from industry and charitable organizations were not included in these numbers. This commentary explores spending by the United States, Canada, and the United Kingdom on HSPR as a fraction of total public spending on health and the importance of these respective investments in advancing health service performance. Proposals are offered on the merits of common nomenclature and accounting for areas of investigation in pursuit of some comparable way of assessing priority HSPR investments and suggestions for earmarking such investments to total investment in health services spending. © 2017 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

“All Models Are Wrong, but Some Are Useful”

USGS Publications Warehouse

Field, Edward H.

2015-01-01

Building a new model, especially one used for policy purposes, takes considerable time, effort, and resources. In justifying such expenditures, one inevitably spends a lot of time denigrating previous models. For example, in pitching the third Uniform California Earthquake Rupture Forecast (UCERF3) (http://www.WGCEP.org/UCERF3), criticisms of the previous model included fault‐segmentation assumptions and the lack of multifault ruptures. In the context of including spatiotemporal clustering for operational earthquake forecasting (e.g., Jordan et al., 2011), another criticism has been that previous candidate models not only ignore elastic rebound but also produce results that are antithetical to that theory. For instance, the short‐term earthquake probabilities model (Gerstenberger et al., 2005), which provided California aftershock hazard maps at the U.S. Geological Survey web site between 2005 and 2010, implies that the time of highest likelihood for any rupture will be the moment after it occurs, even for a big one on the San Andreas fault. Furthermore, Monte Carlo simulations imply that excluding elastic rebound in such models also produces unrealistic triggering statistics (Field, 2012).

Why the Canadian sedentary behaviour guidelines should reflect sex and gender.

PubMed

Liwander, Anna; Pederson, Ann; Boyle, Ellexis

2013-10-31

The world's first evidence-based sedentary behaviour guidelines were released in Canada in 2011. Based on evidence that time spent in sedentary pursuits poses important health risks, the guidelines recommend limits on the time that children and youth are sedentary throughout the day. Although the guidelines reflect differences in age, they do not include recommendations for adults, nor engage with other important determinants of health such as sex and gender, despite research suggesting that girls and boys, women and men, engage in different sedentary behaviours. For example, it has been suggested that girls spend considerable time in communication-based sedentary behaviours such as talking on the phone, texting and instant messaging, while boys are more likely to watch television and videos, or play computer games. There is also evidence suggesting that the health outcomes associated with sedentary behaviour differ for females and males, and there are gendered social and economic barriers that may influence sedentary behaviour. It is therefore time to consider sex and gender in research and policy on sedentary behaviour in order to effectively reduce time spent sedentary and to improve the health of women and men in Canada.

Life satisfaction across nations: the effects of women's political status and public priorities.

PubMed

York, Richard; Bell, Shannon Elizabeth

2014-11-01

Feminist scholars suggest that improving the quality of life of individuals living in nations around the world may be more readily achieved by increasing women's political power and by reorienting public-policy priorities, than by focusing primarily on economic growth. These considerations raise the question of which characteristics of societies are associated with the quality of life of the people in those societies. Here, we address this issue empirically by statistically analyzing cross-national data. We assess the effects of gender equality in the political sphere, as well as a variety of other factors, on the subjective well-being of nations, as indicated by average self-reported levels of life satisfaction. We find that people report the highest levels of life satisfaction in nations where women have greater political representation, where military spending is low, and where health care spending is high, controlling for a variety of other factors. GDP per capita, urbanization, and natural resource exploitation are not clearly associated with life satisfaction. These findings suggest that nations may be able to improve the subjective quality of life of people without increasing material wealth or natural resource consumption by increasing gender equality in politics and changing public spending priorities. Copyright © 2014 Elsevier Inc. All rights reserved.

[Cuts, austerity and health. SESPAS report 2014].

PubMed

Segura Benedicto, Andreu

2014-06-01

Since 2009, the economic recession has led to cuts in spending on social welfare policy and in health care. The most important risks to health depend on negative changes in social determinants. Notable among these determinants are unemployment and the large proportion of people at risk of poverty, which affects 30% of children younger than 14 years. Social inequalities have increased significantly, much more than health inequalities, probably because the value of retirement pensions has been maintained until now. Most of the population is fairly satisfied with the public health system, although it is under considerable pressure. Mortality statistics have not been affected so far, but there has been an increase in mood disorders and mental health problems. Health services utilization has decreased and the number of publicly prescribed drugs has fallen dramatically. This restriction accounts for much of the decrease in public spending on health, since the hospital care budget has not decreased, despite the fall in primary care and public health spending. The crisis could encourage community health and the inclusion of health in all policies. It is the responsibility of professionals and public health institutions monitoring the trend in health problems and their determinants to avoid irreversible situations as far as possible. Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.

State tobacco control expenditures and tax paid cigarette sales

PubMed Central

Tauras, John A.; Xu, Xin; Huang, Jidong; King, Brian; Lavinghouze, S. Rene; Sneegas, Karla S.; Chaloupka, Frank J.

2018-01-01

This research is the first nationally representative study to examine the relationship between actual state-level tobacco control spending in each of the 5 CDC’s Best Practices for Comprehensive Tobacco Control Program categories and cigarette sales. We employed several alternative two-way fixed-effects regression techniques to estimate the determinants of cigarette sales in the United States for the years 2008–2012. State spending on tobacco control was found to have a negative and significant impact on cigarette sales in all models that were estimated. Spending in the areas of cessation interventions, health communication interventions, and state and community interventions were found to have a negative impact on cigarette sales in all models that were estimated, whereas spending in the areas of surveillance and evaluation, and administration and management were found to have negative effects on cigarette sales in only some models. Our models predict that states that spend up to seven times their current levels could still see significant reductions in cigarette sales. The findings from this research could help inform further investments in state tobacco control programs. PMID:29652890

Generic entry, reformulations and promotion of SSRIs in the US.

PubMed

Huskamp, Haiden A; Donohue, Julie M; Koss, Catherine; Berndt, Ernst R; Frank, Richard G

2008-01-01

Previous research has shown that a manufacturer's promotional strategy for a brand name drug is typically affected by generic entry. However, little is known about how newer strategies to extend patent life, including product reformulation introduction or obtaining approval to market for additional clinical indications, influence promotion. To examine the relationships among promotional expenditures, generic entry, reformulation entry and new indication approval. We used quarterly data on national product-level promotional spending (including expenditures for physician detailing and direct-to-consumer advertising [DTCA], and the retail value of free samples distributed in physician offices) for selective serotonin reuptake inhibitors (SSRIs) over the period 1997-2004. We estimated econometric models of detailing, DTCA and total quarterly promotional expenditures as a function of the timing of generic entry, entry of new product formulations and US FDA approval for new clinical indications for existing medications in the SSRI class. Expenditures by pharmaceutical manufacturers for promotion of antidepressant medications was the main outcome measure. Over the period 1997-2004, there was considerable variation in the composition of promotional expenditures across the SSRIs. Promotional expenditures for the original brand molecule decreased dramatically when a reformulation of the molecule was introduced. Promotional spending (both total and detailing alone) for a specific molecule was generally lower after generic entry than before, although the effect of generic entry on promotional spending appears to be closely linked with the choice of product reformulation strategy pursued by the manufacturer. Detailing expenditures for Paxil were increased after the manufacturer received FDA approval to market the drug for generalized anxiety disorder (GAD), while the likelihood of DTCA outlays for the drug was not changed. In contrast, FDA approval to market Paxil and Zoloft for social anxiety disorder (SAD) did not affect the manufacturers' detailing expenditures but did result in a greater likelihood of DTCA outlays. The introduction of new product formulations appears to be a common strategy for attempting to extend market exclusivity for medications facing impending generic entry. Manufacturers who introduced a reformulation before generic entry shifted most promotion dollars from the original brand to the reformulation long before generic entry, and in some cases manufacturers appeared to target a particular promotion type for a given indication. Given the significant impact that pharmaceutical promotion has on demand for prescription drugs in the US, these findings have important implications for prescription drug spending and public health.

Changing the Way We Work

ERIC Educational Resources Information Center

Coote, Anna

2010-01-01

A 21-hour working week is a long way from today's standard of 40 hours or more, but not so far-fetched when people consider the infinitely varied ways in which they actually spend their time. On average, people of working age spend 19.6 hours a week in paid employment and 20.4 hours in unpaid housework and childcare. These averages mask huge…

Does Increasing Hours of Schooling Lead to Improvements in Student Learning? Policy Brief No. 1

ERIC Educational Resources Information Center

Sandoval-Hernandez, Andres; Aghakasiri, Parisa; Wild, Justin; Rutkowski, David

2013-01-01

Increasing the number of hours students spend in school each year, on the assumption that this will improve student achievement, has become a widespread trend. However, the analysis reported here suggests that this trend can be misguided: the time students spend in the classroom is not always positively related to their academic achievement.…

Mental health and substance use disorder spending in the Department of Veterans Affairs, fiscal years 2000-2007.

PubMed

Wagner, Todd H; Sinnott, Patricia; Siroka, Andrew M

2011-04-01

This study analyzed spending for treatment of mental health and substance use disorders in the Department of Veterans Affairs (VA) in fiscal years (FYs) 2000 through 2007. VA spending as reported in the VA Decision Support System was linked to patient utilization data as reported in the Patient Treatment Files, the National Patient Care Database, and the VA Fee Basis files. All care and costs from FY 2000 to FY 2007 were analyzed. Over the study period the number of veterans treated at the VA increased from 3.7 million to over 5.1 million (an average increase of 4.9% per year), and costs increased .7% per person per year. For mental health and substance use disorder treatment, the volume of inpatient care decreased markedly, residential care increased, and spending decreased on average 2% per year (from $668 in FY 2000 to $578 per person in FY 2007). FY 2007 saw large increases in mental health spending, bucking the trend from FY 2000 through FY 2006. VA's continued emphasis on outpatient and residential care was evident through 2007. This trend in spending might be unimpressive if VA were enrolling healthier Veterans, but the opposite seems to be true: over this time period the prevalence of most chronic conditions, including depression and posttraumatic stress disorder, increased. VA spending on mental health care grew rapidly in 2007, and given current military activities, this trend is likely to increase.

The Effect of Line Maintenance Activity on Airline Safety Quality

NASA Technical Reports Server (NTRS)

Rhoades, Dawna L.; Reynolds, Rosemarie; Waguespack, Blaise, Jr.; Williams, Michael

2005-01-01

One of the arguments against deregulation of the airline industry has been the possibility that financially troubled carriers would be tempted to lower line maintenance spending, thus lowering maintenance quality and decreasing the overall safety of the carrier. Given the financial crisis triggered by the events of 9/11: it appears to be a good time to revisit this issue. This paper examines the quality of airline line maintenance activity and examines the impact of maintenance spending on maintenance quality and overall safety. Findings indicate that increased maintenance spending is associated with increased line maintenance activity and increased overall safety quality for the major U.S. carriers.

Physical Activity in Hemodialysis Patients Measured by Triaxial Accelerometer

PubMed Central

Gomes, Edimar Pedrosa; Reboredo, Maycon Moura; Carvalho, Erich Vidal; Teixeira, Daniel Rodrigues; Carvalho, Laís Fernanda Caldi d'Ornellas; Filho, Gilberto Francisco Ferreira; de Oliveira, Julio César Abreu; Sanders-Pinheiro, Helady; Chebli, Júlio Maria Fonseca; de Paula, Rogério Baumgratz; Pinheiro, Bruno do Valle

2015-01-01

Different factors can contribute to a sedentary lifestyle among hemodialysis (HD) patients, including the period they spend on dialysis. The aim of this study was to evaluate characteristics of physical activities in daily life in this population by using an accurate triaxial accelerometer and to correlate these characteristics with physiological variables. Nineteen HD patients were evaluated using the DynaPort accelerometer and compared to nineteen control individuals, regarding the time spent in different activities and positions of daily life and the number of steps taken. HD patients were more sedentary than control individuals, spending less time walking or standing and spending more time lying down. The sedentary behavior was more pronounced on dialysis days. According to the number of steps taken per day, 47.4% of hemodialysis patients were classified as sedentary against 10.5% in control group. Hemoglobin level, lower extremity muscle strength, and physical functioning of SF-36 questionnaire correlated significantly with the walking time and active time. Looking accurately at the patterns of activity in daily life, HDs patients are more sedentary, especially on dialysis days. These patients should be motivated to enhance the physical activity. PMID:26090432

An approach to forecasting health expenditures, with application to the U.S. Medicare system.

PubMed

Lee, Ronald; Miller, Timoth

2002-10-01

To quantify uncertainty in forecasts of health expenditures. Stochastic time series models are estimated for historical variations in fertility, mortality, and health spending per capita in the United States, and used to generate stochastic simulations of the growth of Medicare expenditures. Individual health spending is modeled to depend on the number of years until death. A simple accounting model is developed for forecasting health expenditures, using the U.S. Medicare system as an example. Medicare expenditures are projected to rise from 2.2 percent of GDP (gross domestic product) to about 8 percent of GDP by 2075. This increase is due in equal measure to increasing health spending per beneficiary and to population aging. The traditional projection method constructs high, medium, and low scenarios to assess uncertainty, an approach that has many problems. Using stochastic forecasting, we find a 95 percent probability that Medicare spending in 2075 will fall between 4 percent and 18 percent of GDP, indicating a wide band of uncertainty. Although there is substantial uncertainty about future mortality decline, it contributed little to uncertainty about future Medicare spending, since lower mortality both raises the number of elderly, tending to raise spending, and is associated with improved health of the elderly, tending to reduce spending. Uncertainty about fertility, by contrast, leads to great uncertainty about the future size of the labor force, and therefore adds importantly to uncertainty about the health-share of GDP. In the shorter term, the major source of uncertainty is health spending per capita. History is a valuable guide for quantifying our uncertainty about future health expenditures. The probabilistic model we present has several advantages over the high-low scenario approach to forecasting. It indicates great uncertainty about future Medicare expenditures relative to GDP.

Two-Year Impact of the Alternative Quality Contract on Pediatric Health Care Quality and Spending

PubMed Central

Song, Zirui; Chernew, Michael E.; Landon, Bruce E.; McNeil, Barbara J.; Safran, Dana G.; Schuster, Mark A.

2014-01-01

OBJECTIVE: To examine the 2-year effect of Blue Cross Blue Shield of Massachusetts’ global budget arrangement, the Alternative Quality Contract (AQC), on pediatric quality and spending for children with special health care needs (CSHCN) and non-CSHCN. METHODS: Using a difference-in-differences approach, we compared quality and spending trends for 126 975 unique 0- to 21-year-olds receiving care from AQC groups with 415 331 propensity-matched patients receiving care from non-AQC groups; 23% of enrollees were CSHCN. We compared quality and spending pre (2006–2008) and post (2009–2010) AQC implementation, adjusting analyses for age, gender, health risk score, and secular trends. Pediatric outcome measures included 4 preventive and 2 acute care measures tied to pay-for-performance (P4P), 3 asthma and 2 attention-deficit/hyperactivity disorder quality measures not tied to P4P, and average total annual medical spending. RESULTS: During the first 2 years of the AQC, pediatric care quality tied to P4P increased by +1.8% for CSHCN (P < .001) and +1.2% for non-CSHCN (P < .001) for AQC versus non-AQC groups; quality measures not tied to P4P showed no significant changes. Average total annual medical spending was ∼5 times greater for CSHCN than non-CSHCN; there was no significant impact of the AQC on spending trends for children. CONCLUSIONS: During the first 2 years of the contract, the AQC had a small but significant positive effect on pediatric preventive care quality tied to P4P; this effect was greater for CSHCN than non-CSHCN. However, it did not significantly influence (positively or negatively) CSHCN measures not tied to P4P or affect per capita spending for either group. PMID:24366988

Two-year impact of the alternative quality contract on pediatric health care quality and spending.

PubMed

Chien, Alyna T; Song, Zirui; Chernew, Michael E; Landon, Bruce E; McNeil, Barbara J; Safran, Dana G; Schuster, Mark A

2014-01-01

To examine the 2-year effect of Blue Cross Blue Shield of Massachusetts' global budget arrangement, the Alternative Quality Contract (AQC), on pediatric quality and spending for children with special health care needs (CSHCN) and non-CSHCN. Using a difference-in-differences approach, we compared quality and spending trends for 126,975 unique 0- to 21-year-olds receiving care from AQC groups with 415,331 propensity-matched patients receiving care from non-AQC groups; 23% of enrollees were CSHCN. We compared quality and spending pre (2006-2008) and post (2009-2010) AQC implementation, adjusting analyses for age, gender, health risk score, and secular trends. Pediatric outcome measures included 4 preventive and 2 acute care measures tied to pay-for-performance (P4P), 3 asthma and 2 attention-deficit/hyperactivity disorder quality measures not tied to P4P, and average total annual medical spending. During the first 2 years of the AQC, pediatric care quality tied to P4P increased by +1.8% for CSHCN (P < .001) and +1.2% for non-CSHCN (P < .001) for AQC versus non-AQC groups; quality measures not tied to P4P showed no significant changes. Average total annual medical spending was ~5 times greater for CSHCN than non-CSHCN; there was no significant impact of the AQC on spending trends for children. During the first 2 years of the contract, the AQC had a small but significant positive effect on pediatric preventive care quality tied to P4P; this effect was greater for CSHCN than non-CSHCN. However, it did not significantly influence (positively or negatively) CSHCN measures not tied to P4P or affect per capita spending for either group.

Mapping nurses' activities in surgical hospital wards: A time study.

PubMed

van den Oetelaar, W F J M; van Stel, H F; van Rhenen, W; Stellato, R K; Grolman, W

2018-01-01

Balancing the number of nursing staff in relation to the number of patients is important for hospitals to remain efficient and optimizing the use of resources. One way to do this is to work with a workload management method. Many workload management methods use a time study to determine how nurses spend their time and to relate this to patient characteristics in order to predict nurse workload. In our study, we aim to determine how nurses spend their working day and we will attempt to explain differences between specialized surgical wards. The research took place in an academic hospital in the Netherlands. Six surgical wards were included, capacity 15 to 30 beds. We have used a work sampling methodology where trained observers registered activities of nurses and patient details every ten minutes during the day shift for a time period of three weeks. The work sampling showed that nurses spend between 40.1% and 55.8% of their time on direct patient care. In addition to this, nurses spend between 11.0% and 14.1% on collective patient care. In total, between 52.1% and 68% of time spent on tasks is directly patient related. We found significant differences between wards for 10 of the 21 activity groups. We also found that nurses spend on average 31% with the patient (bedside), which is lower than in another study (37%). However, we noticed a difference between departments. For regular surgical departments in our study this was on average 34% and for two departments that have additional responsibilities in training and education of nursing students, this was on average 25%. We found a relatively low percentage of time spent on direct plus indirect care, and a lower percentage of time spent with the patient. We suspect that this is due to the academic setting of the study; in our hospital, there are more tasks related to education than in hospitals in other study settings. We also found differences between the wards in our study, which are mostly explained by differences in the patient mix, nurse staffing (proportion of nursing students), type of surgery and region of the body where the surgery was performed. However, we could not explain all differences. We made a first attempt in identifying and explaining differences in nurses' activities between wards, however this domain needs more research in order to better explain the differences.

Mathematics and Science Learning Opportunities in Preschool Classrooms

PubMed Central

Piasta, Shayne B.; Pelatti, Christina Yeager; Miller, Heather Lynnine

2014-01-01

Research findings The present study observed and coded instruction in 65 preschool classrooms to examine (a) overall amounts and (b) types of mathematics and science learning opportunities experienced by preschool children as well as (c) the extent to which these opportunities were associated with classroom and program characteristics. Results indicated that children were afforded an average of 24 and 26 minutes of mathematics and science learning opportunities, respectively, corresponding to spending approximately 25% of total instructional time in each domain. Considerable variability existed, however, in the amounts and types of mathematics and science opportunities provided to children in their classrooms; to some extent, this variability was associated with teachers’ years of experience, teachers’ levels of education, and the socioeconomic status of children served in the program. Practice/policy Although results suggest greater integration of mathematics and science in preschool classrooms than previously established, there was considerable diversity in the amounts and types of learning opportunities provided in preschool classrooms. Affording mathematics and science experiences to all preschool children, as outlined in professional and state standards, may require additional professional development aimed at increasing preschool teachers’ understanding and implementation of learning opportunities in these two domains in their classrooms. PMID:25489205

Inequity in costs of seeking sexual and reproductive health services in India and Kenya.

PubMed

Haghparast-Bidgoli, Hassan; Pulkki-Brännström, Anni-Maria; Lafort, Yves; Beksinska, Mags; Rambally, Letitia; Roy, Anuradha; Reza-Paul, Sushena; Ombidi, Wilkister; Gichangi, Peter; Skordis-Worrall, Jolene

2015-09-15

This study aims to assess inequity in expenditure on sexual and reproductive health (SRH) services in India and Kenya. In addition, this analysis aims to measure the extent to which payments are catastrophic and to explore coping mechanisms used to finance health spending. Data for this study were collected as a part of the situational analysis for the "Diagonal Interventions to Fast Forward Enhanced Reproductive Health" (DIFFER) project, a multi-country project with fieldwork sites in three African sites; Mombasa (Kenya), Durban (South Africa) and Tete (Mozambique), and Mysore in India. Information on access to SRH services, the direct costs of seeking care and a range of socio-economic variables were obtained through structured exit interviews with female SRH service users in Mysore (India) and Mombasa (Kenya) (n = 250). The costs of seeking care were analysed by household income quintile (as a measure of socio-economic status). The Kakwani index and quintile ratios are used as measures of inequitable spending. Catastrophic spending on SRH services was calculated using the threshold of 10% of total household income. The results showed that spending on SRH services was highly regressive in both sites, with lower income households spending a higher percentage of their income on seeking care, compared to households with a higher income. Spending on SRH as a percentage of household income ranged from 0.02 to 6.2% and 0.03-7.5% in India and Kenya, respectively. There was a statistically significant difference in the proportion of spending on SRH services across income quintiles in both settings. In India, the poorest households spent two times, and in Kenya ten times, more on seeking care than the least poor households. The most common coping mechanisms in India and Kenya were "receiving [money] from partner or household members" (69%) and "using own savings or regular income" (44%), respectively. Highly regressive spending on SRH services highlights the heavier burden borne by the poorest when seeking care in resource-constrained settings such as India and Kenya. The large proportion of service users, particularly in India, relying on money received from family members to finance care seeking suggests that access would be more difficult for those with weak social ties, small social networks or weak bargaining positions within the family - although this requires further study.

Do Expenditures Other Than Instructional Expenditures Affect Graduation and Persistence Rates in American Higher Education. NBER Working Paper No. 15216

ERIC Educational Resources Information Center

Webber, Douglas A.; Ehrenberg, Ronald G.

2009-01-01

During the last two decades, median instructional spending per full-time equivalent (FTE) student at American 4-year colleges and universities has grown at a slower rate than median spending per FTE student in a number of other expenditure categories including academic support, student services and research. Our paper uses institutional level…

Brief Report: Disposable Income, and Spending on Fast Food, Alcohol, Cigarettes, and Gambling by New Zealand Secondary School Students

ERIC Educational Resources Information Center

Darling, Helen; Reeder, Anthony I.; McGee, Rob; Williams, Sheila

2006-01-01

We describe self-reported sources of income and expenditure, and the association between part-time employment and spending on fast food, alcohol, cigarettes, and gambling for a sample of 3434 New Zealand (NZ) secondary school students (mean age 15.0 years). Disposable income was usually received from parents and guardians, but nearly 40% of…

Child Care Costs as a Barrier to Women's Employment. Final Report.

ERIC Educational Resources Information Center

Brayfield, April

A study focused on how child care costs may restrict women's employment prospects, in terms of their current employment status and the amount of time they spend in paid work. It compared the effects of four dimensions of child care costs on women's labor supply: market price of care within a local area, amount of money parents spend on child care,…

How Can School Funding Increase If Operating Budgets Are Declining? Get the Facts... #2

ERIC Educational Resources Information Center

Kansas Association of School Boards (NJ1), 2012

2012-01-01

State and local funding for general operating budgets for Kansas public schools will be at a five-year low this school year, yet total Kansas school district spending will reach an all-time high of $5.67 billion according to estimates released by the Kansas State Department of Education. Total per pupil spending is projected to reach $12,454 per…

Spending on medicines in Israel in an international context.

PubMed

Sax, Philip

2005-05-01

Like most developed countries, in the last decade Israel's healthcare system has been subject to cost-containing measures in the drug sector. To provide comparative information in an international context on the level of outpatient drug expenditures in Israel, both total and those publicly financed, and to analyze how these have changed with time during the last decade. Using definitions of the OECD (Organization of Economic Cooperation and Development), internationally comparable data on total expenditure and public expenditure on medicines in Israel are provided. The Israeli estimates are based on data from the Ministry of Health audited reports of financial activities of the health management organizations and from the family expenditure surveys carried out by the Central Bureau of Statistics. Per capita total and public expenditures in Israel are analyzed over time, as are their share of national expenditure on health and of gross domestic product. Israel expenditures are then compared with those for individual member countries of the OECD, as well as a 21 country average, from 1992 to 2002. Analysis of the Israeli expenditure data shows a considerable reduction in growth of per capita total and public expenditures on medicines since 1997. Growth in the share of total drug expenditure of NEH and of GDP has also been constrained since 1997. In an international context, per capita expenditure on medicines in Israel, particularly what is publicly financed, is one of the lowest. Furthermore, its share of NEH and GDP is also very low compared to other countries. This substantive gap in spending on medicines between Israel and other countries has increased since 1997. Israel, a medium-income country with a lower than average level of expenditure on health compared to OECD countries, has a particularly low level of expenditure on medicines. Whereas the share of health expenditure of GDP in Israel is similar to the international average, the share of drug expenditure of GDP is well below the average. In addition to structural and longer-term factors contributing to Israel's low per capita spending on medicines, such as the young population and the apparently low level of actual prices paid by most institutional purchasers, recent years are witness to the growing impact of National Health Insurance budgetary pressures on HMOs as well as continual increases in prescription cost sharing by patients. The impact is felt both on the demand side (higher copayments, administrative and prescribing restrictions) and perhaps more crucially on the supply side (price competition, mainly from generics). Substantial extra public funding for the addition of new drugs to the NHI basket in recent years has had no overall impact on these longer-term spending patterns.

Spending patterns in region of residency training and subsequent expenditures for care provided by practicing physicians for Medicare beneficiaries.

PubMed

Chen, Candice; Petterson, Stephen; Phillips, Robert; Bazemore, Andrew; Mullan, Fitzhugh

2014-12-10

Graduate medical education training may imprint young physicians with skills and experiences, but few studies have evaluated imprinting on physician spending patterns. To examine the relationship between spending patterns in the region of a physician's graduate medical education training and subsequent mean Medicare spending per beneficiary. Secondary multilevel multivariable analysis of 2011 Medicare claims data (Part A hospital and Part B physician) for a random, nationally representative sample of family medicine and internal medicine physicians completing residency between 1992 and 2010 with Medicare patient panels of 40 or more patients (2851 physicians providing care to 491,948 Medicare beneficiaries). Locations of practice and residency training were matched with Dartmouth Atlas Hospital Referral Region (HRR) files. Training and practice HRRs were categorized into low-, average-, and high-spending groups, with approximately equal distribution of beneficiary numbers. There were 674 physicians in low-spending training and low-spending practice HRRs, 180 in average-spending training/low-spending practice, 178 in high-spending training/low-spending practice, 253 in low-spending training/average-spending practice, 417 in average-spending training/average-spending practice, 210 in high-spending training/average-spending practice, 97 in low-spending training/high-spending practice, 275 in average-spending training/high-spending practice, and 567 in high-spending training/high-spending practice. Mean physician spending per Medicare beneficiary. For physicians practicing in high-spending regions, those trained in high-spending regions had a mean spending per beneficiary per year $1926 higher (95% CI, $889-$2963) than those trained in low-spending regions. For practice in average-spending HRRs, mean spending was $897 higher (95% CI, $71-$1723) for physicians trained in high- vs low-spending regions. For practice in low-spending HRRs, the difference across training HRR levels was not significant ($533; 95% CI, -$46 to $1112). After controlling for patient, community, and physician characteristics, there was a 7% difference (95% CI, 2%-12%) in patient expenditures between low- and high-spending training HRRs. Across all practice HRRs, this corresponded to an estimated $522 difference (95% CI, $146-$919) between low- and high-spending training regions. For physicians 1 to 7 years in practice, there was a 29% difference ($2434; 95% CI, $1004-$4111) in spending between those trained in low- and high-spending regions; however, after 16 to 19 years, there was no significant difference. Among general internists and family physicians who completed residency training between 1992 and 2010, the spending patterns in the HRR in which their residency program was located were associated with expenditures for subsequent care they provided as practicing physicians for Medicare beneficiaries. Interventions during residency training may have the potential to help control future health care spending.

The home electronic media environment and parental safety concerns: relationships with outdoor time after school and over the weekend among 9-11 year old children.

PubMed

Wilkie, Hannah J; Standage, Martyn; Gillison, Fiona B; Cumming, Sean P; Katzmarzyk, Peter T

2018-04-05

Time spent outdoors is associated with higher physical activity levels among children, yet it may be threatened by parental safety concerns and the attraction of indoor sedentary pursuits. The purpose of this study was to explore the relationships between these factors and outdoor time during children's discretionary periods (i.e., after school and over the weekend). Data from 462 children aged 9-11 years old were analysed using generalised linear mixed models. The odds of spending > 1 h outdoors after school, and > 2 h outdoors on a weekend were computed, according to demographic variables, screen-based behaviours, media access, and parental safety concerns. Interactions with sex and socioeconomic status (SES) were explored. Boys, low SES participants, and children who played on their computer for < 2 h on a school day had higher odds of spending > 1 h outside after school than girls, high SES children and those playing on a computer for ≥2 h, respectively. Counterintuitive results were found for access to media devices and crime-related safety concerns as both of these were positively associated with time spent outdoors after school. A significant interaction for traffic-related concerns*sex was found; higher road safety concerns were associated with lower odds of outdoor time after school in boys only. Age was associated with weekend outdoor time, which interacted with sex and SES; older children were more likely to spend > 2 h outside on weekends but this was only significant among girls and high SES participants. Our results suggest that specific groups of children are less likely to spend their free time outside, and it would seem that only prolonged recreational computer use has a negative association with children's outdoor time after school. Further research is needed to explore potential underlying mechanisms, and parental safety concerns in more detail.

The Economics of NASA Mission Cost Reserves

NASA Technical Reports Server (NTRS)

Whitley, Sally; Shinn, Stephen

2012-01-01

Increases in NASA mission costs are well-noted but not well-understood, and there is little evidence that they are decreasing in frequency or amount over time. The need to control spending has led to analysis of the causes and magnitude of historical mission overruns, and many program control efforts are being implemented to attempt to prevent or mitigate the problem (NPR 7120). However, cost overruns have not abated, and while some direct causes of increased spending may be obvious (requirements creep, launch delays, directed changes, etc.), the underlying impetus to spend past the original budget may be more subtle. Gaining better insight into the causes of cost overruns will help NASA and its contracting organizations to avoid .them. This paper hypothesizes that one cause of NASA mission cost overruns is that the availability of reserves gives project team members an incentive to make decisions and behave in ways that increase costs. We theorize that the presence of reserves is a contributing factor to cost overruns because it causes organizations to use their funds less efficiently or to control spending less effectively. We draw a comparison to the insurance industry concept of moral hazard, the phenomenon that the presence of insurance causes insureds to have more frequent and higher insurance losses, and we attempt to apply actuarial techniques to quantifY the increase in the expected cost of a mission due to the availability of reserves. We create a theoretical model of reserve spending motivation by defining a variable ReserveSpending as a function of total reserves. This function has a positive slope; for every dollar of reserves available, there is a positive probability of spending it. Finally, the function should be concave down; the probability of spending each incremental dollar of reserves decreases progressively. We test the model against available NASA CADRe data by examining missions with reserve dollars initially available and testing whether they are more likely to spend those dollars, and whether larger levels of reserves lead to higher cost overruns. Finally, we address the question of how to prevent reserves from increasing mission spending without increasing cost risk to projects budgeted without any reserves. Is there a "sweet spot"? How can we derive the maximum benefit associated with risk reduction from reserves while minimizing the effects of reserve spending motivation?

D. Alan Shewmon and the PCBE's White Paper on Brain Death: are brain-dead patients dead?

PubMed

Brugger, E Christian

2013-04-01

The December 2008 White Paper (WP) on "Brain Death" published by the President's Council on Bioethics (PCBE) reaffirmed its support for the traditional neurological criteria for human death. It spends considerable time explaining and critiquing what it takes to be the most challenging recent argument opposing the neurological criteria formulated by D. Alan Shewmon, a leading critic of the "whole brain death" standard. The purpose of this essay is to evaluate and critique the PCBE's argument. The essay begins with a brief background on the history of the neurological criteria in the United States and on the preparation of the 2008 WP. After introducing the WP's contents, the essay sets forth Shewmon's challenge to the traditional neurological criteria and the PCBE's reply to Shewmon. The essay concludes by critiquing the WP's novel justification for reaffirming the traditional conclusion, a justification the essay finds wanting.

Listening, watching, and reading: the structure and correlates of entertainment preferences.

PubMed

Rentfrow, Peter J; Goldberg, Lewis R; Zilca, Ran

2011-04-01

People spend considerable amounts of time and money listening to music, watching TV and movies, and reading books and magazines, yet almost no attention in psychology has been devoted to understanding individual differences in preferences for such entertainment. The present research was designed to examine the structure and correlates of entertainment genre preferences. Analyses of the genre preferences of more than 3,000 individuals revealed a remarkably clear factor structure. Using multiple samples, methods, and geographic regions, data converged to reveal five entertainment-preference dimensions: Communal, Aesthetic, Dark, Thrilling, and Cerebral. Preferences for these entertainment dimensions were uniquely related to demographics and personality traits. Results also indicated that personality accounted for significant proportions of variance in entertainment preferences over and above demographics. The results provide a foundation for developing and testing hypotheses about the psychology of entertainment preferences. © 2011 The Authors. Journal of Personality © 2011, Wiley Periodicals, Inc.

Colour Consideration for Waiting areas in hospitals

NASA Astrophysics Data System (ADS)

Zraati, Parisa

2012-08-01

Colour is one the most important factors in the nature that can have some affects on human behaviour. Many years ago, it was proven that using colour in public place can have some affect on the users. Depend of the darkness and lightness; it can be vary from positive to negative. The research will mainly focus on the colour and psychological influences and physical factors. The statement of problem in this research is what is impact of colour usually applied to waiting area? The overall aim of the study is to explore the visual environment of hospitals and to manage the colour psychological effect of the hospital users in the waiting area by creating a comfortable, pleasant and cozy environment for users while spend their time in waiting areas. The analysisconcentrate on satisfaction and their interesting regarding applied colour in two private hospital waiting area in Malaysia.

The Third Rail of Family Systems: Sibling Relationships, Mental and Behavioral Health, and Preventive Intervention in Childhood and Adolescence

PubMed Central

Feinberg, Mark E.; Solmeyer, Anna R.; McHale, Susan M.

2011-01-01

Sibling relationships are an important context for development, but are often ignored in research and preventive interventions with youth and families. In childhood and adolescence siblings spend considerable time together, and siblings’ characteristics and sibling dynamics substantially influence developmental trajectories and outcomes. This paper reviews research on sibling relationships in childhood and adolescence, focusing on sibling dynamics as part of the family system and sibling influences on adjustment problems, including internalizing and externalizing behaviors and substance use. We present a theoretical model that describes three key pathways of sibling influence: one that extends through siblings’ experiences with peers and school, and two that operate largely through family relationships. We then describe the few existing preventive interventions that target sibling relationships and discuss the potential utility of integrating siblings into child and family programs. PMID:22105663

Identifying Marine Phytoplankton

NASA Astrophysics Data System (ADS)

Hargraves, Paul E.

Until recently, anyone who needed to accurately identify marine phytoplankton had one of four choices: use the outdated Englishlanguage volumes by E. E. Cupp and N. I. Hendey plus the more recent book by J. Dodge, acquire a working knowledge of German and use the old volumes by Schiller and Hustedt, spend huge amounts of time in an exceedingly well-equipped marine science library trying in vain to keep up with the rapidly evolving field of phytoplankton systematics and taxonomy, or track down one of the rarest of endangered species—a phytoplankton taxonomist—and beg for help.To these unfortunate choices is added one considerably more hopeful: Identifying Marine Phytoplankton. This volume, which has seven contributing authors, contains most of the taxonomic groups that make up the planktonic autotrophs and some heterotrophs of the seas, coasts, and estuaries of the world (missing are cyanobacteria and some of the picoplankton groups).

Amphibian Bioacoustics

NASA Astrophysics Data System (ADS)

Christensen-Dalsgaard, Jakob

Anuran amphibians (frogs and toads) of most of the 3,500 species that exist today are highly vocal animals. In most frogs, males will spend considerable energy on calling and incur sizeable predation risks and the females’ detection and localization of the calls of conspecific males is often a prerequisite for successful mating. Therefore, acoustic communication is evidently evolutionarily important in the anurans, and their auditory system is probably shaped by the selective pressures associated with production, detection and localization of the communication calls.

FY2017 Defense Spending Under an Interim Continuing Resolution (CR): In Brief

DTIC Science & Technology

2016-09-16

rated based on the fraction of a year for which the interim CR is in effect . In recent fiscal years, the referenced funding level on which interim or...of the Federal Government: Causes, Processes, and Effects , coordinated by Clinton T. Brass. 8 Typically, such funding is specified as an annualized...congressional consideration of a CR to fund the federal government through the opening months of the fiscal year is widely anticipated. This report

[Assessment of the pharmaceutical expenditure in Hungary].

PubMed

Inotai, András; Merész, Gergo; Kaló, Zoltán

2010-01-01

Scarcity of health care resources draws attention to the expenditure on pharmaceuticals, as drugs are considered to be one of the major growth drivers of health care spending. This article assesses the Hungarian expenditure on pharmaceuticals by taking into account the economic status of the country and benchmarks from other OECD countries with special focus on indicators of Visegrad V4 countries (Czech Republic, Slovakia, Poland and Hungary). Our results highlight the heterogeneity of pharmaceutical expenditure data derived from different indicators among observed countries. Pharmaceutical spending is relatively higher in middle-income countries, mainly due the price convergence of innovative drug's, on contrary manpower cost of health care services are adjusted to local price levels, therefore the price differential of health care services between middle income and developed countries is greater. International trends of the global pharmaceutical market are also valid in Hungary. Increased private funding, mainly out of pocket payments above the average of V4 countries, has been the major growth driver of pharmaceutical expenditure recently in Hungary. Increased private pharmaceutical expenditure was mainly derived from the severe cost-containment measures in 2006. The annual growth rate of the National Health Insurance Fund's pharmaceutical budget for drug reimbursement was 1.37% in real terms between 1994 and 2009. This is much beneath the expansion of global pharmaceutical market. Consequently, cost-containment of public pharmaceutical spending was very successful in the last fifteen years, and the burden of market growth has been shifted to households. Public health programmes, investment into preventive care, with consideration on unfavourable Hungarian morbidity and mortality indicators, however, necessitate the increase of public pharmaceutical budget. In order to improve the allocative efficiency of health care spending, available resources should be spent only on effective, cost-effective, economically affordable medicines.

Mass imprisonment and the life course revisited: Cumulative years spent imprisoned and marked for working-age black and white men.

PubMed

Patterson, Evelyn J; Wildeman, Christopher

2015-09-01

Over the last 40 years, imprisonment has become a common stage in the life-course for low-skilled and minority men, with implications not only for inequality among adult men but also for inequality more broadly. Unfortunately, all research documenting how increases in imprisonment have transformed the life-course of poor, minority men has neglected to estimate how much time black and white men on average spend imprisoned or marked as an ex-prisoner. In this article, we fill this gap by using multistate life tables to estimate what share of their working lives (18-64) black and white men will spend imprisoned and marked as ex-prisoners. Our estimates imply that white men spend on average 0.33 years of their working lives imprisoned and 2.31 years marked, while black men spend on average 1.79 years of their working lives imprisoned and 11.14 years marked. This implies that black men spend on average one-third of their working lives either imprisoned or having been freed but marked by the penal system. For the 32.2% of black men who ever experience imprisonment (Bonczar, 2003), moreover, these estimates imply that they spend on average 5.56 years imprisoned, corresponding to 13.4% of their working lives. Taken together, these findings imply a dramatic reorientation of the life course for black men, as one-third of the black male population will spend one-seventh of their working life in prison. Copyright © 2015 Elsevier Inc. All rights reserved.

Effects of age, season, gender and urban-rural status on time-activity: CanadianHuman Activity Pattern Survey 2 (CHAPS 2).

PubMed

Matz, Carlyn J; Stieb, David M; Davis, Karelyn; Egyed, Marika; Rose, Andreas; Chou, Benedito; Brion, Orly

2014-02-19

Estimation of population exposure is a main component of human health risk assessment for environmental contaminants. Population-level exposure assessments require time-activity pattern distributions in relation to microenvironments where people spend their time. Societal trends may have influenced time-activity patterns since previous Canadian data were collected 15 years ago. The Canadian Human Activity Pattern Survey 2 (CHAPS 2) was a national survey conducted in 2010-2011 to collect time-activity information from Canadians of all ages. Five urban and two rural locations were sampled using telephone surveys. Infants and children, key groups in risk assessment activities, were over-sampled. Survey participants (n = 5,011) provided time-activity information in 24-hour recall diaries and responded to supplemental questionnaires concerning potential exposures to specific pollutants, dwelling characteristics, and socio-economic factors. Results indicated that a majority of the time was spent indoors (88.9%), most of which was indoors at home, with limited time spent outdoors (5.8%) or in a vehicle (5.3%). Season, age, gender and rurality were significant predictors of time activity patterns. Compared to earlier data, adults reported spending more time indoors at home and adolescents reported spending less time outdoors, which could be indicative of broader societal trends. These findings have potentially important implications for assessment of exposure and risk. The CHAPS 2 data also provide much larger sample sizes to allow for improved precision and are more representative of infants, children and rural residents.

Limited Influence of Excipients in Extemporaneous Compounded Suspensions

PubMed Central

Dijkers, Eli; Nanhekhan, Valerie; Thorissen, Astrid; Marro, Diego; Uriel, Marta

2017-01-01

Objective: The objective of this study was to identify whether compounding oral suspensions with SyrSpend SF based on tablets or capsules is a suitable alternative for using raw pharmaceutical materials. Methods: Suspensions based on 5 different tablets and capsules were studied in SyrSpend SF. The summary of product characteristics of these different tablets and capsules were obtained from the manufacturer. Our hypothesis was that, if the maximum beyond-use date of the study was reached, the excipient did not seem to have an influence on the stability of the active pharmaceutical ingredient (API) within the studied time frame. Results: All excipients used in flecainide acetate, labetalol HCl, and tiagabine HCl tablets as well as in celecoxib and oseltamivir capsules did not seem to influence the beyond-use date of the overall suspension based on SyrSpend SF. Conclusion: Although using raw materials as API sources is preferred, oral suspensions with SyrSpend SF prepared from crushed tablets or opened capsules could be a possible alternative. Based on this study, a wide range of different excipients does not seem to impact the beyond-use date of different APIs compounded in SyrSpend SF. PMID:29276267

Limited Influence of Excipients in Extemporaneous Compounded Suspensions.

PubMed

Dijkers, Eli; Nanhekhan, Valerie; Thorissen, Astrid; Marro, Diego; Uriel, Marta

2017-06-01

Objective: The objective of this study was to identify whether compounding oral suspensions with SyrSpend SF based on tablets or capsules is a suitable alternative for using raw pharmaceutical materials. Methods: Suspensions based on 5 different tablets and capsules were studied in SyrSpend SF. The summary of product characteristics of these different tablets and capsules were obtained from the manufacturer. Our hypothesis was that, if the maximum beyond-use date of the study was reached, the excipient did not seem to have an influence on the stability of the active pharmaceutical ingredient (API) within the studied time frame. Results: All excipients used in flecainide acetate, labetalol HCl, and tiagabine HCl tablets as well as in celecoxib and oseltamivir capsules did not seem to influence the beyond-use date of the overall suspension based on SyrSpend SF. Conclusion: Although using raw materials as API sources is preferred, oral suspensions with SyrSpend SF prepared from crushed tablets or opened capsules could be a possible alternative. Based on this study, a wide range of different excipients does not seem to impact the beyond-use date of different APIs compounded in SyrSpend SF.

Tell it like it is.

PubMed

Lee, S L

2000-05-01

Nurses, therapists and case managers were spending too much time each week on the phone waiting to read patient reports to live transcriptionists who would then type the reports for storage in VNSNY's clinical management mainframe database. A speech recognition system helped solve the problem by providing the staff 24-hour access to an automated transcription service any day of the week. Nurses and case managers no longer wait in long queues to transmit patient reports or to retrieve information from the database. Everything is done automatically within minutes. VNSNY saved both time and money by updating its transcription strategy. Now nurses can spend more time with patients and less time on the phone transcribing notes. It also means fewer staff members are needed on weekends to do manual transcribing.

LiFi based automated shopping assistance application in IoT

NASA Astrophysics Data System (ADS)

Akter, Sharmin; Funke Olanrewaju, Rashidah, Dr; Islam, Thouhedul; Salma

2018-05-01

Urban people minimize shopping time in daily life due to time constrain. From that point of view, the concept of supermarket is being popular while consumers can buy different items from same place. However, customer spends hours and hours to find desired items in a large supermarket. In addition, it’s also required to be queued during payment at counter that is also time consuming. As a result, a customer has to spend 2-3 hours for shopping in a large superstore. This paper proposes an Internet of Things and Li-Fi based automated application for smart phone and web to find items easily during shopping that can save consumer’s time as well as reduce man power in supermarket.

Federal Spending for Means Tested Programs, 2007 to 2027

DTIC Science & Technology

2017-02-01

child tax credits (which are refundable), the Supplemental Nutrition Assistance Program (SNAP), and Supplemental Security Income. The largest non...child tax credits, and SNAP—have been or will be significantly affected by program changes that unfold over time: B Medicaid spending rose by 35...total outlays in the Part D program). Increases in the number of beneficiaries account for about one- third of that growth; the introduction of new

Educate the Women and You Change the World: Investing in the Education of Women Is the Best Investment in a Country's Growth and Development

ERIC Educational Resources Information Center

Jackson, Leah Witcher

2009-01-01

An extensive body of research indicates a significant correlation between gender equality and the level of economic and social development of a country. Gender inequities have been found to influence the way members of the family spend their time and resources. Evidence suggests that women with more control over resources will spend more money on…

The impact of pharmaceutical policy measures: an endogenous structural-break approach.

PubMed

Barros, Pedro Pita; Nunes, Luis C

2010-08-01

Pharmaceutical spending in many countries has seen a steep increase in recent years. Governments have adopted several measures to reduce pharmaceutical expenditure growth, ranging from increased co-payments to price decreases determined administratively. Promotion of generic consumption has also ranked high in political priorities. We adopt a novel time series approach to the detection of which policy measures have a noticeable impact. The number and timing of the structural breaks are endogenously determined. As an illustration, we assess the overall impact of the several policy measures on total pharmaceutical spending, using monthly data from January 1995 to August 2008 for the Portuguese market. Our findings suggest that, in general, policy measures aimed at controlling pharmaceutical expenditure have been unsuccessful. Two breaks that were identified coincide with administratively determined price decreases. Measures aimed at increasing competition in the market had no visible effect on the dynamics of Government spending in pharmaceutical products. In particular, the introduction of reference pricing had only a transitory effect of less than one year, with historical growth resuming quickly. The consequence of this policy ineffectiveness is a transfer of financial burden from the Government to the patients, with no apparent effect on the dynamics of total pharmaceutical spending. Copyright 2010 Elsevier Ltd. All rights reserved.

Improved nurse job satisfaction and job retention with the transition from a "mandatory consultation" model to a "semiclosed" surgical intensive care unit: a 1-year prospective evaluation.

PubMed

Haut, Elliott R; Sicoutris, Corinna P; Meredith, Denise M; Sonnad, Seema S; Reilly, Patrick M; Schwab, C William; Hanson, C William; Gracias, Vicente H

2006-02-01

The change from a "mandatory consultation" to a "semiclosed" surgical intensive care unit (SICU) model will impact nurses considerably. We hypothesize that nurse job satisfaction, job turnover rates, and hospital costs for temporary agency nurses will improve and these improvements will be more dramatic in SICU sections with greater involvement of a dedicated surgical critical care service (SCCS). Prospective longitudinal survey. Tertiary-care university hospital. SICU staff nurses. Change from mandatory consultation to semiclosed SICU. We surveyed SICU nurses during the year-long transition to a semiclosed SICU service (five time points, 3-month intervals). The first four surveys included ten questions on nurse job satisfaction. The final survey included two additional questions. All questions were on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree). Nurse job turnover rates and money spent on agency nurses were compared over time; 503 of a possible 914 surveys were completed (55% overall return rate). Nurse job satisfaction scores significantly improved over time for all questions (p < .05). Hospital spending on agency nurses decreased significantly (p = .0098). The yearly nurse job turnover rate dropped from 25% to 16% (p = .15). The scores for both year-end statements ("I am more satisfied with my job now than 1 year ago" and "The SCCS management of all orders has improved my job satisfaction") were significantly higher in sections with greater SCCS involvement (p = .0070 and p < .0001). Nurse job satisfaction improved significantly with the transition to a semiclosed SICU. This higher satisfaction was associated with a significant decrease in spending on temporary agency nurses and a trend toward increased staff nurse job retention. SICU sections with greater SCCS involvement had more dramatic improvements. This semiclosed SICU model may help retain SICU nurses in a competitive job market in which experienced nurses are in short supply.

Absence of Gut Microbiota Reduces Emotional Reactivity in Japanese Quails (Coturnix japonica)

PubMed Central

Kraimi, Narjis; Calandreau, Ludovic; Biesse, Manon; Rabot, Sylvie; Guitton, Edouard; Velge, Philippe; Leterrier, Christine

2018-01-01

Background: Recent studies have demonstrated an effect of the gut microbiota on brain development and behavior leading to the concept of the microbiota-gut-brain axis. However, its effect on behavior in birds is unknown. The aim of the present study was to determine the effect of the absence of gut microbiota on emotional reactivity in birds by comparing germ-free (GF) quails to those colonized (COL) with gut microbiota. Material and Methods: From hatching, the quails of both groups GF (n = 36) and COL (n = 36) were reared in sterile isolators. The COL quails were colonized at day 2 by introducing a pool of droppings from conventional adult females into the drinking water and feed. The quails were weighed individually on day 2, 6, and 14. From day 8, emotional reactivity was assessed in each group in the isolators through several behavioral tests. Results: GF quails showed a considerable decrease in emotional reactivity demonstrated by spending less time in tonic immobility during the tonic immobility test (242 s ± 31 vs. 331 s ± 32, p ≤ 0.05), traveling a shorter distance (3,897 cm ± 242 vs. 4,827 cm ± 278, p ≤ 0.05) at a lower velocity (6.55 cm/s ± 0.4 vs. 8.1 cm/s ± 0.5, p ≤ 0.05) during the social separation test and spending more time near an object at the beginning of the novel object test (33.7 s ± 6.4 vs. 18.5 s ± 4.1, p ≤ 0.05). No difference in growth was found between the 2 groups. Conclusion: For the first time, this study demonstrates that the absence of gut microbiota reduces emotional reactivity in Japanese quails in situations of fear and social perturbation without influence on growth. PMID:29881357

Absence of Gut Microbiota Reduces Emotional Reactivity in Japanese Quails (Coturnix japonica).

PubMed

Kraimi, Narjis; Calandreau, Ludovic; Biesse, Manon; Rabot, Sylvie; Guitton, Edouard; Velge, Philippe; Leterrier, Christine

2018-01-01

Background: Recent studies have demonstrated an effect of the gut microbiota on brain development and behavior leading to the concept of the microbiota-gut-brain axis. However, its effect on behavior in birds is unknown. The aim of the present study was to determine the effect of the absence of gut microbiota on emotional reactivity in birds by comparing germ-free (GF) quails to those colonized (COL) with gut microbiota. Material and Methods: From hatching, the quails of both groups GF ( n = 36) and COL ( n = 36) were reared in sterile isolators. The COL quails were colonized at day 2 by introducing a pool of droppings from conventional adult females into the drinking water and feed. The quails were weighed individually on day 2, 6, and 14. From day 8, emotional reactivity was assessed in each group in the isolators through several behavioral tests. Results: GF quails showed a considerable decrease in emotional reactivity demonstrated by spending less time in tonic immobility during the tonic immobility test (242 s ± 31 vs. 331 s ± 32, p ≤ 0.05), traveling a shorter distance (3,897 cm ± 242 vs. 4,827 cm ± 278, p ≤ 0.05) at a lower velocity (6.55 cm/s ± 0.4 vs. 8.1 cm/s ± 0.5, p ≤ 0.05) during the social separation test and spending more time near an object at the beginning of the novel object test (33.7 s ± 6.4 vs. 18.5 s ± 4.1, p ≤ 0.05). No difference in growth was found between the 2 groups. Conclusion: For the first time, this study demonstrates that the absence of gut microbiota reduces emotional reactivity in Japanese quails in situations of fear and social perturbation without influence on growth.

Revisiting the Time Trade-Off Hypothesis: Work, Organized Activities, and Academics During College.

PubMed

Greene, Kaylin M; Maggs, Jennifer L

2015-08-01

How adolescents spend their time has long-term implications for their educational, health, and labor market outcomes, yet surprisingly little research has explored the time use of students across days and semesters. The current study used longitudinal daily diary data from a sample of college students attending a large public university in the Northeastern US (n = 726, M age = 18.4) that was followed for 14 days within each of seven semesters (for up to 98 diary days per student). The study had two primary aims. The first aim was to explore demographic correlates of employment time, organized activity time, and academic time. The second aim was to provide a rigorous test of the time trade-off hypothesis, which suggests that students will spend less time on academics when they spend more time on employment and extracurricular activities. The results demonstrated that time use varied by gender, parental education, and race/ethnicity. Furthermore, the results from multi-level models provided some support for the time trade-off hypothesis, although associations varied by the activity type and whether the day was a weekend. More time spent on employment was linked to less time spent on academics across days and semesters whereas organized activities were associated with less time on academics at the daily level only. The negative associations between employment and academics were most pronounced on weekdays. These results suggest that students may balance certain activities across days, whereas other activities may be in competition over longer time frames (i.e., semesters).

Revisiting the Time Trade-off Hypothesis: Work, Organized Activities, and Academics during College

PubMed Central

Maggs, Jennifer L.

2014-01-01

How adolescents spend their time has long-term implications for their educational, health, and labor market outcomes, yet surprisingly little research has explored the time use of students across days and semesters. The current study used longitudinal daily diary data from a sample of college students attending a large public university in the Northeastern US (n = 726, Mage = 18.4) that was followed for 14 days within each of 7 semesters (for up to 98 diary days per student). The study had two primary aims. The first aim was to explore demographic correlates of employment time, organized activity time, and academic time. The second aim was to provide a rigorous test of the time trade-off hypothesis, which suggests that students will spend less time on academics when they spend more time on employment and extracurricular activities. The results demonstrated that time use varied by gender, parental education, and race/ethnicity. Furthermore, the results from multi-level models provided some support for the time trade-off hypothesis, although associations varied by the activity type and whether the day was a weekend. More time spent on employment was linked to less time spent on academics across days and semesters whereas organized activities were associated with less time on academics at the daily level only. The negative associations between employment and academics were most pronounced on weekdays. These results suggest that students may balance certain activities across days, whereas other activities may be in competition over longer time frames (i.e., semesters). PMID:25381597

A self-determination theory perspective on the role of autonomy in solitary behavior.

PubMed

Chua, Sook Ning; Koestner, Richard

2008-10-01

People are often seen as social creatures and, consequently, solitary behaviors are often cast in a negative light. However, the authors hypothesized that the act of spending time alone is not necessarily related to negative outcomes; rather, individuals' motivation for doing so plays a key role. On the basis of self-determination theory (E. L Deci & R. M. Ryan, 2000; R. M. Ryan & E. L. Deci, 2000), the authors predicted and found that when individuals spend time alone in a volitional and autonomous manner, they counterintuitively report lower levels of loneliness and higher levels of well-being.

Comparison of historical medical spending patterns among the BRICS and G7.

PubMed

Jakovljevic, Mihajlo Michael

2016-01-01

The past few decades have been marked by a bold increase in national health spending across the globe. Rather successful health reforms in leading emerging markets such as BRICS reveal a reshaping of their medical care-related expenditures. There is a scarcity of evidence explaining differences in long-term medical spending patterns between top ranked G7 traditional welfare economies and the BRICS nations. A retrospective observational study was conducted on a longitudinal WHO Global Health Expenditure data-set based on the National Health Accounts (NHA) system. Data were presented in a simple descriptive manner, pointing out health expenditure dynamics and differences between the two country groups (BRICS and G7) and individual nations in a 1995-2013 time horizon. Average total per capita health spending still remains substantially higher among G7 (4747 Purchase Power Parity (PPP) $PPP in 2013) compared to the BRICS (1004 $PPP in 2013) nations. The percentage point share of G7 in global health expenditure (million current PPP international $US) has been falling constantly since 1995 (from 65% in 1995 to 53.2% in 2013), while in BRICS nations it grew (from 10.7% in 1995 to 20.2% in 2013). Chinese national level medical spending exceeded significantly that of all G7 members except the US in terms of current $PPP in 2013. Within a limited time horizon of only 19 years it appears that the share of global medical spending by the leading emerging markets has been growing steadily. Simultaneously, the world's richest countries' global share has been falling constantly, although it continues to dominate the landscape. If the contemporary global economic mainstream continues, the BRICS per capita will most likely reach or exceed the OECD average in future decades. Rising out-of-pocket expenses threatening affordability of medical care to poor citizens among the BRICS nations and a too low percentage of GDP in India remain the most notable setbacks of these developments.

Productive Curriculum Time.

ERIC Educational Resources Information Center

Walberg, Herbert J.; And Others

1994-01-01

Discusses productive use of time and its effects on academic success, reviewing research on how students spend their time, describing relationships between allocated, engaged, and productive time and exploring psychological perspectives related to time and curriculum. Curricular and instructional modifications to increase productive time and…

Determining Financial Capability of SSI/SSDI Beneficiaries with Psychiatric Disabilities: A Case Series

PubMed Central

Lazar, Christina M.; Black, Anne C.; McMahon, Thomas J; O’Shea, Kevin; Rosen, Marc I.

2015-01-01

Objective Social Security beneficiaries’ liberty is constrained if they are judged incapable of managing their disability payments and are assigned a fiduciary to manage benefit payments on their behalf. Conversely, beneficiaries’ well-being may be compromised if they misspend money that they need to survive. Several studies have shown that determinations of financial capability are made inconsistently and capability guidelines appear to be applied inconsistently in practice. This case series describes the ambiguities remaining for a small number of individuals even after published criteria for capability— failing to meet basic needs and/or harmful spending on drugs— are applied. Methods Trained, experienced assessors rated the financial capability of 119 individuals in intensive outpatient or inpatient psychiatric facilities who received SSI or SSDI payments. Ten individuals’ cases were determined difficult to judge. Results Six sources of ambiguity were identified by case review: distinguishing incapability from the challenges of navigating poverty, the amount of nonessential spending needed to be considered incapable, the amount of spending on harmful things needed to be considered incapable, how intermittent periods of capability and incapability should be considered, the relative weighting of past behavior and future plans to change, and discrepancies between different sources of information. Conclusion The cases raise fundamental questions about what financial incapability is, but also illustrate how detailed consideration of beneficiaries’ living situations and decision making can inform the difficult dichotomous decision about capability. PMID:25727116

[Financial rating optimization in pressure ulcers management: yes, but at what price?].

PubMed

Crouzet, C; Chaput, B; Grolleau, J-L

2013-06-01

The surgical management of pressure ulcers remains very expensive even if preventive measures and improved care pathways allowed to reduce spending in this domain in recent years. Since 2004, the funding of French hospitals by "fee-for-service" and the needs of saving health spending necessarily compels us to interest ourselves in these purely economic considerations and sometimes modify our requirements for hospital stay to optimize a "patient' valorisation group". In the future, this may lead the surgeon to bias the real needs of the patient for the benefit of hospital establishment. Through a medico-economic analysis of our practices conducted in the plastic surgery department of the University hospital of Toulouse, we tried to identify how to optimize the surgical management of pressure ulcers in terms of valorisation of hospital stay. The aim is still to remain critical about the aberrations that this could introduce in the future for our clinical activity. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Cost Savings Effects of Olanzapine as Long Term Treatment for Bipolar Disorder

PubMed Central

Zhang, Yuting

2007-01-01

Newer and more expensive drugs account for most of the recent rapid growth of spending on prescription drugs in the past nine years. But if more expensive drugs can reduce the use of other types of health care services, total health care costs might fall. In this paper, I investigate the “drug-offset” hypothesis for an atypical antipsychotic drug, olanzapine, compared to lithium, to treat bipolar disorder. I use a propensity-score method to match on observed variables. Then, using various identification strategies, namely interrupted time series, differencing strategies, and an instrument-variable approach, I find that olanzapine does not reduce spending on other types of medical care services, compared with lithium. Olanzapine users spend $330 per month more than lithium users on non-drug health care services after drug treatment and $470 more per month on total health care spending, contradicting the “drug-offset” hypothesis in this case. JEL classification: H51; I1; I18; C1; C2 PMID:18806303

Private enrollments and expenditure on education: Some macro trends

NASA Astrophysics Data System (ADS)

Tan, Jee-Peng

1985-12-01

Many less-developed countries (LDCs) are today facing difficulties in the financing of education. On the one hand, state budgetary allocations to the sector are already very high, and appear likely to grow only slowly, if at all. At the same time, however, the demand for education is rising, not least because of demographic pressures. Without changes in the system, both to reduce unit costs through improving efficiency and to mobilize additional resources for the sector, the level of educational development, particularly in the poorest LDCs, is likely to remain low. Coupled with the stagnation in public spending on education, the data suggest that total national spending in the sector has tended to decline as GDP grew. This trend should perhaps be discouraged since education contributes significantly to economic development. One way of doing so is to increase the share of private participation in total spending in the sector, for example, by increasing the role of private education, especially where it is weak and declining over time.

To increase the statutory limit on the public debt and to require House and Senate votes on constitutional amendments to balance the Federal budget and to restrict new entitlement spending.

THOMAS, 113th Congress

Rep. Crawford, Eric A. "Rick" [R-AR-1

2014-02-10

House - 02/10/2014 Referred to the Committee on Ways and Means, and in addition to the Committee on Rules, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned. (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

To reduce Federal spending and the deficit by terminating taxpayer financing of presidential election campaigns and party conventions and by terminating the Election Assistance Commission.

THOMAS, 113th Congress

Rep. Harper, Gregg [R-MS-3

2013-01-15

House - 01/15/2013 Referred to the Committee on House Administration, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee... (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

An Approach to Forecasting Health Expenditures, with Application to the U.S. Medicare System

PubMed Central

Lee, Ronald; Miller, Timothy

2002-01-01

Objective To quantify uncertainty in forecasts of health expenditures. Study Design Stochastic time series models are estimated for historical variations in fertility, mortality, and health spending per capita in the United States, and used to generate stochastic simulations of the growth of Medicare expenditures. Individual health spending is modeled to depend on the number of years until death. Data Sources/Study Setting A simple accounting model is developed for forecasting health expenditures, using the U.S. Medicare system as an example. Principal Findings Medicare expenditures are projected to rise from 2.2 percent of GDP (gross domestic product) to about 8 percent of GDP by 2075. This increase is due in equal measure to increasing health spending per beneficiary and to population aging. The traditional projection method constructs high, medium, and low scenarios to assess uncertainty, an approach that has many problems. Using stochastic forecasting, we find a 95 percent probability that Medicare spending in 2075 will fall between 4 percent and 18 percent of GDP, indicating a wide band of uncertainty. Although there is substantial uncertainty about future mortality decline, it contributed little to uncertainty about future Medicare spending, since lower mortality both raises the number of elderly, tending to raise spending, and is associated with improved health of the elderly, tending to reduce spending. Uncertainty about fertility, by contrast, leads to great uncertainty about the future size of the labor force, and therefore adds importantly to uncertainty about the health-share of GDP. In the shorter term, the major source of uncertainty is health spending per capita. Conclusions History is a valuable guide for quantifying our uncertainty about future health expenditures. The probabilistic model we present has several advantages over the high–low scenario approach to forecasting. It indicates great uncertainty about future Medicare expenditures relative to GDP. PMID:12479501

The effects of mental health parity on spending and utilization for bipolar, major depression, and adjustment disorders.

PubMed

Busch, Alisa B; Yoon, Frank; Barry, Colleen L; Azzone, Vanessa; Normand, Sharon-Lise T; Goldman, Howard H; Huskamp, Haiden A

2013-02-01

The Mental Health Parity and Addiction Equity Act requires insurance parity for mental health/substance use disorder and general medical services. Previous research found that parity did not increase mental health/substance use disorder spending and lowered out-of-pocket spending. Whether parity's effects differ by diagnosis is unknown. The authors examined this question in the context of parity implementation in the Federal Employees Health Benefits (FEHB) Program. The authors compared mental health/substance use disorder treatment use and spending before and after parity (2000 and 2002, respectively) for two groups: FEHB enrollees diagnosed in 1999 with bipolar disorder, major depression, or adjustment disorder (N=19,094) and privately insured enrollees unaffected by the policy in a comparison national sample (N=10,521). Separate models were fitted for each diagnostic group. A difference-in-difference design was used to control for secular time trends and to better reflect the specific impact of parity on spending and utilization. Total spending was unchanged among enrollees with bipolar disorder and major depression but decreased for those with adjustment disorder (-$62, 99.2% CI=-$133, -$11). Out-of-pocket spending decreased for all three groups (bipolar disorder: -$148, 99.2% CI=-$217, -$85; major depression: -$100, 99.2% CI=-$123, -$77; adjustment disorder: -$68, 99.2% CI=-$84, -$54). Total annual utilization (e.g., medication management visits, psychotropic prescriptions, and mental health/substance use disorder hospitalization bed days) remained unchanged across all diagnoses. Annual psychotherapy visits decreased significantly only for individuals with adjustment disorders (-12%, 99.2% CI=-19%, -4%). Parity implemented under managed care improved financial protection and differentially affected spending and psychotherapy utilization across groups. There was some evidence that resources were preferentially preserved for diagnoses that are typically more severe or chronic and reduced for diagnoses expected to be less so.

The Impact of Green House Adoption on Medicare Spending and Utilization.

PubMed

Grabowski, David C; Afendulis, Christopher C; Caudry, Daryl J; O'Malley, A James; Kemper, Peter

2016-02-01

To evaluate the impact of the Green House (GH) model of nursing home care on Medicare acute hospital, other hospital, skilled nursing facility, and hospice spending and utilization. Medicare claims and enrollment data from 2005 through 2010 merged with resident-level minimum data set (MDS) assessments. Using a difference-in-differences framework, we compared Medicare Part A and hospice expenditures and utilization in 15 nursing homes that adopted the GH model relative to changes over the same time period in 223 matched nonadopting nursing homes. We applied the same method for residents of GH homes and for residents of "legacy" homes, the original nursing homes that stay open alongside the GH home(s). The adoption of GH had no detectable impact on Medicare Part A (plus hospice) spending and utilization across all residents living in the nursing home. When we analyzed residents living in GH homes and legacy units separately, however, we found that the adoption of the GH model reduced overall annual Medicare Part A spending by $7,746 per resident, although this appeared to be partially offset by an increase in spending in legacy homes. To the extent that the GH model reduces Medicare spending, adopting nursing homes do not receive any of the related Medicare savings under traditional payment mechanisms. New approaches that are currently being developed and piloted, which better align financial incentives for providers and payers, could incentivize greater adoption of the GH model. © Health Research and Educational Trust.

Natural family planning.

PubMed

Brown, J B; Blackwell, L F; Billings, J J; Conway, B; Cox, R I; Garrett, G; Holmes, J; Smith, M A

1987-10-01

It is now well accepted that a woman can conceive from an act of intercourse for a maximum of only about 7 days of her menstrual cycle. The reliability of natural family planning depends on identifying this window of fertility without ambiguity. Several symptomatic markers, cervical mucus and basal body temperature, have been used extensively and with considerable success in most women but failures occur. Ovarian and pituitary hormone production show characteristic patterns during the cycle. Urinary estrogen and pregnanediol measurements yield reliable information concerning the beginning, peak, and end of the fertile period, provided that the assays are accurate and performed on timed specimens of urine. We have developed such enzyme immunoassays for urinary estrogen and pregnanediol glucuronides that can be performed at home. In the early versions of the assays, enzyme reaction rates were measured by eye, but more recently, a simple photoelectronic rate meter has been used. The final problem to be solved is not technologic but whether women are sufficiently motivated to expend the same time and effort each day for 10 days a month, with less cost, on fertility awareness as they spend on making a cup of tea.

Effects of Age, Season, Gender and Urban-Rural Status on Time-Activity: Canadian Human Activity Pattern Survey 2 (CHAPS 2)

PubMed Central

Matz, Carlyn J.; Stieb, David M.; Davis, Karelyn; Egyed, Marika; Rose, Andreas; Chou, Benedito; Brion, Orly

2014-01-01

Estimation of population exposure is a main component of human health risk assessment for environmental contaminants. Population-level exposure assessments require time-activity pattern distributions in relation to microenvironments where people spend their time. Societal trends may have influenced time-activity patterns since previous Canadian data were collected 15 years ago. The Canadian Human Activity Pattern Survey 2 (CHAPS 2) was a national survey conducted in 2010–2011 to collect time-activity information from Canadians of all ages. Five urban and two rural locations were sampled using telephone surveys. Infants and children, key groups in risk assessment activities, were over-sampled. Survey participants (n = 5,011) provided time-activity information in 24-hour recall diaries and responded to supplemental questionnaires concerning potential exposures to specific pollutants, dwelling characteristics, and socio-economic factors. Results indicated that a majority of the time was spent indoors (88.9%), most of which was indoors at home, with limited time spent outdoors (5.8%) or in a vehicle (5.3%). Season, age, gender and rurality were significant predictors of time activity patterns. Compared to earlier data, adults reported spending more time indoors at home and adolescents reported spending less time outdoors, which could be indicative of broader societal trends. These findings have potentially important implications for assessment of exposure and risk. The CHAPS 2 data also provide much larger sample sizes to allow for improved precision and are more representative of infants, children and rural residents. PMID:24557523

The Effect of Working Position on Trunk Posture and Exertion for Routine Nursing Tasks: An Experimental Study

PubMed Central

Freitag, Sonja

2014-01-01

Objectives: To examine the influence of the two following factors on the proportion of time that nurses spend in a forward-bending trunk posture: (i) the bed height during basic care activities at the bedside and (ii) the work method during basic care activities in the bathroom. A further aim was to examine the connection between the proportion of time spent in a forward-bending posture and the perceived exertion. Methods: Twelve nurses in a geriatric nursing home each performed a standardized care routine at the bedside and in the bathroom. The CUELA (German abbreviation for ‘computer-assisted recording and long-term analysis of musculoskeletal loads’) measuring system was used to record all trunk inclinations. Each participant conducted three tests with the bed at different heights (knee height, thigh height, and hip height) and in the bathroom, three tests were performed with different work methods (standing, kneeling, and sitting). After each test, participants rated their perceived exertion on the 15-point Borg scale (6 = no exertion at all and 20 = exhaustion). Results: If the bed was raised from knee to thigh level, the proportion of time spent in an upright position increased by 8.2% points. However, the effect was not significant (P = 0.193). Only when the bed was raised to hip height, there was a significant increase of 19.8% points (reference: thigh level; P = 0.003) and 28.0% points (reference: knee height; P < 0.001). Bathroom tests: compared with the standing work method, the kneeling and sitting work methods led to a significant increase in the proportion of time spent in an upright posture, by 19.4% points (P = 0.003) and 25.7% points (P < 0.001), respectively. The greater the proportion of time spent in an upright position, the lower the Borg rating (P < 0.001) awarded. Conclusions: The higher the proportion of time that nursing personnel work in an upright position, the less strenuous they perceive the work to be. Raising the bed to hip height and using a stool in the bathroom significantly increase the proportion of time that nursing personnel work in an upright position. Nursing staff can spend a considerably greater proportion of their time in an ergonomic posture if stools and height-adjustable beds are provided in healthcare institutions. PMID:24371043

The effect of working position on trunk posture and exertion for routine nursing tasks: an experimental study.

PubMed

Freitag, Sonja; Seddouki, Rachida; Dulon, Madeleine; Kersten, Jan Felix; Larsson, Tore J; Nienhaus, Albert

2014-04-01

To examine the influence of the two following factors on the proportion of time that nurses spend in a forward-bending trunk posture: (i) the bed height during basic care activities at the bedside and (ii) the work method during basic care activities in the bathroom. A further aim was to examine the connection between the proportion of time spent in a forward-bending posture and the perceived exertion. Twelve nurses in a geriatric nursing home each performed a standardized care routine at the bedside and in the bathroom. The CUELA (German abbreviation for 'computer-assisted recording and long-term analysis of musculoskeletal loads') measuring system was used to record all trunk inclinations. Each participant conducted three tests with the bed at different heights (knee height, thigh height, and hip height) and in the bathroom, three tests were performed with different work methods (standing, kneeling, and sitting). After each test, participants rated their perceived exertion on the 15-point Borg scale (6 = no exertion at all and 20 = exhaustion). If the bed was raised from knee to thigh level, the proportion of time spent in an upright position increased by 8.2% points. However, the effect was not significant (P = 0.193). Only when the bed was raised to hip height, there was a significant increase of 19.8% points (reference: thigh level; P = 0.003) and 28.0% points (reference: knee height; P < 0.001). Bathroom tests: compared with the standing work method, the kneeling and sitting work methods led to a significant increase in the proportion of time spent in an upright posture, by 19.4% points (P = 0.003) and 25.7% points (P < 0.001), respectively. The greater the proportion of time spent in an upright position, the lower the Borg rating (P < 0.001) awarded. The higher the proportion of time that nursing personnel work in an upright position, the less strenuous they perceive the work to be. Raising the bed to hip height and using a stool in the bathroom significantly increase the proportion of time that nursing personnel work in an upright position. Nursing staff can spend a considerably greater proportion of their time in an ergonomic posture if stools and height-adjustable beds are provided in healthcare institutions.

Energetic Constraints on Fungal Growth.

PubMed

Heaton, Luke L M; Jones, Nick S; Fricker, Mark D

2016-02-01

Saprotrophic fungi are obliged to spend energy on growth, reproduction, and substrate digestion. To understand the trade-offs involved, we developed a model that, for any given growth rate, identifies the strategy that maximizes the fraction of energy that could possibly be spent on reproduction. Our model's predictions of growth rates and bioconversion efficiencies are consistent with empirical findings, and it predicts the optimal investment in reproduction, resource acquisition, and biomass recycling for a given environment and timescale of reproduction. Thus, if the timescale of reproduction is long compared to the time required for the fungus to double in size, the model suggests that the total energy available for reproduction is maximal when a very small fraction of the energy budget is spent on reproduction. The model also suggests that fungi growing on substrates with a high concentration of low-molecular-weight compounds will not benefit from recycling: they should be able to grow more rapidly and allocate more energy to reproduction without recycling. In contrast, recycling offers considerable benefits to fungi growing on recalcitrant substrates, where the individual hyphae are not crowded and the time taken to consume resource is significantly longer than the fungus doubling time.

Toward a next-generation high-energy gamma-ray telescope. Proceedings

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

Bloom, E.D.; Evans, L.L.

It has been some time between the time of the first Gamma-ray Large Area Space Telescope (GLAST) workshop, Towards a Next Generation High-Energy Gamma-Ray Telescope, in late August 1994, and the publication of a partial proceedings of that meeting. Since then there has been considerable progress in both the technical and project development of GLAST. From its origins at SLAC/Stanford in early 1992, the collaboration has currently grown to more than 20 institutions from France, Germany, Italy, Japan, and the US, and is still growing. About half of these are astrophysics/astronomy institutions; the other half are high-energy physics institutions. Aboutmore » 100 astronomers, astrophysicists, and particle physicists are currently spending some fraction of their time on the GLAST R and D program. The late publication date of this proceedings has resulted in some additions to the original content of the meeting. The first paper is actually a brochure prepared for NASA by Peter Michelson in early 1996. Except for the appendix, the other papers in the proceedings were presented at the conference, and written up over the following two years. Some presentations were never written up.« less

Theoretical impact of insecticide-impregnated school uniforms on dengue incidence in Thai children.

PubMed

Massad, Eduardo; Amaku, Marcos; Coutinho, Francisco Antonio Bezerra; Kittayapong, Pattamaporn; Wilder-Smith, Annelies

2013-03-28

Children carry the main burden of morbidity and mortality caused by dengue. Children spend a considerable amount of their day at school; hence strategies that reduce human-mosquito contact to protect against the day-biting habits of Aedes mosquitoes at schools, such as insecticide-impregnated uniforms, could be an effective prevention strategy. We used mathematical models to calculate the risk of dengue infection based on force of infection taking into account the estimated proportion of mosquito bites that occur in school and the proportion of school time that children wear the impregnated uniforms. The use of insecticide-impregnated uniforms has efficacy varying from around 6% in the most pessimistic estimations, to 55% in the most optimistic scenarios simulated. Reducing contact between mosquito bites and human hosts via insecticide-treated uniforms during school time is theoretically effective in reducing dengue incidence and may be a valuable additional tool for dengue control in school-aged children. The efficacy of this strategy, however, is dependent on the compliance of the target population in terms of proper and consistent wearing of uniforms and, perhaps more importantly, the proportion of bites inflicted by the Aedes population during school time.

Theoretical impact of insecticide-impregnated school uniforms on dengue incidence in Thai children

PubMed Central

Massad, Eduardo; Amaku, Marcos; Coutinho, Francisco Antonio Bezerra; Kittayapong, Pattamaporn; Wilder-Smith, Annelies

2013-01-01

Background Children carry the main burden of morbidity and mortality caused by dengue. Children spend a considerable amount of their day at school; hence strategies that reduce human–mosquito contact to protect against the day-biting habits of Aedes mosquitoes at schools, such as insecticide-impregnated uniforms, could be an effective prevention strategy. Methodology We used mathematical models to calculate the risk of dengue infection based on force of infection taking into account the estimated proportion of mosquito bites that occur in school and the proportion of school time that children wear the impregnated uniforms. Principal findings The use of insecticide-impregnated uniforms has efficacy varying from around 6% in the most pessimistic estimations, to 55% in the most optimistic scenarios simulated. Conclusions Reducing contact between mosquito bites and human hosts via insecticide-treated uniforms during school time is theoretically effective in reducing dengue incidence and may be a valuable additional tool for dengue control in school-aged children. The efficacy of this strategy, however, is dependent on the compliance of the target population in terms of proper and consistent wearing of uniforms and, perhaps more importantly, the proportion of bites inflicted by the Aedes population during school time. PMID:23541045

A Study towards Building An Optimal Graph Theory Based Model For The Design of Tourism Website

NASA Astrophysics Data System (ADS)

Panigrahi, Goutam; Das, Anirban; Basu, Kajla

2010-10-01

Effective tourism website is a key to attract tourists from different parts of the world. Here we identify the factors of improving the effectiveness of website by considering it as a graph, where web pages including homepage are the nodes and hyperlinks are the edges between the nodes. In this model, the design constraints for building a tourism website are taken into consideration. Our objectives are to build a framework of an effective tourism website providing adequate level of information, service and also to enable the users to reach to the desired page by spending minimal loading time. In this paper an information hierarchy specifying the upper limit of outgoing link of a page has also been proposed. Following the hierarchy, the web developer can prepare an effective tourism website. Here loading time depends on page size and network traffic. We have assumed network traffic as uniform and the loading time is directly proportional with page size. This approach is done by quantifying the link structure of a tourism website. In this approach we also propose a page size distribution pattern of a tourism website.

Machine-Learning Algorithms to Code Public Health Spending Accounts

PubMed Central

Leider, Jonathon P.; Resnick, Beth A.; Alfonso, Y. Natalia; Bishai, David

2017-01-01

Objectives: Government public health expenditure data sets require time- and labor-intensive manipulation to summarize results that public health policy makers can use. Our objective was to compare the performances of machine-learning algorithms with manual classification of public health expenditures to determine if machines could provide a faster, cheaper alternative to manual classification. Methods: We used machine-learning algorithms to replicate the process of manually classifying state public health expenditures, using the standardized public health spending categories from the Foundational Public Health Services model and a large data set from the US Census Bureau. We obtained a data set of 1.9 million individual expenditure items from 2000 to 2013. We collapsed these data into 147 280 summary expenditure records, and we followed a standardized method of manually classifying each expenditure record as public health, maybe public health, or not public health. We then trained 9 machine-learning algorithms to replicate the manual process. We calculated recall, precision, and coverage rates to measure the performance of individual and ensembled algorithms. Results: Compared with manual classification, the machine-learning random forests algorithm produced 84% recall and 91% precision. With algorithm ensembling, we achieved our target criterion of 90% recall by using a consensus ensemble of ≥6 algorithms while still retaining 93% coverage, leaving only 7% of the summary expenditure records unclassified. Conclusions: Machine learning can be a time- and cost-saving tool for estimating public health spending in the United States. It can be used with standardized public health spending categories based on the Foundational Public Health Services model to help parse public health expenditure information from other types of health-related spending, provide data that are more comparable across public health organizations, and evaluate the impact of evidence-based public health resource allocation. PMID:28363034

Machine-Learning Algorithms to Code Public Health Spending Accounts.

PubMed

Brady, Eoghan S; Leider, Jonathon P; Resnick, Beth A; Alfonso, Y Natalia; Bishai, David

Government public health expenditure data sets require time- and labor-intensive manipulation to summarize results that public health policy makers can use. Our objective was to compare the performances of machine-learning algorithms with manual classification of public health expenditures to determine if machines could provide a faster, cheaper alternative to manual classification. We used machine-learning algorithms to replicate the process of manually classifying state public health expenditures, using the standardized public health spending categories from the Foundational Public Health Services model and a large data set from the US Census Bureau. We obtained a data set of 1.9 million individual expenditure items from 2000 to 2013. We collapsed these data into 147 280 summary expenditure records, and we followed a standardized method of manually classifying each expenditure record as public health, maybe public health, or not public health. We then trained 9 machine-learning algorithms to replicate the manual process. We calculated recall, precision, and coverage rates to measure the performance of individual and ensembled algorithms. Compared with manual classification, the machine-learning random forests algorithm produced 84% recall and 91% precision. With algorithm ensembling, we achieved our target criterion of 90% recall by using a consensus ensemble of ≥6 algorithms while still retaining 93% coverage, leaving only 7% of the summary expenditure records unclassified. Machine learning can be a time- and cost-saving tool for estimating public health spending in the United States. It can be used with standardized public health spending categories based on the Foundational Public Health Services model to help parse public health expenditure information from other types of health-related spending, provide data that are more comparable across public health organizations, and evaluate the impact of evidence-based public health resource allocation.

The price of conserving avian phylogenetic diversity: a global prioritization approach

PubMed Central

Nunes, Laura A.; Turvey, Samuel T.; Rosindell, James

2015-01-01

The combination of rapid biodiversity loss and limited funds available for conservation represents a major global concern. While there are many approaches for conservation prioritization, few are framed as financial optimization problems. We use recently published avian data to conduct a global analysis of the financial resources required to conserve different quantities of phylogenetic diversity (PD). We introduce a new prioritization metric (ADEPD) that After Downlisting a species gives the Expected Phylogenetic Diversity at some future time. Unlike other metrics, ADEPD considers the benefits to future PD associated with downlisting a species (e.g. moving from Endangered to Vulnerable in the International Union for Conservation of Nature Red List). Combining ADEPD scores with data on the financial cost of downlisting different species provides a cost–benefit prioritization approach for conservation. We find that under worst-case spending $3915 can save 1 year of PD, while under optimal spending $1 can preserve over 16.7 years of PD. We find that current conservation spending patterns are only expected to preserve one quarter of the PD that optimal spending could achieve with the same total budget. Maximizing PD is only one approach within the wider goal of biodiversity conservation, but our analysis highlights more generally the danger involved in uninformed spending of limited resources. PMID:25561665

The price of conserving avian phylogenetic diversity: a global prioritization approach.

PubMed

Nunes, Laura A; Turvey, Samuel T; Rosindell, James

2015-02-19

The combination of rapid biodiversity loss and limited funds available for conservation represents a major global concern. While there are many approaches for conservation prioritization, few are framed as financial optimization problems. We use recently published avian data to conduct a global analysis of the financial resources required to conserve different quantities of phylogenetic diversity (PD). We introduce a new prioritization metric (ADEPD) that After Downlisting a species gives the Expected Phylogenetic Diversity at some future time. Unlike other metrics, ADEPD considers the benefits to future PD associated with downlisting a species (e.g. moving from Endangered to Vulnerable in the International Union for Conservation of Nature Red List). Combining ADEPD scores with data on the financial cost of downlisting different species provides a cost-benefit prioritization approach for conservation. We find that under worst-case spending $3915 can save 1 year of PD, while under optimal spending $1 can preserve over 16.7 years of PD. We find that current conservation spending patterns are only expected to preserve one quarter of the PD that optimal spending could achieve with the same total budget. Maximizing PD is only one approach within the wider goal of biodiversity conservation, but our analysis highlights more generally the danger involved in uninformed spending of limited resources.

Effects of a consumer driven health plan on pharmaceutical spending and utilization.

PubMed

Parente, Stephen T; Feldman, Roger; Chen, Song

2008-10-01

To compare pharmaceutical spending and utilization in a consumer driven health plan (CDHP) with a three-tier pharmacy benefit design, and to examine whether the CDHP creates incentives to reduce pharmaceutical spending and utilization for chronically ill patients, generic or brand name drugs, and mail-order drugs. Retrospective insurance claims analysis from a large employer that introduced a CDHP in 2001 in addition to a point of service (POS) plan and a preferred provider organization (PPO), both of which used a three-tier pharmacy benefit. Difference-in-differences regression models were estimated for drug spending and utilization. Control variables included the employee's income, age, and gender, number of covered lives per contract, election of flexible spending account, health status, concurrent health shock, cohort, and time trend. Results. CDHP pharmaceutical expenditures were lower than those in the POS cohort in 1 year without differences in the use of brand name drugs. We find limited evidence of less drug consumption by CDHP enrollees with chronic illnesses, and some evidence of less generic drug use and more mail-order drug use among CDHP members. The CDHP is cost-neutral or cost-saving to both the employer and the employee compared with three-tier benefits with no differences in brand name drug use. © Health Research and Educational Trust.

Assessing child time-activity patterns in relation to indoor cooking fires in developing countries: a methodological comparison.

PubMed

Barnes, Brendon; Mathee, Angela; Moiloa, Kebitsamang

2005-01-01

Indoor air pollution, caused by the indoor burning of biomass fuels, has been associated with an increased risk of child acute respiratory infections in developing countries. The amount of time that children spend in proximity to fires is a crucial determinant of the health impact of indoor air pollution. Researchers are reliant on social scientific methods to assess exposure based on child location patterns in relation to indoor fires. The inappropriate use of methods could lead to misclassification of exposure. The aim of this paper is to compare two methods (observations and questionnaire interview) with video analysis (which is thought to offer a more accurate assessment of exposure) in rural South African villages. Compared to video analysis, results show that observations may underestimate the amount of time that children spend very close (within 1.5 m) to fires. This is possibly due to reactivity caused by the presence of an observer. The questionnaire interview offers a more accurate assessment of the amounts of time that children spend within 1.5 m of fires at the expense of a detailed behavioural analysis. By drawing on the strengths and weaknesses of each, this paper discusses the appropriateness of methods to different research contexts.

Who children spend time with after school: associations with objectively recorded indoor and outdoor physical activity.

PubMed

Pearce, Matthew; Page, Angie S; Griffin, Tom P; Cooper, Ashley R

2014-03-30

Understanding how the determinants of behaviour vary by context may support the design of interventions aiming to increase physical activity. Such factors include independent mobility, time outdoors and the availability of other children. At present little is known about who children spend their time with after school, how this relates to time spent indoors or outdoors and activity in these locations. This study aimed to quantify who children spend their time with when indoors or outdoors and associations with moderate to vigorous physical activity (MVPA). Participants were 427 children aged 10-11 from Bristol, UK. Physical activity was recorded using an accelerometer (Actigraph GT1M) and matched to Global Positioning System receiver (Garmin Foretrex 201) data to differentiate indoor and outdoor location. Children self-reported who they spent time with after school until bed-time using a diary. Each 10 second epoch was coded as indoors or outdoors and for 'who with' (alone, friend, brother/sister, mum/dad, other grown-up) creating 10 possible physical activity contexts. Time spent and MVPA were summarised for each context. Associations between time spent in the different contexts and MVPA were examined using multiple linear regression adjusting for daylight, age, deprivation and standardised body mass index. During the after school period, children were most often with their mum/dad or alone, especially when indoors. When outdoors more time was spent with friends (girls: 32.1%; boys: 28.6%) than other people or alone. Regression analyses suggested hours outdoors with friends were positively associated with minutes of MVPA for girls (beta-coefficient [95% CI]: 17.4 [4.47, 30.24]) and boys (17.53 [2.76, 32.31]). Being outdoors with brother/sister was associated with MVPA for girls (21.2 [14.17, 28.25]) but not boys. Weaker associations were observed for time indoors with friends (girls: 4.61 [1.37, 7.85]; boys: (7.42 [2.99, 11.85]) and other adults (girls: 5.33 [2.95, 7.71]; boys: (4.44 [1.98, 6.90]). Time spent alone was not associated with MVPA regardless of gender or indoor/outdoor location. Time spent outdoors with other children is an important source of MVPA after school. Interventions to increase physical activity may benefit from fostering friendship groups and limiting the time children spend alone.

Who children spend time with after school: associations with objectively recorded indoor and outdoor physical activity

PubMed Central

2014-01-01

Background Understanding how the determinants of behaviour vary by context may support the design of interventions aiming to increase physical activity. Such factors include independent mobility, time outdoors and the availability of other children. At present little is known about who children spend their time with after school, how this relates to time spent indoors or outdoors and activity in these locations. This study aimed to quantify who children spend their time with when indoors or outdoors and associations with moderate to vigorous physical activity (MVPA). Methods Participants were 427 children aged 10–11 from Bristol, UK. Physical activity was recorded using an accelerometer (Actigraph GT1M) and matched to Global Positioning System receiver (Garmin Foretrex 201) data to differentiate indoor and outdoor location. Children self-reported who they spent time with after school until bed-time using a diary. Each 10 second epoch was coded as indoors or outdoors and for ‘who with’ (alone, friend, brother/sister, mum/dad, other grown-up) creating 10 possible physical activity contexts. Time spent and MVPA were summarised for each context. Associations between time spent in the different contexts and MVPA were examined using multiple linear regression adjusting for daylight, age, deprivation and standardised body mass index. Results During the after school period, children were most often with their mum/dad or alone, especially when indoors. When outdoors more time was spent with friends (girls: 32.1%; boys: 28.6%) than other people or alone. Regression analyses suggested hours outdoors with friends were positively associated with minutes of MVPA for girls (beta-coefficient [95% CI]: 17.4 [4.47, 30.24]) and boys (17.53 [2.76, 32.31]). Being outdoors with brother/sister was associated with MVPA for girls (21.2 [14.17, 28.25]) but not boys. Weaker associations were observed for time indoors with friends (girls: 4.61 [1.37, 7.85]; boys: (7.42 [2.99, 11.85]) and other adults (girls: 5.33 [2.95, 7.71]; boys: (4.44 [1.98, 6.90]). Time spent alone was not associated with MVPA regardless of gender or indoor/outdoor location. Conclusions Time spent outdoors with other children is an important source of MVPA after school. Interventions to increase physical activity may benefit from fostering friendship groups and limiting the time children spend alone. PMID:24679149

The Canadian Human Activity Pattern Survey: report of methods and population surveyed.

PubMed

Leech, J A; Wilby, K; McMullen, E; Laporte, K

1996-01-01

The assessment of health risk due to environmental contaminants depends upon accurate estimates of the distribution of population exposures. Exposure assessment, in turn, requires information on the time people spend in micro-environments and their activities during periods of exposure. This paper describes preliminary results including study methodology and population sampled in a large Canadian survey of time-activity patterns. A 24-hour diary recall survey was performed in 2381 households (representing a 65% response rate) to describe in detail the timing, location and activity pattern of one household member (the adult or child with the next birthday). Four cities (Toronto, Vancouver, Edmonton and Saint John, NB) and their suburbs were sampled by random-digit dialling over a nine-month period in 1994/1995. Supplemental questionnaires inquiring about sociodemographic information, house and household characteristics and potential exposure to toxins in the air and water were also administered. In general, the results show that respondents spend the majority of their time indoors (88.6%) with smaller proportions of time outdoors (6.1%) and in vehicles (5.3%). Children under the age of 12 spend more time both indoors and outdoors and less time in transit than do adults. The data from this study will be used to define more accurately the exposure of Canadians to a variety of toxins in exposure assessment models and to improve upon the accuracy of risk assessment for a variety of acute and chronic health effects known or suspected to be related to environmental exposures.

Generic Entry, Reformulations, and Promotion of SSRIs

PubMed Central

Donohue, Julie M.; Koss, Catherine; Berndt, Ernst R.; Frank, Richard G.

2009-01-01

Background Previous research has shown that a manufacturer’s promotional strategy for a brand-name drug is typically affected by generic entry. However, little is known about how newer strategies to extend patent life, including product reformulation introduction or obtaining approval to market for additional clinical indications, influence promotion. Objective To examine the relationship between promotional expenditures, generic entry, reformulation entry, and new indication approval. Study Design/Setting We used quarterly data on national product-level promotional spending (including expenditures for physician detailing and direct-to-consumer advertising (DTCA), and the retail value of free samples distributed in physician offices) for selective serotonin reuptake inhibitors (SSRIs) over the period 1997 through 2004. We estimated econometric models of detailing, DTCA, and total quarterly promotional expenditures as a function of the timing of generic entry, entry of new product formulations, and Food and Drug Administration (FDA) approval for new clinical indications for existing medications in the SSRI class. Main Outcome Measure Expenditures by pharmaceutical manufacturers for promotion of antidepressant medications. Results Over the period 1997–2004, there was considerable variation in the composition of promotional expenditures across the SSRIs. Promotional expenditures for the original brand molecule decreased dramatically when a reformulation of the molecule was introduced. Promotional spending (both total and detailing alone) for a specific molecule was generally lower after generic entry than before, although the effect of generic entry on promotional spending appears to be closely linked with the choice of product reformulation strategy pursued by the manufacturer. Detailing expenditures for Paxil were increased after the manufacturer received FDA approval to market the drug for generalized anxiety disorder (GAD), while the likelihood of DTCA outlays for the drug was not changed. In contrast, FDA approval to market Paxil and Zoloft for social anxiety disorder (SAD) did not affect the manufacturers’ detailing expenditures but did result in a greater likelihood of DTCA outlays. Conclusion The introduction of new product formulations appears to be a common strategy for attempting to extend market exclusivity for medications facing impending generic entry. Manufacturers that introduced a reformulation before generic entry shifted most promotion dollars from the original brand to the reformulation long before generic entry, and in some cases manufacturers appeared to target a particular promotion type for a given indication. Given the significant impact pharmaceutical promotion has on demand for prescription drugs, these findings have important implications for prescription drug spending and public health. PMID:18563951

Generational Differences In U.S. Public Spending, 1980–2000

PubMed Central

Pati, Susmita; Keren, Ron; Alessandrini, Evaline A.; Schwarz, Donald F.

2013-01-01

The balance between spending on children and spending on the elderly is important in evaluating the allocation of public welfare spending. We examine trends in public spending on social welfare programs for children and the elderly during 1980–2000. For both groups, social welfare spending as a percentage of gross domestic product changed little, even during the economic expansions of the 1990s. In constant dollars, the gap in per capita social welfare spending between children and the elderly grew 20 percent. Unlike spending for programs for the elderly, spending for children’s programs suffered during recessions. Public discussion about the current imbalance in public spending is needed. PMID:15371377

Research and Development Spending to Bring a Single Cancer Drug to Market and Revenues After Approval.

PubMed

Prasad, Vinay; Mailankody, Sham

2017-11-01

A common justification for high cancer drug prices is the sizable research and development (R&D) outlay necessary to bring a drug to the US market. A recent estimate of R&D spending is $2.7 billion (2017 US dollars). However, this analysis lacks transparency and independent replication. To provide a contemporary estimate of R&D spending to develop cancer drugs. Analysis of US Securities and Exchange Commission filings for drug companies with no drugs on the US market that received approval by the US Food and Drug Administration for a cancer drug from January 1, 2006, through December 31, 2015. Cumulative R&D spending was estimated from initiation of drug development activity to date of approval. Earnings were also identified from the time of approval to the present. The study was conducted from December 10, 2016, to March 2, 2017. Median R&D spending on cancer drug development. Ten companies and drugs were included in this analysis. The 10 companies had a median time to develop a drug of 7.3 years (range, 5.8-15.2 years). Five drugs (50%) received accelerated approval from the US Food and Drug Administration, and 5 (50%) received regular approval. The median cost of drug development was $648.0 million (range, $157.3 million to $1950.8 million). The median cost was $757.4 million (range, $203.6 million to $2601.7 million) for a 7% per annum cost of capital (or opportunity costs) and $793.6 million (range, $219.1 million to $2827.1 million) for a 9% opportunity costs. With a median of 4.0 years (range, 0.8-8.8 years) since approval, the total revenue from sales of these 10 drugs since approval was $67.0 billion compared with total R&D spending of $7.2 billion ($9.1 billion, including 7% opportunity costs). The cost to develop a cancer drug is $648.0 million, a figure significantly lower than prior estimates. The revenue since approval is substantial (median, $1658.4 million; range, $204.1 million to $22 275.0 million). This analysis provides a transparent estimate of R&D spending on cancer drugs and has implications for the current debate on drug pricing.

Daily internet time: towards an evidence-based recommendation?

PubMed

Berchtold, André; Akre, Christina; Barrense-Dias, Yara; Zimmermann, Grégoire; Surís, Joan-Carles

2018-04-17

Since 2001, a recommendation of no more than 2 h per day of screen time for children 2 years of age or older was adopted in many countries. However, this recommendation was rarely examined empirically. The goal of the present study was to question this recommendation in today's connected world. We used data from the ado@internet.ch survey (spring 2012), a representative sample of 8th graders in the Canton of Vaud, Switzerland (n = 2942, 50.6% female). Internet use, health outcomes, substance use, well-being and socio-demographic characteristics were considered. Bi-variate statistical analyses were performed. All outcomes were significantly associated with the time spent on internet, more time being associated with a higher prevalence of adverse consequences. Youth spending on average one more hour on Internet per day than the reference category (1.5-2.5 h) did not differ in terms of adverse health outcomes. Differences began to appear on sleeping problems, tobacco use, alcohol misuse, cannabis use and sport inactivity with youth spending between 3.5 h and 4.5 h per day on internet. This study demonstrates the absence of justification for setting a limit to only 2 h of screen time per day. Significant effects on health seem to appear only beyond 4 h per day and there may be benefits for those who spend less than an hour and a half on internet.

The AMCP Format for Formulary Submissions: Welcome to Version 4.0.

PubMed

2016-05-01

Managed care pharmacists are increasingly presented with complex considerations related to prescription drug formulary management. As prescription drug spending soars, and new effective, but expensive drugs rush to the market, pharmacists and other health care decision makers must evaluate a myriad of important clinical and economic considerations in determining the relative value and, subsequently, the appropriate placement of a product within a formulary. The AMCP Format for Formulary Submissions, Version 4.0, is the next iteration of the Format, which was first released in 2000. Version 4.0, developed by pharmacists from health plan, manufacturer, and academic perspectives, provides updated recommendations on acquiring and evaluating clinical and economic evidence to inform formulary and medical policy decisions. It also includes new guidance related to emerging special topic considerations such as biosimilars, specialty pharmacy products, and companion diagnostic tests. Version 4.0 has been modified to improve the usability of the Format, with clarifying guidance related to logistical considerations such as a recommended time frame for implementation of Version 4.0, as well as dossier updates and ongoing communication between manufacturers and health care decision makers. The Format should be used as a framework for ongoing evidence-based dialogue between manufacturers and payers. The evolving health care landscape will require new levels of collaboration and communication among key stakeholders to successfully navigate the challenges of this new environment. The Format provides a framework to support these critical interactions related to product value by facilitating an evidence-based, transparent approach. This document was prepared by Jeff Lee, PharmD, FCCP, on behalf of the AMCP Format Executive Committee. Committee members reviewed and provided feedback on the final draft. No conflicts of interest, financial or otherwise, were reported.

National Health Care Spending In 2016: Spending And Enrollment Growth Slow After Initial Coverage Expansions.

PubMed

Hartman, Micah; Martin, Anne B; Espinosa, Nathan; Catlin, Aaron; The National Health Expenditure Accounts Team

2018-01-01

Total nominal US health care spending increased 4.3 percent and reached $3.3 trillion in 2016. Per capita spending on health care increased by $354, reaching $10,348. The share of gross domestic product devoted to health care spending was 17.9 percent in 2016, up from 17.7 percent in 2015. Health spending growth decelerated in 2016 following faster growth in 2014 and 2015 associated with coverage expansions under the Affordable Care Act (ACA) and strong retail prescription drug spending growth. In 2016 the slowdown was broadly based, as spending for the largest categories by payer and by service decelerated. Enrollment trends drove the slowdown in Medicaid and private health insurance spending growth in 2016, while slower per enrollee spending growth influenced Medicare spending. Furthermore, spending for retail prescription drugs slowed, partly as a result of lower spending for drugs used to treat hepatitis C, while slower use and intensity of services drove the slowdown in hospital care and physician and clinical services.

Patterns of Healthcare Spending in the Last Year of Life

PubMed Central

Davis, Matthew A.; Nallamothu, Brahmajee K.; Banerjee, Mousumi; Bynum, Julie P.W.

2016-01-01

The underlying assumption that healthcare spending skyrockets at the end-of-life may suggest that policymakers should target the last few months of life to control costs. However, spending patterns leading up to death have not been fully examined. We applied a new methodology to administrative claims data for older Medicare beneficiaries who died in 2012 to characterize trajectories of healthcare spending in the last year of life. After adjustment, we identified four unique spending trajectories among decedents: 48.7 percent had High Persistent spending, 29.0 percent had Moderate Persistent spending, 10.2 percent had Progressive spending, and only 12.1 percent had Late Rise spending. High spending throughout the full year before death (approximately half of all decedents) was associated with having multiple chronic conditions but not any specific diseases. These findings suggest that spending at the end-of-life is a marker of general spending patterns often set in motion long before death. PMID:27307350

Jet lag prevention

MedlinePlus

... a day to adjust to one to two time zones. So if you travel over three time zones, it will take about two days for ... decisions the first day. Once you arrive, spend time in the sun. This can help reset your internal clock.

Specialty Payment Model Opportunities and Assessment

PubMed Central

Huckfeldt, Peter J.; Chan, Chris; Hirshman, Samuel; Kofner, Aaron; Liu, Jodi L.; Mulcahy, Andrew W.; Popescu, Ioana; Stevens, Clare; Timbie, Justin W.; Hussey, Peter S.

2015-01-01

Abstract This article describes research related to the design of a payment model for specialty oncology services for possible testing by the Center for Medicare and Medicaid Innovation at the Centers for Medicare & Medicaid Services (CMS). Cancer is a common and costly condition. Episode-based payment, which aims to create incentives for high-quality, low-cost care, has been identified as a promising alternative payment model for oncology care. Episode-based payment systems can provide flexibility to health care providers to select among the most effective and efficient treatment alternatives, including activities that are not currently reimbursed under Medicare payment policies. However, the model design also needs to ensure that high-quality care is delivered and that beneficial treatments are not withheld from patients. CMS asked MITRE and RAND to conduct analyses to inform design decisions related to an episode-based oncology model for Medicare beneficiaries undergoing chemotherapy treatment for cancer. In particular, this study focuses on analyses of Medicare claims data related to the definition of the initiation of an episode of chemotherapy, patterns of spending during and surrounding episodes of chemotherapy, and attribution of episodes of chemotherapy to physician practices. We found that the time between the primary cancer diagnosis and chemotherapy initiation varied widely across patients, ranging from one day to over seven years, with a median of 2.4 months. The average level of total monthly payments varied considerably across cancers, with the highest spending peak of $9,972 for lymphoma, and peaks of $3,109 for breast cancer and $2,135 for prostate cancer. PMID:28083364

Specialty Payment Model Opportunities and Assessment: Oncology Model Design Report.

PubMed

Huckfeldt, Peter J; Chan, Chris; Hirshman, Samuel; Kofner, Aaron; Liu, Jodi L; Mulcahy, Andrew W; Popescu, Ioana; Stevens, Clare; Timbie, Justin W; Hussey, Peter S

2015-07-15

This article describes research related to the design of a payment model for specialty oncology services for possible testing by the Center for Medicare and Medicaid Innovation at the Centers for Medicare & Medicaid Services (CMS). Cancer is a common and costly condition. Episode-based payment, which aims to create incentives for high-quality, low-cost care, has been identified as a promising alternative payment model for oncology care. Episode-based payment systems can provide flexibility to health care providers to select among the most effective and efficient treatment alternatives, including activities that are not currently reimbursed under Medicare payment policies. However, the model design also needs to ensure that high-quality care is delivered and that beneficial treatments are not withheld from patients. CMS asked MITRE and RAND to conduct analyses to inform design decisions related to an episode-based oncology model for Medicare beneficiaries undergoing chemotherapy treatment for cancer. In particular, this study focuses on analyses of Medicare claims data related to the definition of the initiation of an episode of chemotherapy, patterns of spending during and surrounding episodes of chemotherapy, and attribution of episodes of chemotherapy to physician practices. We found that the time between the primary cancer diagnosis and chemotherapy initiation varied widely across patients, ranging from one day to over seven years, with a median of 2.4 months. The average level of total monthly payments varied considerably across cancers, with the highest spending peak of $9,972 for lymphoma, and peaks of $3,109 for breast cancer and $2,135 for prostate cancer.

Shopper marketing nutrition interventions: Social norms on grocery carts increase produce spending without increasing shopper budgets.

PubMed

Payne, Collin R; Niculescu, Mihai; Just, David R; Kelly, Michael P

2015-01-01

We assessed the efficacy of an easy-to-implement shopper marketing nutrition intervention in a pilot and two additional studies to increase produce demand without decreasing store profitability or increasing shopper budgets. We created grocery cart placards that detailed the number of produce items purchased (i.e., descriptive norm) at particular stores (i.e., provincial norm). The effect of these placards on produce spending was assessed across 971,706 individual person grocery store transactions aggregated by day. The pilot study designated a baseline period (in both control and intervention store) followed by installation of grocery cart placards (in the intervention store) for two weeks. The pilot study was conducted in Texas in 2012. In two additional stores, we designated baseline periods followed by 28 days of the same grocery cart placard intervention as in the pilot. Additional interventions were conducted in New Mexico in 2013. The pilot study resulted in a significant difference between average produce spending per day per person across treatment periods (i.e., intervention versus same time period in control) (16%) and the difference between average produce spending per day per person across stores in the control periods (4%); Furthermore, the same intervention in two additional stores resulted in significant produce spending increases of 12.4% and 7.5% per day per person respectively. In all stores, total spending did not change. Descriptive and provincial social norm messages (i.e., on grocery cart placards) may be an overlooked tool to increase produce demand without decreasing store profitability and increasing shopper budgets.

Resource allocation for pharmaceutical procurement in the Brazilian Unified Health System.

PubMed

Vieira, Fabiola Sulpino; Zucchi, Paola

2011-10-01

To analyze resource allocation for pharmaceutical procurement by federative entities in the Brazilian Unified Health System. The amounts allocated to purchase pharmaceuticals during 2009 in two information systems were analyzed: Siga Brasil (Follow Brazil) for national data and Sistema de Informações sobre Orçamentos Públicos em Saúde (Information System on Public Health Budgets) for states, the Federal District and municipalities data. Per capita spending and the mean and median spending were calculated by municipalities, according to region and population size. The Spearman correlation coefficient was calculated for some variables. The statistical analysis included tests of normality and multiple comparisons for differences between groups. In 2009 the total amount spent by the three spheres of government for purchase of medicines was approximately R$ 8.9 billion. States and the Federal District were the main players, accounting for 47.1% of the total amount spent in the health system. Some states had per capita spending well above the mean (R$ 22.00 per resident/year) and the median (R$ 17.00 per resident/year). There were differences in municipal spending by region. The mean per capita expenditure of municipalities with less than 5,000 residents was 3.9 times that of municipalities with over 500,000 residents. Municipalities with less than 10,000 residents had higher per capita spending than other municipalities. Economic aspects such as the scale of procurement and bargaining power may explain differences in per capita spending between federal entities, especially among municipalities. The study indicates inefficiencies in the use of financial resources to procure medicines in the Brazilian Unified Health System.

Growth in spending on substance use disorder treatment services for the privately insured population.

PubMed

Thomas, Cindy Parks; Hodgkin, Dominic; Levit, Katharine; Mark, Tami L

2016-03-01

Approximately 8% of individuals with private health insurance in the United States have substance use disorders (SUDs), but in 2009 only 0.4% of all private insurance spending was on SUDs. The objective of this study was to determine if changes that occurred between 2009 and 2012 - such as more generous SUD benefits, an epidemic of opioid use disorders, and slow recovery from a recession - were associated with greater use of SUD treatment. Data were from the 2004-2012 Truven Health Analytics MarketScan(®) Commercial Claims and Encounters Database. This database is representative of individuals with private insurance in the United States. Per enrollee use of and spending on SUD treatment was determined and compared with spending on all health care services. Trends were examined for inpatient care, outpatient care, and prescription medications. During the 2009-2012 time period, use of and spending on SUD services increased compared with all diagnoses. Two-thirds of the increase was driven by higher growth rates in outpatient use and prices. Despite the high growth rates, SUD treatment penetration rates remained low. As of 2012, only 0.6% of individuals with private insurance used SUD outpatient services, 0.2% filled SUD medication prescriptions, and 0.1% used inpatient SUD services. In 2012, SUD services accounted for less than 0.7% of all private insurance spending. Despite recent coverage improvements, individuals with private health insurance still may not receive adequate levels of treatment for SUDs, as evidenced by the small proportion of individuals who access treatment. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Shopper marketing nutrition interventions: Social norms on grocery carts increase produce spending without increasing shopper budgets☆

PubMed Central

Payne, Collin R.; Niculescu, Mihai; Just, David R.; Kelly, Michael P.

2015-01-01

Objectives We assessed the efficacy of an easy-to-implement shopper marketing nutrition intervention in a pilot and two additional studies to increase produce demand without decreasing store profitability or increasing shopper budgets. Methods We created grocery cart placards that detailed the number of produce items purchased (i.e., descriptive norm) at particular stores (i.e., provincial norm). The effect of these placards on produce spending was assessed across 971,706 individual person grocery store transactions aggregated by day. The pilot study designated a baseline period (in both control and intervention store) followed by installation of grocery cart placards (in the intervention store) for two weeks. The pilot study was conducted in Texas in 2012. In two additional stores, we designated baseline periods followed by 28 days of the same grocery cart placard intervention as in the pilot. Additional interventions were conducted in New Mexico in 2013. Results The pilot study resulted in a significant difference between average produce spending per day per person across treatment periods (i.e., intervention versus same time period in control) (16%) and the difference between average produce spending per day per person across stores in the control periods (4%); Furthermore, the same intervention in two additional stores resulted in significant produce spending increases of 12.4% and 7.5% per day per person respectively. In all stores, total spending did not change. Conclusions Descriptive and provincial social norm messages (i.e., on grocery cart placards) may be an overlooked tool to increase produce demand without decreasing store profitability and increasing shopper budgets. PMID:26844084

How nursing staff spend their time on activities in a nursing home: an observational study.

PubMed

Munyisia, Esther Naliaka; Yu, Ping; Hailey, David

2011-09-01

This article is a report of a study to examine how nursing staff spend their time on activities in a nursing home. Few studies have investigated how nursing staff spend their time on activities in a nursing home. Such information is important for nurse managers in deciding on staff deployment, and for evaluating the effects of changes in nursing practice. A work sampling study with an observational component was undertaken in 2009 with nursing staff at a nursing home. A total of 430 activities were recorded for Registered Nurses, 331 for Endorsed Enrolled Nurses, 5276 for Personal Carers, and 501 for Recreational Activity Officers. Registered Nurses spent 48·4% of their time on communication and 18·1% on medication management. Endorsed Enrolled Nurses spent 37·7% on communication and 29·0% on documentation tasks. Communication was the most time-consuming activity for Recreational Activity Officers and Personal Carers, except that Personal Carers in a high care house spent more time on direct care duties. Hygiene duties and resident interaction were more frequently multitasked by the nursing staff in high care than in low care house. Nursing staff value their face-to-face interaction for successful care delivery. There is need, however, to investigate the effects of this form of communication on quality of care given to residents. Differences in multi-tasked activities between high care and low care houses should be considered when deploying staff in a nursing home. © 2011 Blackwell Publishing Ltd.

Parental mediation of television viewing and videogaming of adolescents with autism spectrum disorder and their siblings.

PubMed

Kuo, Melissa H; Magill-Evans, Joyce; Zwaigenbaum, Lonnie

2015-08-01

Adolescents with autism spectrum disorder spend considerable time in media activities. Parents play an important role in shaping adolescents' responses to media. This study explored the mediation strategies that parents of adolescents with autism spectrum disorder used to manage television and video game use, factors associated with their use of different strategies, and whether mediation strategies changed over time. A secondary purpose was to examine whether parents applied different mediation strategies to adolescents with autism spectrum disorder versus siblings, and the factors that created stress related to managing media use. Parents of 29 adolescents with autism spectrum disorder and 16 siblings completed questionnaires at two time points. Parents most frequently supervised their television viewing by watching it with the adolescents, and used restrictive strategies to regulate their videogaming. Parents used similar strategies for siblings, but more frequently applied restrictive and instructive strategies for videogaming with adolescents with autism spectrum disorder than their siblings. Restrictive mediation of television viewing for the adolescents decreased significantly over the year. Adolescents' time spent in media activities, age, and behavior problems, and parents' concerns about media use were significant factors associated with the strategies that parents employed. Parents' stress related to the adolescents' behavioral and emotional responses to parental restrictions. © The Author(s) 2014.

Analyzing whether countries are equally efficient at improving longevity for men and women.

PubMed

Barthold, Douglas; Nandi, Arijit; Mendoza Rodríguez, José M; Heymann, Jody

2014-11-01

We examined the efficiency of country-specific health care spending in improving life expectancies for men and women. We estimated efficiencies of health care spending for 27 Organisation for Economic Co-operation and Development (OECD) countries during the period 1991 to 2007 using multivariable regression models, including country fixed-effects and controlling for time-varying levels of national social expenditures, economic development, and health behaviors. Findings indicated robust differences in health-spending efficiency. A 1% annual increase in health expenditures was associated with percent changes in life expectancy ranging from 0.020 in the United States (95% confidence interval [CI] = 0.008, 0.032) to 0.121 in Germany (95% CI = 0.099, 0.143). Health-spending increases were associated with greater life expectancy improvements for men than for women in nearly every OECD country. This is the first study to our knowledge to estimate the effect of country-specific health expenditures on life expectancies of men and women. Future work understanding the determinants of these differences has the potential to improve the overall efficiency and equity of national health systems.

Health Care Spending on Diabetes in the U.S., 1996-2013.

PubMed

Squires, Ellen; Duber, Herbert; Campbell, Madeline; Cao, Jackie; Chapin, Abigail; Horst, Cody; Li, Zhiyin; Matyasz, Taylor; Reynolds, Alex; Hirsch, Irl B; Dieleman, Joseph L

2018-05-10

Health care spending on diabetes in the U.S. has increased dramatically over the past several decades. This research describes health care spending on diabetes to quantify how that spending has changed from 1996 to 2013 and to determine what drivers are increasing spending. Spending estimates were extracted from the Institute for Health Metrics and Evaluation's Disease Expenditure 2013 database. Estimates were produced for each year from 1996 to 2013 for each of 38 age and sex groups and six types of care. Data on disease burden were extracted from the Global Burden of Disease 2016 study. We analyzed the drivers of spending by measuring the impact of population growth and aging and changes in diabetes prevalence, service utilization, and spending per encounter. Spending on diabetes in the U.S. increased from $37 billion (95% uncertainty interval $32-$42 billion) in 1996 to $101 billion ($97-$107 billion) in 2013. The greatest amount of health care spending on diabetes in 2013 occurred in prescribed retail pharmaceuticals (57.6% [53.8-62.1%] of spending growth) followed by ambulatory care (23.5% [21.7-25.7%]). Between 1996 and 2013, pharmaceutical spending increased by 327.0% (222.9-456.6%). This increase can be attributed to changes in demography, increased disease prevalence, increased service utilization, and, especially, increases in spending per encounter, which increased pharmaceutical spending by 144.0% (87.3-197.3%) between 1996 and 2013. Health care spending on diabetes in the U.S. has increased, and spending per encounter has been the biggest driver. This information can help policymakers who are attempting to control future spending on diabetes. © 2018 by the American Diabetes Association.

Most Americans Have Good Health, Little Unmet Need, And Few Health Care Expenses.

PubMed

Berk, Marc L; Fang, Zhengyi

2017-04-01

The distribution of health care expenditures remains highly concentrated, but most Americans use few health care resources and have low out-of-pocket spending. More than 93 percent of "low spenders" (those in the bottom half of the population) believe they have received all needed care in a timely manner. The low spending by the majority of the population has remained almost unchanged during the thirty-seven-year period examined. Project HOPE—The People-to-People Health Foundation, Inc.

Navy Planning, Programming, Budgeting, and Execution: A Reference Guide for Senior Leaders, Managers, and Action Officers

DTIC Science & Technology

2016-01-01

one- or two-day course to members still trying to learn the abbreviations and acronyms is not an effective way to spend anyone’s time. It takes a...requirements genera- tion process. This guide does not take a position in that debate, but it can offer lessons learned over the past few decades. First...and some lead- ers spend most of their careers learning about just one. But one can be effective sooner and more consistently by remembering and

The Identification of Filters and Interdependencies for Effective Resource Allocation: Coupling the Mitigation of Natural Hazards to Economic Development.

NASA Astrophysics Data System (ADS)

Agar, S. M.; Kunreuther, H.

2005-12-01

Policy formulation for the mitigation and management of risks posed by natural hazards requires that governments confront difficult decisions for resource allocation and be able to justify their spending. Governments also need to recognize when spending offers little improvement and the circumstances in which relatively small amounts of spending can make substantial differences. Because natural hazards can have detrimental impacts on local and regional economies, patterns of economic development can also be affected by spending decisions for disaster mitigation. This paper argues that by mapping interdependencies among physical, social and economic factors, governments can improve resource allocation to mitigate the risks of natural hazards while improving economic development on local and regional scales. Case studies of natural hazards in Turkey have been used to explore specific "filters" that act to modify short- and long-term outcomes. Pre-event filters can prevent an event from becoming a natural disaster or change a routine event into a disaster. Post-event filters affect both short and long-term recovery and development. Some filters cannot be easily modified by spending (e.g., rural-urban migration) but others (e.g., land-use practices) provide realistic spending targets. Net social benefits derived from spending, however, will also depend on the ways by which filters are linked, or so-called "interdependencies". A single weak link in an interdependent system, such as a power grid, can trigger a cascade of failures. Similarly, weak links in social and commercial networks can send waves of disruption through communities. Conversely, by understanding the positive impacts of interdependencies, spending can be targeted to maximize net social benefits while mitigating risks and improving economic development. Detailed information on public spending was not available for this study but case studies illustrate how networks of interdependent filters can modify social benefits and costs. For example, spending after the 1992 Erzincan earthquake targeted local businesses but limited alternative employment, labor losses and diminished local markets all contributed to economic stagnation. Spending after the 1995 Dinar earthquake provided rent subsidies, supporting a major exodus from the town. Consequently many local people were excluded from reconstruction decisions and benefits offered by reconstruction funds. After the 1999 Marmara earthquakes, a 3-year economic decline in Yalova illustrates the vulnerability of local economic stability to weak regulation enforcement by a few agents. A resource allocation framework indicates that government-community relations, lack of economic diversification, beliefs, and compensation are weak links for effective spending. Stronger positive benefits could be achieved through spending to target land-use regulation enforcement, labor losses, time-critical needs of small businesses, and infrastructure. While the impacts of the Marmara earthquakes were devastating, strong commercial networks and international interests helped to re-establish the regional economy. Interdependencies may have helped to drive a recovery. Smaller events in eastern Turkey, however, can wipe out entire communities and can have long-lasting impacts on economic development. These differences may accelerate rural to urban migration and perpetuate regional economic divergence in the country. 1: Research performed in the Wharton MBA Program, Univ. of Pennsylvania.

Acute Hospital Care Is The Chief Driver of Regional Spending Variation in Medicare Patients with Advanced Cancer

PubMed Central

Brooks, Gabriel A.; Li, Ling; Uno, Hajime; Hassett, Michael J.; Landon, Bruce E.; Schrag, Deborah

2014-01-01

The root causes of regional variation in medical spending are poorly understood and vary by clinical condition. To identify drivers of regional spending variation for Medicare patients with advanced cancer, we used linked Surveillance, Epidemiology, and End Results (SEER) program–Medicare data from 2004–10. We broke down Medicare spending into thirteen cancer-relevant service categories. We then calculated the contribution of each category to spending and regional spending variation. Acute hospital care was the largest component of spending and the chief driver of regional spending variation, accounting for 48 percent of spending and 67 percent of variation. In contrast, chemotherapy accounted for 16 percent of spending and 10 percent of variation. Hospice care comprised 5 percent of spending; however variation in hospice spending was fully offset by opposing variation in other categories. Our analysis suggests that the strategy with the greatest potential to improve the value of care for patients with advanced cancer is to reduce reliance on acute hospital care for this patient population. PMID:25288424

U.S. outlook issues: putting America's house in order.

PubMed

Brinner, R E

1989-03-01

Despite the economic growth in 1987 and 1988, there are three issues of concern: the strength of consumer spending, the risk of accelerating inflation, and the federal budget deficit. The history of recent consumer spending is reviewed, and the recommendation made that if the recent "binge" of 1987-1988 has caused the economy to overshoot its production capacity, monetary and fiscal policies should be adjusted to rein in the spending. Regarding inflation, despite projected productivity gains, the economy seems to be heading for a 4.5%-5.0% core rate of inflation, a rate that can surge to 1970s-like levels with any substantial bad news. The observation is made that no major sustained cut in financing costs will occur until U.S. fiscal policy is changed. Regarding the deficit, voters cannot seek more services without either higher taxes or higher interest rates; growth alone will not cure the federal deficit. The distinction between good and bad types of debt is made and the history and causes of the $ 2 trillion increase in federal debt between fiscal years 1980 and 1988 is reviewed. Corporate debt and the recent corporate acquisitions and leveraged buyouts are analyzed. Public policy considerations arise primarily from the need to limit the system risks imposed by the scale of the buyout mania and to insure fair treatment of current debt holders of target corporations. Greater regulation of pension investments may be necessary, and widespread use of change-of-ownership clauses in bonds would be productive.

Does equity in healthcare spending exist among Indian states? Explaining regional variations from national sample survey data.

PubMed

Dwivedi, Rinshu; Pradhan, Jalandhar

2017-01-14

Equity and justice in healthcare payment form an integral part of health policy and planning. In the majority of low and middle-income countries (LMICs), healthcare inequalities are further aggravated by Out of Pocket Expenditure (OOPE). This paper examines the pattern of health equity and regional disparities in healthcare spending among Indian states by applying Andersen's behavioural model of healthcare utilization. The present study uses data from the 66 th quinquennial round of Consumer Expenditure Survey, of the National Sample Survey Organization (NSSO), conducted in 2009-10 by Ministry of Statistics and Programme Implementation (MoSPI), Government of India (GoI). To measure equity and regional disparities in healthcare expenditure, states have been categorized under three heads on the basis of monthly OOPE i.e., Category A (OOPE > =INR 100); Category B (OOPE between INR 50 to 99) and Category C (OOPE < INR 50). Multiple Generalised Linear Regression Model (GLRM) has been employed to explore the effect of various socio-economic covariates on the level of OOPE. The gap in the ratio of average healthcare spending between the poorest and richest households was maximum in Category A states (richest/poorest = 14.60), followed by Category B (richest/poorest 11.70) and Category C (richest/poorest 11.40). Results also indicate geographical concentration of lower level healthcare spending among Indian states (e.g., Odisha, Chhattisgarh and all the north-eastern states). Results from the multivariate analysis suggest that people residing in urban areas, having higher economic status, belonging to non-Muslim communities, non-Scheduled Tribes (STs), and non-poor households spend more on healthcare than their counterparts. In spite of various efforts by the government to reduce the burden of healthcare spending, widespread inequalities in healthcare expenditure are prevalent. Households with high healthcare needs (SCs/STs, and the poor) are in a more disadvantaged position in terms of spending on health care. It has also been observed that spending on healthcare was comparatively lower among backward or isolated states. No doubt, the overall social security measures should be enhanced, but at the same time, looking at the regional differences, more priority should be assigned to the disadvantaged states to reduce the burden of OOPE. It is proposed that there is need to increase government spending, especially for the disadvantaged states and population, to minimise the burden of OOPE.

Regional variation in physician adoption of antipsychotics: Impact on US Medicare expenditures

PubMed Central

Donohue, Julie M.; Normand, Sharon-Lise T.; Horvitz-Lennon, Marcela; Men, Aiju; Berndt, Ernst R.; Huskamp, Haiden A.

2016-01-01

Background Regional variation in US Medicare prescription drug spending is driven by higher prescribing of costly brand-name drugs in some regions. This variation likely arises from differences in the speed of diffusion of newly-approved medications. Second-generation antipsychotics were widely adopted for treatment of severe mental illness and for several off-label uses. Rapid diffusion of new psychiatric drugs likely increases drug spending but its relationship to non-drug spending is unclear. The impact of antipsychotic diffusion on drug and medical spending is of great interest to public payers like Medicare, which finance a majority of mental health spending in the U.S. Aims We examine the association between physician adoption of new antipsychotics and antipsychotic spending and non-drug medical spending among disabled and elderly Medicare enrollees. Methods We linked physician-level data on antipsychotic prescribing from an all-payer dataset (IMS Health's Xponent™) to patient-level data from Medicare. Our physician sample included 16,932 U.S. psychiatrists and primary care providers with ≥10 antipsychotic prescriptions per year from 1997-2011. We constructed a measure of physician adoption of 3 antipsychotics introduced during this period (quetiapine, ziprasidone and aripiprazole) by estimating a shared frailty model of the time to first prescription for each drug. We then assigned physicians to one of 306 U.S. hospital referral regions (HRRs) and measured the average propensity to adopt per region. Using 2010 data for a random sample of 1.6 million Medicare beneficiaries, we identified 138,680 antipsychotic users. A generalized linear model with gamma distribution and log link was used to estimate the effect of region-level adoption propensity on beneficiary-level antipsychotic spending and non-drug medical spending adjusting for patient demographic and socioeconomic characteristics, health status, eligibility category, and whether the antipsychotic was for an on- vs. off-label use. Results In our sample, mean patient age was 62 years, 42% were male, and 86% had low-income. Half of antipsychotic users in Medicare had an on-label indication. The weighted average propensity to adopt the three new antipsychotics varied four-fold across HRRs. For every one standard deviation increase in the propensity to adopt there was a 5% increase in antipsychotic spending after adjusting for covariates (adjusted ratio of spending = 1.05, 95% CI 1.01-1.08, p= 0.005). Physician propensity to adopt new antipsychotics was not associated with non-drug medical spending (adjusted ratio 0.96, 95% CI 0.91-1.01, p<0.117). Discussion These findings suggest wide regional variation in physicians’ propensity to adopt new antipsychotic medications. While physician adoption of new antipsychotics was positively associated with antipsychotic expenditures, it was not associated with non-drug spending. Our analysis is limited to Medicare and may not generalize to other payers. Also, claims data do not allow the measurement of health outcomes, which would be important to evaluate when calculating the value of rapid vs. slow technology adoption. Implications for Health Policies This study will provide important insight on the relationship between the speed of adoption of new antipsychotic medications and drug and non-drug medical spending for payers and policymakers seeking to maximize the value of health care expenditures. PMID:27453458

Health spending by state of residence, 1991-2009.

PubMed

Cuckler, Gigi; Martin, Anne; Whittle, Lekha; Heffler, Stephen; Sisko, Andrea; Lassman, Dave; Benson, Joseph

2011-12-06

Provide a detailed discussion of baseline health spending by state of residence (per capita personal health care spending, per enrollee Medicare spending, and per enrollee Medicaid spending) in 2009, over the last decade (1998-2009), as well as the differential regional and state impacts of the recent recession. State Health Expenditures by State of Residence for 1991-2009, produced by the Centers for Medicare & Medicaid Services' Office of the Actuary. In 2009, the 10 states where per capita spending was highest ranged from 13 to 36 percent higher than the national average, and the 10 states where per capita spending was lowest ranged from 8 to 26 percent below the national average. States with the highest per capita spending tended to have older populations and the highest per capita incomes; states with the lowest per capita spending tended to have younger populations, lower per capita incomes, and higher rates of uninsured. Over the last decade, the New England and Mideast regions exhibited the highest per capita personal health care spending, while states in the Southwest and Rocky Mountain regions had the lowest per capita spending. Variation in per enrollee Medicaid spending, however, has consistently been greater than that of total per capita personal health care spending or per enrollee Medicare spending from 1998-2009. The Great Lakes, New England, and Far West regions experienced the largest slowdown in per person health spending growth during the recent recession, largely as a result of higher unemployment rates. Public Domain.

The Economics of an Investment in Kaizen

NASA Astrophysics Data System (ADS)

Visuwan, Danupun

2010-10-01

Kaizen has been widely accepted as a continuous process improvement with the gradualist approach. This paper presents the research carried out to explore the pattern of an investment in Kaizen to enhance overall profit. System dynamics-based simulation has been employed with an optimization technique, a Steepest Ascent approach, to improve experimental variables e.g. the amount of spending on prevention and appraisal activities, the time and the amount to reduce the investment which results in maximum Net Present Value (NPV) of profit. The simulation model in this study is based on a Thai automobile manufacturer as a case study company. The result suggests that the investment in Kaizen should spend on activities to eliminate and detect all defects in the early phase and then reduce economically when the process is under controlled. It can be named as the `Hybrid quality improvement', which was proved in this study that it provides greater overall profit than the Stepwise Kaizen and the constant spending. This study also presents the behavior of quality costs and profit against time scale along the different patterns of the investment in Kaizen.

Has the Marital Time Cost of Parenting Changed over Time?

ERIC Educational Resources Information Center

Dew, Jeffrey

2009-01-01

Qualitative and quantitative research has suggested that married couples handle the increasing demands of intensive parenting norms and work expectations by reducing spousal time (e.g., the time that spouses spend alone with each other). Using nationally representative time-diary data, this study examined whether married individuals with children…

Medicare Part D Payments for Topical Steroids

PubMed Central

Song, Hannah; Adamson, Adewole

2017-01-01

Importance Rising pharmaceutical costs in the United States are an increasing source of financial burden for payers and patients. Although topical steroids are among the most commonly prescribed medications in dermatology, there are limited data on steroid-related spending and utilization. Objective To characterize Medicare and patient out-of-pocket costs for topical steroids, and to model potential savings that could result from substitution of the cheapest topical steroid from the corresponding potency class. Design, Setting, and Participants This study was a retrospective cost analysis of the Medicare Part D Prescriber Public Use File, which details annual drug utilization and spending on both generic and branded drugs from 2011 to 2015 by Medicare Part D participants who filled prescriptions for topical steroids. Main Outcomes and Measures Total and potential Medicare and out-of-pocket patient spending. Costs were adjusted for inflation and reported in 2015 dollars. Results Medicare Part D expenditures on topical steroids between 2011 and 2015 were $2.3 billion. Patients’ out-of-pocket spending for topical steroids over the same period was $333.7 million. The total annual spending increased from $237.6 million to $775.9 million, an increase of 226.5%. Patients’ annual out-of-pocket spending increased from $41.4 million to $101.8 million, an increase of 145.9%. The total number of prescriptions were 7.7 million in 2011 and 10.6 million in 2015, an increase of 37.0%. Generic medication costs accounted for 97.8% of the total spending during this time period. The potential health care savings and out-of-pocket patient savings from substitution of the cheapest topical steroid within the corresponding potency class were $944.8 million and $66.6 million, respectively. Conclusions and Relevance Most topical steroids prescribed were generic drugs. There has been a sharp increase in Medicare and out-of-pocket spending on topical steroids that is driven by higher costs for generics. Use of clinical decision support tools to enable substitution of the most affordable generic topical steroid from the corresponding potency class may reduce drug expenditures. PMID:28453645

The effect of food environments on fruit and vegetable intake as modified by time spent at home: a cross-sectional study.

PubMed

Chum, Antony; Farrell, Eddie; Vaivada, Tyler; Labetski, Anna; Bohnert, Arianne; Selvaratnam, Inthuja; Larsen, Kristian; Pinter, Theresa; O'Campo, Patricia

2015-06-04

There is a growing body of research that investigates how the residential neighbourhood context relates to individual diet. However, previous studies ignore participants' time spent in the residential environment and this may be a problem because time-use studies show that adults' time-use pattern can significantly vary. To better understand the role of exposure duration, we designed a study to examine 'time spent at home' as a moderator to the residential food environment-diet association. Cross-sectional observational study. City of Toronto, Ontario, Canada. 2411 adults aged 25-65. Frequency of vegetable and fruit intake (VFI) per day. To examine how time spent at home may moderate the relationship between residential food environment and VFI, the full sample was split into three equal subgroups--short, medium and long duration spent at home. We detected significant associations between density of food stores in the residential food environment and VFI for subgroups that spend medium and long durations at home (ie, spending a mean of 8.0 and 12.3 h at home, respectively--not including sleep time), but no associations exist for people who spend the lowest amount of time at home (mean=4.7 h). Also, no associations were detected in analyses using the full sample. Our study is the first to demonstrate that time spent at home may be an important variable to identify hidden population patterns regarding VFI. Time spent at home can impact the association between the residential food environment and individual VFI. 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.

The effect of food environments on fruit and vegetable intake as modified by time spent at home: a cross-sectional study

PubMed Central

Chum, Antony; Farrell, Eddie; Vaivada, Tyler; Labetski, Anna; Selvaratnam, Inthuja; Larsen, Kristian; Pinter, Theresa; O'Campo, Patricia

2015-01-01

Objective There is a growing body of research that investigates how the residential neighbourhood context relates to individual diet. However, previous studies ignore participants’ time spent in the residential environment and this may be a problem because time-use studies show that adults’ time-use pattern can significantly vary. To better understand the role of exposure duration, we designed a study to examine ‘time spent at home’ as a moderator to the residential food environment-diet association. Design Cross-sectional observational study. Settings City of Toronto, Ontario, Canada. Participants 2411 adults aged 25–65. Primary outcome measure Frequency of vegetable and fruit intake (VFI) per day. Results To examine how time spent at home may moderate the relationship between residential food environment and VFI, the full sample was split into three equal subgroups—short, medium and long duration spent at home. We detected significant associations between density of food stores in the residential food environment and VFI for subgroups that spend medium and long durations at home (ie, spending a mean of 8.0 and 12.3 h at home, respectively—not including sleep time), but no associations exist for people who spend the lowest amount of time at home (mean=4.7 h). Also, no associations were detected in analyses using the full sample. Conclusions Our study is the first to demonstrate that time spent at home may be an important variable to identify hidden population patterns regarding VFI. Time spent at home can impact the association between the residential food environment and individual VFI. PMID:26044756

Engineer at Lehigh University Campaigns for More Construction Research.

ERIC Educational Resources Information Center

Wheeler, David L.

1987-01-01

A civil engineering professor would like to see civil engineers spend less time looking at broken structures and more time testing construction materials, and has founded a research center for that purpose. (MSE)

Compared to Canadians, U.S. physicians spend nearly four times as much money interacting with payers.

PubMed

Zimmerman, Christina

2011-11-01

(1) In Canadian office practices, physi­cians spent 2.2 hours per week interacting with payers, nurses spent 2.5 hours, and clerical staff spent 15.9 hours. In U.S. practices, physicians spent 3.4 hours per week interacting with payers, nurses spent 20.6 hours, and clerical staff spent 53.1 hours. (2) Canadian physician practices spent $22,205 per physician per year on interactions with health plans. U.S. physician practices spent $82,975 per physician per year. (3) U.S. physician practices spend $60,770 per physician per year more (approximately four times as much) than their Canadian counterparts.

The Effects of Socioeconomic Vulnerability, Psychosocial Services, and Social Service Spending on Family Reunification: A Multilevel Longitudinal Analysis

PubMed Central

Esposito, Tonino; Delaye, Ashleigh; Chabot, Martin; Trocmé, Nico; Rothwell, David; Hélie, Sonia; Robichaud, Marie-Joelle

2017-01-01

Socio-environmental factors such as poverty, psychosocial services, and social services spending all could influence the challenges faced by vulnerable families. This paper examines the extent to which socioeconomic vulnerability, psychosocial service consultations, and preventative social services spending impacts the reunification for children placed in out-of-home care. This study uses a multilevel longitudinal research design that draws data from three sources: (1) longitudinal administrative data from Quebec’s child protection agencies; (2) 2006 and 2011 Canadian Census data; and, (3) intra-province health and social services data. The final data set included all children (N = 39,882) placed in out-of-home care for the first time between 1 April 2002 and 31 March 2013, and followed from their initial out-of-home placement. Multilevel hazard results indicate that socioeconomic vulnerability, controlling for psychosocial services and social services spending, contributes to the decreased likelihood of reunification. Specifically, socioeconomic vulnerability, psychosocial services, and social services spending account for 24.0% of the variation in jurisdictional reunification for younger children less than 5 years of age, 12.5% for children age 5 to 11 years and 21.4% for older children age 12 to 17 years. These findings have implications for decision makers, funding agencies, and child protection agencies to improve jurisdictional resources to reduce the socioeconomic vulnerabilities of reunifying families. PMID:28891940

The Effects of Socioeconomic Vulnerability, Psychosocial Services, and Social Service Spending on Family Reunification: A Multilevel Longitudinal Analysis.

PubMed

Esposito, Tonino; Delaye, Ashleigh; Chabot, Martin; Trocmé, Nico; Rothwell, David; Hélie, Sonia; Robichaud, Marie-Joelle

2017-09-09

Socio-environmental factors such as poverty, psychosocial services, and social services spending all could influence the challenges faced by vulnerable families. This paper examines the extent to which socioeconomic vulnerability, psychosocial service consultations, and preventative social services spending impacts the reunification for children placed in out-of-home care. This study uses a multilevel longitudinal research design that draws data from three sources: (1) longitudinal administrative data from Quebec's child protection agencies; (2) 2006 and 2011 Canadian Census data; and, (3) intra-province health and social services data. The final data set included all children ( N = 39,882) placed in out-of-home care for the first time between 1 April 2002 and 31 March 2013, and followed from their initial out-of-home placement. Multilevel hazard results indicate that socioeconomic vulnerability, controlling for psychosocial services and social services spending, contributes to the decreased likelihood of reunification. Specifically, socioeconomic vulnerability, psychosocial services, and social services spending account for 24.0% of the variation in jurisdictional reunification for younger children less than 5 years of age, 12.5% for children age 5 to 11 years and 21.4% for older children age 12 to 17 years. These findings have implications for decision makers, funding agencies, and child protection agencies to improve jurisdictional resources to reduce the socioeconomic vulnerabilities of reunifying families.

Health Spending For Low-, Middle-, And High-Income Americans, 1963-2012.

PubMed

Dickman, Samuel L; Woolhandler, Steffie; Bor, Jacob; McCormick, Danny; Bor, David H; Himmelstein, David U

2016-07-01

US medical spending growth slowed between 2004 and 2013. At the same time, many Americans faced rising copayments and deductibles, which may have particularly affected lower-income people. To explore whether the health spending slowdown affected all income groups equally, we divided the population into income quintiles. We then assessed trends in health expenditures by and on behalf of people in each quintile using twenty-two national surveys carried out between 1963 and 2012. Before the 1965 passage of legislation creating Medicare and Medicaid, the lowest income quintile had the lowest expenditures, despite their worse health compared to other income groups. By 1977 the unadjusted expenditures for the lowest quintile exceeded those for all other income groups. This pattern persisted until 2004. Thereafter, expenditures fell for the lowest quintile, while rising more than 10 percent for the middle three quintiles and close to 20 percent for the highest income quintile, which had the highest expenditures in 2012. The post-2004 divergence of expenditure trends for the wealthy, middle class, and poor occurred only among the nonelderly. We conclude that the new pattern of spending post-2004, with the wealthiest quintile having the highest expenditures for health care, suggests that a redistribution of care toward wealthier Americans accompanied the health spending slowdown. Project HOPE—The People-to-People Health Foundation, Inc.

Pharmaceutical Spending and German Reunification: Parity Comes Quickly to Berlin

PubMed Central

Katz, Eric M.

1994-01-01

As the Berlin Wall fell and the population of the Federal Republic of Germany (FRG, West Germany) swelled by 25 percent with the addition of the former German Democratic Republic (GDR, East Germany), the health care system struggled to keep pace. This article examines drug outlays by the statutory sickness funds during the first 2 years of unified operations. It shows that providing equivalent coverage quickly led to equal rates of pharmaceutical consumption nationwide, while in Berlin the former East outdistanced the West by a considerable margin. PMID:10137795

Economic rationality, the affordability of private long-term care insurance, and the role for public policy.

PubMed

Crown, W H; Capitman, J; Leutz, W N

1992-08-01

This study uses data from the 1984 panel of the Survey of Income and Program Participation (SIPP) of the U.S. Bureau of the Census to develop new estimates of the potential market for private long-term care insurance. It found that this market is potentially significant--especially among individuals in the 65-69 age group who are willing to spend up to 50% of their discretionary income on such insurance--but considerably lower than previous estimates, such as those of Cohen and colleagues (1987).

Using time-series intervention analysis to understand U.S. Medicaid expenditures on antidepressant agents.

PubMed

Ferrand, Yann; Kelton, Christina M L; Guo, Jeff J; Levy, Martin S; Yu, Yan

2011-03-01

Medicaid programs' spending on antidepressants increased from $159 million in 1991 to $2 billion in 2005. The National Institute for Health Care Management attributed this expenditure growth to increases in drug utilization, entry of newer higher-priced antidepressants, and greater prescription drug insurance coverage. Rising enrollment in Medicaid has also contributed to this expenditure growth. This research examines the impact of specific events, including branded-drug and generic entry, a black box warning, direct-to-consumer advertising (DTCA), and new indication approval, on Medicaid spending on antidepressants. Using quarterly expenditure data for 1991-2005 from the national Medicaid pharmacy claims database maintained by the Centers for Medicare and Medicaid Services, a time-series autoregressive integrated moving average (ARIMA) intervention analysis was performed on 6 specific antidepressant drugs and on overall antidepressant spending. Twenty-nine potentially relevant interventions and their dates of occurrence were identified from the literature. Each was tested for an impact on the time series. Forecasts from the models were compared with a holdout sample of actual expenditure data. Interventions with significant impacts on Medicaid expenditures included the patent expiration of Prozac® (P<0.01) and the entry of generic paroxetine producers (P=0.04), which reduced expenditures on Prozac® and Paxil®, respectively, and the 1997 increase in DTCA (P=0.05), which increased spending on Wellbutrin®. Except for Paxil®, the ARIMA models had low prediction errors. Generic entry at the aggregate level did not lead to a reduction in overall expenditures (P>0.05), implying that the expanding market for antidepressants overwhelmed the effect of generic competition. Copyright © 2011 Elsevier Inc. All rights reserved.

Early Performance of Accountable Care Organizations in Medicare

PubMed Central

McWilliams, J. Michael; Hatfield, Laura A.; Chernew, Michael E.; Landon, Bruce E.; Schwartz, Aaron L.

2016-01-01

BACKGROUND In the Medicare Shared Savings Program (MSSP), accountable care organizations (ACOs) have financial incentives to lower spending and improve quality. We used quasi-experimental methods to assess the early performance of MSSP ACOs. METHODS Using Medicare claims from 2009 through 2013 and a difference-in-differences design, we compared changes in spending and in performance on quality measures from before the start of ACO contracts to after the start of the contracts between beneficiaries served by the 220 ACOs entering the MSSP in mid-2012 (2012 ACO cohort) or January 2013 (2013 ACO cohort) and those served by non-ACO providers (control group), with adjustment for geographic area and beneficiary characteristics. We analyzed the 2012 and 2013 ACO cohorts separately because entry time could reflect the capacity of an ACO to achieve savings. We compared ACO savings according to organizational structure, baseline spending, and concurrent ACO contracting with commercial insurers. RESULTS Adjusted Medicare spending and spending trends were similar in the ACO cohorts and the control group during the precontract period. In 2013, the differential change (i.e., the between-group difference in the change from the precontract period) in total adjusted annual spending was −$144 per beneficiary in the 2012 ACO cohort as compared with the control group (P = 0.02), consistent with a 1.4% savings, but only −$3 per beneficiary in the 2013 ACO cohort as compared with the control group (P = 0.96). Estimated savings were consistently greater in independent primary care groups than in hospital-integrated groups among 2012 and 2013 MSSP entrants (P = 0.005 for interaction). MSSP contracts were associated with improved performance on some quality measures and unchanged performance on others. CONCLUSIONS The first full year of MSSP contracts was associated with early reductions in Medicare spending among 2012 entrants but not among 2013 entrants. Savings were greater in independent primary care groups than in hospital-integrated groups. PMID:27075832

Nonresearch Industry Payments to Radiologists: Characteristics and Associations With Regional Medical Imaging Utilization.

PubMed

Kokabi, Nima; Junn, Jacqueline C; Xing, Minzhi; Hemingway, Jennifer; Hughes, Danny R; Duszak, Richard

2017-03-01

To evaluate characteristics of nonresearch industry payments to radiologists and associations with regional diagnostic imaging utilization. Using 2014 CMS Open Payment data, all disclosed nonresearch-related industry payments to radiologists were identified. Health Resources and Services Administration Area Health Resources Files were used to identify actual and population-weighted numbers of radiologists by state. Utilizing the 5% random beneficiary sample CMS Research Identifiable Files from 2014, average Medicare imaging spending per beneficiary in each state was calculated. Average frequency and dollar amounts of nonresearch nonroyalty payments to radiologists were calculated at the state level. Using the Pearson correlation coefficient, the relationship between frequency and amounts of nonresearch payments to radiologists versus per-beneficiary Medicare imaging spending was evaluated at the state level. Overall, 2,008 radiologists (1,670 diagnostic, 338 interventional) received nonresearch nonroyalty payments from industry, representing 5.2% of all 38,857 radiologists nationwide. A total of 4,975 individual transfers translated to 2.5 ± 1.3 discrete payments per receiving radiologist with a mean of $432 ± $1,976 (median $26; range $1-$34,050). Food and beverage expenses constituted the vast majority of disclosed transfers (4,111; 83%), followed by travel and lodging (444; 9%), consulting fees (279; 6%), and educational expenses (51; 1%). Considerable geographic variation in payments was observed, ranging from 0% of radiologists in Vermont to 12.9% in the District of Columbia. No correlation was identified between average per-beneficiary Medicare imaging spending and the proportion of nonresearch-funded radiologists in each state (r = 0.06). Similarly, no correlation was identified between average per-beneficiary Medicare imaging spending and the average nonresearch transfer amount to radiologists in each state (r = -0.08). In 2014, only a small minority of United States radiologists received nonresearch payments from industry. At the state level, medical imaging utilization does not seem to be influenced by such financial relationships. Copyright © 2016. Published by Elsevier Inc.

16 CFR 1115.14 - Time computations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION CONSUMER PRODUCT SAFETY ACT REGULATIONS SUBSTANTIAL... spend a reasonable time for investigation and evaluation. (See § 1115.14(d).) (d) Time for investigation and evaluation. A subject firm may conduct a reasonably expeditious investigation in order to evaluate...

Health Spending by State of Residence, 1991–2009

PubMed Central

Cuckler, Gigi; Martin, Anne; Whittle, Lekha; Heffler, Stephen; Sisko, Andrea; Lassman, Dave; Benson, Joseph

2011-01-01

Objective Provide a detailed discussion of baseline health spending by state of residence (per capita personal health care spending, per enrollee Medicare spending, and per enrollee Medicaid spending) in 2009, over the last decade (1998–2009), as well as the differential regional and state impacts of the recent recession. Data Source State Health Expenditures by State of Residence for 1991–2009, produced by the Centers for Medicare & Medicaid Services' Office of the Actuary. Principal Findings In 2009, the 10 states where per capita spending was highest ranged from 13 to 36 percent higher than the national average, and the 10 states where per capita spending was lowest ranged from 8 to 26 percent below the national average. States with the highest per capita spending tended to have older populations and the highest per capita incomes; states with the lowest per capita spending tended to have younger populations, lower per capita incomes, and higher rates of uninsured. Over the last decade, the New England and Mideast regions exhibited the highest per capita personal health care spending, while states in the Southwest and Rocky Mountain regions had the lowest per capita spending. Variation in per enrollee Medicaid spending, however, has consistently been greater than that of total per capita personal health care spending or per enrollee Medicare spending from 1998–2009. The Great Lakes, New England, and Far West regions experienced the largest slowdown in per person health spending growth during the recent recession, largely as a result of higher unemployment rates. PMID:22340779

National legislation and spending on vaccines in Latin America and the Caribbean.

PubMed

McQuestion, Michael; Garcia, Ana Gabriela Felix; Janusz, Cara; Andrus, Jon Kim

2017-02-01

This study examined the dynamics of vaccine spending and vaccine legislation in the Americas Region over the period 1980-2013. Annual vaccine expenditures from thirty-one countries were extracted from the Pan American Health Organization Revolving Fund database. Information on vaccine laws and regulations was provided by the PAHO Family, Gender, and Life Course Unit. Both time series and event history models were estimated. The results show that passing an immunization law led a representative country to increase its vaccine spending, controlling for income, infant mortality, population size, and DPT3 vaccine coverage. Countries with higher vaccine coverage were also more likely to have passed laws. Conversely, higher income countries were less likely to have vaccine laws. Vaccine legislation will likely play a similarly important role in other regions as more countries move towards immunization program ownership.

Understanding the recent growth in Medicaid spending, 2000-2003.

PubMed

Holahan, John; Ghosh, Arunabh

2005-01-01

Growth in Medicaid spending averaged 10.2 percent per year between 2000 and 2003, resulting in a one-third increase in program spending. Spending growth was lower from 2002 to 2003 because of slower growth in enrollment and in spending per enrollee, particularly for acute care services, and declines in disproportionate-share hospital (DSH) payments and upper payment limit (UPL) programs. For the entire 2000-2003 period, Medicaid spending increases were largely driven by enrollment growth, much of which was attributable to the economic downturn. Increases in spending per enrollee over the period were faster than inflation but slower than increases in private insurance spending.

Effect of an Internet-Based System for Doctor-Patient Communication on Health Care Spending

PubMed Central

Baker, Laurence; Rideout, Jeffrey; Gertler, Paul; Raube, Kristiana

2005-01-01

We studied the effect of a structured electronic communication service on health care spending, comparing doctor office and laboratory spending for a group of patients before and after the service became available to them relative to changes in a control group. In the treatment group, doctor office spending and laboratory spending fell in the period after the service became available, relative to the control group (p < 0.05). A rough estimate is that average doctor office spending per treatment group member per month fell $1.71 after availability of the service, and laboratory spending fell roughly $0.12. Spending associated with use of the electronic service was $0.29 per member per month. We conclude that use of structured electronic visits can reduce health care spending. PMID:15905484

The Relation between Teachers’ and Children’s Playfulness: A Pilot Study

PubMed Central

Pinchover, Shulamit

2017-01-01

Young children spend considerable time in educational settings, in which traditionally, their primary occupation is play. A playful preschool environment has been related to better cognitive, social and emotional development. Although it is assumed that teachers’ playful behaviors are important in creating a playful school environment, empirical knowledge on this subject is lacking. The current study pilot examines the relation between teachers’ and children’s playfulness. Thirty-one teacher–child dyads participated. The teachers were asked to complete the Adult Playfulness Scale (APS). Thirty-minute videotapes of teacher–child play interactions were used to evaluate the child’s playfulness using the Test of Playfulness. A positive relation was found between two of the APS subscales (spontaneity and silliness) and child playfulness. Teacher silliness mediated the relation between children’s age and playfulness. This study is the first to show that teachers’ playfulness aspects are related to higher playfulness in children. Promoting teachers’ playful behaviors can be related to better teacher–child playful interactions, thereby enhancing children’s playfulness. PMID:29312069

Use of Web-based materials to enhance anatomy instruction in the health sciences.

PubMed

Granger, Noelle A; Calleson, Diane C; Henson, O W; Juliano, Eve; Wineski, Lawrence; McDaniel, Martha D; Burgoon, Jennifer M

2006-07-01

Teaching anatomy by dissection is under considerable pressure to evolve and/or even be eliminated, and curricular hours in the dissection laboratory are decreasing. As a possible means of easing this pressure, an online interactive anatomy program has been created to enhance the dissection experience, observational learning, and three-dimensional comprehension of human anatomy. An assessment was made of the utility of the program in preparing students for dissection laboratories and for examinations. The efficacy of the application was evaluated by first-year students and faculty with pre- and post-use surveys in anatomy courses at three medical schools. It was found that students felt better prepared if they utilized the Web site prior to their dissection laboratory, and faculty reported spending less time explaining basic concepts or techniques. It is concluded that a comprehensive online program significantly enhances the quality and efficiency of instruction in human anatomy in the dissection laboratory and could prove to be a useful tool at other institutions.

Getting the story straight. The press and "partial-birth abortion".

PubMed

Farmer, A

2000-06-01

This paper discusses the controversy of the banning of ¿partial-birth abortion¿ in the state of Nebraska. This controversy arises as a result of how several major news sources described the Nebraska statute--that is, as a pre-viability abortion ban, and not a ban on late-term abortion procedures. This issue did not only occur in Nebraska, but also in Michigan when abortion opponents simultaneously initiated a publicity scheme to mislead the public into believing the ban was about ¿gruesome¿ late-term procedures. The deceptive term ¿partial-birth abortion¿, also seemed to suggest abortions performed on viable fetuses and the language describing the ban was confusing and slippery. In response to this controversy, Janet Benshoof, the president of the Center for Reproductive Law and Policy (CRLP) immediately made a statement to counteract the allegation imposed by abortion opponents. Also, CRLP Communications Deputy Director Margie Kelly spends a considerable amount of time informing the press of the extreme measures of the laws.

Patients' perception of their experience of primary percutaneous intervention for ST segment elevation myocardial infarction.

PubMed

Young, Lynne E; Murray, Jackie

2011-01-01

Many patients experiencing ST segment elevation myocardial infarction (STEMI) are currently treated with primary percutaneous intervention (PCI). This relatively new procedure has reduced the time patients with the diagnosis of STEMI spend in hospital. In this literature review we explore patients' perceptions of their experience of receiving primary percutaneous intervention (PCI) as a treatment for STEMI. We critiqued and graded for relevance 10 papers that included original research and other sources. Key findings indicate that there is considerable variability in how patients treated for STEMI perceive the experience of PCI. Further, there is a misalignment between some patients' perceptions and health professionals' perceptions of this experience related to the event as well as the language used to speak of it. Thus, we recommend that nurses assess patients' perception of the experience and patients' health literacy level, then tailor the content and language of patient and family education to ensure an effective educative intervention.

In-depth survey report of Early and Daniel Co. , Inc. , Louisville, Kentucky

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

Zaebst, D.D.

1986-09-01

An in-depth industrial hygiene survey was conducted to evaluate worker exposures to phosphine during fumigation of grain at the Early and Daniel Co. grain elevator in Louisville, Kentucky. Stored grain was fumigated using aluminum phosphide. Aluminum-phosphide pellets were also added directly to the grain by the blender as it was poured into the storage containers. Local exhaust ventilation was used at points in the grain-moving system where grain dust was generated. Air samples were taken during full-shift periods at the breathing zone of the weighmaster, two bin floormen, and the blender. Area monitoring samples were also taken. If the operatorsmore » spend considerable time in the vicinity of a bin which is being filled with grain, there is a likelihood of far greater exposure levels being noted. According to the author, further studies of the use of phosphide products at other elevators should be conducted to determine the effect of environmental and process parameters on phosphine exposures.« less

The demand for speech pathology services for children: Do we need more or just different?

PubMed

Reilly, Sheena; Harper, Megan; Goldfeld, Sharon

2016-12-01

An inability or difficulty communicating can have a profound impact on a child's future ability to participate in society as a productive adult. Over the past few years the number of interventions for children with speech and language problems has almost doubled; the majority are targeted interventions delivered by speech pathologists. In this paper we examine the distribution of speech pathology services in metropolitan Melbourne and how these are aligned with need as defined by vulnerability in language and social disadvantage. We identified three times as many private sector services compared to public services for the 0-5 year age group. Overall there was poorer availability of services in some of the most vulnerable areas. The profound and long-term impact of impoverished childhood language, coupled with the considerable limitations on public spending, provide a strong impetus to deliver more equitably distributed speech pathology services. © 2016 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

Geographic Correlation Between Large-Firm Commercial Spending and Medicare Spending

PubMed Central

Chernew, Michael E.; Sabik, Lindsay M.; Chandra, Amitabh; Gibson, Teresa B.; Newhouse, Joseph P.

2012-01-01

Objective To investigate the correlation between geographic variation in inpatient days, total spending, and spending growth in traditional Medicare versus the large-firm commercial sector. Study Design Retrospective descriptive analysis. Methods Medicare spending data at the hospital referral region (HRR) level were obtained from the Dartmouth Atlas. Commercial claims data from large employers were obtained from Thomson Reuters MarketScan Database for 1996-2006 and aggregated to the HRR level. County-level data on inpatient days per capita and market characteristics were obtained from the Area Resource File. We computed correlations between Medicare and commercial spending and spending growth, as well as Medicare and non-Medicare inpatient days, and examined traits of high- and low-spending HRRs in both sectors. Results We found a positive correlation between inpatient days per capita across counties, but a small inverse correlation between measures of commercial and Medicare spending across HRRs. Spending growth was weakly positively correlated across HRRs. Markets in the upper third of commercial spending had more concentrated hospital markets than markets in the lower third of commercial spending. The reverse was true for Medicare spending. Conclusions The positive correlation in utilization and lack of correlation in spending implies an inverse correlation in prices. This is consistent with evidence that the differences appear to be, at least partially, related to aspects of the market structure. If private markets are to work better to reduce cost, stronger efforts are needed to reduce provider market concentration and promote competitive pricing for healthcare services. PMID:20148618

Geographic correlation between large-firm commercial spending and Medicare spending.

PubMed

Chernew, Michael E; Sabik, Lindsay M; Chandra, Amitabh; Gibson, Teresa B; Newhouse, Joseph P

2010-02-01

To investigate the correlation between geographic variation in inpatient days, total spending, and spending growth in traditional Medicare versus the large-firm commercial sector. Retrospective descriptive analysis. Medicare spending data at the hospital referral region (HRR) level were obtained from the Dartmouth Atlas. Commercial claims data from large employers were obtained from Thomson Reuters MarketScan Database for 1996-2006 and aggregated to the HRR level. County-level data on inpatient days per capita and market characteristics were obtained from the Area Resource File. We computed correlations between Medicare and commercial spending and spending growth, as well as Medicare and non-Medicare inpatient days, and examined traits of high- and low-spending HRRs in both sectors. We found a positive correlation between inpatient days per capita across counties, but a small inverse correlation between measures of commercial and Medicare spending across HRRs. Spending growth was weakly positively correlated across HRRs. Markets in the upper third of commercial spending had more concentrated hospital markets than markets in the lower third of commercial spending. The reverse was true for Medicare spending. The positive correlation in utilization and lack of correlation in spending implies an inverse correlation in prices. This is consistent with evidence that the differences appear to be, at least partially, related to aspects of the market structure. If private markets are to work better to reduce cost, stronger efforts are needed to reduce provider market concentration and promote competitive pricing for healthcare services.

Western Australian students' alcohol consumption and expenditure intentions for Schoolies.

PubMed

Jongenelis, Michelle I; Pettigrew, Simone; Biagioni, Nicole; Hagger, Martin S

2017-07-01

In Australia, the immediate post-school period (known as 'Schoolies') is associated with heavy drinking and high levels of alcohol-related harm. This study investigated students' intended alcohol consumption during Schoolies to inform interventions to reduce alcohol-related harm among this group. An online survey was administered to students in their senior year of schooling. Included items related to intended daily alcohol consumption during Schoolies, amount of money intended to be spent on alcohol over the Schoolies period, and past drinking behaviour. On average, participants (n=187) anticipated that they would consume eight standard drinks per day, which is substantially higher than the recommended maximum of no more than four drinks on a single occasion. Participants intended to spend an average of A$131 on alcohol over the Schoolies period. Although higher than national guidelines, intended alcohol consumption was considerably lower than has been previously documented during Schoolies events. The substantial amounts of money expected to be spent during Schoolies suggest this group has adequate spending power to constitute an attractive target market for those offering alternative activities that are associated with lower levels of alcohol-related harm.

Use of the computer and Internet among Italian families: first national study.

PubMed

Bricolo, Francesco; Gentile, Douglas A; Smelser, Rachel L; Serpelloni, Giovanni

2007-12-01

Although home Internet access has continued to increase, little is known about actual usage patterns in homes. This nationally representative study of over 4,700 Italian households with children measured computer and Internet use of each family member across 3 months. Data on actual computer and Internet usage were collected by Nielsen//NetRatings service and provide national baseline information on several variables for several age groups separately, including children, adolescents, and adult men and women. National averages are shown for the average amount of time spent using computers and on the Web, the percentage of each age group online, and the types of Web sites viewed. Overall, about one-third of children ages 2 to 11, three-fourths of adolescents and adult women, and over four-fifths of adult men access the Internet each month. Children spend an average of 22 hours/month on the computer, with a jump to 87 hours/month for adolescents. Adult women spend less time (about 60 hours/month), and adult men spend more (over 100). The types of Web sites visited are reported, including the top five for each age group. In general, search engines and Web portals are the top sites visited, regardless of age group. These data provide a baseline for comparisons across time and cultures.

Appeal of playing online First Person Shooter Games.

PubMed

Jansz, Jeroen; Tanis, Martin

2007-02-01

First Person Shooter Games (FPSG) such as Counter Strike are often the subject of public concern. Surprisingly, there is no published research available about playing these games. We conducted an exploratory Internet survey (n 5 751) in order to gather information about who the players of online first person shooters are, and why they spend time on playing this particular kind of video game. The results of our survey on the one hand confirmed the stereotype of the gamer as it is often presented in popular media: the players of online FPS were indeed almost exclusively young men (mean age about 18 years) who spend a lot of their leisure time on gaming (about 2.6 h per day). We also found that the most committed gamers, that is, the ones who were members of a (semi)professional clan, scored highest on motives with respect to competition, and challenge in comparison with members of amateur clans and online gamers who had not joined a clan. On the other hand, our results cast doubt on the accuracy of the stereotype. This study showed clearly that online FPSG are not played in isolation. More than 80% of our respondents were member of a clan. Also, the regression analysis showed that the social interaction motive was the strongest predictor of the time actually spend on gaming.

Primary prevention of cardiovascular diseases: a cost study in family practices.

PubMed

de Bekker-Grob, Esther W; van Dulmen, Sandra; van den Berg, Matthijs; Verheij, Robert A; Slobbe, Laurentius C J

2011-07-06

Considering the scarcity of health care resources and the high costs associated with cardiovascular diseases, we investigated the spending on cardiovascular primary preventive activities and the prescribing behaviour of primary preventive cardiovascular medication (PPCM) in Dutch family practices (FPs). A mixed methods design was used, which consisted of a questionnaire (n = 80 FPs), video recordings of hypertension- or cholesterol-related general practitioner visits (n = 56), and the database of Netherlands Information Network of General Practice (n = 45 FPs; n = 157,137 patients). The questionnaire and video recordings were used to determine the average frequency and time spent on cardiovascular primary preventive activities per FP respectively. Taking into account the annual income and full time equivalents of general practitioners, health care assistants, and practice nurses as well as the practice costs, the total spending on cardiovascular primary preventive activities in Dutch FPs was calculated. The database of Netherlands Information Network of General Practice was used to determine the prescribing behaviour in Dutch FPs by conducting multilevel regression models and adjusting for patient and practice characteristics. Total expenditure on cardiovascular primary preventive activities in FPs in 2009 was €38.8 million (€2.35 per capita), of which 47% was spent on blood pressure measurements, 26% on cardiovascular risk profiling, and 11% on lifestyle counselling. Fifteen percent (€11 per capita) of all cardiovascular medication prescribed in FPs was a PPCM. FPs differed greatly on prescription of PPCM (odds ratio of 3.1). Total costs of cardiovascular primary preventive activities in FPs such as blood pressure measurements and lifestyle counselling are relatively low compared to the costs of PPCM. There is considerable heterogeneity in prescribing behaviour of PPCM between FPs. Further research is needed to determine whether such large differences in prescription rates are justified. Striving for an optimal use of cardiovascular primary preventive activities might lead to similar health outcomes, but may achieve important cost savings.

End-Of-Life Medical Spending In Last Twelve Months Of Life Is Lower Than Previously Reported.

PubMed

French, Eric B; McCauley, Jeremy; Aragon, Maria; Bakx, Pieter; Chalkley, Martin; Chen, Stacey H; Christensen, Bent J; Chuang, Hongwei; Côté-Sergent, Aurelie; De Nardi, Mariacristina; Fan, Elliott; Échevin, Damien; Geoffard, Pierre-Yves; Gastaldi-Ménager, Christelle; Gørtz, Mette; Ibuka, Yoko; Jones, John B; Kallestrup-Lamb, Malene; Karlsson, Martin; Klein, Tobias J; de Lagasnerie, Grégoire; Michaud, Pierre-Carl; O'Donnell, Owen; Rice, Nigel; Skinner, Jonathan S; van Doorslaer, Eddy; Ziebarth, Nicolas R; Kelly, Elaine

2017-07-01

Although end-of-life medical spending is often viewed as a major component of aggregate medical expenditure, accurate measures of this type of medical spending are scarce. We used detailed health care data for the period 2009-11 from Denmark, England, France, Germany, Japan, the Netherlands, Taiwan, the United States, and the Canadian province of Quebec to measure the composition and magnitude of medical spending in the three years before death. In all nine countries, medical spending at the end of life was high relative to spending at other ages. Spending during the last twelve months of life made up a modest share of aggregate spending, ranging from 8.5 percent in the United States to 11.2 percent in Taiwan, but spending in the last three calendar years of life reached 24.5 percent in Taiwan. This suggests that high aggregate medical spending is due not to last-ditch efforts to save lives but to spending on people with chronic conditions, which are associated with shorter life expectancies. Project HOPE—The People-to-People Health Foundation, Inc.

A collaborative approach to lean laboratory workstation design reduces wasted technologist travel.

PubMed

Yerian, Lisa M; Seestadt, Joseph A; Gomez, Erron R; Marchant, Kandice K

2012-08-01

Lean methodologies have been applied in many industries to reduce waste. We applied Lean techniques to redesign laboratory workstations with the aim of reducing the number of times employees must leave their workstations to complete their tasks. At baseline in 68 workflows (aggregates or sequence of process steps) studied, 251 (38%) of 664 tasks required workers to walk away from their workstations. After analysis and redesign, only 59 (9%) of the 664 tasks required technologists to leave their workstations to complete these tasks. On average, 3.4 travel events were removed for each workstation. Time studies in a single laboratory section demonstrated that workers spend 8 to 70 seconds in travel each time they step away from the workstation. The redesigned workstations will allow employees to spend less time travelling around the laboratory. Additional benefits include employee training in waste identification, improved overall laboratory layout, and identification of other process improvement opportunities in our laboratory.

Time Use and Educational Attainment: A Study of Undergraduate Students.

ERIC Educational Resources Information Center

Etcheverry, Emily J.; And Others

1993-01-01

A Canadian university study of 308 students' time use in academic areas used a model relating variables of social background, social psychological characteristics, time use, and educational attainment. Findings suggested that, taking into account these other variables, the time students spend on academic activities and paid employment has little…

Fathers' and Mothers' Involvement with Their Adolescents

ERIC Educational Resources Information Center

Phares, Vicky; Fields, Sherecce; Kamboukos, Dimitra

2009-01-01

We explored mothers' and fathers' time spent with their adolescents and found that mothers reported spending more time with their adolescents than did fathers. Developmental patterns were found for some aspects of time involvement, with both mothers and fathers reporting higher involvement with younger adolescents. Ratings of time-spent were not…

Intended and unintended consequences of the gabapentin off-label marketing lawsuit among patients with bipolar disorder.

PubMed

Chace, Meredith J; Zhang, Fang; Fullerton, Catherine A; Huskamp, Haiden A; Gilden, Daniel; Soumerai, Stephen B

2012-11-01

The number of lawsuits accusing pharmaceutical companies of off-label marketing has risen in recent years. The impact of such lawsuits on drug prescribing and spending has not been examined. We evaluated a nationwide sample to determine whether the $430 million gabapentin off-label marketing lawsuit and accompanying media coverage affected gabapentin market share, substitution of other scientifically substantiated and unsubstantiated anticonvulsants, and anticonvulsant spending of Medicare/Medicaid patients diagnosed with bipolar disorder. Using a national 5% sample of Medicare recipients linked to Medicaid claims, we used an interrupted times series design to evaluate the impact of the lawsuit on monthly market share, utilization, and spending from January 1, 2001, to December 31, 2005. The start of the lawsuit was associated with a 28% relative reduction in gabapentin market share (from ∼ 21% to ∼ 15%) and a reduction in the rate of prescribing from 108 prescriptions per 1,000 patients per month before the start of the lawsuit to 90 by the end of follow-up (P < .001). We also observed increases in market share for 3 other anticonvulsants. Total anticonvulsant use and spending per 1,000 patients increased by 13% and 74%, respectively, after the intervention. The increase in anticonvulsant spending was equivalent to $7,554 per 1,000 patients per year higher than expected compared with the baseline trend (P = .01). We conclude that the lawsuit resulted in a reduction in gabapentin market share, increased market share for other anticonvulsants, and substantially increased total anticonvulsant spending to approximately half of the settlement amount, not counting substitutions of newer drugs for other illnesses affected by the lawsuit. These findings support the need for further study of the effects of current lawsuits regarding off-label drug marketing. © Copyright 2012 Physicians Postgraduate Press, Inc.

Two-step adaptive management for choosing between two management actions

USGS Publications Warehouse

Moore, Alana L.; Walker, Leila; Runge, Michael C.; McDonald-Madden, Eve; McCarthy, Michael A

2017-01-01

Adaptive management is widely advocated to improve environmental management. Derivations of optimal strategies for adaptive management, however, tend to be case specific and time consuming. In contrast, managers might seek relatively simple guidance, such as insight into when a new potential management action should be considered, and how much effort should be expended on trialing such an action. We constructed a two-time-step scenario where a manager is choosing between two possible management actions. The manager has a total budget that can be split between a learning phase and an implementation phase. We use this scenario to investigate when and how much a manager should invest in learning about the management actions available. The optimal investment in learning can be understood intuitively by accounting for the expected value of sample information, the benefits that accrue during learning, the direct costs of learning, and the opportunity costs of learning. We find that the optimal proportion of the budget to spend on learning is characterized by several critical thresholds that mark a jump from spending a large proportion of the budget on learning to spending nothing. For example, as sampling variance increases, it is optimal to spend a larger proportion of the budget on learning, up to a point: if the sampling variance passes a critical threshold, it is no longer beneficial to invest in learning. Similar thresholds are observed as a function of the total budget and the difference in the expected performance of the two actions. We illustrate how this model can be applied using a case study of choosing between alternative rearing diets for hihi, an endangered New Zealand passerine. Although the model presented is a simplified scenario, we believe it is relevant to many management situations. Managers often have relatively short time horizons for management, and might be reluctant to consider further investment in learning and monitoring beyond collecting data from a single time period.

Two-step adaptive management for choosing between two management actions.

PubMed

Moore, Alana L; Walker, Leila; Runge, Michael C; McDonald-Madden, Eve; McCarthy, Michael A

2017-06-01

Adaptive management is widely advocated to improve environmental management. Derivations of optimal strategies for adaptive management, however, tend to be case specific and time consuming. In contrast, managers might seek relatively simple guidance, such as insight into when a new potential management action should be considered, and how much effort should be expended on trialing such an action. We constructed a two-time-step scenario where a manager is choosing between two possible management actions. The manager has a total budget that can be split between a learning phase and an implementation phase. We use this scenario to investigate when and how much a manager should invest in learning about the management actions available. The optimal investment in learning can be understood intuitively by accounting for the expected value of sample information, the benefits that accrue during learning, the direct costs of learning, and the opportunity costs of learning. We find that the optimal proportion of the budget to spend on learning is characterized by several critical thresholds that mark a jump from spending a large proportion of the budget on learning to spending nothing. For example, as sampling variance increases, it is optimal to spend a larger proportion of the budget on learning, up to a point: if the sampling variance passes a critical threshold, it is no longer beneficial to invest in learning. Similar thresholds are observed as a function of the total budget and the difference in the expected performance of the two actions. We illustrate how this model can be applied using a case study of choosing between alternative rearing diets for hihi, an endangered New Zealand passerine. Although the model presented is a simplified scenario, we believe it is relevant to many management situations. Managers often have relatively short time horizons for management, and might be reluctant to consider further investment in learning and monitoring beyond collecting data from a single time period. © 2017 by the Ecological Society of America.

Non-Participant Fathers in Time-Use Studies: Uninvolved or Data Artifact?

ERIC Educational Resources Information Center

Pacholok, Shelley; Gauthier, Anne

2010-01-01

It is well-established that time spent with parents is beneficial for children's development. However, time-use studies from various countries consistently indicate that there are a substantial number of parents, especially fathers, who report spending no time with their children. Much of the literature on parental time simply ignores these…

A pheromone-rate-based analysis on the convergence time of ACO algorithm.

PubMed

Huang, Han; Wu, Chun-Guo; Hao, Zhi-Feng

2009-08-01

Ant colony optimization (ACO) has widely been applied to solve combinatorial optimization problems in recent years. There are few studies, however, on its convergence time, which reflects how many iteration times ACO algorithms spend in converging to the optimal solution. Based on the absorbing Markov chain model, we analyze the ACO convergence time in this paper. First, we present a general result for the estimation of convergence time to reveal the relationship between convergence time and pheromone rate. This general result is then extended to a two-step analysis of the convergence time, which includes the following: 1) the iteration time that the pheromone rate spends on reaching the objective value and 2) the convergence time that is calculated with the objective pheromone rate in expectation. Furthermore, four brief ACO algorithms are investigated by using the proposed theoretical results as case studies. Finally, the conclusions of the case studies that the pheromone rate and its deviation determine the expected convergence time are numerically verified with the experiment results of four one-ant ACO algorithms and four ten-ant ACO algorithms.

Future and potential spending on health 2015-40: development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries.

PubMed

2017-05-20

The amount of resources, particularly prepaid resources, available for health can affect access to health care and health outcomes. Although health spending tends to increase with economic development, tremendous variation exists among health financing systems. Estimates of future spending can be beneficial for policy makers and planners, and can identify financing gaps. In this study, we estimate future gross domestic product (GDP), all-sector government spending, and health spending disaggregated by source, and we compare expected future spending to potential future spending. We extracted GDP, government spending in 184 countries from 1980-2015, and health spend data from 1995-2014. We used a series of ensemble models to estimate future GDP, all-sector government spending, development assistance for health, and government, out-of-pocket, and prepaid private health spending through 2040. We used frontier analyses to identify patterns exhibited by the countries that dedicate the most funding to health, and used these frontiers to estimate potential health spending for each low-income or middle-income country. All estimates are inflation and purchasing power adjusted. We estimated that global spending on health will increase from US$9·21 trillion in 2014 to $24·24 trillion (uncertainty interval [UI] 20·47-29·72) in 2040. We expect per capita health spending to increase fastest in upper-middle-income countries, at 5·3% (UI 4·1-6·8) per year. This growth is driven by continued growth in GDP, government spending, and government health spending. Lower-middle income countries are expected to grow at 4·2% (3·8-4·9). High-income countries are expected to grow at 2·1% (UI 1·8-2·4) and low-income countries are expected to grow at 1·8% (1·0-2·8). Despite this growth, health spending per capita in low-income countries is expected to remain low, at $154 (UI 133-181) per capita in 2030 and $195 (157-258) per capita in 2040. Increases in national health spending to reach the level of the countries who spend the most on health, relative to their level of economic development, would mean $321 (157-258) per capita was available for health in 2040 in low-income countries. Health spending is associated with economic development but past trends and relationships suggest that spending will remain variable, and low in some low-resource settings. Policy change could lead to increased health spending, although for the poorest countries external support might remain essential. Bill & Melinda Gates Foundation. Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Do Physicians Spend More Time with Non-English-Speaking Patients?

PubMed Central

Tocher, Thomas M; Larson, Eric B

1999-01-01

OBJECTIVE To determine whether physicians at a general internal medicine clinic spend more time with non-English-speaking patients. DESIGN A time-motion study comparing physician time spent with non-English-speaking patients and time spent with English-speaking patients during 5 months of observation. We also tested physicians’ perceptions of their time use with a questionnaire. SETTING Primary care internal medicine clinic at a county hospital. PATIENTS/PARTICIPANTS One hundred sixty-six established clinic patients, of whom 57 were non-English speaking and 109 were English speaking, and 15 attending physicians and 8 third-year resident physicians. MEASUREMENTS AND MAIN RESULTS Outcome measures included total patient time in clinic, wait for first nurse or physician contact, time in contact with the nurse or physician, physician time spent on the visit, and physician perceptions of time use with non-English-speaking patients. After adjustment for demographic and comorbidity variables, non-English-speaking and English-speaking patients did not differ on any time-motion variables, including physician time spent on the visit (26.0 vs 25.8 minutes). A significant number of clinic physicians believed that they spent more time during a visit with non-English-speaking patients (85.7%) and needed more time to address important issues during a visit (90.4%), (both p < .01). Physicians did not perceive differences in the amount they accomplished during a visit with non-English-speaking patients. CONCLUSIONS There were no differences in the time these physicians spent providing care to non-English-speaking patients and English-speaking patients. An important limitation of this study is that we were unable to measure quality of care provided or patients’ satisfaction with their care. Physicians may believe that they are spending more time with non-English-speaking patients because of the challenges of language and cultural barriers. PMID:10337040

Patterns in Gut Microbiota Similarity Associated with Degree of Sociality among Sex Classes of a Neotropical Primate.

PubMed

Amato, Katherine R; Van Belle, Sarie; Di Fiore, Anthony; Estrada, Alejandro; Stumpf, Rebecca; White, Bryan; Nelson, Karen E; Knight, Rob; Leigh, Steven R

2017-07-01

Studies of human and domestic animal models indicate that related individuals and those that spend the most time in physical contact typically have more similar gut microbial communities. However, few studies have examined these factors in wild mammals where complex social dynamics and a variety of interacting environmental factors may impact the patterns observed in controlled systems. Here, we explore the effect of host kinship and time spent in social contact on the gut microbiota of wild, black howler monkeys (Alouatta pigra). Our results indicate that closely related individuals had less similar gut microbial communities than non-related individuals. However, the effect was small. In contrast, as previously reported in baboons and chimpanzees, individuals that spent more time in contact (0 m) and close proximity (0-1 m) had more similar gut microbial communities. This pattern was driven by adult female-adult female dyads, which generally spend more time in social contact than adult male-adult male dyads or adult male-adult female dyads. Relative abundances of individual microbial genera such as Bacteroides, Clostridium, and Streptococcus were also more similar in individuals that spent more time in contact or close proximity. Overall, our data suggest that even in arboreal primates that live in small social groups and spend a relatively low proportion of their time in physical contact, social interactions are associated with variation in gut microbiota composition. Additionally, these results demonstrate that within a given host species, subgroups of individuals may interact with the gut microbiota differently.

Suspension Needn't Arrest Learning.

ERIC Educational Resources Information Center

Seegrist, Ruth

1985-01-01

An inschool suspension program at a Pennsylvania school district is described. Students spend suspension time completing classroom assignments under strict teacher supervision in detention halls. (TE)

Stem cell research: elephants in the room.

PubMed

Theise, Neil D

2003-08-01

The degree to which these elephants are disruptive to the steady advancement of the adult stem cell field will become clear with time. In some ways they enliven the discourse, but in many ways they interfere with efficient progress. Naming these elephants is a first step toward dealing with them. If we remain aware of these issues when evaluating new research, we are less likely to make careless mistakes, and we are more likely to be able to hold scientists, politicians, journalists, and entrepreneurs accountable for their practices. Although all adult stem cell researchers will spend time profitably riding some of these elephants, we will all inevitably spend more time cleaning up after them. Perhaps open, careful, and unbiased discussions of these elephants will help the cleanup work be less odious and completed sooner, rather than later.

Study of Development for RFID System to Hospital Environment.

PubMed

Hong, Seung Kwon; Sung, Myung-Whun

2015-01-01

RFID/USN develops information systems for anytime, anywhere to anybody access Electronic Medical Records (EMR). The goal of the present study is to develop a RFID/USN-based information system for the hospital environment. First, unable to recognize, second, able to recognize as a pursuit of place and suppose the time of medical examination. A retrospective analysis of 235 RFID monitoring results, from four ENT ambulatory clinics of Seoul National University Hospital were extracted by a reader program and monitoring of RFID tag (2006.11.16~2006.12.16). RFID detection for sensing reader of this study has been put into representing "place" and "spending time" of patients for medical history taking and examination. Through the RFID of detection for specific place and spending time of medical examination, RFID/USN develops information system progressing in the EMR of hospital system.

The Impact of Global Budgets on Pharmaceutical Spending and Utilization

PubMed Central

Fendrick, A. Mark; Song, Zirui; Landon, Bruce E.; Safran, Dana Gelb; Mechanic, Robert E.; Chernew, Michael E.

2014-01-01

In 2009, Blue Cross Blue Shield of Massachusetts implemented a global budget-based payment system, the Alternative Quality Contract (AQC), in which provider groups assumed accountability for spending. We investigate the impact of global budgets on the utilization of prescription drugs and related expenditures. Our analyses indicate no statistically significant evidence that the AQC reduced the use of drugs. Although the impact may change over time, early evidence suggests that it is premature to conclude that global budget systems may reduce access to medications. PMID:25500751

Effects of macroeconomic trends on social security spending due to sickness and disability.

PubMed

Khan, Jahangir; Gerdtham, Ulf-G; Jansson, Bjarne

2004-11-01

We analyzed the relationship between macroeconomic conditions, measured as unemployment rate and social security spending, from 4 social security schemes and total spending due to sickness and disability. We obtained aggregated panel data from 13 Organization for Economic Cooperation and Development member countries for 1980-1996. We used regression analysis and fixed effect models to examine spending on sickness benefits, disability pensions, occupational-injury benefits, survivor's pensions, and total spending. A decline in unemployment increased sickness benefits spending and reduced disability pension spending. These effects reversed direction after 4 years of unemployment. Inclusion of mortality rate as an additional variable in the analysis did not affect the findings. Macroeconomic conditions influence some reimbursements from social security schemes but not total spending.

Time and Teaching

NASA Astrophysics Data System (ADS)

Zielinski, Theresa Julia; Brooks, David W.; Crippen, Kent J.; March, Joe L.

2001-06-01

Time management is an important issue for teachers and students. This article discusses teachers' use of time from the perspective of curriculum and instruction. Average high school students spend fewer than 5 hours per week in outside-of-class study; average college students spend about 20 hours. Procrastination, often viewed in a negative light by teachers, usually pays off so well for college students that seniors become better at it than freshmen. Three suggestions for designing instruction are: test early and often; do not waste the best students' time in an effort to improve overall performance; and use engaging activities that motivate students to give of their time. The impact of computers on curricula is a double-edged sword. Time must be devoted to teaching the use of applications, but the programs reduce busywork. Will this turn out to be a simple tradeoff, or will the programs make us much more efficient so that less time is required? Will computer programs ultimately lead to an expanded criterion for expertise, thus demanding even more time to become an expert? These issues are described and suggestions for controlling time during instruction are provided.

Analyzing Whether Countries Are Equally Efficient at Improving Longevity for Men and Women

PubMed Central

Nandi, Arijit; Mendoza Rodríguez, José M.; Heymann, Jody

2014-01-01

Objectives. We examined the efficiency of country-specific health care spending in improving life expectancies for men and women. Methods. We estimated efficiencies of health care spending for 27 Organisation for Economic Co-operation and Development (OECD) countries during the period 1991 to 2007 using multivariable regression models, including country fixed-effects and controlling for time-varying levels of national social expenditures, economic development, and health behaviors. Results. Findings indicated robust differences in health-spending efficiency. A 1% annual increase in health expenditures was associated with percent changes in life expectancy ranging from 0.020 in the United States (95% confidence interval [CI] = 0.008, 0.032) to 0.121 in Germany (95% CI = 0.099, 0.143). Health-spending increases were associated with greater life expectancy improvements for men than for women in nearly every OECD country. Conclusions. This is the first study to our knowledge to estimate the effect of country-specific health expenditures on life expectancies of men and women. Future work understanding the determinants of these differences has the potential to improve the overall efficiency and equity of national health systems. PMID:24328639

Consumption of food away from home in Bangladesh: Do rich households spend more?

PubMed

Mottaleb, Khondoker A; Rahut, Dil Bahadur; Mishra, Ashok K

2017-12-01

While consumption of food away from home (FAFH) is an established phenomenon among households in the developed countries, FAFH is a growing phenomenon in many middle-income and rapidly growing developing countries. Although, studies are available on the factors affecting consumption of FAFH in developed countries, there is a paucity of such studies in developing countries. This study examines households' choice of and expenditures on FAFH. We used information from Bangladeshi households and applied a double-hurdle regression model estimation procedure. Findings show that, in general, rich households are spending proportionately less on FAFH and, over time, the trend is continuing. Although households with female members who work in the non-farm sector are more likely to consume FAFH, educated household heads and spouses, and particularly urban households are less likely to consume and spend on FAFH. As the problem of food adulteration by dishonest sellers is rampant in Bangladesh, perhaps it discourages rich, urban and households headed by educated heads and spouses to consume and spend more on FAFH. Based on the findings, some points of interventions are also prescribed in this study. Copyright © 2017 Elsevier Ltd. All rights reserved.

General budget support: has it benefited the health sector?

PubMed

Fernandes Antunes, Adelio; Xu, Ke; James, Chris D; Saksena, Priyanka; Van de Maele, Nathalie; Carrin, Guy; Evans, David B

2013-12-01

There has been recent controversy about whether aid directed specifically to health has caused recipient governments to reallocate their own funds to non-health areas. At the same time, general budget support (GBS) has been increasing. GBS allows governments to set their own priorities, but little is known about how these additional resources are subsequently used. This paper uses cross-country panel data to assess the impact of GBS programmes on health spending in low-income and middle-income countries, using dynamic panel techniques to estimate unbiased coefficients in the presence of serial correlation. We found no clear evidence that GBS had any impact, positive or negative, on government health spending derived from domestic sources. GBS also had no observed impact on total government health spending from all sources (external as well as domestic). In contrast, health-specific aid was associated with a decline in health expenditures from domestic sources, but there was not a full substitution effect. That is, despite this observed fungibility, health-specific aid still increases total government health spending from all sources. Finally, increases in total government expenditure led to substantial increases in domestic government health expenditures. Copyright © 2012 John Wiley & Sons, Ltd.

Michigan's fee-for-value physician incentive program reduces spending and improves quality in primary care.

PubMed

Lemak, Christy Harris; Nahra, Tammie A; Cohen, Genna R; Erb, Natalie D; Paustian, Michael L; Share, David; Hirth, Richard A

2015-04-01

As policy makers and others seek to reduce health care cost growth while improving health care quality, one approach gaining momentum is fee-for-value reimbursement. This payment strategy maintains the traditional fee-for-service arrangement but includes quality and spending incentives. We examined Blue Cross Blue Shield of Michigan's Physician Group Incentive Program, which uses a fee-for-value approach focused on primary care physicians. We analyzed the program's impact on quality and spending from 2008 to 2011 for over three million beneficiaries in over 11,000 physician practices. Participation in the incentive program was associated with approximately 1.1 percent lower total spending for adults (5.1 percent lower for children) and the same or improved performance on eleven of fourteen quality measures over time. Our findings contribute to the growing body of evidence about the potential effectiveness of models that align payment with cost and quality performance, and they demonstrate that it is possible to transform reimbursement within a fee-for-service framework to encourage and incentivize physicians to provide high-quality care, while also reducing costs. Project HOPE—The People-to-People Health Foundation, Inc.

23 CFR 1252.5 - Procedures.

Code of Federal Regulations, 2010 CFR

2010-04-01

... module(s). If an employee is spending time on a combination of administration and planning functions and... allocate costs based on acutal time spent on an activity, the State highway safety agency must keep accurate time records showing the work activities for each employee. The State's record keeping system must...

78 FR 43227 - Proposed Collection, Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-19

... in the United States. It measures, for example, time spent with children, working, sleeping, or doing... their time vary across demographic and labor force characteristics, such as age, sex, race, ethnicity, employment status, earnings, and education? How much time do parents spend in the company of their children...

Teaching Online: Where Do Faculty Spend Their Time?

ERIC Educational Resources Information Center

Mandernach, B. Jean; Holbeck, Rick

2016-01-01

An understanding of online teaching time requirements provides essential information to inform scheduling, course size and instructor workload; in addition, awareness of the distribution of time across online teaching tasks provides insight to focus faculty efforts and tailor professional development to target instructional needs. The purpose of…

Sitting on the runway : current aircraft taxi times now exceed pre-9/11 experience

DOT National Transportation Integrated Search

2008-05-01

Several high profi le incidents have focused attention on : tarmac delays that resulted in air travelers spending long : periods of time aboard aircraft waiting to either take off or : move to a gate after landing. Taxi-time data collected by :...

Database for propagation models

NASA Astrophysics Data System (ADS)

Kantak, Anil V.

1991-07-01

A propagation researcher or a systems engineer who intends to use the results of a propagation experiment is generally faced with various database tasks such as the selection of the computer software, the hardware, and the writing of the programs to pass the data through the models of interest. This task is repeated every time a new experiment is conducted or the same experiment is carried out at a different location generating different data. Thus the users of this data have to spend a considerable portion of their time learning how to implement the computer hardware and the software towards the desired end. This situation may be facilitated considerably if an easily accessible propagation database is created that has all the accepted (standardized) propagation phenomena models approved by the propagation research community. Also, the handling of data will become easier for the user. Such a database construction can only stimulate the growth of the propagation research it if is available to all the researchers, so that the results of the experiment conducted by one researcher can be examined independently by another, without different hardware and software being used. The database may be made flexible so that the researchers need not be confined only to the contents of the database. Another way in which the database may help the researchers is by the fact that they will not have to document the software and hardware tools used in their research since the propagation research community will know the database already. The following sections show a possible database construction, as well as properties of the database for the propagation research.

Parenting

MedlinePlus

... Providing order and consistency Setting and enforcing limits Spending time with your child Monitoring your child's friendships and activities Leading by example NIH: National Institute of Child Health and Human Development

Fever

MedlinePlus

... before eating, after using the toilet, after spending time in a crowd or around someone who's sick, after petting animals, and during travel on public transportation. Show your children how to ...

How to rediscover Nature in the Digital Era: Earth sciences, Art and Technology

NASA Astrophysics Data System (ADS)

Lanza, Tiziana

2016-04-01

How much time spend in Nature the average man? And how much time men spend in the virtual world? Can we consider this one of the main issues when mourning the growing devastating input coming from human activities on the environment? This preliminary work on the theme collect some ideas on the issue and prospect some solution to the light of the work already done in the past. Starting from data collected from the web describing the impact of technology on everyday life, and passing through some studies concerning the impact of technology on the human brain, a new way of conceiving Earth education takes inspiration from a cross cutting of ideas and results coming from different disciplines describing the contemporary world.

Protecting Pakistan's health during the global economic crisis.

PubMed

Jooma, R; Khan, A; Khan, A A

2012-03-01

The world is facing an unprecedented global economic crisis, with many countries needing to reconsider their level of health care spending. This paper explores the many consequences of the global economic turndown on Pakistan's health, including reduced government and donor spending and increased poverty with the consequent diversion of funds away from health. Nevertheless, these challenges may provide opportunities not only to mitigate the adverse effects of the economic crisis but also to institute some much-needed reforms that may not receive political support during more affluent times. Our suggestions focus on setting priorities based on the national disease burden, prioritizing prevention interventions, demanding results, curbing corruption, experimenting with innovative funding mechanisms, advocating for increased funding by presenting health spending as an investment rather than an expense and by selected recourse to civil society interventions and philanthropy to bridge the gap between available and needed resources.

Medical considerations for extending human presence in space

NASA Technical Reports Server (NTRS)

Leach, C. S.; Dietlein, L. F.; Pool, S. L.; Nicogossian, A. E.

1990-01-01

The prospects for extending the length of time that humans can safely remain in space depend partly on resolution of a number of medical issues. Physiologic effects of weightlessness that may affect health during flight include loss of body fluid, functional alterations in the cardiovascular system, loss of red blood cells and bone mineral, compromised immune system function, and neurosensory disturbances. Some of the physiologic adaptations to weightlessness contribute to difficulties with readaptation to Earth's gravity. These include cardiovascular deconditioning and loss of body fluids and electrolytes; red blood cell mass; muscle mass, strength, and endurance; and bone mineral. Potentially harmful factors in space flight that are not related to weightlessness include radiation, altered circadian rhythms and rest/work cycles, and the closed, isolated environment of the spacecraft. There is no evidence that space flight has long-term effects on humans, except that bone mass lost during flight may not be replaced, and radiation damage is cumulative. However, the number of people who have spent several months or longer in space is still small. Only carefully-planned experiments in space preceded by thorough ground-based studies can provide the information needed to increase the amount of time humans can safely spend in space.

Circulation of core collection monographs in an academic medical library.

PubMed

Schmidt, C M; Eckerman, N L

2001-04-01

Academic medical librarians responsible for monograph acquisition face a challenging task. From the plethora of medical monographs published each year, academic medical librarians must select those most useful to their patrons. Unfortunately, none of the selection tools available to medical librarians are specifically intended to assist academic librarians with medical monograph selection. The few short core collection lists that are available are intended for use in the small hospital or internal medicine department library. As these are the only selection tools available, however, many academic medical librarians spend considerable time reviewing these collection lists and place heavy emphasis on the acquisition of listed books. The study reported here was initiated to determine whether the circulation of listed books in an academic library justified the emphasis placed on the acquisition of these books. Circulation statistics for "listed" and "nonlisted" books in the hematology (WH) section of Indiana University School of Medicine's Ruth Lilly Medical Library were studied. The average circulation figures for listed books were nearly two times as high as the corresponding figures for the WH books in general. These data support the policies of those academic medical libraries that place a high priority on collection of listed books.

Adolescent Sexual Health and Education: Where Does the Pediatrician's Responsibility Fall?

PubMed

Dawson, Rachel S

2018-04-01

Adolescence is a stressful time with a considerable amount of change, not only physically, with all the changes expected throughout puberty, but also emotionally, spiritually, and psychosocially. Teens are learning how to build and sustain relationships, learning boundaries in all areas of their lives, experimenting, as well as setting values that will sustain them throughout their lives. Home, school, various social settings, and places of worship all contribute to where adolescents learn what their values are, what they want their values to be, and how they start to make choices about their personal beliefs, which may not always align with their family values. Adolescents spend most of their time in school, so the classroom is a logical place where certain discussions, such as puberty and sexuality, should happen regarding changes that are occurring with their bodies. The home environment, as well as the willingness of parents to have open, honest dialogue about sexual education, is also a vital component of ensuring that adolescents feel safe to openly discuss this topic. Pediatric clinicians also play an important role in helping to inform adolescents and their families about sexual health and development. [Pediatr Ann. 2018;47(4):e136-e139.]. Copyright 2018, SLACK Incorporated.

Planning for life after orthopaedics.

PubMed

Barr, Joseph S; McCaslin, Michael J; Hinds, Cynthia K

2014-01-01

The word retirement is going out of fashion. Many orthopaedic surgeons want to work in some capacity when they stop performing surgery. Making a smooth transition from a busy orthopaedic practice to alternative work demands advanced planning. The surgeon must consider personal issues that involve how to use human capital (his or her accumulated knowledge and experience). New ventures, hobbies, travel, and spending time with family and friends are some possibilities. Plans for slowing down or leaving the practice should be discussed and agreed on well ahead of time. Agreements for buyouts may be difficult to work out and will require creative thinking. The solo practitioner can close the practice or hire a successor. Financial planning is perhaps the most important consideration and should be started by approximately age 40. It is recommended that the surgeon develop a portfolio of secure investments and annuities to provide adequate income for as long as is needed and then to turn the residual income to one's family, favorite charities, or other desired cause. A team of competent advisors is needed to help develop and achieve one's goals, create financial security, and provide the discipline to carry out the needed planning for life after orthopaedics.

Interpersonal boundaries in clinical nursing education: An exploratory Canadian qualitative study.

PubMed

Zieber, Mark P; Hagen, Brad

2009-11-01

Clinical nursing instructors and students spend considerable time together, and share clinical experiences that can be intense and emotionally charged. Yet despite clinical teaching being so commonplace, little is known about how clinical instructors experience relationships with their students, and how they negotiate interpersonal boundaries within these relationships. In-depth unstructured interviews were conducted with eight clinical nursing instructors in Western Canada, to explore how they defined and constructed interpersonal boundaries with their students during clinical nursing teaching rotations. The data analysis resulted in four major themes: "the fluidity of boundaries", "personal sharing and self-disclosure", "time dependent", and "the touchy topic of touch". All participants agreed that rigid boundaries were occasionally needed to prevent flagrant boundary violations, such as sexual relations with students. However, participants also stated that overall, the unique and complex nature of clinical teaching called for instructors to have fluid and flexible interpersonal boundaries with students. The nature of clinical nursing education may encourage instructors to form relationships with their students that are characterized by flexible and fluid interpersonal boundaries. Clinical nursing instructors may benefit from opportunities to dialogue with trusted colleagues about the unique nature of relationships and boundaries with students during clinical teaching.

Circulation of core collection monographs in an academic medical library

PubMed Central

Schmidt, Cynthia M.; Eckerman, Nancy L.

2001-01-01

Academic medical librarians responsible for monograph acquisition face a challenging task. From the plethora of medical monographs published each year, academic medical librarians must select those most useful to their patrons. Unfortunately, none of the selection tools available to medical librarians are specifically intended to assist academic librarians with medical monograph selection. The few short core collection lists that are available are intended for use in the small hospital or internal medicine department library. As these are the only selection tools available, however, many academic medical librarians spend considerable time reviewing these collection lists and place heavy emphasis on the acquisition of listed books. The study reported here was initiated to determine whether the circulation of listed books in an academic library justified the emphasis placed on the acquisition of these books. Circulation statistics for “listed” and “nonlisted” books in the hematology (WH) section of Indiana University School of Medicine's Ruth Lilly Medical Library were studied. The average circulation figures for listed books were nearly two times as high as the corresponding figures for the WH books in general. These data support the policies of those academic medical libraries that place a high priority on collection of listed books. PMID:11337947

Public Expenditures on Children through 2008: Key Facts

ERIC Educational Resources Information Center

Macomber, Jennifer; Isaacs, Julia; Kent, Adam; Vericker, Tracy

2010-01-01

This report provides the key findings on the public spending on children through 2008. They are: (1) Spending on children increased under the American Recovery and Reinvestment Act (ARRA) and other stimulus spending, but not proportionately to other federal spending. As ARRA expires, we project that spending on children will decline, assuming no…

Spending on mental and substance use disorders projected to grow more slowly than all health spending through 2020.

PubMed

Mark, Tami L; Levit, Katharine R; Yee, Tracy; Chow, Clifton M

2014-08-01

Spending on mental and substance use disorders will likely grow more slowly than all health spending through 2020. We project that spending on mental and substance use disorders, as a share of all health spending, will fall from 7.4 percent in 2009 ($172 billion out of $2.3 trillion) to 6.5 percent in 2020 ($281 billion out of $4.3 trillion). This trend is the projected result of reduced spending on mental health drugs because of patent expirations, the low likelihood of innovative drugs entering the market, and a slowdown in spending growth for hospital treatment. By 2020 the expansion of coverage to previously uninsured Americans under the Affordable Care Act (ACA), combined with the projected slowdown in Medicare provider payment rates under the ACA and the Budget Control Act of 2011, are expected to add 2.7 percent to behavioral health spending, compared to spending without these changes. Project HOPE—The People-to-People Health Foundation, Inc.

How Young Children Spend Their Time: Television and Other Activities.

ERIC Educational Resources Information Center

Huston, Aletha C.; Wright, John C.; Marquis, Janet; Green, Samuel B.

1999-01-01

Examined television viewing over three years among two cohorts of 2- and 4-year olds. Found that viewing declined with age. With age, time in reading and educational activities increased on weekdays but declined on weekends, and sex differences in time-use patterns increased. Increased time in educational activities, social interaction, and video…

Strategies to Increase Behavior-Specific Teacher Praise in an Inclusive Environment

ERIC Educational Resources Information Center

Musti-Rao, Shobana; Haydon, Todd

2011-01-01

Managing students' disruptive behavior in the classroom can be a time-consuming task and greatly reduces the amount of time teachers spend on instruction. Although there are several research-validated classroom management strategies, teachers are more likely to adopt strategies that are less time-consuming than strategies that take more time or…

Is Medicaid sustainable? Spending projections for the program's second forty years.

PubMed

Kronick, Richard; Rousseau, David

2007-01-01

We constructed long-term projections of Medicaid spending and compared projected growth in spending with that of state and federal revenues. Notwithstanding the anticipated decline in employer-sponsored insurance and the long-term care needs of the baby boomers, we project that Medicaid spending as a share of national health spending will average 16.6 percent from 2006 to 2025--roughly unchanged from 16.5 percent in 2005--and then increase slowly to 19.0 percent by 2045. Growth in government revenues is projected to be large enough to sustain both Medicaid spending increases and substantial real growth in spending for other services.

National health spending in 2013: growth slows, remains in step with the overall economy.

PubMed

Hartman, Micah; Martin, Anne B; Lassman, David; Catlin, Aaron

2015-01-01

In 2013 US health care spending increased 3.6 percent to $2.9 trillion, or $9,255 per person. The share of gross domestic product devoted to health care spending has remained at 17.4 percent since 2009. Health care spending decelerated 0.5 percentage point in 2013, compared to 2012, as a result of slower growth in private health insurance and Medicare spending. Slower growth in spending for hospital care, investments in medical structures and equipment, and spending for physician and clinical care also contributed to the low overall increase. Project HOPE—The People-to-People Health Foundation, Inc.

Design Considerations for a Crewed Mars Ascent Vehicle

NASA Technical Reports Server (NTRS)

Rucker, Michelle A.

2015-01-01

Exploration architecture studies identified the Mars Ascent Vehicle (MAV) as one of the largest "gear ratio" items in a crewed Mars mission. Because every kilogram of mass ascended from the Martian surface requires seven kilograms or more of ascent propellant, it is desirable for the MAV to be as small and lightweight as possible. Analysis identified four key factors that drive MAV sizing: 1) Number of crew: more crew members require more equipment-and a larger cabin diameter to hold that equipment-with direct implications to structural, thermal, propulsion, and power subsystem mass. 2) Which suit is worn during ascent: Extravehicular Activity (EVA) type suits are physically larger and heavier than Intravehicular Activity (IVA) type suits and because they are less flexible, EVA suits require more elbow-room to maneuver in and out of. An empty EVA suit takes up about as much cabin volume as a crew member. 3) How much time crew spends in the MAV: less than about 12 hours and the MAV can be considered a "taxi" with few provisions for crew comfort. However, if the crew spends more than 12 consecutive hours in the MAV, it begins to look like a Habitat requiring more crew comfort items. 4) How crew get into/out of the MAV: ingress/egress method drives structural mass (for example, EVA hatch vs. pressurized tunnel vs. suit port) as well as consumables mass for lost cabin atmosphere, and has profound impacts on surface element architecture. To minimize MAV cabin mass, the following is recommended: Limit MAV usage to 24 consecutive hours or less; discard EVA suits on the surface and ascend wearing IVA suits; Limit MAV functionality to ascent only, rather than dual-use ascent/habitat functions; and ingress/egress the MAV via a detachable tunnel to another pressurized surface asset.

Roles of prices, poverty, and health in Medicare and private spending in Texas.

PubMed

White, Chapin; Taychakhoonavudh, Suthira; Parikh, Rohan; Franzini, Luisa

2015-05-01

To investigate the roles of prices, poverty, and health in divergences between Medicare and private spending in Texas. Retrospective observational design using 2011 Blue Cross Blue Shield of Texas claims data and publicly available Medicare data. We measured market-level spending per enrollee among the privately insured. Variation in Medicare and private spending per person are decomposed into prices and quantities, and their associations with poverty are measured. Markets are divided into 4 groups and are compared based on the ratio of Medicare to private spending: "high-private," "proportional," "high-Medicare," and "extremely high-Medicare." Among the privately insured, poverty appears to have large spillover effects; it is strongly associated with lower prices, quantities, and spending. Among Medicare beneficiaries, health status is a key driver of spending variation. The 2 markets with extremely high Medicare-to-private spending ratios (Harlingen and McAllen) are predominantly Hispanic communities with markedly higher rates of poverty and lack of insurance and also extremely low physician supply. The markets with relatively high private spending stand out for having good health-system performance and health outcomes, and higher than average hospital prices. Variation in private spending appears to reflect the ability of the local population to pay for healthcare, whereas variation in Medicare is more heavily driven by health status, and presumably, by clinical need. These findings highlight the inadvisability of using Medicare spending as a proxy for systemwide spending, and the need for comprehensive market-level spending data that allow comparisons among populations with different sources of insurance coverage.

The Advertising Strategies of Early E-cigarette Brand Leaders in the United States.

PubMed

Haardörfer, Regine; Cahn, Zachary; Lewis, Michael; Kothari, Shreya; Sarmah, Raina; Getachew, Betelihem; Berg, Carla J

2017-04-01

We examined differential advertising strategies used by 4 major United States e-cigarette companies with differential affiliations with the traditional tobacco industry (ie, Njoy - independent, Blu - acquired, Vuse and MarkTen - launched by cigarette companies) over time. We conducted a mixed-methods study regarding e-cigarette adspend, adspend per media channel (eg, TV, print), and advertising messaging strategies among these 4 top e-cigarette brands from January 2013 through December 2015. E-cigarette adspend increased from $59 million in 2013 to $91 million in 2014, followed by a sharp decline to $37 million in 2015. These companies showed distinct spending trajectories overall and across media channels, with Njoy and Vuse spending a higher proportion of their dollars on TV and Blu and MarkTen spending more on print. Marketing messages were also different by company. Key themes included switching from cigarettes (particularly by Njoy and Blu), circumventing smoke-free policies (particularly by Blu), and technological advancement (particularly by Vuse and MarkTen). These e-cigarette brands have shifted their adspend, use of media channels, and advertising messaging strategies over time. Some differing strategies may reflect the different affiliations of each brand to the traditional cigarette industry.

Who Has the Time? The Relationship between Household Labor Time and Sexual Frequency

ERIC Educational Resources Information Center

Gager, Constance T.; Yabiku, Scott T.

2010-01-01

Motivated by the trend of women spending more time in paid labor and the general speedup of everyday life, the authors explore whether the resulting time crunch affects sexual frequency among married couples. Although prior research has examined the associations between relationship quality and household labor time, few have examined a dimension…

Changing Teacher Time

ERIC Educational Resources Information Center

Vannest, Kimberly J.; Soares, Denise A.; Harrison, Judith R.; Brown, Leanne; Parker, Richard I.

2009-01-01

Studies on special education teacher time use (TTU) have indicated that special education teachers spend small percentages of their day teaching. The authors examined goal setting and self-monitoring to change the time use of 4 teachers. In terms of TTU, each teacher articulated goals for increasing some tasks (e.g., instruction) and decreasing…

RESIDENCE TIME DISTRIBUTION OF FLUIDS IN STIRRED ANNULAR PHOTOREACTORS

EPA Science Inventory

When gases flow through an annular photoreactor at constant rate, some of the gas spends more or less than the average residence time in the reactor. This spread of residence time can have an important effect on the performance of the reactor. this study tested how the residence...

29 CFR 541.700 - Primary duty.

Code of Federal Regulations, 2010 CFR

2010-07-01

... other types of duties; the amount of time spent performing exempt work; the employee's relative freedom... employees for the kind of nonexempt work performed by the employee. (b) The amount of time spent performing.... Thus, employees who spend more than 50 percent of their time performing exempt work will generally...

29 CFR 553.210 - Fire protection activities.

Code of Federal Regulations, 2010 CFR

2010-07-01

... upon to spend substantially all (i.e., 80 percent or more) of their time during the applicable work... activities” also refers to employees who work for forest conservation agencies or other public agencies..., regardless of their status as full time or part time agency employees or as temporary or casual workers...

Investigating the American Time Use Survey from an Exposure Modeling Perspective

EPA Science Inventory

This paper describes an evaluation of the U.S. Bureau of Labor Statistics' American Time Use Survey (ATUS) for potential use in modeling human exposures to environmental pollutants. The ATUS is a large, on-going, cross-sectional survey of where Americans spend time and what activ...

A provincial study of opportunities for school-based physical activity in secondary schools.

PubMed

Dwyer, John J M; Allison, Kenneth R; LeMoine, Karen N; Adlaf, Edward M; Goodman, Jack; Faulkner, Guy E J; Lysy, Daria C

2006-07-01

Adolescents spend considerable time at school and thus it is important to understand their opportunities for school-based physical activity. This study surveyed Ontario secondary schools to identify the range of structured opportunities and their engagement by students. A questionnaire was mailed to key informants in 600 randomly selected secondary schools in Ontario, for which 474 respondents (79%) returned completed questionnaires. Curriculum-based physical education (PE) classes in grade nine were reported to be offered in all schools and these classes in grades 10, 11 and 12 were offered in almost all schools. Student enrollment in PE decreased from grades 9 to 12 (97.9%, 49.6%, 43.3% and 35.9%, respectively). Respondents reported that funding, timetable, facilities and resources made it somewhat difficult to implement the health and physical education curriculum in their schools. About two-thirds (65.5%) of the schools had an intramural program and 15.0% of students participated in it, whereas 97.2% of the schools had an inter-school sports program and 25.0% of students participated in it. Supervision issues made it difficult to provide intramural programs and funding made it difficult to provide inter-school sports programs. Although provision of physical activity opportunities in Ontario appears satisfactory, actual engagement by students is low. The results suggest that strategies to increase student participation in PE, intramural programs, and inter-school sports programs need further consideration.

The Mental Health Parity and Addiction Equity Act evaluation study: Impact on specialty behavioral healthcare utilization and spending among enrollees with substance use disorders.

PubMed

Friedman, Sarah; Xu, Haiyong; Harwood, Jessica M; Azocar, Francisca; Hurley, Brian; Ettner, Susan L

2017-09-01

The federal Mental Health Parity and Addiction Equity Act (MHPAEA) sought to eliminate historical disparities between behavioral health and medical health insurance benefits among the commercially insured. This study determines whether MHPAEA was associated with increased BH expenditures and utilization among a population with substance use disorder (SUD) diagnoses. Claims and eligibility data from 5,987,776 enrollees, 2008-2013, were obtained from a national, commercial, managed behavioral health organization. An interrupted time series study design with segmented regression analysis estimated time trends of per-member-per-month (PMPM) spending and use before (2008-2009), during (2010), and after (2011-2013) MHPAEA compliance. The study sample contained individuals with drug or alcohol use disorder diagnosis during study period (N=2,716,473 member-month observations). Outcomes included: total, plan, patient out-of-pocket spending; outpatient utilization (assessment/diagnostic evaluation visits; medication management; individual, group and family psychotherapy, and structured outpatient care); intermediate care utilization (day treatment; recovery home and residential); and inpatient utilization. Starting at the beginning of the post-parity period, MHPAEA was associated with increased levels of PMPM total and plan spending ($25.80 [p=0.01]; $28.33 [p=0.00], respectively), as well as the number of PMPM assessment/evaluation, individual psychotherapy, and group psychotherapy visits, and inpatient days (0.01 visits [p=0.01]; 0.02 visits [p=0.01]; 0.01 visits [p=0.03]; 0.01days [p=0.01], respectively). Following these initial level changes, MHPAEA was also associated with monthly increases in PMPM total, plan, and patent out-of-pocket spending ($2.56/month [p=0.00]; $2.25/month [p=0.00]; $0.27 [p=0.03], respectively), as well as structured outpatient visits and inpatient days (0.0012 visits/month [p=0.01]; 0.0012days/month [p=0.00]). MHPAEA was associated with modest increases in total, plan, and patient out-of-pocket spending and outpatient and inpatient utilization. These increases, while modest in magnitude, are larger in magnitude than increases detected among a sample of all enrollees (i.e. not only those with SUD diagnoses). Published by Elsevier Inc.