Statistical Power for Causally Defined Indirect Effects in Group-Randomized Trials with Individual-Level Mediators

ERIC Educational Resources Information Center

Kelcey, Benjamin; Dong, Nianbo; Spybrook, Jessaca; Cox, Kyle

2017-01-01

Designs that facilitate inferences concerning both the total and indirect effects of a treatment potentially offer a more holistic description of interventions because they can complement "what works" questions with the comprehensive study of the causal connections implied by substantive theories. Mapping the sensitivity of designs to…

Direct effects of tadalafil on lower urinary tract symptoms versus indirect effects mediated through erectile dysfunction symptom improvement: integrated data analyses from 4 placebo controlled clinical studies.

PubMed

Brock, Gerald B; McVary, Kevin T; Roehrborn, Claus G; Watts, Steven; Ni, Xiao; Viktrup, Lars; Wong, David G; Donatucci, Craig

2014-02-01

Tadalafil has regulatory approval for the treatment of men with signs/symptoms of benign prostatic hyperplasia with and without erectile dysfunction. We assessed whether the effects of treatment with tadalafil for lower urinary tract symptoms/benign prostatic hyperplasia are independent of improvements in erectile dysfunction. Four separate analyses used integrated data from 4 randomized, double-blind, placebo controlled studies in men with lower urinary tract symptoms/benign prostatic hyperplasia with and without erectile dysfunction to test whether total I-PSS (International Prostate Symptom Score) improvement was due to improvement in IIEF-EF (International Index of Erectile Function-Erectile Function domain score). Unidirectional and bidirectional path analysis models determined direct and indirect treatment effects mediated by improvements in lower urinary tract symptoms/benign prostatic hyperplasia and erectile dysfunction symptoms. A total of 1,496 men, of whom 77% had erectile dysfunction, received at least 1 dose of tadalafil 5 mg once daily or placebo. The placebo adjusted treatment effect for men with erectile dysfunction was represented by a mean decrease of -2.3 (p <0.0001) in total I-PSS vs -2.2 (p = 0.0007) for men without erectile dysfunction. The correlation between change from baseline in total I-PSS and IIEF-EF was weak (r(2) = 0.08, p <0.0001). The unidirectional path analysis model suggested that the total treatment effect on total I-PSS score improvement (2.25) was derived from a direct treatment effect of 1.57 (70%, p <0.001) and an indirect treatment effect of 0.67 (30% via IIEF-EF improvement, p <0.001). Bidirectional path analysis showed that total I-PSS improvement was largely attributed to direct (92.5%, p <0.001) vs indirect (7.5%, p = 0.32) treatment effects via IIEF-EF improvement. Regardless of the analytical approach, self-reported erectile dysfunction status did not appreciably influence tadalafil treatment response in men with lower urinary tract symptoms/benign prostatic hyperplasia, supporting the dual action of tadalafil on lower urinary tract symptoms/benign prostatic hyperplasia and erectile dysfunction. Copyright © 2014. Published by Elsevier Inc.

Sleep-wake time perception varies by direct or indirect query.

PubMed

Alameddine, Y; Ellenbogen, J M; Bianchi, M T

2015-01-15

The diagnosis of insomnia rests on self-report of difficulty initiating or maintaining sleep. However, subjective reports may be unreliable, and possibly may vary by the method of inquiry. We investigated this possibility by comparing within-individual response to direct versus indirect time queries after overnight polysomnography. We obtained self-reported sleep-wake times via morning questionnaires in 879 consecutive adult diagnostic polysomnograms. Responses were compared within subjects (direct versus indirect query) and across groups defined by apnea-hypopnea index and by self-reported insomnia symptoms in pre-sleep questionnaires. Direct queries required a time duration response, while indirect queries required clock times from which we calculated time durations. Direct and indirect queries of sleep latency were the same in only 41% of cases, and total sleep time queries matched in only 5.4%. For both latency and total sleep, the most common discrepancy involved the indirect value being larger than the direct response. The discrepancy between direct and indirect queries was not related to objective sleep metrics. The degree of discrepancy was not related to the presence of insomnia symptoms, although patients reporting insomnia symptoms showed underestimation of total sleep duration by direct response. Self-reported sleep latency and total sleep time are often internally inconsistent when comparing direct and indirect survey queries of each measure. These discrepancies represent substantive challenges to effective clinical practice, particularly when diagnosis and management depends on self-reported sleep patterns, as with insomnia. Although self-reported sleep-wake times remains fundamental to clinical practice, objective measures provide clinically relevant adjunctive information. © 2015 American Academy of Sleep Medicine.

[Effects decomposition in mediation analysis: a numerical example].

PubMed

Zugna, Daniela; Richiardi, Lorenzo

2018-01-01

Mediation analysis aims to decompose the total effect of the exposure on the outcome into a direct effect (unmediated) and an indirect effect (mediated by a mediator). When the interest also lies on understanding whether the exposure effect differs in different sub-groups of study population or under different scenarios, the mediation analysis needs to be integrated with interaction analysis. In this setting it is necessary to decompose the total effect not only into two components, the direct and indirect effects, but other two components linked to interaction. The interaction between the exposure and the mediator in their effect on the outcome could indeed act through the effect of the exposure on the mediator or through the mediator when the mediator is not totally explained by the exposure. We describe options for decomposition, proposed in literature, of the total effect and we illustrate them through a hypothetical example of the effect of age at diagnosis of cancer on survival, mediated and unmediated by the therapeutical approach, and a numerical example.

Unpacking Direct and Indirect Relationships of Short-Term Memory to Word Reading: Evidence From Korean-Speaking Children.

PubMed

Kim, Young-Suk Grace; Cho, Jeung-Ryeul; Park, Soon-Gil

2017-08-01

We examined the relations of short-term memory (STM), metalinguistic awareness (phonological, morphological, and orthographic awareness), and rapid automatized naming (RAN) to word reading in Korean, a language with a relatively transparent orthography. STM, metalinguistic awareness, and RAN have been shown to be important to word reading, but the nature of the relations of STM, metalinguistic awareness, and RAN to word reading has rarely been investigated. Two alternative models were fitted. In the indirect relation model, STM was hypothesized to be indirectly related to word reading via metalinguistic awareness and RAN. In the direct and indirect relations model, STM was hypothesized to be directly and indirectly related to word reading. Results from 207 beginning readers in South Korea showed that STM was directly related to word reading as well as indirectly via metalinguistic awareness and RAN. Although the direct effect of STM was relatively small (.16), the total effect incorporating the indirect effect was substantial (.42). These results suggest that STM is an important, foundational cognitive capacity that underpins metalinguistic awareness and RAN as well as word reading, and further indicate the importance of considering both direct and indirect effects of language and cognitive skills on word reading.

Relative importance of demographic, socioeconomic and health factors on life expectancy in low- and lower-middle-income countries.

PubMed

Mondal, Md Nazrul Islam; Shitan, Mahendran

2014-01-01

We attempted to identify the pathways by which demographic changes, socioeconomic inequalities, and availability of health factors influence life expectancy in low- and lower-middle-income countries. Data for 91 countries were obtained from United Nations agencies. The response variable was life expectancy, and the determinant factors were demographic events (total fertility rate and adolescent fertility rate), socioeconomic status (mean years of schooling and gross national income per capita), and health factors (physician density and human immunodeficiency virus [HIV] prevalence rate). Path analysis was used to determine the direct, indirect, and total effects of these factors on life expectancy. All determinant factors were significantly correlated with life expectancy. Mean years of schooling, total fertility rate, and HIV prevalence rate had significant direct and indirect effects on life expectancy. The total effect of higher physician density was to increase life expectancy. We identified several direct and indirect pathways that predict life expectancy. The findings suggest that policies should concentrate on improving reproductive decisions, increasing education, and reducing HIV transmission. In addition, special attention should be paid to the emerging need to increase life expectancy by increasing physician density.

Relative Importance of Demographic, Socioeconomic and Health Factors on Life Expectancy in Low- and Lower-Middle-Income Countries

PubMed Central

Mondal, Md. Nazrul Islam; Shitan, Mahendran

2014-01-01

Background We attempted to identify the pathways by which demographic changes, socioeconomic inequalities, and availability of health factors influence life expectancy in low- and lower-middle-income countries. Methods Data for 91 countries were obtained from United Nations agencies. The response variable was life expectancy, and the determinant factors were demographic events (total fertility rate and adolescent fertility rate), socioeconomic status (mean years of schooling and gross national income per capita), and health factors (physician density and human immunodeficiency virus [HIV] prevalence rate). Path analysis was used to determine the direct, indirect, and total effects of these factors on life expectancy. Results All determinant factors were significantly correlated with life expectancy. Mean years of schooling, total fertility rate, and HIV prevalence rate had significant direct and indirect effects on life expectancy. The total effect of higher physician density was to increase life expectancy. Conclusions We identified several direct and indirect pathways that predict life expectancy. The findings suggest that policies should concentrate on improving reproductive decisions, increasing education, and reducing HIV transmission. In addition, special attention should be paid to the emerging need to increase life expectancy by increasing physician density. PMID:24390415

Multi-year application of WRF-CAM5 over East Asia-Part II: Interannual variability, trend analysis, and aerosol indirect effects

NASA Astrophysics Data System (ADS)

Zhang, Yang; Wang, Kai; He, Jian

2017-09-01

Following a comprehensive evaluation of WRF-CAM5 in Part I, Part II describes analyses of interannual variability, multi-year variation trends, and the direct, indirect, and total effects of anthropogenic aerosols. The interannual variations of chemical column and surface concentrations, and ozone (O3)/particulate matter (PM) indicators are strongly correlated to anthropogenic emission changes. Despite model biases, the model captures well the observed interannual variations of temperature at 2-m, cloud fraction, shortwave cloud forcing, downwelling shortwave radiation, cloud droplet number concentration, column O3, and column formaldehyde (HCHO) for the whole domain. While the model reproduces the volatile organic compound (VOC)-limited regimes of O3 chemistry at sites in Hong Kong, Taiwan, Japan, South Korea, and from the Acid Deposition Monitoring Network in East Asia (EANET) and the degree of sulfate neutralization at the EANET sites, it has limited capability in capturing the interannual variations of the ratio of O3 and nitrogen dioxide (O3/NO2) and PM chemical regime indicators, due to uncertainties in the emissions of precursors for O3 and secondary PM, the model assumption for ammonium bisulfate (NH4HSO4) as well as lack of gas/particle partitioning of total ammonia and total nitrate. While the variation trends in multi-year periods in aerosol optical depth and column concentrations of carbon monoxide, sulfur dioxide, and NO2 are mainly caused by anthropogenic emissions, those of major meteorological and cloud variables partly reflect feedbacks of chemistry to meteorological variables. The impacts of anthropogenic aerosol indirect effects either dominate or play an important role in the aerosol total effects for most cloud and chemical predictions, whereas anthropogenic aerosol direct effects influence most meteorological and radiation variables. The direct, indirect, and total effects of anthropogenic aerosols exhibit a strong interannual variability in 2001, 2006, and 2011.

A complete graphical criterion for the adjustment formula in mediation analysis.

PubMed

Shpitser, Ilya; VanderWeele, Tyler J

2011-03-04

Various assumptions have been used in the literature to identify natural direct and indirect effects in mediation analysis. These effects are of interest because they allow for effect decomposition of a total effect into a direct and indirect effect even in the presence of interactions or non-linear models. In this paper, we consider the relation and interpretation of various identification assumptions in terms of causal diagrams interpreted as a set of non-parametric structural equations. We show that for such causal diagrams, two sets of assumptions for identification that have been described in the literature are in fact equivalent in the sense that if either set of assumptions holds for all models inducing a particular causal diagram, then the other set of assumptions will also hold for all models inducing that diagram. We moreover build on prior work concerning a complete graphical identification criterion for covariate adjustment for total effects to provide a complete graphical criterion for using covariate adjustment to identify natural direct and indirect effects. Finally, we show that this criterion is equivalent to the two sets of independence assumptions used previously for mediation analysis.

Indirect effects of predators control herbivore richness and abundance in a benthic eelgrass (Zostera marina) mesograzer community.

PubMed

Amundrud, Sarah L; Srivastava, Diane S; O'Connor, Mary I

2015-07-01

Herbivore communities can be sensitive to changes in predator pressure (top-down effects) and resource availability (bottom-up effects) in a wide range of systems. However, it remains unclear whether such top-down and bottom-up effects reflect direct impacts of predators and/or resources on herbivores, or are indirect, reflecting altered interactions among herbivore species. We quantified direct and indirect effects of bottom-up and top-down processes on an eelgrass (Zostera marina) herbivore assemblage. In a field experiment, we factorially manipulated water column nutrients (with Osmocote(™) slow-release fertilizer) and predation pressure (with predator exclusion cages) and measured the effects on herbivore abundance, richness and beta diversity. We examined likely mechanisms of community responses by statistically exploring the response of individual herbivore species to trophic manipulations. Predators increased herbivore richness and total abundance, in both cases through indirect shifts in community composition. Increases in richness occurred through predator suppression of common gammarid amphipod species (Monocorophium acherusicum and Photis brevipes), permitting the inclusion of rarer gammarid species (Aoroides columbiae and Pontogeneia rostrata). Increased total herbivore abundance reflected increased abundance of a caprellid amphipod species (Caprella sp.), concurrent with declines in the abundance of other common species. Furthermore, predators decreased beta diversity by decreasing variability in Caprella sp. abundance among habitat patches. Osmocote(™) fertilization increased nutrient concentrations locally, but nutrients dissipated to background levels within 3 m of the fertilizer. Nutrient addition weakly affected the herbivore assemblage, not affecting richness and increasing total abundance by increasing one herbivore species (Caprella sp.). Nutrient addition did not affect beta diversity. We demonstrated that assemblage-level effects of trophic manipulations on community structure are the result of distinct and often indirect responses of herbivore species. These results underscore the importance of understanding herbivore-herbivore interactions in a system commonly subjected to both eutrophication and overfishing. © 2015 The Authors. Journal of Animal Ecology © 2015 British Ecological Society.

Estimation of Asian Dust Aerosol Effect on Cloud Radiation Forcing Using Fu-Liou Radiative Model and CERES Measurements

NASA Technical Reports Server (NTRS)

Su, Jing; Huang, Jianping; Fu, Qiang; Minnis, Patrick; Ge, Jinming; Bi, Jianrong

2008-01-01

The impact of Asian dust on cloud radiative forcing during 2003-2006 is studied by using the Earth's Radiant Energy Budget Scanner (CERES) data and the Fu-Liou radiative transfer model. Analysis of satellite data shows that the dust aerosol significantly reduced the cloud cooling effect at TOA. In dust contaminated cloudy regions, the 4-year mean values of the instantaneous shortwave, longwave and net cloud radiative forcing are -138.9, 69.1, and -69.7 Wm(sup -2), which are 57.0, 74.2, and 46.3%, respectively, of the corresponding values in more pristine cloudy regions. The satellite-retrieved cloud properties are significantly different in the dusty regions and can influence the radiative forcing indirectly. The contributions to the cloud radiation forcing by the dust direct, indirect and semi-direct effects are estimated using combined satellite observations and Fu-Liou model simulation. The 4-year mean value of combination of indirect and semi-direct shortwave radiative forcing (SWRF) is 82.2 Wm(sup -2), which is 78.4% of the total dust effect. The direct effect is only 22.7 Wm(sup -2), which is 21.6% of the total effect. Because both first and second indirect effects enhance cloud cooling, the aerosol-induced cloud warming is mainly the result of the semi-direct effect of dust.

Direct and Indirect Effects of Stimulating Phoneme Awareness vs. Other Linguistic Skills in Preschoolers with Co-Occurring Speech and Language Impairments

ERIC Educational Resources Information Center

Tyler, Ann A.; Gillon, Gail; Macrae, Toby; Johnson, Roberta L.

2011-01-01

Aim: The purpose of this study was to examine the effects of an integrated phoneme awareness/speech intervention in comparison to an alternating speech/morphosyntax intervention for specific areas targeted by the different interventions, as well as the extent of indirect gains in nontargeted areas. Method: A total of 30 children with co-occurring…

The effect of severity of depressive disorder on economic burden in a university hospital in Singapore.

PubMed

Ho, Roger C M; Mak, Kwok-Kei; Chua, Anna N C; Ho, Cyrus S H; Mak, Anselm

2013-08-01

Depressive disorder is treatable but costly, thus influencing quality of life of people. Determine direct and indirect costs incurred by depressive disorder in Singapore. A 1-year prospective naturalistic study was conducted in a university mood disorder center between 2007 and 2008. Patients with primary International Classification of Disease-10 diagnosis of depressive disorder were recruited. Disease costs between mild, moderate and severe depression, and cost predictors were analyzed and determined. Forty nine patients completed the study. Mean annual total costs per patient were US$7638. Indirect costs (81%) dominated the total costs. Approximately 50% of indirect costs were associated with loss of productivity and unemployment. Higher education level, higher mean Hamilton Rating Scale for Depression score and number of suicide attempts were independent variables associated with increased direct costs while mean Hamilton Rating Scale for Depression scale score was an independent variable for indirect costs. Medical cost saving strategies should focus on indirect costs.

Interventional effects for mediation analysis with multiple mediators

PubMed Central

Vansteelandt, Stijn; Daniel, Rhian M.

2016-01-01

The mediation formula for the identification of natural (in)direct effects has facilitated mediation analyses that better respect the nature of the data, with greater consideration of the need for confounding control. The default assumptions on which it relies are strong, however. In particular, they are known to be violated when confounders of the mediator–outcome association are affected by the exposure. This complicates extensions of counterfactual-based mediation analysis to settings that involve repeatedly measured mediators, or multiple correlated mediators. VanderWeele, Vansteelandt, and Robins21 introduced so-called interventional (in)direct effects. These can be identified under much weaker conditions than natural (in)direct effects, but have the drawback of not adding up to the total effect. In this article, we adapt their proposal in order to achieve an exact decomposition of the total effect, and extend it to the multiple mediator setting. Interestingly, the proposed effects capture the path-specific effects of an exposure on an outcome that are mediated by distinct mediators, even when – as often – the structural dependence between the multiple mediators is unknown; for instance, when the direction of the causal effects between the mediators is unknown, or there may be unmeasured common causes of the mediators. PMID:27922534

Interventional Effects for Mediation Analysis with Multiple Mediators.

PubMed

Vansteelandt, Stijn; Daniel, Rhian M

2017-03-01

The mediation formula for the identification of natural (in)direct effects has facilitated mediation analyses that better respect the nature of the data, with greater consideration of the need for confounding control. The default assumptions on which it relies are strong, however. In particular, they are known to be violated when confounders of the mediator-outcome association are affected by the exposure. This complicates extensions of counterfactual-based mediation analysis to settings that involve repeatedly measured mediators, or multiple correlated mediators. VanderWeele, Vansteelandt, and Robins introduced so-called interventional (in)direct effects. These can be identified under much weaker conditions than natural (in)direct effects, but have the drawback of not adding up to the total effect. In this article, we adapt their proposal to achieve an exact decomposition of the total effect, and extend it to the multiple mediator setting. Interestingly, the proposed effects capture the path-specific effects of an exposure on an outcome that are mediated by distinct mediators, even when-as often-the structural dependence between the multiple mediators is unknown, for instance, when the direction of the causal effects between the mediators is unknown, or there may be unmeasured common causes of the mediators.

Estimation of indirect effect when the mediator is a censored variable.

PubMed

Wang, Jian; Shete, Sanjay

2017-01-01

A mediation model explores the direct and indirect effects of an initial variable ( X) on an outcome variable ( Y) by including a mediator ( M). In many realistic scenarios, investigators observe censored data instead of the complete data. Current research in mediation analysis for censored data focuses mainly on censored outcomes, but not censored mediators. In this study, we proposed a strategy based on the accelerated failure time model and a multiple imputation approach. We adapted a measure of the indirect effect for the mediation model with a censored mediator, which can assess the indirect effect at both the group and individual levels. Based on simulation, we established the bias in the estimations of different paths (i.e. the effects of X on M [ a], of M on Y [ b] and of X on Y given mediator M [ c']) and indirect effects when analyzing the data using the existing approaches, including a naïve approach implemented in software such as Mplus, complete-case analysis, and the Tobit mediation model. We conducted simulation studies to investigate the performance of the proposed strategy compared to that of the existing approaches. The proposed strategy accurately estimates the coefficients of different paths, indirect effects and percentages of the total effects mediated. We applied these mediation approaches to the study of SNPs, age at menopause and fasting glucose levels. Our results indicate that there is no indirect effect of association between SNPs and fasting glucose level that is mediated through the age at menopause.

Indirect associations of combat exposure with post-deployment physical symptoms in U.S. soldiers: roles of post-traumatic stress disorder, depression and insomnia.

PubMed

Quartana, Phillip J; Wilk, Joshua E; Balkin, Thomas J; Hoge, Charles W

2015-05-01

To characterize the indirect associations of combat exposure with post-deployment physical symptoms through shared associations with post-traumatic stress disorder (PTSD), depression and insomnia symptoms. Surveys were administered to a sample of U.S. soldiers (N = 587) three months after a 15-month deployment to Iraq. A multiple indirect effects model was used to characterize direct and indirect associations between combat exposure and physical symptoms. Despite a zero-order correlation between combat exposure and physical symptoms, the multiple indirect effects analysis did not provide evidence of a direct association between these variables. Evidence for a significant indirect association of combat exposure and physical symptoms was observed through PTSD, depression, and insomnia symptoms. In fact, 92% of the total effect of combat exposure on physical symptoms scores was indirect. These findings were evident even after adjusting for the physical injury and relevant demographics. This is the first empirical study to suggest that PTSD, depression and insomnia collectively and independently contribute to the association between combat exposure and post-deployment physical symptoms. Limitations, future research directions, and potential policy implications are discussed. Published by Elsevier Inc.

Direct and indirect effects of body weight on adult wages.

PubMed

Han, Euna; Norton, Edward C; Powell, Lisa M

2011-12-01

Previous estimates of the association between body weight and wages in the literature have been conditional on education and occupation. In addition to the effect of current body weight status (body mass index (BMI) or obesity) on wages, this paper examines the indirect effect of body weight status in the late-teenage years on wages operating through education and occupation choice. Using the National Longitudinal Survey of Youth 1979 data, for women, we find that a one-unit increase in BMI is directly associated with 1.83% lower hourly wages whereas the indirect BMI wage penalty is not statistically significant. Neither a direct nor an indirect BMI wage penalty is found for men. However, results based on clinical weight classification reveal that the indirect wage penalty occurs to a larger extent at the upper tail of the BMI distribution for both men and women via the pathways of education and occupation outcomes. Late-teen obesity is indirectly associated with 3.5% lower hourly wages for both women and men. These results are important because they imply that the total effect of obesity on wages is significantly larger than has been estimated in previous cross-sectional studies. 2011 Elsevier B.V. All rights reserved.

The effect of Channeling on in-home utilization and subsequent nursing home care: a simultaneous equation perspective.

PubMed Central

Rabiner, D J; Stearns, S C; Mutran, E

1994-01-01

OBJECTIVE. This study explored the relationship between participation in a home/community-based long-term care case management intervention (known as the Channeling demonstration), use of formal in-home care, and subsequent nursing home utilization. STUDY DESIGN. Structural analysis of the randomized Channeling intervention was conducted to decompose the total effects of Channeling on nursing home use into direct and indirect effects. DATA COLLECTION METHOD. Secondary data analysis of the National Long-Term Care Data Set. PRINCIPAL FINDINGS. The use of formal in-home care, which was increased by the Channeling intervention, was positively associated with nursing home utilization at 12 months. However, the negative direct effect of Channeling on nursing home use was of sufficient magnitude to offset this positive indirect effect, so that a small but significant negative total effect of Channeling on subsequent nursing home utilization was found. CONCLUSIONS. This study shows why Channeling did not have a large total impact on nursing home utilization. The analysis did not provide evidence of direct substitution of in-home care for nursing home care because the direct reductions in nursing home utilization due to other aspects of Channeling (including, but not limited to case management) were substantially offset by the indirect increases in nursing home utilization associated with additional home care use. PMID:8002352

Finite element analysis of weightbath hydrotraction treatment of degenerated lumbar spine segments in elastic phase.

PubMed

Kurutz, M; Oroszváry, L

2010-02-10

3D finite element models of human lumbar functional spinal units (FSU) were used for numerical analysis of weightbath hydrotraction therapy (WHT) applied for treating degenerative diseases of the lumbar spine. Five grades of age-related degeneration were modeled by material properties. Tensile material parameters of discs were obtained by parameter identification based on in vivo measured elongations of lumbar segments during regular WHT, compressive material constants were obtained from the literature. It has been proved numerically that young adults of 40-45 years have the most deformable and vulnerable discs, while the stability of segments increases with further aging. The reasons were found by analyzing the separated contrasting effects of decreasing incompressibility and increasing hardening of nucleus, yielding non-monotonous functions of stresses and deformations in terms of aging and degeneration. WHT consists of indirect and direct traction phases. Discs show a bilinear material behaviour with higher resistance in indirect and smaller in direct traction phase. Consequently, although the direct traction load is only 6% of the indirect one, direct traction deformations are 15-90% of the indirect ones, depending on the grade of degeneration. Moreover, the ratio of direct stress relaxation remains equally about 6-8% only. Consequently, direct traction controlled by extra lead weights influences mostly the deformations being responsible for the nerve release; while the stress relaxation is influenced mainly by the indirect traction load coming from the removal of the compressive body weight and muscle forces in the water. A mildly degenerated disc in WHT shows 0.15mm direct, 0.45mm indirect and 0.6mm total extension; 0.2mm direct, 0.6mm indirect and 0.8mm total posterior contraction. A severely degenerated disc exhibits 0.05mm direct, 0.05mm indirect and 0.1mm total extension; 0.05mm direct, 0.25mm indirect and 0.3mm total posterior contraction. These deformations are related to the instant elastic phase of WHT that are doubled during the creep period of the treatment. The beneficial clinical impacts of WHT are still evident even 3 months later. Copyright 2009 Elsevier Ltd. All rights reserved.

Effect of Ursodeoxycholic Acid on Indirect Hyperbilirubinemia in Neonates Treated With Phototherapy.

PubMed

Honar, Naser; Ghashghaei Saadi, Elham; Saki, Forough; Pishva, Narjes; Shakibazad, Nader; Hosseini Teshnizi, Saeed

2016-01-01

Hyperbilirubinemia is a common neonatal problem. The present study aimed to investigate the effect of ursodeoxycholic acid in reducing indirect hyperbilirubinemia of infants under phototherapy. This double-blind randomized clinical trial was conducted on neonates with jaundice, who had received phototherapy in the hospitals affiliated with the Shiraz University of Medical Sciences in 2013. A total of 80 neonates were enrolled in the study and were randomly divided into 2 groups. The intervention group (n =  0) with indirect hyperbilirubinemia received 10 mg · kg(-1) · day(-1) divided every 12 hours Ursobil (capsule 300 mg) in addition to phototherapy, whereas the control group (n =  0) received only phototherapy. Total bilirubin levels were measured every 12 hours until reaching <10 mg/dL, and then phototherapy was disrupted. The duration of phototherapy was measured. The 2 groups were compared regarding total bilirubin levels at different time points and duration of phototherapy using the generalized estimating equation (GEE) test. The mean of total bilirubin in the intervention group was 12 ± 1.6, 10 ± 1.1, and 9.8 ± 0.2 mg/dL 12, 24, and 48 hours after the beginning of phototherapy, respectively. On the contrary, these measures were 14.4 ± 1.3, 12.5 ± 1.4, and 10.1 ± 1.1 mg/dL in the control group, respectively, (P < 0.05). The mean time required for phototherapy to decrease the bilirubin level to < 10 mg/dL was 15.5 ± 6 and 44.6 ± 13.3 hours in the case and the control group, respectively, (P = 0.001). Ursodeoxycholic acid had additive effect with phototherapy in neonates with indirect hyperbilirubinemia. This drug also reduced the time period needed for phototherapy and, consequently, decreased the hospitalization period.

A Climatologically Significant Aerosol Longwave Indirect Effect in the Arctic

NASA Astrophysics Data System (ADS)

Lubin, D.; Vogelmann, A.

2006-12-01

Analysis of Atmospheric Emitted Radiance Interferometer (AERI) data from the U.S. Department of Energy Atmospheric Radiation Measurement (ARM) Program North Slope of Alaska (NSA) site confirms a pervasive first indirect effect of aerosols in low-level stratiform clouds, which are the prevailing meteorological condition throughout the Arctic. The AERI longwave emission spectra under clouds of low to moderate optical depth (<8) are sensitive to both the effective droplet radius and the liquid water path, and can be used to retrieve both quantities. When supplemented by additional NSA sensor data, these AERI retrievals reveal a longwave surface flux enhancement of 8.2 Watts per square meter under liquid water clouds subject to aerosol entrainment versus similar clouds in clean air. Of this total enhancement revealed by co-located pyrgeometer data, 3.4 Watts per square meter can be readily attributed to the first indirect effect. This observed indirect effect occurs frequently during spring, but rarely during summer. The indirect effect's manifestation in the longwave is climatologically significant given that this part of the spectrum dominates the radiation budget at high latitudes throughout most of the year. Lubin, D., and A. M. Voglemann, Nature, 439, 453-456 (2006).

Comparing Alternative Effect Decomposition Methods: The Role of Literacy in Mediating Educational Effects on Mortality.

PubMed

Nguyen, Thu T; Tchetgen Tchetgen, Eric J; Kawachi, Ichiro; Gilman, Stephen E; Walter, Stefan; Glymour, M Maria

2016-09-01

Inverse odds ratio weighting, a newly proposed tool to evaluate mediation in exposure-disease associations, may be valuable for a host of research questions, but little is known about its performance in real data. We compare this approach to a more conventional Baron and Kenny type of decomposition on an additive hazards scale to estimate total, direct, and indirect effects using the example of the role of literacy in mediating the effects of education on mortality. Health and Retirement Study participants born in the United States between 1900 and 1947 were interviewed biennially for up to 12 years (N = 17,054). Literacy was measured with a brief vocabulary assessment. Decomposition estimates were derived based on Aalen additive hazards models. A 1 standard deviation difference in educational attainment (3 years) was associated with 6.7 fewer deaths per 1000 person-years (β = -6.7, 95% confidence interval [CI]: -7.9, -5.4). Of this decrease, 1.3 fewer deaths (β = -1.3, 95% CI: -4.0, 1.2) were attributed to the literacy pathway (natural indirect), representing 19% of the total effect. Baron and Kenny estimates were consistent with inverse odds ratio weighting estimates but were less variable (natural indirect effect: -1.2 [95% CI: -1.7, -0.69], representing 18% of total effect). In a cohort of older Americans, literacy partially mediated the effect of education on mortality. See Video Abstract at http://links.lww.com/EDE/B78.

Spatial spillover effects of a community action programme targeting on-licensed premises on violent assaults: evidence from a natural experiment.

PubMed

Brännström, Lars; Trolldal, Björn; Menke, Martin

2016-03-01

Spatial dependencies may influence the success of community action strategies to prevent and reduce harmful alcohol use. This study examined the effectiveness of a multicomponent Responsible Beverage Service (RBS) programme targeting on-licensed premises on police-recorded assaults in Swedish municipalities. It was expected that the implementation of the programme within any given municipality had an indirect effect by reducing violent assaults in adjacent municipalities. This study was a natural experiment exploiting the temporal and spatial variation in the implementation of the RBS programme to predict change in the rate of violent assaults in all Swedish municipalities during 1996-2009 (n=288; T=14; N=4 032). Yearly police-recorded violent assaults per 100,000 inhabitants aged 15 and above committed on weekend nights were used as a dependent variable. Programme fidelity was identified by means of survey data. A semilogarithmic fixed-effects spatial panel regression model was used to estimate the direct, indirect and total effects of the programme. The direct, indirect and total effects were -1.8% (95% CI -4.4% to 0.8%), -5.8% (95% CI -11.5% to -0.1%) and -7.6% (95% CI -13.2% to -2.2%), respectively. Averaged over time and across all municipalities, implementing one additional programme component in all municipalities will thus reduce violent assaults in one typical municipality by nearly 8%. The indirect effect of the programme was three times larger than its direct effect. Failing to account for such local spillover effects can result in a considerable underestimation of the programme's total impact and may lead to erroneous policy recommendations. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Effects of zilpaterol hydrochloride on methane production, total body oxygen consumption, and blood metabolites in finishing beef steers

USDA-ARS?s Scientific Manuscript database

An indirect calorimetry experiment was conducted to determine the effects of feeding zilpaterol hydrochloride (ZH) for 20 d on total body oxygen consumption, respiratory quotient, methane production, and blood metabolites in finishing beef steers. Sixteen Angus steers (initial BW = 555 ± 12.7 kg) w...

Entrainment, Drizzle, and the Indirect Effect in Stratiform Clouds

NASA Technical Reports Server (NTRS)

Ackerman, Andrew

2005-01-01

Activation of some fraction of increased concentrations of sub-micron soluble aerosol particles lead to enhanced cloud droplet concentrations and hence smaller droplets, increasing their total cross sectional area and thus reflecting solar radiation more efficiently (the Twomey, or first indirect, effect). However, because of competition during condensational growth, droplet distributions tend to broaden as numbers increase, reducing the sensitivity of cloud albedo to droplet concentration on the order of 10%. Also, smaller droplets less effectively produce drizzle through collisions and coalescence, and it is widely expected (and found in large-scale models) that decreased precipitation leads to clouds with more cloud water on average (the so-called cloud lifetime, or second indirect, effect). Much of the uncertainty regarding the overall indirect aerosol effect stems from inadequate understanding of such changes in cloud water. Detailed simulations based on FIRE-I, ASTEX, and DYCOMS-II conditions show that suppression of precipitation from increased droplet concentrations leads to increased cloud water only when sufficient precipitation reaches the surface, a condition favored when the overlying air is-humid or droplet concentrations are very low. Otherwise, aerosol induced suppression of precipitation enhances entrainment of overlying dry air, thereby reducing cloud water and diminishing the indirect climate forcing.

Depression among Transgender Older adults: General and Minority Stress

PubMed Central

Hoy-Ellis, Charles P.; Fredriksen-Goldsen, Karen I.

2017-01-01

Objectives This study aims to (1) examine the direct and indirect effects internalized heterosexism, concealment of gender identity, and perceived general stress in association with depression among transgender older adults; and (2) to assess the relative contribution of each relationship. Methods Secondary analyses of data from a large community-based study of older sexual and gender minorities were conducted utilizing structural equation modeling with a subsample (n = 174) of transgender adults aged 50 to 86-years old. Results Disclosure of gender identity had no significant direct or indirect effects on either perceived general stress or depression. Internalized heterosexism did not have a direct effect on depression, but did have a significant indirect effect through perceived general stress. Finally, perceived general stress had an additional significant direct effect on depression, over and above internalized heterosexism. Total effect sizes appear to be considerable with standardized betas greater than 5.0. Conclusion Perceived general stress and internalized heterosexism independently and cumulatively have significant direct and indirect effects on depression among transgender older adults. Implications for depression among transgender older adults and the role of community psychology are discussed. PMID:28369987

Global Studies of the Sulfur Cycle Including the Influence of DMS and Fossil Fuel Sulfur on Climate and Climate Change

NASA Technical Reports Server (NTRS)

Penner, Joyce E.

1998-01-01

The indirect effect of anthropogenic aerosols, wherein aerosol particles are thought to increase cloud droplet concentrations and cloud lifetime, is the most uncertain component of climate forcing over the past 100 years. Here, for the first time, we use a mechanistic treatment of droplet nucleation and a prognostic treatment of the number of cloud droplets to study the indirect aerosol effect from changes in carbonaceous and sulfate aerosols. Cloud droplet nucleation is parameterized as a function of total aerosol number concentration, updraft velocity and a shape parameter, which takes into account the mechanism, of sulfate aerosol formation, while cloud droplet number depends on the nucleation as well as on droplet sinks. Whereas previous treatments have predicted annual average indirect effects between -1 and -2 W/sq m, we obtain an indirect aerosol effect between -0.14 W/sq m and -0.42 W/sq m in the global mean.

Gender Variations in the Effects of Number of Organizational Memberships, Number of Social Networking Sites, and Grade-Point Average on Global Social Responsibility in Filipino University Students

PubMed Central

Lee, Romeo B.; Baring, Rito V.; Sta. Maria, Madelene A.

2016-01-01

The study seeks to estimate gender variations in the direct effects of (a) number of organizational memberships, (b) number of social networking sites (SNS), and (c) grade-point average (GPA) on global social responsibility (GSR); and in the indirect effects of (a) and of (b) through (c) on GSR. Cross-sectional survey data were drawn from questionnaire interviews involving 3,173 Filipino university students. Based on a path model, the three factors were tested to determine their inter-relationships and their relationships with GSR. The direct and total effects of the exogenous factors on the dependent variable are statistically significantly robust. The indirect effects of organizational memberships on GSR through GPA are also statistically significant, but the indirect effects of SNS on GSR through GPA are marginal. Men and women significantly differ only in terms of the total effects of their organizational memberships on GSR. The lack of broad gender variations in the effects of SNS, organizational memberships and GPA on GSR may be linked to the relatively homogenous characteristics and experiences of the university students interviewed. There is a need for more path models to better understand the predictors of GSR in local students. PMID:27247700

Gender Variations in the Effects of Number of Organizational Memberships, Number of Social Networking Sites, and Grade-Point Average on Global Social Responsibility in Filipino University Students.

PubMed

Lee, Romeo B; Baring, Rito V; Sta Maria, Madelene A

2016-02-01

The study seeks to estimate gender variations in the direct effects of (a) number of organizational memberships, (b) number of social networking sites (SNS), and (c) grade-point average (GPA) on global social responsibility (GSR); and in the indirect effects of (a) and of (b) through (c) on GSR. Cross-sectional survey data were drawn from questionnaire interviews involving 3,173 Filipino university students. Based on a path model, the three factors were tested to determine their inter-relationships and their relationships with GSR. The direct and total effects of the exogenous factors on the dependent variable are statistically significantly robust. The indirect effects of organizational memberships on GSR through GPA are also statistically significant, but the indirect effects of SNS on GSR through GPA are marginal. Men and women significantly differ only in terms of the total effects of their organizational memberships on GSR. The lack of broad gender variations in the effects of SNS, organizational memberships and GPA on GSR may be linked to the relatively homogenous characteristics and experiences of the university students interviewed. There is a need for more path models to better understand the predictors of GSR in local students.

Effects of trimester-specific and total gestational weight gain on children's anthropometrics.

PubMed

Bayer, Otmar; Ensenauer, Regina; Nehring, Ina; von Kries, Rüdiger

2014-10-08

Gestational weight gain (GWG) has been shown to be a risk factor for overweight in offspring.Aim of this study was to quantify the contributions of trimester-specific and total GWG on offspring's BMI and waist circumference (WC). This is of interest for the design of interventions targeted at women showing a high GWG in early pregnancy. In a retrospective cohort study data on GWG (total and by trimester, exposure), a number of potential confounders, and children's BMI z-scores and WC (outcomes) were analyzed using structural equation models to disentangle the trimester-specific direct effects of GWG and indirect effects mediated via total GWG. 7313 mother child pairs with a children's mean age of 5.81 years were analyzed. Total effects (indirect + direct) of GWG (kg/week) on children's BMI z-score and WC (cm) were observed in all trimesters, most prominently in the second. The longitudinal effect of GWG is a composite of trimester-specific direct effects (on BMI: 0.105, 0.255, 0.002, on WC: 0.538, 1.64, 0.308) and total GWG (on BMI 0.608, on WC: 1.03) at the end of pregnancy. Both trimester-specific priming and total GWG explained offspring's anthropometrics. The results indicate, that reversal from additional weight gain attained early in pregnancy resulting in normal total GWG at the end of pregnancy might still contribute to a substantial reduction of offspring's BMI and WC.

Inconsistency between direct and indirect comparisons of competing interventions: meta-epidemiological study.

PubMed

Song, Fujian; Xiong, Tengbin; Parekh-Bhurke, Sheetal; Loke, Yoon K; Sutton, Alex J; Eastwood, Alison J; Holland, Richard; Chen, Yen-Fu; Glenny, Anne-Marie; Deeks, Jonathan J; Altman, Doug G

2011-08-16

To investigate the agreement between direct and indirect comparisons of competing healthcare interventions. Meta-epidemiological study based on sample of meta-analyses of randomised controlled trials. Data sources Cochrane Database of Systematic Reviews and PubMed. Inclusion criteria Systematic reviews that provided sufficient data for both direct comparison and independent indirect comparisons of two interventions on the basis of a common comparator and in which the odds ratio could be used as the outcome statistic. Inconsistency measured by the difference in the log odds ratio between the direct and indirect methods. The study included 112 independent trial networks (including 1552 trials with 478,775 patients in total) that allowed both direct and indirect comparison of two interventions. Indirect comparison had already been explicitly done in only 13 of the 85 Cochrane reviews included. The inconsistency between the direct and indirect comparison was statistically significant in 16 cases (14%, 95% confidence interval 9% to 22%). The statistically significant inconsistency was associated with fewer trials, subjectively assessed outcomes, and statistically significant effects of treatment in either direct or indirect comparisons. Owing to considerable inconsistency, many (14/39) of the statistically significant effects by direct comparison became non-significant when the direct and indirect estimates were combined. Significant inconsistency between direct and indirect comparisons may be more prevalent than previously observed. Direct and indirect estimates should be combined in mixed treatment comparisons only after adequate assessment of the consistency of the evidence.

Inconsistency between direct and indirect comparisons of competing interventions: meta-epidemiological study

PubMed Central

Xiong, Tengbin; Parekh-Bhurke, Sheetal; Loke, Yoon K; Sutton, Alex J; Eastwood, Alison J; Holland, Richard; Chen, Yen-Fu; Glenny, Anne-Marie; Deeks, Jonathan J; Altman, Doug G

2011-01-01

Objective To investigate the agreement between direct and indirect comparisons of competing healthcare interventions. Design Meta-epidemiological study based on sample of meta-analyses of randomised controlled trials. Data sources Cochrane Database of Systematic Reviews and PubMed. Inclusion criteria Systematic reviews that provided sufficient data for both direct comparison and independent indirect comparisons of two interventions on the basis of a common comparator and in which the odds ratio could be used as the outcome statistic. Main outcome measure Inconsistency measured by the difference in the log odds ratio between the direct and indirect methods. Results The study included 112 independent trial networks (including 1552 trials with 478 775 patients in total) that allowed both direct and indirect comparison of two interventions. Indirect comparison had already been explicitly done in only 13 of the 85 Cochrane reviews included. The inconsistency between the direct and indirect comparison was statistically significant in 16 cases (14%, 95% confidence interval 9% to 22%). The statistically significant inconsistency was associated with fewer trials, subjectively assessed outcomes, and statistically significant effects of treatment in either direct or indirect comparisons. Owing to considerable inconsistency, many (14/39) of the statistically significant effects by direct comparison became non-significant when the direct and indirect estimates were combined. Conclusions Significant inconsistency between direct and indirect comparisons may be more prevalent than previously observed. Direct and indirect estimates should be combined in mixed treatment comparisons only after adequate assessment of the consistency of the evidence. PMID:21846695

Indirect causes of severe adverse maternal outcomes: a secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health.

PubMed

Lumbiganon, P; Laopaiboon, M; Intarut, N; Vogel, J P; Souza, J P; Gülmezoglu, A M; Mori, R

2014-03-01

To assess the proportion of severe maternal outcomes resulting from indirect causes, and to determine pregnancy outcomes of women with indirect causes. Secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health. A total of 359 health facilities in 29 countries in Africa, Asia, Latin America, and the Middle East. A total of 314 623 pregnant women admitted to the participating facilities. We identified the percentage of women with severe maternal outcomes arising from indirect causes. We evaluated the risk of severe maternal and perinatal outcomes in women with, versus without, underlying indirect causes, using adjusted odds ratios and 95% confidence intervals, by a multilevel, multivariate logistic regression model, accounting for clustering effects within countries and health facilities. Severe maternal outcomes and preterm birth, fetal mortality, early neonatal mortality, perinatal mortality, low birthweight, and neonatal intensive care unit admission. Amongst 314 623 included women, 2822 were reported to suffer from severe maternal outcomes, out of which 20.9% (589/2822; 95% CI 20.1-21.6%) were associated with indirect causes. The most common indirect cause was anaemia (50%). Women with underlying indirect causes showed significantly higher risk of obstetric complications (adjusted odds ratio, aOR, 7.0; 95% CI 6.6-7.4), severe maternal outcomes (aOR 27.9; 95% CI 24.7-31.6), and perinatal mortality (aOR 3.8; 95% CI 3.5-4.1). Indirect causes were responsible for about one-fifth of severe maternal outcomes. Women with underlying indirect causes had significantly increased risks of severe maternal and perinatal outcomes. © 2014 RCOG The World Health Organization retains copyright and all other rights in the manuscript of this article as submitted for publication.

Aerosol radiative effects on mesoscale cloud-precipitation variables over Northeast Asia during the MAPS-Seoul 2015 campaign

NASA Astrophysics Data System (ADS)

Park, Shin-Young; Lee, Hyo-Jung; Kang, Jeong-Eon; Lee, Taehyoung; Kim, Cheol-Hee

2018-01-01

The online model, Weather Research and Forecasting Model with Chemistry (WRF-Chem) is employed to interpret the effects of aerosol-cloud-precipitation interaction on mesoscale meteorological fields over Northeast Asia during the Megacity Air Pollution Study-Seoul (MAPS-Seoul) 2015 campaign. The MAPS-Seoul campaign is a pre-campaign of the Korea-United States Air Quality (KORUS-AQ) campaign conducted over the Korean Peninsula. We validated the WRF-Chem simulations during the campaign period, and analyzed aerosol-warm cloud interactions by diagnosing both aerosol direct, indirect, and total effects. The results demonstrated that aerosol directly decreased downward shortwave radiation up to -44% (-282 W m-2) for this period and subsequently increased downward longwave radiation up to +15% (∼52 W m-2) in the presence of low-level clouds along the thematic area. Aerosol increased cloud fraction indirectly up to ∼24% with the increases of both liquid water path and the droplet number mixing ratio. Precipitation properties were altered both directly and indirectly. Direct effects simply changed cloud-precipitation quantities via simple updraft process associated with perturbed radiation and temperature, while indirect effects mainly suppressed precipitation, but sometimes increased precipitation in the higher relative humidity atmosphere or near vapor-saturated condition. The total aerosol effects caused a time lag of the precipitation rate with the delayed onset time of up to 9 h. This implies the importance of aerosol effects in improving mesoscale precipitation rate prediction in the online approach in the presence of non-linear warm cloud.

The direct and indirect effects of corruption on motor vehicle crash deaths.

PubMed

Hua, Law Teik; Noland, Robert B; Evans, Andrew W

2010-11-01

Recent empirical research has found that there is an inverted U-shaped or Kuznets relationship between income and motor vehicle crash (MVC) deaths, such that MVC deaths increase as national income increases and decrease after reaching a critical level. Corruption has been identified as one of the underlying factors that could affect this relationship, primarily by undermining institutional development and effective enforcement schemes. The total effect of corruption can be decomposed into two components, a direct and an indirect effect. The direct effect measures the immediate impact of corruption on MVC deaths by undermining effective enforcement and regulations, while the indirect effect captures the impact of corruption on hindering increases in per capita income and the consequent impact of reduced income on MVC deaths. By influencing economic growth, corruption can lead to an increase or decrease in MVC deaths depending on the income level. Using data from 60 countries between 1982 and 2003, these effects are estimated using linear panel and fixed effects negative binomial models. The estimation results suggest that corruption has different direct effects for less developed and highly developed countries. It has a negative (decreasing) effect on MVC deaths for less developed countries and a positive (increasing) effect on MVC deaths for highly developed countries. For highly developed countries, the total effect is positive at lower per capita income levels, but decreases with per capita income and becomes negative at per capita income levels of about US$ 38,248. For less developed countries, the total effect is negative within the sample range and decreases with increased per capita income. In summary, the results of this study suggest that reduction of corruption is likely a necessary condition to effectively tackle road safety problems. 2010 Elsevier Ltd. All rights reserved.

Direct and Indirect Effects of Tofacitinib on Treatment Satisfaction in Patients with Ulcerative Colitis.

PubMed

Panés, Julian; Su, Chinyu; Bushmakin, Andrew G; Cappelleri, Joseph C; Healey, Paul

2016-11-01

This mediation modelling analysis evaluated direct and indirect effects of tofacitinib, an oral, small molecule Janus kinase inhibitor under investigation for ulcerative colitis, on patient treatment satisfaction. Data from an 8-week randomized Phase 2 trial [NCT00787202] in adults with moderate-to-severe, active ulcerative colitis receiving twice-daily tofacitinib 0.5-15mg [n=146] or placebo [n=48] were analysed in patient-reported [n=149] and clinician-reported [n=170] outcomes-based mediation models. Binary predictor variable: Treatment [pooled active treatment vs placebo]. Eventual dependent variable: Week 8 patient treatment satisfaction [measured on a five-point Likert scale]. Mediators of treatment effect on satisfaction: Week 8 Inflammatory Bowel Disease Questionnaire domains [Bowel Symptoms, Emotional Health, Social Function and Systemic Symptoms] and Mayo scale domains [Stool Frequency, Rectal Bleeding, Physician's Global Assessment and Endoscopic Disease Activity] for patient-reported and clinician-reported models, respectively. Overall tofacitinib indirect effect on satisfaction via Inflammatory Bowel Disease Questionnaire domains was 40.5% [p<0.05] and via Mayo scale domains was 84.0% [p<0.01] for patient-reported and clinician-reported models, respectively. Bowel function had the most important indirect effect: of the total tofacitinib effect on satisfaction, 32.4% [p=0.05] was indirectly mediated via Bowel Symptoms; and 30.0% [p=0.04] via Stool Frequency. In total, 59.5% [p<0.01] and only 16.0% [p=0.56] of tofacitinib's effect on satisfaction was unrelated to Inflammatory Bowel Disease Questionnaire and Mayo scale domains in the patient-reported and clinician-reported models, respectively. Bowel function is an important factor for patient treatment satisfaction with tofacitinib. Treatment effect on patient satisfaction was almost completely mediated via improvement in Mayo scale domains. Copyright © 2016 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Effect of indirect composite treatment microtensile bond strength of self-adhesive resin cements

PubMed Central

Escribano, Nuria; Baracco, Bruno; Romero, Martin; Ceballos, Laura

2016-01-01

Background No specific indications about the pre-treatment of indirect composite restorations is provided by the manufacturers of most self-adhesive resin cements. The potential effect of silane treatment to the bond strength of the complete tooth/indirect restoration complex is not available.The aim of this study was to determine the contribution of different surface treatments on microtensile bond strength of composite overlays to dentin using several self-adhesive resin cements and a total-etch one. Material and Methods Composite overlays were fabricated and bonding surfaces were airborne-particle abraded and randomly assigned to two different surface treatments: no treatment or silane application (RelyX Ceramic Primer) followed by an adhesive (Adper Scotchbond 1 XT). Composite overlays were luted to flat dentin surfaces using the following self-adhesive resin cements: RelyX Unicem, G-Cem, Speedcem, Maxcem Elite or Smartcem2, and the total-etch resin cement RelyX ARC. After 24 h, bonded specimens were cut into sticks 1 mm thick and stressed in tension until failure. Two-way ANOVA and SNK tests were applied at α=0.05. Results Bond strength values were significantly influenced by the resin cement used (p<0.001). However, composite surface treatment and the interaction between the resin cement applied and surface treatment did not significantly affect dentin bond strength (p>0.05). All self-adhesive resin cements showed lower bond strength values than the total-etch RelyX ARC. Among self-adhesive resin cements, RelyX Unicem and G-Cem attained statistically higher bond strength values. Smartcem2 and Maxcem Elite exhibited 80-90% of pre-test failures. Conclusions The silane and adhesive application after indirect resin composite sandblasting did not improve the bond strength of dentin-composite overlay complex. Selection of the resin cement seems to be a more relevant factor when bonding indirect composites to dentin than its surface treatment. Key words:Bond strength, self-adhesive cement, silane, dentin, indirect composite. PMID:26855700

Direct and indirect effects of episodic frost on plant growth and reproduction in subalpine wildflowers.

PubMed

Pardee, Gabriella L; Inouye, David W; Irwin, Rebecca E

2018-02-01

Frost is an important episodic event that damages plant tissues through the formation of ice crystals at or below freezing temperatures. In montane regions, where climate change is expected to cause earlier snow melt but may not change the last frost-free day of the year, plants that bud earlier might be directly impacted by frost through damage to flower buds and reproductive structures. However, the indirect effects of frost mediated through changes in plant-pollinator interactions have rarely been explored. We examined the direct and pollinator-mediated indirect effects of frost on three wildflower species in southwestern Colorado, USA, Delphinium barbeyi (Ranunculaceae), Erigeron speciosus (Asteraceae), and Polemonium foliosissimum (Polemoniaceae), by simulating moderate (-1 to -5°C) frost events in early spring in plants in situ. Subsequently, we measured plant growth, and upon flowering measured flower morphology and phenology. Throughout the flowering season, we monitored pollinator visitation and collected seeds to measure plant reproduction. We found that frost had species-specific direct and indirect effects. Frost had direct effects on two of the three species. Frost significantly reduced flower size, total flowers produced, and seed production of Erigeron. Furthermore, frost reduced aboveground plant survival and seed production for Polemonium. However, we found no direct effects of frost on Delphinium. When we considered the indirect impacts of frost mediated through changes in pollinator visitation, one species, Erigeron, incurred indirect, negative effects of frost on plant reproduction through changes in floral traits and pollinator visitation, along with direct effects. Overall, we found that flowering plants exhibited species-specific direct and pollinator-mediated indirect responses to frost, thus suggesting that frost may play an important role in affecting plant communities under climate change. © 2017 John Wiley & Sons Ltd.

Sensitivity studies of different aerosol indirect effects in mixed-phase clouds

NASA Astrophysics Data System (ADS)

Lohmann, U.; Hoose, C.

2009-11-01

Aerosols affect the climate system by changing cloud characteristics. Using the global climate model ECHAM5-HAM, we investigate different aerosol effects on mixed-phase clouds: The glaciation effect, which refers to a more frequent glaciation due to anthropogenic aerosols, versus the de-activation effect, which suggests that ice nuclei become less effective because of an anthropogenic sulfate coating. The glaciation effect can partly offset the indirect aerosol effect on warm clouds and thus causes the total anthropogenic aerosol effect to be smaller. It is investigated by varying the parameterization for the Bergeron-Findeisen process and the threshold coating thickness of sulfate (SO4-crit), which is required to convert an externally mixed aerosol particle into an internally mixed particle. Differences in the net radiation at the top-of-the-atmosphere due to anthropogenic aerosols between the different sensitivity studies amount up to 0.5 W m-2. This suggests that the investigated mixed-phase processes have a major effect on the total anthropogenic aerosol effect.

Sensitivity studies of different aerosol indirect effects in mixed-phase clouds

NASA Astrophysics Data System (ADS)

Lohmann, U.; Hoose, C.

2009-07-01

Aerosols affect the climate system by changing cloud characteristics. Using the global climate model ECHAM5-HAM, we investigate different aerosol effects on mixed-phase clouds: The glaciation effect, which refers to a more frequent glaciation due to anthropogenic aerosols, versus the de-activation effect, which suggests that ice nuclei become less effective because of an anthropogenic sulfate coating. The glaciation effect can partly offset the indirect aerosol effect on warm clouds and thus causes the total anthropogenic aerosol effect to be smaller. It is investigated by varying the parameterization for the Bergeron-Findeisen process and the threshold coating thickness of sulfate (SO4-crit), which is required to convert an externally mixed aerosol particle into an internally mixed particle. Differences in the net radiation at the top-of-the-atmosphere due to anthropogenic aerosols between the different sensitivity studies amount up to 0.5 W m-2. This suggests that the investigated mixed-phase processes have a major effect on the total anthropogenic aerosol effect.

The importance of indirect costs in primary cardiovascular disease prevention: can we save lives and money with statins?

PubMed

Grover, Steven A; Ho, Vivian; Lavoie, Frédéric; Coupal, Louis; Zowall, Hanna; Pilote, Louise

2003-02-10

The losses in productivity due to cardiovascular disease (CVD) are substantial but rarely considered in health economic analyses. We compared the cost-effectiveness of lipid level modification in the primary prevention of CVD with and without these indirect costs. We used the Cardiovascular Life Expectancy Model to estimate the long-term benefits and cost-effectiveness of lipid level modification with atorvastatin calcium, including 28% and 38% reductions in total cholesterol and low-density lipoprotein cholesterol levels, respectively, and a 5.5% increase in high-density lipoprotein cholesterol level. The direct costs included all medical care costs associated with CVD. The indirect costs represented the loss of employment income and the decreased value of housekeeping services after different manifestations of CVD. All costs were expressed in 2000 Canadian dollars. When only direct medical care costs were considered, the incremental cost-effectiveness ratios for lifelong therapy with atorvastatin calcium, 10 mg/d, were generally positive, ranging from a few thousand to nearly $20 000 per year of life saved. When the societal point of view was adopted and indirect costs were included, the total costs were generally negative, representing substantial cost savings (up to $50 000) and increased life expectancy for most groups of individuals. Lipid therapy with statins can reduce CVD morbidity and mortality as demonstrated in a number of clinical trials. Adding the indirect CVD costs associated with productivity losses at work and home can result in forecasted cost savings to society as a whole such that lipid therapy could potentially save lives and money.

Estimating the direct and indirect costs of lung cancer: a prospective analysis in a Greek University Pulmonary Department.

PubMed

Zarogoulidou, Vasiliki; Panagopoulou, Efharis; Papakosta, Despina; Petridis, Dimitris; Porpodis, Konstantinos; Zarogoulidis, Konstantinos; Zarogoulidis, Paul; Arvanitidou, Malamatenia

2015-02-01

Lung cancer (LC) is a disease with high morbidity and mortality while the prevention and treatment constitutes a significant financial burden. This economic burden has an increasing trend, with hospitalization being the highest cost factor in most studies, while the patients' quality of life (QoL) and response to treatment is not proven to be positively affected. To evaluate the direct and indirect cost of managing patients with LC in Greece according to stage and histological type of cancer, total chemotherapy cycles, age, gender, smoking habit, overall survival (OS), treatment outcome (TO) and QoL. One hundred thirteen of 128 consecutive patients met the inclusion criteria and were included in this prospective study. Patient enrolment started in August 2011 and ended in November 2011. The duration of the patient follow up was 32 months after diagnosis until end of registry. Total direct cost included diagnosis and treatment cost. Indirect cost constituted of patient's and family caregivers lost days of productivity. QoL was assessed with EORTC-QLQ-30 and Lung Cancer Symptom Scale (LCSS) questionnaires before treatment and every three months. Total direct cost was €1,853,984 and chemotherapy drugs was the highest cost factor (€1,216,421). Total indirect cost was 28,774 days of which 27,293 were related to patients. Total direct cost was significantly related to the increased number of total chemotherapy cycles, longer OS, histological type of adenocarcinoma, female gender and younger patients. No relation was found between total indirect cost and the above factors. When the association between total direct/indirect cost and QoL was examined no significant results were drawn. The burden of LC on health care systems remains very high and was associated with the increased number of total chemotherapy cycles, longer OS, adenocarcinoma histological type of cancer, female gender and younger patients. Chemotherapy drugs constituted the higher factor of total direct cost. Indirect cost was considerably higher for patients than family caregivers and did not significantly differ in relation to the above factors. No significant conclusion was drawn regarding QoL and total direct/indirect cost.

The Impact of Patient Profiles and Procedures on Hospitalization Costs through Length of Stay in Community-Acquired Pneumonia Patients Based on a Japanese Administrative Database

PubMed Central

Uematsu, Hironori; Kunisawa, Susumu; Yamashita, Kazuto; Imanaka, Yuichi

2015-01-01

Background Community-acquired pneumonia is a common cause of patient hospitalization, and its burden on health care systems is increasing in aging societies. In this study, we aimed to investigate the factors that affect hospitalization costs in community-acquired pneumonia patients while considering the intermediate influence of patient length of stay. Methods Using a multi-institutional administrative claims database, we analyzed 30,041 patients hospitalized for community-acquired pneumonia who had been discharged between April 1, 2012 and September 30, 2013 from 289 acute care hospitals in Japan. Possible factors associated with hospitalization costs were investigated using structural equation modeling with length of stay as an intermediate variable. We calculated the direct, indirect (through length of stay), and total effects of the candidate factors on hospitalization costs in the model. Lastly, we calculated the ratio of indirect effects to direct effects for each factor. Results The structural equation model showed that higher disease severities (using A-DROP, Barthel Index, and Charlson Comorbidity Index scores), use of mechanical ventilation, and tube feeding were associated with higher hospitalization costs, regardless of the intermediate influence of length of stay. The severity factors were also associated with longer length of stay durations. The ratio of indirect effects to direct effects on total hospitalization costs showed that the former was greater than the latter in the factors, except in the use of mechanical ventilation. Conclusions Our structural equation modeling analysis indicated that patient profiles and procedures impacted on hospitalization costs both directly and indirectly. Furthermore, the profiles were generally shown to have greater indirect effects (through length of stay) on hospitalization costs than direct effects. These findings may be useful in supporting the more appropriate distribution of health care resources. PMID:25923785

Economic importance of elk hunting in Jackson Hole, Wyoming

USGS Publications Warehouse

Koontz, Lynne; Loomis, John B.

2005-01-01

As more hunters come to an area, local businesses will purchase extra labor and supplies to meet the increase in demand for additional services. The income and employment resulting from purchases by hunter at local businesses represent the direct effects of hunter spending within the economy. In order to increase supplies to local businesses, input suppliers must also increase their purchases of inputs from other industries. The income and employment resulting from these secondary purchases by input suppliers are the indirect effects of hunter spending within the local economy. The input supplier’s new employees use their incomes to purchase goods and services. The resulting increased economic activity from new employee income is the induced effect associated with hunter spending. The indirect and induced effects are known as the secondary effects. Multipliers capture the size of the secondary effects, usually as a ratio of total effects to direct effects (Stynes, 1998). The sums of the direct and secondary effects describe the total economic impact of hunter spending in the local economy.

Expanding the developmental models of writing: A direct and indirect effects model of developmental writing (DIEW)

PubMed Central

Kim, Young-Suk Grace; Schatschneider, Christopher

2016-01-01

We investigated direct and indirect effects of component skills on writing (DIEW) using data from 193 children in Grade 1. In this model, working memory was hypothesized to be a foundational cognitive ability for language and cognitive skills as well as transcription skills, which, in turn, contribute to writing. Foundational oral language skills (vocabulary and grammatical knowledge) and higher-order cognitive skills (inference and theory of mind) were hypothesized to be component skills of text generation (i.e., discourse-level oral language). Results from structural equation modeling largely supported a complete mediation model among four variations of the DIEW model. Discourse-level oral language, spelling, and handwriting fluency completely mediated the relations of higher-order cognitive skills, foundational oral language, and working memory to writing. Moreover, language and cognitive skills had both direct and indirect relations to discourse-level oral language. Total effects, including direct and indirect effects, were substantial for discourse-level oral language (.46), working memory (.43), and spelling (.37), followed by vocabulary (.19), handwriting (.17), theory of mind (.12), inference (.10), and grammatical knowledge (.10). The model explained approximately 67% of variance in writing quality. These results indicate that multiple language and cognitive skills make direct and indirect contributions, and it is important to consider both direct and indirect pathways of influences when considering skills that are important to writing. PMID:28260812

Depression Among Transgender Older Adults: General and Minority Stress.

PubMed

Hoy-Ellis, Charles P; Fredriksen-Goldsen, Karen I

2017-06-01

This study aims to (a) examine the direct and indirect effects internalized heterosexism, disclosure of gender identity, and perceived general stress in association with depression among transgender older adults; and (b) to assess the relative contribution of each relationship. Secondary analyses of data from a large community-based study of older sexual and gender minorities were conducted utilizing structural equation modeling with a subsample (n = 174) of transgender adults aged 50 to 86-years old. Disclosure of gender identity had no significant direct or indirect effects on either perceived general stress or depression. Internalized heterosexism did not have a direct effect on depression, but did have a significant indirect effect through perceived general stress. Finally, perceived general stress had an additional significant direct effect on depression, over and above internalized heterosexism. Total effect sizes appear to be considerable with standardized betas greater than 5.0. Perceived general stress and internalized heterosexism independently and cumulatively have significant direct and indirect effects on depression among transgender older adults. Implications for depression among transgender older adults and the role of community psychology are discussed. © Society for Community Research and Action 2017.

Smoking Cessation Is Associated With Lower Indirect Costs.

PubMed

Baker, Christine L; Bruno, Marianna; Emir, Birol; Li, Vicky W; Goren, Amir

2018-06-01

This study quantified differences in indirect costs due to decreased work productivity between current and former smokers. Former smokers were further categorized by number of years since quitting to assess corresponding differences. Data on employed individuals were obtained from the 2013 US National Health and Wellness Survey (NHWS; N = 75,000). Indirect costs were calculated for current smokers and former smokers from weekly wages based on age and sex. The annual total indirect costs for current smokers were $1327.53, $1560.18, and $1839.87 higher than for those who quit 0 to 4 years, 5 to 10 years, and more than or equal to 11 years prior, respectively. There were no significant differences in mean total indirect costs between the former smoker groups. Current smokers showed significantly higher total annual indirect costs compared with former smokers, independently of the number of years since quitting smoking.

Development and Evaluation of Recombinant Nucleocapsid Protein Based Diagnostic ELISA for Detection of Nipah Virus Infection in Pigs.

PubMed

Kulkarni, Diwakar D; Venkatesh, Govindarajalu; Tosh, Chakradhar; Patel, Priyanka; Mashoria, Anita; Gupta, Vandana; Gupta, Sourabh; D, Senthilkumar

2016-01-01

The recombinant viral protein-based indirect enzyme-linked immunosorbent assay (ELISA) is a cost-effective, safe, specific, and rapid tool to diagnose the viral infection. Nipah virus nucleocapsid (NiV-N) protein was expressed in Escherichia coli and purified by histidine tag-based affinity chromatography. The N protein was selected based on its immuno dominance and conservation among different NiV strains. An indirect immunoglobulin G (IgG) enzyme-linked immunosorbent assay (ELISA) for swine sera was optimized using the recombinant NiV-N protein as an antigen along with negative and positive controls. The background reading was blocked using skim milk powder and chicken serum. A total number of 1709 swine serum samples from various states of India were tested with indirect ELISA and Western blot. The test was considered positive only when its total reactivity reading was higher than 0.2 cut-off value and the ratio of the total reactivity to the background reading was more than 2.0. Since specificity is high for Western blotting it was used as standard test for comparison of results of indirect ELISA. Sensitivity and specificity of indirect ELISA was 100% and 98.7%, respectively, in comparison with Western blotting. Recombinant N protein-based ELISA can be used in screening large number of serum samples for epidemiological investigations in developing countries where high containment laboratories are not available to handle this zoonotic virus.

The relationship between physical activity and physical self-esteem in adolescents: the role of physical fitness indices.

PubMed

Haugen, Tommy; Ommundsen, Yngvar; Seiler, Stephen

2013-02-01

The aim of this study was to investigate if physical fitness (strength/power, endurance, flexibility and coordination) mediates the cross-sectional relationship between physical activity and physical self-perception (athletic competence and physical appearance) in a sample of 15-year old adolescents. We wanted to investigate the relative strength of each indirect effect. The present data are taken from two waves of a larger data collection for the project "Youth in Balance", and was collected in the autumn of 2005 (N = 1207) and 2008 (N = 632). A total of 1839 students (889 girls and 950 boys) from 12 schools in Kristiansand took part. A bias-corrected bootstrapping technique was used to examine indirect effects. Results revealed that cardiovascular endurance, lower-body strength/power, and upper-body strength stood out as unique mediators in the relationship between physical activity and athletic competence in both genders. Furthermore, there was an indirect effect of physical activity on physical appearance through physical strength/power and flexibility in males. No indirect effects of physical activity on physical appearance through actual physical fitness indices were detected in females.

Stand structural diversity rather than species diversity enhances aboveground carbon storage in secondary subtropical forests in Eastern China

NASA Astrophysics Data System (ADS)

Ali, Arshad; Yan, En-Rong; Chen, Han Y. H.; Chang, Scott X.; Zhao, Yan-Tao; Yang, Xiao-Dong; Xu, Ming-Shan

2016-08-01

Stand structural diversity, typically characterized by variances in tree diameter at breast height (DBH) and total height, plays a critical role in influencing aboveground carbon (C) storage. However, few studies have considered the multivariate relationships of aboveground C storage with stand age, stand structural diversity, and species diversity in natural forests. In this study, aboveground C storage, stand age, tree species, DBH and height diversity indices, were determined across 80 subtropical forest plots in Eastern China. We employed structural equation modelling (SEM) to test for the direct and indirect effects of stand structural diversity, species diversity, and stand age on aboveground C storage. The three final SEMs with different directions for the path between species diversity and stand structural diversity had a similar goodness of fit to the data. They accounted for 82 % of the variation in aboveground C storage, 55-59 % of the variation in stand structural diversity, and 0.1 to 9 % of the variation in species diversity. Stand age demonstrated strong positive total effects, including a positive direct effect (β = 0.41), and a positive indirect effect via stand structural diversity (β = 0.41) on aboveground C storage. Stand structural diversity had a positive direct effect on aboveground C storage (β = 0.56), whereas there was little total effect of species diversity as it had a negative direct association with, but had a positive indirect effect, via stand structural diversity, on aboveground C storage. The negligible total effect of species diversity on aboveground C storage in the forests under study may have been attributable to competitive exclusion with high aboveground biomass, or a historical logging preference for productive species. Our analyses suggested that stand structural diversity was a major determinant for variations in aboveground C storage in the secondary subtropical forests in Eastern China. Hence, maintaining tree DBH and height diversity through silvicultural operations might constitute an effective approach for enhancing aboveground C storage in these forests.

Socioeconomic impact of osteoarthritis in Hong Kong: utilization of health and social services, and direct and indirect costs.

PubMed

Woo, Jean; Lau, Edith; Lau, Chak Sing; Lee, Polly; Zhang, James; Kwok, Timothy; Chan, Cynthia; Chiu, P; Chan, Kai Ming; Chan, A; Lam, D

2003-08-15

To determine the direct and indirect cost of osteoarthritis (OA) according to disease severity, and to estimate the total cost of the disease in Hong Kong. This study is a retrospective, cross-sectional, nonrandom, cohort design, with subjects stratified according to disease severity based on functional limitation and the presence or absence of joint prosthesis. Subjects were recruited from primary care, geriatric medicine, rheumatology, and orthopedic clinics. There were 219 patients in the mild disease category, 290 patients in the severe category, and 65 patients with joint replacement. A questionnaire gathered information on demographic and socioeconomic characteristics, function limitation, use of health and social services, and effect on occupation and living arrangements over the previous 12 months. Costs were calculated as direct and indirect. Low education and socioeconomic class were associated with more severe disease. OA affected family or close relationships in 44%. The average cost incurred as a result of side effects of medication is similar to the average cost of medication itself. Excluding joint replacement, the direct costs ranged from Hong Kong (HK) dollar $11,690 to $40,180 per person per year and indirect costs, HK $3,300-$6,640. The direct costs are comparable to those reported in Western countries; however, the ratio of direct to indirect costs is much higher than 1, in contrast to the greater indirect versus direct costs reported in whites. The total cost expressed as a percentage of gross national product is also much lower in Hong Kong. The socioeconomic impact of OA in the Hong Kong population is comparable to Western countries, but the economic burden is largely placed on the government, with patients having relatively low out-of-pocket expenditures.

The bioavailability of chemicals in soil for earthworms

USGS Publications Warehouse

Lanno, R.; Wells, J.; Conder, Jason M.; Bradham, K.; Basta, N.

2004-01-01

The bioavailability of chemicals to earthworms can be modified dramatically by soil physical/chemical characteristics, yet expressing exposure as total chemical concentrations does not address this problem. In order to understand the effects of modifying factors on bioavailability, one must measure and express chemical bioavailability to earthworms in a consistent, logical manner. This can be accomplished by direct biological measures of bioavailability (e.g., bioaccumulation, critical body residues), indirect biological measures of bioavailability (e.g., biomarkers, reproduction), or indirect chemical measures of bioavailability (e.g., chemical or solid-phase extracts of soil). If indirect chemical measures of bioavailability are to be used, they must be correlated with some biological response. Bioavailability can be incorporated into ecological risk assessment during risk analysis, primarily in the estimation of exposure. However, in order to be used in the site-specific ecological risk assessment of chemicals, effects concentrations must be developed from laboratory toxicity tests based on exposure estimates utilizing techniques that measure the bioavailable fraction of chemicals in soil, not total chemical concentrations. ?? 2003 Elsevier Inc. All rights reserved.

Relationships among Prenatal Aeroallergen Exposure, Maternal and Cord Blood Immunoglobulin E: Project ACCESS

PubMed Central

Peters, Junenette L.; Suglia, Shakira Franco; Platts-Mills, Thomas A.E.; Hosen, Jacob; Gold, Diane R.; Wright, Rosalind J.

2009-01-01

Background While some evidence suggests that antigen sensitization may begin prenatally, the influence of maternal allergen exposure during pregnancy has not been fully elucidated. Objectives We examined the relationship between prenatal maternal aeroallergen exposure and cord blood total immunoglobulin E (IgE) and the potential mediating/indirect effect of maternal immune response. Methods This study was performed in 301 mother-infant pairs enrolled in the Asthma Coalition on Community, Environment, and Social Stress (ACCESS) project, a study examining the effects of prenatal and early life social and physical environmental exposures on urban asthma risk. Dust samples collected prenatally from mothers’ bedrooms were analyzed for cockroach and dust mite allergens. Cord blood was analyzed for total IgE and maternal serum collected during pregnancy for total and specific IgE. We assessed the relationship between prenatal exposure and cord blood total IgE and the potential mediation effect adjusting for maternal age, race, education, smoking status and dust collection season; and child’s gender and season of birth. Results In multivariate models, elevated prenatal dust mite levels (> 0.2 µg/g) increased cord blood IgE concentrations by 29% (p=0.08) and continuous dust mite concentration was associated with a significant non-linear increase in cord blood IgE (p=0.02). Elevated prenatal exposure to cockroach allergen (> 2 U/g) was not associated with cord blood IgE, but showed a significant indirect relationship through maternal total IgE (β=0.23; 95% CI: 0.08, 0.41). Conclusions These results demonstrate that maternal prenatal exposure to household allergens may impact cord blood IgE albeit the underlying mechanism may be allergen-specific. Clinical Implications Maternal prenatal inhalant allergen exposure may precipitate infant immune response although the pathway of the effect may differ by allergen. Capsule Summary Prenatal exposure to dust mite was associated with increased cord blood total IgE whereas the relationship between prenatal cockroach exposure and total cord blood IgE was only observed through the indirect effect of maternal allergic response. PMID:19361844

An event-related brain potential study of schizotypal personality and associative semantic processing

PubMed Central

Kiang, Michael; Prugh, Jocelyn; Kutas, Marta

2009-01-01

To examine whether schizotypal personality is associated with the degree to which concepts activate each other in semantic memory, event-related brain potentials (ERPs) were recorded during a delayed lexical decision task from healthy volunteers rated for schizotypy. Each target word was directly, indirectly, or not at all related to a prime word preceding it at a 300- or 750-ms stimulus-onset asynchrony (SOA). Overall, N400 amplitudes were largest for unrelated targets, smallest for directly related targets, and intermediate for indirectly related targets. Higher total Schizotypal Personality Questionnaire (SPQ) scores correlated with smaller N400 indirect priming effects (i.e., smaller N400 amplitude differences between unrelated and indirectly related targets) at both SOAs. In addition, schizotypal subscale scores were differentially associated with N400 effects. Higher SPQ Cognitive-Perceptual scores correlated with smaller N400 direct priming effects (smaller N400 amplitude differences between unrelated and directly related targets) at both SOAs, and with smaller N400 indirect priming effects at the shorter SOA. These correlations are consistent with the hypothesis that decreased use of meaningful context to activate related concepts in general, and/or to inhibit unrelated concepts, may play some role in the development of unusual beliefs. PMID:19818815

The relationships among Muslim Uyghur and Kazakh disabled elders' life satisfaction, activity of daily living, and informal family caregiver's burden, depression, and life satisfaction in far western China: A structural equation model.

PubMed

Wang, Wen Ting; He, Bin; Wang, Yu Huan; Wang, Mei Yan; Chen, Xue Feng; Wu, Fu Chen; Yang, Xue

2017-04-01

1 Hypothesis Disabled elders' activities of daily living, caregiver burden, caregiver depression, and caregivers' life satisfaction are significantly related to the life satisfaction of elderly people with disability. 2 Hypothesis There are direct and indirect effects between the life satisfaction of elders, disabled elders' activities of daily living, and family caregivers' factors. This study explored the interrelationships of disabled elders' life satisfaction and activities of daily living, caregivers' factors (burden, depression, and life satisfaction) through a structural equation model. In total, 621 dyads of disabled elders and informal family caregivers completed questionnaires during face-to-face interviews in Xinjiang Uyghur Autonomous Region from September 2013 to January 2014. Activity of daily living exerted a direct effect on life satisfaction of disabled elders and 30.4% indirect effect through caregivers' factors. Caregiver burden had a 60.0% direct effect on life satisfaction of disabled elders and a 40.0% indirect effect through the caregiver depression. Caregiver depression showed 76% direct effect on life satisfaction of disabled elders and 24% indirect effect through caregivers' life satisfaction. Direct relationships between activity of daily living and caregiver burden, caregiver burden and caregiver depression, and caregiver depression and caregivers' life satisfaction were observed. Activity of daily living had a 91.3% indirect effect on caregiver depression mediated by caregiver burden; caregiver burden had a 40.0% indirect effect on caregivers' life satisfaction mediated by caregiver depression. Results provide useful information for nurses and policymakers and shed light on the need to consider caregivers' factors in improving care recipients' life satisfaction. © 2017 John Wiley & Sons Australia, Ltd.

Costs and Effects of Abdominal versus Laparoscopic Hysterectomy: Systematic Review of Controlled Trials

PubMed Central

Bijen, Claudia B. M.; Vermeulen, Karin M.; Mourits, Marian J. E.; de Bock, Geertruida H.

2009-01-01

Objective Comparative evaluation of costs and effects of laparoscopic hysterectomy (LH) and abdominal hysterectomy (AH). Data sources Controlled trials from Cochrane Central register of controlled trials, Medline, Embase and prospective trial registers. Selection of studies Twelve (randomized) controlled studies including the search terms costs, laparoscopy, laparotomy and hysterectomy were identified. Methods The type of cost analysis, perspective of cost analyses and separate cost components were assessed. The direct and indirect costs were extracted from the original studies. For the cost estimation, hospital stay and procedure costs were selected as most important cost drivers. As main outcome the major complication rate was taken. Findings Analysis was performed on 2226 patients, of which 1013 (45.5%) in the LH group and 1213 (54.5%) in the AH group. Five studies scored ≥10 points (out of 19) for methodological quality. The reported total direct costs in the LH group ($63,997) were 6.1% higher than the AH group ($60,114). The reported total indirect costs of the LH group ($1,609) were half of the total indirect in the AH group ($3,139). The estimated mean major complication rate in the LH group (14.3%) was lower than in the AH group (15.9%). The estimated total costs in the LH group were $3,884 versus $3,312 in the AH group. The incremental costs for reducing one patient with major complication(s) in the LH group compared to the AH group was $35,750. Conclusions The shorter hospital stay in the LH group compensates for the increased procedure costs, with less morbidity. LH points in the direction of cost effectiveness, however further research is warranted with a broader costs perspective including long term effects as societal benefit, quality of life and survival. PMID:19806210

Direct and Indirect Effects of Behavioral Parent Training on Infant Language Production

PubMed Central

Bagner, Daniel M.; Garcia, Dainelys; Hill, Ryan

2016-01-01

Given the strong association between early behavior problems and language impairment, we examined the effect of a brief home-based adaptation of Parent–child Interaction Therapy on infant language production. Sixty infants (55% male; mean age 13.47 ± 1.31 months) were recruited at a large urban primary care clinic and were included if their scores exceeded the 75th percentile on a brief screener of early behavior problems. Families were randomly assigned to receive the home-based parenting intervention or standard pediatric primary care. The observed number of infant total (i.e., token) and different (i.e., type) utterances spoken during an observation of an infant-led play and a parent-report measure of infant externalizing behavior problems were examined at pre- and post-intervention and at 3- and 6-month follow-ups. Infants receiving the intervention demonstrated a significantly higher number of observed different and total utterances at the 6-month follow-up compared to infants in standard care. Furthermore, there was an indirect effect of the intervention on infant language production, such that the intervention led to decreases in infant externalizing behavior problems from pre- to post-intervention, which, in turn, led to increases in infant different utterances at the 3- and 6-month follow-ups and total utterances at the 6-month follow-up. Results provide initial evidence for the effect of this brief and home-based intervention on infant language production, including the indirect effect of the intervention on infant language through improvements in infant behavior, highlighting the importance of targeting behavior problems in early intervention. PMID:26956651

Business interruption impacts of a terrorist attack on the electric power system of Los Angeles: customer resilience to a total blackout.

PubMed

Rose, Adam; Oladosu, Gbadebo; Liao, Shu-Yi

2007-06-01

Regional economies are highly dependent on electricity, thus making their power supply systems attractive terrorist targets. We estimate the largest category of economic losses from electricity outages-business interruption-in the context of a total blackout of electricity in Los Angeles. We advance the state of the art in the estimation of the two factors that strongly influence the losses: indirect effects and resilience. The results indicate that indirect effects in the context of general equilibrium analysis are moderate in size. The stronger factor, and one that pushes in the opposite direction, is resilience. Our analysis indicates that electricity customers have the ability to mute the potential shock to their business operations by as much as 86%. Moreover, market resilience lowers the losses, in part through the dampening of general equilibrium effects.

Method for evaluating multiple mediators: mediating effects of smoking and COPD on the association between the CHRNA5-A3 variant and lung cancer risk.

PubMed

Wang, Jian; Spitz, Margaret R; Amos, Christopher I; Wu, Xifeng; Wetter, David W; Cinciripini, Paul M; Shete, Sanjay

2012-01-01

A mediation model explores the direct and indirect effects between an independent variable and a dependent variable by including other variables (or mediators). Mediation analysis has recently been used to dissect the direct and indirect effects of genetic variants on complex diseases using case-control studies. However, bias could arise in the estimations of the genetic variant-mediator association because the presence or absence of the mediator in the study samples is not sampled following the principles of case-control study design. In this case, the mediation analysis using data from case-control studies might lead to biased estimates of coefficients and indirect effects. In this article, we investigated a multiple-mediation model involving a three-path mediating effect through two mediators using case-control study data. We propose an approach to correct bias in coefficients and provide accurate estimates of the specific indirect effects. Our approach can also be used when the original case-control study is frequency matched on one of the mediators. We employed bootstrapping to assess the significance of indirect effects. We conducted simulation studies to investigate the performance of the proposed approach, and showed that it provides more accurate estimates of the indirect effects as well as the percent mediated than standard regressions. We then applied this approach to study the mediating effects of both smoking and chronic obstructive pulmonary disease (COPD) on the association between the CHRNA5-A3 gene locus and lung cancer risk using data from a lung cancer case-control study. The results showed that the genetic variant influences lung cancer risk indirectly through all three different pathways. The percent of genetic association mediated was 18.3% through smoking alone, 30.2% through COPD alone, and 20.6% through the path including both smoking and COPD, and the total genetic variant-lung cancer association explained by the two mediators was 69.1%.

Examining the link between weight suppression and non-suicidal self-injurious behaviors.

PubMed

Keel, Pamela K; Jean Forney, K; Buchman-Schmitt, Jennifer M; Kennedy, Grace A; Joiner, Thomas E

2018-06-02

Given the negative consequences of excess weight, a large portion of the US population is seeking to obtain and maintain weight loss. Weight Suppression (WS) represents the difference between previous highest adult weight and current weight and may have negative psychological consequences. The current study examined the link between WS and lifetime non-suicidal self-injurious (NSSI) behavior and explored indirect effects in this link using survey data in two large samples. Sample 1 included 1011 college students (67% female, mean age = 19 years); Sample 2 included 2461 participants from an epidemiological study (68% female, mean age = 34 years). Models of direct and indirect effects were tested in MPlus using bootstrapping. As hypothesized, greater WS was associated with increased likelihood of lifetime NSSI in both samples (OR = 1.05 and 1.02). In both samples, significant indirect effects of drive for thinness (Total R 2  = 0.06 and 0.09) and depressive symptoms (Total R 2  = 0.13 and 0.29) accounted for this association. Alternative models in which the indirect effect of WS was tested in associations between drive for thinness or depressive symptoms and NSSI were not supported. Results suggest that the link between WS and lifetime NSSI may be accounted for by eating or mood-related pathology. Future research should test whether addressing associated eating and mood problems would eliminate the link between WS and NSSI as a means for reducing suicide risk. Copyright © 2018 Elsevier Ltd. All rights reserved.

Ecological restructuring in experimental aquatic mesocosms due to the application of diflubenzuron

USGS Publications Warehouse

Boyle, Terence P.; Fairchild, James F.; Haverland, Pamela S.; Lebo, Jon A.; Robinson-Wilson, Everett

1996-01-01

Diflubenzuron is a chitin-inhibiting insecticide that is registered for use in controlling a multitude of invertebrate pests. The selective mode of action of diflubenzuron provided us with a unique tool for examining the indirect responses of an experimental aquatic ecosystem following direct impacts at the primary consumer (invertebrate) trophic level. Twelve outdoor aquatic mesocosms (0.1 ha each) were randomly assigned to three treatments of diflubenzuron (four mesocosms/treatment): control, monthly (five total 10-μg/L applications), or biweekly (twice monthly; nine total 10-μg/L applications). Direct impacts on invertebrates (numbers and species composition of insects and zooplankton) and indirect impacts on fish (mortality, growth, and reproduction of bluegill sunfish and largemouth bass), phytoplankton (biomass and productivity), and water quality were measured over 16 weeks posttreatment. Both monthly and biweekly treatments of diflubenzuron decreased total numbers (fivefold reduction) and species richness (twofold reduction) and increased dominance (twofold increase) of zooplankton within 4 weeks posttreatment; Cladocerans, Copepods, and Rotifers were all sensitive. Diflubenzuron reduced species richness of emergent insects, which resulted in increased dominance by a few species; however, impacts on emergent insects were confounded by a treatment × time interaction. Direct reductions in invertebrate grazers caused indirect increases in algal biomass. Indirect effects on biomass (50% reduction) and individual weight (50% reduction) of juvenile bluegill occurred because of apparent decreases in invertebrate food resources. No statistically significant impacts were observed on adult bluegill or largemouth bass for the duration of the experiment. Results indicated that diflubenzuron had both direct and indirect impacts on the experimental aquatic ecosystems under the conditions tested.

Effect of adalimumab on work productivity and indirect costs in moderate to severe Crohn’s disease: A meta-analysis

PubMed Central

Binion, David G; Louis, Edouard; Oldenburg, Bas; Mulani, Parvez; Bensimon, Arielle G; Yang, Mei; Chao, Jingdong

2011-01-01

OBJECTIVE: To assess the effect of adalimumab on work productivity and indirect costs in patients with Crohn’s disease (CD) using a meta-analysis of clinical trials. METHODS: Study-level results were pooled from all clinical trials of adalimumab for moderate to severe CD in which work productivity outcomes were evaluated. Work Productivity and Activity Impairment Questionnaire outcomes (absenteeism, presenteeism and total work productivity impairment [TWPI]) were extracted from adalimumab trials. Meta-analyses were used to estimate pooled averages and 95% CIs of one-year accumulated reductions in work productivity impairment with adalimumab. Pooled averages were multiplied by the 2008 United States national average annual salary ($44,101) to estimate per-patient indirect cost savings during the year following adalimumab initiation. RESULTS: The four included trials (ACCESS, CARE, CHOICE and EXTEND) represented a total of 1202 employed adalimumab-treated patients at baseline. Each study followed patients for a minimum of 20 weeks. Pooled estimates (95% CIs) of one-year accumulated work productivity improvements were as follows: −9% (−10% to −7%) for absenteeism; −22% (−26% to −18%) for presenteeism; and −25% (−30% to −20%) for TWPI. Reductions in absenteeism and TWPI translated into per-patient indirect cost savings (95% CI) of $3,856 ($3,183 to $4,529) and $10,964 ($8,833 to $13,096), respectively. CONCLUSION: Adalimumab provided clinically meaningful improvements in work productivity among patients with moderate to severe CD, which may translate into substantial indirect cost savings from an employer’s perspective. PMID:21912760

Differentiation of direct and indirect socioeconomic effects on suicide attempts in South Korea

PubMed Central

Ki, Myung; Seong Sohn, Eui; An, Byungduck; Lim, Jiseun

2017-01-01

Abstract Despite the wide recognition of the inverse association between socioeconomic position (SEP) and suicidal behaviors, its underlying process and potential mediators are little known. This study investigated the pathway from SEP to suicide attempts with attention to potential mediators. From the Korean Health and Nutrition Examination Survey 2007–2013, which is a nationwide cross-sectional survey of the health and nutritional status, a total of 34,565 participants (≥30 years) were included in the analysis. To unfold the pathways linking SEP to suicide attempts, the direct and indirect effects of 3 SEP measures (educational attainment, household income, and occupational group) and 3 mediators (physical illness, mental health problems, and problematic drinking) were differentiated using structured equation model (SEM). Most of direct and indirect effects of educational attainment, household income, and occupational group on suicide attempts were significant; Nonemployment status had the largest total (β = 0.291, P < .01) and direct effects (β = 0.212, P < .01), while educational attainment had the largest indirect effect (β = −0.124, P < .01). Educational attainment was mainly mediated by physical illness and problem drinking, whereas household income and occupational group were mainly mediated by anxious or depressed mood and problem drinking. Physical illness played a major role in explaining suicide attempts, compared to mental health problem and problem drinking. Overall, experience of socioeconomic disadvantage increased suicide attempts independently of mental and physical problems. An extension of suicide prevention program is required for comprehensively targeting people with general problems such as physical illness and low SEP, complemented to narrowly targeting high risk group with, such as mental health problem. PMID:29390510

The direct and indirect association of cervical microbiota with the risk of cervical intraepithelial neoplasia.

PubMed

Zhang, Chaoting; Liu, Ying; Gao, Weijiao; Pan, Yaqi; Gao, Yunong; Shen, Jing; Xiong, Hongchao

2018-05-01

Cervical microbiota composition is associated with cervical HPV infection and CIN severity. Previous studies only assessed the total association between cervical microbiota and HPV infections or CINs, and yet no study reported the direct and indirect associations between cervical microbiota and CINs mediated by HPV infection, respectively. The aim of this study was to investigate the direct and indirect associations between microbiotas and CIN severity. Cervical microbiota of 126 women with CIN 1- (normal cytology and CIN 1) and 40 with CIN 2+ (CIN 2 and CIN 3) were analyzed using Illumina sequencing based on the 16S rRNA gene. HPV was detected using a highly sensitive PCR primer set (SPF1/GP6+). Indirect effects of Pseudomonas stutzeri, Bacteroides fragilis, Lactobacillus delbrueckii, Atopobium vaginae, and Streptococcus agalactiae mediated by HPV infection on CIN status were observed. The directions of the direct and the indirect associations between CIN status and Ps. stutzeri were opposite. The directions of the direct and the indirect associations between CIN status and A. vaginae were the same. B. fragilis, L. delbrueckii, and S. agalactiae only had indirect association with CIN status. In summary, our study provided suggestive evidence that some microbial populations could have direct or indirect effects mediated by affecting HPV infection on CIN progression. Besides HPV infection, microbial community composition possibly plays a role in cervical carcinogenesis. © 2018 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

Interference in the gg→h→γγ On-Shell Rate and the Higgs Boson Total Width.

PubMed

Campbell, John; Carena, Marcela; Harnik, Roni; Liu, Zhen

2017-11-03

We consider interference between the Higgs signal and QCD background in gg→h→γγ and its effect on the on-shell Higgs rate. The existence of sizable strong phases leads to destructive interference of about 2% of the on-shell cross section in the standard model. This effect can be enhanced by beyond the standard model physics. In particular, since it scales differently from the usual rates, the presence of interference allows indirect limits to be placed on the Higgs width in a novel way, using on-shell rate measurements. Our study motivates further QCD calculations to reduce uncertainties. We discuss possible width-sensitive observables, both using total and differential rates and find that the HL-LHC can potentially indirectly constrain widths of order tens of MeV.

Economic costs of depression in China.

PubMed

Hu, Teh-wei; He, Yanling; Zhang, Mingyuan; Chen, Ningshan

2007-02-01

A recent survey in China indicated the 12-month prevalence rate of depressive disorders was 2.5% in Beijing and 1.7% in Shanghai. These disorders may result in disability, premature death, and severe suffering of those affected and their families. This study estimates the economic consequences of depressive disorders in China. Depressive disorders can have both direct and indirect costs. To obtain direct costs, the research team interviewed 505 patients with depressive disorders and their caregivers in eight clinics/hospitals in five cities in China. Depression-related suicide rates were obtained from published literature. The human capital approach was used to estimate indirect costs. Epidemiological data were taken from available literature. The total estimated cost of depression in China is 51,370 million Renminbi (RMB) (or US $6,264 million) at 2002 prices. Direct costs were 8,090 million RMB (or US$ 986 million), about 16% of the total cost of depression. Indirect costs were 43,280 million RMB (or US$ 5,278 million), about 84% of the total cost of depression. Depression is a very costly disorder in China. The application of an effective treatment--reducing the length of depressive episodes (or preventing episodes) and reducing suicide rates--will lead to a significant reduction in the total burden resulting from depressive disorders. Government policymakers should seriously consider further investments in mental health services.

Direct and Indirect Effects of Behavioral Parent Training on Infant Language Production.

PubMed

Bagner, Daniel M; Garcia, Dainelys; Hill, Ryan

2016-03-01

Given the strong association between early behavior problems and language impairment, we examined the effect of a brief home-based adaptation of Parent-child Interaction Therapy on infant language production. Sixty infants (55% male; mean age 13.47±1.31 months) were recruited at a large urban primary care clinic and were included if their scores exceeded the 75th percentile on a brief screener of early behavior problems. Families were randomly assigned to receive the home-based parenting intervention or standard pediatric primary care. The observed number of infant total (i.e., token) and different (i.e., type) utterances spoken during an observation of an infant-led play and a parent-report measure of infant externalizing behavior problems were examined at pre- and post-intervention and at 3- and 6-month follow-ups. Infants receiving the intervention demonstrated a significantly higher number of observed different and total utterances at the 6-month follow-up compared to infants in standard care. Furthermore, there was an indirect effect of the intervention on infant language production, such that the intervention led to decreases in infant externalizing behavior problems from pre- to post-intervention, which, in turn, led to increases in infant different utterances at the 3- and 6-month follow-ups and total utterances at the 6-month follow-up. Results provide initial evidence for the effect of this brief and home-based intervention on infant language production, including the indirect effect of the intervention on infant language through improvements in infant behavior, highlighting the importance of targeting behavior problems in early intervention. Copyright © 2015. Published by Elsevier Ltd.

Psychosocial health among young victims and offenders of direct and indirect bullying.

PubMed

van der Wal, Marcel F; de Wit, Cees A M; Hirasing, Remy A

2003-06-01

To assess the association between bullying (both directly and indirectly) and indicators of psychosocial health for boys and girls separately. A school-based questionnaire survey of bullying, depression, suicidal ideation, and delinquent behavior. Primary schools in Amsterdam, The Netherlands. A total of 4811 children aged 9 to 13. Depression and suicidal ideation are common outcomes of being bullied in both boys and girls. These associations are stronger for indirect than direct bullying. After correction, direct bullying had a significant effect on depression and suicidal ideation in girls, but not in boys. Boy and girl offenders of bullying far more often reported delinquent behavior. Bullying others directly is a much greater risk factor for delinquent behavior than bullying others indirectly. This was true for both boys and girls. Boy and girl offenders of bullying also more often reported depressive symptoms and suicidal ideation. However, after correction for both sexes only a significant association still existed between bullying others directly and suicidal ideation. The association between bullying and psychosocial health differs notably between girls and boys as well as between direct and indirect forms of bullying. Interventions to stop bullying must pay attention to these differences to enhance effectiveness.

Placental Abruption and Perinatal Mortality With Preterm Delivery as a Mediator: Disentangling Direct and Indirect Effects

PubMed Central

Ananth, Cande V.; VanderWeele, Tyler J.

2011-01-01

The authors use recent methodology in causal inference to disentangle the direct and indirect effects that operate through a mediator in an exposure-response association paradigm. They demonstrate how total effects can be partitioned into direct and indirect effects even when the exposure and mediator interact. The impact of bias due to unmeasured confounding on the exposure-response association is assessed through a series of sensitivity analyses. These methods are applied to a problem in perinatal epidemiology to examine the extent to which the effect of abruption on perinatal mortality is mediated through preterm delivery. Data on over 26 million US singleton births (1995–2002) were utilized. Risks of mortality among abruption and nonabruption births were 102.7 and 6.2 per 1,000 births, respectively. Risk ratios of the natural direct and indirect (preterm delivery-mediated) effects of abruption on mortality were 10.18 (95% confidence interval: 9.80, 10.58) and 1.35 (95% confidence interval: 1.33, 1.38), respectively. The proportion of increased mortality risk mediated through preterm delivery was 28.1%, with even higher proportions associated with deliveries at earlier gestational ages. Sensitivity analyses underscore that the qualitative conclusions of some mediated effects and substantial direct effects are reasonably robust to unmeasured confounding of a fairly considerable magnitude. PMID:21430195

Radiation May Indirectly Impair Growth Resulting in Reduced Standing Height via Subclinical Inflammation in Atomic-Bomb Survivors Exposed at Young Ages

DOE PAGES

Nakashima, Eiji; Neriishi, Kazuo; Hsu, Wan-Ling

2015-01-01

For youngmore » atomic-bomb (A-bomb) survivors, A-bomb radiation’s (total) effect on standing height is thought to comprise the sum of direct effect and indirect effect via inflammation. With the data of five inflammatory markers—white blood cell count, sialic acid, corrected erythrocyte sedimentation rate (ESR), α 1 globulin, and α 2 globulin—obtained in adulthood during the period 1988 to 1992, a summary inflammatory index was constructed as a surrogate for the five subclinical inflammatory markers. For 3,327 A-bomb survivors exposed at ages of less than 25 years, a structural equation model was analyzed to measure direct radiation effects on adult height as well as mediating effect of radiation via inflammation on the height after adjustment for other risk factors, smoking, cancer, inflammatory disease, obesity, and diabetes mellitus. The mediation proportion of the radiation effect on height via inflammation was approximately 5% for both sexes for all ages, and indirect dose effects via inflammation were statistically significant for both sexes combined and for females exposed at ages 0 to 5 years. Indirect dose effects for all ages via sialic acid, corrected ESR, and α 2 globulin were marginally significant for both sexes combined and for females. These proportions are likely underestimated.« less

Radiation May Indirectly Impair Growth Resulting in Reduced Standing Height via Subclinical Inflammation in Atomic-Bomb Survivors Exposed at Young Ages

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

Nakashima, Eiji; Neriishi, Kazuo; Hsu, Wan-Ling

For youngmore » atomic-bomb (A-bomb) survivors, A-bomb radiation’s (total) effect on standing height is thought to comprise the sum of direct effect and indirect effect via inflammation. With the data of five inflammatory markers—white blood cell count, sialic acid, corrected erythrocyte sedimentation rate (ESR), α 1 globulin, and α 2 globulin—obtained in adulthood during the period 1988 to 1992, a summary inflammatory index was constructed as a surrogate for the five subclinical inflammatory markers. For 3,327 A-bomb survivors exposed at ages of less than 25 years, a structural equation model was analyzed to measure direct radiation effects on adult height as well as mediating effect of radiation via inflammation on the height after adjustment for other risk factors, smoking, cancer, inflammatory disease, obesity, and diabetes mellitus. The mediation proportion of the radiation effect on height via inflammation was approximately 5% for both sexes for all ages, and indirect dose effects via inflammation were statistically significant for both sexes combined and for females exposed at ages 0 to 5 years. Indirect dose effects for all ages via sialic acid, corrected ESR, and α 2 globulin were marginally significant for both sexes combined and for females. These proportions are likely underestimated.« less

Tolerance to bovine clinical mastitis: Total, direct, and indirect milk losses.

PubMed

Detilleux, J

2018-04-01

The objectives of this paper were to estimate direct and indirect milk losses associated with mastitis. Indirect losses, linked to indirect tolerance, are mediated by the increase in milk somatic cell count (SCC) in response to bacterial infection. Direct losses, linked to weak direct tolerance, are not mediated by the increase in SCC. So far, studies have evaluated milk loss associated with clinical mastitis without considering both components, which may lead to biased estimates of their sum; that is, the total loss in milk. A total of 43,903 test-day records on milk and SCC from 3,716 cows and 5,858 lactations were analyzed with mediation mixed models and health trajectories to estimate the amount of direct, indirect, and total milk losses after adjustment for known and potentially unmeasured (sensitivity analyses) confounding factors. Estimates were formalized under the counterfactual causal theory of causation. In this study, milk losses were mostly mediated by an increase in SCC. They were highest in the first month of lactation, when SCC were highest. Milk losses were estimated at 0.5, 0.8, and 1.1 kg/d in first, second, and third and greater parity, respectively. Two phases described how changes in milk were associated with changes in SCC: on average, one occurred before and one after the day preceding the clinical diagnosis. In both phases, changes in milk were estimated at 1 mg/d per 10 3 cells/mL. After adjusting for known confounders, cow effect accounted for 20.7 and 64.2% of the variation in milk in the first and second phases, respectively. This suggests that deviations from the resilient path were highest during the second phase of inflammation and that selection for cows more tolerant to mastitis is feasible. As discussed herein, epigenetic regulation of macrophage polarization may contribute to the variation in milk observed in the second phase. Copyright © 2018 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Interference in the g g → h → γ γ On-Shell Rate and the Higgs Boson Total Width

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

Campbell, John; Carena, Marcela; Harnik, Roni

We consider interference between the Higgs signal and QCD background inmore » $$gg\\rightarrow h \\rightarrow \\gamma\\gamma$$ and its effect on the on-shell Higgs rate. The existence of sizable strong phases leads to destructive interference of about 2% of the on-shell cross section in the Standard Model. This effect can be enhanced by beyond the standard model physics. In particular, since it scales differently from the usual rates, the presence of interference allows indirect limits to be placed on the Higgs width in a novel way, using on-shell rate measurements. Our study motivates further QCD calculations to reduce uncertainties. We discuss potential width-sensitive observables, both using total and differential rates and find that the HL-LHC can potentially indirectly probe widths of order tens of MeV.« less

The Direct and Indirect Effects of Paliperidone Extended-release on Depressive Symptoms in Schizoaffective Disorder: A Path Analysis.

PubMed

Turkoz, Ibrahim; Fu, Dong-Jing; Bossie, Cynthia A; Alphs, Larry

2015-01-01

This analysis evaluates improvement in symptoms of depression in patients with schizoaffective disorder administered oral paliperidone extended-release by accounting for the magnitude of direct and indirect (changes in negative and positive symptoms and worsening of extrapyramidal symptoms) treatment effects on depressive symptoms. Data for this post hoc analysis were drawn from two six-week, randomized, placebo-controlled studies of paliperidone extended-release versus placebo in adult subjects with schizoaffective disorder (N=614; NCT00412373, NCT00397033). Subjects with baseline 17-item Hamilton Rating Scale for Depression scores of 16 or greater were included. Structural equation models (path analyses) were used to separate total effects into direct and indirect effects on depressive symptoms. Change from baseline in 17-item Hamilton Rating Scale for Depression score at the Week 6 end point was the dependent variable; changes in Positive and Negative Syndrome Scale positive and negative factors and Simpson-Angus Scale (to evaluate extrapyramidal symptoms) scores were independent variables. At baseline, 332 of 614 (54.1%) subjects had a 17-item Hamilton Rating Scale for Depression score of 16 or greater. Path analysis determined that up to 26.4 percent of the paliperidone extended-release versus placebo effect on depressive symptoms may be attributed to a direct treatment effect, and 45.8 percent and 28.4 percent were mediated indirectly through improvements on positive and negative symptoms, respectively. No effects were identified as mediated through extrapyramidal symptoms changes (-0.7%). RESULTS of this analysis suggest that paliperidone's effect on depressive symptoms in subjects with schizoaffective disorder participating in two six-week, randomized, placebo-controlled studies is mediated through indirect effects (e.g., positive and negative symptom changes) and a direct treatment effect.

Serum bilirubin concentration is associated with eGFR and urinary albumin excretion in patients with type 1 diabetes mellitus.

PubMed

Nishimura, Takeshi; Tanaka, Masami; Sekioka, Risa; Itoh, Hiroshi

2015-01-01

Although relationships of serum bilirubin concentration with estimated glomerular filtration rate (eGFR) and urinary albumin excretion (UAE) in patients with type 2 diabetes have been reported, whether such relationships exist in patients with type 1 diabetes is unknown. A total of 123 patients with type 1 diabetes were investigated in this cross-sectional study. The relationship between bilirubin (total and indirect) concentrations and log(UAE) as well as eGFR was examined by Pearson's correlation analyses. Multivariate regression analyses were used to assess the association of bilirubin (total and indirect) with eGFR as well as log(UAE). A positive correlation was found between serum bilirubin concentration and eGFR; total bilirubin (r=0.223, p=0.013), indirect bilirubin (r=0.244, p=0.007). A negative correlation was found between serum bilirubin concentration and log(UAE); total bilirubin (r=-0.258, p=0.005), indirect bilirubin (r=-0.271, p=0.003). Multivariate regression analyses showed that indirect bilirubin concentration was an independent determinant of eGFR and log(UAE). Bilirubin concentration is associated with both eGFR and log(UAE) in patients with type 1 diabetes. Bilirubin might have a protective role in the progression of type 1 diabetic nephropathy. Copyright © 2015 Elsevier Inc. All rights reserved.

Physician Impact on the Total Cost of Care

PubMed Central

Taheri, Paul A.; Butz, David; Griffes, Louisa C.; Morlock, David R.; Greenfield, Lazar J.

2000-01-01

Background and Objectives Physicians’ efforts at cost containment focus on decreased resource utilization and reduced length of stay. Although these efforts appear to be appropriate, little data exist to gauge their success. As such, the goal of this study is to determine trauma service cost allocations and how this information can help physicians to contain costs. Materials and Methods The authors analyzed the costs for 696 trauma admissions at a level I trauma center for fiscal year 1997. Data were obtained from the hospital costing system. Costs analyzed were variable direct, fixed direct, and Indirect costs. Together, the fixed and indirect costs are referred to as “hospital overhead.” Total Cost equals variable direct plus fixed direct plus indirect costs. Results The mean variable, fixed, and indirect costs per patient were $7,998, $3,534, and $11,086, respectively. Mean total cost per patient was $22,618. Conclusion The 35% variable direct cost represents the percentage of total cost that is typically under the immediate influence of physicians, in contrast to the 65% of total cost over which physicians have little control. Physicians must gain a better understanding of cost drivers and must participate in the operations and allocations of institutional fixed direct and indirect costs if the overall cost of care is to be reduced. PMID:10714637

Finding benefits from acculturative stress among Asian Americans: Self-reflection moderating the mediating effects of ethnocultural empathy on positive outcomes.

PubMed

Wei, Meifen; Li, Chun-I; Wang, Cixin; Ko, Stacy Y

2016-11-01

This study examined a moderated mediation model to see whether self-reflection moderated (a) the association between acculturative stress and ethnocultural empathy and (b) the indirect effects of acculturative stress on 2 positive outcomes (i.e., bicultural competence and making positive sense of adversity) through ethnocultural empathy. A total of 330 Asian American college students from a West coast university participated in an online survey. Results from PROCESS supported hypotheses. First, self-reflection significantly moderated the effects of acculturative stress on ethnocultural empathy. Specifically, the effect of acculturative stress on ethnocultural empathy was significantly positive for those with lower self-reflection. Conversely, this effect was not significant for those with higher self-reflection, but ethnocultural empathy was consistently high across all levels of acculturative stress for those with higher self-reflection. Post hoc exploratory analyses examined the moderated mediation model using each of the 5 domains of acculturative stress as predictors; results supported the moderated mediation hypotheses for 2 domains, discrimination and cultural isolation. Second, self-reflection significantly moderated the indirect effects of acculturative stress on 2 positive outcomes through ethnocultural empathy. Results from conditional indirect effects suggested that the indirect effects of acculturative stress on 2 positive outcomes through ethnocultural empathy were significantly positive for those with lower self-reflection. Conversely, the indirect effects were not significant for those with higher self-reflection, but the 2 positive outcomes stayed high at all levels of acculturative stress. Post hoc analyses found that 5 of 6 components of bicultural competence used as outcome variables supported the moderation mediation hypotheses. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Parents' job insecurity affects children's grade performance through the indirect effects of beliefs in an unjust world and negative mood.

PubMed

Barling, J; Mendelson, M B

1999-10-01

The authors postulated a model in which children's perceptions of their parents' job insecurity indirectly affect their grade performance through the effects of beliefs in an unjust world and negative mood. A total of 127 undergraduate students (55 male, 72 female) completed questionnaires on their perceptions of their parents' job insecurity and their own beliefs in an unjust world and negative mood. The parents reported on their own job insecurity. In addition, students provided their course grades from the previous semester 3 months after completing the questionnaires. Support for the proposed model was provided using LISREL 8.

Urban sprawl as a risk factor in motor vehicle crashes

USGS Publications Warehouse

Ewing, Reid; Hamidi, Shima; Grace, James B.

2016-01-01

A decade ago, compactness/sprawl indices were developed for metropolitan areas and counties which have been widely used in health and other research. In this study, we first update the original county index to 2010, then develop a refined index that accounts for more relevant factors, and finally seek to test the relationship between sprawl and traffic crash rates using structural equation modelling. Controlling for covariates, we find that sprawl is associated with significantly higher direct and indirect effects on fatal crash rates. The direct effect is likely due to the higher traffic speeds in sprawling areas, and the indirect effect is due to greater vehicle miles driven in such areas. Conversely, sprawl has negative direct relationships with total crashes and non-fatal injury crashes, and these offset (and sometimes overwhelm) the positive indirect effects of sprawl on both types of crashes through the mediating effect of increased vehicle miles driven. The most likely explanation is the greater prevalence of fender benders and other minor accidents in the low speed, high conflict traffic environments of compact areas, negating the lower vehicle miles travelled per capita in such areas.

Effects of levomilnacipran extended-release on motivation/energy and functioning in adults with major depressive disorder.

PubMed

Thase, Michael E; Gommoll, Carl; Chen, Changzheng; Kramer, Kenneth; Sambunaris, Angelo

2016-11-01

The objective of this post-hoc analysis was to investigate the relationship between motivation/energy and functional impairment in patients with major depressive disorder (MDD). Data were taken from a phase 3 trial of levomilnacipran extended-release (ER) in adults with MDD (NCT01034462; N=429) that used the 18-item Motivation and Energy Inventory (MEI) to assess motivation/energy. Two subgroups with lower and higher motivation/energy were defined using baseline MEI total scores (≤28 and >28, respectively). Change from baseline in the Sheehan Disability Scale (SDS) total score was analyzed in the intent-to-treat (ITT) population and both subgroups. Path analyses were carried out in the ITT population and a lower MEI subgroup to assess the direct and indirect effects of levomilnacipran ER on SDS total score change. In the ITT population and the lower MEI subgroup, significant differences were found between levomilnacipran ER and placebo for changes in the SDS total score (-2.6 and -3.9, both P<0.01), but not in the higher MEI subgroup. The indirect effect of levomilnacipran ER on SDS total score improvement, as mediated by MEI total score change, was 79.9% in the lower MEI subgroup and 67.2% in the ITT population. Levomilnacipran ER was previously shown to improve motivation/energy in adults with MDD. The current analysis indicates that improvements in functional impairment were considerably mediated by improvements in motivation/energy, particularly in patients with lower motivation/energy at baseline.

Household and neighborhood conditions partially account for associations between education and physical capacity in the National Health and Aging Trends Study

PubMed Central

Samuel, Laura J.; Glass, Thomas A.; Thorpe, Roland J.; Szanton, Sarah L.; Roth, David L.

2015-01-01

Socioeconomic resources, such as education, prevent disability but are not readily modifiable. We tested the hypothesis that household and neighborhood conditions, which may be modifiable, partially account for associations between education and physical capacity in a population-based sample of older adults. The National Health and Aging Trends Study measured education (

Household and neighborhood conditions partially account for associations between education and physical capacity in the National Health and Aging Trends Study.

PubMed

Samuel, Laura J; Glass, Thomas A; Thorpe, Roland J; Szanton, Sarah L; Roth, David L

2015-03-01

Socioeconomic resources, such as education, prevent disability but are not readily modifiable. We tested the hypothesis that household and neighborhood conditions, which may be modifiable, partially account for associations between education and physical capacity in a population-based sample of older adults. The National Health and Aging Trends Study measured education (

Eutrophication effects on greenhouse gas fluxes from shallow-lake mesocosms override those of climate warming.

PubMed

Davidson, Thomas A; Audet, Joachim; Svenning, Jens-Christian; Lauridsen, Torben L; Søndergaard, Martin; Landkildehus, Frank; Larsen, Søren E; Jeppesen, Erik

2015-12-01

Fresh waters make a disproportionately large contribution to greenhouse gas (GHG) emissions, with shallow lakes being particular hot spots. Given their global prevalence, how GHG fluxes from shallow lakes are altered by climate change may have profound implications for the global carbon cycle. Empirical evidence for the temperature dependence of the processes controlling GHG production in natural systems is largely based on the correlation between seasonal temperature variation and seasonal change in GHG fluxes. However, ecosystem-level GHG fluxes could be influenced by factors, which while varying seasonally with temperature are actually either indirectly related (e.g. primary producer biomass) or largely unrelated to temperature, for instance nutrient loading. Here, we present results from the longest running shallow-lake mesocosm experiment which demonstrate that nutrient concentrations override temperature as a control of both the total and individual GHG flux. Furthermore, testing for temperature treatment effects at low and high nutrient levels separately showed only one, rather weak, positive effect of temperature (CH4 flux at high nutrients). In contrast, at low nutrients, the CO2 efflux was lower in the elevated temperature treatments, with no significant effect on CH4 or N2 O fluxes. Further analysis identified possible indirect effects of temperature treatment. For example, at low nutrient levels, increased macrophyte abundance was associated with significantly reduced fluxes of both CH4 and CO2 for both total annual flux and monthly observation data. As macrophyte abundance was positively related to temperature treatment, this suggests the possibility of indirect temperature effects, via macrophyte abundance, on CH4 and CO2 flux. These findings indicate that fluxes of GHGs from shallow lakes may be controlled more by factors indirectly related to temperature, in this case nutrient concentration and the abundance of primary producers. Thus, at ecosystem scale, response to climate change may not follow predictions based on the temperature dependence of metabolic processes. © 2015 John Wiley & Sons Ltd.

The cost of clinical mastitis in the first 30 days of lactation: An economic modeling tool.

PubMed

Rollin, E; Dhuyvetter, K C; Overton, M W

2015-12-01

Clinical mastitis results in considerable economic losses for dairy producers and is most commonly diagnosed in early lactation. The objective of this research was to estimate the economic impact of clinical mastitis occurring during the first 30 days of lactation for a representative US dairy. A deterministic partial budget model was created to estimate direct and indirect costs per case of clinical mastitis occurring during the first 30 days of lactation. Model inputs were selected from the available literature, or when none were available, from herd data. The average case of clinical mastitis resulted in a total economic cost of $444, including $128 in direct costs and $316 in indirect costs. Direct costs included diagnostics ($10), therapeutics ($36), non-saleable milk ($25), veterinary service ($4), labor ($21), and death loss ($32). Indirect costs included future milk production loss ($125), premature culling and replacement loss ($182), and future reproductive loss ($9). Accurate decision making regarding mastitis control relies on understanding the economic impacts of clinical mastitis, especially the longer term indirect costs that represent 71% of the total cost per case of mastitis. Future milk production loss represents 28% of total cost, and future culling and replacement loss represents 41% of the total cost of a case of clinical mastitis. In contrast to older estimates, these values represent the current dairy economic climate, including milk price ($0.461/kg), feed price ($0.279/kg DM (dry matter)), and replacement costs ($2,094/head), along with the latest published estimates on the production and culling effects of clinical mastitis. This economic model is designed to be customized for specific dairy producers and their herd characteristics to better aid them in developing mastitis control strategies. Copyright © 2015 The Authors. Published by Elsevier B.V. All rights reserved.

The costs of hepatitis A infections in South Korea

PubMed Central

Kim, Kyohyun; Jeong, Baek-Geun; Ki, Moran; Park, Mira; Park, Jin Kyung; Choi, Bo Youl; Yoo, Weon-Seob

2014-01-01

OBJECTIVES: The incidence of hepatitis A infections among young adults has recently increased in South Korea. Although universal vaccination has often been suggested to mitigate the problem, its rationale has not been well-understood. Estimating the societal costs of hepatitis A infections might support the development of intervention strategies. METHODS: We classified hepatitis A infections into eight clinical pathways and estimated the number of occurrences and cost per case for each clinical pathway using claim data from National Health Insurance and several national surveys as well as assumptions based on previous studies. To determine the total costs of a hepatitis A infection, both direct and indirect costs were estimated. Indirect costs were estimated using the human-capital approach. All costs are adjusted to the year 2008. RESULTS: There were 30,240 identified cases of hepatitis A infections in 2008 for a total cost of 80,873 million won (2.7 million won per case). Direct and indirect costs constituted 56.2% and 43.8% of the total costs, respectively. People aged 20-39 accounted for 71.3% of total cases and 74.6% of total costs. Medical costs per capita were the lowest in the 0-4 age group and highest in the 20-29 age group. CONCLUSIONS: This study could provide evidence for development of cost-effective interventions to control hepatitis A infections. But the true costs including uncaptured and intangible costs of hepatitis A infections might be higher than our results indicate. PMID:25139060

The indirect and direct pathways between physical fitness and academic achievement on commencement in post-compulsory education in a historical cohort of Danish school youth.

PubMed

Andersen, Mikkel Porsborg; Starkopf, Liis; Sessa, Maurizio; Mortensen, Rikke Nørmark; Vardinghus-Nielsen, Henrik; Bøggild, Henrik; Lange, Theis; Torp-Pedersen, Christian

2017-09-11

Some studies have found positive associations between physical fitness and academic achievements. Pupils' academic achievements should indicate scholastic abilities to commence a post-compulsory education. However, the effect magnitude of physical fitness and academic achievements on commencement in post-compulsory education is unknown. We examined the pathways between physical fitness and academic achievement on pupils' commencement in post-compulsory education. This historical cohort study followed 530 girls and 554 boys from the Danish municipality of Aalborg in the period 2008-2014, 13 to 15 years old in 2010. Physical fitness was assessed through a watt-max cycle ergometer test represented as VO 2 max (mL·kg -1 ·min -1 ). Academic achievement, commencement status and information on covariates were obtained from Danish nationwide registers. Causal inference based mediation analysis was used to investigate the indirect and direct pathways by separating the total effect of physical fitness on post-compulsory education commencement. Adjusting for sex, age, ethnicity and socioeconomic status, the overall mediation analysis showed an odds ratio (OR) of 1.87 (95% confidence interval (CI): 1.30; 2.73) for the total effect, corresponding to an increase in odds of post-compulsory education commencement when the physical fitness was increased by 10 units of VO 2 max. The separated total effect showed a natural direct OR of 1.36 (95% CI: 0.93; 1.98) and a natural indirect (i.e., through academic achievement) OR of 1.37 (95% CI: 1.20; 1.57). Thus, 51% (95% CI: 27%; 122%) of the effect of physical fitness on post-compulsory education commencement was mediated through academic achievement. Physical fitness had a positive effect on post-compulsory education commencement. A substantial part of this effect was mediated through academic achievement.

Direct and indirect relationships of physical fitness, weight status, and learning duration to academic performance in Japanese schoolchildren.

PubMed

Ishihara, Toru; Morita, Noriteru; Nakajima, Toshihiro; Okita, Koichi; Yamatsu, Koji; Sagawa, Masato

2018-03-01

The purpose of this study was to determine, using structural equation modelling (SEM), the direct and indirect influence of daily behaviours (i.e. exercise/learning durations), weight status, and physical fitness on academic performance among seventh-grade schoolchildren, after controlling for socioeconomic status. We analysed cross-sectional data from 274 schoolchildren (159 males and 115 females; 12-13 years old). Academic performance was assessed using the total grade points in eight academic subjects. Physical fitness was evaluated using the total score of eight physical fitness tests and weight status using body mass index. The daily behaviours and socioeconomic status were assessed by the questionnaire. The SEM showed an adequate fit to the data (χ 2  = 0.684, p = .710, RMSEA = .000). Physical fitness and learning durations had direct effects on academic performance (β = .301, p < .001; β = .132, p = .037, respectively) after controlling for confounders. Healthy weight status and exercise habits positively indirectly influenced academic performance via physical fitness. These findings suggest that, independent of socioeconomic status and learning durations, exercise habits and maintaining healthy weight status may indirectly contribute to academic success via better physical fitness in children.

Costs and global impacts of black carbon abatement strategies

NASA Astrophysics Data System (ADS)

Rypdal, Kristin; Rive, Nathan; Berntsen, Terje K.; Klimont, Zbigniew; Mideksa, Torben K.; Myhre, Gunnar; Skeie, Ragnhild B.

2009-09-01

Abatement of particulate matter has traditionally been driven by health concerns rather than its role in global warming. Here we assess future abatement strategies in terms of how much they reduce the climate impact of black carbon (BC) and organic carbon (OC) from contained combustion. We develop global scenarios which take into account regional differences in climate impact, costs of abatement and ability to pay, as well as both the direct and indirect (snow-albedo) climate impact of BC and OC. To represent the climate impact, we estimate consistent region-specific values of direct and indirect global warming potential (GWP) and global temperature potential (GTP). The indirect GWP has been estimated using a physical approach and includes the effect of change in albedo from BC deposited on snow. The indirect GWP is highest in the Middle East followed by Russia, Europe and North America, while the total GWP is highest in the Middle East, Africa and South Asia. We conclude that prioritizing emission reductions in Asia represents the most cost-efficient global abatement strategy for BC because Asia is (1) responsible for a large share of total emissions, (2) has lower abatement costs compared to Europe and North America and (3) has large health cobenefits from reduced PM10 emissions.

Aerosol indirect effects - general circulation model intercomparison and evaluation with satellite data

NASA Astrophysics Data System (ADS)

Quaas, J.; Ming, Y.; Menon, S.; Takemura, T.; Wang, M.; Penner, J. E.; Gettelman, A.; Lohmann, U.; Bellouin, N.; Boucher, O.; Sayer, A. M.; Thomas, G. E.; McComiskey, A.; Feingold, G.; Hoose, C.; Kristjánsson, J. E.; Liu, X.; Balkanski, Y.; Donner, L. J.; Ginoux, P. A.; Stier, P.; Grandey, B.; Feichter, J.; Sednev, I.; Bauer, S. E.; Koch, D.; Grainger, R. G.; Kirkevåg, A.; Iversen, T.; Seland, Ø.; Easter, R.; Ghan, S. J.; Rasch, P. J.; Morrison, H.; Lamarque, J.-F.; Iacono, M. J.; Kinne, S.; Schulz, M.

2009-11-01

Aerosol indirect effects continue to constitute one of the most important uncertainties for anthropogenic climate perturbations. Within the international AEROCOM initiative, the representation of aerosol-cloud-radiation interactions in ten different general circulation models (GCMs) is evaluated using three satellite datasets. The focus is on stratiform liquid water clouds since most GCMs do not include ice nucleation effects, and none of the model explicitly parameterises aerosol effects on convective clouds. We compute statistical relationships between aerosol optical depth (τa) and various cloud and radiation quantities in a manner that is consistent between the models and the satellite data. It is found that the model-simulated influence of aerosols on cloud droplet number concentration (Nd) compares relatively well to the satellite data at least over the ocean. The relationship between τa and liquid water path is simulated much too strongly by the models. This suggests that the implementation of the second aerosol indirect effect mainly in terms of an autoconversion parameterisation has to be revisited in the GCMs. A positive relationship between total cloud fraction (fcld) and τa as found in the satellite data is simulated by the majority of the models, albeit less strongly than that in the satellite data in most of them. In a discussion of the hypotheses proposed in the literature to explain the satellite-derived strong fcld-τa relationship, our results indicate that none can be identified as a unique explanation. Relationships similar to the ones found in satellite data between τa and cloud top temperature or outgoing long-wave radiation (OLR) are simulated by only a few GCMs. The GCMs that simulate a negative OLR-τa relationship show a strong positive correlation between τa and fcld. The short-wave total aerosol radiative forcing as simulated by the GCMs is strongly influenced by the simulated anthropogenic fraction of τa, and parameterisation assumptions such as a lower bound on Nd. Nevertheless, the strengths of the statistical relationships are good predictors for the aerosol forcings in the models. An estimate of the total short-wave aerosol forcing inferred from the combination of these predictors for the modelled forcings with the satellite-derived statistical relationships yields a global annual mean value of -1.5±0.5 Wm-2. In an alternative approach, the radiative flux perturbation due to anthropogenic aerosols can be broken down into a component over the cloud-free portion of the globe (approximately the aerosol direct effect) and a component over the cloudy portion of the globe (approximately the aerosol indirect effect). An estimate obtained by scaling these simulated clear- and cloudy-sky forcings with estimates of anthropogenic τa and satellite-retrieved Nd-τa regression slopes, respectively, yields a global, annual-mean aerosol direct effect estimate of -0.4±0.2 Wm-2 and a cloudy-sky (aerosol indirect effect) estimate of -0.7±0.5 Wm-2, with a total estimate of -1.2±0.4 Wm-2.

Aerosol indirect effects ? general circulation model intercomparison and evaluation with satellite data

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

Quaas, Johannes; Ming, Yi; Menon, Surabi

2010-03-12

Aerosol indirect effects continue to constitute one of the most important uncertainties for anthropogenic climate perturbations. Within the international AEROCOM initiative, the representation of aerosol-cloud-radiation interactions in ten different general circulation models (GCMs) is evaluated using three satellite datasets. The focus is on stratiform liquid water clouds since most GCMs do not include ice nucleation effects, and none of the model explicitly parameterises aerosol effects on convective clouds. We compute statistical relationships between aerosol optical depth ({tau}{sub a}) and various cloud and radiation quantities in a manner that is consistent between the models and the satellite data. It is foundmore » that the model-simulated influence of aerosols on cloud droplet number concentration (N{sub d}) compares relatively well to the satellite data at least over the ocean. The relationship between {tau}{sub a} and liquid water path is simulated much too strongly by the models. This suggests that the implementation of the second aerosol indirect effect mainly in terms of an autoconversion parameterisation has to be revisited in the GCMs. A positive relationship between total cloud fraction (f{sub cld}) and {tau}{sub a} as found in the satellite data is simulated by the majority of the models, albeit less strongly than that in the satellite data in most of them. In a discussion of the hypotheses proposed in the literature to explain the satellite-derived strong f{sub cld} - {tau}{sub a} relationship, our results indicate that none can be identified as a unique explanation. Relationships similar to the ones found in satellite data between {tau}{sub a} and cloud top temperature or outgoing long-wave radiation (OLR) are simulated by only a few GCMs. The GCMs that simulate a negative OLR - {tau}{sub a} relationship show a strong positive correlation between {tau}{sub a} and f{sub cld} The short-wave total aerosol radiative forcing as simulated by the GCMs is strongly influenced by the simulated anthropogenic fraction of {tau}{sub a}, and parameterization assumptions such as a lower bound on N{sub d}. Nevertheless, the strengths of the statistical relationships are good predictors for the aerosol forcings in the models. An estimate of the total short-wave aerosol forcing inferred from the combination of these predictors for the modelled forcings with the satellite-derived statistical relationships yields a global annual mean value of -1.5 {+-} 0.5 Wm{sup -2}. In an alternative approach, the radiative flux perturbation due to anthropogenic aerosols can be broken down into a component over the cloud-free portion of the globe (approximately the aerosol direct effect) and a component over the cloudy portion of the globe (approximately the aerosol indirect effect). An estimate obtained by scaling these simulated clear- and cloudy-sky forcings with estimates of anthropogenic {tau}{sub a} and satellite-retrieved Nd - {tau}{sub a} regression slopes, respectively, yields a global, annual-mean aerosol direct effect estimate of -0.4 {+-} 0.2 Wm{sup -2} and a cloudy-sky (aerosol indirect effect) estimate of -0.7 {+-} 0.5 Wm{sup -2}, with a total estimate of -1.2 {+-} 0.4 Wm{sup -2}.« less

Assessment of the ripple effects and spatial heterogeneity of total losses in the capital of China after a great catastrophic shock

NASA Astrophysics Data System (ADS)

Zhang, Zhengtao; Li, Ning; Xie, Wei; Liu, Yu; Feng, Jieling; Chen, Xi; Liu, Li

2017-03-01

The total losses caused by natural disasters have spatial heterogeneity due to the different economic development levels inside the disaster-hit areas. This paper uses scenarios of direct economic loss to introduce the sectors' losses caused by the 2008 Wenchuan earthquake (2008 WCE) in Beijing, utilizing the Adaptive Regional Input-Output (ARIO) model and the Inter-regional ripple effect (IRRE) model. The purpose is to assess the ripple effects of indirect economic loss and spatial heterogeneity of both direct and indirect economic loss at the scale of the smallest administrative divisions of China (streets, villages, and towns). The results indicate that the district of Beijing with the most severe indirect economic loss is the Chaoyang District; the finance and insurance industry (15, see Table 1) of Chaowai Street suffers the most in the Chaoyang District, which is 1.46 times that of its direct economic loss. During 2008-2014, the average annual GDP (gross domestic product) growth rate of Beijing was decreased 3.63 % by the catastrophe. Compared with the 8 % of GDP growth rate target, the decreasing GDP growth rate is a significant and noticeable economic impact, and it can be efficiently mitigated by increasing rescue effort and by supporting the industries which are located in the seriously damaged regions.

Direct and indirect effects of organizational justice on work ability.

PubMed

Spanier, K; Radoschewski, F M; Gutenbrunner, C; Bethge, M

2014-12-01

Organizational justice (OJ), involving transparent workplace procedures and treating staff members with respect, has been of growing concern in recent epidemiological research as a determinant of health-related outcomes. To examine the factorial validity of the German version of Moorman's Organizational Justice Questionnaire (OJQ), to investigate the direct cross-sectional effect of OJ on self-rated work ability and to analyse if there is an additional indirect effect of OJ on work ability mediated by effort-reward imbalance. An analysis of cross-sectional data from the Second German Sociomedical Panel of Employees, involving white-collar workers employed at least half time. We performed confirmatory factor analyses to test the factorial validity of the OJQ and analysed the direct and indirect associations of OJ and self-rated work ability by path model analysis. Of the 1217 participants (47% female; mean age: 51) 36% had poor work ability. Factor analyses confirmed the two-factor structure of the German OJQ. Work ability was explained directly by OJ (β = 0.30) and effort-reward imbalance (β = -0.27). Additionally, we identified an indirect effect of OJ that was mediated by effort-reward imbalance (β = 0.14). The total effect of OJ on work ability was remarkably strong (β = 0.44). Associations remained unchanged after adjustment for socio-demographic parameters. This study showed the importance of considering additional indirect pathways when examining the impact of OJ on the work ability of employees. © The Author 2014. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Climate Impacts of Ice Nucleation

NASA Technical Reports Server (NTRS)

Gettelman, Andrew; Liu, Xiaohong; Barahona, Donifan; Lohmann, Ulrike; Chen, Celia

2012-01-01

Several different ice nucleation parameterizations in two different General Circulation Models (GCMs) are used to understand the effects of ice nucleation on the mean climate state, and the Aerosol Indirect Effects (AIE) of cirrus clouds on climate. Simulations have a range of ice microphysical states that are consistent with the spread of observations, but many simulations have higher present-day ice crystal number concentrations than in-situ observations. These different states result from different parameterizations of ice cloud nucleation processes, and feature different balances of homogeneous and heterogeneous nucleation. Black carbon aerosols have a small (0.06 Wm(exp-2) and not statistically significant AIE when included as ice nuclei, for nucleation efficiencies within the range of laboratory measurements. Indirect effects of anthropogenic aerosols on cirrus clouds occur as a consequence of increasing anthropogenic sulfur emissions with different mechanisms important in different models. In one model this is due to increases in homogeneous nucleation fraction, and in the other due to increases in heterogeneous nucleation with coated dust. The magnitude of the effect is the same however. The resulting ice AIE does not seem strongly dependent on the balance between homogeneous and heterogeneous ice nucleation. Regional effects can reach several Wm2. Indirect effects are slightly larger for those states with less homogeneous nucleation and lower ice number concentration in the base state. The total ice AIE is estimated at 0.27 +/- 0.10 Wm(exp-2) (1 sigma uncertainty). This represents a 20% offset of the simulated total shortwave AIE for ice and liquid clouds of 1.6 Wm(sup-2).

Comparing the shear bond strength of direct and indirect composite inlays in relation to different surface conditioning and curing techniques

PubMed Central

Zorba, Yahya Orcun; Ilday, Nurcan Ozakar; Bayındır, Yusuf Ziya; Demirbuga, Sezer

2013-01-01

Objective: The aim of this study was to test the null hypothesis that different surface conditioning (etch and rinse and self-etch) and curing techniques (light cure/dual cure) had no effect on the shear bond strength of direct and indirect composite inlays. Materials and Methods: A total of 112 extracted human molar teeth were horizontally sectioned and randomly divided into two groups according to restoration technique (direct and indirect restorations). Each group was further subdivided into seven subgroups (n = 8) according to bonding agent (etch and rinse adhesives Scotchbond multi-purpose plus, All-Bond 3, Adper Single Bond and Prime Bond NT; and self-etch adhesives Clearfil Liner Bond, Futurabond DC and G bond). Indirect composites were cemented to dentin surfaces using dual-curing luting cement. Shear bond strength of specimens was tested using a Universal Testing Machine. Two samples from each subgroup were evaluated under Scanning electron microscopy to see the failing modes. Data was analyzed using independent sample t-tests and Tukey's tests. Results: Surface conditioning and curing of bonding agents were all found to have significant effects on shear bond strength (P < 0.05) of both direct and indirect composite inlays. With direct restoration, etch and rinse systems and dual-cured bonding agents yielded higher bond strengths than indirect restoration, self-etch systems and light-cured bonding agents. Conclusions: The results of the present study indicated that direct restoration to be a more reliable method than indirect restoration. Although etch and rinse bonding systems showed higher shear bond strength to dentin than self-etch systems, both systems can be safely used for the adhesion of direct as well as indirect restorations. PMID:24932118

Comparing the shear bond strength of direct and indirect composite inlays in relation to different surface conditioning and curing techniques.

PubMed

Zorba, Yahya Orcun; Ilday, Nurcan Ozakar; Bayındır, Yusuf Ziya; Demirbuga, Sezer

2013-10-01

The aim of this study was to test the null hypothesis that different surface conditioning (etch and rinse and self-etch) and curing techniques (light cure/dual cure) had no effect on the shear bond strength of direct and indirect composite inlays. A total of 112 extracted human molar teeth were horizontally sectioned and randomly divided into two groups according to restoration technique (direct and indirect restorations). Each group was further subdivided into seven subgroups (n = 8) according to bonding agent (etch and rinse adhesives Scotchbond multi-purpose plus, All-Bond 3, Adper Single Bond and Prime Bond NT; and self-etch adhesives Clearfil Liner Bond, Futurabond DC and G bond). Indirect composites were cemented to dentin surfaces using dual-curing luting cement. Shear bond strength of specimens was tested using a Universal Testing Machine. Two samples from each subgroup were evaluated under Scanning electron microscopy to see the failing modes. Data was analyzed using independent sample t-tests and Tukey's tests. Surface conditioning and curing of bonding agents were all found to have significant effects on shear bond strength (P < 0.05) of both direct and indirect composite inlays. With direct restoration, etch and rinse systems and dual-cured bonding agents yielded higher bond strengths than indirect restoration, self-etch systems and light-cured bonding agents. The results of the present study indicated that direct restoration to be a more reliable method than indirect restoration. Although etch and rinse bonding systems showed higher shear bond strength to dentin than self-etch systems, both systems can be safely used for the adhesion of direct as well as indirect restorations.

Cloud microphysics and aerosol indirect effects in the global climate model ECHAM5-HAM

NASA Astrophysics Data System (ADS)

Lohmann, U.; Stier, P.; Hoose, C.; Ferrachat, S.; Kloster, S.; Roeckner, E.; Zhang, J.

2007-07-01

The double-moment cloud microphysics scheme from ECHAM4 that predicts both the mass mixing ratios and number concentrations of cloud droplets and ice crystals has been coupled to the size-resolved aerosol scheme ECHAM5-HAM. ECHAM5-HAM predicts the aerosol mass, number concentrations and mixing state. The simulated liquid, ice and total water content and the cloud droplet and ice crystal number concentrations as a function of temperature in stratiform mixed-phase clouds between 0 and -35° C agree much better with aircraft observations in the ECHAM5 simulations. ECHAM5 performs better because more realistic aerosol concentrations are available for cloud droplet nucleation and because the Bergeron-Findeisen process is parameterized as being more efficient. The total anthropogenic aerosol effect includes the direct, semi-direct and indirect effects and is defined as the difference in the top-of-the-atmosphere net radiation between present-day and pre-industrial times. It amounts to -1.9 W m-2 in ECHAM5, when a relative humidity dependent cloud cover scheme and aerosol emissions representative for the years 1750 and 2000 from the AeroCom emission inventory are used. The contribution of the cloud albedo effect amounts to -0.7 W m-2. The total anthropogenic aerosol effect is larger when either a statistical cloud cover scheme or a different aerosol emission inventory are employed because the cloud lifetime effect increases.

Direct and indirect effects of glomalin, mycorrhizal hyphae, and roots on aggregate stability in rhizosphere of trifoliate orange.

PubMed

Wu, Qiang-Sheng; Cao, Ming-Qin; Zou, Ying-Ning; He, Xin-hua

2014-07-25

To test direct and indirect effects of glomalin, mycorrhizal hyphae, and roots on aggregate stability, perspex pots separated by 37-μm nylon mesh in the middle were used to form root-free hyphae and root/hyphae chambers, where trifoliate orange (Poncirus trifoliata) seedlings were colonized by Funneliformis mosseae or Paraglomus occultum in the root/hyphae chamber. Both fungal species induced significantly higher plant growth, root total length, easily-extractable glomalin-related soil protein (EE-GRSP) and total GRSP (T-GRSP), and mean weight diameter (an aggregate stability indicator). The Pearson correlation showed that root colonization or soil hyphal length significantly positively correlated with EE-GRSP, difficultly-extractable GRSP (DE-GRSP), T-GRSP, and water-stable aggregates in 2.00-4.00, 0.50-1.00, and 0.25-0.50 mm size fractions. The path analysis indicated that in the root/hyphae chamber, aggregate stability derived from a direct effect of root colonization, EE-GRSP or DE-GRSP. Meanwhile, the direct effect was stronger by EE-GRSP or DE-GRSP than by mycorrhizal colonization. In the root-free hyphae chamber, mycorrhizal-mediated aggregate stability was due to total effect but not direct effect of soil hyphal length, EE-GRSP and T-GRSP. Our results suggest that GRSP among these tested factors may be the primary contributor to aggregate stability in the citrus rhizosphere.

Childhood abuse and psychotic experiences - evidence for mediation by adulthood adverse life events.

PubMed

Bhavsar, V; Boydell, J; McGuire, P; Harris, V; Hotopf, M; Hatch, S L; MacCabe, J H; Morgan, C

2017-10-09

We have previously reported an association between childhood abuse and psychotic experiences (PEs) in survey data from South East London. Childhood abuse is related to subsequent adulthood adversity, which could form one pathway to PEs. We aimed to investigate evidence of mediation of the association between childhood abuse and PEs by adverse life events. Data were analysed from the South East London Community Health Study (SELCoH, n = 1698). Estimates of the total effects on PEs of any physical or sexual abuse while growing up were partitioned into direct (i.e. unmediated) and indirect (total and specific) effects, mediated via violent and non-violent life events. There was strong statistical evidence for direct (OR 1.58, 95% CI: 1.19-2.1) and indirect (OR 1.51, 95% CI: 1.32-1.72) effects of childhood abuse on PEs after adjustment for potential confounders, indicating partial mediation of this effect via violent and non-violent life events. An estimated 47% of the total effect of abuse on PEs was mediated via adulthood adverse life events, of which violent life events made up 33% and non-violent life events the remaining 14%. The association between childhood abuse and PEs is partly mediated through the experience of adverse life events in adulthood. There is some evidence that a larger proportion of this effect was mediated through violent life events than non-violent life events.

The mediating role of emotional symptomatology between anticipatory fatigue and the perception of fatigue.

PubMed

Rodríguez Testal, Juan F; Fuentes Márquez, Sandra; Senín Calderón, Cristina; Carrasco, Miguel A

2016-05-01

Clinical research stresses the importance of cognitive variables for predisposition, onset, and especially, perpetuation of perceived fatigue. The aim was to analyze the mediating effects of emotional symptomatology (somatic, depressive and anxiety) between anticipatory fatigue and perception of physical and cognitive fatigue. The sample was composed of 317 participants (29% from a clinical population) aged 18 to 76. Anticipatory fatigue and perception of fatigue were measured by fatigue scales. Emotional symptoms were assessed by the General Health Questionnaire, GHQ-28.  Results : Depressive symptomatology mediated the relationship between anticipatory fatigue and cognitive fatigue in both groups, and also somatic symptoms/somatization in patients. The indirect effect of physical fatigue was observed only in the clinical group, with depressive symptoms partially mediating the anticipatory fatigue and cognitive fatigue relationship. Anticipatory fatigue has a partial indirect effect on total physical fatigue, and full indirect effect on cognitive fatigue, mediated by depressive and somatic symptoms. Anticipatory fatigue is a relevant cognitive factor in the design of psychological intervention for improvement of cognitive and physical fatigue.

Effects of levomilnacipran ER on noradrenergic symptoms, anxiety symptoms, and functional impairment in adults with major depressive disorder: Post hoc analysis of 5 clinical trials.

PubMed

Blier, Pierre; Gommoll, Carl; Chen, Changzheng; Kramer, Kenneth

2017-03-01

To evaluate the effects of levomilnacipran extended-release (LVM-ER; 40-120mg/day) on noradrenergic (NA) and anxiety-related symptoms in adults with major depressive disorder (MDD) and explore the relationship between these symptoms and functional impairment. Data were pooled from 5 randomized, double-blind, placebo-controlled trials (N=2598). Anxiety and NA Cluster scores were developed by adding selected item scores from the Montgomery-Åsberg Depression Rating Scale (MADRS) and 17-item Hamilton Depression Rating Scale (HAMD 17 ). A path analysis was conducted to estimate the direct effects of LVM-ER on functional impairment (Sheehan Disability Scale [SDS] total score) and the indirect effects through changes in NA and Anxiety Cluster scores. Mean improvements from baseline in NA and Anxiety Cluster scores were significantly greater with LVM-ER versus placebo (both P<0.001), as were the response rates (≥50% score improvement): NA Cluster (44% vs 34%; odds ratio=1.56; P<0.0001); Anxiety Cluster (39% vs 36%; odds ratio=1.19; P=0.041). Mean improvement in SDS total score was also significantly greater with LVM-ER versus placebo (-7.3 vs -5.6; P<0.0001). LVM-ER had an indirect effect on change in SDS total score that was mediated more strongly through NA Cluster score change (86%) than Anxiety Cluster score change (18%); the direct effect was negligible. NA and Anxiety Cluster scores, developed based on the face validity of individual MADRS and HAMD 17 items, were not predefined as efficacy outcomes in any of the studies. In adults with MDD, LVM-ER indirectly improved functional impairment mainly through improvements in NA symptoms and less so via anxiety symptoms. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.

Direct and indirect mortality in Florida during the 2004 hurricane season

NASA Astrophysics Data System (ADS)

McKinney, Nathan; Houser, Chris; Meyer-Arendt, Klaus

2011-07-01

Previous studies have shown that natural disasters, and hurricanes in particular, have led to more deaths than those usually documented in short post-storm surveys. Such indirect deaths, thought to be related to dietary, stress or pre-existing medical conditions, can exceed the number of direct deaths and may persist for weeks or even months beyond the event itself. In the present study, cumulative sum of deviations plots are used to quantify the number of direct and indirect deaths resulting from Hurricanes Charley, Frances, Ivan and Jeanne that made landfall in Florida in 2004. Results suggest that there was an elevated mortality for up to 2 months following each storm, resulting in a total of 624 direct and indirect deaths attributable to the storm. Trauma-related deaths that can be associated directly with the storm account for only ˜4% of the total storm-related mortality, while indirect mortality accounts for most storm-related deaths. Specifically, a large percentage of the elevated mortality was associated with heart (34%) and cancer-related deaths (19%), while diabetes (5%) and accident-related deaths (9%) account for a smaller but still significant percentage of the elevated mortality. The results further suggest that the elevated mortality was the result of additional deaths that would not have otherwise occurred within that 5 month period, and not simply a clustering of deaths that were inevitable between 1 August and 31 December 2004. The elevated mortality identified in this study is significantly greater than the official count of 31 direct and 113 indirect deaths resulting from the four hurricanes combined. This suggests a need for improved mortality counts and surveillance in order to better evaluate and identify effective prevention policies, and to identify preventable deaths.

Inter-Sectoral Bisphenol A (BPA) Flows in the 2012 Chinese Economy.

PubMed

Jiang, Daqian; Chen, Wei-Qiang; Liu, Wei; Chertow, Marian

2017-08-01

Bisphenol A (BPA), a widely used petrochemical compound, has become an emerging global environmental management challenge because its leakage is associated with potential environmental and human health impacts. Until now, available BPA statistics have been limited to the products that directly use BPA. In this study, we delineate direct and indirect BPA flows for the 2012 Chinese economy. We find that construction, production of educational and recreational products, and automobile manufacturing are the most BPA-intensive sectors in terms of total BPA flows (300, 157, and 130 Gg total BPA flows, respectively). The public management and health sectors, however, incur significant indirect BPA flows, defined as embedded and inter-sectoral BPA placed into use, even though direct BPA use by these sectors is limited. By revealing the currently overlooked indirect BPA flows, this study reveals data gaps that are highly relevant to improving the accuracy of estimated BPA flows and losses. The method used herein is transferrable to other emerging and environmentally relevant materials, thereby providing the holistic understanding needed for cities, regions, or nations to design effective policy interventions.

The Role of Industrial Parks in Mitigating Greenhouse Gas Emissions from China.

PubMed

Guo, Yang; Tian, Jinping; Zang, Na; Gao, Yang; Chen, Lujun

2018-06-14

This study uncovered the direct and indirect energy-related GHG emissions of 213 Chinese national-level industrial parks, providing 11% of China's GDP, from a life-cycle perspective. Direct emissions are sourced from fuel combustion, and indirect emissions are embodied in energy production. The results indicated that in 2015, the direct and indirect GHG emissions of the parks were 1042 and 181 million tonne CO2 eq., respectively, totally accounting for 11% of national GHG emissions. The total energy consumption of the parks accounted for 10% of national energy consumption. Coal constituted 74% of total energy consumption in these parks. Baseline and low-carbon scenarios are established for 2030, and five GHG mitigation measures targeting energy consumption are modeled. The GHG mitigation potential for these parks in 2030 is quantified as 116 million tonne, equivalent to 9.5% of the parks' total emission in 2015. The measures that increase the share of natural gas consumption, reduce the GHG emission factor of electricity grid, and improve the average efficiency of industrial coal-fired boilers, will totally contribute 94% and 98% in direct and indirect GHG emissions reductions, respectively. These findings will provide a solid foundation for the low-carbon development of Chinese industrial parks.

Direct and indirect effects of nutritional status, physical function and cognitive function on activities of daily living in Japanese older adults requiring long-term care.

PubMed

Kamo, Tomohiko; Nishida, Yuusuke

2014-10-01

To identify the direct and indirect effects of nutritional status, physical function, and cognitive function on activities of daily living in Japanese older adults requiring long-term care. In total, 179 participants aged ≥ 65 years who were eligible for long-term care insurance (mean age 85.5 ± 7.8 years) were recruited for this study. Nutritional status (Mini Nutritional Assessment, Short Form) and physical function (Short Physical Performance Battery) were examined. Activities of daily living, cognitive function and frailty were assessed using the Barthel Index, Mini-Mental State Examination and Clinical Frailty Scale, respectively. Path analysis was used to determine relationships between these factors and the activities of daily living. For Japanese older adults requiring long-term care, pathways were modeled for nutritional status, physical function and the activities of daily living. The total effect of nutritional status was 0.516 (P<0.001). The indirect effect of nutritional status through physical function on the activities of daily living was 0.458 (P<0.001). Finally, no significant direct effect of nutritional status on activities of daily living was observed (b=0.058, P=0.258). The present study identified the complex pathway from nutritional status to the activities of daily living through physical function in aged Japanese people requiring long-term care. These findings suggest that maintaining good nutritional status and nutritional support might delay physical function decline, and prolong the activities of daily living. © 2013 Japan Geriatrics Society.

Effects of levomilnacipran extended-release on motivation/energy and functioning in adults with major depressive disorder

PubMed Central

Gommoll, Carl; Chen, Changzheng; Kramer, Kenneth; Sambunaris, Angelo

2016-01-01

The objective of this post-hoc analysis was to investigate the relationship between motivation/energy and functional impairment in patients with major depressive disorder (MDD). Data were taken from a phase 3 trial of levomilnacipran extended-release (ER) in adults with MDD (NCT01034462; N=429) that used the 18-item Motivation and Energy Inventory (MEI) to assess motivation/energy. Two subgroups with lower and higher motivation/energy were defined using baseline MEI total scores (≤28 and >28, respectively). Change from baseline in the Sheehan Disability Scale (SDS) total score was analyzed in the intent-to-treat (ITT) population and both subgroups. Path analyses were carried out in the ITT population and a lower MEI subgroup to assess the direct and indirect effects of levomilnacipran ER on SDS total score change. In the ITT population and the lower MEI subgroup, significant differences were found between levomilnacipran ER and placebo for changes in the SDS total score (−2.6 and −3.9, both P<0.01), but not in the higher MEI subgroup. The indirect effect of levomilnacipran ER on SDS total score improvement, as mediated by MEI total score change, was 79.9% in the lower MEI subgroup and 67.2% in the ITT population. Levomilnacipran ER was previously shown to improve motivation/energy in adults with MDD. The current analysis indicates that improvements in functional impairment were considerably mediated by improvements in motivation/energy, particularly in patients with lower motivation/energy at baseline. PMID:27455513

Ratio-of-Mediator-Probability Weighting for Causal Mediation Analysis in the Presence of Treatment-by-Mediator Interaction

ERIC Educational Resources Information Center

Hong, Guanglei; Deutsch, Jonah; Hill, Heather D.

2015-01-01

Conventional methods for mediation analysis generate biased results when the mediator-outcome relationship depends on the treatment condition. This article shows how the ratio-of-mediator-probability weighting (RMPW) method can be used to decompose total effects into natural direct and indirect effects in the presence of treatment-by-mediator…

Ratio-of-Mediator-Probability Weighting for Causal Mediation Analysis in the Presence of Treatment-by-Mediator Interaction

ERIC Educational Resources Information Center

Hong, Guanglei; Deutsch, Jonah; Hill, Heather D.

2015-01-01

Conventional methods for mediation analysis generate biased results when the mediator--outcome relationship depends on the treatment condition. This article shows how the ratio-of-mediator-probability weighting (RMPW) method can be used to decompose total effects into natural direct and indirect effects in the presence of treatment-by-mediator…

Aerosol indirect effects -- general circulation model intercomparison and evaluation with satellite data

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

Quaas, Johannes; Ming, Yi; Menon, Surabi

2009-04-10

Aerosol indirect effects continue to constitute one of the most important uncertainties for anthropogenic climate perturbations. Within the international AEROCOM initiative, the representation of aerosol-cloud-radiation interactions in ten different general circulation models (GCMs) is evaluated using three satellite datasets. The focus is on stratiform liquid water clouds since most GCMs do not include ice nucleation effects, and none of the model explicitly parameterizes aerosol effects on convective clouds. We compute statistical relationships between aerosol optical depth (Ta) and various cloud and radiation quantities in a manner that is consistent between the models and the satellite data. It is found thatmore » the model-simulated influence of aerosols on cloud droplet number concentration (Nd) compares relatively well to the satellite data at least over the ocean. The relationship between Ta and liquid water path is simulated much too strongly by the models. It is shown that this is partly related to the representation of the second aerosol indirect effect in terms of autoconversion. A positive relationship between total cloud fraction (fcld) and Ta as found in the satellite data is simulated by the majority of the models, albeit less strongly than that in the satellite data in most of them. In a discussion of the hypotheses proposed in the literature to explain the satellite-derived strong fcld - Ta relationship, our results indicate that none can be identified as unique explanation. Relationships similar to the ones found in satellite data between Ta and cloud top temperature or outgoing long-wave radiation (OLR) are simulated by only a few GCMs. The GCMs that simulate a negative OLR - Ta relationship show a strong positive correlation between Ta and fcld The short-wave total aerosol radiative forcing as simulated by the GCMs is strongly influenced by the simulated anthropogenic fraction of Ta, and parameterisation assumptions such as a lower bound on Nd. Nevertheless, the strengths of the statistical relationships are good predictors for the aerosol forcings in the models. An estimate of the total short-wave aerosol forcing inferred from the combination of these predictors for the modelled forcings with the satellite-derived statistical relationships yields a global annual mean value of -1.5+-0.5 Wm-2. An alternative estimate obtained by scaling the simulated clear- and cloudy-sky forcings with estimates of anthropogenic Ta and satellite-retrieved Nd - Ta regression slopes, respectively, yields a global annual mean clear-sky (aerosol direct effect) estimate of -0.4+-0.2 Wm-2 and a cloudy-sky (aerosol indirect effect) estimate of -0.7+-0.5 Wm-2, with a total estimate of -1.2+-0.4 Wm-2.« less

Direct and indirect effects of metal contamination on soil biota in a Zn-Pb post-mining and smelting area (S Poland).

PubMed

Kapusta, Paweł; Szarek-Łukaszewska, Grażyna; Stefanowicz, Anna M

2011-06-01

Effects of metal contamination on soil biota activity were investigated at 43 sites in 5 different habitats (defined by substratum and vegetation type) in a post-mining area. Sites were characterised in terms of soil pH and texture, nutrient status, total and exchangeable metal concentrations, as well as plant species richness and cover, abundances of enchytraeids, nematodes and tardigrades, and microbial respiration and biomass. The concentrations of total trace metals were highest in soils developed on mining waste (metal-rich dolomite), but these habitats were more attractive than sandy sites for plants and soil biota because of their higher content of organic matter, clay and nutrients. Soil mesofauna and microbes were strongly dependent on natural habitat properties. Pollution (exchangeable Zn and Cd) negatively affected only enchytraeid density; due to a positive relationship between enchytraeids and microbes it indirectly reduced microbial activity. Copyright © 2011 Elsevier Ltd. All rights reserved.

CHRNA5/A3/B4 Variant rs3743078 and Nicotine-Related Phenotypes: Indirect Effects Through Nicotine Craving.

PubMed

Shmulewitz, Dvora; Meyers, Jacquelyn L; Wall, Melanie M; Aharonovich, Efrat; Frisch, Amos; Spivak, Baruch; Weizman, Abraham; Edenberg, Howard J; Gelernter, Joel; Hasin, Deborah S

2016-03-01

Nicotine craving is considered an important element in the persistence of cigarette smoking, but little is known about the role of craving in the widely recognized association between variants mapped to the neuronal nicotinic acetylcholine receptor (CHRN) genes on chromosome 15 and nicotine phenotypes. The associations between CHRNA5-CHRNA3-CHRNB4 variants and cigarettes per day (CPD), the Fagerström Test for Nicotine Dependence (FTND), and craving were analyzed in data from 662 lifetime smokers from an Israeli adult Jewish household sample. Indirect effects of genotype on nicotine phenotypes through craving were formally tested using regression and bootstrapping procedures. At CHRNA3, allele G of rs3743078 was associated with increased craving, CPD, and FTND scores: Participants with one or two copies of the G allele had, on average, higher scores on the craving scale (p = .0025), more cigarettes smoked (p = .0057), and higher scores on the FTND (p =.0024). With craving in the model, variant rs3743078 showed a significant indirect effect through craving on CPD (p = .0026) and on FTND score (p = .0024). A sizeable proportion of the total rs3743078 effect on CPD (56.4%) and FTND (65.2%) was indirect through craving. These results suggest that nicotine craving may play a central role in nicotine use disorders and may have utility as a therapeutic target.

States of direct and indirect excitons in strained zinc-blende GaN/InGaN asymmetric quantum wells

NASA Astrophysics Data System (ADS)

Rojas-Briseño, J. G.; Martínez-Orozco, J. C.; Mora-Ramos, M. E.

2017-12-01

The total and binding energies of excitons in step-like asymmetric quantum wells made of zincblende GaN/InxlGa(1-xl)N/InxrGa(1-xr)N/GaN are theoretically reported. It is discussed how the asymmetry in the carrier confinement leads to singular behaviors in the exciton binding energy, allowing to observe both direct and indirect exciton states in the heterostructure. The study is carried out with the use of the effective mass approximation. The effects of strain are taken into account and a comparison of the results obtained for both strained and unstrained situations is presented. Exciton energy shows a decreasing behavior when the size of the effective confinement region is augmented. The total exciton energy as well as the binding energy are reported as functions of the indium concentration and quantum well width. In addition, the results of the calculation of the photoluminescence peak are presented. For this latter quantity, our results for the limiting case of a single zinc-blende GaN/InGaN quantum well show very good agreement with published experimental ones.

Direct and Indirect Effects of Brain Volume, Socioeconomic Status and Family Stress on Child IQ

PubMed Central

Marcus Jenkins, Jade V; Woolley, Donald P; Hooper, Stephen R; De Bellis, Michael D

2013-01-01

1.1. Background A large literature documents the detrimental effects of socioeconomic disparities on intelligence and neuropsychological development. Researchers typically measure environmental factors such as socioeconomic status (SES), using income, parent's occupation and education. However, SES is more complex, and this complexity may influence neuropsychological outcomes. 1.2. Methods This studyused principal components analysis to reduce 14 SES and 28 family stress indicators into their core dimensions (e.g. community and educational capital, financial resources, marital conflict). Core dimensions were used in path analyses to examine their relationships with parent IQ and cerebral volume (white matter, grey matter and total brain volume), to predict child IQ in a sample of typically developing children. 1.3. Results Parent IQ affected child IQ directly and indirectly through community and educational capital, demonstrating how environmental factors interact with familial factors in neuro-development. There were no intervening effects of cerebral white matter, grey matter, or total brain volume. 1.4. Conclusions Findings may suggest that improving community resources can foster the intellectual development of children. PMID:24533427

Hand-held indirect calorimeter offers advantages compared with prediction equations, in a group of overweight women, to determine resting energy expenditures and estimated total energy expenditures during research screening.

PubMed

Spears, Karen E; Kim, Hyunsook; Behall, Kay M; Conway, Joan M

2009-05-01

To compare standardized prediction equations to a hand-held indirect calorimeter in estimating resting energy and total energy requirements in overweight women. Resting energy expenditure (REE) was measured by hand-held indirect calorimeter and calculated by prediction equations Harris-Benedict, Mifflin-St Jeor, World Health Organization/Food and Agriculture Organization/United Nations University (WHO), and Dietary Reference Intakes (DRI). Physical activity level, assessed by questionnaire, was used to estimate total energy expenditure (TEE). Subjects (n=39) were female nonsmokers older than 25 years of age with body mass index more than 25. Repeated measures analysis of variance, Bland-Altman plot, and fitted regression line of difference. A difference within +/-10% of two methods indicated agreement. Significant proportional bias was present between hand-held indirect calorimeter and prediction equations for REE and TEE (P<0.01); prediction equations overestimated at lower values and underestimated at higher values. Mean differences (+/-standard error) for REE and TEE between hand-held indirect calorimeter and Harris-Benedict were -5.98+/-46.7 kcal/day (P=0.90) and 21.40+/-75.7 kcal/day (P=0.78); between hand-held indirect calorimeter and Mifflin-St Jeor were 69.93+/-46.7 kcal/day (P=0.14) and 116.44+/-75.9 kcal/day (P=0.13); between hand-held indirect calorimeter and WHO were -22.03+/-48.4 kcal/day (P=0.65) and -15.8+/-77.9 kcal/day (P=0.84); and between hand-held indirect calorimeter and DRI were 39.65+/-47.4 kcal/day (P=0.41) and 56.36+/-85.5 kcal/day (P=0.51). Less than 50% of predictive equation values were within +/-10% of hand-held indirect calorimeter values, indicating poor agreement. A significant discrepancy between predicted and measured energy expenditure was observed. Further evaluation of hand-held indirect calorimeter research screening is needed.

Monitoring and Controlling Engineering and Construction Management Cost Performance Within the Corps of Engineers

DTIC Science & Technology

1988-12-01

COST MANAGEMENT The CMIF approach addresses total costs but does not permit the analysis of indirect costs. We found that indirect costs vary...responsibility USACE/divisions Increasing CMIF Districts/divisions level of by fund type detail G&A, technical indirect, burden Districts by fund type

Male and Female University Students' Experiences of Indirect Aggression

ERIC Educational Resources Information Center

Leenaars, Lindsey; Rinaldi, Christina M.

2010-01-01

This study examines the role of sex, gender role orientation, social representations of indirect aggression, and indicators of psychosocial adjustment in indirect aggression and victimization in an emerging adult sample. A total of 42 participants (19 men, 23 women) recruited are required to complete the questionnaires, along with 18 participants…

Mitigating Undesignated Trail Use: The Efficacy of Messaging and Direct Site Management Actions in an Urban-Proximate Open Space Context.

PubMed

Schwartz, F; Taff, B D; Lawhon, B; VanderWoude, D

2018-05-08

The use and creation of undesignated recreational trails can lead to erosion, vegetation damage, unsafe trail conditions, and impacts to local wildlife. The mitigation of undesignated trail use is typically addressed indirectly through minimum-impact visitor education programs such as Leave No Trace, or directly through closures or sanctions. In this study, researchers collaborated with City of Boulder, Colorado Open Space and Mountain Parks (OSMP) staff to develop a quasi-experimental field study that examined the effectiveness of indirect (messaging) and direct (barriers) management approaches to mitigating undesignated trail use. The study applied a Theory of Planned Behavior framework, utilized Leave No Trace messaging, and employed a method to pair survey and direct observation data. A total of 2232 visitor parties were observed, and 147 surveys were collected. The combined direct (barrier) and indirect (messaging) intervention was the most effective at mitigating undesignated trail use. Implications for management and future research are discussed.

The mediating effect of effort-reward imbalance in household and family work on the relationship between education and women's health.

PubMed

Sperlich, Stefanie; Geyer, Siegfried

2015-04-01

Occupational stress as a key determinant for explaining health inequalities has been well established while the impact of stress related to family work has rarely been considered. This study investigates whether stress in household and family work may contribute to health inequalities in women. We used a population-based sample of German mothers (n = 3129) to determine the total, direct and indirect effects of education on somatic complaints by means of OLS regression-based mediation models. Inference about indirect effects was determined by 95% bias corrected bootstrap confidence intervals. Education was assessed by a measure combining school education and vocational training. Stress was measured using the adopted effort-reward-imbalance (ERI) questionnaire for household and family work. The von Zerssen list of somatic complaints was used as measure of subjective health. We found a significant total effect of education on somatic complaints (p ≤ 0.001) as well as significant indirect effects through 'effort' (p = 0.006) and 'reward' in household and family work (p ≤ 0.001). However, the subscales of ERI pointed into different directions: while levels of 'effort' increased with women's educational attainment, levels of distress related to low 'reward' decreased with higher levels of education. Our findings suggest that the effect of women's education on somatic complaints is mediated through stress related to low reward for household and family work. In particular, lack of 'societal esteem' for household and family work contributed to health disadvantages in lower educated mothers. We conclude that research on health inequality would benefit from taking stressful experiences in household and family work greater into account. Copyright © 2015 Elsevier Ltd. All rights reserved.

The cost of care of rheumatoid arthritis and ankylosing spondylitis patients in tertiary care rheumatology units in Turkey.

PubMed

Malhan, Simten; Pay, Salih; Ataman, Sebnem; Dalkilic, Ediz; Dinc, Ayhan; Erken, Eren; Ertenli, Ihsan; Ertugrul, Esin; Gogus, Feride; Hamuryudan, Vedat; Inanc, Murat; Karaarslan, Yasar; Karadag, Omer; Karakoc, Yuksel; Keskin, Goksal; Kisacik, Bunyamin; Kiraz, Sedat; Oksel, Fahrettin; Oksuz, Ergun; Pirildar, Timur; Sari, Ismail; Soy, Mehmet; Senturk, Taskin; Taylan, Ali

2012-01-01

To determine the direct and indirect costs due to rheumatoid arthritis (RA) and ankylosing spondylitis (AS) patients in Turkey. An expert panel was convened to estimate the direct and indirect costs of care of patients with RA and AS in Turkey. The panel was composed of 22 experts chosen from all national tertiary care rheumatology units (n=53). To calculate direct costs, the medical management of RA and AS patients was estimated using 'cost-of-illness' methodology. To measure indirect costs, the number of days of sick leave, the extent of disability, and the levels of early retirement and early death were also evaluated. Lost productivity costs were calculated using the 'human capital approach', based on the minimum wage. The total annual direct costs were 2,917.03 Euros per RA patient and 3,565.9 Euros for each AS patient. The direct costs were thus substantial, but the indirect costs were much higher because of extensive morbidity and mortality rates. The total annual indirect costs were 7,058.99 Euros per RA patient and 6,989.81 for each AS patient. Thus, the total cost for each RA patient was 9,976.01 Euros and that for an AS patient 10,555.72 Euros, in Turkey. From the societal perspective, both RA and AS have become burden in Turkey. The cost of lost productivity is higher than the medical cost. Another important conclusion is that indirect costs constitute 70% and 66% of total costs in patients with RA and AS, respectively.

Optical Properties of Aeolian Dusts Common to West Texas

USDA-ARS?s Scientific Manuscript database

Both recent models and historical events such as the Dust Bowl and volcanic eruptions have illustrated aerosols can play a significant role in climate change through direct and indirect optical effects. Soil dust aerosols generated by Aeolian processes represent a significant fraction of the total ...

Interactive Nature of Climate Change and Aerosol Forcing

NASA Technical Reports Server (NTRS)

Nazarenko, L.; Rind, D.; Tsigaridis, K.; Del Genio, A. D.; Kelley, M.; Tausnev, N.

2017-01-01

The effect of changing cloud cover on climate, based on cloud-aerosol interactions, is one of the major unknowns for climate forcing and climate sensitivity. It has two components: (1) the impact of aerosols on clouds and climate due to in-situ interactions (i.e., rapid response); and (2) the effect of aerosols on the cloud feedback that arises as climate changes - climate feedback response. We examine both effects utilizing the NASA GISS ModelE2 to assess the indirect effect, with both mass-based and microphysical aerosol schemes, in transient twentieth-century simulations. We separate the rapid response and climate feedback effects by making simulations with a coupled version of the model as well as one with no sea surface temperature or sea ice response (atmosphere-only simulations). We show that the indirect effect of aerosols on temperature is altered by the climate feedbacks following the ocean response, and this change differs depending upon which aerosol model is employed. Overall the effective radiative forcing (ERF) for the direct effect of aerosol-radiation interaction (ERFari) ranges between -0.2 and -0.6 W/sq m for atmosphere-only experiments while the total effective radiative forcing, including the indirect effect (ERFari+aci) varies between about -0.4 and -1.1 W/sq m for atmosphere-only simulations; both ranges are in agreement with those given in IPCC (2013). Including the full feedback of the climate system lowers these ranges to -0.2 to -0.5 W/sq m for ERFari, and -0.3 to -0.74 W/sq m for ERFari+aci. With both aerosol schemes, the climate change feedbacks have reduced the global average indirect radiative effect of atmospheric aerosols relative to what the emission changes would have produced, at least partially due to its effect on tropical upper tropospheric clouds.

The unique effects of angry and depressive rumination on eating-disorder psychopathology and the mediating role of impulsivity.

PubMed

Wang, Shirley B; Borders, Ashley

2018-04-01

Negative affect and maladaptive emotion regulation strategies are associated with eating-disorder (ED) psychopathology. Depressive rumination is a maladaptive cognitive style associated with the onset, maintenance, and severity of ED psychopathology among both clinical and nonclinical samples. However, although anger is also strongly associated with ED behaviors, the associations between angry rumination and ED psychopathology, as well as mechanisms of the relationships between rumination and ED psychopathology, remain largely unknown. The current study sought to examine the unique influences of trait depressive and angry rumination on ED psychopathology and whether trait negative urgency (i.e., responding rashly to negative affect) mediated these relationships. Study 1 sampled undergraduate students (N = 119) cross-sectionally and longitudinally (five months), and Study 2 sampled patients with eating disorders (N = 85). All participants completed questionnaires assessing angry rumination, depressive rumination, ED psychopathology, and negative urgency. Angry rumination had consistent indirect effects on ED psychopathology via negative urgency among both clinical and nonclinical samples. However, there was mixed support for the influence of depressive rumination: whereas depressive rumination showed total and indirect effects on ED psychopathology in Study 1 cross-sectional analyses, no total or indirect effects emerged in Study 1 longitudinal analyses or in Study 2. Associations between depressive rumination and ED psychopathology may reflect the strong overlap between angry and depressive rumination. Interventions targeting angry rumination and negative urgency may enhance prevention and treatment of disordered eating across eating disorder diagnosis and severity. Copyright © 2018 Elsevier Ltd. All rights reserved.

The Obesity Paradox in Recurrent Attacks of Gout in Observational Studies: Clarification and Remedy

PubMed Central

Nguyen, Uyen-Sa D. T.; Zhang, Yuqing; Louie-Gao, Qiong; Niu, Jingbo; Felson, David T.; LaValley, Michael P.; Choi, Hyon K.

2016-01-01

Objective Obesity is strongly associated with incident gout risk; its association with risk of recurrent gout attacks has been null or weak, constituting an obesity paradox. We sought to demonstrate and overcome the methodologic issues associated with the obesity paradox for risk of recurrent gout attacks. Methods Using the MRFIT database, we decomposed the total effect of obesity into its direct and indirect (i.e., mediated) effects using marginal structural models. We also estimated the total effect of BMI change from baseline among incident gout patients. Results Of 11,816 gout-free subjects at baseline, we documented 408 incident gout cases, with 132 developing recurrent gout attacks over a 7-year follow-up. The adjusted odds ratio (OR) for incident gout among obese individuals was 2.6, while that for recurrent gout attacks among gout patients was 0.98 (i.e., the obesity paradox). These ORs correlated well with the ORs for the indirect and direct effects of obesity on risk of recurrent gout attacks (i.e., 2.83 and 0.98, respectively). Compared with no BMI change, the OR of losing vs. gaining >5% of baseline BMI was 0.61 and 1.60 for recurrent gout attacks, respectively (P for trend <0.01), suggesting a dose-response association. Conclusion The obesity paradox for risk of recurrent gout attacks is explained by the absence of the direct effect, which is often measured in conventional analyses and misinterpreted as the intended total effect of interest. In contrast, the BMI change analysis correctly estimated the intended total effect of BMI, and revealed a dose-response relationship. PMID:27331767

Direct and indirect effects of glomalin, mycorrhizal hyphae, and roots on aggregate stability in rhizosphere of trifoliate orange

PubMed Central

Wu, Qiang-Sheng; Cao, Ming-Qin; Zou, Ying-Ning; He, Xin-hua

2014-01-01

To test direct and indirect effects of glomalin, mycorrhizal hyphae, and roots on aggregate stability, perspex pots separated by 37-μm nylon mesh in the middle were used to form root-free hyphae and root/hyphae chambers, where trifoliate orange (Poncirus trifoliata) seedlings were colonized by Funneliformis mosseae or Paraglomus occultum in the root/hyphae chamber. Both fungal species induced significantly higher plant growth, root total length, easily-extractable glomalin-related soil protein (EE-GRSP) and total GRSP (T-GRSP), and mean weight diameter (an aggregate stability indicator). The Pearson correlation showed that root colonization or soil hyphal length significantly positively correlated with EE-GRSP, difficultly-extractable GRSP (DE-GRSP), T-GRSP, and water-stable aggregates in 2.00–4.00, 0.50–1.00, and 0.25–0.50 mm size fractions. The path analysis indicated that in the root/hyphae chamber, aggregate stability derived from a direct effect of root colonization, EE-GRSP or DE-GRSP. Meanwhile, the direct effect was stronger by EE-GRSP or DE-GRSP than by mycorrhizal colonization. In the root-free hyphae chamber, mycorrhizal-mediated aggregate stability was due to total effect but not direct effect of soil hyphal length, EE-GRSP and T-GRSP. Our results suggest that GRSP among these tested factors may be the primary contributor to aggregate stability in the citrus rhizosphere. PMID:25059396

A structural equation modeling approach to understanding pathways that connect socioeconomic status and smoking.

PubMed

Martinez, Sydney A; Beebe, Laura A; Thompson, David M; Wagener, Theodore L; Terrell, Deirdra R; Campbell, Janis E

2018-01-01

The inverse association between socioeconomic status and smoking is well established, yet the mechanisms that drive this relationship are unclear. We developed and tested four theoretical models of the pathways that link socioeconomic status to current smoking prevalence using a structural equation modeling (SEM) approach. Using data from the 2013 National Health Interview Survey, we selected four indicator variables (poverty ratio, personal earnings, educational attainment, and employment status) that we hypothesize underlie a latent variable, socioeconomic status. We measured direct, indirect, and total effects of socioeconomic status on smoking on four pathways through four latent variables representing social cohesion, financial strain, sleep disturbance, and psychological distress. Results of the model indicated that the probability of being a smoker decreased by 26% of a standard deviation for every one standard deviation increase in socioeconomic status. The direct effects of socioeconomic status on smoking accounted for the majority of the total effects, but the overall model also included significant indirect effects. Of the four mediators, sleep disturbance and psychological distress had the largest total effects on current smoking. We explored the use of structural equation modeling in epidemiology to quantify effects of socioeconomic status on smoking through four social and psychological factors to identify potential targets for interventions. A better understanding of the complex relationship between socioeconomic status and smoking is critical as we continue to reduce the burden of tobacco and eliminate health disparities related to smoking.

A structural equation modeling approach to understanding pathways that connect socioeconomic status and smoking

PubMed Central

Beebe, Laura A.; Thompson, David M.; Wagener, Theodore L.; Terrell, Deirdra R.; Campbell, Janis E.

2018-01-01

The inverse association between socioeconomic status and smoking is well established, yet the mechanisms that drive this relationship are unclear. We developed and tested four theoretical models of the pathways that link socioeconomic status to current smoking prevalence using a structural equation modeling (SEM) approach. Using data from the 2013 National Health Interview Survey, we selected four indicator variables (poverty ratio, personal earnings, educational attainment, and employment status) that we hypothesize underlie a latent variable, socioeconomic status. We measured direct, indirect, and total effects of socioeconomic status on smoking on four pathways through four latent variables representing social cohesion, financial strain, sleep disturbance, and psychological distress. Results of the model indicated that the probability of being a smoker decreased by 26% of a standard deviation for every one standard deviation increase in socioeconomic status. The direct effects of socioeconomic status on smoking accounted for the majority of the total effects, but the overall model also included significant indirect effects. Of the four mediators, sleep disturbance and psychological distress had the largest total effects on current smoking. We explored the use of structural equation modeling in epidemiology to quantify effects of socioeconomic status on smoking through four social and psychological factors to identify potential targets for interventions. A better understanding of the complex relationship between socioeconomic status and smoking is critical as we continue to reduce the burden of tobacco and eliminate health disparities related to smoking. PMID:29408939

Social Cognitive Theory and Physical Activity Among Korean Male High-School Students.

PubMed

Lee, Chung Gun; Park, Seiyeong; Lee, Seung Hwan; Kim, Hyunwoo; Park, Ji-Won

2018-02-01

The most critical step in developing and implementing effective physical activity interventions is to understand the determinants and correlates of physical activity, and it is strongly suggested that such effort should be based on theories. The purpose of this study is to test the direct, indirect, and total effect of social cognitive theory constructs on physical activity among Korean male high-school students. Three-hundred and forty-one 10th-grade male students were recruited from a private single-sex high school located in Seoul, South Korea. Structural equation modeling was used to test the expected relationships among the latent variables. The proposed model accounted for 42% of the variance in physical activity. Self-efficacy had the strongest total effect on physical activity. Self-efficacy for being physically active was positively associated with physical activity ( p < .01). Self-efficacy also had positive indirect effects on physical activity through perceived benefits ( p < .05) and goal setting ( p < .01). The results of this study indicated that the social cognitive theory is a useful framework to understand physical activity among Korean male adolescents. Physical activity interventions targeting Korean male high-school students should focus on the major sources of efficacy.

Not just sticks and stones: Indirect ethnic discrimination leads to greater physiological reactivity.

PubMed

Huynh, Virginia W; Huynh, Que-Lam; Stein, Mary-Patricia

2017-07-01

We examined the effect of indirect ethnic discrimination on physiological reactivity (i.e., cortisol, blood pressure, heart rate) in Latino emerging adults. Participants (N = 32) were randomly assigned to be exposed to indirect ethnic discrimination (experimental condition) or not (control condition) while undergoing a cognitive stress task. Greater total cortisol output was observed in participants in the experimental condition, relative to those in the control condition. No significant differences in heart rate or blood pressure were noted. Results suggest that witnessing ethnic discrimination affects cortisol recovery responses, but not cardiovascular reactivity. Words that are not intentionally hurtful or directed at a specific person may still "hurt"-affecting biological processes associated with hypothalamic-pituitary-adrenocortical (HPA) axis and potentially leading to long-term health consequences. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Cost-of-Illness Analysis of Type 2 Diabetes Mellitus in Iran

PubMed Central

Javanbakht, Mehdi; Baradaran, Hamid R.; Mashayekhi, Atefeh; Haghdoost, Ali Akbar; Khamseh, Mohammad E.; Kharazmi, Erfan; Sadeghi, Aboozar

2011-01-01

Introduction Diabetes is a worldwide high prevalence chronic progressive disease that poses a significant challenge to healthcare systems. The aim of this study is to provide a detailed economic burden of diagnosed type 2 diabetes mellitus (T2DM) and its complications in Iran in 2009 year. Methods This is a prevalence-based cost-of-illness study focusing on quantifying direct health care costs by bottom-up approach. Data on inpatient hospital services, outpatient clinic visits, physician services, drugs, laboratory test, education and non-medical cost were collected from two national registries. The human capital approach was used to calculate indirect costs separately in male and female and also among different age groups. Results The total national cost of diagnosed T2DM in 2009 is estimated at 3.78 billion USA dollars (USD) including 2.04±0.28 billion direct (medical and non-medical) costs and indirect costs of 1.73 million. Average direct and indirect cost per capita was 842.6±102 and 864.8 USD respectively. Complications (48.9%) and drugs (23.8%) were main components of direct cost. The largest components of medical expenditures attributed to diabetes's complications are cardiovascular disease (42.3% of total Complications cost), nephropathy (23%) and ophthalmic complications (14%). Indirect costs include temporarily disability (335.7 million), permanent disability (452.4 million) and reduced productivity due to premature mortality (950.3 million). Conclusions T2DM is a costly disease in the Iran healthcare system and consume more than 8.69% of total health expenditure. In addition to these quantified costs, T2DM imposes high intangible costs on society in terms of reduced quality of life. Identification of effective new strategies for the control of diabetes and its complications is a public health priority. PMID:22066013

On the characteristics of aerosol indirect effect based on dynamic regimes in global climate models

DOE PAGES

Zhang, Shipeng; Wang, Minghuai; Ghan, Steven J.; ...

2016-03-04

Aerosol–cloud interactions continue to constitute a major source of uncertainty for the estimate of climate radiative forcing. The variation of aerosol indirect effects (AIE) in climate models is investigated across different dynamical regimes, determined by monthly mean 500 hPa vertical pressure velocity ( ω 500), lower-tropospheric stability (LTS) and large-scale surface precipitation rate derived from several global climate models (GCMs), with a focus on liquid water path (LWP) response to cloud condensation nuclei (CCN) concentrations. The LWP sensitivity to aerosol perturbation within dynamic regimes is found to exhibit a large spread among these GCMs. It is in regimes of strongmore » large-scale ascent ( ω 500  <  −25 hPa day −1) and low clouds (stratocumulus and trade wind cumulus) where the models differ most. Shortwave aerosol indirect forcing is also found to differ significantly among different regimes. Shortwave aerosol indirect forcing in ascending regimes is close to that in subsidence regimes, which indicates that regimes with strong large-scale ascent are as important as stratocumulus regimes in studying AIE. It is further shown that shortwave aerosol indirect forcing over regions with high monthly large-scale surface precipitation rate (> 0.1 mm day −1) contributes the most to the total aerosol indirect forcing (from 64 to nearly 100 %). Results show that the uncertainty in AIE is even larger within specific dynamical regimes compared to the uncertainty in its global mean values, pointing to the need to reduce the uncertainty in AIE in different dynamical regimes.« less

12 CFR 702.202 - Prompt corrective action for “undercapitalized” credit unions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... open new branches; (4) Restrict member business loans. Beginning the effective date of classification as “undercapitalized” or lower, not increase the total dollar amount of member business loans..., branching, new lines of business. Prohibit a credit union from, directly or indirectly, acquiring any...

Exposure to violent video games and aggression in German adolescents: a longitudinal analysis.

PubMed

Möller, Ingrid; Krahé, Barbara

2009-01-01

The relationship between exposure to violent electronic games and aggressive cognitions and behavior was examined in a longitudinal study. A total of 295 German adolescents completed the measures of violent video game usage, endorsement of aggressive norms, hostile attribution bias, and physical as well as indirect/relational aggression cross-sectionally, and a subsample of N=143 was measured again 30 months later. Cross-sectional results at T1 showed a direct relationship between violent game usage and aggressive norms, and an indirect link to hostile attribution bias through aggressive norms. In combination, exposure to game violence, normative beliefs, and hostile attribution bias predicted physical and indirect/relational aggression. Longitudinal analyses using path analysis showed that violence exposure at T1 predicted physical (but not indirect/relational) aggression 30 months later, whereas aggression at T1 was unrelated to later video game use. Exposure to violent games at T1 influenced physical (but not indirect/relational) aggression at T2 via an increase of aggressive norms and hostile attribution bias. The findings are discussed in relation to social-cognitive explanations of long-term effects of media violence on aggression. Copyright 2008 Wiley-Liss, Inc.

Efficacy and tolerability of brivaracetam compared to lacosamide, eslicarbazepine acetate, and perampanel as adjunctive treatments in uncontrolled focal epilepsy: Results of an indirect comparison meta-analysis of RCTs.

PubMed

Brigo, Francesco; Bragazzi, Nicola Luigi; Nardone, Raffaele; Trinka, Eugen

2016-11-01

Brivaracetam (BRV), eslicarbazepine acetate (ESL), lacosamide (LCM), and perampanel (PER) have been recently marketed as adjunctive treatments for focal onset seizures. To date, no randomized controlled trial (RCT) has directly compared BRV with ESL, LCM, or PER. To compare BRV with the other add-on AEDs in patients with uncontrolled focal epilepsy, estimating their efficacy and tolerability through an adjusted, common-reference based indirect comparison meta-analysis. We systematically searched RCTs in which add-on treatment with ESL or LCM in patients with focal onset seizures have been compared with placebo. Efficacy and tolerability outcomes were considered. Random-effects Mantel-Haenszel meta-analyses were performed to obtain odds ratios (ORs) for the efficacy of BRV, LCM, ESL, or PER versus placebo. Adjusted indirect comparisons were then made between BRV and the other three AEDs using the obtained results, comparing the minimum and the highest effective recommended daily dose of each drug. Seventeen RCTs, with a total of 4971 patients were included. After adjusting for dose-effects, indirect comparisons showed no difference between BRV and LCM, ESL, or PER for responder rate and seizure freedom. Lower adverse events were observed with high dose BRV compared to high dose ESL or PER, but no difference was found in withdrawing because of adverse events. Indirect comparisons do not demonstrate a significant difference in efficacy between add-on BRV and LCM, ESL, or PER in focal epilepsy, and might suggest a better tolerability of BRV than ESL, and possibly also PER, at the highest effective recommended dose. Copyright © 2016 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

Healthcare resource use, direct and indirect costs of hypoglycemia in type 1 and type 2 diabetes, and nationwide projections. Results of the HYPOS-1 study.

PubMed

Giorda, C B; Rossi, M C; Ozzello, O; Gentile, S; Aglialoro, A; Chiambretti, A; Baccetti, F; Gentile, F M; Romeo, F; Lucisano, G; Nicolucci, A

2017-03-01

To obtain an accurate picture of the total costs of hypoglycemia, including the indirect costs and comparing the differences between type 1 (T1DM) and type 2 diabetes mellitus (T2DM). HYPOS-1 was a multicenter, retrospective cohort study which analyzed the data of 2229 consecutive patients seen at 18 diabetes clinics. Data on healthcare resource use and indirect costs by diabetes type were collected via a questionnaire. The domains of inpatient admission and hospital stay, work days lost, and third-party assistance were also explored. Resource utilization was reported as estimated incidence rates (IRs) of hypoglycemic episodes per 100 person-years and estimated costs as IRs per person-years. For every 100 patients with T1DM, 9 emergency room (ER) visits and 6 emergency medical service calls for hypoglycemia were required per year; for every 100 patients with T2DM, 3 ER visits and 1 inpatient admission were required, with over 3 nights spent in hospital. Hypoglycemia led to 58 work days per 100 person-years lost by the patient or a family member in T1DM versus 19 in T2DM. The costs in T1DM totaled €90.99 per person-year and €62.04 in T2DM. Direct and indirect costs making up the total differed by type of diabetes (60% indirect costs in T1DM versus 43% in T2DM). The total cost associated with hypoglycemia in Italy is estimated to be €107 million per year. Indirect costs meaningfully contribute to the total costs associated with hypoglycemia. As compared with T1DM, T2DM requires fewer ER visits and incurs lower indirect costs but more frequent hospital use. Copyright © 2016 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

Grazing disturbance increases transient but decreases persistent soil seed bank.

PubMed

Ma, Miaojun; Walck, Jeffrey L; Ma, Zhen; Wang, Lipei; Du, Guozhen

2018-04-30

Very few studies have examined whether the impacts of grazing disturbance on soil seed banks occur directly or indirectly through aboveground vegetation and soil properties. The potential role of the seed bank in alpine wetland restoration is also unknown. We used SEM (structural equation modeling) to explore the direct effect of grazing disturbance on the seed bank and the indirect effect through aboveground vegetation and soil properties. We also studied the role of the seed bank on the restoration potential in wetlands with various grazing intensities: low (fenced, winter grazed only), medium (seasonally grazed), and high (whole-year grazed). For the seed bank, species richness and density per plot showed no difference among grazing intensities for each depth (0-5, 5-10, 10-15 cm) and for the whole depth (0-15 cm) in spring and summer. There was no direct effect of grazing disturbance on seed bank richness and density both in spring and summer, and also no indirect effect on the seed bank through its direct effect on vegetation richness and abundance. Grazing disturbance indirectly increased spring seed bank density but decreased summer seed bank density through its direct effect (negative correlation) on soil moisture and total nitrogen and its indirect effect on vegetation abundance. Species composition of the vegetation changed with grazing regime, but that of the seed bank did not. An increased trend of similarity between the seed bank and aboveground vegetation with increased grazing disturbance was found in the shallow depth and in the whole depth only in spring. Although there was almost no change in seed bank size with grazing intensities, grazing disturbance increased the quantity of transient seeds but decreased persistent seeds. Persistent seeds stored in the soil could play a crucial role in vegetation regeneration and in restoration of degraded wetland ecosystems. The seed bank should be an integral part of alpine wetland restoration programs. © 2018 by the Ecological Society of America.

European Union-28: An annualised cost-of-illness model for venous thromboembolism.

PubMed

Barco, Stefano; Woersching, Alex L; Spyropoulos, Alex C; Piovella, Franco; Mahan, Charles E

2016-04-01

Annual costs for venous thromboembolism (VTE) have been defined within the United States (US) demonstrating a large opportunity for cost savings. Costs for the European Union-28 (EU-28) have never been defined. A literature search was conducted to evaluate EU-28 cost sources. Median costs were defined for each cost input and costs were inflated to 2014 Euros (€) in the study country and adjusted for Purchasing Power Parity between EU countries. Adjusted costs were used to populate previously published cost-models based on adult incidence-based events. In the base model, annual expenditures for total, hospital-associated, preventable, and indirect costs were €1.5-2.2 billion, €1.0-1.5 billion, €0.5-1.1 billion and €0.2-0.3 billion, respectively (indirect costs: 12 % of expenditures). In the long-term attack rate model, total, hospital-associated, preventable, and indirect costs were €1.8-3.3 billion, €1.2-2.4 billion, €0.6-1.8 billion and €0.2-0.7 billion (indirect costs: 13 % of expenditures). In the multiway sensitivity analysis, annual expenditures for total, hospital-associated, preventable, and indirect costs were €3.0-8.5 billion, €2.2-6.2 billion, €1.1-4.6 billion and €0.5-1.4 billion (indirect costs: 22 % of expenditures). When the value of a premature life-lost increased slightly, aggregate costs rose considerably since these costs are higher than the direct medical costs. When evaluating the models aggregately for costs, the results suggests total, hospital-associated, preventable, and indirect costs ranging from €1.5-13.2 billion, €1.0-9.7 billion, €0.5-7.3 billion and €0.2-6.1 billion, respectively. Our study demonstrates that VTE costs have a large financial impact upon the EU-28's healthcare systems and that significant savings could be realised if better preventive measures are applied.

PTSD symptoms and suicide risk in veterans: Serial indirect effects via depression and anger.

PubMed

McKinney, Jessica M; Hirsch, Jameson K; Britton, Peter C

2017-05-01

Suicide rates are higher in veterans compared to the general population, perhaps due to trauma exposure. Previous literature highlights depressive symptoms and anger as contributors to suicide risk. PTSD symptoms may indirectly affect suicide risk by increasing the severity of such cognitive-emotional factors. A sample of community dwelling veterans (N=545) completed online surveys, including the PTSD Checklist-Military Version, Suicidal Behaviors Questionnaire-Revised, Multidimensional Health Profile-Psychosocial Functioning, and Differential Emotions Scale -IV. Bivariate and serial mediation analyses were conducted to test for direct and indirect effects of PTSD symptoms on suicide risk. In bivariate analyses, PTSD symptoms, depression, anger, and internal hostility were positively related to suicide risk. In serial mediation analyses, there was a significant total effect of PTSD symptoms on suicide risk in both models. PTSD symptoms were also indirectly related to suicidal behavior via depression and internal hostility, and via internal hostility alone. Anger was not a significant mediator. Our cross-sectional sample was predominantly White and male; prospective studies with diverse veterans are needed. Our findings may have implications for veteran suicide prevention. The effects of PTSD and depression on anger, particularly internal hostility, are related to suicide risk, suggesting a potential mechanism of action for the PTSD-suicide linkage. A multi-faceted therapeutic approach, targeting depression and internal hostility, via cognitive-behavioral techniques such as behavioral activation and cognitive restructuring, may reduce suicide risk in veterans who have experienced trauma. Copyright © 2017 Elsevier B.V. All rights reserved.

CHRNA5/A3/B4 Variant rs3743078 and Nicotine-Related Phenotypes: Indirect Effects Through Nicotine Craving

PubMed Central

Shmulewitz, Dvora; Meyers, Jacquelyn L.; Wall, Melanie M.; Aharonovich, Efrat; Frisch, Amos; Spivak, Baruch; Weizman, Abraham; Edenberg, Howard J.; Gelernter, Joel; hasin, Deborah S.

2016-01-01

Objective: Nicotine craving is considered an important element in the persistence of cigarette smoking, but little is known about the role of craving in the widely recognized association between variants mapped to the neuronal nicotinic acetylcholine receptor (CHRN) genes on chromosome 15 and nicotine phenotypes. Method: The associations between CHRNA5–CHRNA3–CHRNB4 variants and cigarettes per day (CPD), the Fagerström Test for Nicotine Dependence (FTND), and craving were analyzed in data from 662 lifetime smokers from an Israeli adult Jewish household sample. Indirect effects of genotype on nicotine phenotypes through craving were formally tested using regression and bootstrapping procedures. Results: At CHRNA3, allele G of rs3743078 was associated with increased craving, CPD, and FTND scores: Participants with one or two copies of the G allele had, on average, higher scores on the craving scale (p = .0025), more cigarettes smoked (p = .0057), and higher scores on the FTND (p = .0024). With craving in the model, variant rs3743078 showed a significant indirect effect through craving on CPD (p = .0026) and on FTND score (p = .0024). A sizeable proportion of the total rs3743078 effect on CPD (56.4%) and FTND (65.2%) was indirect through craving. Conclusions: These results suggest that nicotine craving may play a central role in nicotine use disorders and may have utility as a therapeutic target. PMID:26997181

[Variations of soil microbial community composition and enzyme activities with different salinities on Yuyao coast, Zhejiang, China].

PubMed

Sun, Hui; Zhang, Jian Feng; Xu, Hua Sen; Chen, Guang Cai; Wang, Li Ping

2016-10-01

In October 2015, soil samples with different salinity were collected in a coast area in Yuyao, Zhejiang, and soil microbial community composition, soil catalase, urease activities, as well as soil physical and chemical properties were studied. The results showed that Nitrospira took absolute advantage in the bacterial community, and showed good correlations to total potassium. Cladosporium and Fusarium were predominant in the fungal community. Meanwhile, Cladosporium was related to soil urease and total nitrogen, and same correlation was found between Fusarium and soil urease. Catalase activity ranged from 3.52 to 4.56 mL·g -1 , 3.08 to 4.61 mL·g -1 and 5.81 to 6.91 mL·g -1 for soils with heavy, medium and weak salinity, respectively. Catalase activity increased with the soil layer deepening, which was directly related to soil total potassium, and indirectly related to pH, organic matter, total nitrogen and total phosphorus through total potassium. Soil urease activity ranged among 0.04 to 0.52 mg·g -1 , 0.08 to 1.07 mg·g -1 and 0.27 to 8.21 mg·g -1 for each saline soil, respectively. Urease activity decreased with soil layer deepening which was directly related to soil total nitrogen, and was indirectly related to pH, organic matter and total potassium through total nitrogen. The total phosphorus was the largest effect factor on the bacterial community CCA ordination, and the urease was on fungal community.

The role of prenatal exposures on body fat patterns at 7 years: Intrauterine programming or birthweight effects?

PubMed

Santos, S; Severo, M; Gaillard, R; Santos, A C; Barros, H; Oliveira, A

2016-11-01

It remains unknown whether the effects of prenatal exposures on child's adiposity reflect entirely intrauterine programming. We aimed to assess the effects of maternal gestational weight gain, diabetes and smoking on the child's body fat patterns, disentangling the direct (through intrauterine programming) and indirect (through birthweight) effects. We included 4747 singleton 7-year-old children from the Generation XXI birth cohort (Porto, Portugal). At birth, maternal and newborn's characteristics were obtained. Anthropometrics were measured at age 7 years and body fat patterns were identified by principal component analysis. Path analysis was used to quantify direct, indirect and total effects of gestational weight gain, diabetes and smoking on body fat patterns. Pattern 1 was characterized by strong factor loadings with body mass index, fat mass index and waist-to-height ratio (fat quantity) and pattern 2 with waist-to-hip ratio, waist-to-thigh ratio, and waist-to-weight ratio (fat distribution). The positive total effect of maternal gestational weight gain and diabetes on the child's fat quantity was mainly through a direct pathway, responsible for 91.7% and 83.7% of total effects, respectively (β = 0.022; 95% Confidence Interval (CI): 0.017, 0.027; β = 0.041; 95% CI: -0.011, 0.093). No effects on fat distribution were found. Maternal prenatal smoking had a positive direct effect on patterns 1 and 2, explaining 94.9% and 76.1% of total effects, respectively. The effects of maternal gestational weight gain, diabetes and smoking on a child's fat quantity seem to be mainly through intrauterine programming. Maternal smoking also showed a positive direct effect on child's fat distribution. Copyright © 2016 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

[Evaluation of Direct and Indirect Expenditures for Management of Patients With Stable Ischemic Heart Disease After Stenting of Coronary Arteries].

PubMed

Sveshnikova, N D; Paleev, F N

2016-03-01

Assessment of cost of management of patients during 1 year after stenting of coronary arteries has shown that priority should be given to active introduction into practical health care of technologies increasing duration of life and lowering probability of invalidization. We stress the need for evaluation of indirect expenditures on patients care because of their substantial share in the total cost. We also consider essential to elaborate measures of state regulation of medication supply irrespective of type of treatment for shifting expenditures from hospital to ambulatory sector and improvement of effectiveness of pharmacotherapy.

Inverse odds ratio-weighted estimation for causal mediation analysis.

PubMed

Tchetgen Tchetgen, Eric J

2013-11-20

An important scientific goal of studies in the health and social sciences is increasingly to determine to what extent the total effect of a point exposure is mediated by an intermediate variable on the causal pathway between the exposure and the outcome. A causal framework has recently been proposed for mediation analysis, which gives rise to new definitions, formal identification results and novel estimators of direct and indirect effects. In the present paper, the author describes a new inverse odds ratio-weighted approach to estimate so-called natural direct and indirect effects. The approach, which uses as a weight the inverse of an estimate of the odds ratio function relating the exposure and the mediator, is universal in that it can be used to decompose total effects in a number of regression models commonly used in practice. Specifically, the approach may be used for effect decomposition in generalized linear models with a nonlinear link function, and in a number of other commonly used models such as the Cox proportional hazards regression for a survival outcome. The approach is simple and can be implemented in standard software provided a weight can be specified for each observation. An additional advantage of the method is that it easily incorporates multiple mediators of a categorical, discrete or continuous nature. Copyright © 2013 John Wiley & Sons, Ltd.

The coincidence of daily rainfall events in Liberia, Costa Rica and tropical cyclones in the Caribbean basin

NASA Astrophysics Data System (ADS)

Waylen, Peter R.; Harrison, Michael

2005-10-01

The occurrence of tropical cyclones in the Caribbean and North Atlantic basins has been previously noted to have a significant effect both upon individual hydro-climatological events as well as on the quantity of annual precipitation experienced along the Pacific flank of Central America. A methodology for examining the so-called indirect effects of tropical cyclones (i.e. those effects resulting from a tropical cyclone at a considerable distance from the area of interest) on a daily rainfall record is established, which uses a variant of contingency table analysis. The method is tested using a single station on the Pacific slope of Costa Rica. Employing daily precipitation records from Liberia, north-western Costa Rica (1964-1995), and historic storm tracks of tropical cyclones in the North Atlantic, it is determined that precipitation falling in coincidence with the passage of tropical depressions, tropical storms, and hurricanes accounts for approximately 15% of average annual precipitation. The greatest effects are associated with storms passing within 1300 km of the precipitation station, and are most apparent in the increased frequency of daily rainfall totals in the range of 40-60 mm, rather than in the largest daily totals. The complexity and nonstationarity of factors affecting precipitation in this region are reflected in the decline in the number of tropical cyclones and their significance to annual precipitation totals after 1980, simultaneous to an increase in annual precipitation totals. The methodology employed in this study is shown to be a useful tool in illuminating the indirect effects of tropical cyclones in the region, with the potential for application in other areas.

Estimating the indirect costs associated with the expected number of cancer cases in Mexico by 2020.

PubMed

Gutiérrez-Delgado, Cristina; Armas-Texta, Daniel; Reynoso-Noverón, Nancy; Meneses-García, Abelardo; Mohar-Betancourt, Alejandro

2016-04-01

To estimate the indirect costs generated by adults with cancer in Mexico from 2002-2020. Using information from national sources and the national cancer incidence from GLOBOCAN, we estimated income lost due to premature death (ILPD), short-term benefits (STBs), disability pensions (DPs), and opportunity costs for the carer (OCCs) generated by patients with cancer. Amounts were reported in Mexican pesos. We estimated 23 359 deaths and 216 679 new cases of cancer by 2020, which would be associated with a total indirect cost of 20.15 billion Mexican pesos. Men are expected to generate 54.9% of these costs. ILPD is expected to comprise the highest percentage of the cost (60%), followed by OCCs (22%), STBs (17%) and DPs (1%). From an economic perspective, the results emphasize the need to strengthen preventive interventions and early detection of cancer among adults to reduce its effect on the productivity of Mexico.

Assessment of socioeconomic costs to China's air pollution

NASA Astrophysics Data System (ADS)

Xia, Yang; Guan, Dabo; Jiang, Xujia; Peng, Liqun; Schroeder, Heike; Zhang, Qiang

2016-08-01

Particulate air pollution has had a significant impact on human health in China and it is associated with cardiovascular and respiratory diseases and high mortality and morbidity. These health impacts could be translated to reduced labor availability and time. This paper utilized a supply-driven input-output (I-O) model to estimate the monetary value of total output losses resulting from reduced working time caused by diseases related to air pollution across 30 Chinese provinces in 2007. Fine particulate matter (PM2.5) pollution was used as an indicator to assess impacts to health caused by air pollution. The developed I-O model is able to capture both direct economic costs and indirect cascading effects throughout inter-regional production supply chains and the indirect effects greatly outnumber the direct effects in most Chinese provinces. Our results show the total economic losses of 346.26 billion Yuan (approximately 1.1% of the national GDP) based on the number of affected Chinese employees (72 million out of a total labor population of 712 million) whose work time in years was reduced because of mortality, hospital admissions and outpatient visits due to diseases resulting from PM2.5 air pollution in 2007. The loss is almost the annual GDP of Vietnam in 2010. The proposed modelling approach provides an alternative method for health-cost measurement with additional insights on inter-industrial and inter-regional linkages along production supply chains.

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

Campbell, John; Carena, Marcela; Harnik, Roni

We consider interference between the Higgs signal and QCD background inmore » $$gg\\rightarrow h \\rightarrow \\gamma\\gamma$$ and its effect on the on-shell Higgs rate. The existence of sizable strong phases leads to destructive interference of about 2% of the on-shell cross section in the Standard Model. This effect can be enhanced by beyond the standard model physics. In particular, since it scales differently from the usual rates, the presence of interference allows indirect limits to be placed on the Higgs width in a novel way, using on-shell rate measurements. Our study motivates further QCD calculations to reduce uncertainties. We discuss potential width-sensitive observables, both using total and differential rates and find that the HL-LHC can potentially indirectly probe widths of order tens of MeV.« less

Relationships among Humour, Self-Esteem, and Social Support to Burnout in School Teachers

ERIC Educational Resources Information Center

Ho, Sammy K.

2016-01-01

This study examined the total, direct, and indirect effects of humour on burnout among 539 school teachers. As predicted, those with high humour reported significantly lower levels of emotional exhaustion and depersonalisation but higher levels of personal accomplishment. Self-esteem consistently explained parts of the associations between humour…

Greenhouse gas emissions for refrigerant choices in room air conditioner units.

PubMed

Galka, Michael D; Lownsbury, James M; Blowers, Paul

2012-12-04

In this work, potential replacement refrigerants for window-mounted room air conditioners (RACs) in the U.S. have been evaluated using a greenhouse gas (GHG) emissions analysis. CO(2)-equivalent emissions for several hydrofluoroethers (HFEs) and other potential replacements were compared to the most widely used refrigerants today. Included in this comparison are pure refrigerants that make up a number of hydrofluorocarbon (HFC) mixtures, pure hydrocarbons, and historically used refrigerants such as propane and ammonia. GHG emissions from direct and indirect sources were considered in this thermodynamic analysis. Propylene, dimethyl ether, ammonia, R-152a, propane, and HFE-152a all performed effectively in a 1 ton window unit and produced slightly lower emissions than the currently used R-22 and R-134a. The results suggest that regulation of HFCs in this application would have some effect on reducing emissions since end-of-life emissions remain at 55% of total refrigerant charge despite EPA regulations that mandate 80% recovery. Even so, offsite emissions due to energy generation dominate over direct GHG emissions and all the refrigerants perform similarly in totals of indirect GHG emissions.

Direct and mediated effects of language and cognitive skills on comprehension of oral narrative texts (listening comprehension) for children.

PubMed

Kim, Young-Suk Grace

2016-01-01

We investigated component language and cognitive skills of oral language comprehension of narrative texts (i.e., listening comprehension). Using the construction-integration model of text comprehension as an overarching theoretical framework, we examined direct and mediated relations of foundational cognitive skills (working memory and attention), foundational language skills (vocabulary and grammatical knowledge), and higher-order cognitive skills (inference, theory of mind, and comprehension monitoring) to listening comprehension. A total of 201 first grade children in South Korea participated in the study. Structural equation modeling results showed that listening comprehension is directly predicted by working memory, grammatical knowledge, inference, and theory of mind and is indirectly predicted by attention, vocabulary, and comprehension monitoring. The total effects were .46 for working memory, .07 for attention, .30 for vocabulary, .49 for grammatical knowledge, .31 for inference, .52 for theory of mind, and .18 for comprehension monitoring. These results suggest that multiple language and cognitive skills make contributions to listening comprehension, and their contributions are both direct and indirect. Copyright © 2015 Elsevier Inc. All rights reserved.

Incremental direct and indirect cost burden attributed to endometriosis surgeries in the United States.

PubMed

Soliman, Ahmed M; Taylor, Hugh S; Bonafede, Machaon; Nelson, James K; Castelli-Haley, Jane

2017-05-01

To compare direct and indirect costs between endometriosis patients who underwent endometriosis-related surgery (surgery cohort) and those who have not received surgery (no-surgery cohort). Retrospective cohort study. Not applicable. Endometriosis patients (aged 18-49 years) with (n = 124,530) or without (n = 37,106) a claim for endometriosis-related surgery were identified from the Truven Health MarketScan Commercial and Health and Productivity Management databases for 2006-2014. Not applicable. Primary outcomes were healthcare utilization during 12-month pre- and post-index periods, annual direct (healthcare) and indirect (absenteeism and short- and long-term disability) costs during the 12-month post-index period (in 2014 US dollars). Indirect costs were assessed for patients with available productivity data. Patients in the surgery cohort had significantly higher healthcare resource utilization during the post-index period and had mean annual total adjusted post-index direct costs approximately three times the costs among patients in the no-surgery cohort ($19,203 [SD $7,133] vs. $6,365 [SD $2,364]; average incremental annual direct cost = $12,838). The mean cost of surgery ($7,268 [SD $7,975]) was the single largest contributor to incremental annual direct cost. Mean estimated annual total indirect costs were $8,843 (surgery cohort) vs. $5,603 (no-surgery cohort); average incremental annual indirect cost = $3,240. Endometriosis patients who underwent surgery, compared with endometriosis patients who did not, incurred significantly higher direct costs due to healthcare utilization and indirect costs due to absenteeism or short-term disability. Regardless of the surgery type, the cost of index surgery contributed substantially to the total healthcare expenditure. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Direct and indirect effects of the temperament and character on alexithymia: a pathway analysis with mood and anxiety.

PubMed

Lee, Yu Jin; Yu, Seung-Hee; Cho, Seong-Jin; Cho, In Hee; Koh, Seung-Hee; Kim, Seog Ju

2010-01-01

We aimed to assess the pathway from personality to alexithymia through mood and anxiety as mediators. Three hundred thirty-four subjects (130 male), whose psychiatric health was verified by Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Axis I disorders, completed the Toronto Alexithymia Scale-20 (TAS-20), the Temperament and Character Inventory, the State-Trait Anxiety Inventory (STAI), and the Center for Epidemiological Studies-Depression scale (CES-D). The schematic models for the pathway analysis from Temperament and Character Inventory (TCI) to TAS-20 scores were made. Low reward dependence (RD), low self-directedness (S-D), and high cooperativeness (CO) had paths to TAS-20 total (P = .000, P = .000, and P = .042, respectively). S-D had also an indirect path via STAI-state to TAS total. On TAS-20 factor 1, low RD, low S-D, and high self-transcendence (ST) had direct effects (P = .004, P = .000, and P = .000, respectively). S-D had also an indirect path via STAI-state and (CES-D) on TAS-20 factor 1. On TAS factor 2, low novelty seeking (NS), high harm avoidance (HA), low RD, low S-D, and high cooperativeness (CO) had direct effects (P = .005, P = .011, P = .000, P = .000, and P = .004, respectively). On TAS-20 factor 3, low RD and S-D had direct effects (P = .002 and P = .000, respectively). Current results suggest that although alexithymia is affected by the personality, state-dependent mood and anxiety may mediate the relationship between alexithymia and personality. Copyright 2009 Elsevier Inc. All rights reserved.

Aerosol direct and indirect radiative effect over Eastern Mediterranean

NASA Astrophysics Data System (ADS)

Georgoulias, Aristeidis; Alexandri, Georgia; Zanis, Prodromos; Ntogras, Christos; Poeschl, Ulrich; Kourtidis, Kostas

In this work, we present results from the QUADIEEMS project which is focused on the aerosol-cloud relations and the aerosol direct and indirect radiative effect over the region of Eastern Mediterranean. First, a gridded dataset at a resolution of 0.1x0.1 degrees (~10km) with aerosol and cloud related parameters was compiled, using level-2 satellite observations from MODIS TERRA (3/2000-12/2012) and AQUA (7/2002-12/2012). The aerosol gridded dataset has been validated against sunphotometric measurements from 12 AERONET ground stations, showing that generally MODIS overestimates aerosol optical depth (AOD550). Then, the AOD550 and fine mode ratio (FMR550) data from MODIS were combined with aerosol index (AI) data from the Earth Probe TOMS and OMI satellite sensors, wind field data from the ERA-interim reanalysis and AOD550 data for various aerosol types from the GOCART model and the MACC reanalysis to quantify the relative contribution of different aerosol types (marine, dust, anthropogenic, fine-mode natural) to the total AOD550. The aerosol-cloud relations over the region were investigated with the use of the joint high resolution aerosol-cloud gridded dataset. Specifically, we focused on the seasonal relations between the cloud droplet number concentration (CDNC) and AOD550. The aerosol direct and first indirect radiative effect was then calculated for each aerosol type separately making use of the aerosol relative contribution to the total AOD550, the CDND-AOD550 relations and satellite-based parameterizations. The direct radiative effect was also quantified using simulations from a regional climate model (REGCM4), simulations with a radiative transfer model (SBDART) and the three methods were finally intervalidated.

Indirect Effects of Environmental Change in Resource Competition Models.

PubMed

Kleinhesselink, Andrew R; Adler, Peter B

2015-12-01

Anthropogenic environmental change can affect species directly by altering physiological rates or indirectly by changing competitive outcomes. The unknown strength of competition-mediated indirect effects makes it difficult to predict species abundances in the face of ongoing environmental change. Theory developed with phenomenological competition models shows that indirect effects are weak when coexistence is strongly stabilized, but these models lack a mechanistic link between environmental change and species performance. To extend existing theory, we examined the relationship between coexistence and indirect effects in mechanistic resource competition models. We defined environmental change as a change in resource supply points and quantified the resulting competition-mediated indirect effects on species abundances. We found that the magnitude of indirect effects increases in proportion to niche overlap. However, indirect effects also depend on differences in how competitors respond to the change in resource supply, an insight hidden in nonmechanistic models. Our analysis demonstrates the value of using niche overlap to predict the strength of indirect effects and clarifies the types of indirect effects that global change can have on competing species.

An analysis of structural relationship among achievement motive on social participation, purpose in life, and role expectations among community dwelling elderly attending day services

PubMed Central

Kyougoku, Makoto

2016-01-01

Background. Achievement motive is defined as the intention to achieve one’s goals. Achievement motive is assumed to promote clients to choices and actions toward their valuable goal, so it is an important consideration in rehabilitation. Purpose. The purpose of this study is to demonstrate the structural relationship among achievement motive on purpose in life, social participation, and role expectation of community-dwelling elderly people. Methods. Participants were community-dwelling elderly people in day-service centers. A total of 281 participants (male: 127, female: 154) answered the self-administered questionnaire in cross-sectional research. The questionnaire was comprised of demographic data and scales that evaluated achievement motive, social participation, purpose in life, and role expectation. We studied the structural relationship established by our hypothesized model via a structural equation modeling approach. Results. We checked the standardized path coefficients and the modification indices; the modified model’s statistics were a good fit: CFI = 0.984, TLI = 0.983, RMSEA = 0.050, 90% CI [0.044–0.055]. Achievement motive had a significantly direct effect on purpose in life (direct effect = 0.445, p value < 0.001), a significantly indirect effect on purpose in life via social participation or role expectation (indirect effect = 0.170, p value < 0.001) and a total effect on purpose in life (total effect = 0.615). Discussion. This result suggests that enhancing the intention to achieve one’s goals enables participants to feel a spirit of challenge with a purpose and a sense of fulfillment in their daily lives. PMID:26835188

An analysis of structural relationship among achievement motive on social participation, purpose in life, and role expectations among community dwelling elderly attending day services.

PubMed

Sano, Nobuyuki; Kyougoku, Makoto

2016-01-01

Background. Achievement motive is defined as the intention to achieve one's goals. Achievement motive is assumed to promote clients to choices and actions toward their valuable goal, so it is an important consideration in rehabilitation. Purpose. The purpose of this study is to demonstrate the structural relationship among achievement motive on purpose in life, social participation, and role expectation of community-dwelling elderly people. Methods. Participants were community-dwelling elderly people in day-service centers. A total of 281 participants (male: 127, female: 154) answered the self-administered questionnaire in cross-sectional research. The questionnaire was comprised of demographic data and scales that evaluated achievement motive, social participation, purpose in life, and role expectation. We studied the structural relationship established by our hypothesized model via a structural equation modeling approach. Results. We checked the standardized path coefficients and the modification indices; the modified model's statistics were a good fit: CFI = 0.984, TLI = 0.983, RMSEA = 0.050, 90% CI [0.044-0.055]. Achievement motive had a significantly direct effect on purpose in life (direct effect = 0.445, p value < 0.001), a significantly indirect effect on purpose in life via social participation or role expectation (indirect effect = 0.170, p value < 0.001) and a total effect on purpose in life (total effect = 0.615). Discussion. This result suggests that enhancing the intention to achieve one's goals enables participants to feel a spirit of challenge with a purpose and a sense of fulfillment in their daily lives.

[A Structural Equation Model on Family Strength of Married Working Women].

PubMed

Hong, Yeong Seon; Han, Kuem Sun

2015-12-01

The purpose of this study was to identify the effect of predictive factors related to family strength and develop a structural equation model that explains family strength among married working women. A hypothesized model was developed based on literature reviews and predictors of family strength by Yoo. This constructed model was built of an eight pathway form. Two exogenous variables included in this model were ego-resilience and family support. Three endogenous variables included in this model were functional couple communication, family stress and family strength. Data were collected using a self-report questionnaire from 319 married working women who were 30~40 of age and lived in cities of Chungnam province in Korea. Data were analyzed with PASW/WIN 18.0 and AMOS 18.0 programs. Family support had a positive direct, indirect and total effect on family strength. Family stress had a negative direct, indirect and total effect on family strength. Functional couple communication had a positive direct and total effect on family strength. These predictive variables of family strength explained 61.8% of model. The results of the study show a structural equation model for family strength of married working women and that predicting factors for family strength are family support, family stress, and functional couple communication. To improve family strength of married working women, the results of this study suggest nursing access and mediative programs to improve family support and functional couple communication, and reduce family stress.

Interventions for preventing voice disorders in adults.

PubMed

Ruotsalainen, J H; Sellman, J; Lehto, L; Jauhiainen, M; Verbeek, J H

2007-10-17

Poor voice quality due to a voice disorder can lead to a reduced quality of life. In occupations where voice use is substantial it can lead to periods of absence from work. To evaluate the effectiveness of interventions to prevent voice disorders in adults. We searched MEDLINE (PubMed, 1950 to 2006), EMBASE (1974 to 2006), CENTRAL (The Cochrane Library, Issue 2 2006), CINAHL (1983 to 2006), PsychINFO (1967 to 2006), Science Citation Index (1986 to 2006) and the Occupational Health databases OSH-ROM (to 2006). The date of the last search was 05/04/06. Randomised controlled clinical trials (RCTs) of interventions evaluating the effectiveness of treatments to prevent voice disorders in adults. For work-directed interventions interrupted time series and prospective cohort studies were also eligible. Two authors independently extracted data and assessed trial quality. Meta-analysis was performed where appropriate. We identified two randomised controlled trials including a total of 53 participants in intervention groups and 43 controls. One study was conducted with teachers and the other with student teachers. Both trials were poor quality. Interventions were grouped into 1) direct voice training, 2) indirect voice training and 3) direct and indirect voice training combined.1) Direct voice training: One study did not find a significant decrease of the Voice Handicap Index for direct voice training compared to no intervention.2) Indirect voice training: One study did not find a significant decrease of the Voice Handicap Index for indirect voice training when compared to no intervention.3) Direct and indirect voice training combined: One study did not find a decrease of the Voice Handicap Index for direct and indirect voice training combined when compared to no intervention. The same study did however find an improvement in maximum phonation time (Mean Difference -3.18 sec; 95 % CI -4.43 to -1.93) for direct and indirect voice training combined when compared to no intervention. No work-directed studies were found. None of the studies found evaluated the effectiveness of prevention in terms of sick leave or number of diagnosed voice disorders. We found no evidence that either direct or indirect voice training or the two combined are effective in improving self-reported vocal functioning when compared to no intervention. The current practice of giving training to at-risk populations for preventing the development of voice disorders is therefore not supported by definitive evidence of effectiveness. Larger and methodologically better trials are needed with outcome measures that better reflect the aims of interventions.

Costs of dementia in the Czech Republic.

PubMed

Holmerová, Iva; Hort, Jakub; Rusina, Robert; Wimo, Anders; Šteffl, Michal

2017-11-01

The aim of this study was to estimate the cost of dementia in the Czech Republic. One hundred and nineteen patient-caregiver dyads participated in our multicenter observational cost-of-illness study. The modified Resource Utilization in Dementia Questionnaire was used as the main tool to collect data from patients and caregivers. Medical specialists provided additional data from medical records. The average costs of dementia were calculated and patients were then divided by the level of cognitive impairment. A generalized linear model was used to determine if differences were present for selected cost variables. The mean (standard deviation) for direct cost per a patient in a month was estimated to be €243.0 (138.0), €1727.1 (1075.6) for the indirect cost, and €1970.0 (1090.3) for the total cost of dementia in the Czech Republic. All of the costs increased as dementia severity increased. Both the indirect and total costs significantly (p < 0.05) increased if patients were living with their primary caregiver, and if the severity of cognitive impairment was increased. The indirect cost, which was represented mainly by informal care, comprised the main part of the total cost of care for patients with dementia in the Czech Republic. Both total and indirect care costs increased significantly the cognition declined.

Direct and indirect genetic and fine-scale location effects on breeding date in song sparrows.

PubMed

Germain, Ryan R; Wolak, Matthew E; Arcese, Peter; Losdat, Sylvain; Reid, Jane M

2016-11-01

Quantifying direct and indirect genetic effects of interacting females and males on variation in jointly expressed life-history traits is central to predicting microevolutionary dynamics. However, accurately estimating sex-specific additive genetic variances in such traits remains difficult in wild populations, especially if related individuals inhabit similar fine-scale environments. Breeding date is a key life-history trait that responds to environmental phenology and mediates individual and population responses to environmental change. However, no studies have estimated female (direct) and male (indirect) additive genetic and inbreeding effects on breeding date, and estimated the cross-sex genetic correlation, while simultaneously accounting for fine-scale environmental effects of breeding locations, impeding prediction of microevolutionary dynamics. We fitted animal models to 38 years of song sparrow (Melospiza melodia) phenology and pedigree data to estimate sex-specific additive genetic variances in breeding date, and the cross-sex genetic correlation, thereby estimating the total additive genetic variance while simultaneously estimating sex-specific inbreeding depression. We further fitted three forms of spatial animal model to explicitly estimate variance in breeding date attributable to breeding location, overlap among breeding locations and spatial autocorrelation. We thereby quantified fine-scale location variances in breeding date and quantified the degree to which estimating such variances affected the estimated additive genetic variances. The non-spatial animal model estimated nonzero female and male additive genetic variances in breeding date (sex-specific heritabilities: 0·07 and 0·02, respectively) and a strong, positive cross-sex genetic correlation (0·99), creating substantial total additive genetic variance (0·18). Breeding date varied with female, but not male inbreeding coefficient, revealing direct, but not indirect, inbreeding depression. All three spatial animal models estimated small location variance in breeding date, but because relatedness and breeding location were virtually uncorrelated, modelling location variance did not alter the estimated additive genetic variances. Our results show that sex-specific additive genetic effects on breeding date can be strongly positively correlated, which would affect any predicted rates of microevolutionary change in response to sexually antagonistic or congruent selection. Further, we show that inbreeding effects on breeding date can also be sex specific and that genetic effects can exceed phenotypic variation stemming from fine-scale location-based variation within a wild population. © 2016 The Authors. Journal of Animal Ecology © 2016 British Ecological Society.

Annual national direct and indirect cost estimates of the prevention and treatment of cervical cancer in Brazil

PubMed Central

Novaes, Hillegonda Maria Dutilh; Itria, Alexander; Silva, Gulnar Azevedo e; Sartori, Ana Marli Christovam; Rama, Cristina Helena; de Soárez, Patrícia Coelho

2015-01-01

OBJECTIVE: To estimate the annual direct and indirect costs of the prevention and treatment of cervical cancer in Brazil. METHODS: This cost description study used a "gross-costing" methodology and adopted the health system and societal perspectives. The estimates were grouped into sets of procedures performed in phases of cervical cancer care: the screening, diagnosis and treatment of precancerous lesions and the treatment of cervical cancer. The costs were estimated for the public and private health systems, using data from national health information systems, population surveys, and literature reviews. The cost estimates are presented in 2006 USD. RESULTS: From the societal perspective, the estimated total costs of the prevention and treatment of cervical cancer amounted to USD $1,321,683,034, which was categorized as follows: procedures (USD $213,199,490), visits (USD $325,509,842), transportation (USD $106,521,537) and productivity losses (USD $676,452,166). Indirect costs represented 51% of the total costs, followed by direct medical costs (visits and procedures) at 41% and direct non-medical costs (transportation) at 8%. The public system represented 46% of the total costs, and the private system represented 54%. CONCLUSION: Our national cost estimates of cervical cancer prevention and treatment, indicating the economic importance of cervical cancer screening and care, will be useful in monitoring the effect of the HPV vaccine introduction and are of interest in research and health care management. PMID:26017797

Comparison of Glucose Lowering Effect of Metformin and Acarbose in Type 2 Diabetes Mellitus: A Meta-Analysis

PubMed Central

Gu, Shuyan; Shi, Jihao; Tang, Zhiliu; Sawhney, Monika; Hu, Huimei; Shi, Lizheng; Fonseca, Vivian; Dong, Hengjin

2015-01-01

Background Metformin is the first-line oral hypoglycemic agent for type 2 diabetes mellitus recommended by international guidelines. However, little information exists comparing it with acarbose which is also commonly used in China. This study expanded knowledge by combining direct and indirect evidence to ascertain the glucose lowering effects of both drugs. Methods PubMed (1980- December 2013) and China National Knowledge Infrastructure databases (1994-January 2014) were systematically searched for eligible randomized controlled trials from Chinese and English literatures. Meta-analysis was conducted to estimate the glucose lowering effects of metformin vs. acarbose, or either of them vs. common comparators (placebo or sulphonylureas), using random- and fixed-effect models. Bucher method with indirect treatment comparison calculator was applied to convert the summary estimates from the meta-analyses into weighted-mean-difference (WMD) and 95% confidence intervals (CIs) to represent the comparative efficacy between metformin and acarbose. Results A total of 75 studies were included in the analysis. In direct comparison (8 trials), metformin reduced glycosylated hemoglobin (HbA1c) by 0.06% more than acarbose, with no significant difference (WMD,-0.06%; 95% CI, -0.32% to 0.20%). In indirect comparisons (67 trials), by using placebo and sulphonylureas as common comparators, metformin achieved significant HbA1c reduction than acarbose, by -0.38% (WMD,-0.38%, 95% CI, -0.736% to -0.024%) and -0.34% (WMD, -0.34%, 95% CI, -0.651% to -0.029%) respectively. Conclusion The glucose lowering effects of metformin monotherapy and acarbose monotherapy are the same by direct comparison, while metformin is a little better by indirect comparison. This implies that the effect of metformin is at least as good as acarbose's. PMID:25961824

Comparison of glucose lowering effect of metformin and acarbose in type 2 diabetes mellitus: a meta-analysis.

PubMed

Gu, Shuyan; Shi, Jihao; Tang, Zhiliu; Sawhney, Monika; Hu, Huimei; Shi, Lizheng; Fonseca, Vivian; Dong, Hengjin

2015-01-01

Metformin is the first-line oral hypoglycemic agent for type 2 diabetes mellitus recommended by international guidelines. However, little information exists comparing it with acarbose which is also commonly used in China. This study expanded knowledge by combining direct and indirect evidence to ascertain the glucose lowering effects of both drugs. PubMed (1980- December 2013) and China National Knowledge Infrastructure databases (1994-January 2014) were systematically searched for eligible randomized controlled trials from Chinese and English literatures. Meta-analysis was conducted to estimate the glucose lowering effects of metformin vs. acarbose, or either of them vs. common comparators (placebo or sulphonylureas), using random- and fixed-effect models. Bucher method with indirect treatment comparison calculator was applied to convert the summary estimates from the meta-analyses into weighted-mean-difference (WMD) and 95% confidence intervals (CIs) to represent the comparative efficacy between metformin and acarbose. A total of 75 studies were included in the analysis. In direct comparison (8 trials), metformin reduced glycosylated hemoglobin (HbA1c) by 0.06% more than acarbose, with no significant difference (WMD,-0.06%; 95% CI, -0.32% to 0.20%). In indirect comparisons (67 trials), by using placebo and sulphonylureas as common comparators, metformin achieved significant HbA1c reduction than acarbose, by -0.38% (WMD,-0.38%, 95% CI, -0.736% to -0.024%) and -0.34% (WMD, -0.34%, 95% CI, -0.651% to -0.029%) respectively. The glucose lowering effects of metformin monotherapy and acarbose monotherapy are the same by direct comparison, while metformin is a little better by indirect comparison. This implies that the effect of metformin is at least as good as acarbose's.

Deployment of ARM Aerial Facility Scanning Mobility Particle Sizer Field Campaign Report

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

Wang, Jian

2016-09-01

Atmospheric aerosols influence global climate by scattering and absorbing sunlight (direct effects) and by changing the microphysical structure, lifetime, and coverage of clouds (indirect effects). While it is widely accepted that aerosol indirect effects cool the Earth-atmosphere system by increasing cloud reflectivity and coverage, the magnitudes of the indirect effects are poorly quantified. One key aerosol property for understanding aerosol indirect effects is the ability of aerosol particles to form cloud droplets at atmospheric relevant supersaturations—i.e., cloud condensation Nuclei (CCN) activity. For particles consisting of typical atmospheric inorganic compounds, their CCN activity is well understood and can be effectively predictedmore » using Köhler theory based on physicochemical properties of the solute, such as its mass, molar volume, and activity coefficient. However, atmospheric aerosols often consist of hundreds of organic species, which can contribute ~20-90% to the total fine aerosol mass. Depending on their properties, organic species can significantly influence the ability of aerosol particles to act as CCN and form cloud droplets. This project focuses on the CCN activity of secondary organic aerosol (SOA) compounds formed from key biogenic volatile organic compounds (VOCs) under representative conditions, and the relationship between the hygroscopicity and composition of organic aerosols. The U.S. Department of Energy (DOE) Atmospheric Radiation Measurement (ARM) Climate Research Facility Aerial Facility (AAF) scanning mobility particles sizer (SMPS) was deployed during a ~ 2-week intensive measurement campaign, taking place February 10-February 23, 2016 at the Pacific Northwest National Laboratory (PNNL) Environmental Simulation Chamber. The SMPS was operated with a CCN counter (CCNc). Aerosol particles were first classified by the differential mobility analyzer inside the SMPS; the classified aerosol will then be simultaneously characterized by a condensation particle counter (CPC) (part of the SMPS) and the CCNc.« less

Direct and indirect economic costs among private-sector employees with osteoarthritis.

PubMed

Berger, Ariel; Hartrick, Craig; Edelsberg, John; Sadosky, Alesia; Oster, Gerry

2011-11-01

To estimate direct and indirect economic costs among private-sector employees with osteoarthritis (OA). Using a large US employer benefits database, we identified all employees with evidence of OA during calendar year 2007, and compared their costs of health care and work loss to age-and-sex-matched employees without evidence of OA in that year. Private-sector employees with OA (n = 2399) averaged 62.9 days of absenteeism versus 36.7 days among matched comparators (n = 2399) (P < 0.01). Mean total direct costs among these persons were $17,751 and $5057, respectively (P < 0.01); 34% of health care costs among persons with OA arose from medical encounters with listed diagnoses of OA. Mean total indirect costs were two-fold higher among persons with OA ($5002 versus $2120 for those without OA; P < 0.01). Private-sector employees with OA have higher direct and indirect costs than those without this condition.

Calculation versus measurement of total energy expenditure.

PubMed

van Lanschot, J J; Feenstra, B W; Vermeij, C G; Bruining, H A

1986-11-01

In acutely ill patients both hypo- and hyperalimentation must be avoided by adjusting caloric intake to total energy expenditure (TEE). We determined the discrepancy between basal energy expenditure (BEE) calculated from the basic Harris-Benedict formula and TEE measured by continuous indirect calorimetry in a heterogeneous group of mechanically ventilated surgical patients. We also compared the accuracy of TEE calculated from the corrected Harris-Benedict formula or estimated by intermittent indirect calorimetry to that of TEE measured by continuous indirect calorimetry. The poor correlation between calculated BEE and measured TEE was significantly (p less than .05) improved by a correction factor based on each patient's clinical condition. The mean absolute difference between calculated TEE and measured TEE was 8.9 +/- 9.6 (SD) %. Calculations were significantly (p less than .05) improved by estimating TEE from two 5-min recording periods, which suggests that continuous indirect calorimetry may not always be necessary to guide caloric replacement.

History of Childhood Maltreatment and College Academic Outcomes: Indirect Effects of Hot Execution Function

PubMed Central

Welsh, Marilyn C.; Peterson, Eric; Jameson, Molly M.

2017-01-01

College students who report a history of childhood maltreatment may be at risk for poor outcomes. In the current study, we conducted an exploratory analysis to examine potential models that statistically mediate associations between aspects of maltreatment and aspects of academic outcome, with a particular focus on executive functions (EF). Consistent with contemporary EF research, we distinguished between relatively “cool” EF tasks (i.e., performed in a context relatively free of emotional or motivational valence) and “hot” EF tasks that emphasize performance under more emotionally arousing conditions. Sixty-one male and female college undergraduates self-reported childhood maltreatment history (emotional abuse and neglect, physical abuse and neglect, and sexual abuse) on the Childhood Trauma Questionnaire (CTQ), and were given two EF measures: (1) Go-No-Go (GNG) test that included a Color Condition (cool); Neutral Face Condition (warm); and Emotion Face condition (hot), and (2) Iowa Gambling Task (IGT), a measure of risky decision making that reflects hot EF. Academic outcomes were: (1) grade point average (GPA: first-semester, cumulative, and semester concurrent with testing), and (2) Student Adaptation to College Questionnaire (SACQ). Correlational patterns suggested two EF scores as potential mediators: GNG reaction time (RT) in the Neutral Face condition, and IGT Block 2 adaptive responding. Indirect effects analyses indicated that IGT Block 2 adaptive responding has an indirect effect on the relationship between CTQ Total score and 1st semester GPA, and between CTQ Emotional Abuse and concurrent GPA. Regarding college adaptation, we identified a consistent indirect effect of GNG Neutral Face RT on the relationship between CTQ Emotional Neglect and SACQ total, academic, social, and personal–emotional adaption scores. Our results demonstrate that higher scores on a child maltreatment history self-report negatively predict college academic outcomes as assessed by GPA and by self-reported adaptation. Further, relatively “hot” EF task performance on the IGT and GNG tasks serves as a link between child maltreatment experiences and college achievement and adaptation, suggesting that hot EF skills may be a fruitful direction for future intervention efforts to improve academic outcomes for this population. PMID:28725204

Tree species diversity affects decomposition through modified micro-environmental conditions across European forests.

PubMed

Joly, François-Xavier; Milcu, Alexandru; Scherer-Lorenzen, Michael; Jean, Loreline-Katia; Bussotti, Filippo; Dawud, Seid Muhie; Müller, Sandra; Pollastrini, Martina; Raulund-Rasmussen, Karsten; Vesterdal, Lars; Hättenschwiler, Stephan

2017-05-01

Different tree species influence litter decomposition directly through species-specific litter traits, and indirectly through distinct modifications of the local decomposition environment. Whether these indirect effects on decomposition are influenced by tree species diversity is presently not clear. We addressed this question by studying the decomposition of two common substrates, cellulose paper and wood sticks, in a total of 209 forest stands of varying tree species diversity across six major forest types at the scale of Europe. Tree species richness showed a weak but positive correlation with the decomposition of cellulose but not with that of wood. Surprisingly, macroclimate had only a minor effect on cellulose decomposition and no effect on wood decomposition despite the wide range in climatic conditions among sites from Mediterranean to boreal forests. Instead, forest canopy density and stand-specific litter traits affected the decomposition of both substrates, with a particularly clear negative effect of the proportion of evergreen tree litter. Our study suggests that species richness and composition of tree canopies modify decomposition indirectly through changes in microenvironmental conditions. These canopy-induced differences in the local decomposition environment control decomposition to a greater extent than continental-scale differences in macroclimatic conditions. © 2017 The Authors. New Phytologist © 2017 New Phytologist Trust.

Pathways maintaining physical health problems from childhood to young adulthood: The role of stress and mood

PubMed Central

Hammen, Constance L.; Brennan, Patricia A; Najman, Jake M.

2016-01-01

Objective Poor physical health in childhood is associated with a variety of negative health-related outcomes in adulthood. Psychosocial pathways contributing to the maintenance of physical health problems from childhood to young adulthood remain largely unexamined, despite evidence that factors such as negative mood and stress impact physical health. Design The current study tested the direct and indirect effects of ongoing health, chronic stress, health-related chronic stress, and depressive symptoms at age 20 on the link between health problems in childhood and young adulthood (age 21) in a longitudinal sample (n = 384). Main Outcome Measures The hypotheses were tested using a multiple mediation path analysis framework; the primary outcome measure was a composite index of health status markers in young adulthood. Results The proposed model provided an adequate fit for the data, with significant total indirect effects of the four mediators and significant specific indirect effects of health-related chronic stress and depressive symptoms in maintaining health problems from childhood into young adulthood. Conclusions Health problems are maintained from early childhood into young adulthood in part through psychosocial mechanisms. Depressive symptoms and health-related chronic stress have significant, unique effects on the relationship between health problems in early childhood and young adulthood. PMID:27329508

Practical Guidance for Conducting Mediation Analysis With Multiple Mediators Using Inverse Odds Ratio Weighting

PubMed Central

Nguyen, Quynh C.; Osypuk, Theresa L.; Schmidt, Nicole M.; Glymour, M. Maria; Tchetgen Tchetgen, Eric J.

2015-01-01

Despite the recent flourishing of mediation analysis techniques, many modern approaches are difficult to implement or applicable to only a restricted range of regression models. This report provides practical guidance for implementing a new technique utilizing inverse odds ratio weighting (IORW) to estimate natural direct and indirect effects for mediation analyses. IORW takes advantage of the odds ratio's invariance property and condenses information on the odds ratio for the relationship between the exposure (treatment) and multiple mediators, conditional on covariates, by regressing exposure on mediators and covariates. The inverse of the covariate-adjusted exposure-mediator odds ratio association is used to weight the primary analytical regression of the outcome on treatment. The treatment coefficient in such a weighted regression estimates the natural direct effect of treatment on the outcome, and indirect effects are identified by subtracting direct effects from total effects. Weighting renders treatment and mediators independent, thereby deactivating indirect pathways of the mediators. This new mediation technique accommodates multiple discrete or continuous mediators. IORW is easily implemented and is appropriate for any standard regression model, including quantile regression and survival analysis. An empirical example is given using data from the Moving to Opportunity (1994–2002) experiment, testing whether neighborhood context mediated the effects of a housing voucher program on obesity. Relevant Stata code (StataCorp LP, College Station, Texas) is provided. PMID:25693776

Cost analysis of direct versus indirect and individual versus group modes of manual-based speech-and-language therapy for primary school-age children with primary language impairment.

PubMed

Dickson, Kirstin; Marshall, Marjorie; Boyle, James; McCartney, Elspeth; O'Hare, Anne; Forbes, John

2009-01-01

The study is the first within trial cost analysis of direct versus indirect and individual versus group modes of speech-and-language therapy for children with primary language impairment. To compare the short-run resource consequences of the four interventions alongside the effects achieved measured by standardized scores on a test of expressive and receptive language. The study design was a cost analysis integrated within a randomized controlled trial using a 2x2 factorial design (direct/indirect versus individual/group therapy) together with a control group that received usual levels of community-based speech-and-language therapy. Research interventions were delivered in school settings in Scotland, UK. Children aged between 6 and 11 years, attending a mainstream school, with standard scores on the Clinical Evaluation of Language Fundamentals (CELF-III(UK)) of less than -1.25 standard deviation (SD) (receptive and/or expressive) and non-verbal IQ on the Wechsler Abbreviated Scale of Intelligence (WASI) above 75, and no reported hearing loss, no moderate/severe articulation/phonology/dysfluency problems or otherwise requiring individual work with a speech-and-language therapist. The intervention involved speech-and-language therapists and speech-and-language therapy assistants working with individual children or small groups of children. A therapy manual was constructed to assist the choice of procedures and activities for intervention. The cost analysis focused on the salary and travel costs associated with each mode of intervention. The cumulative distribution of total costs arising from the time of randomization to post-intervention assessment was estimated. Arithmetic mean costs were compared and reported with their 95% confidence intervals. The results of the intention-to-treat analysis revealed that there were no significant post-intervention differences between direct and indirect modes of therapy, or between individual and group modes on any of the primary language outcome measures. The cost analysis identified indirect therapy, particularly indirect group therapy, as the least costly of the intervention modes with direct individual therapy as the most costly option. The programme cost of providing therapy in practice over 30 weeks for children could represent between 30% and 75% of the total gross revenue spend in primary school per pupil, depending on the choice of assistant led group therapy or therapist-led individual therapy. This study suggests that speech-and-language therapy assistants can act as effective surrogates for speech-and-language therapists in delivering cost-effective services to children with primary language impairment. The resource gains from adopting a group-based approach may ensure that effective therapy is provided to more children in a more efficient way.

Indirect costs of absenteeism due to rheumatoid arthritis, psoriasis, multiple sclerosis, insulin-dependent diabetes mellitus, and ulcerative colitis in 2012: a study based on real-life data from the Social Insurance Institution in Poland.

PubMed

Malinowski, Krzysztof Piotr; Kawalec, Paweł Piotr; Moćko, Paweł

2016-01-01

The aim of this study is to assess the indirect costs of six major autoimmune diseases including seropositive rheumatoid arthritis, other types of rheumatoid arthritis, psoriasis, multiple sclerosis, Type 1 diabetes, and ulcerative colitis. Relevant data for 2012 on sick leave and short- and long-term work disabilities were obtained from the Social Insurance Institution in Poland. Indirect costs were estimated using the human capital approach based on gross domestic product per capita, gross value added per worker, and gross income per worker in Poland in 2012 and expressed in euro. We recorded data on the total number of 45,500 patients. The total indirect costs were EUR 146,862,569; 353,683,508; and 108,154,271, calculated using gross domestic product, gross value added, and gross income, respectively. Considering only data on absenteeism collected by the Social Insurance Institution in Poland, we can conclude that the selected autoimmune diseases are associated with great indirect costs.

[Relationship of job stress with job burnout and quality of work life in workers for offshore oil platforms].

PubMed

Zhang, Y; Liu, X L; Wei, T D; Lan, Y J

2017-03-20

Objective: To evaluate the current status of job burnout and qual ity of work life (QWL) in workers for offshore oil platforms, and to analyze the relationship of job stress with job burnout and QWL and the direct and indirect effects of job stress on QWL. Methods: Cluster random sampling was used to select 382 work-ers for 8 oil platforms of China National Offshore Oil Corporation in October 2015. A self - designed questionnaire was used to collect the individual characteristics of subjects. The Quality of Work Life Scale (QWL7 - 32) , Occupa-tional Stress Inventory - Revised Edition (OSI - R) , and Maslach Burnout Inventory - General Survey (MBI - GS) were used to investigate the QWL, job stress, and job burnout of subjects. Results: Among all the workers for offshore oil platforms, 87.2% had mild job burnout. The total QWL score was 116.01 ± 16.73; 8.3% of the workers had poor QWL, and 68.5% had moderate QWL. QWL was reduced with heavier task, vaguer task, and increasing mental stress and physical stress ( P <0.05) , and increased with more social support ( P <0.05) . Job stress had di-rect and indirect effects on QWL; stress reaction had the most effect on QWL (total effect size - 0.509) , followed by social support (total effect size 0.444) . Conclusion: Most workers for offshore oil platforms have mild job burn-out and moderate QWL. Job stress is associated with job burnout and QWL, and stress reaction and social support have relatively high influence on QWL.

Insulation materials for commercial buildings in North America: An assessment of lifetime energy and environmental impacts

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

Biswas, Kaushik; Shrestha, Som S.; Bhandari, Mahabir S.

In the United States, commercial buildings accounted for about 19 percent of the total primary energy consumption in 2012. Further, 29 percent of the site energy in commercial buildings was consumed for space heating and cooling. Applying insulation materials to building envelopes is an effective way of reducing energy consumption for heating and cooling, and limiting the negative environmental impacts from the buildings sector. While insulation materials have a net positive impact on the environment due to reduced energy consumption, they also have some negative impacts associated with their 'embodied energy'. The total lifetime environmental impacts of insulation materials aremore » a summation of: (1) direct impacts due to their embodied energy, and (2) indirect or impacts avoided due to the reduced building energy consumption. Here, assessments of the lifetime environmental impacts of selected insulation materials are presented. Direct and indirect environmental impact factors were estimated for the cradle-to-grave insulation life cycle stages. Impact factors were calculated for two categories: primary energy consumption and global warming potential. The direct impact factors were calculated using data from existing literature and a life cycle assessment software. The indirect impact factors were calculated through simulations of a set of standard whole-building models.« less

Insulation materials for commercial buildings in North America: An assessment of lifetime energy and environmental impacts

DOE PAGES

Biswas, Kaushik; Shrestha, Som S.; Bhandari, Mahabir S.; ...

2015-12-12

In the United States, commercial buildings accounted for about 19 percent of the total primary energy consumption in 2012. Further, 29 percent of the site energy in commercial buildings was consumed for space heating and cooling. Applying insulation materials to building envelopes is an effective way of reducing energy consumption for heating and cooling, and limiting the negative environmental impacts from the buildings sector. While insulation materials have a net positive impact on the environment due to reduced energy consumption, they also have some negative impacts associated with their 'embodied energy'. The total lifetime environmental impacts of insulation materials aremore » a summation of: (1) direct impacts due to their embodied energy, and (2) indirect or impacts avoided due to the reduced building energy consumption. Here, assessments of the lifetime environmental impacts of selected insulation materials are presented. Direct and indirect environmental impact factors were estimated for the cradle-to-grave insulation life cycle stages. Impact factors were calculated for two categories: primary energy consumption and global warming potential. The direct impact factors were calculated using data from existing literature and a life cycle assessment software. The indirect impact factors were calculated through simulations of a set of standard whole-building models.« less

A Mediation Model to Explain the Role of Mathematics Skills and Probabilistic Reasoning on Statistics Achievement

ERIC Educational Resources Information Center

Primi, Caterina; Donati, Maria Anna; Chiesi, Francesca

2016-01-01

Among the wide range of factors related to the acquisition of statistical knowledge, competence in basic mathematics, including basic probability, has received much attention. In this study, a mediation model was estimated to derive the total, direct, and indirect effects of mathematical competence on statistics achievement taking into account…

Household Costs of Leprosy Reactions (ENL) in Rural India

PubMed Central

Chandler, David J.; Hansen, Kristian S.; Mahato, Bhabananda; Darlong, Joydeepa; John, Annamma; Lockwood, Diana N. J.

2015-01-01

Background Erythema nodosum leprosum (ENL) is a common immune-mediated complication of lepromatous (LL) and borderline lepromatous (BL) leprosy. Most patients experience chronic or multiple acute ENL over many years during an economically active period of their lives. Understanding the economic burden of ENL is essential to provide effective patient support, yet this area has not been investigated. Methods Ninety-one patients with LL or BL leprosy attending a leprosy hospital in Purulia district of West Bengal, India, were interviewed using a structured questionnaire. Cases (n = 53) were identified as those who had one or more episodes of ENL within the last 3 years. Controls (n = 38) had LL or BL leprosy but no history of ENL. Data were collected on household income, direct and indirect costs, and coping strategies. Findings The total household cost was Rs 1543 per month or 27.9% (IQR 13.2-52.6) of monthly household income for cases, and Rs 237 per month or 4.9% (IQR 1.7-13.4) of monthly household income for controls. Indirect costs accounted for 65% of total household costs for cases. Direct costs accounted for the remaining 35% of household costs, and resulted almost entirely from treatment-seeking in the private sector. Total household costs exceeded 40% of household income for 37.7% of cases (n = 20) and 2.6% of controls (n = 1) [1 USD = 59 INR]. Interpretation Households affected by ENL face significant economic burden and are at risk of being pushed further into poverty. Health policy should acknowledge the importance of private sector provision and the significant contribution to total household costs of lost productivity (indirect cost). Further work is needed to explore this area and identify solutions. PMID:25590638

Is the effect of person-organisation fit on turnover intention mediated by job satisfaction? A survey of community health workers in China

PubMed Central

Yan, Fei; Wang, Wei; Li, Guohong

2017-01-01

Objectives Person-organisation fit (P-O fit) is a predictor of work attitude. However, in the area of human resource for health, the literature of P-O fit is quite limited. It is unclear whether P-O fit directly or indirectly affects turnover intention. This study aims to examine the mediation effect of job satisfaction on the relationship between P-O fit and turnover intention based on data from China. Design and methods This is a cross-sectional survey of community health workers (CHWs) in China in 2013. A questionnaire of P-O fit, job satisfaction and turnover intention was developed, and its validity and reliability were assessed. Multiple regression and structural equation modelling were used to examine the relationship among P-O fit, job satisfaction and turnover intention. Setting and participants Multistage sampling was applied. In total, 656 valid questionnaire responses were collected from CHWs in four provincial regions in China, namely Shanghai, Shaanxi, Shandong and Anhui. Results P-O fit was directly related to job satisfaction (standardised β 0.246) and inversely related to turnover intention (standardised β −0.186). In the mediation model, the total effect of P-O fit on turnover intention was −0.186 (p<0.001); the direct effect of P-O fit on turnover intention was −0.094 (p<0.01); the indirect effect of job satisfaction on the relationship between P-O fit and turnover intention was −0.092 (p<0.001). Conclusions The effect of P-O fit on turnover intention was partially mediated through job satisfaction. It is suggested that more work attitude variables and different dimensions of P-O fit be taken into account to examine the complete mechanism of person-organisation interaction. Indirect measures of P-O fit should be encouraged in practice to enhance work attitudes of health workers. PMID:28399513

Impact of increasing adherence to disease-modifying therapies on healthcare resource utilization and direct medical and indirect work loss costs for patients with multiple sclerosis.

PubMed

Yermakov, Sander; Davis, Matthew; Calnan, Michaela; Fay, Monica; Cox-Buckley, Brieana; Sarda, Sujata; Duh, Mei Sheng; Iyer, Ravi

2015-01-01

To estimate the effect of adherence to disease-modifying therapies (DMTs) among patients with multiple sclerosis (MS) on healthcare resource utilization (HRU) and costs, and model the impact of a 10 percentage point increase in adherence on these outcomes. Employed patients, 18-64 years old, with ≥2 MS diagnoses and ≥1 DMT claim during January 1, 2002 to September 30, 2012 were identified from a large commercially-insured US claims database. Adherence was measured as proportion of days covered (PDC) during follow-up. Multivariate regression analyses were conducted to estimate the effect of adherence on HRU related to urgent care (i.e., inpatient or emergency room visit), days of work loss, direct medical cost, and indirect work loss costs. Model coefficients were used to evaluate the impact of a 10 percentage point increase in adherence on the outcomes. A total of 1510 patients were included (mean age = 43.4 years, 64% female). Patients with higher adherence had lower HRU, fewer days of work loss, and lower direct and indirect costs. A 10 percentage point increase in adherence significantly decreased the likelihood of an inpatient or emergency room visit by 9-19%, days of work loss by 3-8%, and direct and indirect costs by 3-5%, depending on the follow-up period (all p < 0.01). Increasing DMT adherence was found to significantly decrease urgent-care HRU, days of work loss, and direct and indirect costs among patients with MS.

Indirect fluorometric detection techniques on thin layer chromatography and effect of ultrasound on gel electrophoresis

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

Yinfa, Ma.

Thin-layer chromatography (TLC) is a broadly applicable separation technique. It offers many advantages over high performance liquid chromatography (HPLC), such as easily adapted for two-dimensional separation, for whole-column'' detection and for handling multiple samples, etc. However, due to its draggy development of detection techniques comparing with HPLC, TLC has not received the attention it deserves. Therefore, exploring new detection techniques is very important to the development of TLC. It is the principal of this dissertation to present a new detection method for TLC -- indirect fluorometric detection method. This detection technique is universal sensitive, nondestructive, and simple. This will bemore » described in detail from Sections 1 through Section 5. Section 1 and 3 describe the indirect fluorometric detection of anions and nonelectrolytes in TLC. In Section 2, a detection method for cations based on fluorescence quenching of ethidium bromide is presented. In Section 4, a simple and interesting TLC experiment is designed, three different fluorescence detection principles are used for the determination of caffeine, saccharin and sodium benzoate in beverages. A laser-based indirect fluorometric detection technique in TLC is developed in Section 5. Section 6 is totally different from Sections 1 through 5. An ultrasonic effect on the separation of DNA fragments in agarose gel electrophoresis is investigated. 262 refs.« less

Direct and indirect costs of asthma in Canada, 1990.

PubMed Central

Krahn, M D; Berka, C; Langlois, P; Detsky, A S

1996-01-01

OBJECTIVE: To calculate the direct and indirect costs of asthma in Canada. DESIGN: Cost-of-illness study. SETTING: Canada. PATIENTS: All Canadians receiving inpatient or outpatient care for asthma in 1990. OUTCOME MEASURES: Direct costs incurred by inpatient care, emergency services, physician and nursing services, ambulance use, drugs and devices, outpatient diagnostic tests, research and education. Indirect costs from productivity loss due to absence from work, inability to to perform housekeeping activities, need to care for children with asthma who were absent from school, time spent travelling and waiting for medical care, and premature death from asthma. All costs are in 1990 Canadian dollars. RESULTS: Depending on assumptions, the total cost of asthma was estimated to be between $504 million and $648 million. Direct costs were $306 million. The single largest component of direct costs was the cost of drugs ($124 million). The largest component of indirect costs was illness-related disability ($76 million). CONCLUSIONS: Annual costs of treating asthma are comparable to the individual cost of infectious diseases, hematological diseases, congenital defects, perinatal illnesses, home care and ambulance services. Asthma costs may increase in the future, given current morbidity and mortality trends. Further evaluation of the effectiveness and cost-effectiveness of available asthma interventions in addition to aggregate cost data are required to determine whether resource allocation for the treatment of asthma can be improved. PMID:8634960

Gender differences in exercise dependence and eating disorders in young adults: a path analysis of a conceptual model.

PubMed

Meulemans, Shelli; Pribis, Peter; Grajales, Tevni; Krivak, Gretchen

2014-11-05

The purpose of our study was to study the prevalence of exercise dependence (EXD) among college students and to investigate the role of EXD and gender on exercise behavior and eating disorders. Excessive exercise can become an addiction known as exercise dependence. In our population of 517 college students, 3.3% were at risk for EXD and 8% were at risk for an eating disorder. We used Path analysis the simplest case of Structural Equation Modeling (SEM) to investigate the role of EXD and exercise behavior on eating disorders. We observed a small direct effect from gender to eating disorders. In females we observed significant direct effect between exercise behavior (r = -0.17, p = 0.009) and EXD (r = 0.34, p < 0.001) on eating pathology. We also observed an indirect effect of exercise behavior on eating pathology (r = 0.16) through EXD (r = 0.48, r2 = 0.23, p < 0.001). In females the total variance of eating pathology explained by the SEM model was 9%. In males we observed a direct effect between EXD (r = 0.23, p < 0.001) on eating pathology. We also observed indirect effect of exercise behavior on eating pathology (r = 0.11) through EXD (r = 0.49, r2 = 0.24, p < 0.001). In males the total variance of eating pathology explained by the SEM model was 5%.

Implications of Middle School Behavior Problems for High School Graduation and Employment Outcomes of Young Adults: Estimation of a Recursive Model.

PubMed

Karakus, Mustafa C; Salkever, David S; Slade, Eric P; Ialongo, Nicholas; Stuart, Elizabeth

2012-01-01

The potentially serious adverse impacts of behavior problems during adolescence on employment outcomes in adulthood provide a key economic rationale for early intervention programs. However, the extent to which lower educational attainment accounts for the total impact of adolescent behavior problems on later employment remains unclear As an initial step in exploring this issue, we specify and estimate a recursive bivariate probit model that 1) relates middle school behavior problems to high school graduation and 2) models later employment in young adulthood as a function of these behavior problems and of high school graduation. Our model thus allows for both a direct effect of behavior problems on later employment as well as an indirect effect that operates via graduation from high school. Our empirical results, based on analysis of data from the NELS, suggest that the direct effects of externalizing behavior problems on later employment are not significant but that these problems have important indirect effects operating through high school graduation.

Estimating two indirect logging costs caused by accelerated erosion.

Treesearch

Glen O. Klock

1976-01-01

In forest areas where high soil erosion potential exists, a comparative yarding cost estimate, including the indirect costs determined by methods proposed here, shows that the total cost of using "advanced" logging methods may be less than that of "traditional" systems.

Treatment of Adults With Treatment-Resistant Depression: Electroconvulsive Therapy Plus Antidepressant or Electroconvulsive Therapy Alone? Evidence From an Indirect Comparison Meta-Analysis

PubMed Central

Song, Guo-Min; Tian, Xu; Shuai, Ting; Yi, Li-Juan; Zeng, Zi; Liu, Shuang; Zhou, Jian-Guo; Wang, Yan

2015-01-01

Abstract Electroconvulsive therapy (ECT) and antidepressant are the effective treatment alternatives for patients with treatment-resistant depression (TRD); however, the effects and safety of the ECT plus antidepressant relative to ECT alone remain controversial. We decide to assess the potential of ECT plus antidepressant compared with ECT alone by undertaking an indirect comparison meta-analysis. Databases from PubMed, ISI Web of Science, CENTRAL, Clinicaltrials.gov, EMBASE, CBM (China Biomediccal Literatures Database), and CNKI (China National Knowledge Infrastructure) were searched for relevant studies through November 21, 2014. Literature was screened, data were extracted and methodological quality of the eligible trial was assessed by 2 independent reviewers accordingly. Then, head-to-head and indirect comparison meta-analyses were carried out. A total of 17 studies which including 13 studies regarding ECT plus antidepressant versus antidepressant alone and 4 studies concerning ECT versus antidepressant alone containing a total of 1098 patients were incorporated into this meta-analysis. The head-to-head comparison suggested that response rate can be improved in the ECT plus antidepressant (RR, 1.82; 95% CI, 1.55–2.14) and ECT alone group (RR, 2.24, 95% CI, 1.51–3.33) compared with antidepressant alone, respectively; adverse complications including memory deterioration and somatization were not significantly increased except incidence of memory deterioration in ECT plus antidepressant in the 4th weeks after treatment (RR, 0.09, 95% CI, 0.02–0.49). Indirect comparison meta-analysis showed that no significant differences were detected in response rate and memory deterioration between ECT plus antidepressant and ECT alone. However, ECT plus antidepressant increased the incidence of memory deterioration relative to ECT alone. With present evidence, the regime of ECT plus antidepressant should not be preferentially recommended to treat the patients with TRD relative to ECT alone. PMID:26131818

Early rheumatoid arthritis 6 years after diagnosis is still associated with high direct costs and increasing loss of productivity: the Swedish TIRA project.

PubMed

Hallert, E; Husberg, M; Kalkan, A; Skogh, T; Bernfort, L

2014-01-01

To calculate total costs over 6 years after diagnosis of early rheumatoid arthritis (RA). In the longitudinal prospective multicentre TIRA study, 239 patients from seven units, diagnosed in 1996-98, reported regularly on health-care utilization and the number of days lost from work. Costs were obtained from official databases and calculated using unit costs (Swedish kronor, SEK) from 2001. Indirect costs were calculated using the human capital approach (HCA). Costs were inflation adjusted to Euro June 2012, using the Swedish Consumer Price Index and the exchange rate of June 2012. Statistical analyses were based on linear mixed models (LMMs) for changes over time. The mean total cost per patient was EUR 14,768 in year 1, increasing to EUR 18,438 in year 6. Outpatient visits and hospitalization decreased but costs for surgery increased from EUR 92/patient in year 1 to EUR 444/patient in year 6. Drug costs increased from EUR 429/patient to EUR 2214/patient, mainly because of the introduction of biologics. In year 1, drugs made up for 10% of direct costs, and increased to 49% in year 6. Sick leave decreased during the first years but disability pensions increased, resulting in unchanged indirect costs. Over the following years, disability pensions increased further and indirect costs increased from EUR 10,284 in year 1 to EUR 13,874 in year 6. LMM analyses showed that indirect costs were unchanged whereas direct costs, after an initial fall, increased over the following years, leading to increasing total costs. In the 6 years after diagnosis of early RA, drug costs were partially offset by decreasing outpatient visits but indirect costs remained unchanged and total costs increased.

Association of maternal gestational weight gain with their offspring's anthropometric outcomes at late infancy and 6 years old: mediating roles of birth weight and breastfeeding duration.

PubMed

Liu, J X; Xu, X; Liu, J H; Hardin, J W; Li, R

2018-01-01

Longitudinal studies examining the potential mediating roles of birth weight and breastfeeding duration on the pathways between maternal gestational weight gain (GWG) and offspring anthropometric outcomes are lacking. We analyzed data from the mother-child pairs in the Infant Feeding Practices Study II (IFPS II) in late infancy (n=1548) and at the Year 6 Follow-up (n=1514) Study. Child anthropometrics included age- and sex-specific Z-scores for weight for age (WAZ), height /length for age, weight for height/length and body mass index (BMIZ). Structural equation models were used to estimate the total, direct and indirect effects of GWG on child anthropometrics through birth weight and breastfeeding duration. The total effect of GWG on offspring anthropometric outcomes was significant for WAZ (β=0.107, 95% confidence interval (CI): 0.052, 0.161) at late infancy and for WAZ (β=0.122, 95% CI: 0.066, 0.177) and BMIZ (β=0.120, 95% CI: 0.063, 0.178) at 6 years old. The direct effects of GWG on offspring's WAZ and BMIZ were observed only at 6 years old. The indirect effects of GWG through birth weight were significant on most of the offspring's anthropometric measures. Compared to breastfeeding duration, birth weight was a stronger mediator on the pathways between GWG and all proposed anthropometric measures both in late infancy and in early childhood. Longer duration of breastfeeding was inversely associated with all offspring anthropometric outcomes at late infancy but not with those outcomes at 6 years old. Our findings suggest a stronger indirect rather than direct effect of GWG on children's anthropometric outcomes mainly through birth weight, independent of maternal sociodemographic and reproductive factors. Longer duration of breastfeeding might suppress the positive relationship between GWG, birth weight and anthropometric outcomes in late infancy but not among 6 years old.

Cost effectiveness of pomalidomide in patients with relapsed and refractory multiple myeloma in Sweden.

PubMed

Borg, Sixten; Nahi, Hareth; Hansson, Markus; Lee, Dawn; Elvidge, Jamie; Persson, Ulf

2016-05-01

Multiple myeloma (MM) patients who have progressed following treatment with both bortezomib and lenalidomide have a poor prognosis. In this late stage, other effective alternatives are limited, and patients in Sweden are often left with best supportive care. Pomalidomide is a new anti-angiogenic and immunomodulatory drug for the treatment of MM. Our objective was to evaluate the cost effectiveness of pomalidomide as an add-on to best supportive care in patients with relapsed and refractory MM in Sweden. We developed a health-economic discrete event simulation model of a patient's course through stable disease and progressive disease, until death. It estimates life expectancy, quality-adjusted life years (QALYs) and costs from a societal perspective. Effectiveness data and utilities were taken from the MM-003 trial comparing pomalidomide plus low-dose dexamethasone with high-dose dexamethasone (HIDEX). Cost data were taken from official Swedish price lists, government sources and literature. The model estimates that, if a patient is treated with HIDEX, life expectancy is 1.12 years and the total cost is SEK 179 976 (€19 100), mainly indirect costs. With pomalidomide plus low-dose dexamethasone, life expectancy is 2.33 years, with a total cost of SEK 767 064 (€81 500), mainly in drug and indirect costs. Compared to HIDEX, pomalidomide treatment gives a QALY gain of 0.7351 and an incremental cost of SEK 587 088 (€62 400) consisting of increased drug costs (59%), incremental indirect costs (33%) and other healthcare costs (8%). The incremental cost-effectiveness ratio is SEK 798 613 (€84 900) per QALY gained. In a model of late-stage MM patients with a poor prognosis in the Swedish setting, pomalidomide is associated with a relatively high incremental cost per QALY gained. This model was accepted by the national Swedish reimbursement authority TLV, and pomalidomide was granted reimbursement in Sweden.

Trends in resource utilization and prescription of anticonvulsants for patients with active epilepsy in Germany from 2003 to 2013 - A ten-year overview.

PubMed

Willems, Laurent M; Richter, Saskia; Watermann, Nina; Bauer, Sebastian; Klein, Karl Martin; Reese, Jens-Peter; Schöffski, Oliver; Hamer, Hajo M; Knake, Susanne; Rosenow, Felix; Strzelczyk, Adam

2018-06-01

This study evaluated trends in resource use and prescription patterns in patients with active epilepsy over a 10-year period at the same outpatient clinic of a German epilepsy center. We analyzed a cross-sectional patient sample of consecutive adults with active epilepsy over a 3-month period in 2013 and compared them with equally acquired data from the years 2003 and 2008. Using validated patient questionnaires, data on socioeconomic status, course of epilepsy, as well as direct and indirect costs were recorded. A total of 198 patients (mean age: 39.6±15.0years, 49.5% male) were enrolled and compared with our previous assessments in 2003 (n=101) and 2008 (n=151). In the 2013 cohort, 75.8% of the patients had focal epilepsy, and the majority were taking antiepileptic drugs (AEDs) (39.9% monotherapy, 59.1% polytherapy). We calculated epilepsy-specific costs of €3674 per three months per patient. Direct medical costs were mainly due to anticonvulsants (20.9% of total direct costs) and to hospitalization (20.8% of total direct costs). The proportion of enzyme-inducing anticonvulsants and 'old' AEDs decreased between 2003 and 2013. Indirect costs of €1795 in 2013 were mainly due to early retirement (55.0% of total indirect costs), unemployment (26.5%), and days off due to seizures (18.2%). In contrast to our previous findings from 2003 and 2008, our data show a stagnating cost increase with slightly reduced total costs and balanced direct and indirect costs in patients with active epilepsy. These findings are accompanied by an ongoing cost-neutral increase in the prescription of 'newer' and non-enzyme-inducing AEDs. However, the number and distribution of indirect cost components remained unchanged. Copyright © 2018 Elsevier Inc. All rights reserved.

Epidemiological and clinical outcome comparison of indirect ('strain') versus direct ('contusion') anterior and posterior thigh muscle injuries in male elite football players: UEFA Elite League study of 2287 thigh injuries (2001-2013).

PubMed

Ueblacker, Peter; Müller-Wohlfahrt, Hans-Wilhelm; Ekstrand, Jan

2015-11-01

Data regarding direct athletic muscle injuries (caused by a direct blunt or sharp external force) compared to indirect ones (without the influence of a direct external trauma) are missing in the current literature--this distinction has clinical implications. To compare incidence, duration of absence and characteristics of indirect and direct anterior (quadriceps) and posterior thigh (hamstring) muscle injuries. 30 football teams and 1981 players were followed prospectively from 2001 until 2013. The team medical staff recorded individual player exposure and time-loss injuries. Muscle injuries were defined as indirect or direct according to their injury mechanism. In total, 2287 thigh muscle injuries were found, representing 25% of all injuries. Two thousand and three were valid for further analysis, of which 88% were indirect and 12% direct. The incidence was eight times higher for indirect injuries (1.48/1000 h) compared to direct muscle injuries (0.19/1000 h) (p<0.01). Indirect muscle injuries caused 19% of total absence, and direct injuries 1%. The mean lay-off time for indirect injuries amounted to 18.5 days and differed significantly from direct injuries which accounted for 7 days (p<0.001). 60% of indirect injuries and 76% of direct injuries occurred in match situations. Foul play was involved in 7% of all thigh muscle injuries, as well as in 2% of indirect injuries and 42% of direct injuries. Muscle anterior and posterior thigh injuries in elite football are more frequent than have been previously described. Direct injuries causing time loss are less frequent than indirect ones, and players can usually return to full activity in under half the average time for an indirect injury. Foul play is involved in 7.5% of all thigh muscle injuries. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Re-visiting internet addiction among Taiwanese students: a cross-sectional comparison of students' expectations, online gaming, and online social interaction.

PubMed

Lee, Yuan-Hsuan; Ko, Chih-Hung; Chou, Chien

2015-04-01

Using expectancy theory, this study aimed at identifying the attitudinal/behavioral factors that explain the relationship between Internet expectancies and Internet addiction among Taiwanese adolescents. A total of 25,573 students (49.8% boys and 50.2% girls) across junior and senior high schools participated in the study. The students reported on their background characteristics, general expectations from the Internet, attitudes toward online social interaction and online gaming, preferences in online social interaction, and dys-controlled online gaming behavior. Structural equation modeling was used to examine the indirect effects of Internet expectancies on Internet addiction through these attitudinal/behavioral factors. The results showed that Internet expectancies positively predicted students' attitudes toward online games and online social interaction, which in turn predicted their respective preferences or dys-controlled behavior and Internet addiction. The indirect effect of Internet expectancies was higher on Internet addiction via attitudes toward online gaming and dys-controlled online gaming than via attitudes toward and preferences of online social interaction. The indirect effects exhibited a larger impact on boys than on girls. The authors recommend that the expectancies of online gaming and social interaction be addressed in efforts to prevent and attenuate the severity of adolescent Internet addiction.

Indirect immunoglobulin G (IgG) and IgM enzyme-linked immunosorbent assays (ELISAs) and IgM capture ELISA for detection of antibodies to lipopolysaccharide in adult typhoid fever patients in Pakistan.

PubMed

Sippel, J; Bukhtiari, N; Awan, M B; Krieg, R; Duncan, J F; Karamat, K A; Malik, I A; Igbal, L M; Legters, L

1989-06-01

Sera from 339 adult febrile patients in Pakistan were tested for antibodies to Salmonella typhi lipopolysaccharide by indirect immunoglobulin G (IgG) and IgM enzyme-linked immunosorbent assay (ELISA) and IgM capture ELISA. A total of 55 patients had S. typhi cultured from their blood, 20 had S. typhi cultured from their stool, 24 were blood or stool culture positive for S. paratyphi A, 41 were culture negative but clinically diagnosed as having enteric fever, 41 had gastrointestinal or urinary tract infections, 41 were clinically diagnosed as having malaria, 20 were smear-positive patients with malaria, 58 had respiratory infections, and the remaining 39 individuals were placed in a miscellaneous group who did not have Salmonella infection. The sensitivities of the indirect IgG ELISA, indirect IgM ELISA, and IgM capture ELISA determined with specimens obtained from the blood culture-positive patients with typhoid fever (positive controls) were 80, 64, and 62%, respectively. The specificities of the assays determined with sera from the patients with respiratory infections (negative controls) were 95, 95, and 97%, respectively. The percentage of smear-positive patients with malaria who were positive by these assays was lower than that in the negative control group. The percentages of individuals in the other patient categories who were positive by these tests were between those obtained with the positive and negative controls. Of the positive controls, 26 were positive by both IgM assays, 9 were IgM positive only by indirect ELISA, and 8 were IgM positive only by IgM capture ELISA. A total of 70% of the positive control patients who were tested for O agglutinins by the Widal tube agglutination assay were positive; however, 29% of the negative control patients were also positive. The indirect IgG ELISA was the single most effective test for the serodiagnosis of typhoid fever in this population.

Indirect immunoglobulin G (IgG) and IgM enzyme-linked immunosorbent assays (ELISAs) and IgM capture ELISA for detection of antibodies to lipopolysaccharide in adult typhoid fever patients in Pakistan.

PubMed Central

Sippel, J; Bukhtiari, N; Awan, M B; Krieg, R; Duncan, J F; Karamat, K A; Malik, I A; Igbal, L M; Legters, L

1989-01-01

Sera from 339 adult febrile patients in Pakistan were tested for antibodies to Salmonella typhi lipopolysaccharide by indirect immunoglobulin G (IgG) and IgM enzyme-linked immunosorbent assay (ELISA) and IgM capture ELISA. A total of 55 patients had S. typhi cultured from their blood, 20 had S. typhi cultured from their stool, 24 were blood or stool culture positive for S. paratyphi A, 41 were culture negative but clinically diagnosed as having enteric fever, 41 had gastrointestinal or urinary tract infections, 41 were clinically diagnosed as having malaria, 20 were smear-positive patients with malaria, 58 had respiratory infections, and the remaining 39 individuals were placed in a miscellaneous group who did not have Salmonella infection. The sensitivities of the indirect IgG ELISA, indirect IgM ELISA, and IgM capture ELISA determined with specimens obtained from the blood culture-positive patients with typhoid fever (positive controls) were 80, 64, and 62%, respectively. The specificities of the assays determined with sera from the patients with respiratory infections (negative controls) were 95, 95, and 97%, respectively. The percentage of smear-positive patients with malaria who were positive by these assays was lower than that in the negative control group. The percentages of individuals in the other patient categories who were positive by these tests were between those obtained with the positive and negative controls. Of the positive controls, 26 were positive by both IgM assays, 9 were IgM positive only by indirect ELISA, and 8 were IgM positive only by IgM capture ELISA. A total of 70% of the positive control patients who were tested for O agglutinins by the Widal tube agglutination assay were positive; however, 29% of the negative control patients were also positive. The indirect IgG ELISA was the single most effective test for the serodiagnosis of typhoid fever in this population. PMID:2754002

Effects of native herbs and light on garlic mustard (Alliaria petiolata) invasion

USGS Publications Warehouse

Phillips-Mao, Laura; Larson, Diane L.; Jordan, Nicholas R.

2014-01-01

The degree to which invasive species drive or respond to environmental change has important implications for conservation and invasion management. Often characterized as a driver of change in North American woodlands, the invasive herb garlic mustard may instead respond to declines in native plant cover and diversity. We tested effects of native herb cover, richness, and light availability on garlic mustard invasion in a Minnesota oak woodland. We planted 50 garlic mustard seeds into plots previously planted with 0 to 10 native herb species. We measured garlic mustard seedling establishment, survival to rosette and adult stages, and average (per plant) and total (per plot) biomass and silique production. With the use of structural equation models, we analyzed direct, indirect, and net effects of native cover, richness, and light on successive garlic mustard life stages. Native plant cover had a significant negative effect on all life stages. Species richness had a significant positive effect on native cover, resulting in indirect negative effects on all garlic mustard stages, and net negative effects on adult numbers, total biomass, and silique production. Light had a strong negative effect on garlic mustard seedling establishment and a positive effect on native herb cover, resulting in significant negative net effects on garlic mustard rosette and adult numbers. However, light's net effect on total garlic mustard biomass and silique production was positive; reproductive output was high even in low-light/high-cover conditions. Combined effects of cover, richness, and light suggest that native herbs provide biotic resistance to invasion by responding to increased light availability and suppressing garlic mustard responses, although this resistance may be overwhelmed by high propagule pressure. Garlic mustard invasion may occur, in part, in response to native plant decline. Restoring native herbs and controlling garlic mustard seed production may effectively reduce garlic mustard spread and restore woodland diversity.

Esthetics and Biocompatibility of Composite Dental Laminates.

PubMed

D'Souza, Dsj; Kumar, M

2010-07-01

Advances in modern dental materials provide patients with a choice of natural looking veneers to provide esthetic restorations. These may be directly fabricated composite resin veneers or indirectly fabricated veneers. This study was carried out to evaluate the clinical effect of new generation indirect veneering composites and to compare them with veneers fabricated from direct composite restorations. The present study was carried out in the Prosthodontics department of a medical college. A total of forty patients requiring restoration of the anterior teeth using composite veneers were selected and either of the two materials was used to fabricate the veneers. Clinical evaluation was done for esthetics and periodontal health. Statistical analysis showed that there were no significant changes to the periodontal health during the period of the study. The evidence obtained from this study indicates that both direct as well as indirect composite materials had clinically acceptable outcomes in terms of restoration of esthetics. Biocompatibility with the periodontal tissues of both materials was also evident by the improvement in oral health indices used in the study.

The economic impact of chronic prostatitis.

PubMed

Calhoun, Elizabeth A; McNaughton Collins, Mary; Pontari, Michel A; O'Leary, Michael; Leiby, Benjamin E; Landis, J Richard; Kusek, John W; Litwin, Mark S

2004-06-14

Little information exists on the economic impact of chronic prostatitis. The objective of this study was to determine the direct and indirect costs associated with chronic prostatitis. Outcomes were assessed using a questionnaire designed to capture health care resource utilization. Resource estimates were converted into unit costs with direct medical cost estimates based on hospital cost-accounting data and indirect costs based on modified labor force, employment, and earnings data from the US Census Bureau. The total direct costs for the 3 months prior to entry into the cohort, excluding hospitalization, were $126 915 for the 167 study participants for an average of $954 per person among the 133 consumers. Of the men, 26% reported work loss valued at an average of $551. The average total costs (direct and indirect) for the 3 months was $1099 per person for those 137 men who had resource consumption with an expected annual total cost per person of $4397. For those study participants with any incurred costs, tests for association revealed that the National Institutes of Health Chronic Prostatitis Symptom Index (P<.001) and each of the 3 subcategories of pain (P =.003), urinary function (P =.03), and quality-of-life (P =.002) were significantly associated with resource use, although the quality-of-life subscale score from the National Institutes of Health Chronic Prostatitis Symptom Index was the only predictor of resource consumption. Chronic prostatitis is associated with substantial costs and lower quality-of-life scores, which predicted resource consumption. The economic impact of chronic prostatitis warrants increased medical attention and resources to identify and test effective treatment strategies.

Direct and indirect costs incurred by Australian living kidney donors.

PubMed

Barnieh, Lianne; Kanellis, John; McDonald, Stephen; Arnold, Jennifer; Sontrop, Jessica M; Cuerden, Meaghan; Klarenbach, Scott; Garg, Amit X; Boudville, Neil

2017-12-07

To describe the direct and indirect costs incurred by Australian living kidney donors. We studied 55 living kidney donors from 3 centres in Perth, Australia and 1 centre in Melbourne, Australia (2010-2014); 49 donors provided information on expenses incurred during the donor evaluation period and up to 3 months after donation. We used a micro-costing approach to measure and value the units of resources consumed. Expenses were grouped as direct costs (ground and air travel, accommodation, and prescription medications) and indirect costs (lost wages and lost productivity). We standardized costs to the year 2016 in Australian dollars. The most common direct costs were for ground travel (100%), parking (76%), and post-donation pain medications or antibiotics (73%). The highest direct costs were for air travel (median $1,986 [3 donors]) and ground travel (median $459 [49 donors]). Donors also reported lost wages (median $9,891 [37 donors]). The inability to perform household activities or care for dependants were reported by 32 (65%) and 23 (47%) donors. Total direct costs averaged $1,682 per donor (median $806 among 49 donors). Total indirect costs averaged $7,249 per donor (median $7,273 among 49 donors). Total direct and indirect costs averaged $8,932 per donor (median $7,963 among 49 donors). Many Australian living kidney donors incur substantial costs during the donation process. Our findings inform the continued development of policies and programs designed to minimize costs incurred by living kidney donors. This article is protected by copyright. All rights reserved.

Estimation of direct and indirect impacts of fireworks on the physicochemical characteristics of atmospheric fine and coarse particles

NASA Astrophysics Data System (ADS)

Tian, Y.-Z.; Wang, J.; Peng, X.; Shi, G.-L.; Feng, Y.-C.

2014-05-01

To quantify total, direct and indirect impacts of fireworks individually, size-resolved PM samples were collected before, during, and after a Chinese folk-custom festival (Chinese New Year) in a megacity in China. Through chemical analysis and morphology characterization, strong influence of fireworks on physicochemical characteristics of PM10 and PM2.5 was observed. Concentrations of many species exhibited an increasing trend during heavy-firework period, especially for K+, Mg2+ and Cr; and the results of non-sea-salt ions demonstrated anthropogenic influence on them. Then, source apportionment was conducted by receptor models and Peak Analysis. Total influence of fireworks was quantified by PMF, showing that fireworks contributed rather higher fractions (23.40% to PM10 and 29.66% to PM2.5) during heavy-firework period than those during light-firework period (4.28% to PM10 and 7.18% to PM2.5). Profiles of total fireworks obtained by two independent methods (PMF and Peak Analysis) were consistent, with higher abundances of K+, Al, Si, Ca and OC. Finally, individual contributions of direct and indirect impacts of fireworks were quantified by CMB. The percentage contributions of resuspended dust, biomass combustion and direct-fireworks were 36.82, 14.08 and 44.44% for PM10 and 34.89, 16.60 and 52.54% for PM2.5, in terms of the total fireworks. The quantification of total, direct and indirect impacts of fireworks to ambient PM gives an original contribution to understand the physicochemical characteristics and mechanisms of such high-intensity anthropogenic activities.

[Socio-economic costs of road traffic accidents in the Canary Islands, Spain, in 1997].

PubMed

López, J; Serrano, P; Duque, B; Artiles, J

2001-01-01

To evaluate the economic impact in terms of direct and indirect costs road traffic accidents in Canarias Islands (Spain) in 1997. The cost-of-illness method was used. Direct and indirect costs were estimated using prevalence cost, i.e., the costs produced in 1997. Direct costs were divided into health services costs, insurance administration costs and the costs of material damage to the vehicles. Indirect costs were obtained through transformation of physical units into monetary units using the approach of human capital theory. The total cost of road traffic accidents was 39,887.16 million pesetas, equivalent to 24,470 for each inhabitant of the Canary Islands and representing 1.3% of the GNP in this region. The total direct cost was 32,559.67 million pesetas, constituting 82% of the total, which was distributed according to the different concepts analyzed: health service costs: 2,407.40 million pesetas; insurance administration costs, 13,415.89 million pesetas and the costs of material damages to the vehicles: 16,736.38 million pesetas. The total indirect costs was 7,327.49 million pesetas, accounting for 18% of the total costs, which was distributed in premature mortality (6,884.88 million pesetas) and absenteeism from work (442.61 million pesetas). Although this study adopts a conservative approach by omitting costs associated with pain and suffering, permanent disability, and those of at-home care provided by the family, the hight socio-economic cost of road traffic accidents clearly indicates the need for the different administrations of the Canary Islands to collaborate in implementing preventive measures.

Understanding the Thermodynamic Properties of the Elastocaloric Effect Through Experimentation and Modelling

NASA Astrophysics Data System (ADS)

Tušek, Jaka; Engelbrecht, Kurt; Mañosa, Lluis; Vives, Eduard; Pryds, Nini

2016-12-01

This paper presents direct and indirect methods for studying the elastocaloric effect (eCE) in shape memory materials and its comparison. The eCE can be characterized by the adiabatic temperature change or the isothermal entropy change (both as a function of applied stress/strain). To get these quantities, the evaluation of the eCE can be done using either direct methods, where one measures (adiabatic) temperature changes or indirect methods where one can measure the stress-strain-temperature characteristics of the materials and from these deduce the adiabatic temperature and isothermal entropy changes. The former can be done using the basic thermodynamic relations, i.e. Maxwell relation and Clausius-Clapeyron equation. This paper further presents basic thermodynamic properties of shape memory materials, such as the adiabatic temperature change, isothermal entropy change and total entropy-temperature diagrams (all as a function of temperature and applied stress/strain) of two groups of materials (Ni-Ti and Cu-Zn-Al alloys) obtained using indirect methods through phenomenological modelling and Maxwell relation. In the last part of the paper, the basic definition of the efficiency of the elastocaloric thermodynamic cycle (coefficient of performance) is defined and discussed.

The health-related social costs of alcohol in Belgium.

PubMed

Verhaeghe, Nick; Lievens, Delfine; Annemans, Lieven; Vander Laenen, Freya; Putman, Koen

2017-12-16

Alcohol is associated with adverse health effects causing a considerable economic impact to society. A reliable estimate of this economic impact for Belgium is lacking. This is the aim of the study. A prevalence-based approach estimating the direct, indirect and intangible costs for the year 2012 was used. Attributional fractions for a series of health effects were derived from literature. The human capital approach was used to estimate indirect costs, while the concept of disability-adjusted life years was used to estimate intangible costs. Sensitivity and scenario analyses were conducted to assess the uncertainty around cost estimates and to evaluate the impact of alternative modelling assumptions. In 2012, total alcohol-attributable direct costs were estimated at €906.1 million, of which the majority were due to hospitalization (€743.7 million, 82%). The indirect costs amounted to €642.6 million, of which 62% was caused by premature mortality. Alcohol was responsible for 157,500 disability-adjusted life years representing €6.3 billion intangible costs. Despite a number of limitations intrinsic to this kind of research, the study can be considered as the most comprehensive analysis thus far of the health-related social costs of alcohol in Belgium.

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

Zhang, S.; Wang, Minghuai; Ghan, Steven J.

Aerosol-cloud interactions continue to constitute a major source of uncertainty for the estimate of climate radiative forcing. The variation of aerosol indirect effects (AIE) in climate models is investigated across different dynamical regimes, determined by monthly mean 500 hPa vertical pressure velocity (ω500), lower-tropospheric stability (LTS) and large-scale surface precipitation rate derived from several global climate models (GCMs), with a focus on liquid water path (LWP) response to cloud condensation nuclei (CCN) concentrations. The LWP sensitivity to aerosol perturbation within dynamic regimes is found to exhibit a large spread among these GCMs. It is in regimes of strong large-scale ascendmore » (ω500 < -25 hPa/d) and low clouds (stratocumulus and trade wind cumulus) where the models differ most. Shortwave aerosol indirect forcing is also found to differ significantly among different regimes. Shortwave aerosol indirect forcing in ascending regimes is as large as that in stratocumulus regimes, which indicates that regimes with strong large-scale ascend are as important as stratocumulus regimes in studying AIE. 42" It is further shown that shortwave aerosol indirect forcing over regions with high monthly large-scale surface precipitation rate (> 0.1 mm/d) contributes the most to the total aerosol indirect forcing (from 64% to nearly 100%). Results show that the uncertainty in AIE is even larger within specific dynamical regimes than that globally, pointing to the need to reduce the uncertainty in AIE in different dynamical regimes.« less

Direct and indirect costs for systemic lupus erythematosus in Sweden. A nationwide health economic study based on five defined cohorts.

PubMed

Jönsen, Andreas; Hjalte, Frida; Willim, Minna; Carlsson, Katarina Steen; Sjöwall, Christopher; Svenungsson, Elisabet; Leonard, Dag; Bengtsson, Christine; Rantapää-Dahlqvist, Solbritt; Pettersson, Susanne; Gunnarsson, Iva; Zickert, Agneta; Gustafsson, Johanna T; Rönnblom, Lars; Petersson, Ingemar F; Bengtsson, Anders A; Nived, Ola

2016-06-01

The main objectives of this study were to calculate total costs of illness and cost-driving disease features among patients with systemic lupus erythematosus (SLE) in Sweden. Five cohorts of well-defined SLE patients, located in different parts of the country were merged. Incident and prevalent cases from 2003 through 2010 were included. The American College of Rheumatology (ACR) classification criteria was used. From the local cohorts, data on demographics, disease activity (SLEDAI 2K), and organ damage (SDI) were collected. Costs for inpatient care, specialist outpatient care and drugs were retrieved from national registries at the National Board of Health and Welfare. Indirect costs were calculated based on sickness leave and disability pensions from the Swedish Social Insurance Agency. In total, 1029 SLE patients, 88% females, were included, and approximately 75% were below 65 years at the end of follow-up, and thus in working age. The mean number of annual specialist physician visits varied from six to seven; mean annual inpatient days were 3.1-3.6, and mean annual sick leave was 123-148 days, all per patient. The total annual cost was 208,555 SEK ($33,369 = 22,941€), of which direct cost was 63,672kr ($10,188 = 7004€) and the indirect cost was 144,883 SEK ($23,181 = 15,937€), all per patient. The costs for patients with short disease duration were higher. Higher disease activity as measured by a SLEDAI 2K score > 3 was associated with approximately 50% increase in both indirect and direct costs. Damage in the neuropsychiatric and musculoskeletal domains were also linked to higher direct and indirect costs, while organ damage in the renal and ocular systems increased direct costs. Based on this study and an estimate of slightly more than 6000 SLE patients in Sweden, the total annual cost for SLE in the country is estimated at $188 million (=129.5 million €). Both direct (30%) and indirect costs (70%) are substantial. Medication accounts for less than 10% of the total cost. The tax paid national systems for health care and social security in Sweden ensure equal access to health care, sick leave reimbursements, and disability pensions nationwide. Our extrapolated annual costs for SLE in Sweden are therefore the best supported estimations thus far, and they clearly underline the importance of improved management, especially to reduce the indirect costs. Copyright © 2016 Elsevier Inc. All rights reserved.

Context-dependency of arbuscular mycorrhizal fungi on plant-insect interactions in an agroecosystem

PubMed Central

Barber, Nicholas A.; Kiers, E. Toby; Hazzard, Ruth V.; Adler, Lynn S.

2013-01-01

Plants interact with a variety of other community members that have the potential to indirectly influence each other through a shared host plant. Arbuscular mycorrhizal fungi (AMF) are generally considered plant mutualists because of their generally positive effects on plant nutrient status and growth. AMF may also have important indirect effects on plants by altering interactions with other community members. By influencing plant traits, AMF can modify aboveground interactions with both mutualists, such as pollinators, and antagonists, such as herbivores. Because herbivory and pollination can dramatically influence plant fitness, comprehensive assessment of plant–AMF interactions should include these indirect effects. To determine how AMF affect plant–insect interactions, we grew Cucumis sativus (Cucurbitaceae) under five AMF inoculum treatments and control. We measured plant growth, floral production, flower size, and foliar nutrient content of half the plants, and transferred the other half to a field setting to measure pollinator and herbivore preference of wild insects. Mycorrhizal treatment had no effect on plant biomass or floral traits but significantly affected leaf nutrients, pollinator behavior, and herbivore attack. Although total pollinator visitation did not vary with AMF treatment, pollinators exhibited taxon-specific responses, with honey bees, bumble bees, and Lepidoptera all responding differently to AMF treatments. Flower number and size were unaffected by treatments, suggesting that differences in pollinator preference were driven by other floral traits. Mycorrhizae influenced leaf K and Na, but these differences in leaf nutrients did not correspond to variation in herbivore attack. Overall, we found that AMF indirectly influence both antagonistic and mutualistic insects, but impacts depend on the identity of both the fungal partner and the interacting insect, underscoring the context-dependency of plant–AMF interactions. PMID:24046771

The effect of maternal substance abuse on the cost of neonatal care.

PubMed

Norton, E C; Zarkin, G A; Calingaert, B; Bradley, C J

1996-01-01

This study addresses the effect of maternal substance abuse on the cost of neonatal care in a sample of all singleton live births in Maryland in 1991. Most other cost studies have analyzed data from only one hospital; we analyzed data from 54 hospitals and therefore can control for individual hospital effects and correlation of observations within hospitals. We find that maternal drug abuse has a significant positive effect on total hospital charges, length of stay, and average daily charges, with the increase in length of stay being proportionally greater than the increase in average daily charges. Maternal alcohol abuse also has a positive effect on hospital charges and length of stay, but the effects are not statistically significant. About half the effect of drug abuse on total charges works indirectly through premature birth and other comorbidities.

Reasons why undergraduate women comply with unwanted, non-coercive sexual advances: A serial indirect effect model integrating sexual script theory and sexual self-control perspectives.

PubMed

Quinn-Nilas, Christopher; Kennett, Deborah J

2018-01-16

This study explored the predictors of young women's compliance with unwanted sexual activities, integrating the social with the cognitive and behavioral correlates of sexual compliance. In total, 222 young heterosexual women completed measures examining the Sexual Self-Control model, including reasons for consenting, sexual resourcefulness, and compliance with unwanted sex, as well as gender role measures pertaining to sexual script theory, including the sexual double standard, gender role stress, and virginity scripts. An exploratory analysis of serial indirect effects demonstrated that women scoring lower in sexual resourcefulness endorsed higher female gender role stress, which in turn was associated with higher endorsement of reasons for consent, translating into more frequent compliance with unwanted sexual activities. The relationship between one's ability to refuse and their decision to refuse appears quite complex. Understanding one's decision requires consideration of the social aspects of gender role endorsement.

Effect of direct and indirect contact with mental illness on dangerousness and social distance.

PubMed

Lee, Minhwa; Seo, Mikyung

2018-03-01

This study is based on the contact hypothesis that contact with mental illness is the most effective anti-stigma strategy. This study aims to analyze which form of contact can most effectively decrease the dangerousness and social distance associated with schizophrenia, depression and alcoholism. In total, 573 Korean adults ( M age  = 43.71 years, standard deviation ( SD) = 13.41; 54.1% male, 45.9% female) were surveyed about randomly assigned vignettes of schizophrenia, depression and alcoholism. The participants were questioned on the dangerousness and social distance associated with the assigned vignette, as well as direct and indirect contact experience with the mental illness. Two-way analysis of variance (ANOVA) was used to determine the main effect and interaction effect that the type of mental illness and contact experience have on the two dependent variables (dangerousness and social distance). The findings show that the type of mental illness has a significant main effect on dangerousness and social distance, but contact type only has a significant main effect on social distance. Moreover, the two independent variables (mental illness subtype and contact experience) have an interaction effect on two dependent variables (dangerousness and social distance). Therefore, the anti-stigma effect of contact varies according to the type of mental illness. Our findings suggest that appropriate anti-stigma strategies are required for each type of mental illness. Considering that opportunities for direct contact with persons with mental illness are highly limited, it is necessary to actively utilize indirect contact.

The Kjeldahl method as a primary reference procedure for total protein in certified reference materials used in clinical chemistry. II. Selection of direct Kjeldahl analysis and its preliminary performance parameters.

PubMed

Vinklárková, Bára; Chromý, Vratislav; Šprongl, Luděk; Bittová, Miroslava; Rikanová, Milena; Ohnútková, Ivana; Žaludová, Lenka

2015-01-01

To select a Kjeldahl procedure suitable for the determination of total protein in reference materials used in laboratory medicine, we reviewed in our previous article Kjeldahl methods adopted by clinical chemistry and found an indirect two-step analysis by total Kjeldahl nitrogen corrected for its nonprotein nitrogen and a direct analysis made on isolated protein precipitates. In this article, we compare both procedures on various reference materials. An indirect Kjeldahl method gave falsely lower results than a direct analysis. Preliminary performance parameters qualify the direct Kjeldahl analysis as a suitable primary reference procedure for the certification of total protein in reference laboratories.

Environmental, psychological, and social influences on physical activity among Japanese adults: structural equation modeling analysis.

PubMed

Ishii, Kaori; Shibata, Ai; Oka, Koichiro

2010-08-05

An understanding of the contributing factors to be considered when examining how individuals engage in physical activity is important for promoting population-based physical activity. The environment influences long-term effects on population-based health behaviors. Personal variables, such as self-efficacy and social support, can act as mediators of the predictive relationship between the environment and physical activity. The present study examines the direct and indirect effects of environmental, psychological, and social factors on walking, moderate-intensity activity excluding walking, and vigorous-intensity activity among Japanese adults. The participants included 1,928 Japanese adults aged 20-79 years. Seven sociodemographic attributes (e.g., gender, age, education level, employment status), psychological variables (self-efficacy, pros, and cons), social variables (social support), environmental variables (home fitness equipment, access to facilities, neighborhood safety, aesthetic sensibilities, and frequency of observing others exercising), and the International Physical Activity Questionnaire were assessed via an Internet-based survey. Structural equation modeling was conducted to determine associations between environmental, psychological, and social factors with physical activity. Environmental factors could be seen to have indirect effects on physical activity through their influence on psychological and social variables such as self-efficacy, pros and cons, and social support. The strongest indirect effects could be observed by examining the consequences of environmental factors on physical activity through cons to self-efficacy. The total effects of environmental factors on physical activity were 0.02 on walking, 0.02 on moderate-intensity activity excluding walking, and 0.05 on vigorous-intensity activity. The present study indicates that environmental factors had indirect effects on walking, moderate-intensity activity excluding walking and vigorous-intensity activity among Japanese adults, especially through the effects on these factors of self-efficacy, social support, and pros and cons. The findings of the present study imply that intervention strategies to promote more engagement in physical activity for population-based health promotion may be necessary.

Environmental, psychological, and social influences on physical activity among Japanese adults: structural equation modeling analysis

PubMed Central

2010-01-01

Background An understanding of the contributing factors to be considered when examining how individuals engage in physical activity is important for promoting population-based physical activity. The environment influences long-term effects on population-based health behaviors. Personal variables, such as self-efficacy and social support, can act as mediators of the predictive relationship between the environment and physical activity. The present study examines the direct and indirect effects of environmental, psychological, and social factors on walking, moderate-intensity activity excluding walking, and vigorous-intensity activity among Japanese adults. Methods The participants included 1,928 Japanese adults aged 20-79 years. Seven sociodemographic attributes (e.g., gender, age, education level, employment status), psychological variables (self-efficacy, pros, and cons), social variables (social support), environmental variables (home fitness equipment, access to facilities, neighborhood safety, aesthetic sensibilities, and frequency of observing others exercising), and the International Physical Activity Questionnaire were assessed via an Internet-based survey. Structural equation modeling was conducted to determine associations between environmental, psychological, and social factors with physical activity. Results Environmental factors could be seen to have indirect effects on physical activity through their influence on psychological and social variables such as self-efficacy, pros and cons, and social support. The strongest indirect effects could be observed by examining the consequences of environmental factors on physical activity through cons to self-efficacy. The total effects of environmental factors on physical activity were 0.02 on walking, 0.02 on moderate-intensity activity excluding walking, and 0.05 on vigorous-intensity activity. Conclusions The present study indicates that environmental factors had indirect effects on walking, moderate-intensity activity excluding walking and vigorous-intensity activity among Japanese adults, especially through the effects on these factors of self-efficacy, social support, and pros and cons. The findings of the present study imply that intervention strategies to promote more engagement in physical activity for population-based health promotion may be necessary. PMID:20684794

Evaluating The Indirect Effect of Cirrus Clouds

NASA Astrophysics Data System (ADS)

Dobbie, S.; Jonas, P. R.

What effect would an increase in nucleating aerosols have on the radiative and cloud properties? What error would be incurred by evaluating the indirect effect by taking an evolved cloud and fixing the integrated water content and vary the number of ice crystals? These questions will be addressed in this work. We will use the UK LES cloud resolving model to perform a sensitivity study for cirrus clouds to the indirect effect, and will evaluate approximate methods in the process. In this work, we will initialize the base (no increase of aerosol) cirrus clouds so that the double moment scheme is constrained to agree with observations through the ef- fective radius. Effective radius is calculated using the local concentration and the ice water content. We then perform a sensitivity experiment to investigate the dependence of the average IWC, effective size, and radiative properties (including heating rates) to variations in the nucleation rate. Conclusions will be draw as to the possible ef- fect of changes in aerosol amounts on cirrus. We will determine how sensitive the cloud and radiative properties are to various aerosol increases. We will also discuss the applicability of the Meyer et al. (1992) nucleation formulae for our simulations. It is important to stress that in this work we only change the nucleation rate for the newly forming cloud. By doing this, we are not fixing the total water content and redistributing the water amongst increased ice crystals. We increase the number of aerosols available to be nucleated and allow the model to evolve the size distributions. In this way, there is competition for the water vapour, the ice particles are evolved dynamically with different fall speeds, the conversion rates to other hydrometers (such as aggregates) are affected, and the heating rates are different due to the different size distributions that evolve. We will look at how the water content, the distribution of water, and the radiative properties are affected by the indirect effect.

Positive and negative feedback loops in nutrient phytoplankton interactions related to climate dynamics factors in a shallow temperate estuary (Vistula Lagoon, southern Baltic)

NASA Astrophysics Data System (ADS)

Kruk, Marek; Kobos, Justyna; Nawrocka, Lidia; Parszuto, Katarzyna

2018-04-01

This study aims to demonstrate that factors associated with climate dynamics, such as temperature and wind, affect the ecosystem of the shallow Vistula Lagoon in the southern Baltic and cause nutrient forms phytoplankton interactions: the growth of biomass and constraints of it. This occurs through a network of direct and indirect relationships between environmental and phytoplankton factors, including interactions of positive and negative feedback loops. Path analysis supported by structural equation modeling (SEM) was used to test hypotheses regarding the impact of climate factors on algal assemblages. Increased phytoplankton biomass was affected directly by water temperature and salinity, while the wind speed effect was indirect as it resulted in increased concentrations of suspended solids (SS) in the water column. Simultaneously, the concentration of SS in the water was positively correlated with particulate organic carbon (POC), particulate nitrogen (PN), and particulate phosphorus (PP), and was negatively correlated with the total nitrogen to phosphorus (N:P) ratio. Particulate forms of C, N, and phosphorus (P), concentrations of soluble reactive phosphorus (SRP) and nitrate and nitrite nitrogen (NO3-N + NO2-N), and ratios of the total N:P and DIN:SRP, all indirectly effected Cyanobacteria C concentrations. These processes influence other phytoplankton groups (Chlorophyta, Bacillariophyceae and the picophytoplankton fraction). Increased levels of SRP associated with organic matter (POC), which stemmed from reduced DIN:SRP ratios, contributed to increased Cyanoprokaryota and picophytoplankton C concentrations, which created a positive feedback loop. However, a simultaneous reduction in the total N:P ratio could have inhibited increases in the biomass of these assemblages by limiting N, which likely formed a negative feedback loop. The study indicates that the nutrients-phytoplankton feedback loop phenomenon can intensify eutrophication in a temperate lagoon, including increases of the biomass of Cyanobacteria and picophytoplankton. However, it can also constrain this increase.

Landslides in Colorado, USA--Impacts and loss estimation for 2010

USGS Publications Warehouse

Highland, Lynn M.

2012-01-01

The focus of this study is to investigate landslides and consequent losses which affected Colorado in the year 2010. By obtaining landslide reports from a variety of sources, this report will demonstrate the feasibility of creating a profile of landslides and their effects on communities. A short overview of the current status of landslide-loss studies for the United States is introduced, followed by a compilation of landslide occurrence and associated losses and impacts which affected Colorado for the year 2010. Direct costs are summarized in descriptive and tabular form, and where possible, indirect costs are also noted or estimated. Total direct costs of landslides in Colorado for the year 2010 were approximately $9,149,335.00 (2010 U.S. dollars). (Since not all data for damages and costs were obtained, this figure realistically could be considerably higher.) Indirect costs were noted where available but are not totaled due to the fact that most indirect costs were not obtainable for various reasons outlined later in this report. Casualty data are considered as being within the scope of loss evaluation, and are reported in Appendix 1, but are not assigned dollar losses. More details on the source material for loss data not found in the reference section are reported in Appendix 2, and Appendix 3 summarizes notes on landslide-loss investigations in general and lessons learned during the process of loss-data collection.

Effect of direct and indirect transfer status on trauma mortality in sub Saharan Africa.

PubMed

Boschini, Laura P; Lu-Myers, Yemeng; Msiska, Nelson; Cairns, Bruce; Charles, Anthony G

2016-05-01

Traumatic injuries account for the greatest portion of global surgical burden particularly in low- and middle-income countries (LMICs). To assess effectiveness of a developing trauma system, we hypothesize that there are survival differences between direct and indirect transfer of trauma patients to a tertiary hospital in sub Saharan Africa. Retrospective analysis of 51,361 trauma patients within the Kamuzu Central Hospital (KCH) trauma registry from 2008 to 2012 was performed. Analysis of patient characteristics and logistic regression modelling for in-hospital mortality was performed. The primary study outcome is in hospital mortality in the direct and indirect transfer groups. There were 50,059 trauma patients were included in this study. 6578 patients transferred from referring facilities and 43,481 patients transported from the scene. The indirect and direct transfer cohorts were similar in age and sex. The mechanism of injury for transferred patients was 78.1% blunt, 14.5% penetrating, and 7.4% other, whereas for the scene group it was 70.7% blunt, 24.0% penetrating, and 5.2% other. Median times to presentation were 13 (4-30) and 3 (1-14)h for transferred and scene patients, respectively. Mortality rate was 4.2% and 1.6% for indirect and direct transfer cohorts, respectively. A total of 8816 patients were admitted of which 3636 and 5963 were in the transfer and scene cohort, respectively. After logistic regression analysis, the adjusted in-hospital mortality odds ratio was 2.09 (1.24-3.54); P=0.006 for indirect transfer versus direct transfer cohort, after controlling for significant covariates. Direct transfer of trauma patients from the scene to the tertiary care centre is associated with a survival benefit. Our findings suggest that trauma education and efforts directed at regionalization of trauma care, strengthening pre-hospital care and timely transfer from district hospitals could mitigate trauma-related mortality in a resource-poor setting. Copyright © 2016 Elsevier Ltd. All rights reserved.

Shear bond strength between an indirect composite layering material and feldspathic porcelain-coated zirconia ceramics.

PubMed

Fushiki, Ryosuke; Komine, Futoshi; Blatz, Markus B; Koizuka, Mai; Taguchi, Kohei; Matsumura, Hideo

2012-10-01

This study aims to evaluate the effect of both feldspathic porcelain coating of zirconia frameworks and priming agents on shear bond strength between an indirect composite material and zirconia frameworks. A total of 462 airborne-particle-abraded zirconia disks were divided into three groups: untreated disks (ZR-AB), airborne-particle-abraded zirconia disks coated with feldspathic porcelain, (ZR-PO-AB), and hydrofluoric acid-etched zirconia disks coated with feldspathic porcelain (ZR-PO-HF). Indirect composite (Estenia C&B) was bonded to zirconia specimens with no (CON) or one of four priming agents--Clearfil Photo Bond (CPB), Clearfil Photo Bond with Clearfil Porcelain Bond Activator (CPB + activator), Estenia Opaque primer, or Porcelain Liner M Liquid B (PLB)--with or without an opaque material (Estenia C&B Opaque). All specimens were tested for shear bond strength before and after 20,000 thermocycles. The Steel-Dwass test and Mann-Whitney U test were used to compare shear bond strength. In ZR-AB specimens, the initial bond strength of the CPB and CPB + Activator groups was significantly higher as compared with the other three groups (P < 0.05), whereas the PLB and CPB + Activator groups had the highest pre- and post-thermocycling bond strengths in ZR-PO-AB and ZR-PO-HF specimens. Among CON disks without opaque material, bond strength was significantly lower in ZR-AB specimens than in ZR-PO-AB and ZR-PO-HF specimens (P < 0.05). Feldspathic porcelain coating of a Katana zirconia framework enhanced the bond strength of Estenia C&B indirect composite to zirconia independent of surface treatment. The use of a silane coupling agent and opaque material yields durable bond strength between the indirect composite and feldspathic-porcelain-coated zirconia. The results of the present study suggest that feldspathic porcelain coating of zirconia frameworks is an effective method to obtain clinically acceptable bond strengths of a layering indirect composite material to a zirconia framework.

Evolution in response to direct and indirect ecological effects in pitcher plant inquiline communities.

PubMed

terHorst, Casey P

2010-12-01

Ecologists have long recognized the importance of indirect ecological effects on species abundances, coexistence, and diversity. However, the evolutionary consequences of indirect interactions are rarely considered. Here I conduct selection experiments and examine the evolutionary response of Colpoda sp., a ciliated protozoan, to other members of the inquiline community of purple pitcher plants (Sarracenia purpurea). I measured the evolution of six traits in response to (1) predation by mosquito larvae, (2) competition from other ciliated protozoans, and (3) simultaneous predation and competition. The latter treatment incorporated both direct effects and indirect effects due to interactions between predators and competitors. Population growth rate and cell size evolved in response to direct effects of predators and competitors. However, trait values in the multispecies treatment were similar to those in the monoculture treatment, indicating that direct effects were offset by strong indirect effects on the evolution of traits. For most of the traits measured, indirect effects were opposed to, and often stronger than, direct effects. These indirect effects occurred as a result of behavioral changes of the predator in the presence of competitors and as a result of reduced densities of competitors in the presence of predators. Incorporating indirect effects provides a more realistic description of how species evolve in complex natural communities.

The impact of job and family demands on partner's fatigue: A study of Japanese dual-earner parents.

PubMed

Watanabe, Mayumi; Shimazu, Akihito; Bakker, Arnold B; Demerouti, Evangelia; Shimada, Kyoko; Kawakami, Norito

2017-01-01

This study of Japanese dual-earner couples examined the impact of family and job demands on one's own and one's partner's fatigue as well as gender differences in these effects. A total of 2,502 parents (1,251 couples) were surveyed using a self-administered questionnaire. A crossover model was tested using structural equation modeling. The results of structural equation modeling analyses showed that both job and family demands independently exacerbated fatigue. There was an indirect effect of job and family demands on partner fatigue through one's own fatigue only from husbands to wives. An indirect effect of job demands on partner fatigue through partner's family demands was identified only from wives to husbands. Furthermore, there were gender differences in the crossover of fatigue. This study shows that job and family demands influence family circumstances. When considering means to reduce employees' fatigue, gender differences in the mechanism of fatigue need to be taken into account.

Confidence Limits for the Indirect Effect: Distribution of the Product and Resampling Methods

ERIC Educational Resources Information Center

MacKinnon, David P.; Lockwood, Chondra M.; Williams, Jason

2004-01-01

The most commonly used method to test an indirect effect is to divide the estimate of the indirect effect by its standard error and compare the resulting z statistic with a critical value from the standard normal distribution. Confidence limits for the indirect effect are also typically based on critical values from the standard normal…

Received social support and exercising: An intervention study to test the enabling hypothesis.

PubMed

Rackow, Pamela; Scholz, Urte; Hornung, Rainer

2015-11-01

Received social support is considered important for health-enhancing exercise participation. The enabling hypothesis of social support suggests an indirect association of social support and exercising via constructs of self-regulation, such as self-efficacy. This study aimed at examining an expanded enabling hypothesis by examining effects of different kinds of social support (i.e., emotional and instrumental) on exercising not only via self-efficacy but also via self-monitoring and action planning. An 8-week online study was conducted. Participants were randomly assigned to an intervention or a control group. The intervention comprised finding and then exercising regularly with a new exercise companion. Intervention and control group effects were compared by a manifest multigroup model. Received emotional social support predicted self-efficacy, self-monitoring, and action planning in the intervention group. Moreover, received emotional social support was indirectly connected with exercise via the examined mediators. The indirect effect from received emotional social support via self-efficacy mainly contributed to the total effect. No direct or indirect effect of received instrumental social support on exercise emerged. In the control group, neither emotional nor instrumental social support was associated with any of the self-regulation constructs nor with exercise. Actively looking for a new exercise companion and exercising together seems to be beneficial for the promotion of received emotional and instrumental social support. Emotional support in turn promotes exercise by enabling better self-regulation, in particular self-efficacy. Statement of contribution What is already known on this subject? With the 'enabling hypothesis', Benight and Bandura (2004, Behav. Res. Ther., 42, 1129) claimed that social support indirectly affects behaviour via self-efficacy. Research in the domain of physical exercise has provided evidence for this enabling hypothesis on a correlational basis only preventing causal inferences. What does this study add? We found evidence for the enabling hypothesis of received social support via self-efficacy on physical exercise in an intervention study. Moreover, this study demonstrated the distinct contribution of received emotional and instrumental social support in the context of the enabling hypothesis. © 2015 The British Psychological Society.

Effects of Arthroscopy for Femoroacetabular Impingement Syndrome on Quality of Life and Economic Outcomes.

PubMed

Mather, Richard C; Nho, Shane J; Federer, Andrew; Demiralp, Berna; Nguyen, Jennifer; Saavoss, Asha; Salata, Michael J; Philippon, Marc J; Bedi, Asheesh; Larson, Christopher M; Byrd, J W Thomas; Koenig, Lane

2018-04-01

The diagnosis and treatment of femoroacetabular impingement (FAI) have increased steadily within the past decade, and research indicates clinically significant improvements after treatment of FAI with hip arthroscopy. This study examined the societal and economic impact of hip arthroscopy by high-volume surgeons for patients with FAI syndrome aged <50 years with noncontroversial diagnosis and indications for surgery. Economic and decision analysis; Level of evidence, 2. The cost-effectiveness of hip arthroscopy versus nonoperative treatment was evaluated by calculating direct and indirect treatment costs. Direct cost was calculated with Current Procedural Terminology medical codes associated with FAI treatment. Indirect cost was measured with the patient-reported data of 102 patients who underwent arthroscopy and from the reimbursement records of 32,143 individuals between the ages of 16 and 79 years who had information in a private insurance claims data set contained within the PearlDiver Patient Records Database. The indirect economic benefits of hip arthroscopy were inferred through regression analysis to estimate the statistical relationship between functional status and productivity. A simulation-based approach was then used to estimate the change in productivity associated with the change in functional status observed in the treatment cohort between baseline and follow-up. To analyze cost-effectiveness, 1-, 2-, and 3-way sensitivity analyses were performed on all variables in the model, and Monte Carlo analysis evaluated the impact of uncertainty in the model assumptions. Analysis of indirect costs identified a statistically significant increase of mean aggregate productivity of $8968 after surgery. Cost-effectiveness analysis showed a mean cumulative total 10-year societal savings of $67,418 per patient from hip arthroscopy versus nonoperative treatment. Hip arthroscopy also conferred a gain of 2.03 quality-adjusted life years over this period. The mean cost for hip arthroscopy was estimated at $23,120 ± $10,279, and the mean cost of nonoperative treatment was estimated at $91,602 ± $14,675. In 99% of trials, hip arthroscopy was recognized as the preferred cost-effective strategy. FAI syndrome produces a substantial economic burden on society that may be reduced through the indirect cost savings and economic benefits from hip arthroscopy.

Social support and social undermining as explanatory factors for health-related quality of life in people living with HIV/AIDS.

PubMed

Oetzel, John; Wilcox, Bryan; Archiopoli, Ashley; Avila, Magdalena; Hell, Cia; Hill, Ricky; Muhammad, Michael

2014-01-01

This study aimed to examine the influence of social support (from personal networks and health care providers) and social undermining (from personal networks) on health-related quality of life (HRQOL; general health perceptions, physical functioning, and depression). Specifically, the authors aimed to identify the nature of the effects (direct, mediating, or moderating) of social support and social undermining on HRQOL. A total of 344 people living with HIV/AIDS and who were patients in a federally funded clinic in New Mexico completed a self-report survey questionnaire. The major findings of this study are the following: (a) social support and social undermining had direct and indirect effects on HRQOL-there was no evidence of a moderating effect of social support and social undermining; (b) for direct effects, social undermining was a stronger predictor of HRQOL than social support with social support variables having positive relations and social undermining variables having negative relations with HRQOL; and (c) for indirect effects, providers' social support partially mediated the influence of unstable employment/unemployment and social undermining on HRQOL.

Is CO2 emission a side effect of financial development? An empirical analysis for China.

PubMed

Hao, Yu; Zhang, Zong-Yong; Liao, Hua; Wei, Yi-Ming; Wang, Shuo

2016-10-01

Based on panel data for 29 Chinese provinces from 1995 to 2012, this paper explores the relationship between financial development and environmental quality in China. A comprehensive framework is utilized to estimate both the direct and indirect effects of financial development on CO 2 emissions in China using a carefully designed two-stage regression model. The first-difference and orthogonal-deviation Generalized Method of Moments (GMM) methods are used to control for potential endogeneity and introduce dynamics. To ensure the robustness of the estimations, two indicators measuring financial development-financial depth and financial efficiency-are used. The empirical results indicate that the direct effects of financial depth and financial efficiency on environmental quality are positive and negative, respectively. The indirect effects of both indicators are U shaped and dominate the shape of the total effects. These findings suggest that the influences of the financial development on environment depend on the level of economic development. At the early stage of economic growth, financial development is environmentally friendly. When the economy is highly developed, a higher level of financial development is harmful to the environmental quality.

Cost Analysis of Spinal Versus General Anesthesia for Lumbar Diskectomy and Laminectomy Spine Surgery.

PubMed

Agarwal, Prateek; Pierce, John; Welch, William C

2016-05-01

Lumbar spine surgery can be performed using various anesthetic modalities, most notably general or spinal anesthesia. Because data comparing the cost of these anesthetic modalities in spine surgery are scarce, this study asks whether spinal anesthesia is less costly than general anesthesia. A total of 542 patients who underwent elective lumbar diskectomy or laminectomy spine surgery between 2007 and 2011 were retrospectively identified, with 364 having received spinal anesthesia and 178 having received general anesthesia. Mean direct operating cost, indirect cost (general support staff, insurance, taxes, floor space, facility, and administrative costs), and total cost were compared among patients who received general and spinal anesthesia. Linear multiple regression analysis was used to identify the effect of anesthesia type on cost and determine the factors underlying this effect, while controlling for patient and procedure characteristics. When controlling for patient and procedure characteristics, use of spinal anesthesia was associated with a 41.1% lower direct operating cost (-$3629 ± $343, P < 0.001), 36.6% lower indirect cost (-$1603 ± $168, P < 0.001), and 39.6% lower total cost (-$5232 ± $482, P < 0.001) compared with general anesthesia. Shorter hospital stay, shorter duration of anesthesia, shorter duration of operation, and lower estimated blood loss contributed to lower costs for spinal anesthesia, but other factors beyond these were also responsible for lower direct operating and total costs. When comparing the benefits of spinal and general anesthesia, spinal anesthesia is less costly when used in patients undergoing lumbar diskectomy and laminectomy spine surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

Direct contra naïve-indirect comparison of clinical failure rates between high-viscosity GIC and conventional amalgam restorations: an empirical study.

PubMed

Mickenautsch, Steffen; Yengopal, Veerasamy

2013-01-01

Naïve-indirect comparisons are comparisons between competing clinical interventions' evidence from separate (uncontrolled) trials. Direct comparisons are comparisons within randomised control trials (RCTs). The objective of this empirical study is to test the null-hypothesis that trends and performance differences inferred from naïve-indirect comparisons and from direct comparisons/RCTs regarding the failure rates of amalgam and direct high-viscosity glass-ionomer cement (HVGIC) restorations in permanent posterior teeth have similar direction and magnitude. A total of 896 citations were identified through systematic literature search. From these, ten and two uncontrolled clinical longitudinal studies for HVGIC and amalgam, respectively, were included for naïve-indirect comparison and could be matched with three out twenty RCTs. Summary effects sizes were computed as Odds ratios (OR; 95% Confidence intervals) and compared with those from RCTs. Trend directions were inferred from 95% Confidence interval overlaps and direction of point estimates; magnitudes of performance differences were inferred from the median point estimates (OR) with 25% and 75% percentile range, for both types of comparison. Mann-Whitney U test was applied to test for statistically significant differences between point estimates of both comparison types. Trends and performance differences inferred from naïve-indirect comparison based on evidence from uncontrolled clinical longitudinal studies and from direct comparisons based on RCT evidence are not the same. The distributions of the point estimates differed significantly for both comparison types (Mann-Whitney U  =  25, n(indirect)  =  26; n(direct)  =  8; p  =  0.0013, two-tailed). The null-hypothesis was rejected. Trends and performance differences inferred from either comparison between HVGIC and amalgam restorations failure rates in permanent posterior teeth are not the same. It is recommended that clinical practice guidance regarding HVGICs should rest on direct comparisons via RCTs and not on naïve-indirect comparisons based on uncontrolled longitudinal studies in order to avoid inflation of effect estimates.

Pathways for Disordered Eating Behaviors in Minority Girls: The Role of Adiposity, Peer Weight-Related Teasing, and Desire to Be Thinner

ERIC Educational Resources Information Center

Olvera, Norma; McCarley, Kendall; Matthews-Ewald, Molly R.; Fisher, Felicia; Jones, Martinque; Flynn, Erika G.

2017-01-01

This study investigated the direct and indirect effects of biological, psychological, and sociocultural factors in predicting disordered eating behaviors in girls with overweight/obesity. A total of 135 Hispanic and African American girls ([x-bar][subscript age] = 11.13 ± 1.54 years) completed surveys assessing the desire to be thinner, peer…

E-Learning and the University of Huelva: A Study of WebCT and the Technological Acceptance Model

ERIC Educational Resources Information Center

Sanchez, R. Arteaga; Hueros, A. Duarte; Ordaz, M. Garcia

2013-01-01

Purpose: The purpose of this paper is to investigate the factors that determine the acceptance of the WebCT learning system among students of the faculties of Business and Education Sciences at the University of Huelva, and to verify the direct and indirect effects of these factors. Design/methodology/approach: A total of 226 students at the…

Monitoring baseline suspended sediment in forested basins: the effects of sampling on suspended sediment rating curves

Treesearch

Robert B. Thomas

1988-01-01

Abstract - Rating curves are widely used for directly assessing changes in the suspended sediment delivery process and indirectly for estimating total yields. Four sampling methods were simulated-over a 31-day record of suspended sediment from the North Fork of the Mad River near Korbel, California. The position and size of the four groups of plotted slope/intercept...

The Mediating Effect of Regulatory Emotional Self-Efficacy on the Association between Self-Esteem and School Bullying in Middle School Students: A Cross-Sectional Study.

PubMed

Wang, Xiaoqin; Zhang, Yue; Hui, Zhaozhao; Bai, Wanyue; Terry, Paul D; Ma, Mei; Li, Yang; Cheng, Li; Gu, Wei; Wang, Mingxu

2018-05-15

School bullying is negatively associated with self-esteem, but psychological mediators of bullying have yet to be clarified. We examined regulatory emotional self-efficacy (RESE) as a possible mediator in the association between self-esteem and school bullying. A cross-sectional study of 995 adolescents was conducted in two middle schools of Xi'an. All of the participants completed the Chinese version of the School Bullying Experience Questionnaire (C-SBEQ), Self-Esteem Scale (SES), and Regulatory Emotional Self-Efficacy Scale (RESE). Descriptive statistics analysis, the bias corrected percentile Bootstrap CI method, and structural equation modelling were used to analyze the data. The results showed that 418 students (42.0%) reported that they were involved in school bullying in the past year. Self-esteem was negatively associated with school bullying (total effect: β = -0.275, 95% CI = -0.381⁻-0.034), and RESE mediated the association between self-esteem and school bullying (indirect effect: β = -0.136, 95% CI = -0.245⁻-0.037). Furthermore, self-esteem had an indirect effect through perceived self-efficacy in managing negative affect, while self-esteem had no indirect effect through self-efficacy in the expression of positive affect. The present study suggests that school authorities and the related education departments should not only focus on improving students' self-esteem, but should also pay more attention to students' RESE, in order to mitigate, and potentially reduce, the occurrence of bullying.

Best cost-effectiveness and worker productivity with initial triple DMARD therapy compared with methotrexate monotherapy in early rheumatoid arthritis: cost-utility analysis of the tREACH trial.

PubMed

de Jong, Pascal H P; Hazes, Johanna M; Buisman, Leander R; Barendregt, Pieternella J; van Zeben, Derkjen; van der Lubbe, Peter A; Gerards, Andreas H; de Jager, Mike H; de Sonnaville, Peter B J; Grillet, Bernard A; Luime, Jolanda J; Weel, Angelique E A M

2016-12-01

To evaluate direct and indirect costs per quality adjusted life year (QALY) for different initial treatment strategies in very early RA. The 1-year data of the treatment in the Rotterdam Early Arthritis Cohort trial were used. Patients with a high probability (>70%) according to their likelihood of progressing to persistent arthritis, based on the prediction model of Visser, were randomized into one of following initial treatment strategies: (A) initial triple DMARD therapy (iTDT) with glucocorticoids (GCs) intramuscular (n = 91); (B) iTDT with an oral GC tapering scheme (n = 93); and (C) initial MTX monotherapy (iMM) with GCs similar to B (n = 97). Data on QALYs, measured with the Dutch EuroQol, and direct and indirect cost were used. Direct costs are costs of treatment and medical consumption, whereas indirect costs are costs due to loss of productivity. Average QALYs (sd) for A, B and C were, respectively, 0.75 (0.12), 0.75 (0.10) and 0.73 (0.13) for Dutch EuroQol. Highest total costs per QALY (sd) were, respectively, €12748 (€18767), €10 380 (€15 608) and €17 408 (€21 828) for strategy A, B and C (P = 0.012, B vs C). Direct as well as indirect costs were higher with iMM (strategy C) compared with iTDT (strategy B). Higher direct costs were due to ∼40% more biologic usage over time. Higher indirect costs, on the other hand, were caused by more long-term sickness and reduction in contract hours. iTDT was >95% cost-effective across all willingness-to-pay thresholds compared with iMM. iTDT was more cost-effective and had better worker productivity compared with iMM. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Effectiveness and efficiency of a CAD/CAM orthodontic bracket system.

PubMed

Brown, Matthew W; Koroluk, Lorne; Ko, Ching-Chang; Zhang, Kai; Chen, Mengqi; Nguyen, Tung

2015-12-01

The first straight-wire appliance was introduced over 40 years ago to increase the consistency and efficiency of orthodontic treatment. More recently, computer-aided design and computer-aided manufacturing (CAD/CAM) technology has been used to create individualized orthodontic appliances. The purpose of this study was to investigate the clinical effectiveness and efficiency of CAD/CAM customized orthodontic appliances compared with direct and indirect bonded stock orthodontic brackets. This retrospective study included 3 treatment groups: group 1 patients were direct bonded with self-ligating appliances, group 2 patients were indirect bonded with self-ligating appliances, and group 3 patients were indirect bonded with CAD/CAM self-ligating appliances. Complete pretreatment and posttreatment records were obtained for all patients. The American Board of Orthodontics (ABO) Discrepancy Index was used to evaluate the pretreatment records, and the posttreatment outcomes were analyzed using the ABO Cast-Radiograph Evaluation. All data collection and analysis were completed by 1 evaluator. There were no statistically significant differences in the ABO Discrepancy Index or the ABO Cast-Radiograph Evaluation among the groups. Treatment times for the 3 groups were significantly different; the CAD/CAM group was the shortest at 13.8 ± 3.4 months, compared with 21.9 ± 5.0 and 16.9 ± 4.1 months for the direct bonded and indirect bonded groups, respectively. The number of treatment appointments for the CAD/CAM group was significantly fewer than for the direct bonded group. The CAD/CAM orthodontic bracket system evaluated in this study was as effective in treatment outcome measures as were standard brackets bonded both directly and indirectly. The CAD/CAM appliance was more efficient in regard to treatment duration, although the decrease in total archwire appointments was minimal. Further investigation is needed to better quantify the clinical benefits of CAD/CAM orthodontic appliances. Copyright © 2015 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

Relativistic effects on the NMR parameters of Si, Ge, Sn, and Pb alkynyl compounds: Scalar versus spin-orbit effects

NASA Astrophysics Data System (ADS)

Demissie, Taye B.

2017-11-01

The NMR chemical shifts and indirect spin-spin coupling constants of 12 molecules containing 29Si, 73Ge, 119Sn, and 207Pb [X(CCMe)4, Me2X(CCMe)2, and Me3XCCH] are presented. The results are obtained from non-relativistic as well as two- and four-component relativistic density functional theory (DFT) calculations. The scalar and spin-orbit relativistic contributions as well as the total relativistic corrections are determined. The main relativistic effect in these molecules is not due to spin-orbit coupling but rather to the scalar relativistic contraction of the s-shells. The correlation between the calculated and experimental indirect spin-spin coupling constants showed that the four-component relativistic density functional theory (DFT) approach using the Perdew's hybrid scheme exchange-correlation functional (PBE0; using the Perdew-Burke-Ernzerhof exchange and correlation functionals) gives results in good agreement with experimental values. The indirect spin-spin coupling constants calculated using the spin-orbit zeroth order regular approximation together with the hybrid PBE0 functional and the specially designed J-coupling (JCPL) basis sets are in good agreement with the results obtained from the four-component relativistic calculations. For the coupling constants involving the heavy atoms, the relativistic corrections are of the same order of magnitude compared to the non-relativistically calculated results. Based on the comparisons of the calculated results with available experimental values, the best results for all the chemical shifts and non-existing indirect spin-spin coupling constants for all the molecules are reported, hoping that these accurate results will be used to benchmark future DFT calculations. The present study also demonstrates that the four-component relativistic DFT method has reached a level of maturity that makes it a convenient and accurate tool to calculate indirect spin-spin coupling constants of "large" molecular systems involving heavy atoms.

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

PubMed

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

2010-12-01

To investigate the direct, indirect and intangible costs due to hepatitis B-related diseases and to explore main factors associated with the costs in Shenzhen. Cluster sampling for cases collected consecutively during the study period was administrated. Subjects were selected from eligible hepatitis B-related patients. By pre-trained professional investigators, health economics-related information was collected, using a structured questionnaire. Hospitalization expenses were obtained through hospital records after the patients were discharged from hospital. Total economic burden of hepatitis B-related patients would involve direct, indirect and intangible costs. Direct costs were further divided into direct medical costs and direct nonmedical costs. Human Capital Approach was employed to measure the indirect costs both on patients and the caregivers in 1-year time span. Willing to pay method was used to estimate the intangible costs. Multiple linear stepwise regression models were conducted to determine the factors linked to the economic burden. On average, the total annual cost of per patient with hepatitis B-related diseases was 81 590.23 RMB Yuan. Among which, direct, indirect and intangible costs were 30 914.79 Yuan (account for 37.9%), 15 258.01 Yuan (18.7%), 35 417.43 Yuan (43.4%), respectively. The total annual costs per patient for hepatocellular carcinoma, severe hepatitis B, decompensated cirrhosis, compensated cirrhosis, chronic hepatitis B and acute hepatitis B were 194 858.40 Yuan, 144 549.20 Yuan, 120 333.60 Yuan, 79 528.81 Yuan, 66 282.46 Yuan and 39 286.81 Yuan, respectively. The ratio of direct to indirect costs based on the base-case estimation foot add to 2.0:1, increased from hepato-cellular carcinoma (0.7:1) to compensated cirrhosis (3.5:1), followed by acute hepatitis B (3.3:1), severe hepatitis B (2.8:1), decompensate cirrhosis (2.3:1) and chronic hepatitis B (2.2:1). Direct medical costs were more than direct nonmedical. Ratio between the sum total was 16:1. The proportions of total annual cost per patient with hepatitis B-related diseases accounted for annual patient income were 285.3%, and 75.4% for annual household income. Furthermore, proportions of direct costs accounted for annual patient income and annual household income were 108.1% and 28.6%. The total annual indirect cost per person was 8123.38 Yuan for patients of all hepatitis B-related diseases, while 7134.63 Yuan for caregivers. Corresponding work-loss days were 55.74 days for patients and 19.83 days for caregivers. Based on multiple linear stepwise regression analysis, age of patients was a common influencing factor to all kinds of costs. Other factors were as follows: complicated with other diseases, antiviral medication, monthly household income and self-medications. The economic burden of hepatitis B-related diseases was substantial for patients and their families. All costs tended to increase with the severity of disease. The direct costs were larger than the indirect costs. And the direct medical costs were more than the direct ones. Indirect costs based on patients were larger than the ones of caregivers.

Total environmental impacts of biofuels from corn stover using a hybrid life cycle assessment model combining process life cycle assessment and economic input-output life cycle assessment.

PubMed

Liu, Changqi; Huang, Yaji; Wang, Xinye; Tai, Yang; Liu, Lingqin; Liu, Hao

2018-01-01

Studies on the environmental analysis of biofuels by fast pyrolysis and hydroprocessing (BFPH) have so far focused only on the environmental impacts from direct emissions and have included few indirect emissions. The influence of ignoring some indirect emissions on the environmental performance of BFPH has not been well investigated and hence is not really understood. In addition, in order to avoid shifting environmental problems from one medium to another, a comprehensive assessment of environmental impacts caused by the processes must quantify the environmental emissions to all media (air, water, and land) in relation to each life cycle stage. A well-to-wheels assessment of the total environmental impacts resulting from direct emissions and indirect emissions of a BFPH system with corn stover is conducted using a hybrid life cycle assessment (LCA) model combining the economic input-output LCA and the process LCA. The Tool for the Reduction and Assessment of Chemical and other environmental Impacts (TRACI) has been used to estimate the environmental impacts in terms of acidification, eutrophication, global climate change, ozone depletion, human health criteria, photochemical smog formation, ecotoxicity, human health cancer, and human health noncancer caused by 1 MJ biofuel production. Taking account of all the indirect greenhouse gas (GHG) emissions, the net GHG emissions (81.8 g CO 2 eq/MJ) of the biofuels are still less than those of petroleum-based fuels (94 g CO 2 eq/MJ). Maize production and pyrolysis and hydroprocessing make major contributions to all impact categories except the human health criteria. All impact categories resulting from indirect emissions except eutrophication and smog air make more than 24% contribution to the total environmental impacts. Therefore, the indirect emissions are important and cannot be ignored. Sensitivity analysis has shown that corn stover yield and bio-oil yield affect the total environmental impacts of the biofuels more significantly than the biomass transportation distance and biofuel transportation distance. Integr Environ Assess Manag 2018;14:139-149. © 2017 SETAC. © 2017 SETAC.

Gender Differences in Exercise Dependence and Eating Disorders in Young Adults: A Path Analysis of a Conceptual Model

PubMed Central

Meulemans, Shelli; Pribis, Peter; Grajales, Tevni; Krivak, Gretchen

2014-01-01

The purpose of our study was to study the prevalence of exercise dependence (EXD) among college students and to investigate the role of EXD and gender on exercise behavior and eating disorders. Excessive exercise can become an addiction known as exercise dependence. In our population of 517 college students, 3.3% were at risk for EXD and 8% were at risk for an eating disorder. We used Path analysis the simplest case of Structural Equation Modeling (SEM) to investigate the role of EXD and exercise behavior on eating disorders. We observed a small direct effect from gender to eating disorders. In females we observed significant direct effect between exercise behavior (r = −0.17, p = 0.009) and EXD (r = 0.34, p < 0.001) on eating pathology. We also observed an indirect effect of exercise behavior on eating pathology (r = 0.16) through EXD (r = 0.48, r2 = 0.23, p < 0.001). In females the total variance of eating pathology explained by the SEM model was 9%. In males we observed a direct effect between EXD (r = 0.23, p < 0.001) on eating pathology. We also observed indirect effect of exercise behavior on eating pathology (r = 0.11) through EXD (r = 0.49, r2 = 0.24, p < 0.001). In males the total variance of eating pathology explained by the SEM model was 5%. PMID:25379689

Indirect effects in community ecology: Their definition, study and importance.

PubMed

Strauss, S Y

1991-07-01

The diversity of indirect interactions that can occur within communities is large. Recent research on indirect interactions is scattered in the literature under numerous labels. The definition of indirect effects is an important aspect of their study, and clarifies some of the subtle differences among indirect effects found in natural communities. Choosing which species to study, how to manipulate species and for what duration, which attributes to measure and, finally, which analytical techniques to use are all problems facing the community ecologist. Ultimately, we are striving for the best means of determining the relative importance of direct and indirect effects in structuring communities. Copyright © 1991. Published by Elsevier Ltd.

Adult cognitive ability and socioeconomic status as mediators of the effects of childhood disadvantage on salivary cortisol in aging adults

PubMed Central

Franz, Carol E.; Spoon, Kelly; Thompson, Wesley; Hauger, Richard L.; Hellhammer, Dirk H.; Jacobson, Kristen C.; Lupien, Sonia; Lyons, Michael J.; McCaffery, Jeanne; McKenzie, Ruth; Mendoza, Sally P.; Panizzon, Matthew S.; Ramundo, Ana; Shahroudi, Afrand; Kremen, William S.

2015-01-01

Summary In this longitudinal study we investigate the influence of childhood disadvantage on midlife hypothalamic-pituitary-adrenal (HPA) axis regulation. Two mechanisms by which early life stress may affect later pathophysiology are through its influence on cognitive functioning or later socioeconomic (SES) disadvantage. We predicted that individual differences in young adult cognitive ability and midlife SES would mediate the influence of childhood disadvantage on midlife cortisol. On each of three nonconsecutive days, participants provided five salivary cortisol samples corresponding to their diurnal rhythm (N = 727 men; mean age 55, SD = 2.6). We calculated three measures of cortisol regulation (area-under-the curve cortisol reflecting total daytime cortisol output; cortisol-awakening-response; and wake-to-bed slope), averaging scores for each measure across multiple days. Childhood disadvantage combined four dichotomous indicators used previously by Rutter (1985): father low SES; mother education less than 12th grade; major family disruption/separation before age 18; and large family size (more than 5 siblings). The two mediators were a measure of general cognitive ability assessed at age 20 and highest achieved midlife SES. Men from more disadvantaged childhoods were significantly more likely to have dysregulated cortisol at midlife, with higher daytime cortisol levels decades after their childhood experience. Effects of childhood disadvantage were both direct and indirect. Cognitive ability and adult SES, however, only partially mediated the associations between early life stress and midlife cortisol. Specific indirect effects accounted for 33.8% of the total effect of childhood disadvantage [β = 0.12 (0.05; 0.18)] on total daytime cortisol. Associations remained significant after accounting for ethnicity, smoking status, and self-reported depressive symptoms. PMID:23684478

[The effects of social networks on health check-up service use among pre-frail older adults (candidate so-called "specified elderly individuals") compared with older people in general].

PubMed

Sugisawa, Hidehiro; Sugihara, Yoko

2011-09-01

Nursing care prevention programs cannot accomplish their goals without effective screening of pre-frail older people. Health check-up services provide a very opportunity for this purpose. In the present study we examined not only the direct and indirect effects of social networks on check-up service use among candidate pre-frail older people, but also whether these effects differ from those among older people in general. Subjects for this study were respondents of a survey for probability sampled aged 65 and over living in a city, Tokyo. Individuals who gave effective responses to items used in our analysis made up 55.8 percent of the sample. 734 candidate pre-frail older people were selected using the screening criteria provided by the ministry of Heath, Labor and Welfare. The general category of older people numbered 2,057, excluding the candidates and elderly certified for long-term care. Social networks were measured from five aspects: family size; contact with children or relatives living separately; contact with neighbors or friends; involvement in community activities; and seeing a doctor. Our model of indirect effects of social networks on check-up use included awareness of nursing care prevention programs as a mediating factor. Information about whether the subjects used the health check-up service was provided.by the regional government. Magnitude of the effects was evaluated from two aspects; using statistical tests and focusing on marginal effects. Although none of the social network indicators had direct significant impacts on check-up use, contact with children or relatives living separately, contact with neighbors or friends, or involvement with community activities demonstrated significant indirect influence. Contact with neighbors or friends, involvement with community activities, or seeing a doctor had direct significant effects on use among the general category of older people, but none of the social network indicators demonstrated significant indirect effects. Involvement with community activities had the strongest total (direct plus indirect) effects on the use in the social networks indicators among the candidates when viewed with the focus on marginal effects. However, it was estimated that the rate of use would raise only about 5 percent even if average frequency of contacts with community activities were to increase from less than one time to one time over a month among the candidates. It is suggested that effects of social networks on health check-up service use among candidates of pre-frail older people could be produced by improving awareness of nursing care prevention programs.

Costs and quality of life of patients with ankylosing spondylitis in Hong Kong.

PubMed

Zhu, T Y; Tam, L-S; Lee, V W-Y; Hwang, W W; Li, T K; Lee, K K; Li, E K

2008-09-01

To assess the annual direct, indirect and total societal costs, quality of life (QoL) of AS in a Chinese population in Hong Kong and determine the cost determinants. A retrospective, non-randomized, cross-sectional study was performed in a cohort of 145 patients with AS in Hong Kong. Participants completed questionnaires on sociodemographics, work status and out-of-pocket expenses. Health resources consumption was recorded by chart review. Functional impairment and disease activity were measured using the Bath Ankylosing Spondylitis Functional Index (BASFI) and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), respectively. Patients' QoL was assessed using the Short Form-36 (SF-36). The mean age of the patients was 40 yrs with mean disease duration of 10 yrs. The mean BASDAI score was 4.7 and BASFI score was 3.3. Annual total costs averaged USD 9120. Direct costs accounted for 38% of the total costs while indirect costs accounted for 62%. Costs of technical examinations represented the largest proportion of total cost. Patients with AS reported significantly impaired QoL. Functional impairment became the major cost driver of direct costs and total costs. There is a substantial societal cost related to the treatment of AS in Hong Kong. Functional impairment is the most important cost driver. Treatments that reduce functional impairment may be effective to decrease the costs of AS and improve the patient's QoL, and ease the pressure on the healthcare system.

Economic evaluation of the societal costs of hepatitis B in South Korea.

PubMed

Yang, B M; Paik, S W; Hahn, O S; Yi, D H; Choi, M S; Payne, S

2001-03-01

Hepatitis B (HBV) infection remains a major public health problem in South Korea, and accounts for considerable morbidity and mortality. At present, very little is known about the cost of HBV to the South Korean health-care system and society. The present study was therefore conducted to estimate the total annual cost of HBV infection in South Korea for a given year (1997). The study was conducted from the South Korean societal perspective, taking into account the direct and indirect costs of HBV vaccination programs (prevention costs), and those related to the treatment of acute and chronic hepatitis, cirrhosis and liver cancer (disease costs). Several assumptions were made in arriving to actual cost estimates. The total societal cost of HBV in 1997 was 1078.3 billion Won ($US 959.7 million), 142.3 billion Won or 13.2% being attributable to prevention costs and 225.4 billion Won or 20.9% being attributable to indirect costs of HBV-related diseases. The total cost (direct plus indirect) associated with HBV-related diseases to the South Korean society was 936.1 billion Won ($US 833.1 million), of which 45.3% was attributable to cirrhosis-related costs. In terms of disease-related direct costs alone (710.5 billion Won or $US 632.3 million), the estimated annual spending per patient was 1.37 million Won ($US 1219). The direct costs of the HBV disease (prevention and disease treatment, amounting to 782.2 billion Won or $US 696.2 million) is equivalent to 3.2% of the national health-care expenditure for 1997. This study confirms that HBV is a significant cost burden to the South Korean society, and in the absence of an effective cure reinforces the importance of continued disease prevention via vaccination.

2 CFR Appendix IV to Part 200 - Indirect (F&A) Costs Identification and Assignment, and Rate Determination for Nonprofit...

Code of Federal Regulations, 2014 CFR

2014-01-01

... the direct costs and the indirect costs must exclude capital expenditures and unallowable costs... total direct costs (excluding capital expenditures and other distorting items, such contracts or... buildings, furniture and equipment; care of grounds; maintenance and operation of buildings and other plant...

Chinese Parents' Expectations and Child Preacademic Skills: The Indirect Role of Parenting and Social Competence

ERIC Educational Resources Information Center

Ren, Lixin; Edwards, Carolyn Pope

2017-01-01

Research Findings: This study examined how parenting styles and child social-emotional functioning may help explain the indirect relations between Chinese parents' expectations for their preschool-age children's social-emotional development and their children's preacademic skills. A total of 154 parents with preschool-age children were recruited…

75 FR 39583 - Agency Information Collection Activities: Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-09

... information on the unreimbursed indirect costs and cost sharing portion of their R&D expenditures total. The... grants, or to judge public institutions by how well they recovered indirect costs on R&D projects... state of academic R&D. The redesigned survey was renamed the Higher Education R&D Survey and was pilot...

Exploring the risk factors of suicidal ideation among the seniors in Shandong, China: A path analysis.

PubMed

Ge, Dandan; Sun, Long; Zhou, Chengchao; Qian, Yangyang; Zhang, Li; Medina, Alexis

2017-01-01

Suicide is a global public health problem that has a significant negative influence on individuals, families and the society. The objective of this study is to explore the risk factors associated with suicidal ideation among the elderly in Shandong Province, China. A total of 3313 participants (60+) of Shandong Province, China were included in this study. Suicidal ideation was assessed by using questions from the NCS (National Comorbidity Survey). Multiple logistic regression analysis was performed to examine the factors associated with suicidal ideation. Path analysis was conducted to test the direct and indirect association between factors and suicidal ideation. The prevalence of suicidal ideation among the seniors in Shandong, China was 4.2%. Depression had the strongest direct (β=0.303, p-value<0.05) and total effect (β=0.303), life satisfaction (β=-0.103, p-value<0.05; β=-0.136, p-value<0.05), economic status (β=-0.046, p-value<0.05; β=-0.040, p-value<0.05) had both direct and indirect impacts on suicidal ideation. Social support (β=-0.040, p-value<0.05) had indirect influence on suicidal ideation. Depression was a mediator between life satisfaction, economic status, social support and suicidal ideation. The data used in this study was cross-sectional, and the relationship between identified factors and suicidal ideation cannot be interpreted as cause-effect. Depression was the strongest influencing factor of suicidal ideation among the elderly, followed by life satisfaction, economic status. Active intervention measures focusing on the depression screening and treatment both in urban and rural communities should be taken to prevent suicide. Copyright © 2016 Elsevier B.V. All rights reserved.

The Role of Dyadic Coping on the Marital and Emotional Adjustment of Couples With Infertility.

PubMed

Chaves, Catarina; Canavarro, Maria Cristina; Moura-Ramos, Mariana

2018-04-30

Infertility is a challenging experience, affecting individual and couples' adjustment. However, the way the members of the couple support each other may affect the experience of infertility and their adjustment. This study aimed to investigate the role of dyadic coping by oneself and by the partner in the association between the impact of infertility and dyadic and emotional adjustment (anxiety and depression) to infertility. In this cross-sectional study, a total of 134 participants (67 couples with infertility) completed self-report questionnaires assessing infertility-related stress, dyadic coping, dyadic adjustment, and depression and anxiety symptoms. A path analysis examined the direct and indirect effects between the impact of infertility in one's life and dyadic and emotional adjustment. There is an indirect effect of the impact of infertility in one's life on dyadic adjustment through men's perceived dyadic coping efforts employed by the self (dyadic coping by oneself) and women's perceived dyadic coping efforts of the partner (dyadic coping by the partner). Regarding the emotional adjustment of infertile couples, infertility stress impact had an indirect effect only on depressive symptoms through men's dyadic coping by oneself. The results highlight the importance of men's dyadic coping strategies for the marital adjustment of couples as well as for men's emotional adjustment. Findings emphasize the importance of involving men in the fertility treatment process, reinforcing the dyadic nature of infertility processes. © 2018 Family Process Institute.

Implications of Middle School Behavior Problems for High School Graduation and Employment Outcomes of Young Adults: Estimation of a Recursive Model

PubMed Central

Karakus, Mustafa C.; Salkever, David S.; Slade, Eric P.; Ialongo, Nicholas; Stuart, Elizabeth

2013-01-01

The potentially serious adverse impacts of behavior problems during adolescence on employment outcomes in adulthood provide a key economic rationale for early intervention programs. However, the extent to which lower educational attainment accounts for the total impact of adolescent behavior problems on later employment remains unclear As an initial step in exploring this issue, we specify and estimate a recursive bivariate probit model that 1) relates middle school behavior problems to high school graduation and 2) models later employment in young adulthood as a function of these behavior problems and of high school graduation. Our model thus allows for both a direct effect of behavior problems on later employment as well as an indirect effect that operates via graduation from high school. Our empirical results, based on analysis of data from the NELS, suggest that the direct effects of externalizing behavior problems on later employment are not significant but that these problems have important indirect effects operating through high school graduation. PMID:23576834

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

Zhang, Shipeng; Wang, Minghuai; Ghan, Steven J.

Aerosol–cloud interactions continue to constitute a major source of uncertainty for the estimate of climate radiative forcing. The variation of aerosol indirect effects (AIE) in climate models is investigated across different dynamical regimes, determined by monthly mean 500 hPa vertical pressure velocity ( ω 500), lower-tropospheric stability (LTS) and large-scale surface precipitation rate derived from several global climate models (GCMs), with a focus on liquid water path (LWP) response to cloud condensation nuclei (CCN) concentrations. The LWP sensitivity to aerosol perturbation within dynamic regimes is found to exhibit a large spread among these GCMs. It is in regimes of strongmore » large-scale ascent ( ω 500  <  −25 hPa day −1) and low clouds (stratocumulus and trade wind cumulus) where the models differ most. Shortwave aerosol indirect forcing is also found to differ significantly among different regimes. Shortwave aerosol indirect forcing in ascending regimes is close to that in subsidence regimes, which indicates that regimes with strong large-scale ascent are as important as stratocumulus regimes in studying AIE. It is further shown that shortwave aerosol indirect forcing over regions with high monthly large-scale surface precipitation rate (> 0.1 mm day −1) contributes the most to the total aerosol indirect forcing (from 64 to nearly 100 %). Results show that the uncertainty in AIE is even larger within specific dynamical regimes compared to the uncertainty in its global mean values, pointing to the need to reduce the uncertainty in AIE in different dynamical regimes.« less

Disparities in drinking patterns and risks among ethnic majority and minority groups in China: The roles of acculturation, religion, family and friends.

PubMed

He, Jianhui; Assanangkornchai, Sawitri; Cai, Le; McNeil, Edward

2016-02-01

Studies investigating alcohol consumption related factors have rarely focused on the relationship between acculturation, religion and drinking patterns. The objective of this study is to explore the predictors of drinking patterns and their mutual relationships, especially acculturation, ethnicity and religion. A cross-sectional household survey using a multistage systematic sampling technique was conducted in Yunnan Province of China. A revised Vancouver Index of Acculturation (VIA) and Alcohol Use Disorder Identification Test (AUDIT) Chinese version were used to measure acculturation and drinking patterns. Structural equation modeling (SEM) was used to explore the structures of how predictors affect drinking patterns. A total of 977 subjects aged 12-35 years were surveyed. A higher percentage of binge drinking was found among Lisu people. However, the proportion of drinking until intoxication was highest among Han. Gender and enculturation had both direct (standardized β=-0.193, -0.079) and indirect effects (standardized β=-0.126, 0.033) on risky drinking pattern; perceived risk of alcohol consumption (-0.065), family drinking environment (0.061), and friend drinking environment (0.352) affected risky drinking pattern directly, while education level (0.066), ethnicity (-0.038), acculturation (0.012), religious belief (-0.038), and age group (0.088) had indirect effects. Risky drinking pattern was associated with gender and aboriginal culture enculturation both directly and indirectly, and related to mainstream culture acculturation and religious belief indirectly. Other demographic (such as education level) and social family factors (friend drinking environment for example) also had effects on risky drinking pattern. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Financial strain indirectly influences smoking cessation through withdrawal symptom severity.

PubMed

Kendzor, Darla E; Businelle, Michael S; Waters, Aaron F; Frank, Summer G; Hébert, Emily T

2018-02-01

Financial strain has an adverse impact on smoking cessation. However, the mechanisms through which financial strain influences cessation remain unclear. The purpose of the current study was to determine whether financial strain indirectly influenced smoking cessation through withdrawal symptom severity. Participants (N=139) were primarily Black (63.3%) and female (57.6%) adults enrolled in a smoking cessation program at a safety-net hospital. A self-report financial strain questionnaire was completed one week prior to the scheduled quit date, and the Wisconsin Smoking Withdrawal Scale (WSWS) was completed on the day after the scheduled quit date. Biochemically-verified 7-day point prevalence abstinence was assessed four weeks after the scheduled quit date. Adjusted mediation analyses were conducted using the PROCESS macro for SPSS to evaluate the indirect effects of financial strain on smoking cessation via post-quit withdrawal symptom severity. Analyses indicated a significant indirect effect of financial strain on smoking cessation through total withdrawal symptom severity, B=0.027; 95% CI (0.003, 0.066); and specifically anger, B=0.035; 95% CI (0.008, 0.074), anxiety, B=0.021; 95% CI (0.001, 0.051), and sleep symptoms, B=0.015; 95% CI (0.005, 0.043). Greater pre-quit financial strain was associated with greater post-quit withdrawal symptom severity, which increased the likelihood of non-abstinence 4 weeks after the scheduled quit attempt. The direct effect of financial strain on smoking cessation was not significant in any of the mediation models. Findings: suggest that withdrawal severity is an underlying mechanism through which financial strain influences smoking cessation. Copyright © 2017 Elsevier B.V. All rights reserved.

Cloud microphysics and aerosol indirect effects in the global climate model ECHAM5-HAM

NASA Astrophysics Data System (ADS)

Lohmann, U.; Stier, P.; Hoose, C.; Ferrachat, S.; Roeckner, E.; Zhang, J.

2007-03-01

The double-moment cloud microphysics scheme from ECHAM4 has been coupled to the size-resolved aerosol scheme ECHAM5-HAM. ECHAM5-HAM predicts the aerosol mass and number concentrations and the aerosol mixing state. This results in a much better agreement with observed vertical profiles of the black carbon and aerosol mass mixing ratios than with the previous version ECHAM4, where only the different aerosol mass mixing ratios were predicted. Also, the simulated liquid, ice and total water content and the cloud droplet and ice crystal number concentrations as a function of temperature in stratiform mixed-phase clouds between 0 and -35°C agree much better with aircraft observations in the ECHAM5 simulations. ECHAM5 performs better because more realistic aerosol concentrations are available for cloud droplet nucleation and because the Bergeron-Findeisen process is parameterized as being more efficient. The total anthropogenic aerosol effect includes the direct, semi-direct and indirect effects and is defined as the difference in the top-of-the-atmosphere net radiation between present-day and pre-industrial times. It amounts to -1.8 W m-2 in ECHAM5, when a relative humidity dependent cloud cover scheme and present-day aerosol emissions representative for the year 2000 are used. It is larger when either a statistical cloud cover scheme or a different aerosol emission inventory are employed.

Religion, Purpose in Life, Social Support, and Psychological Distress in Chinese University Students.

PubMed

Wang, Zhizhong; Koenig, Harold G; Ma, Hui; Shohaib, Saad Al

2016-06-01

We examined the relationship between religious involvement and psychological distress and explored the mediating effects of social support and purpose in life in university students in western, mid-western, and eastern China. Cross-sectional survey of a representative sample of 1812 university students was conducted. The Purpose in Life scale, Duke Social Support Index, and Religious Commitment Inventory-10 were administered, along with Kessler's Psychological Distress Scale. Structural equation modeling was used to test two models of the mediation hypothesis, examining direct, indirect, and total effects. Model 1 (with direction of effect hypothesized from religiosity to psychological distress) indicated that religious involvement had a direct effect on increasing psychological distress (β = 0.23, p < .01) with minor mediated effects. However, Model 2 (with direction of effect hypothesized from psychological distress to religiosity) indicated strong indirect protective effects of religiosity on psychological distress through purpose in life and social support (β = -.40, p < .01). The findings are consistent with the hypothesis that psychological distress increases religious involvement, which then increases purpose in life and social support that then lead to lower psychological distress.

Is the effect of person-organisation fit on turnover intention mediated by job satisfaction? A survey of community health workers in China.

PubMed

Zhang, Mingji; Yan, Fei; Wang, Wei; Li, Guohong

2017-02-22

Person-organisation fit (P-O fit) is a predictor of work attitude. However, in the area of human resource for health, the literature of P-O fit is quite limited. It is unclear whether P-O fit directly or indirectly affects turnover intention. This study aims to examine the mediation effect of job satisfaction on the relationship between P-O fit and turnover intention based on data from China. This is a cross-sectional survey of community health workers (CHWs) in China in 2013. A questionnaire of P-O fit, job satisfaction and turnover intention was developed, and its validity and reliability were assessed. Multiple regression and structural equation modelling were used to examine the relationship among P-O fit, job satisfaction and turnover intention. Multistage sampling was applied. In total, 656 valid questionnaire responses were collected from CHWs in four provincial regions in China, namely Shanghai, Shaanxi, Shandong and Anhui. P-O fit was directly related to job satisfaction (standardised β 0.246) and inversely related to turnover intention (standardised β -0.186). In the mediation model, the total effect of P-O fit on turnover intention was -0.186 (p<0.001); the direct effect of P-O fit on turnover intention was -0.094 (p<0.01); the indirect effect of job satisfaction on the relationship between P-O fit and turnover intention was -0.092 (p<0.001). The effect of P-O fit on turnover intention was partially mediated through job satisfaction. It is suggested that more work attitude variables and different dimensions of P-O fit be taken into account to examine the complete mechanism of person-organisation interaction. Indirect measures of P-O fit should be encouraged in practice to enhance work attitudes of health workers. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Mechanisms and mediation in survival analysis: towards an integrated analytical framework.

PubMed

Pratschke, Jonathan; Haase, Trutz; Comber, Harry; Sharp, Linda; de Camargo Cancela, Marianna; Johnson, Howard

2016-02-29

A wide-ranging debate has taken place in recent years on mediation analysis and causal modelling, raising profound theoretical, philosophical and methodological questions. The authors build on the results of these discussions to work towards an integrated approach to the analysis of research questions that situate survival outcomes in relation to complex causal pathways with multiple mediators. The background to this contribution is the increasingly urgent need for policy-relevant research on the nature of inequalities in health and healthcare. The authors begin by summarising debates on causal inference, mediated effects and statistical models, showing that these three strands of research have powerful synergies. They review a range of approaches which seek to extend existing survival models to obtain valid estimates of mediation effects. They then argue for an alternative strategy, which involves integrating survival outcomes within Structural Equation Models via the discrete-time survival model. This approach can provide an integrated framework for studying mediation effects in relation to survival outcomes, an issue of great relevance in applied health research. The authors provide an example of how these techniques can be used to explore whether the social class position of patients has a significant indirect effect on the hazard of death from colon cancer. The results suggest that the indirect effects of social class on survival are substantial and negative (-0.23 overall). In addition to the substantial direct effect of this variable (-0.60), its indirect effects account for more than one quarter of the total effect. The two main pathways for this indirect effect, via emergency admission (-0.12), on the one hand, and hospital caseload, on the other, (-0.10) are of similar size. The discrete-time survival model provides an attractive way of integrating time-to-event data within the field of Structural Equation Modelling. The authors demonstrate the efficacy of this approach in identifying complex causal pathways that mediate the effects of a socio-economic baseline covariate on the hazard of death from colon cancer. The results show that this approach has the potential to shed light on a class of research questions which is of particular relevance in health research.

Herd Protection from Drinking Water, Sanitation, and Hygiene Interventions

PubMed Central

Fuller, James A.; Eisenberg, Joseph N. S.

2016-01-01

Herd immunity arises when a communicable disease is less able to propagate because a substantial portion of the population is immune. Nonimmunizing interventions, such as insecticide-treated bednets and deworming drugs, have shown similar herd-protective effects. Less is known about the herd protection from drinking water, sanitation, and hand hygiene (WASH) interventions. We first constructed a transmission model to illustrate mechanisms through which different WASH interventions may provide herd protection. We then conducted an extensive review of the literature to assess the validity of the model results and identify current gaps in research. The model suggests that herd protection accounts for a substantial portion of the total protection provided by WASH interventions. However, both the literature and the model suggest that sanitation interventions in particular are the most likely to provide herd protection, since they reduce environmental contamination. Many studies fail to account for these indirect effects and thus underestimate the total impact an intervention may have. Although cluster-randomized trials of WASH interventions have reported the total or overall efficacy of WASH interventions, they have not quantified the role of herd protection. Just as it does in immunization policy, understanding the role of herd protection from WASH interventions can help inform coverage targets and strategies that indirectly protect those that are unable to be reached by WASH campaigns. Toward this end, studies are needed to confirm the differential role that herd protection plays across the WASH interventions suggested by our transmission model. PMID:27601516

Herd Protection from Drinking Water, Sanitation, and Hygiene Interventions.

PubMed

Fuller, James A; Eisenberg, Joseph N S

2016-11-02

Herd immunity arises when a communicable disease is less able to propagate because a substantial portion of the population is immune. Nonimmunizing interventions, such as insecticide-treated bednets and deworming drugs, have shown similar herd-protective effects. Less is known about the herd protection from drinking water, sanitation, and hand hygiene (WASH) interventions. We first constructed a transmission model to illustrate mechanisms through which different WASH interventions may provide herd protection. We then conducted an extensive review of the literature to assess the validity of the model results and identify current gaps in research. The model suggests that herd protection accounts for a substantial portion of the total protection provided by WASH interventions. However, both the literature and the model suggest that sanitation interventions in particular are the most likely to provide herd protection, since they reduce environmental contamination. Many studies fail to account for these indirect effects and thus underestimate the total impact an intervention may have. Although cluster-randomized trials of WASH interventions have reported the total or overall efficacy of WASH interventions, they have not quantified the role of herd protection. Just as it does in immunization policy, understanding the role of herd protection from WASH interventions can help inform coverage targets and strategies that indirectly protect those that are unable to be reached by WASH campaigns. Toward this end, studies are needed to confirm the differential role that herd protection plays across the WASH interventions suggested by our transmission model. © The American Society of Tropical Medicine and Hygiene.

Consumers mediate the effects of experimental ocean acidification and warming on primary producers.

PubMed

Alsterberg, Christian; Eklöf, Johan S; Gamfeldt, Lars; Havenhand, Jonathan N; Sundbäck, Kristina

2013-05-21

It is well known that ocean acidification can have profound impacts on marine organisms. However, we know little about the direct and indirect effects of ocean acidification and also how these effects interact with other features of environmental change such as warming and declining consumer pressure. In this study, we tested whether the presence of consumers (invertebrate mesograzers) influenced the interactive effects of ocean acidification and warming on benthic microalgae in a seagrass community mesocosm experiment. Net effects of acidification and warming on benthic microalgal biomass and production, as assessed by analysis of variance, were relatively weak regardless of grazer presence. However, partitioning these net effects into direct and indirect effects using structural equation modeling revealed several strong relationships. In the absence of grazers, benthic microalgae were negatively and indirectly affected by sediment-associated microalgal grazers and macroalgal shading, but directly and positively affected by acidification and warming. Combining indirect and direct effects yielded no or weak net effects. In the presence of grazers, almost all direct and indirect climate effects were nonsignificant. Our analyses highlight that (i) indirect effects of climate change may be at least as strong as direct effects, (ii) grazers are crucial in mediating these effects, and (iii) effects of ocean acidification may be apparent only through indirect effects and in combination with other variables (e.g., warming). These findings highlight the importance of experimental designs and statistical analyses that allow us to separate and quantify the direct and indirect effects of multiple climate variables on natural communities.

Practical guidance for conducting mediation analysis with multiple mediators using inverse odds ratio weighting.

PubMed

Nguyen, Quynh C; Osypuk, Theresa L; Schmidt, Nicole M; Glymour, M Maria; Tchetgen Tchetgen, Eric J

2015-03-01

Despite the recent flourishing of mediation analysis techniques, many modern approaches are difficult to implement or applicable to only a restricted range of regression models. This report provides practical guidance for implementing a new technique utilizing inverse odds ratio weighting (IORW) to estimate natural direct and indirect effects for mediation analyses. IORW takes advantage of the odds ratio's invariance property and condenses information on the odds ratio for the relationship between the exposure (treatment) and multiple mediators, conditional on covariates, by regressing exposure on mediators and covariates. The inverse of the covariate-adjusted exposure-mediator odds ratio association is used to weight the primary analytical regression of the outcome on treatment. The treatment coefficient in such a weighted regression estimates the natural direct effect of treatment on the outcome, and indirect effects are identified by subtracting direct effects from total effects. Weighting renders treatment and mediators independent, thereby deactivating indirect pathways of the mediators. This new mediation technique accommodates multiple discrete or continuous mediators. IORW is easily implemented and is appropriate for any standard regression model, including quantile regression and survival analysis. An empirical example is given using data from the Moving to Opportunity (1994-2002) experiment, testing whether neighborhood context mediated the effects of a housing voucher program on obesity. Relevant Stata code (StataCorp LP, College Station, Texas) is provided. © The Author 2015. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Effectiveness of a live oral human rotavirus vaccine after programmatic introduction in Bangladesh: A cluster-randomized trial

PubMed Central

Zaman, K.; Yunus, Mohammad; Hossain, Ilias; Azim, Tasnim; Rahman, Mustafizur; Lewis, Kristen D. C.; Feller, Andrea J.; Qadri, Firdausi; Halloran, M. Elizabeth; Cravioto, Alejandro

2017-01-01

Background Rotavirus vaccines are now globally recommended by the World Health Organization (WHO), but in early 2009 WHO’s Strategic Advisory Group of Experts on Immunization reviewed available data and concluded that there was no evidence for the efficacy or effectiveness of a two-dose schedule of the human rotavirus vaccine (HRV; Rotarix) given early at 6 and 10 wk of age. Additionally, the effectiveness of programmatic rotavirus vaccination, including possible indirect effects, has not been assessed in low-resource populations in Asia. Methods and findings In Bangladesh, we cluster-randomized (1:1) 142 villages of the Matlab Health and Demographic Surveillance System to include two doses of HRV with the standard infant vaccines at 6 and 10 wk of age or to provide standard infant vaccines without HRV. The study was initiated November 1, 2008, and surveillance was conducted concurrently at Matlab Diarrhoea Hospital and two community treatment centers to identify children less than 2 y of age presenting with acute rotavirus diarrhea (ARD) through March 31, 2011. Laboratory confirmation was made by enzyme immunoassay detection of rotavirus antigen in stool specimens. Overall effectiveness of the HRV vaccination program (primary objective) was measured by comparing the incidence rate of ARD among all children age-eligible for vaccination in villages where HRV was introduced to that among such children in villages where HRV was not introduced. Total effectiveness among vaccinees and indirect effectiveness were also evaluated. In all, 6,527 infants were age-eligible for vaccination in 71 HRV villages, and 5,791 in 71 non-HRV villages. In HRV villages, 4,808 (73.7%) infants received at least one dose of HRV. The incidence rate of ARD was 4.10 cases per 100 person-years in non-HRV villages compared to 2.8 per 100 person-years in HRV villages, indicating an overall effectiveness of 29.0% (95% CI, 11.3% to 43.1%). The total effectiveness of HRV against ARD among vaccinees was 41.4% (95% CI, 23.2% to 55.2%). The point estimate for total effectiveness was higher against ARD during the first year of life than during the second (45.2% versus 28.9%), but estimates for the second year of life lacked precision and did not reach statistical significance. Indirect effects were not detected. To check for bias in presentation to treatment facilities, we evaluated the effectiveness of HRV against acute diarrhea associated with enterotoxigenic Escherichia coli; it was 4.0% (95% CI, −46.5% to 37.1%), indicating that bias likely was not introduced. Thirteen serious adverse events were identified among recipients of HRV, but none were considered related to receipt of study vaccine. The main limitation of this study is that it was an open-label study with an observed-only control group (no placebo). Conclusions The two-dose HRV rotavirus vaccination program significantly reduced medically attended ARD in this low-resource population in Asia. Protection among vaccinees was similar to that in other low-resource settings. In low-resource populations with high rotavirus incidence, large-scale vaccination across a wide population may be required to obtain the full benefit of rotavirus vaccination, including indirect effects. Trial registration ClinicalTrials.gov NCT00737503 PMID:28419095

Effectiveness of a live oral human rotavirus vaccine after programmatic introduction in Bangladesh: A cluster-randomized trial.

PubMed

Zaman, K; Sack, David A; Neuzil, Kathleen M; Yunus, Mohammad; Moulton, Lawrence H; Sugimoto, Jonathan D; Fleming, Jessica A; Hossain, Ilias; Arifeen, Shams El; Azim, Tasnim; Rahman, Mustafizur; Lewis, Kristen D C; Feller, Andrea J; Qadri, Firdausi; Halloran, M Elizabeth; Cravioto, Alejandro; Victor, John C

2017-04-01

Rotavirus vaccines are now globally recommended by the World Health Organization (WHO), but in early 2009 WHO's Strategic Advisory Group of Experts on Immunization reviewed available data and concluded that there was no evidence for the efficacy or effectiveness of a two-dose schedule of the human rotavirus vaccine (HRV; Rotarix) given early at 6 and 10 wk of age. Additionally, the effectiveness of programmatic rotavirus vaccination, including possible indirect effects, has not been assessed in low-resource populations in Asia. In Bangladesh, we cluster-randomized (1:1) 142 villages of the Matlab Health and Demographic Surveillance System to include two doses of HRV with the standard infant vaccines at 6 and 10 wk of age or to provide standard infant vaccines without HRV. The study was initiated November 1, 2008, and surveillance was conducted concurrently at Matlab Diarrhoea Hospital and two community treatment centers to identify children less than 2 y of age presenting with acute rotavirus diarrhea (ARD) through March 31, 2011. Laboratory confirmation was made by enzyme immunoassay detection of rotavirus antigen in stool specimens. Overall effectiveness of the HRV vaccination program (primary objective) was measured by comparing the incidence rate of ARD among all children age-eligible for vaccination in villages where HRV was introduced to that among such children in villages where HRV was not introduced. Total effectiveness among vaccinees and indirect effectiveness were also evaluated. In all, 6,527 infants were age-eligible for vaccination in 71 HRV villages, and 5,791 in 71 non-HRV villages. In HRV villages, 4,808 (73.7%) infants received at least one dose of HRV. The incidence rate of ARD was 4.10 cases per 100 person-years in non-HRV villages compared to 2.8 per 100 person-years in HRV villages, indicating an overall effectiveness of 29.0% (95% CI, 11.3% to 43.1%). The total effectiveness of HRV against ARD among vaccinees was 41.4% (95% CI, 23.2% to 55.2%). The point estimate for total effectiveness was higher against ARD during the first year of life than during the second (45.2% versus 28.9%), but estimates for the second year of life lacked precision and did not reach statistical significance. Indirect effects were not detected. To check for bias in presentation to treatment facilities, we evaluated the effectiveness of HRV against acute diarrhea associated with enterotoxigenic Escherichia coli; it was 4.0% (95% CI, -46.5% to 37.1%), indicating that bias likely was not introduced. Thirteen serious adverse events were identified among recipients of HRV, but none were considered related to receipt of study vaccine. The main limitation of this study is that it was an open-label study with an observed-only control group (no placebo). The two-dose HRV rotavirus vaccination program significantly reduced medically attended ARD in this low-resource population in Asia. Protection among vaccinees was similar to that in other low-resource settings. In low-resource populations with high rotavirus incidence, large-scale vaccination across a wide population may be required to obtain the full benefit of rotavirus vaccination, including indirect effects. ClinicalTrials.gov NCT00737503.

The economic costs of traffic accidents in Spain.

PubMed

Bastida, Julio López; Aguilar, Pedro Serrano; González, Beatriz Duque

2004-04-01

This study aimed to evaluate the economic impact of traffic accidents in Spain during 1997. The cost-of-illness method was used. Direct costs were divided into health services costs, insurance administration costs, and the costs of the material damages to the vehicles. Indirect costs were obtained through transformation of physical units into monetary units using the approach based on the human capital theory. The total cost of traffic accidents was 6,280.36 million euros, which amounts to 157.59 euros for each inhabitant in Spain and represents 1.35% of the gross national product. The total direct cost was 3,397.00 million euros, representing 54.1% of the total cost. The total indirect cost was 2,883.36 million euros, accounting for 45.9% of the total cost. The high socioeconomic cost of traffic accidents clearly indicates the need for the different administrations in Spain to collaborate in implementing preventive measures.

Human related mortality of birds in the United States

USGS Publications Warehouse

Banks, R.C.

1979-01-01

Modern man serves as both a direct and an indirect cause of the death of birds. In the early 1970's, human activity was responsible for the death of approximately 196 million birds per year, or about 1.9% of the wild birds of the continental United States that died each year. Hunting was the largest direct mortality factor and accounted for about 61% of human related bird deaths. Control or prevention of avian depredations took about 1% of the total, and all research and propagation about 0.5%. Collision with man-made objects was the greatest indirect human cause of avian deaths. accounting for about 32% of the human related deaths. Pollution and poisoning caused the death of about 2% of the total. A relatively few species account for most of this mortality but continue to maintain large, harvestable populations, suggesting that the numbers of most bird species are essentially unaffected by the human activities discussed. Other activities of man that do not necessarily result in the death of birds but rather reduce reproductive potential are more likely to have long-term effects on avian populations.

The physics of solid-state neutron detector materials and geometries.

PubMed

Caruso, A N

2010-11-10

Detection of neutrons, at high total efficiency, with greater resolution in kinetic energy, time and/or real-space position, is fundamental to the advance of subfields within nuclear medicine, high-energy physics, non-proliferation of special nuclear materials, astrophysics, structural biology and chemistry, magnetism and nuclear energy. Clever indirect-conversion geometries, interaction/transport calculations and modern processing methods for silicon and gallium arsenide allow for the realization of moderate- to high-efficiency neutron detectors as a result of low defect concentrations, tuned reaction product ranges, enhanced effective omnidirectional cross sections and reduced electron-hole pair recombination from more physically abrupt and electronically engineered interfaces. Conversely, semiconductors with high neutron cross sections and unique transduction mechanisms capable of achieving very high total efficiency are gaining greater recognition despite the relative immaturity of their growth, lithographic processing and electronic structure understanding. This review focuses on advances and challenges in charged-particle-based device geometries, materials and associated mechanisms for direct and indirect transduction of thermal to fast neutrons within the context of application. Calorimetry- and radioluminescence-based intermediate processes in the solid state are not included.

Assessment of Public Health and Economic Impact of Intranasal Live-Attenuated Influenza Vaccination of Children in France Using a Dynamic Transmission Model.

PubMed

Gerlier, L; Lamotte, M; Grenèche, S; Lenne, X; Carrat, F; Weil-Olivier, C; Damm, O; Schwehm, M; Eichner, M

2017-04-01

We estimated the epidemiological and economic impact of extending the French influenza vaccination programme from at-risk/elderly (≥65 years) only to healthy children (2-17 years). A deterministic, age-structured, dynamic transmission model was used to simulate the transmission of influenza in the French population, using the current vaccination coverage with trivalent inactivated vaccine (TIV) in at-risk/elderly individuals (current strategy) or gradually extending the vaccination to healthy children (aged 2-17 years) with intranasal, quadrivalent live-attenuated influenza vaccine (QLAIV) from current uptake up to 50% (evaluated strategy). Epidemiological, medical resource use and cost data were taken from international literature and country-specific information. The model was calibrated to the observed numbers of influenza-like illness visits/year. The 10-year number of symptomatic cases of confirmed influenza and direct medical costs ('all-payer') were calculated for the 0-17- (direct and indirect effects) and ≥18-year-old (indirect effect). The incremental cost-effectiveness ratio (ICER) was calculated for the total population, using a 4% discount rate/year. Assuming 2.3 million visits/year and 1960 deaths/year, the model calibration yielded an all-year average basic reproduction number (R 0 ) of 1.27. In the population aged 0-17 years, QLAIV prevented 865,000 influenza cases/year (58.4%), preventing 10-year direct medical expenses of €374 million. In those aged ≥18 years with unchanged TIV coverage, 1.2 million cases/year were averted (27.6%) via indirect effects (additionally prevented expenses, €457 million). On average, 613 influenza-related deaths were averted annually overall. The ICER was €18,001/life-year gained. The evaluated strategy had a 98% probability of being cost-effective at a €31,000/life-year gained threshold. The model demonstrated strong direct and indirect benefits of protecting healthy children against influenza with QLAIV on public health and economic outcomes in France.

Cruel intentions on television and in real life: can viewing indirect aggression increase viewers' subsequent indirect aggression?

PubMed

Coyne, Sarah M; Archer, John; Eslea, Mike

2004-07-01

Numerous studies have shown that viewing violence in the media can influence an individual's subsequent aggression, but none have examined the effect of viewing indirect aggression. This study examines the immediate effect of viewing indirect and direct aggression on subsequent indirect aggression among 199 children ages 11 to 14 years. They were shown an indirect, direct, or no-aggression video and their subsequent indirect aggression was measured by negative evaluation of a confederate and responses to a vignette. Participants viewing indirect or direct aggression gave a more negative evaluation of and less money to a confederate than participants viewing no-aggression. Participants viewing indirect aggression gave less money to the confederate than those viewing direct aggression. Participants viewing indirect aggression gave more indirectly aggressive responses to an ambiguous situation and participants viewing direct aggression gave more directly aggressive responses. This study provides the first evidence that viewing indirect aggression in the media can have an immediate impact on subsequent aggression.

ACL Fibers Inserting on the Lateral Intercondylar Ridge Carry the Greatest Loads - Are Modern Anatomic Femoral Tunnel Positions Too Low?

PubMed Central

Nawabi, Danyal H.; Imhauser, Carl; Tucker, Scott; Nguyen, Joseph; Wickiewicz, Thomas L.; Pearle, Andrew

2014-01-01

Objectives: Histological studies have shown that the ACL has a direct and indirect insertion on the femur [1]. The direct insertion is located along the lateral intercondylar ridge and the indirect insertion is located ‘lower’ on the lateral wall of the notch. The trend towards anatomic ACL reconstruction using the anteromedial (AM) portal technique has resulted in ‘lower’ non-isometric femoral tunnel positions and increased graft failures [2]. To our knowledge, the load transfer properties of the direct and indirect ACL insertions have not been studied. This information may help in understanding the increased failures reported with AM portal drilling. The purpose of this study was, 1) to compare the load transferred across the native ACL at the direct and indirect femoral insertions and, 2) to determine the strain behavior of ACL grafts placed at different tunnel locations within the direct and indirect insertions. Methods: Ten fresh-frozen cadaveric knees (mean age, 52.5 years; range, 29-65) were mounted to a six degree of freedom robot. A 134N anterior load at 30 and 90° flexion and a combined valgus (8Nm) and internal (4Nm) rotational moment at 15° flexion were applied. The ACL was subsequently sectioned at the femoral footprint by detaching either the direct or indirect insertion (partially sectioned state), followed by the remainder of the ACL (completely sectioned state) (Figure 1). The kinematics of the intact knee were replayed after each stage of sectioning to determine the loads transferred across the direct and indirect ACL fibers. Loads were expressed as a percentage of the total load borne by the ACL. Strain behaviour was tested by generating 3D models of the femur and tibia from CT scans of each knee. Three tunnel locations (anteromedial bundle [AM], center [C], posterolateral bundle [PL]) each were selected for the direct and indirect insertions and a virtual ACL graft was inserted. The isometry of the virtual graft was calculated through a flexion path of 0 to 90°. Results: Under an anterior tibial load at 30° flexion, the direct insertion carried 83.9% of the total ACL load compared to 16.1% in the indirect insertion (p<0.001). The direct insertion also carried more load at 90° flexion (95.2% vs 4.8%; p<0.001). Under a combined rotatory load at 15° flexion, the direct insertion carried 84.2% of the total ACL load compared to 15.8% in the indirect insertion (p<0.001). A virtual ACL graft placed at the AM position in the direct insertion demonstrated the best strain behaviour with a mean 10.9% change in length. This value was significantly lower (p<0.001) than the isometry at all 3 tunnel positions in the indirect insertion (AM = 18.5%; C = 24.9%; PL = 30.9%). Conclusion: Fibers in the direct insertion of the ACL carry more load than fibers in the indirect insertion. Virtual ACL grafts placed in the ‘higher’ direct location are more isometric than in the ‘lower’ indirect location during range of motion testing. Clinical Relevance: ‘Low’ ACL grafts in the indirect ACL insertion, resulting from AM portal drilling techniques, may experience higher loads in-vivo due to unfavorable biomechanics. With the current shift towards anatomic ACL reconstruction, it may be beneficial to create a ‘higher’ femoral tunnel within the direct insertion at the lateral intercondylar ridge. This position remains anatomical but may also be biomechanically favorable.

Making it fit: Associations of line managers' behaviours with the outcomes of an organizational-level intervention.

PubMed

Lundmark, Robert; von Thiele Schwarz, Ulrica; Hasson, Henna; Stenling, Andreas; Tafvelin, Susanne

2018-02-01

Line managers' behaviours are important during implementation of occupational health interventions. Still, little is known about how these behaviours are related to intervention outcomes. This study explored the relationship between line managers' intervention-specific transformational leadership (IsTL), intervention fit (the match between the intervention, persons involved, and the surrounding environment), and change in intrinsic motivation and vigour. Both direct and indirect relationships between IsTL and change in intrinsic motivation and vigour were tested. Ninety employees participating in an organizational-level occupational health intervention provided questionnaire ratings at baseline and after 6 months. The results showed IsTL to be related to intervention fit and intervention fit to be related to intrinsic motivation. Using intervention fit as a mediator, the total effects (direct and indirect combined) of IsTL on change in intrinsic motivation and vigour were significant. In addition, IsTL had a specific indirect effect on intrinsic motivation. This study is the first to use IsTL as a measure line managers' behaviours. It is also the first to empirically evaluate the association between intervention fit and intervention outcomes. By including these measures in evaluations of organizational-level occupational health interventions, we can provide more informative answers as to what can make interventions successful. Copyright © 2017 John Wiley & Sons, Ltd.

Estimating direct and indirect costs of premenstrual syndrome.

PubMed

Borenstein, Jeff; Chiou, Chiun-Fang; Dean, Bonnie; Wong, John; Wade, Sally

2005-01-01

To quantify the economic impact of premenstrual syndrome (PMS) on the employer. Data were collected from 374 women aged 18-45 with regular menses. Direct costs were quantified using administrative claims of these patients and the Medicare Fee Schedule. Indirect costs were quantified by both self-reported days of work missed and lost productivity at work. Regression analyses were used to develop a model to project PMS-related direct and indirect costs. A total of 29.6% (n = 111) of the participants were diagnosed with PMS. A PMS diagnosis was associated with an average annual increase of $59 in direct costs (P < 0.026) and $4333 in indirect costs per patient (P < 0.0001) compared with patients without PMS. A PMS diagnosis correlated with a modest increase in direct medical costs and a large increase in indirect costs.

Accuracy of cast posts fabricated by the direct and the indirect techniques.

PubMed

Rayyan, Mohammad R; Aldossari, Roa'a A; Alsadun, Sarah F; Hijazy, Fatimah R

2016-09-01

Patterns for custom cast posts and cores can be fabricated either by the direct or the indirect technique. Which technique is more accurate is unknown. The purpose of this in vitro study was to investigate the effect of pattern fabrication technique on the accuracy of post fit. Ten intact extracted premolar teeth with a single canal and similar dimensions received root canal treatment. The teeth were sectioned 2 mm above the cementoenamel junction. A total of 20 cast post and core patterns, 2 for each tooth, were fabricated, 10 with the direct technique and 10 with the indirect technique. Patterns were cast to produce 20 cast post and cores. Each tooth was scanned using a microcomputed tomography (μCT) system with a resolution of 14.5 μm, once with the post of the direct technique and once with the post of the indirect technique. Ct analyzer software was used to calculate the overall space between the post and canal walls and the space areas in 3 different standardized sections. The Student paired t test was used to determine any significant difference in the scores of the groups. The overall space between the canal walls and posts made with the direct technique ranged between 7.86 and 17.39 mm(3), with a mean value of 12.25 mm(3), whereas with the indirect technique, the space ranged between 6.68 and 18.02 mm(3), with a mean of 11.92 mm(3). No significant differences were found between the results of either technique (P>.05). Within the limitations of this study, neither the indirect nor direct pattern fabrication technique influenced the accuracy of post fitting. Copyright © 2016 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

Mediating the distal crime-drug relationship with proximal reactive criminal thinking.

PubMed

Walters, Glenn D

2016-02-01

This article describes the results of a study designed to test whether reactive criminal thinking (RCT) does a better job of mediating the crime → drug relationship than it does mediating the drug → crime relationship after the direct effects of crime on drug use/dependency and of drug use/dependency on crime have been rendered nonsignificant by control variables. All 1,170 male members of the Pathways to Desistance study (Mulvey, 2012) served as participants in the current investigation. As predicted, the total (unmediated) effects of crime on substance use/dependence and of substance use/dependence on crime were nonsignificant when key demographic and third variables were controlled, although the indirect (RCT-mediated) effect of crime on drug use was significant. Proactive criminal thinking (PCT), by comparison, failed to mediate either relationship. The RCT continued to mediate the crime → drug relationship and the PCT continued to not mediate either relationship when more specific forms of offending (aggressive, income) and substance use/dependence (drug use, substance-use dependency symptoms) were analyzed. This offers preliminary support for the notion that even when the total crime-drug effect is nonsignificant the indirect path from crime to reactive criminal thinking to drugs can still be significant. Based on these results, it is concluded that mediation by proximal reactive criminal thinking is a mechanism by which distal measures of crime and drug use/dependence are connected. (c) 2016 APA, all rights reserved).

Breast cancer management: quality-of-life and cost considerations.

PubMed

Radice, Davide; Redaelli, Alberto

2003-01-01

The purpose of this article was to provide a literature-based extensive overview of the quality-of-life and cost issues posed by the management of breast cancer. Incidence and mortality rates vary widely in different countries. Breast cancer accounts approximately for one-fifth of all deaths in women aged 40-50 years. The 1994-1998 incidence rate in the US population was on average 114.3 per 100 000 women. Treatment options include surgery, radiotherapy and drug therapy (cytotoxic and endocrine drugs). All treatment options affect patients' health-related quality of life (HR-QOL) in various ways. The use of cytotoxic agents has a particularly large HR-QOL impact. HR-QOL questionnaires are complex tools, not routinely used in breast cancer trials.Worldwide, around 10 million individuals develop cancer each year; this figure is expected to increase to 15 million in 2020. For all cancers, the total economic burden of this disease worldwide was projected by the authors to be in the range of $US 300-400 billion in 2001 (about $US 100-140 billion as direct costs and the remainder as indirect costs [morbidity and mortality]). According to the National Institute of Health (NIH), the total cost of cancer was estimated at $US 156.7 billion in 2001 in US ($US 56.4 billion as direct costs, $US 15.6 as indirect morbidity costs, and $US 84.7 billion as indirect mortality costs). Based on limited information, in the US, breast cancer can be projected to account for about one-fifth/one-fourth of the total cost of cancer. Breast cancer treatment costs are higher in the US than in other developed countries. Both direct and indirect costs are dependent on disease stage. The per-patient costs for initial care in 1992 were estimated at $US 10 813, for continuing care at $US 1084 and for terminal care at $US 17 886. Stage-specific costs provide information for cost-effectiveness analyses of cancer-control initiatives, such as screening programmes. Economic studies on breast cancer are heterogeneous, and the cost estimates made are not easily generalisable. The cost of treatment for breast cancer in developing countries is < or =5% of that in developed regions.

Autologous blood transfusion in total knee replacement surgery.

PubMed

Sarkanović, Mirka Lukić; Gvozdenović, Ljiljana; Savić, Dragan; Ilić, Miroslav P; Jovanović, Gordana

2013-03-01

Total knee replacement (TKR) surgery is one of the most frequent and the most extensive procedures in orthopedic surgery, accompanied with some serious complications. Perioperative blood loss is one of the most serious losses, so it is vital to recognize and treat such losses properly. Autologous blood transfusion is the only true alternative for the allogeneic blood. The aim of this study was to to examine if autologous blood transfusion reduces usage of allogenic blood in total knee replacement surgery, as well as to examine possible effect of autologous blood transfusion on postoperative complications, recovery and hospital stay of patients after total knee replacement surgery. During the controlled, prospective, randomised study we compared two groups of patients (n = 112) with total prosthesis implanted in their knee. The group I consisted of the patients who received the transfusion of other people's (allogeneic) blood (n = 57) and the group II of the patients whose blood was collected postoperatively and then given them [their own (autologous) blood] (n = 55). The transfusion trigger for both groups was hemoglobin level of 85 g/L. In the group of patients whose blood was collected perioperatively only 9 (0.9%) of the patients received transfusion of allogeneic blood, as opposed to the control group in which 98.24% of the patients received the transfusion of allogeneic blood (p < or = 0.01). The patients whose blood was collected stayed in hospital for 6.18 days, while the patients of the control group stayed 7.67 days (p < 0.01). Autologous blood transfusion is a very effective method for reducing consumption of allogenic blood and thus, indirectly for reducing all complications related to allogenic blood transfusion. There is also a positive influence on postoperative recovery after total knee replacement surgery due to the reduction of hospital stay, and indirectly on the reduction of hospital costs.

Resurrecting Limited War Theory

DTIC Science & Technology

2008-05-01

indirectly with an appreciation of the principles and guidelines for limited war. 15. SUBJECT TERMS Limited War, Political Objectives, Total War...conflict between other nations may require the United States to act indirectly with an appreciation of the principles and guidelines for limited war...in war, echoing Clausewitz’s principle of political primacy. Like Clausewitz, he was also a student of

Economic burden of acute pesticide poisoning in South Korea.

PubMed

Choi, Yeongchull; Kim, Younhee; Ko, Yousun; Cha, Eun S; Kim, Jaeyoung; Lee, Won J

2012-12-01

To investigate the magnitude and characteristics of the economic burden resulting from acute pesticide poisoning (APP) in South Korea. The total costs of APP from a societal perspective were estimated by summing the direct medical and non-medical costs together with the indirect costs. Direct medical costs for patients assigned a disease code of pesticide poisoning were extracted from the Korean National Health Insurance Reimbursement Data. Direct non-medical costs were estimated using the average transportation and caregiving costs from the Korea Health Panel Survey. Indirect costs, incurred by pre-mature deaths and work loss, were obtained using 2009 Life Tables for Korea and other relevant literature. In 2009, a total of 11,453 patients were treated for APP and 1311 died, corresponding to an incidence of 23.1 per 100,000 population and a mortality rate of 2.6 per 100,000 population in South Korea. The total costs of APP were estimated at approximately US$ 150 million, 0.3% of the costs of total diseases. Costs due to pre-mature mortality accounted for 90.6% of the total costs, whereas the contribution of direct medical costs was relatively small. Costs from APP demonstrate a unique characteristic of a large proportion of the indirect costs originating from pre-mature mortality. This finding suggests policy implications for restrictions on lethal pesticides and safe storage to reduce fatality and cost due to APP. © 2012 Blackwell Publishing Ltd.

TOTALL: high cost of allergic rhinitis-a national Swedish population-based questionnaire study.

PubMed

Cardell, Lars-Olaf; Olsson, Petter; Andersson, Morgan; Welin, Karl-Olof; Svensson, Johanna; Tennvall, Gunnel Ragnarson; Hellgren, Johan

2016-02-04

Allergic rhinitis is a global illness with a well-recognised impact on quality of life and work performance. Comparatively little is known about the extent of its economic impact on society. The TOTALL study estimates the total cost of allergic rhinitis using a sample representing the entire Swedish population of working age. A questionnaire focused on allergic rhinitis was mailed out to a random population of Swedish residents, aged 18-65 years. Health-care contacts, medications, absenteeism (absence from work) and presenteeism (reduced working capacity at work) were assessed, and the direct and indirect costs of allergic rhinitis were calculated. Medication use was evaluated in relation to the ARIA guidelines. In all, 3,501 of 8,001 (44%) answered the questionnaire, and 855 (24%) of these reported allergic rhinitis. The mean annual direct and indirect costs because of allergic rhinitis were €210.3 and €750.8, respectively, resulting in a total cost of €961.1 per individual/year. Presenteeism represented 70% of the total cost. Antihistamines appear to be used in excess in relation to topical steroids, and the use of nasal decongestants was alarmingly high. The total cost of allergic rhinitis in Sweden, with a population of 9.5 million, was estimated at €1.3 billion annually. These unexpectedly high costs could be related to the high prevalence of disease, in combination with the previously often underestimated indirect costs. Improved adherence to guidelines might ease the economic burden on society.

Effect of bombesin on pancreatic secretion and gall bladder motility of the chicken.

PubMed

Linari, G; Linari, M B

1975-12-01

Bombesin strongly stimulated the chicken pancreatic secretion. When given by i.v. infusion, the threshold dose was of the order of 7.5-45.0 ng/kg/min and maximum enzyme output was obtained at a rate of 60 ng/kg/min. In addition to total enzyme output, enzyme concentration was also increased. Caerulein displayed a more potent stimulant effect, but composition of juice produced by the two polypeptides was similar. Tachyphylaxis occurred only with bombesin. Neither atropine nor gastric acidification affected the response to bombesin. Bombesin was totally ineffective in promoting gall bladder emptying. It is suggested that in the chicken, bombesin acts on the exocrine pancreas indirectly through release of an endogenous pancreozymin possibly devoid of cholecystokinetic activity.

Indirect costs in chronic obstructive pulmonary disease: a review of the economic burden on employers and individuals in the United States.

PubMed

Patel, Jeetvan G; Nagar, Saurabh P; Dalal, Anand A

2014-01-01

To review and summarize existing literature on the indirect burden of chronic obstructive pulmonary disease (COPD) in the US. Medline, Scopus, and OvidSP databases were searched using defined search terms to identify relevant studies. Eligible studies were published in English between January 2000 and April 2012 and calculated the indirect burden of COPD in a US population in terms of prevalence, incidence or costs of productivity loss, disability, morbidity, or mortality. Of 53 studies identified, eleven met eligibility criteria, with data years spanning 1987-2009. Estimates of workforce participation range from 56% to 69% among individuals with COPD and from 65% to 77% among individuals without COPD. Approximately 13%-18% of those with COPD are limited in the amount or type of work they can do and one-third or more experience general activity limitation. Estimates of restricted activity days range from 27-63 days per year. Estimates of mean annual sick leave and/or disability days among employed individuals with COPD range from 1.3-19.4 days. Estimates of bed confinement range from 13-32 days per year. Estimated mean annual indirect costs were $893-$2,234/person (US dollars) with COPD ($1,521-$3,348 in 2010 [US dollars]) and varied with the population studied, specific cost outcomes, and economic inputs. In studies that assessed total (direct and indirect) costs, indirect costs accounted for 27%-61% of total costs, depending on the population studied. COPD is associated with substantial indirect costs. The disease places a burden on employers in terms of lost productivity and associated costs and on individuals in terms of lost income related to absenteeism, activity limitation, and disability. Consideration of indirect as well as direct costs is necessary to gain a more complete view of the societal burden of COPD.

Indirect costs in chronic obstructive pulmonary disease: A review of the economic burden on employers and individuals in the United States

PubMed Central

Patel, Jeetvan G; Nagar, Saurabh P; Dalal, Anand A

2014-01-01

Objective To review and summarize existing literature on the indirect burden of chronic obstructive pulmonary disease (COPD) in the US. Methods Medline, Scopus, and OvidSP databases were searched using defined search terms to identify relevant studies. Eligible studies were published in English between January 2000 and April 2012 and calculated the indirect burden of COPD in a US population in terms of prevalence, incidence or costs of productivity loss, disability, morbidity, or mortality. Results Of 53 studies identified, eleven met eligibility criteria, with data years spanning 1987–2009. Estimates of workforce participation range from 56% to 69% among individuals with COPD and from 65% to 77% among individuals without COPD. Approximately 13%–18% of those with COPD are limited in the amount or type of work they can do and one-third or more experience general activity limitation. Estimates of restricted activity days range from 27–63 days per year. Estimates of mean annual sick leave and/or disability days among employed individuals with COPD range from 1.3–19.4 days. Estimates of bed confinement range from 13–32 days per year. Estimated mean annual indirect costs were $893–$2,234/person (US dollars) with COPD ($1,521–$3,348 in 2010 [US dollars]) and varied with the population studied, specific cost outcomes, and economic inputs. In studies that assessed total (direct and indirect) costs, indirect costs accounted for 27%–61% of total costs, depending on the population studied. Conclusions COPD is associated with substantial indirect costs. The disease places a burden on employers in terms of lost productivity and associated costs and on individuals in terms of lost income related to absenteeism, activity limitation, and disability. Consideration of indirect as well as direct costs is necessary to gain a more complete view of the societal burden of COPD. PMID:24672234

Nitrous oxide and nitrate concentration in under-drainage from arable fields subject to diffuse pollution mitigation measures

NASA Astrophysics Data System (ADS)

Hama-Aziz, Zanist; Hiscock, Kevin; Adams, Christopher; Reid, Brian

2016-04-01

Atmospheric nitrous oxide concentrations are increasing by 0.3% annually and a major source of this greenhouse gas is agriculture. Indirect emissions of nitrous oxide (e.g. from groundwater and surface water) account for about quarter of total nitrous oxide emissions. However, these indirect emissions are subject to uncertainty, mainly due to the range in reported emission factors. It's hypothesised in this study that cover cropping and implementing reduced (direct drill) cultivation in intensive arable systems will reduce dissolved nitrate concentration and subsequently indirect nitrous oxide emissions. To test the hypothesis, seven fields with a total area of 102 ha in the Wensum catchment in eastern England have been chosen for experimentation together with two fields (41 ha) under conventional cultivation (deep inversion ploughing) for comparison. Water samples from field under-drainage have been collected for nitrate and nitrous oxide measurement on a weekly basis from April 2013 for two years from both cultivation areas. A purge and trap preparation line connected to a Shimadzu GC-8A gas chromatograph fitted with an electron capture detector was used for dissolved nitrous oxide analysis. Results revealed that with an oilseed radish cover crop present, the mean concentration of nitrate, which is the predominant form of N, was significantly depleted from 13.9 mg N L-1 to 2.5 mg N L-1. However, slightly higher mean nitrous oxide concentrations under the cover crop of 2.61 μg N L-1 compared to bare fields of 2.23 μg N L-1 were observed. Different inversion intensity of soil tended to have no effect on nitrous oxide and nitrate concentrations. The predominant production mechanism for nitrous oxide was nitrification process and the significant reduction of nitrate was due to plant uptake rather than denitrification. It is concluded that although cover cropping might cause a slight increase of indirect nitrous oxide emission, it can be a highly effective mitigation measure in an agricultural area where high nitrate losses from fields into groundwater or surface water is excessively occurring.

The economics of employing a counsellor in general practice: analysis of data from a randomised controlled trial.

PubMed Central

Friedli, K; King, M B; Lloyd, M

2000-01-01

BACKGROUND: Counselling is currently adopted in many general practices, despite limited evidence of clinical and cost effectiveness. AIM: To compare direct and indirect costs of counsellors and general practitioners (GPs) in providing care to people with emotional problems. METHOD: We carried out a prospective, randomized controlled trial of non-directive counselling and routine general practice care in 14 general practices in north London. Counsellors adhered to a Rogerian model of counselling. The counselling sessions ranged from one to 12 sessions over 12 weeks. As reported elsewhere, there were no differences in clinical outcomes between the two groups. Therefore, we conducted a cost minimisation analysis. We present only the economic outcomes in this paper. Main outcome measures were cost data (service utilisation, travel, and work absence) at baseline, three months, and nine months. RESULTS: One hundred and thirty-six patients with emotional problems, mainly depression, took part. Seventy patients were randomised to the counsellors and 66 to the GPs. The average direct and indirect costs for the counsellor was 162.09 Pounds more per patient after three months compared with costs for the GP group; however, over the following six months the counsellor group was 87.00 Pounds less per patient than the GP group. Over the total nine-month period, the counsellor group remained more expensive per patient. CONCLUSIONS: Referral to counselling is no more clinically effective or expensive than GP care over a nine-month period in terms of direct plus indirect costs. However, further research is needed to establish indirect costs of introducing a counsellor into general practice. PMID:10897510

The effects of sleep deprivation on emotional empathy.

PubMed

Guadagni, Veronica; Burles, Ford; Ferrara, Michele; Iaria, Giuseppe

2014-12-01

Previous studies have shown that sleep loss has a detrimental effect on the ability of the individuals to process emotional information. In this study, we tested the hypothesis that this negative effect extends to the ability of experiencing emotions while observing other individuals, i.e. emotional empathy. To test this hypothesis, we assessed emotional empathy in 37 healthy volunteers who were assigned randomly to one of three experimental groups: one group was tested before and after a night of total sleep deprivation (sleep deprivation group), a second group was tested before and after a usual night of sleep spent at home (sleep group) and the third group was tested twice during the same day (day group). Emotional empathy was assessed by using two parallel versions of a computerized test measuring direct (i.e. explicit evaluation of empathic concern) and indirect (i.e. the observer's reported physiological arousal) emotional empathy. The results revealed that the post measurements of both direct and indirect emotional empathy of participants in the sleep deprivation group were significantly lower than those of the sleep and day groups; post measurement scores of participants in the day and sleep groups did not differ significantly for either direct or indirect emotional empathy. These data are consistent with previous studies showing the negative effect of sleep deprivation on the processing of emotional information, and extend these effects to emotional empathy. The findings reported in our study are relevant to healthy individuals with poor sleep habits, as well as clinical populations suffering from sleep disturbances. © 2014 European Sleep Research Society.

Public health and economic risk assessment of waterborne contaminants and pathogens in Finland.

PubMed

Juntunen, Janne; Meriläinen, Päivi; Simola, Antti

2017-12-01

This study shows that a variety of mathematical modeling techniques can be applied in a comprehensive assessment of the risks involved in drinking water production. In order to track the effects from water sources to the end consumers, we employed four models from different fields of study. First, two models of the physical environment, which track the movement of harmful substances from the sources to the water distribution. Second, a statistical quantitative microbial risk assessment (QMRA) to assess the public health risks of the consumption of such water. Finally, a regional computable general equilibrium (CGE) model to assess the economic effects of increased illnesses. In order to substantiate our analysis, we used an illustrative case of a recently built artificial recharge system in Southern Finland that provides water for a 300,000 inhabitant area. We examine the effects of various chemicals and microbes separately. Our economic calculations allow for direct effects on labor productivity due to absenteeism, increased health care expenditures and indirect effects for local businesses. We found that even a considerable risk has no notable threat to public health and thus barely measurable economic consequences. Any epidemic is likely to spread widely in the urban setting we examined, but is also going to be short-lived in both public health and economic terms. Our estimate for the ratio of total and direct effects is 1.4, which indicates the importance of general equilibrium effects. Furthermore, the total welfare loss is 2.4 times higher than the initial productivity loss. The major remaining uncertainty in the economic assessment is the indirect effects. Copyright © 2017 Elsevier B.V. All rights reserved.

Longitudinal study of diet quality and change in asthma symptoms in adults, according to smoking status.

PubMed

Li, Zhen; Kesse-Guyot, Emmanuelle; Dumas, Orianne; Garcia-Aymerich, Judith; Leynaert, Bénédicte; Pison, Christophe; Le Moual, Nicole; Romieu, Isabelle; Siroux, Valérie; Camargo, Carlos A; Nadif, Rachel; Varraso, Raphaëlle

2017-02-01

It has been hypothesised that increased asthma prevalence in westernised countries is associated with changes in lifestyle factors, including a poorer diet. However, little is known regarding the association between diet quality and asthma. In the diet-asthma association, the role of BMI as a potential mediator needs clarification; moreover, potential effect modification by non-diet sources of oxidants, such as smoking, merits investigation. We investigated the association between diet quality and change in asthma symptoms, as well as assessed effect modification by smoking, while accounting for BMI as a potential mediator. Using data from the French prospective Epidemiological study on the Genetics and Environment of Asthma study, we assessed diet quality using the Alternate Healthy Eating Index 2010 (AHEI-2010) at baseline and change in asthma symptoms (stable (reference), worsening, improved; mean follow-up time: 7 years). Mediation analysis was used to disentangle total and direct effects and the indirect effect mediated by BMI. The analyses included 969 adults (mean age 43 years; 49 % men; 42 % ever asthma). We observed a significant interaction between smoking and AHEI-2010 on change in asthma symptoms (P for interaction=0·04). Among never smokers (n 499), we observed a positive total effect (multivariable OR 1·39; 95 % CI 1·07, 1·80) and a positive direct effect (OR 1·41; 95 % CI 1·09, 1·80) of the AHEI-2010 (per ten-point increment) on improved symptoms. No indirect effect mediated through BMI was observed (OR 0·99; 95 % CI 0·91, 1·07). Among former and current smokers, all effects were statistically non-significant. Better diet quality was associated with improved asthma symptoms over time in never smokers, independently of BMI.

Effects of interest-major congruence, motivation, and academic performance on timely degree attainment.

PubMed

Allen, Jeff; Robbins, Steve

2010-01-01

Using longitudinal student data from 15 four-year (n = 3,072) and 13 (n = 788) two-year postsecondary institutions, the authors tested the effects of interest-major congruence, motivation, and 1st-year academic performance on timely degree completion. Findings suggest that interest-major congruence has a direct effect on timely degree completion at both institutional settings and that motivation has indirect effects (via 1st-year academic performance). The total effects of both interest-major congruence and motivation on timely degree completion underscore the importance of both constructs in understanding student adjustment and postsecondary success. Implications for theory and counseling practice are discussed.

Perceptions of physical and social environment variables and self-efficacy as correlates of self-reported physical activity among adolescent girls.

PubMed

Motl, Robert W; Dishman, Rod K; Saunders, Ruth P; Dowda, Marsha; Pate, Russell R

2007-01-01

This cross-sectional study examined the direct and indirect effects of perceived equipment accessibility, neighborhood safety, and social support on self-reported physical activity among older adolescent girls. Adolescent girls (n = 1,655) who were in the 12th grade completed a battery of questionnaires that included self-report measures of the perceived physical environment, social support, barriers self-efficacy, and physical activity. Perceived neighborhood safety did not exhibit direct or indirect effects on self-reported physical activity. Perceived equipment accessibility exhibited an indirect effect on self-reported physical activity that was accounted for by barriers self-efficacy. Perceived social support exhibited direct and indirect effects on self-reported physical activity; the indirect effect was accounted for by barriers self-efficacy. The relationships were independent of parental education and body mass index (BMI). Perceived physical environmental factors indirectly influenced self-reported physical activity, and perceived social environmental factors both directly and indirectly influenced self-reported physical activity in this sample of older adolescent girls.

CASP-19 special section: how does chronic disease status affect CASP quality of life at older ages? Examining the WHO ICF disability domains as mediators of this relationship.

PubMed

Sexton, E; King-Kallimanis, B L; Layte, R; Hickey, A

2015-07-01

The effect of chronic disease status on quality of life (QoL) has been well established. However, less is known about how chronic diseases affect QoL. This article examines impairment in three domains of the WHO International Classification of Functioning, Health and Disability (ICF) - body function, activity and participation, as well as affective well-being, - as potential mediators of the relationship between chronic disease and QoL. A cross-sectional sample (n = 4961) of the general Irish community-dwelling population aged 50+ years was obtained from the Irish Longitudinal Study of Ageing (TILDA). The CASP measure of QoL was examined as two dimensions - control/autonomy and self-realisation/pleasure. Structural equation modelling was used to test the direct and indirect effects of chronic disease on QoL, via variables capturing body function, activity, participation and positive affect. A factor analysis showed that indicators of body function and activity loaded onto a single overall physical impairment factor. This physical impairment factor fully mediated the effect of chronic disease on positive affect and QoL. The total effect of chronic disease on control/autonomy (-0.160) was primarily composed of an indirect effect via physical impairment (-0.86), and via physical impairment and positive affect (-0.45). The decomposition of effects on self-realisation/pleasure was similar, although the direct effect of physical impairment was weaker. The model fitted the data well (RMSEA = 0.02, TLI = 0.96, CFI = 0.96). Chronic disease affects QoL through increased deficits in physical body function and activity. This overall physical impairment affects QoL both directly and indirectly via reduced positive affect.

[Euthanasia and the doctrine of double effect].

PubMed

Klein, Martin

2005-01-01

Direct active euthanasia is prohibited in most countries while passive and indirect is not. However, many arguments against the legalization of voluntary active euthanasia are flawed. Ethical differences between active and passive or indirect euthanasia are difficult to maintain especially when the passivity of the actor causes death. The crucial point is not activity or passivity but respect for the autonomy of individual human beings. In particular there appears to be little ethical difference between active and indirect euthanasia. Indirect euthanasia has often been justified by the principle of double effect, which traces back to Thomas Aquinas. But resorting to this rule contains a logical fallacy. The principle of double effect does not allow foreseen and unwanted adverse effects of an action to occur when they are avoidable. In terminal sedation, an example for indirect euthanasia, hypoxemia and dehydration can easily be prevented by respirator therapy and fluid administration. Therefore the rule of double effect is not applicable. Indirect and direct active euthanasia cannot be ethically distinguished by resorting to the principle of double effect.

Effect of joint spacing and joint dip on the stress distribution around tunnels using different numerical methods

NASA Astrophysics Data System (ADS)

Nikadat, Nooraddin; Fatehi Marji, Mohammad; Rahmannejad, Reza; Yarahmadi Bafghi, Alireza

2016-11-01

Different conditions may affect the stability of tunnels by the geometry (spacing and orientation) of joints in the surrounded rock mass. In this study, by comparing the results obtained by the three novel numerical methods i.e. finite element method (Phase2), discrete element method (UDEC) and indirect boundary element method (TFSDDM), the effects of joint spacing and joint dips on the stress distribution around rock tunnels are numerically studied. These comparisons indicate the validity of the stress analyses around circular rock tunnels. These analyses also reveal that for a semi-continuous environment, boundary element method gives more accurate results compared to the results of finite element and distinct element methods. In the indirect boundary element method, the displacements due to joints of different spacing and dips are estimated by using displacement discontinuity (DD) formulations and the total stress distribution around the tunnel are obtained by using fictitious stress (FS) formulations.

Living with disability: patterns of health problems and symptom mediation of health consequences.

PubMed

Patterson, Brandon J; Doucette, William R; Lindgren, Scott D; Chrischilles, Elizabeth A

2012-07-01

People with disability experience a range of symptoms that may serve as an important linkage between disability and other health consequences. The aims of this study were to describe and compare symptom experiences of people with and without disability using a population-based sample and to test direct relationships between disability and health status and indirect effects of disability mediated through symptom experience. A Midwestern sample of 12,249 adults aged 40 and older responded to a cross-sectional survey. Data collected included symptom prevalence and frequencies for 21 commonly reported symptoms, self-perceived health status and physical functioning, number of medications, and demographic variables. Two mediation analyses were conducted using cumulative symptom frequency as the mediator between disability status and both self-rated health and physical functioning. Adults with disability reported significantly greater prevalence and frequencies for all 21 symptoms, with pain and fatigue being the most common. The indirect effect through cumulative symptom frequency explained roughly half of the total effect of disability on general health status, and about one third of the total effect of disability on physical functioning. This study found evidence supporting the diverse and significant symptom experience of people living with disability, especially for symptoms of pain and fatigue. Moreover, symptom experience was found to partially mediate the effects of disability on self-reported general health status and physical functioning. This provides support for symptoms serving as an important link to health outcomes in patients with disability. Copyright © 2012 Elsevier Inc. All rights reserved.

Decayed and missing teeth and oral-health-related factors: predicting depression in homeless people.

PubMed

Coles, Emma; Chan, Karen; Collins, Jennifer; Humphris, Gerry M; Richards, Derek; Williams, Brian; Freeman, Ruth

2011-08-01

The objective of the study was to determine the effect of dental health status, dental anxiety and oral-health-related quality of life (OHRQoL) upon homeless people's experience of depression. A cross-sectional survey was conducted on a sample of homeless people in seven National Health Service Boards in Scotland. All participants completed a questionnaire to assess their depression, dental anxiety and OHRQoL using reliable and valid measures. Participants had an oral examination to assess their experience of tooth decay (decayed and missing teeth). Latent variable path analysis was conducted to determine the effects of dental health status on depression via dental anxiety and OHRQoL using intensive resampling methods. A total of 853 homeless people participated, of which 70% yielded complete data sets. Three latent variables, decayed and missing teeth, dental anxiety (Modified Dental Anxiety Scale: five items) and depression (Center for Epidemiological Studies Depression Scale: two factors), and a single variable for OHRQoL (Oral Health Impact Profile total scale) were used in a hybrid structural equation model. The variable decayed and missing teeth was associated with depression through indirect pathways (total standardised indirect effects=0.44, P<.001), via OHRQoL and dental anxiety (χ²=75.90, df=40, comparative fit index=0.985, Tucker-Lewis index=0.977, root mean square error of approximation=0.051 [90% confidence interval: 0.037-0.065]). Depression in Scottish homeless people is related to dental health status and oral-health-related factors. Decayed and missing teeth may influence depression primarily through the psychological constructs of OHRQoL and, to a lesser extent, dental anxiety. Copyright © 2010 Elsevier Inc. All rights reserved.

Assessment of Viral Genotype Impact to the Cost-Effectiveness and Overall Costs of Care for Peg-Interferon-2α + Ribavirine Treated Chronic Hepatitis C Patients

PubMed Central

Jakovljevic, Mihajlo; Mijailovic, Zeljko; Popovska Jovicic, Biljana; Canovic, Predrag; Gajovic, Olgica; Jovanovic, Mirjana; Petrovic, Dejan; Milovanovic, Olivera; Djordjevic, Natasa

2013-01-01

Background Pegylated interferon alfa plus ribavirin protocol is currently considered the most efficient hepatitis C treatment. However, no evidence of costs comparison among common viral genotypes has been published. Objectives We aimed to assess core drivers of hepatitis C medical care costs and compare cost effectiveness of this treatment among patients infected by hepatitis C virus with genotypes 1 or 4 (group I), and 2 or 3 (group II). Patients and Materials Prospective bottom-up cost-effectiveness analysis from societal perspective was conducted at Infectious Diseases Clinic, University Clinic Kragujevac, Serbia, from 2007 to 2010. There were 81 participants with hepatitis C infection, treated with peg alpha-2a interferon plus ribavirin for 48 or 24 weeks. Economic data acquired were direct inpatient medical costs, outpatient drug acquisition costs, and indirect costs calculated through human capital approach. Results Total costs were significantly higher (P = 0.035) in group I (mean ± SD: 12,751.54 ± 5,588.06) compared to group II (mean ± SD: 10,580.57 ± 3,973.02). In addition, both direct (P = 0.039) and indirect (P < 0.001) costs separately were significantly higher in group I compared to group II. Separate comparison within direct costs revealed higher total cost of medical care (P = 0.024) in first compared to second genotype group, while the similar tendency was observed for total drug acquisition (P = 0.072). Conclusion HCV genotypes 1 and 4 cause more severe clinical course require more care and thus incur higher expenses compared to HCV 2 and 3 genotypes. Policy makers should consider willingness to pay threshold differentially depending upon HCV viral genotype detected. PMID:24032044

The impact of job and family demands on partner’s fatigue: A study of Japanese dual-earner parents

PubMed Central

Shimazu, Akihito; Bakker, Arnold B.; Demerouti, Evangelia; Shimada, Kyoko; Kawakami, Norito

2017-01-01

Objectives This study of Japanese dual-earner couples examined the impact of family and job demands on one’s own and one’s partner’s fatigue as well as gender differences in these effects. Methods A total of 2,502 parents (1,251 couples) were surveyed using a self-administered questionnaire. A crossover model was tested using structural equation modeling. Results The results of structural equation modeling analyses showed that both job and family demands independently exacerbated fatigue. There was an indirect effect of job and family demands on partner fatigue through one’s own fatigue only from husbands to wives. An indirect effect of job demands on partner fatigue through partner’s family demands was identified only from wives to husbands. Furthermore, there were gender differences in the crossover of fatigue. Conclusions This study shows that job and family demands influence family circumstances. When considering means to reduce employees’ fatigue, gender differences in the mechanism of fatigue need to be taken into account. PMID:28235008

Exercise motivational regulations and exercise addiction: The mediating role of passion.

PubMed

Sicilia, Álvaro; Alcaraz-Ibáñez, Manuel; Lirola, María-Jesús; Burgueño, Rafael; Maher, Anthony

2018-05-23

Background and aims The study explored the mediating role of forms of passion in the relationship between motivational regulations in exercise and exercise addiction (EA). Methods A total of 485 university students (368 males and 117 females; M age  = 20.43, SD = 3.21) completed a questionnaire measuring the frequency and intensity of exercise, motivational regulations in exercise, passion for exercise, and EA. Controlling the effects of age, frequency, and intensity of practice, the relationships between the study variables were examined though a path analysis. Results Both self-determined and non-self-determined forms of motivation showed positive association with EA. The forms of motivation with greatest predictive power for EA were introjected and integrated regulations. Both forms of motivation had positive direct and indirect effects through obsessive passion (OP) on EA; however, integrated regulation also showed negative indirect effects through harmonious passion on EA. Conclusions Both forms of passion and, especially, OP, seem to affect how motivational regulations are associated with EA. These findings clarify the association found in previous studies between self-determined forms of motivation and EA.

The third wheel: the impact of Twitter use on relationship infidelity and divorce.

PubMed

Clayton, Russell B

2014-07-01

The purpose of this study was to examine how social networking site (SNS) use, specifically Twitter use, influences negative interpersonal relationship outcomes. This study specifically examined the mediational effect of Twitter-related conflict on the relationship between active Twitter use and negative relationship outcomes, and how this mechanism may be contingent on the length of the romantic relationship. A total of 581 Twitter users aged 18 to 67 years (Mage=29, SDage=8.9) completed an online survey questionnaire. Moderation-mediation regression analyses using bootstrapping methods indicated that Twitter-related conflict mediated the relationship between active Twitter use and negative relationship outcomes. The length of the romantic relationship, however, did not moderate the indirect effect on the relationship between active Twitter use and negative relationship outcomes. The results from this study suggest that active Twitter use leads to greater amounts of Twitter-related conflict among romantic partners, which in turn leads to infidelity, breakup, and divorce. This indirect effect is not contingent on the length of the romantic relationship. The current study adds to the growing body of literature investigating SNS use and romantic relationship outcomes.

Malaria's indirect contribution to all-cause mortality in the Andaman Islands during the colonial era.

PubMed

Shanks, G Dennis; Hay, Simon I; Bradley, David J

2008-09-01

Malaria has a substantial secondary effect on other causes of mortality. From the 19th century, malaria epidemics in the Andaman Islands' penal colony were initiated by the brackish swamp-breeding malaria vector Anopheles sundaicus and fuelled by the importation of new prisoners. Malaria was a major determinant of the highly variable all-cause mortality rate (correlation coefficient r(2)=0.60, n=68, p<0.0001) from 1872 to 1939. Directly attributed malaria mortality based on post-mortem examinations rarely exceeded one-fifth of total mortality. Infectious diseases such as pneumonia, tuberculosis, dysentery, and diarrhoea, which combined with malaria made up the majority of all-cause mortality, were positively correlated with malaria incidence over several decades. Deaths secondary to malaria (indirect malaria mortality) were at least as great as mortality directly attributed to malaria infections.

Evaluating the total costs of chemotherapy-induced toxicity: results from a pilot study with ovarian cancer patients.

PubMed

Calhoun, E A; Chang, C H; Welshman, E E; Fishman, D A; Lurain, J R; Bennett, C L

2001-01-01

While chemotherapy-related toxicities affect cancer patients' activities of daily living and result in large expenditures of medical care for treatment, few studies have assessed the out-of-pocket and indirect costs incurred by patients who experience toxicity. The objective of this study was to evaluate the feasibility of obtaining detailed and comprehensive cost information from patients who experienced neutropenia, thrombocytopenia, or neurotoxicity during treatment. Ovarian cancer patients who experienced chemotherapy-associated hematologic or neurologic toxicities were asked to record detailed information about hospitalization, laboratories, physician visits, phone calls, home visits, medication, medical devices, lost productivity, and caregivers. Resource estimates were converted into cost units, with direct medical cost estimates based on hospital cost-accounting data and indirect costs (i.e., productivity loss) on modified labor force, employment, and earnings data. Direct medical costs were highest for neutropenia (mean of $7,546/episode), intermediate for thrombocytopenia (mean of $3,268/episode), and lowest for neurotoxicity (mean of $688/episode). Indirect costs relating to patient and caregiver work loss and payments for caregiver support were substantial, accounting for $4,220, $3,834, and $4,282 for patients who developed neurotoxicity, neutropenia, and thrombocytopenia, respectively. The total costs of chemotherapy-related neurotoxicity, neutropenia, and thrombocytopenia were $4,908, $11,830, and $7,550. Our study has shown that, with the assistance of patients who are experiencing toxicity, estimation of the total costs of cancer-related toxicities is feasible. Indirect costs, while not included in prior estimates of the costs of toxicity studies, accounted for 34% to 86% of the total costs of cancer supportive care.

Direct and indirect costs associated with the onset of seropositive rheumatoid arthritis. Western Consortium of Practicing Rheumatologists.

PubMed

Newhall-Perry, K; Law, N J; Ramos, B; Sterz, M; Wong, W K; Bulpitt, K J; Park, G; Lee, M; Clements, P; Paulus, H E

2000-05-01

To examine the direct and indirect costs of rheumatoid arthritis (RA) during the first year of disease. As part of a longitudinal observational study, 150 patients with seropositive RA of 5.9 +/- 2.9 mo duration were recruited through the Western Consortium of Practicing Rheumatologists. Subjects completed questionnaires about health care services and resources utilized and about the number of days of usual activity lost as a result of RA during the 6 month period prior to enrolment. Study participants had active RA as evidenced by mean tender and swollen joint counts of 24.9 +/- 13.5 and 20.6 +/- 11.6, respectively, and moderate functional impairment reflected by a mean Health Assessment Questionnaire (HAQ) score of 1.24 +/- 0.7. The average total direct cost of RA was $200/month. Health care visits, medications, and radiographs accounted for 78% of the total direct cost, while expenditures for hospitalizations accounted for only 3.5% of the total. The average number of days of usual activity lost per month because of RA was 3.8 +/- 7.7, translating into an average indirect cost of $281/month. Of the 95 subjects who were gainfully employed prior to disease onset, 12 were disabled and 5 were on sick leave as a result of RA, corresponding to a work disability rate of 18%. Work disabled subjects reported significantly lower total household incomes and higher HAQ disability and global disease activity scores than subjects who continued working. In this group of patients with seropositive RA substantial costs, both direct and indirect, were incurred during the first year of disease.

Direct Contra Naïve-Indirect Comparison of Clinical Failure Rates between High-Viscosity GIC and Conventional Amalgam Restorations: An Empirical Study

PubMed Central

Mickenautsch, Steffen; Yengopal, Veerasamy

2013-01-01

Background Naïve-indirect comparisons are comparisons between competing clinical interventions’ evidence from separate (uncontrolled) trials. Direct comparisons are comparisons within randomised control trials (RCTs). The objective of this empirical study is to test the null-hypothesis that trends and performance differences inferred from naïve-indirect comparisons and from direct comparisons/RCTs regarding the failure rates of amalgam and direct high-viscosity glass-ionomer cement (HVGIC) restorations in permanent posterior teeth have similar direction and magnitude. Methods A total of 896 citations were identified through systematic literature search. From these, ten and two uncontrolled clinical longitudinal studies for HVGIC and amalgam, respectively, were included for naïve-indirect comparison and could be matched with three out twenty RCTs. Summary effects sizes were computed as Odds ratios (OR; 95% Confidence intervals) and compared with those from RCTs. Trend directions were inferred from 95% Confidence interval overlaps and direction of point estimates; magnitudes of performance differences were inferred from the median point estimates (OR) with 25% and 75% percentile range, for both types of comparison. Mann-Whitney U test was applied to test for statistically significant differences between point estimates of both comparison types. Results Trends and performance differences inferred from naïve-indirect comparison based on evidence from uncontrolled clinical longitudinal studies and from direct comparisons based on RCT evidence are not the same. The distributions of the point estimates differed significantly for both comparison types (Mann–Whitney U  =  25, nindirect  =  26; ndirect  =  8; p  =  0.0013, two-tailed). Conclusion The null-hypothesis was rejected. Trends and performance differences inferred from either comparison between HVGIC and amalgam restorations failure rates in permanent posterior teeth are not the same. It is recommended that clinical practice guidance regarding HVGICs should rest on direct comparisons via RCTs and not on naïve-indirect comparisons based on uncontrolled longitudinal studies in order to avoid inflation of effect estimates. PMID:24205220

Estimating regional long-term economic consequences of natural hazards - a case study of the 2005 flood event in Tyrol (Austria)

NASA Astrophysics Data System (ADS)

Pfurtscheller, C.; Lochner, B.; Brucker, A.

2012-04-01

The interaction of relief-driven alpine natural processes with the anthropogenic sphere often leads to natural disasters which significantly impact on remote alpine economies. When evaluating the effects of such events for future risk prevention strategies, it is essential to assess indirect losses. While the economic measurement of direct effects - the physical impact on structures and infrastructure - seems fairly manageable, less is known about the dimensions of indirect effects, especially on a local and regional scale within the Alps. The lack of standardized terminology, empirical data and methods to estimate indirect economic effects currently hampers profound decision support. In our study of the 2005 flood event in Tyrol, we surveyed companies from all sectors of the economy to identify the main drivers of indirect effects and interrupted economic flows. In collaboration with the Federal State administration, we extrapolate the total regional economic effects of this catastrophic event. Using quantitative and qualitative methods, we established and analysed a data pool of questionnaire and interview results as well as direct loss data. We mainly focus on the decrease in value creation and the negative impacts on tourism. We observed that disrupted traffic networks can have a highly negative impact, especially for the tourism sector in lateral alpine valleys. Within a month, turnover fell by approximately EUR 3.3 million in the investigated area. In the short run (until August 2006), the shortfall in touristic revenues in the Paznaun valley aggregated to approx. EUR 5.3 million. We observed that overnight stays rebound very quickly so that long-term effects are marginal. In addition, we tried to identify possible economical losers as well as winners of severe hazard impacts. In response to such flood events, high investments are made to improve disaster and risk management. Nearly 70% of the respondents specified the (re)construction sector and similar businesses as main beneficiaries and about 40% mentioned infrastructural improvements, as in streets or protective measures, as the most positive effect. We present an empirical approach to assess the economic consequences of fatal events and provide rules of thumb to quickly estimate indirect economic losses from natural disasters, at least for the Alpine Space, at the local and regional level. The methods and results of this study can help to improve ex-post loss estimations, and with it, ex-ante methods for the cost efficiency of risk reduction measures, e.g. cost-benefit-analysis.

Assessing Mediational Models: Testing and Interval Estimation for Indirect Effects

ERIC Educational Resources Information Center

Biesanz, Jeremy C.; Falk, Carl F.; Savalei, Victoria

2010-01-01

Theoretical models specifying indirect or mediated effects are common in the social sciences. An indirect effect exists when an independent variable's influence on the dependent variable is mediated through an intervening variable. Classic approaches to assessing such mediational hypotheses (Baron & Kenny, 1986; Sobel, 1982) have in recent years…

Direct cost comparison of totally endoscopic versus open ear surgery.

PubMed

Patel, N; Mohammadi, A; Jufas, N

2018-02-01

Totally endoscopic ear surgery is a relatively new method for managing chronic ear disease. This study aimed to test the null hypothesis that open and endoscopic approaches have similar direct costs for the management of attic cholesteatoma, from an Australian private hospital setting. A retrospective direct cost comparison of totally endoscopic ear surgery and traditional canal wall up mastoidectomy for the management of attic cholesteatoma in a private tertiary setting was undertaken. Indirect and future costs were excluded. A direct cost comparison of anaesthetic setup and resources, operative setup and resources, and surgical time was performed between the two techniques. Totally endoscopic ear surgery has a mean direct cost reduction of AUD$2978.89 per operation from the hospital perspective, when compared to canal wall up mastoidectomy. Totally endoscopic ear surgery is more cost-effective, from an Australian private hospital perspective, than canal wall up mastoidectomy for attic cholesteatoma.

Comparing Indirect Effects in SEM: A Sequential Model Fitting Method Using Covariance-Equivalent Specifications

ERIC Educational Resources Information Center

Chan, Wai

2007-01-01

In social science research, an indirect effect occurs when the influence of an antecedent variable on the effect variable is mediated by an intervening variable. To compare indirect effects within a sample or across different samples, structural equation modeling (SEM) can be used if the computer program supports model fitting with nonlinear…

Systematic review of cost-of-illness studies in hand eczema.

PubMed

Politiek, Klaziena; Oosterhaven, Jart A F; Vermeulen, Karin M; Schuttelaar, Marie-Louise A

2016-08-01

The individual burden of disease in hand eczema patients is considerable. However, little is known about the socio-economic impact of this disease. The aims of this review were to evaluate the literature on cost-of-illness in hand eczema, and to compose a checklist for future use. The literature was retrieved from the MEDLINE and EMBASE databases up to October 2015. Quality evaluation was based on seven relevant items in cost-of-illness studies. Cost data (direct and indirect) were extracted and converted into euros (2014 price level) by use of the Dutch Consumer Price Index. Six articles were included. The mean annual total cost per patient ranged from €1311 [corrected] to €9792 (direct cost per patient, €521 to €3722; [corrected] and indirect cost per patient, €100 to €6846). Occupational hand eczema patients showed indirect costs up to 70% of total costs, mainly because of absenteeism. A large diversity in hand eczema severity was found between studies. The socio-economic burden of hand eczema is considerable, especially for more severe and/or occupational hand eczema. Absenteeism from paid work leads to a high total cost-of-illness, although disregard of presenteeism often leads to underestimation of indirect costs. Differences in included cost components, the occupational status of patients and hand eczema severity make international comparison difficult. A checklist was added to standardize the approach to cost-of-illness studies in hand eczema. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Mediation analysis to estimate direct and indirect milk losses associated with bacterial load in bovine subclinical mammary infections.

PubMed

Detilleux, J; Theron, L; Duprez, J-N; Reding, E; Moula, N; Detilleux, M; Bertozzi, C; Hanzen, C; Mainil, J

2016-08-01

Milk losses associated with mastitis can be attributed to either effects of pathogens per se (i.e. direct losses) or to effects of the immune response triggered by the presence of mammary pathogens (i.e. indirect losses). Test-day milk somatic cell counts (SCC) and number of bacterial colony forming units (CFU) found in milk samples are putative measures of the level of immune response and of the bacterial load, respectively. Mediation models, in which one independent variable affects a second variable which, in turn, affects a third one, are conceivable models to estimate direct and indirect losses. Here, we evaluated the feasibility of a mediation model in which test-day SCC and milk were regressed toward bacterial CFU measured at three selected sampling dates, 1 week apart. We applied this method on cows free of clinical signs and with records on up to 3 test-days before and after the date of the first bacteriological samples. Most bacteriological cultures were negative (52.38%), others contained either staphylococci (23.08%), streptococci (9.16%), mixed bacteria (8.79%) or were contaminated (6.59%). Only losses mediated by an increase in SCC were significantly different from null. In cows with three consecutive bacteriological positive results, we estimated a decreased milk yield of 0.28 kg per day for each unit increase in log2-transformed CFU that elicited one unit increase in log2-transformed SCC. In cows with one or two bacteriological positive results, indirect milk loss was not significantly different from null although test-day milk decreased by 0.74 kg per day for each unit increase of log2-transformed SCC. These results highlight the importance of milk losses that are mediated by an increase in SCC during mammary infection and the feasibility of decomposing total milk loss into its direct and indirect components.

Effects of eHealth Literacy on General Practitioner Consultations: A Mediation Analysis

PubMed Central

Fitzpatrick, Mary Anne; Hess, Alexandra; Sudbury-Riley, Lynn; Hartung, Uwe

2017-01-01

Background Most evidence (not all) points in the direction that individuals with a higher level of health literacy will less frequently utilize the health care system than individuals with lower levels of health literacy. The underlying reasons of this effect are largely unclear, though people’s ability to seek health information independently at the time of wide availability of such information on the Internet has been cited in this context. Objective We propose and test two potential mediators of the negative effect of eHealth literacy on health care utilization: (1) health information seeking and (2) gain in empowerment by information seeking. Methods Data were collected in New Zealand, the United Kingdom, and the United States using a Web-based survey administered by a company specialized on providing online panels. Combined, the three samples resulted in a total of 996 baby boomers born between 1946 and 1965 who had used the Internet to search for and share health information in the previous 6 months. Measured variables include eHealth literacy, Internet health information seeking, the self-perceived gain in empowerment by that information, and the number of consultations with one’s general practitioner (GP). Path analysis was employed for data analysis. Results We found a bundle of indirect effect paths showing a positive relationship between health literacy and health care utilization: via health information seeking (Path 1), via gain in empowerment (Path 2), and via both (Path 3). In addition to the emergence of these indirect effects, the direct effect of health literacy on health care utilization disappeared. Conclusions The indirect paths from health literacy via information seeking and empowerment to GP consultations can be interpreted as a dynamic process and an expression of the ability to find, process, and understand relevant information when that is necessary. PMID:28512081

Rejection Sensitivity and Depression: Indirect Effects Through Problem Solving.

PubMed

Kraines, Morganne A; Wells, Tony T

2017-01-01

Rejection sensitivity (RS) and deficits in social problem solving are risk factors for depression. Despite their relationship to depression and the potential connection between them, no studies have examined RS and social problem solving together in the context of depression. As such, we examined RS, five facets of social problem solving, and symptoms of depression in a young adult sample. A total of 180 participants completed measures of RS, social problem solving, and depressive symptoms. We used bootstrapping to examine the indirect effect of RS on depressive symptoms through problem solving. RS was positively associated with depressive symptoms. A negative problem orientation, impulsive/careless style, and avoidance style of social problem solving were positively associated with depressive symptoms, and a positive problem orientation was negatively associated with depressive symptoms. RS demonstrated an indirect effect on depressive symptoms through two social problem-solving facets: the tendency to view problems as threats to one's well-being and an avoidance problem-solving style characterized by procrastination, passivity, or overdependence on others. These results are consistent with prior research that found a positive association between RS and depression symptoms, but this is the first study to implicate specific problem-solving deficits in the relationship between RS and depression. Our results suggest that depressive symptoms in high RS individuals may result from viewing problems as threats and taking an avoidant, rather than proactive, approach to dealing with problems. These findings may have implications for problem-solving interventions for rejection sensitive individuals.

Posttraumatic Stress Disorder and Suicidal Behavior: Indirect Effects of Impaired Social Functioning.

PubMed

Dutton, Courtney E; Rojas, Sasha M; Badour, Christal L; Wanklyn, Sonya G; Feldner, Matthew T

2016-01-01

Social functioning is negatively impacted by the presence of PTSD, while increasing risk of suicidal behavior among individuals with PTSD. However, little research has examined the specific role of social functioning in the association between PTSD and suicidal behavior. Parallel multiple indirect effects analyses were performed to understand the unique indirect effects of four aspects of social functioning. Indirect effects of PTSD on suicidal ideation were significant through three pathways: interpersonal conflict, perceived family support, and interpersonal apprehension. Perceived family support was the only indirect pathway significantly associated with suicide attempt. Findings suggest that social functioning should be assessed and potentially targeted during treatment to help modify the risk for suicidal behavior among individuals with PTSD.

Estimation of the direct and indirect impacts of fireworks on the physicochemical characteristics of atmospheric PM10 and PM2.5

NASA Astrophysics Data System (ADS)

Tian, Y. Z.; Wang, J.; Peng, X.; Shi, G. L.; Feng, Y. C.

2014-09-01

To quantify the total, direct and indirect impacts of fireworks individually, size-resolved PM samples were collected before, during and after a Chinese folk festival (Chinese New Year) in a megacity in China. Through chemical analysis and morphological characterisation, a strong influence of fireworks on the physicochemical characteristics of PM10 and PM2.5 was observed. The concentrations of many species exhibited an increasing trend during the heavy-firework period, especially for K+, Mg2+ and Cr; the results of the non-sea-salt ions demonstrated an anthropogenic influence on K+ and Mg2+. Then, source apportionment was conducted by receptor models and peak analysis (PA). The total influence of the fireworks was quantified by positive matrix factorisation (PMF), showing that the fireworks contributed higher fractions (23.40% for PM10 and 29.66% for PM2.5) during the heavy-firework period than during the light-firework period (4.28% for PM10 and 7.18% for PM2.5). The profiles of the total fireworks obtained by two independent methods (PMF and peak analysis) were consistent, with higher abundances of K+, Al, Si, Ca and organic carbon (OC). Finally, the individual contributions of the direct and indirect impacts of fireworks were quantified by chemical mass balance (CMB). The percentage contributions of resuspended dust, biomass combustion and direct fireworks were 36.8 ± 8.37%, 14.1 ± 2.82% and 44.4 ± 8.26%, respectively, for PM10 and 34.9 ± 4.19%, 16.6 ± 3.05% and 52.5 ± 9.69%, respectively, for PM2.5, in terms of the total fireworks. The quantification of the total, direct and indirect impacts of fireworks in the ambient PM gives a original contribution for understanding the physicochemical characteristics and mechanisms of such high-intensity anthropogenic activities.

Direct and Indirect Costs of Chronic and Episodic Migraine in the United States: A Web-Based Survey.

PubMed

Messali, Andrew; Sanderson, Joanna C; Blumenfeld, Andrew M; Goadsby, Peter J; Buse, Dawn C; Varon, Sepideh F; Stokes, Michael; Lipton, Richard B

2016-02-01

The objective of this study was to compare the societal direct and indirect costs of chronic and episodic migraine in the United States. Episodic and chronic migraine are distinguished by the frequency of headache-days. Chronic migraine has a greater overall impact on quality of life than does episodic migraine. Individuals with chronic migraine also use more healthcare resources (resulting in higher direct costs) and experience greater decreases in productivity (resulting in higher indirect costs) than those with episodic migraine as shown in the American Migraine Prevalence and Prevention (AMPP) Study. The International Burden of Migraine Study utilized a web-based questionnaire to elicit data on several topics related to the burden of migraine illness, including health resource utilization and productivity losses. Potential survey participants were identified by Synovate Healthcare (Chicago, IL, USA) from a pool of registered panelists from various countries. The panelists were screened online to determine eligibility and to identify individuals with migraine (episodic or chronic), based on reported symptoms. Participants from the United States were divided into episodic and chronic migraine groups, based on reported headache-day per month frequency. Direct and indirect costs were estimated by applying estimated unit costs to reported headache-related productivity losses and resource use. Costs were compared between participants with episodic and chronic migraine. Mean [standard deviation] total annual cost of headache among people with chronic migraine ($8243 [$10,646]) was over three times that of episodic migraine ($2649 [$4634], P < .001). Participants with chronic migraine had significantly greater direct medical costs ($4943 [$6382]) and indirect (lost productivity) costs ($3300 [$6907]) than did participants with episodic migraine (direct, $1705 [$3591]; indirect, $943 [$2084]) (P < .001 for each). Unlike previous findings, direct medical costs constituted the majority of total headache-related costs for both chronic migraine (60.0%, $4943 of $8243) and episodic migraine (64.3%, $1705 of $2649) participants. A large portion of direct medical costs are attributable to pharmaceutical utilization among both chronic migraine (80%, $3925 of 4943) and episodic migraine (70%, $1196 of $1705) participants. The results of this study build on previous results of the AMPP Study, demonstrating that headache-related direct, indirect, and total costs are significantly greater among individuals with chronic migraine than with episodic migraine in the United States. © 2016 American Headache Society.

The Relationship between PTSD and Chronic Pain: Mediating Role of Coping Strategies and Depression

PubMed Central

Morasco, Benjamin J.; Lovejoy, Travis I.; Lu, Mary; Turk, Dennis C.; Lewis, Lynsey; Dobscha, Steven K.

2013-01-01

People with chronic pain and comorbid posttraumatic stress disorder (PTSD) report more severe pain and poorer quality of life than those with chronic pain alone. This study evaluated the extent to which associations between PTSD and chronic pain interference and severity are mediated by pain-related coping strategies and depressive symptoms. Veterans with chronic pain were divided into two groups, those with (n=65) and those without (n=136) concurrent PTSD. All participants completed measures of pain severity, interference, emotional functioning, and coping strategies. Those with current PTSD reported significantly greater pain severity and pain interference, had more symptoms of depression, and were more likely to meet diagnostic criteria for a current alcohol or substance use disorder (all p-values ≤ 0.01). Participants with PTSD reported more use of several coping strategies, including guarding, resting, relaxation, exercise/stretching, and coping self-statements. Illness-focused pain coping (i.e., guarding, resting, and asking for assistance) and depressive symptoms jointly mediated the relationship between PTSD and both pain interference (total indirect effect = 0.194, p < 0.001) and pain severity (total indirect effect = 0.153, p = 0.004). Illness-focused pain coping also evidenced specific mediating effects, independent of depression. In summary, specific pain coping strategies and depressive symptoms partially mediated the relationship between PTSD and both pain interference and severity. Future research should examine whether changes in types of coping strategies following targeted treatments predict improvements in pain-related function for chronic pain patients with concurrent PTSD. PMID:23398939

GCM Simulations of the Aerosol Indirect Effect: Sensitivity to Cloud Parameterization and Aerosol Burden

NASA Technical Reports Server (NTRS)

Menon, Surabi; DelGenio, Anthony D.; Koch, Dorothy; Tselioudis, George; Hansen, James E. (Technical Monitor)

2001-01-01

We describe the coupling of the Goddard Institute for Space Studies (GISS) general circulation model (GCM) to an online sulfur chemistry model and source models for organic matter and sea-salt that is used to estimate the aerosol indirect effect. The cloud droplet number concentration is diagnosed empirically from field experiment datasets over land and ocean that observe droplet number and all three aerosol types simultaneously; corrections are made for implied variations in cloud turbulence levels. The resulting cloud droplet number is used to calculate variations in droplet effective radius, which in turn allows us to predict aerosol effects on cloud optical thickness and microphysical process rates. We calculate the aerosol indirect effect by differencing the top-of-the-atmosphere net cloud radiative forcing for simulations with present-day vs. pre-industrial emissions. Both the first (radiative) and second (microphysical) indirect effects are explored. We test the sensitivity of our results to cloud parameterization assumptions that control the vertical distribution of cloud occurrence, the autoconversion rate, and the aerosol scavenging rate, each of which feeds back significantly on the model aerosol burden. The global mean aerosol indirect effect for all three aerosol types ranges from -1.55 to -4.36 W m(exp -2) in our simulations. The results are quite sensitive to the pre-industrial background aerosol burden, with low pre-industrial burdens giving strong indirect effects, and to a lesser extent to the anthropogenic aerosol burden, with large burdens giving somewhat larger indirect effects. Because of this dependence on the background aerosol, model diagnostics such as albedo-particle size correlations and column cloud susceptibility, for which satellite validation products are available, are not good predictors of the resulting indirect effect.

GCM Simulations of the Aerosol Indirect Effect: Sensitivity to Cloud Parameterization and Aerosol Burden

NASA Technical Reports Server (NTRS)

Menon, Surabi; DelGenio, Anthony D.; Koch, Dorothy; Tselioudis, George; Hansen, James E. (Technical Monitor)

2001-01-01

We describe the coupling of the Goddard Institute for Space Studies (GISS) general circulation model (GCM) to an online sulfur chemistry model and source models for organic matter and sea-salt that is used to estimate the aerosol indirect effect. The cloud droplet number concentration is diagnosed empirically from field experiment datasets over land and ocean that observe droplet number and all three aerosol types simultaneously; corrections are made for implied variations in cloud turbulence levels. The resulting cloud droplet number is used to calculate variations in droplet effective radius, which in turn allows us to predict aerosol effects on cloud optical thickness and microphysical process rates. We calculate the aerosol indirect effect by differencing the top-of-the-atmosphere net cloud radiative forcing for simulations with present-day vs. pre-industrial emissions. Both the first (radiative) and second (microphysical) indirect effects are explored. We test the sensitivity of our results to cloud parameterization assumptions that control the vertical distribution of cloud occurrence, the autoconversion rate, and the aerosol scavenging rate, each of which feeds back significantly on the model aerosol burden. The global mean aerosol indirect effect for all three aerosol types ranges from -1.55 to -4.36 W/sq m in our simulations. The results are quite sensitive to the pre-industrial background aerosol burden, with low pre-industrial burdens giving strong indirect effects, and to a lesser extent to the anthropogenic aerosol burden, with large burdens giving somewhat larger indirect effects. Because of this dependence on the background aerosol, model diagnostics such as albedo-particle size correlations and column cloud susceptibility, for which satellite validation products are available, are not good predictors of the resulting indirect effect.

DNA double strand breaks induced by the indirect effect of radiation are more efficiently repaired by non-homologous end joining compared to homologous recombination repair.

PubMed

Bajinskis, Ainars; Natarajan, Adayapalam T; Erixon, Klaus; Harms-Ringdahl, Mats

2013-08-30

The aim of this study was to investigate the relative involvement of three major DNA repair pathways, i.e., non-homologous end joining (NHEJ), homologous recombination (HRR) and base excision (BER) in repair of DNA lesions of different complexity induced by low- or high-LET radiation with emphasis on the contribution of the indirect effect of radiation for these radiation qualities. A panel of DNA repair-deficient CHO cell lines was irradiated by (137)Cs γ-rays or radon progeny α-particles. Irradiation was also performed in the presence of 2M DMSO to reduce the indirect effect of radiation and the complexity of the DNA damage formed. Clonogenic survival and micronucleus assays were used to estimate efficiencies of the different repair pathways for DNA damages produced by direct and indirect effects. Removal of the indirect effect of low-LET radiation by DMSO increased clonogenic survival and decreased MN formation for all cell lines investigated. A direct contribution of the indirect effect of radiation to DNA base damage was suggested by the significant protection by DMSO seen for the BER deficient cell line. Lesions formed by the indirect effect are more readily repaired by the NHEJ pathway than by HRR after irradiation with γ-rays or α-particles as evaluated by cell survival and the yields of MN. The results obtained with BER- and NHEJ-deficient cells suggest that the indirect effect of radiation contributes significantly to the formation of repair substrates for these pathways. Copyright © 2013 Elsevier B.V. All rights reserved.

How coping styles, cognitive distortions, and attachment predict problem gambling among adolescents and young adults.

PubMed

Calado, Filipa; Alexandre, Joana; Griffiths, Mark D

2017-12-01

Background and aims Recent research suggests that youth problem gambling is associated with several factors, but little is known how these factors might influence or interact each other in predicting this behavior. Consequently, this is the first study to examine the mediation effect of coping styles in the relationship between attachment to parental figures and problem gambling. Methods A total of 988 adolescents and emerging adults were recruited to participate. The first set of analyses tested the adequacy of a model comprising biological, cognitive, and family variables in predicting youth problem gambling. The second set of analyses explored the relationship between family and individual variables in problem gambling behavior. Results The results of the first set of analyses demonstrated that the individual factors of gender, cognitive distortions, and coping styles showed a significant predictive effect on youth problematic gambling, and the family factors of attachment and family structure did not reveal a significant influence on this behavior. The results of the second set of analyses demonstrated that the attachment dimension of angry distress exerted a more indirect influence on problematic gambling, through emotion-focused coping style. Discussion This study revealed that some family variables can have a more indirect effect on youth gambling behavior and provided some insights in how some factors interact in predicting problem gambling. Conclusion These findings suggest that youth gambling is a multifaceted phenomenon, and that the indirect effects of family variables are important in estimating the complex social forces that might influence adolescent decisions to gamble.

Treatment cost evaluation of extrauterine gravidity: a literature review of medical and surgical treatment costs.

PubMed

Ebner, Florian; Varga, Dominic; Sorg, Friederike; Vorwerk, Elena; Schochter, Fabienne; Janni, Wolfgang; Wöckel, Achim; DeGregorio, Nikolaus

2015-03-01

The diagnosis of extrauterine pregnancy is possible very early giving the patient and doctors treatment options. As the risks and success rate of medical and surgical treatment are similar, the decision is increasingly influenced by cost-effectiveness. The following article systematically reviews the known literature regarding cost, decision criteria and possible follow-up. Literature review of extrauterine gravity in combination with cost in the online National Library of Medicine since 1.1.1997 following the PRISMA recommendations. Six articles were identified in which the cost of the laparoscopic versus medical treatment is reviewed. In five articles, the medical treatment was shown to be more cost effective and in the sixth article the costs were found to be equal. The cost saving varies between 18 and 88% depending on the consideration of direct and indirect costs. If indirect expenses are considered, the total sum increases with treatment failures. Failure rates are given as up to 27% depending on the type of failure (surgical or medical). These rates seem to be linked indirectly with the β-HCG levels. Predictive parameters for the successful medical treatment are missing. The treatment of small extrauterine gravidities in haemodynamically stable patients (defined by HCG levels <1,500 IU/l) is medically successful and cost-effective. With HCG levels between 1,500 IU/l and 3,000 IU/l, the treatment costs are similar. HCG levels >5,000 IU/l favour the surgical treatment as being more cost-effective. A similar cut-off for the sonographic imaging is missing.

INDIRECT EFFECT OF X-RADIATION ON BONE GROWTH IN RATS

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

Conard, R.A.

1962-12-21

Effects of 200 to 600 r of x irradiation on tibial bone growth in groups of weanling male rats were studied by in vivo measurement of tibial bone growth in serial radiographs. By comparison of growth rates in shielded with unshielded legs, direct and indirect effects of radiation were demonstrated, both roughly dose dependent, but with the indirect effect being about twice that of the direct effect. Pair-feeding experiments showed that about 70% of the indirect effect was due to radiation-induced lowered food consumption. By partial-body shielding experiments, using pnir-fed controls, it was shown that the abdomen may be themore » site of a non-nutritional abscopal effect. (auth)« less

SPSS and SAS procedures for estimating indirect effects in simple mediation models.

PubMed

Preacher, Kristopher J; Hayes, Andrew F

2004-11-01

Researchers often conduct mediation analysis in order to indirectly assess the effect of a proposed cause on some outcome through a proposed mediator. The utility of mediation analysis stems from its ability to go beyond the merely descriptive to a more functional understanding of the relationships among variables. A necessary component of mediation is a statistically and practically significant indirect effect. Although mediation hypotheses are frequently explored in psychological research, formal significance tests of indirect effects are rarely conducted. After a brief overview of mediation, we argue the importance of directly testing the significance of indirect effects and provide SPSS and SAS macros that facilitate estimation of the indirect effect with a normal theory approach and a bootstrap approach to obtaining confidence intervals, as well as the traditional approach advocated by Baron and Kenny (1986). We hope that this discussion and the macros will enhance the frequency of formal mediation tests in the psychology literature. Electronic copies of these macros may be downloaded from the Psychonomic Society's Web archive at www.psychonomic.org/archive/.

The indirect effects of cheatgrass invasion: Grasshopper herbivory on native grasses determined by neighboring cheatgrass abundance

Treesearch

Julie Beckstead; Susan E. Meyer; Carol K. Augsperger

2008-01-01

Invasion biology has focused on the direct effects of plant invasion and has generally overlooked indirect interactions. Here we link theories of invasion biology and herbivory to explore an indirect effect of one invading species on associational herbivory (the effect of neighboring plants on herbivory) of native species. We studied a Great Basin shadscale (...

Stress increases the risk of type 2 diabetes onset in women: A 12-year longitudinal study using causal modelling

PubMed Central

Oldmeadow, Christopher; Hure, Alexis; Luu, Judy; Loxton, Deborah

2017-01-01

Background Type 2 diabetes is associated with significant morbidity and mortality. Modifiable risk factors have been found to contribute up to 60% of type 2 diabetes risk. However, type 2 diabetes continues to rise despite implementation of interventions based on traditional risk factors. There is a clear need to identify additional risk factors for chronic disease prevention. The aim of this study was to examine the relationship between perceived stress and type 2 diabetes onset, and partition the estimates into direct and indirect effects. Methods and findings Women born in 1946–1951 (n = 12,844) completed surveys for the Australian Longitudinal Study on Women’s Health in 1998, 2001, 2004, 2007 and 2010. The total causal effect was estimated using logistic regression and marginal structural modelling. Controlled direct effects were estimated through conditioning in the regression model. A graded association was found between perceived stress and all mediators in the multivariate time lag analyses. A significant association was found between hypertension, as well as physical activity and body mass index, and diabetes, but not smoking or diet quality. Moderate/high stress levels were associated with a 2.3-fold increase in the odds of diabetes three years later, for the total estimated effect. Results were only slightly attenuated when the direct and indirect effects of perceived stress on diabetes were partitioned, with the mediators only explaining 10–20% of the excess variation in diabetes. Conclusions Perceived stress is a strong risk factor for type 2 diabetes. The majority of the effect estimate of stress on diabetes risk is not mediated by the traditional risk factors of hypertension, physical activity, smoking, diet quality, and body mass index. This gives a new pathway for diabetes prevention trials and clinical practice. PMID:28222165

Spatial distribution, risk factors and haemato-biochemical alterations associated with Theileria equi infected equids of Punjab (India) diagnosed by indirect ELISA and nested PCR.

PubMed

Sumbria, Deepak; Singla, L D; Kumar, Sanjay; Sharma, Amrita; Dahiya, Rajesh K; Setia, Raj

2016-03-01

Equine piroplasmosis is a febrile, tick-borne disease of equids predominately caused by obligatory intra-erythrocytic protozoa Theileria equi in the Indian sub-continent. A cross-sectional study was carried out on 464 equids (426 horses and 38 donkeys/mules) in Punjab, India to assess the level of exposure to equine piroplasmosis by 18S rRNA gene nested polymerase chain reaction (nPCR) and equine merozoite antigen-2 (EMA2) indirect-ELISA (enzyme linked immunosorbent assay), to investigate risk factors and haemato-biochemical alterations associated with the infection. The endemicity of the disease was confirmed by positive PCR amplification in 21.77% and positive antibody titers in 49.78% equid samples. There was a fair agreement between these two diagnostic techniques (Kappa coefficient=0.326). The spatial distribution analysis revealed an increasing trend of T. equi prevalence from north-eastern to south-western region of Punjab by both the techniques correspondingly, which proffered a direct relation with temperature and inverse with humidity variables. The relatively prominent risk factor associated with sero-positivity was the presence of other domestic animals in the herd, while the propensity of finding a positive PCR amplification was higher in donkeys/mules, animal kept at unorganised farm or those used for commercial purposes as compared to their counterparts. There was a significant increase in globulins, gamma glutamyl-transferase, total bilirubin, direct bilirubin, indirect bilirubin, glucose levels and decrease in total erythrocyte count, haemoglobin, packed cell volume by animals, which were revealed positive by nPCR (may or may not positive by indirect-ELISA) and increase in creatinine, total bilirubin, direct bilirubin, glucose and decrease in total erythrocytes count by animals, which were revealed positive by indirect-ELISA (alone). To our knowledge, this study, for the first time, brings out a comprehensive report on the status on spatial distribution of T. equi in Punjab (India) state, thoroughly investigated by molecular and serological techniques, evaluating various environmental and demographic risk factors along with the haemato-biochemical alterations in the exposed animals. Copyright © 2015 Elsevier B.V. All rights reserved.

Direct effects dominate responses to climate perturbations in grassland plant communities.

PubMed

Chu, Chengjin; Kleinhesselink, Andrew R; Havstad, Kris M; McClaran, Mitchel P; Peters, Debra P; Vermeire, Lance T; Wei, Haiyan; Adler, Peter B

2016-06-08

Theory predicts that strong indirect effects of environmental change will impact communities when niche differences between competitors are small and variation in the direct effects experienced by competitors is large, but empirical tests are lacking. Here we estimate negative frequency dependence, a proxy for niche differences, and quantify the direct and indirect effects of climate change on each species. Consistent with theory, in four of five communities indirect effects are strongest for species showing weak negative frequency dependence. Indirect effects are also stronger in communities where there is greater variation in direct effects. Overall responses to climate perturbations are driven primarily by direct effects, suggesting that single species models may be adequate for forecasting the impacts of climate change in these communities.

Estimating the Economic Burden of Rheumatoid Arthritis in Taiwan Using the National Health Insurance Database.

PubMed

Wang, Bruce C M; Hsu, Ping-Ning; Furnback, Wesley; Ney, John; Yang, Ya-Wen; Fang, Chi-Hui; Tang, Chao-Hsiun

2016-03-01

Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by inflammation and destruction of the joints. This research aims to estimate the economic burden of RA in Taiwan. The National Health Insurance Research Database (NHIRD), a claims-based dataset encompassing 99 % of Taiwan's population, was applied. We used a micro-costing approach for direct healthcare costs and indirect social costs by estimating the quantities and prices of cost categories. Direct costs included surgeries, hospitalizations, medical devices and materials, laboratory tests, and drugs. The costs and quantities of the direct economic burden were calculated based on 2011 data of NHIRD. We identified RA patients and a control cohort matched 1:4 on demographic and clinical covariates to calculate the incremental cost related to RA. Indirect costs were evaluated by missed work (absenteeism) and worker productivity (presenteeism). For the indirect burden, we estimated the rate of absenteeism and presenteeism from a patient survey. Costs were presented in US dollars (US$1 = 30 TWD). A total of 41,269 RA patients were included in the database with incremental total direct cost of US$86,413,971 and indirect cost of US$138,492,987. This resulted in an average incremental direct cost of US$2050 per RA patient. Within direct costs, the largest burdens were associated with drugs (US$73,028,944), laboratory tests (US$6,132,395), and hospitalizations (US$3,208,559). For indirect costs, absenteeism costs and presenteeism costs were US$16,059,681 and US$114,291,687, respectively. The economic burden of RA in Taiwan is driven by indirect healthcare costs, most notably presenteeism.

Estimating the Economic Burden of Rheumatoid Arthritis in Taiwan Using the National Health Insurance Database.

PubMed

Wang, Bruce C M; Hsu, Ping-Ning; Furnback, Wesley; Ney, John; Yang, Ya-Wen; Fang, Chi-Hui; Tang, Chao-Hsiun

Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by inflammation and destruction of the joints. This research aims to estimate the economic burden of RA in Taiwan. The National Health Insurance Research Database (NHIRD), a claims-based dataset encompassing 99 % of Taiwan's population, was applied. We used a micro-costing approach for direct healthcare costs and indirect social costs by estimating the quantities and prices of cost categories. Direct costs included surgeries, hospitalizations, medical devices and materials, laboratory tests, and drugs. The costs and quantities of the direct economic burden were calculated based on 2011 data of NHIRD. We identified RA patients and a control cohort matched 1:4 on demographic and clinical covariates to calculate the incremental cost related to RA. Indirect costs were evaluated by missed work (absenteeism) and worker productivity (presenteeism). For the indirect burden, we estimated the rate of absenteeism and presenteeism from a patient survey. Costs were presented in US dollars (US$1 = 30 TWD). A total of 41,269 RA patients were included in the database with incremental total direct cost of US$86,413,971 and indirect cost of US$138,492,987. This resulted in an average incremental direct cost of US$2050 per RA patient. Within direct costs, the largest burdens were associated with drugs (US$73,028,944), laboratory tests (US$6,132,395), and hospitalizations (US$3,208,559). For indirect costs, absenteeism costs and presenteeism costs were US$16,059,681 and US$114,291,687, respectively. The economic burden of RA in Taiwan is driven by indirect healthcare costs, most notably presenteeism.

A comparison of direct and indirect analytical approaches to measuring total nicotine equivalents in urine.

PubMed

Taghavi, Taraneh; Novalen, Maria; Lerman, Caryn; George, Tony P; Tyndale, Rachel F

2018-05-31

Total nicotine equivalents (TNE), the sum of nicotine and metabolites in urine, is a valuable tool for evaluating nicotine exposure. Most methods for measuring TNE involve two-step enzymatic hydrolysis for indirect quantification of glucuronide metabolites. Here, we describe a rapid, low-cost direct liquid chromatography - tandem mass spectrometry (LCMS) assay. In 139 smokers' urine samples, Bland-Altman, correlation, and regression analyses were used to investigate differences in quantification of nicotine and metabolites, TNE, and nicotine metabolite ratio (NMR) between direct and indirect LCMS methods. DNA from a subset (n=97 smokers) was genotyped for UGT2B10*2 and UGT2B17*2 and the known impact of these variants was evaluated using urinary ratios determined by the direct versus indirect method. The direct method showed high accuracy (0-9% bias) and precision (3-14% coefficient of variation) with similar distribution of nicotine metabolites to literary estimates and good agreement between the direct and indirect methods for nicotine, cotinine, and 3-hydroxycotinine (ratios 0.99-1.07), but less agreement for their respective glucuronides (ratios 1.16-4.17). The direct method identified urinary 3HC+3HC-GLUC/COT as having the highest concordance with plasma NMR and provided substantially better estimations of the established genetic impact of glucuronidation variants compared to the indirect method. Direct quantification of nicotine and metabolites is less time-consuming and less costly, and provides accurate estimates of nicotine intake, metabolism rate and the impact of genetic variation in smokers. Lower cost and maintenance combined with high accuracy and reproducibility make the direct method ideal for smoking biomarker, NMR and pharmacogenomics studies. Copyright ©2018, American Association for Cancer Research.

The Effect of Long-Term Therapeutics, Prophylaxis and Screening Techniques on Aircrew Medical Standards.

DTIC Science & Technology

1981-03-01

percentage of fat , maximal aerobic power, serum concentrations of triglycerides, total cholesterol and HDL cholesterol. This information is obtained fr-m each...drinkinq and physical activity related to health parameters su-h as wei ,iht , body fat content, maximal aerobic T1ewer and serum concentrations of...subjects, and the body fat is estimated from the body density (4). 3. The maximal aerobic power is assessed indirectly according to the method of Astrand

Association between bilirubin and risk of Non-Alcoholic Fatty Liver Disease based on a prospective cohort study.

PubMed

Tian, Jianbo; Zhong, Rong; Liu, Cheng; Tang, Yuhan; Gong, Jing; Chang, Jiang; Lou, Jiao; Ke, Juntao; Li, Jiaoyuan; Zhang, Yi; Yang, Yang; Zhu, Ying; Gong, Yajie; Xu, Yanyan; Liu, Peiyi; Yu, Xiao; Xiao, Lin; Du, Min; Yang, Ling; Yuan, Jing; Wang, Youjie; Chen, Weihong; Wei, Sheng; Liang, Yuan; Zhang, Xiaomin; He, Meian; Wu, Tangchun; Yao, Ping; Miao, Xiaoping

2016-08-03

The study aimed to assess the association between total, direct, and indirect bilirubin and nonalcoholic fatty live disease (NAFLD) risk given its high prevalence and serious clinical prognosis. Among 27,009 subjects who participated in a healthy screening program from the Dongfeng-Tongji cohort study in 2008, 8189 eligible subjects (aged 35-86 years; males, 43.95%) were ultimately enrolled. The incidence rates of NAFLD in 2013 were compared with respect to baseline bilirubin levels among subjects free of NAFLD, and the effect sizes were estimated by logistic regression analysis. During 5 years follow-up, we observed 1956 cases of newly developed NAFLD with the overall incidence of 23.88%. Direct bilirubin was presented to inversely associate with NAFLD risk. Compared with quartile 1 of direct bilirubin, the multivariable-adjusted ORs (95% CIs) for NAFLD of quartile 2 to 4 were 1.104 (0.867-1.187), 0.843 (0.719-0.989), and 0.768 (0.652-0.905), respectively, P for trend 0.002). Similarly, inverse effects of direct bilirubin on NAFLD incidence were also observed when stratified by sex and BMI. However, no significant associations were found between total, and indirect bilirubin and NAFLD risk. Direct bilirubin reduced NAFLD risk independent of possible confounders among middle-aged and elderly Chinese population, probably based on the endogenous antioxidation of bilirubin.

Cost-utility analysis of a three-month exercise programme vs usual care following multidisciplinary rehabilitation for chronic low back pain.

PubMed

Henchoz, Yves; Pinget, Christophe; Wasserfallen, Jean-Blaise; Paillex, Roland; de Goumoëns, Pierre; Norberg, Michael; Kai-Lik So, Alexander

2010-10-01

To assess the cost-utility of an exercise programme vs usual care after functional multidisciplinary rehabilitation in patients with chronic low back pain. Cost-utility analysis alongside a randomized controlled trial. A total of 105 patients with chronic low back pain. Chronic low back pain patients completing a 3-week functional multidisciplinary rehabilitation were randomized to either a 3-month exercise programme (n = 56) or usual care (n = 49). The exercise programme consisted of 24 training sessions during 12 weeks. At the end of functional multidisciplinary rehabilitation and at 1-year follow-up quality of life was measured with the SF-36 questionnaire, converted into utilities and transformed into quality--adjusted life years. Direct and indirect monthly costs were measured using cost diaries. The incremental cost-effectiveness ratio was calculated as the incremental cost of the exercise programme divided by the difference in quality-adjusted life years between both groups. Quality of life improved significantly at 1-year follow-up in both groups. Similarly, both groups significantly reduced total monthly costs over time. No significant difference was observed between groups. The incremental cost-effectiveness ratio was 79,270 euros. Adding an exercise programme after functional multidisciplinary rehabilitation compared with usual care does not offer significant long-term benefits in quality of life and direct and indirect costs.

Indirect effects of domestic and wild herbivores on butterflies in an African savanna

PubMed Central

Wilkerson, Marit L; Roche, Leslie M; Young, Truman P

2013-01-01

Indirect interactions driven by livestock and wild herbivores are increasingly recognized as important aspects of community dynamics in savannas and rangelands. Large ungulate herbivores can both directly and indirectly impact the reproductive structures of plants, which in turn can affect the pollinators of those plants. We examined how wild herbivores and cattle each indirectly affect the abundance of a common pollinator butterfly taxon, Colotis spp., at a set of long-term, large herbivore exclosure plots in a semiarid savanna in central Kenya. We also examined effects of herbivore exclusion on the main food plant of Colotis spp., which was also the most common flowering species in our plots: the shrub Cadaba farinosa. The study was conducted in four types of experimental plots: cattle-only, wildlife-only, cattle and wildlife (all large herbivores), and no large herbivores. Across all plots, Colotis spp. abundances were positively correlated with both Cadaba flower numbers (adult food resources) and total Cadaba canopy area (larval food resources). Structural equation modeling (SEM) revealed that floral resources drove the abundance of Colotis butterflies. Excluding browsing wildlife increased the abundances of both Cadaba flowers and Colotis butterflies. However, flower numbers and Colotis spp. abundances were greater in plots with cattle herbivory than in plots that excluded all large herbivores. Our results suggest that wild browsing herbivores can suppress pollinator species whereas well-managed cattle use may benefit important pollinators and the plants that depend on them. This study documents a novel set of ecological interactions that demonstrate how both conservation and livelihood goals can be met in a working landscape with abundant wildlife and livestock. PMID:24198932

Do socio-economic inequalities in infant growth in rural India operate through maternal size and birth weight?

PubMed

Griffiths, Paula L; Balakrishna, Nagalla; Fernandez Rao, Sylvia; Johnson, William

2016-01-01

In total, 3.1 million young children die every year from under-nutrition. Greater understanding of associations between socio-economic status (SES) and the biological factors that shape under-nutrition are required to target interventions. To establish whether SES inequalities in under-nutrition, proxied by infant size at 12 months, operate through maternal and early infant size measures. The sample comprised 347 Indian infants born in 60 villages in rural Andhra Pradesh 2005-2007. Structural equation path models were applied to decompose the total relationship between SES (standard of living index) and length and weight for age Z-scores (LAZ/WAZ) at 12 months into direct and indirect (operating through maternal BMI and height, birthweight Z-score and LAZ/WAZ at 6 months) paths. SES had a direct positive association with LAZ (Standardised coefficient = 0.08, 95% CI = 0.02-0.13) and WAZ at age 12 months (Standardised coefficient = 0.08, 95% CI = 0.02-0.15). It also had additional indirect positive associations through increased maternal height and subsequently increased birthweight and WAZ/LAZ at 6 months, accounting for 35% and 53% of the total effect for WAZ and LAZ, respectively. Findings support targeting evidence based growth interventions towards infants from the poorest families with the shortest mothers. Increasing SES can improve growth for two generations.

The costs of social anxiety disorder: the role of symptom severity and comorbidities.

PubMed

Stuhldreher, Nina; Leibing, Eric; Leichsenring, Falk; Beutel, Manfred E; Herpertz, Stephan; Hoyer, Juergen; Konnopka, Alexander; Salzer, Simone; Strauss, Bernhard; Wiltink, Joerg; König, Hans-Helmut

2014-08-01

Social anxiety disorder (SAD) is associated with low direct costs compared to other anxiety disorders while indirect costs tend to be high. Mental comorbidities have been identified to increase costs, but the role of symptom severity is still vague. The objective of this study was to determine the costs of SAD, and to explore the impact of symptoms and comorbidities on direct and indirect costs. Baseline data, collected within the SOPHO-NET multi-centre treatment study (N=495), were used. Costs were calculated based on health care utilization and lost productivity. Symptom severity was measured with the Liebowitz-Social-Anxiety-Scale; comorbidities were included as covariates. Total 6-month costs were accrued to €4802; 23% being direct costs. While there was no significant association with SAD symptom severity for direct costs, costs of absenteeism increased with symptom severity in those with costs >0; comorbid affective disorders and eating disorders had an additional effect. Self-rated productivity was lower with more pronounced symptoms even after controlling for comorbidities. As the study was based on a clinical sample total costs were considered, rather than net costs of SAD and no population costs could be calculated. The burden associated with lost productivity was considerable while costs of healthcare utilization were rather low as most patients had not sought for treatment before. Efforts to identify patients with SAD earlier and to provide adequate treatment should be further increased. Mental comorbidities should be addressed as well, since they account for a large part of indirect costs associated with SAD. Copyright © 2014 Elsevier B.V. All rights reserved.

The evaluation of cost-of-illness due to use of cost-of-illness-based chemicals.

PubMed

Hong, Jiyeon; Lee, Yongjin; Lee, Geonwoo; Lee, Hanseul; Yang, Jiyeon

2015-01-01

This study is conducted to estimate the cost paid by the public suffering from disease possibly caused by chemical and to examine the effect on public health. Cost-benefit analysis is an important factor in analysis and decision-making and is an important policy decision tool in many countries. Cost-of-illness (COI), a kind of scale-based analysis method, estimates the potential value lost as a result of illness as a monetary unit and calculates the cost in terms of direct, indirect and psychological costs. This study estimates direct medical costs, transportation fees for hospitalization and outpatient treatment, and nursing fees through a number of patients suffering from disease caused by chemicals in order to analyze COI, taking into account the cost of productivity loss as an indirect cost. The total yearly cost of the diseases studied in 2012 is calculated as 77 million Korean won (KRW) per person. The direct and indirect costs being 52 million KRW and 23 million KRW, respectively. Within the total cost of illness, mental and behavioral disability costs amounted to 16 million KRW, relevant blood immunological parameters costs were 7.4 million KRW, and disease of the nervous system costs were 6.7 million KRW. This study reports on a survey conducted by experts regarding diseases possibly caused by chemicals and estimates the cost for the general public. The results can be used to formulate a basic report for a social-economic evaluation of the permitted use of chemicals and limits of usage.

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

Walston, L. J.; Cantwell, B. L.; Krummel, J. R.

Energy development has been occurring in the intermountain western United States for over a century, yet few studies have attempted to spatially quantify the impacts of this disturbance on native ecosystems. We used temporal remotely sensed data for the Pinedale Anticline Project Area (PAPA) in western Wyoming, a region that has experienced increased natural gas development within the past 10 yr, to quantify the spatiotemporal distribution of Wyoming big sagebrush Artemisia tridentata, natural gas development, and other landcover types. Our analyses included 5 Landsat Thematic Mapper (TM) images of the PAPA over a 22-yr period (1985-2006). We determined whether Wyomingmore » big sagebrush spatiotemporal patterns were associated with natural gas development or other landcover types. We also developed a footprint model to determine the direct and indirect impacts of natural gas development on the distribution of Wyoming big sagebrush habitats. Over the 22-yr period, we observed an inverse relationship between the amount of Wyoming big sagebrush habitat and natural gas development. During this time, Wyoming big sagebrush habitat declined linearly at a rate of 0.2% yr-1 (4.5% total net loss), whereas natural gas development increased exponentially at a rate of 20% yr-1 (4800% total net increase). Our evaluation indicated that, by 2006, natural gas development directly impacted 2.7% (1750 ha) of original Wyoming big sagebrush habitat. Indirect impacts, quantified to account for degraded habitat quality, affected as much as 58.5% (assuming 1000-m buffers) of the original Wyoming big sagebrush habitat. Integrating assessments of the direct and indirect impacts will yield a better elucidation of the overall effects of disturbances on ecosystem function and quality.« less

Adaptive evolution of body size subject to indirect effect in trophic cascade system.

PubMed

Wang, Xin; Fan, Meng; Hao, Lina

2017-09-01

Trophic cascades represent a classic example of indirect effect and are wide-spread in nature. Their ecological impact are well established, but the evolutionary consequences have received even less theoretical attention. We theoretically and numerically investigate the trait (i.e., body size of consumer) evolution in response to indirect effect in a trophic cascade system. By applying the quantitative trait evolutionary theory and the adaptive dynamic theory, we formulate and explore two different types of eco-evolutionary resource-consumer-predator trophic cascade model. First, an eco-evolutionary model incorporating the rapid evolution is formulated to investigate the effect of rapid evolution of the consumer's body size, and to explore the impact of density-mediate indirect effect on the population dynamics and trait dynamics. Next, by employing the adaptive dynamic theory, a long-term evolutionary model of consumer body size is formulated to evaluate the effect of long-term evolution on the population dynamics and the effect of trait-mediate indirect effect. Those models admit rich dynamics that has not been observed yet in empirical studies. It is found that, both in the trait-mediated and density-mediated system, the body size of consumer in predator-consumer-resource interaction (indirect effect) evolves smaller than that in consumer-resource and predator-consumer interaction (direct effect). Moreover, in the density-mediated system, we found that the evolution of consumer body size contributes to avoiding consumer extinction (i.e., evolutionary rescue). The trait-mediate and density-mediate effects may produce opposite evolutionary response. This study suggests that the trophic cascade indirect effect affects consumer evolution, highlights a more comprehensive mechanistic understanding of the intricate interplay between ecological and evolutionary force. The modeling approaches provide avenue for study on indirect effects from an evolutionary perspective. Copyright © 2017 Elsevier B.V. All rights reserved.

Fitness, Sleep-Disordered Breathing, Symptoms of Depression, and Cognition in Inactive Overweight Children: Mediation Models.

PubMed

Stojek, Monika M K; Montoya, Amanda K; Drescher, Christopher F; Newberry, Andrew; Sultan, Zain; Williams, Celestine F; Pollock, Norman K; Davis, Catherine L

We used mediation models to examine the mechanisms underlying the relationships among physical fitness, sleep-disordered breathing (SDB), symptoms of depression, and cognitive functioning. We conducted a cross-sectional secondary analysis of the cohorts involved in the 2003-2006 project PLAY (a trial of the effects of aerobic exercise on health and cognition) and the 2008-2011 SMART study (a trial of the effects of exercise on cognition). A total of 397 inactive overweight children aged 7-11 received a fitness test, standardized cognitive test (Cognitive Assessment System, yielding Planning, Attention, Simultaneous, Successive, and Full Scale scores), and depression questionnaire. Parents completed a Pediatric Sleep Questionnaire. We used bootstrapped mediation analyses to test whether SDB mediated the relationship between fitness and depression and whether SDB and depression mediated the relationship between fitness and cognition. Fitness was negatively associated with depression ( B = -0.041; 95% CI, -0.06 to -0.02) and SDB ( B = -0.005; 95% CI, -0.01 to -0.001). SDB was positively associated with depression ( B = 0.99; 95% CI, 0.32 to 1.67) after controlling for fitness. The relationship between fitness and depression was mediated by SDB (indirect effect = -0.005; 95% CI, -0.01 to -0.0004). The relationship between fitness and the attention component of cognition was independently mediated by SDB (indirect effect = 0.058; 95% CI, 0.004 to 0.13) and depression (indirect effect = -0.071; 95% CI, -0.01 to -0.17). SDB mediates the relationship between fitness and depression, and SDB and depression separately mediate the relationship between fitness and the attention component of cognition.

The Association Between Obesity and Cognitive Function in Older Persons: How Much Is Mediated by Inflammation, Fasting Plasma Glucose, and Hypertriglyceridemia?

PubMed

Gunathilake, Roshan; Oldmeadow, Christopher; McEvoy, Mark; Inder, Kerry J; Schofield, Peter W; Nair, Balakrishnan R; Attia, John

2016-12-01

The aim of the study was to determine how much of the association between obesity, measured by body mass index (BMI), and cognition in older persons is mediated through inflammation, fasting plasma glucose, and hypertriglyceridemia. Anthropometrics, high-sensitivity C-reactive protein (CRP), fasting plasma glucose, and serum triglycerides were measured in 3,256 community-dwelling individuals aged 55-85 years residing in Newcastle, New South Wales, Australia. Audio recorded cognitive screen (ARCS) was used to assess multiple cognitive domains. Mediation analyses showed very modest but significant direct mediation effects, whereby obesity was associated with better cognitive function after adjusting for potential confounders (controlled direct effect ≈ 1/500 point increase in the total ARCS score per 1.0-kg/m 2 increase in BMI). There were significant indirect negative mediation effects from BMI to cognition mediated through CRP, that is, increased BMI was associated with increased CRP which was associated with decreased cognition (natural indirect effect -0.20 unit; 95% confidence interval [CI] -0.39, -0.02), and through fasting plasma glucose, that is, increased BMI was associated with increased fasting plasma glucose which was associated with decreased cognition (natural indirect effect -0.12 unit; 95% CI -0.24, -0.01], but not through serum triglycerides. There is a weak positive association between obesity and cognitive performance in older persons, which is partially antagonized by inflammation and elevated fasting plasma glucose, but not hypertriglyceridemia. Further studies are needed to elucidate whether this is due to selection bias, or truly reflects biologically complex and counter balancing pathways involved in obesity. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Simulation of between-farm transmission of porcine reproductive and respiratory syndrome virus in Ontario, Canada using the North American Animal Disease Spread Model.

PubMed

Thakur, Krishna K; Revie, Crawford W; Hurnik, Daniel; Poljak, Zvonimir; Sanchez, Javier

2015-03-01

Porcine reproductive and respiratory syndrome (PRRS), a viral disease of swine, has major economic impacts on the swine industry. The North American Animal Disease Spread Model (NAADSM) is a spatial, stochastic, farm level state-transition modeling framework originally developed to simulate highly contagious and foreign livestock diseases. The objectives of this study were to develop a model to simulate between-farm spread of a homologous strain of PRRS virus in Ontario swine farms via direct (animal movement) and indirect (sharing of trucks between farms) contacts using the NAADSM and to compare the patterns and extent of outbreak under different simulated conditions. A total of 2552 swine farms in Ontario province were allocated to each census division of Ontario and geo-locations of the farms were randomly generated within the agriculture land of each Census Division. Contact rates among different production types were obtained using pig movement information from four regions in Canada. A total of 24 scenarios were developed involving various direct (movement of infected animals) and indirect (pig transportation trucks) contact parameters in combination with alternating the production type of the farm in which the infection was seeded. Outbreaks were simulated for one year with 1000 replications. The median number of farms infected, proportion of farms with multiple outbreaks and time to reach the peak epidemic were used to compare the size, progression and extent of outbreaks. Scenarios involving spread only by direct contact between farms resulted in outbreaks where the median percentage of infected farms ranged from 31.5 to 37% of all farms. In scenarios with both direct and indirect contact, the median percentage of infected farms increased to a range from 41.6 to 48.6%. Furthermore, scenarios with both direct and indirect contact resulted in a 44% increase in median epidemic size when compared to the direct contact scenarios. Incorporation of both animal movements and the sharing of trucks within the model indicated that the effect of direct and indirect contact may be nonlinear on outbreak progression. The increase of 44% in epidemic size when indirect contact, via sharing of trucks, was incorporated into the model highlights the importance of proper biosecurity measures in preventing transmission of the PRRS virus. Simulation of between-farm spread of the PRRS virus in swine farms has highlighted the relative importance of direct and indirect contact and provides important insights regarding the possible patterns and extent of spread of the PRRS virus in a completely susceptible population with herd demographics similar to those found in Ontario, Canada. Copyright © 2015 Elsevier B.V. All rights reserved.

Quantifying and Testing Indirect Effects in Simple Mediation Models when the Constituent Paths Are Nonlinear

ERIC Educational Resources Information Center

Hayes, Andrew F.; Preacher, Kristopher J.

2010-01-01

Most treatments of indirect effects and mediation in the statistical methods literature and the corresponding methods used by behavioral scientists have assumed linear relationships between variables in the causal system. Here we describe and extend a method first introduced by Stolzenberg (1980) for estimating indirect effects in models of…

Harris-Benedict equation estimations of energy needs as compared to measured 24-h energy expenditure by indirect calorimetry in people with early to mid-stage Huntington's disease.

PubMed

Gaba, Ann; Zhang, Kuan; Moskowitz, Carol B; Boozer, Carol N; Marder, Karen

2008-10-01

Weight loss and energy metabolism are important clinical research areas in understanding the disease mechanisms in Huntington's disease. Having an accurate method to estimate expected total energy expenditure would likely facilitate the development of studies about these features of the disease. The Harris-Benedict equation is a formula commonly used to estimate basal energy expenditure of individuals, adjusted for height, weight, age and gender. This estimate is then multiplied by a physical activity factor to estimate total daily energy needs to maintain the given weight. Data from 24-h indirect calorimetry was utilized to derive an adjustment formula for the physical activity factor of the Harris-Benedict equation for 13 early to mid-stage Huntington's disease patients. The adjusted activity factor provided the most accurate estimate of energy needs. This adjusted formula can be used in clinical assessments of Huntington's disease patients, as well as in research studies when indirect calorimetry has not been performed.

First-principles studies of electronic, transport and bulk properties of pyrite FeS2

NASA Astrophysics Data System (ADS)

Banjara, Dipendra; Malozovsky, Yuriy; Franklin, LaShounda; Bagayoko, Diola

2018-02-01

We present results from first principle, local density approximation (LDA) calculations of electronic, transport, and bulk properties of iron pyrite (FeS2). Our non-relativistic computations employed the Ceperley and Alder LDA potential and the linear combination of atomic orbitals (LCAO) formalism. The implementation of the LCAO formalism followed the Bagayoko, Zhao, and Williams (BZW) method, as enhanced by Ekuma and Franklin (BZW-EF). We discuss the electronic energy bands, total and partial densities of states, electron effective masses, and the bulk modulus. Our calculated indirect band gap of 0.959 eV (0.96), using an experimental lattice constant of 5.4166 Å, at room temperature, is in agreement with the measured indirect values, for bulk samples, ranging from 0.84 eV to 1.03 ± 0.05 eV. Our calculated bulk modulus of 147 GPa is practically in agreement with the experimental value of 145 GPa. The calculated, partial densities of states reproduced the splitting of the Fe d bands to constitute the dominant upper most valence and lower most conduction bands, separated by the generally accepted, indirect, experimental band gap of 0.95 eV.

Comparative study on individual aromatase inhibitors on cardiovascular safety profile: a network meta-analysis

PubMed Central

Zhao, Xihe; Liu, Lei; Li, Kai; Li, Wusheng; Zhao, Li; Zou, Huawei

2015-01-01

The third-generation aromatase inhibitors (AIs: anastrozole, letrozole, and exemestane) have now become standard adjuvant endocrine treatment for postmenopausal estrogen receptor-positive breast cancer complementing chemotherapy and surgery. Because of the absence of direct head-to-head comparisons of these AIs, an indirect comparison is needed for individual treatment choice. In this network systemic assessment, the cardiovascular (CV) side effects in using anastrozole, letrozole, and exemestane based on original studies on AIs vs placebo or tamoxifen were compared. We integrated all available direct and indirect evidences. The odds ratio (OR) of severe CV events for indirect comparisons between exemestane and anastrozole was 1.41 (95% confidence interval [CI] =0.49–2.78), letrozole and anastrozole was 1.80 (95% CI =0.40–3.92), and letrozole and exemestane was 1.46 (95% CI =0.34–3.4). OR of subgroup risk for AIs and tamoxifen were all >1 except for thrombolism risk subgroup. The results showed that the total and severe CV risk ranking is letrozole, exemestane, and anastrozole in descending order. None of the AIs showed advantages in CV events than tamoxifen except for thromboembolism event incidence. PMID:26491345

A Water-Withdrawal Input-Output Model of the Indian Economy.

PubMed

Bogra, Shelly; Bakshi, Bhavik R; Mathur, Ritu

2016-02-02

Managing freshwater allocation for a highly populated and growing economy like India can benefit from knowledge about the effect of economic activities. This study transforms the 2003-2004 economic input-output (IO) table of India into a water withdrawal input-output model to quantify direct and indirect flows. This unique model is based on a comprehensive database compiled from diverse public sources, and estimates direct and indirect water withdrawal of all economic sectors. It distinguishes between green (rainfall), blue (surface and ground), and scarce groundwater. Results indicate that the total direct water withdrawal is nearly 3052 billion cubic meter (BCM) and 96% of this is used in agriculture sectors with the contribution of direct green water being about 1145 BCM, excluding forestry. Apart from 727 BCM direct blue water withdrawal for agricultural, other significant users include "Electricity" with 64 BCM, "Water supply" with 44 BCM and other industrial sectors with nearly 14 BCM. "Construction", "miscellaneous food products"; "Hotels and restaurants"; "Paper, paper products, and newsprint" are other significant indirect withdrawers. The net virtual water import is found to be insignificant compared to direct water used in agriculture nationally, while scarce ground water associated with crops is largely contributed by northern states.

Autism, Context/Noncontext Information Processing, and Atypical Development

PubMed Central

Skoyles, John R.

2011-01-01

Autism has been attributed to a deficit in contextual information processing. Attempts to understand autism in terms of such a defect, however, do not include more recent computational work upon context. This work has identified that context information processing depends upon the extraction and use of the information hidden in higher-order (or indirect) associations. Higher-order associations underlie the cognition of context rather than that of situations. This paper starts by examining the differences between higher-order and first-order (or direct) associations. Higher-order associations link entities not directly (as with first-order ones) but indirectly through all the connections they have via other entities. Extracting this information requires the processing of past episodes as a totality. As a result, this extraction depends upon specialised extraction processes separate from cognition. This information is then consolidated. Due to this difference, the extraction/consolidation of higher-order information can be impaired whilst cognition remains intact. Although not directly impaired, cognition will be indirectly impaired by knock on effects such as cognition compensating for absent higher-order information with information extracted from first-order associations. This paper discusses the implications of this for the inflexible, literal/immediate, and inappropriate information processing of autistic individuals. PMID:22937255

The relationship between physical and mental health: A mediation analysis.

PubMed

Ohrnberger, Julius; Fichera, Eleonora; Sutton, Matt

2017-12-01

There is a strong link between mental health and physical health, but little is known about the pathways from one to the other. We analyse the direct and indirect effects of past mental health on present physical health and past physical health on present mental health using lifestyle choices and social capital in a mediation framework. We use data on 10,693 individuals aged 50 years and over from six waves (2002-2012) of the English Longitudinal Study of Ageing. Mental health is measured by the Centre for Epidemiological Studies Depression Scale (CES) and physical health by the Activities of Daily Living (ADL). We find significant direct and indirect effects for both forms of health, with indirect effects explaining 10% of the effect of past mental health on physical health and 8% of the effect of past physical health on mental health. Physical activity is the largest contributor to the indirect effects. There are stronger indirect effects for males in mental health (9.9%) and for older age groups in mental health (13.6%) and in physical health (12.6%). Health policies aiming at changing physical and mental health need to consider not only the direct cross-effects but also the indirect cross-effects between mental health and physical health. Copyright © 2017. Published by Elsevier Ltd.

Direct and Indirect Influence of Non-Native Neighbours on Pollination and Fruit Production of a Native Plant.

PubMed

Montero-Castaño, Ana; Vilà, Montserrat

2015-01-01

Entomophilous non-native plants can directly affect the pollination and reproductive success of native plant species and also indirectly, by altering the composition and abundance of floral resources in the invaded community. Separating direct from indirect effects is critical for understanding the mechanisms underlying the impacts of non-native species on recipient communities. Our aims are: (a) to explore both the direct effect of the non-native Hedysarum coronarium and its indirect effect, mediated by the alteration of floral diversity, on the pollinator visitation rate and fructification of the native Leopoldia comosa and (b) to distinguish whether the effects of the non-native species were due to its floral display or to its vegetative interactions. We conducted field observations within a flower removal experimental setup (i.e. non-native species present, absent and with its inflorescences removed) at the neighbourhood scale. Our study illustrates the complexity of mechanisms involved in the impacts of non-native species on native species. Overall, Hedysarum increased pollinator visitation rates to Leopoldia target plants as a result of direct and indirect effects acting in the same direction. Due to its floral display, Hedysarum exerted a direct magnet effect attracting visits to native target plants, especially those made by the honeybee. Indirectly, Hedysarum also increased the visitation rate of native target plants. Due to the competition for resources mediated by its vegetative parts, it decreased floral diversity in the neighbourhoods, which was negatively related to the visitation rate to native target plants. Hedysarum overall also increased the fructification of Leopoldia target plants, even though such an increase was the result of other indirect effects compensating for the observed negative indirect effect mediated by the decrease of floral diversity.

Direct and Indirect Influence of Non-Native Neighbours on Pollination and Fruit Production of a Native Plant

PubMed Central

Montero-Castaño, Ana; Vilà, Montserrat

2015-01-01

Background Entomophilous non-native plants can directly affect the pollination and reproductive success of native plant species and also indirectly, by altering the composition and abundance of floral resources in the invaded community. Separating direct from indirect effects is critical for understanding the mechanisms underlying the impacts of non-native species on recipient communities. Objectives Our aims are: (a) to explore both the direct effect of the non-native Hedysarum coronarium and its indirect effect, mediated by the alteration of floral diversity, on the pollinator visitation rate and fructification of the native Leopoldia comosa and (b) to distinguish whether the effects of the non-native species were due to its floral display or to its vegetative interactions. Methods We conducted field observations within a flower removal experimental setup (i.e. non-native species present, absent and with its inflorescences removed) at the neighbourhood scale. Results Our study illustrates the complexity of mechanisms involved in the impacts of non-native species on native species. Overall, Hedysarum increased pollinator visitation rates to Leopoldia target plants as a result of direct and indirect effects acting in the same direction. Due to its floral display, Hedysarum exerted a direct magnet effect attracting visits to native target plants, especially those made by the honeybee. Indirectly, Hedysarum also increased the visitation rate of native target plants. Due to the competition for resources mediated by its vegetative parts, it decreased floral diversity in the neighbourhoods, which was negatively related to the visitation rate to native target plants. Hedysarum overall also increased the fructification of Leopoldia target plants, even though such an increase was the result of other indirect effects compensating for the observed negative indirect effect mediated by the decrease of floral diversity. PMID:26110630

An analysis of indirect genetic effects on adult body weight of the Pacific white shrimp Litopenaeus vannamei at low rearing density.

PubMed

Luan, Sheng; Luo, Kun; Chai, Zhan; Cao, Baoxiang; Meng, Xianhong; Lu, Xia; Liu, Ning; Xu, Shengyu; Kong, Jie

2015-12-14

Our aim was to estimate the genetic parameters for the direct genetic effect (DGE) and indirect genetic effects (IGE) on adult body weight in the Pacific white shrimp. IGE is the heritable effect of an individual on the trait values of its group mates. To examine IGE on body weight, 4725 shrimp from 105 tagged families were tested in multiple small test groups (MSTG). Each family was separated into three groups (15 shrimp per group) that were randomly assigned to 105 concrete tanks with shrimp from two other families. To estimate breeding values, one large test group (OLTG) in a 300 m(2) circular concrete tank was used for the communal rearing of 8398 individuals from 105 families. Body weight was measured after a growth-test period of more than 200 days. Variance components for body weight in the MSTG programs were estimated using an animal model excluding or including IGE whereas variance components in the OLTG programs were estimated using a conventional animal model that included only DGE. The correlation of DGE between MSTG and OLTG programs was estimated by a two-trait animal model that included or excluded IGE. Heritability estimates for body weight from the conventional animal model in MSTG and OLTG programs were 0.26 ± 0.13 and 0.40 ± 0.06, respectively. The log likelihood ratio test revealed significant IGE on body weight. Total heritable variance was the sum of direct genetic variance (43.5%), direct-indirect genetic covariance (2.1%), and indirect genetic variance (54.4%). It represented 73% of the phenotypic variance and was more than two-fold greater than that (32%) obtained by using a classical heritability model for body weight. Correlations of DGE on body weight between MSTG and OLTG programs were intermediate regardless of whether IGE were included or not in the model. Our results suggest that social interactions contributed to a large part of the heritable variation in body weight. Small and non-significant direct-indirect genetic correlations implied that neutral or slightly cooperative heritable interactions, rather than competition, were dominant in this population but this may be due to the low rearing density.

Malaria’s Indirect Contribution to All-Cause Mortality in the Andaman Islands during the Colonial Era

PubMed Central

Shanks, G. Dennis; Hay, Simon I.; Bradley, David J.

2009-01-01

Malaria appears to have a substantial secondary effect on other causes of mortality. From the 19th century, malaria epidemics in the Andaman Islands Penal Colony were initiated by the brackish swamp breeding malaria vector Anopheles sundaicus and fueled by the importation of new prisoners. Malaria was a major determinant of the highly variable all-cause mortality rate (correlation coefficient r2=0.60, n=68, p< 0.0001) from 1872 to 1939. Directly attributed malaria mortality based on postmortem examinations rarely exceeded one fifth of total mortality. Infectious diseases such as pneumonia, tuberculosis, dysentery and diarrhea, which combined with malaria made up a majority of all-cause mortality, were positively correlated to malaria incidence over several decades. Deaths secondary to malaria (indirect malaria mortality) were at least as great as mortality directly attributed to malaria infections. PMID:18599354

Identification of Indirect Effects in a Cognitive Patient Education (COPE) Intervention for Low Back Pain.

PubMed

Mansell, Gemma; Storheim, Kjersti; Løchting, Ida; Werner, Erik L; Grotle, Margreth

2017-12-01

Many interventions for the treatment of low back pain exist, but the mechanisms through which such treatments work are not always clear. This situation is especially true for biopsychosocial interventions that incorporate several different components and methods of delivery. The study objective was to examine the indirect effects of the Cognitive Patient Education (COPE) intervention via illness perceptions, back pain myths, and pain catastrophizing on disability outcome. This study was a secondary analysis of the COPE randomized controlled trial. Mediation analysis techniques were employed to examine the indirect effects of the COPE intervention via residualized change (baseline - posttreatment) in the 3 variables hypothesized to be targeted by the COPE intervention on posttreatment disability outcome. Pain intensity at baseline, pain duration, clinician type, and a treatment-mediator interaction term were controlled for in the analysis. Preliminary analyses confirmed that changes in pain catastrophizing and illness perceptions (not back pain myths) were related to both allocation to the intervention arm and posttreatment disability score. The treatment exerted statistically significant indirect effects via changes in illness perceptions and pain catastrophizing on posttreatment disability score (illness perceptions standardized indirect effect = 0.09 [95% CI = 0.03 to 0.16]; pain catastrophizing standardized indirect effect = 0.05 [95% CI = 0.01 to 0.12]). However, the inclusion of an interaction term led to the indirect effects being significantly reduced, with the effects no longer being statistically significant. This study presents a secondary analysis of variables not identified a priori as being potentially important treatment targets; other, unmeasured factors could also be important in explaining treatment effects. The finding that small indirect effects of the COPE intervention via changes in illness perceptions and pain catastrophizing on posttreatment disability could be estimated indicates that these variables may be viable treatment targets for biopsychosocial interventions; however, this finding must be viewed in light of the adjusted analyses, which showed that the indirect effects were significantly reduced through the inclusion of a treatment-mediator interaction term. © Crown copyright 2015

Trait- and density-mediated indirect interactions initiated by an exotic invasive plant autogenic ecosystem engineer

Treesearch

Dean E. Pearson

2010-01-01

Indirect interactions are important for structuring ecological systems. However, research on indirect effects has been heavily biased toward top-down trophic interactions, and less is known about other indirect-interaction pathways. As autogenic ecosystem engineers, plants can serve as initiators of nontrophic indirect interactions that, like top-down pathways, can...

Mediating effects of teacher and peer relationships between parental abuse/neglect and emotional/behavioral problems.

PubMed

Ban, Jiyoon; Oh, Insoo

2016-11-01

The current study examined the mediating effects of the teacher and peer relationships between parental abuse/neglect and a child's emotional/behavioral problems. A total of 2070 student surveys from the panel of the Korean Child Youth Panel Study (KCYPS) were analyzed by path analysis. The key findings of this study are outlined below. Firstly, parental physical and emotional abuse and neglect had significant effects on children's problems. The direct effect of parental abuse on emotional/behavioral problems was higher than the direct effect of parental neglect on emotional/behavioral problems. Secondly, the teacher relationship partially mediated the effects of the parental abuse/neglect on emotional/behavioral problems. Thirdly, the peer relationship also partially mediated the effects of parental abuse/neglect on children's emotional/behavioral problems. The indirect effect of parental neglect via teacher relationships and peer relationships was stronger than the indirect effect of parental abuse. This study is significant in that it identified that parental abuse/neglect was mediated by the teacher and peer relationship, thereby suggesting an implication for effective intervention with children who have suffered abuse and neglect. In terms of the teacher and peer relationship, understanding the influence of parental abuse and neglect on children's problems was discussed, and the limitations and recommendations for future study were suggested. Copyright © 2016 Elsevier Ltd. All rights reserved.

Changing concentration, lifetime and climate forcing of atmospheric methane

NASA Astrophysics Data System (ADS)

Lelieveld, Jos; Crutzen, Paul J.; Dentener, Frank J.

1998-04-01

Previous studies on ice core analyses and recent in situ measurements have shown that CH4 has increased from about 0.75 1.73μmol/mol during the past 150years. Here, we review sources and sink estimates and we present global 3D model calculations, showing that the main features of the global CH4 distribution are well represented. The model has been used to derive the total CH4 emission source, being about 600 Tg yr-1. Based on published results of isotope measurements the total contribution of fossil fuel related CH4 emissions has been estimated to be about 110 Tg yr-1. However, the individual coal, natural gas and oil associated CH4 emissions can not be accurately quantified. In particular natural gas and oil associated emissions remain speculative. Since the total anthropogenic CH4 source is about 410 Tg yr-1 (70% of the total source) and the mean recent atmospheric CH4 increase is 20 Tg yr-1 an anthropogenic source reduction of 5% could stabilize the atmospheric CH4 level. We have calculated the indirect chemical effects of increasing CH4 on climate forcing on the basis of global 3D chemistry-transport and radiative transfer calculations. These indicate an enhancement of the direct radiative effect by about 30%, in agreement with previous work. The contribution of CH4 (direct and indirect effects) to climate forcing during the past 150years is 0.57W m2 (direct 0.44W m2, indirect 0.13 W m2). This is about 35% of the climate forcing by CO2 (1.6W m2) and about 22% of the forcing by all long-lived greenhouse gases (2.6 W m2). Scenario calculations (IPCC-IS92a) indicate that the CH4 lifetime in the atmosphere increased by about 25 30%during the past 150years to a current value of 7.9years. Future lifetime changes are expected to be much smaller, about 6%, mostly due to the expected increase of tropospheric O3 (→OH) in the tropics. The global mean concentration of CH4 may increase to about 2.55μmol/mol, its lifetime is expected to increase to 8.4years in the year 2050. Further, we have calculated a CH4 global warming potential (GWP) of 21 (kgCH4/kgCO2) over a time horizon of 100years, in agreement with IPCC (1996). Scenario calculations indicate that the importance of the climate forcing by CH4 (including indirect effects) relative to that of CO2 will decrease in future; currently this is about 35%, while this is expected to decrease to about 15% in the year 2050.

Evaluation of patient compliance, quality of life impact and cost-effectiveness of a "test in-train out" exercise-based rehabilitation program for patients with intermittent claudication.

PubMed

Malagoni, Anna Maria; Vagnoni, Emidia; Felisatti, Michele; Mandini, Simona; Heidari, Mahdi; Mascoli, Francesco; Basaglia, Nino; Manfredini, Roberto; Zamboni, Paolo; Manfredini, Fabio

2011-01-01

Patients with intermittent claudication (IC) could benefit from low-cost, effective rehabilitative programs. This retrospective study evaluates compliance, impact on Quality of Life (QoL) and cost-effectiveness of a hospital prescribed, at-home performed (Test-in/Train-out) rehabilitative program for patients with IC. Two-hundred and eighty-nine patients with IC (71 ± 10.1 years, M = 210) were enrolled for a 2-year period. Two daily 10-min home walking sessions at maximal asymptomatic speed were prescribed, with serial check-ups at the hospital. Compliance with the program was assessed by assigning a score of 1 (lowest compliance) to 4 (highest compliance). The SF-36 questionnaire and a constant-load treadmill test were used to evaluate QoL and Initial/Absolute Claudication Distance, respectively. Both direct and indirect costs of the program were considered for cost-effectiveness analysis. Two-hundred and fifty patients (70.5 ± 9.2 years, M = 191), at Fontaine's II-B stage (86%), were included in the study. No adverse events were reported. The average compliance score was 3.1. At discharge, both SF-36 domains and walking performance significantly increased (P < 0.0001). A total of 1,839 in-hospital check-ups (7.36 /patient) were performed. Direct and indirect costs represented 93% and 7% of the total costs, respectively. The average costs of a visit and of a therapy cycle were C68.93 and C507.20, respectively. The cost to walk an additional meter before stopping was C9.22. A Test-in/Train-out program provided favourable patient compliance, QoL impact and cost-effectiveness in patients with IC.

Cost-utility analysis of minimally invasive versus open multilevel hemilaminectomy for lumbar stenosis.

PubMed

Parker, Scott L; Adogwa, Owoicho; Davis, Brandon J; Fulchiero, Erin; Aaronson, Oran; Cheng, Joseph; Devin, Clinton J; McGirt, Matthew J

2013-02-01

Two-year cost-utility study comparing minimally invasive (MIS) versus open multilevel hemilaminectomy in patients with degenerative lumbar spinal stenosis. The objective of the study was to determine whether MIS versus open multilevel hemilaminectomy for degenerative lumbar spinal stenosis is a cost-effective advancement in lumbar decompression surgery. MIS-multilevel hemilaminectomy for degenerative lumbar spinal stenosis allows for effective treatment of back and leg pain while theoretically minimizing blood loss, tissue injury, and postoperative recovery. No studies have evaluated comprehensive healthcare costs associated with multilevel hemilaminectomy procedures, nor assessed cost-effectiveness of MIS versus open multilevel hemilaminectomy. Fifty-four consecutive patients with lumbar stenosis undergoing multilevel hemilaminectomy through an MIS paramedian tubular approach (n=27) versus midline open approach (n=27) were included. Total back-related medical resource utilization, missed work, and health state values [quality adjusted life years (QALYs), calculated from EuroQuol-5D with US valuation] were assessed after 2-year follow-up. Two-year resource use was multiplied by unit costs based on Medicare national allowable payment amounts (direct cost) and work-day losses were multiplied by the self-reported gross-of-tax wage rate (indirect cost). Difference in mean total cost per QALY gained for MIS versus open hemilaminectomy was assessed as incremental cost-effectiveness ratio (ICER: COST(MIS)-COST(OPEN)/QALY(MIS)-QALY(OPEN)). MIS versus open cohorts were similar at baseline. MIS and open hemilaminectomy were associated with an equivalent cumulative gain of 0.72 QALYs 2 years after surgery. Mean direct medical costs, indirect societal costs, and total 2-year cost ($23,109 vs. $25,420; P=0.21) were similar between MIS and open hemilaminectomy. MIS versus open approach was associated with similar total costs and utility, making it a cost equivalent technology compared with the traditional open approach. MIS versus open multilevel hemilaminectomy was associated with similar cost over 2 years while providing equivalent improvement in QALYs. In our experience, MIS versus open multilevel hemilaminectomy is a cost equivalent technology for patients with lumbar stenosis-associated radicular pain.

Human health effects of ozone reduction

NASA Technical Reports Server (NTRS)

1975-01-01

Modification of the stratosphere, such as a reduction in its equilibrium ozone content, could produce direct and indirect effects on human health. The direct hazard to humans would be caused by an increase in the cumulative amount of UV radiation reaching the earth's surface in the range of 285 to 340 nm, encompassing the UV-B or erythemal wavelength region of 280 to 320 nm. Exposing the susceptible human population to an increased total UV dosage of shorter wavelengths could increase skin cancer incidence. Although effects would be delayed by decades, for each 1% decrease in ozone the expected increase in skin cancer incidence would be on the order of 2%.

Access to primary care for socio-economically disadvantaged older people in rural areas: exploring realist theory using structural equation modelling in a linked dataset.

PubMed

Ford, John A; Jones, Andy; Wong, Geoff; Clark, Allan; Porter, Tom; Steel, Nick

2018-06-19

Realist approaches seek to answer questions such as 'how?', 'why?', 'for whom?', 'in what circumstances?' and 'to what extent?' interventions 'work' using context-mechanism-outcome (CMO) configurations. Quantitative methods are not well-established in realist approaches, but structural equation modelling (SEM) may be useful to explore CMO configurations. Our aim was to assess the feasibility and appropriateness of SEM to explore CMO configurations and, if appropriate, make recommendations based on our access to primary care research. Our specific objectives were to map variables from two large population datasets to CMO configurations from our realist review looking at access to primary care, generate latent variables where needed, and use SEM to quantitatively test the CMO configurations. A linked dataset was created by merging individual patient data from the English Longitudinal Study of Ageing and practice data from the GP Patient Survey. Patients registered in rural practices and who were in the highest deprivation tertile were included. Three latent variables were defined using confirmatory factor analysis. SEM was used to explore the nine full CMOs. All models were estimated using robust maximum likelihoods and accounted for clustering at practice level. Ordinal variables were treated as continuous to ensure convergence. We successfully explored our CMO configurations, but analysis was limited because of data availability. Two hundred seventy-six participants were included. We found a statistically significant direct (context to outcome) or indirect effect (context to outcome via mechanism) for two of nine CMOs. The strongest association was between 'ease of getting through to the surgery' and 'being able to get an appointment' with an indirect mediated effect through convenience (proportion of the indirect effect of the total was 21%). Healthcare experience was not directly associated with getting an appointment, but there was a statistically significant indirect effect through convenience (53% mediated effect). Model fit indices showed adequate fit. SEM allowed quantification of CMO configurations and could complement other qualitative and quantitative techniques in realist evaluations to support inferences about strengths of relationships. Future research exploring CMO configurations with SEM should aim to collect, preferably continuous, primary data.

Cost of illness for outpatients attending public and private hospitals in Bangladesh.

PubMed

Pavel, Md Sadik; Chakrabarty, Sayan; Gow, Jeff

2016-10-10

A central aim of Universal Health Coverage (UHC) is protection for all against the cost of illness. In a low income country like Bangladesh the cost burden of health care in tertiary facilities is likely to be significant for most citizens. This cost of an episode of illness is a relatively unexplored policy issue in Bangladesh. The objective of this study was to estimate an outpatient's total cost of illness as result of treatment in private and public hospitals in Sylhet, Bangladesh. The study used face to face interviews at three hospitals (one public and two private) to elicit cost data from presenting outpatients. Other socio-economic and demographic data was also collected. A sample of 252 outpatients were randomly selected and interviewed. The total cost of outpatients comprises direct medical costs, non-medical costs and the indirect costs of patients and caregivers. Indirect costs comprise travel and waiting times and income losses associated with treatment. The costs of illness are significant for many of Bangladesh citizens. The direct costs are relatively minor compared to the large indirect cost burden that illness places on households. These indirect costs are mainly the result of time off work and foregone wages. Private hospital patients have higher average direct costs than public hospital patients. However, average indirect costs are higher for public hospital patients than private hospital patients by a factor of almost two. Total costs of outpatients are higher in public hospitals compared to private hospitals regardless of patient's income, gender, age or illness. Overall, public hospital patients, who tend to be the poorest, bear a larger economic burden of illness and treatment than relatively wealthier private hospital patients. The large economic impacts of illness need a public policy response which at a minimum should include a national health insurance scheme as a matter of urgency.

The direct and indirect costs of managing chronic obstructive pulmonary disease in Greece.

PubMed

Souliotis, Kyriakos; Kousoulakou, Hara; Hillas, Georgios; Tzanakis, Nikos; Toumbis, Michalis; Vassilakopoulos, Theodoros

2017-01-01

COPD is associated with significant economic burden. The objective of this study was to explore the direct and indirect costs associated with COPD and identify the key cost drivers of disease management in Greece. A Delphi panel of Greek pulmonologists was conducted, which aimed at eliciting local COPD treatment patterns and resource use. Resource use was translated into costs using official health insurance tariffs and Diagnosis-Related Groups (DRGs). In addition, absenteeism and caregiver's costs were recorded in order to quantify indirect COPD costs. The total costs of managing COPD per patient per year were estimated at €4,730, with direct (medical and nonmedical) and indirect costs accounting for 62.5% and 37.5%, respectively. COPD exacerbations were responsible for 32% of total costs (€1,512). Key exacerbation-related cost drivers were hospitalization (€830) and intensive care unit (ICU) admission costs (€454), jointly accounting for 85% of total exacerbation costs. Annual maintenance phase costs were estimated at €835, with pharmaceutical treatment accounting for 77% (€639.9). Patient time costs were estimated at €146 per year. The average number of sick days per year was estimated at 16.9, resulting in productivity losses of €968. Caregiver's costs were estimated at €806 per year. The management of COPD in Greece is associated with intensive resource use and significant economic burden. Exacerbations and productivity losses are the key cost drivers. Cost containment policies should focus on prioritizing treatments that increase patient compliance as these can lead to reduction of exacerbations, longer maintenance phases, and thus lower costs.

Trends in resource utilization and prescription of anticonvulsants for patients with active epilepsy in Germany.

PubMed

Strzelczyk, Adam; Haag, Anja; Reese, Jens P; Nickolay, Tanja; Oertel, Wolfgang H; Dodel, Richard; Knake, Susanne; Rosenow, Felix; Hamer, Hajo M

2013-06-01

This study evaluated trends in the resource use of patients with active epilepsy over a 5-year period at an outpatient clinic of a German epilepsy center. Two cross-sectional cohorts of consecutive adults with active epilepsy were evaluated over a 3-month period in 2003 and 2008. Data on socioeconomic status, course of epilepsy, as well as direct and indirect costs were recorded using validated patient questionnaires. We enrolled 101 patients in 2003 and 151 patients in 2008. In both cohorts, 76% of the patients suffered from focal epilepsy, and the majority was on antiepileptic drug (AED) polytherapy (mean AED number: 1.7 (2003), 1.8 (2008)). We calculated epilepsy-specific costs of € 2955 in 2003 and € 3532 in 2008 per 3 months per patient. Direct medical costs were mainly due to anticonvulsants in 2003 (59.4% of total direct costs, 34.0% in 2008) and to hospitalization in 2008 (46.9% of total direct costs, 27.7% in 2003). The proportion of enzyme-inducing anticonvulsants and 'old' AEDs decreased between 2003 and 2008. Indirect costs of € 1689 and € 1847 were mainly due to early retirement (48.4%; 46.0% of total indirect costs in 2003; 2008), unemployment (26.1%; 24.2%), and days off due to seizures (25.5%; 29.8%). This study showed a shift in distribution of direct cost components with increased hospital costs as well as a cost-neutral increase in the prescription of 'newer' AEDs. The amount and distribution of indirect cost components remained unchanged. Copyright © 2013 Elsevier Inc. All rights reserved.

Projection of Diabetes Population Size and Associated Economic Burden through 2030 in Iran: Evidence from Micro-Simulation Markov Model and Bayesian Meta-Analysis

PubMed Central

Javanbakht, Mehdi; Mashayekhi, Atefeh; Baradaran, Hamid R.; Haghdoost, AliAkbar; Afshin, Ashkan

2015-01-01

Background The aim of this study was to estimate the economic burden of diabetes mellitus (DM) in Iran from 2009 to 2030. Methods A Markov micro-simulation (MM) model was developed to predict the DM population size and associated economic burden. Age- and sex-specific prevalence and incidence of diagnosed and undiagnosed DM were derived from national health surveys. A systematic review was performed to identify the cost of diabetes in Iran and the mean annual direct and indirect costs of patients with DM were estimated using a random-effect Bayesian meta-analysis. Face, internal, cross and predictive validity of the MM model were assessed by consulting an expert group, performing sensitivity analysis (SA) and comparing model results with published literature and national survey reports. Sensitivity analysis was also performed to explore the effect of uncertainty in the model. Results We estimated 3.78 million cases of DM (2.74 million diagnosed and 1.04 million undiagnosed) in Iran in 2009. This number is expected to rise to 9.24 million cases (6.73 million diagnosed and 2.50 million undiagnosed) by 2030. The mean annual direct and indirect costs of patients with DM in 2009 were US$ 556 (posterior standard deviation, 221) and US$ 689 (619), respectively. Total estimated annual cost of DM was $3.64 (2009 US$) billion (including US$1.71 billion direct and US$1.93 billion indirect costs) in 2009 and is predicted to increase to $9.0 (in 2009 US$) billion (including US$4.2 billion direct and US$4.8 billion indirect costs) by 2030. Conclusions The economic burden of DM in Iran is predicted to increase markedly in the coming decades. Identification and implementation of effective strategies to prevent and manage DM should be considered as a public health priority. PMID:26200913

Projection of Diabetes Population Size and Associated Economic Burden through 2030 in Iran: Evidence from Micro-Simulation Markov Model and Bayesian Meta-Analysis.

PubMed

Javanbakht, Mehdi; Mashayekhi, Atefeh; Baradaran, Hamid R; Haghdoost, AliAkbar; Afshin, Ashkan

2015-01-01

The aim of this study was to estimate the economic burden of diabetes mellitus (DM) in Iran from 2009 to 2030. A Markov micro-simulation (MM) model was developed to predict the DM population size and associated economic burden. Age- and sex-specific prevalence and incidence of diagnosed and undiagnosed DM were derived from national health surveys. A systematic review was performed to identify the cost of diabetes in Iran and the mean annual direct and indirect costs of patients with DM were estimated using a random-effect Bayesian meta-analysis. Face, internal, cross and predictive validity of the MM model were assessed by consulting an expert group, performing sensitivity analysis (SA) and comparing model results with published literature and national survey reports. Sensitivity analysis was also performed to explore the effect of uncertainty in the model. We estimated 3.78 million cases of DM (2.74 million diagnosed and 1.04 million undiagnosed) in Iran in 2009. This number is expected to rise to 9.24 million cases (6.73 million diagnosed and 2.50 million undiagnosed) by 2030. The mean annual direct and indirect costs of patients with DM in 2009 were US$ 556 (posterior standard deviation, 221) and US$ 689 (619), respectively. Total estimated annual cost of DM was $3.64 (2009 US$) billion (including US$1.71 billion direct and US$1.93 billion indirect costs) in 2009 and is predicted to increase to $9.0 (in 2009 US$) billion (including US$4.2 billion direct and US$4.8 billion indirect costs) by 2030. The economic burden of DM in Iran is predicted to increase markedly in the coming decades. Identification and implementation of effective strategies to prevent and manage DM should be considered as a public health priority.

Fuel-Burning Technology Alternatives for the Army.

DTIC Science & Technology

1985-01-01

control 0.85 2,287,000 Flue gas desulfurization 0.68 3,410,000 Total 12,478,000 *Capital cost estimate...34......... . . Particulate and sulfur dioxide control are needed. A baghouse and flue gas desulfurization (FD) scrubber system must be installed. Each item’s cost in...direct cost) Contingency (20% of 1,253,000 direct and indirect costs) Subtotal 7,518,000 Particulate control 1,342,000 Flue gas desulfurization

Lost productivity due to premature mortality in developed and emerging countries: an application to smoking cessation.

PubMed

Menzin, Joseph; Marton, Jeno P; Menzin, Jordan A; Willke, Richard J; Woodward, Rebecca M; Federico, Victoria

2012-06-25

Researchers and policy makers have determined that accounting for productivity costs, or "indirect costs," may be as important as including direct medical expenditures when evaluating the societal value of health interventions. These costs are also important when estimating the global burden of disease. The estimation of indirect costs is commonly done on a country-specific basis. However, there are few studies that evaluate indirect costs across countries using a consistent methodology. Using the human capital approach, we developed a model that estimates productivity costs as the present value of lifetime earnings (PVLE) lost due to premature mortality. Applying this methodology, the model estimates productivity costs for 29 selected countries, both developed and emerging. We also provide an illustration of how the inclusion of productivity costs contributes to an analysis of the societal burden of smoking. A sensitivity analysis is undertaken to assess productivity costs on the basis of the friction cost approach. PVLE estimates were higher for certain subpopulations, such as men, younger people, and people in developed countries. In the case study, productivity cost estimates from our model showed that productivity loss was a substantial share of the total cost burden of premature mortality due to smoking, accounting for over 75 % of total lifetime costs in the United States and 67 % of total lifetime costs in Brazil. Productivity costs were much lower using the friction cost approach among those of working age. Our PVLE model is a novel tool allowing researchers to incorporate the value of lost productivity due to premature mortality into economic analyses of treatments for diseases or health interventions. We provide PVLE estimates for a number of emerging and developed countries. Including productivity costs in a health economics study allows for a more comprehensive analysis, and, as demonstrated by our illustration, can have important effects on the results and conclusions.

Lost productivity due to premature mortality in developed and emerging countries: an application to smoking cessation

PubMed Central

2012-01-01

Background Researchers and policy makers have determined that accounting for productivity costs, or “indirect costs,” may be as important as including direct medical expenditures when evaluating the societal value of health interventions. These costs are also important when estimating the global burden of disease. The estimation of indirect costs is commonly done on a country-specific basis. However, there are few studies that evaluate indirect costs across countries using a consistent methodology. Methods Using the human capital approach, we developed a model that estimates productivity costs as the present value of lifetime earnings (PVLE) lost due to premature mortality. Applying this methodology, the model estimates productivity costs for 29 selected countries, both developed and emerging. We also provide an illustration of how the inclusion of productivity costs contributes to an analysis of the societal burden of smoking. A sensitivity analysis is undertaken to assess productivity costs on the basis of the friction cost approach. Results PVLE estimates were higher for certain subpopulations, such as men, younger people, and people in developed countries. In the case study, productivity cost estimates from our model showed that productivity loss was a substantial share of the total cost burden of premature mortality due to smoking, accounting for over 75 % of total lifetime costs in the United States and 67 % of total lifetime costs in Brazil. Productivity costs were much lower using the friction cost approach among those of working age. Conclusions Our PVLE model is a novel tool allowing researchers to incorporate the value of lost productivity due to premature mortality into economic analyses of treatments for diseases or health interventions. We provide PVLE estimates for a number of emerging and developed countries. Including productivity costs in a health economics study allows for a more comprehensive analysis, and, as demonstrated by our illustration, can have important effects on the results and conclusions. PMID:22731620

Indirect effects of an invasive annual grass on seed fates of two native perennial grass species

Treesearch

Susan E. Meyer; Katherine T. Merrill; Phil S. Allen; Julie Beckstead; Anna S. Norte

2014-01-01

Invasive plants exhibit both direct and indirect negative effects on recruitment of natives following invasion. We examined indirect effects of the invader Bromus tectorum (cheatgrass) on seed fates of two native grass species, Elymus elymoides and Pseudoroegneria spicata, by removing B. tectorum and by adding inoculum of the shared seed pathogen Pyrenophora...

Indirect aerosol effect increases CMIP5 models projected Arctic warming

DOE PAGES

Chylek, Petr; Vogelsang, Timothy J.; Klett, James D.; ...

2016-02-20

Phase 5 of the Coupled Model Intercomparison Project (CMIP5) climate models’ projections of the 2014–2100 Arctic warming under radiative forcing from representative concentration pathway 4.5 (RCP4.5) vary from 0.9° to 6.7°C. Climate models with or without a full indirect aerosol effect are both equally successful in reproducing the observed (1900–2014) Arctic warming and its trends. However, the 2014–2100 Arctic warming and the warming trends projected by models that include a full indirect aerosol effect (denoted here as AA models) are significantly higher (mean projected Arctic warming is about 1.5°C higher) than those projected by models without a full indirect aerosolmore » effect (denoted here as NAA models). The suggestion is that, within models including full indirect aerosol effects, those projecting stronger future changes are not necessarily distinguishable historically because any stronger past warming may have been partially offset by stronger historical aerosol cooling. In conclusion, the CMIP5 models that include a full indirect aerosol effect follow an inverse radiative forcing to equilibrium climate sensitivity relationship, while models without it do not.« less

Indirect aerosol effect increases CMIP5 models projected Arctic warming

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

Chylek, Petr; Vogelsang, Timothy J.; Klett, James D.

Phase 5 of the Coupled Model Intercomparison Project (CMIP5) climate models’ projections of the 2014–2100 Arctic warming under radiative forcing from representative concentration pathway 4.5 (RCP4.5) vary from 0.9° to 6.7°C. Climate models with or without a full indirect aerosol effect are both equally successful in reproducing the observed (1900–2014) Arctic warming and its trends. However, the 2014–2100 Arctic warming and the warming trends projected by models that include a full indirect aerosol effect (denoted here as AA models) are significantly higher (mean projected Arctic warming is about 1.5°C higher) than those projected by models without a full indirect aerosolmore » effect (denoted here as NAA models). The suggestion is that, within models including full indirect aerosol effects, those projecting stronger future changes are not necessarily distinguishable historically because any stronger past warming may have been partially offset by stronger historical aerosol cooling. In conclusion, the CMIP5 models that include a full indirect aerosol effect follow an inverse radiative forcing to equilibrium climate sensitivity relationship, while models without it do not.« less

Comparative evaluation of effects of bleaching on color stability and marginal adaptation of discolored direct and indirect composite laminate veneers under in vivo conditions.

PubMed

Jain, Veena; Das, Taposh K; Pruthi, Gunjan; Shah, Naseem; Rajendiran, Suresh

2015-01-01

Change in color and loss of marginal adaptation of tooth colored restorative materials is not acceptable. Bleaching is commonly used for treating discolored teeth. However, the literature is scanty regarding its effect on color and marginal adaptation of direct and indirect composite laminate veneers (CLVs) under in vivo conditions. Purpose of the study was to determine the effect of bleaching on color change and marginal adaptation of direct and indirect CLVs over a period of time when exposed to the oral environment. For this purpose, a total of 14 subjects irrespective of age and sex indicated for CLV restorations on maxillary anterior teeth were selected following the inclusion and exclusion criteria. For each subject, indirect CLVs were fabricated and looted in the first quadrant (Group 1) and direct CLV's (Group 2), were given in the second quadrant. Color change was assessed clinically using intra-oral digital spectrophotometer and marginal adaptation was assessed on epoxy resin replica of the tooth-restoration interface under scanning electron microscope. After 6 months, the subjects underwent a home bleaching regimen for 14 days using 10% carbamide peroxide. The assessment of color change and marginal adaptation was done at 6 months after veneering (0-180 days), immediately after the bleaching regimen (0-194 days) and 3 months after the bleaching regimen (0-284 days). The difference in median color change (ΔE) between the groups was tested using Wilcoxon rank sum test while the median color change with time within the groups was tested using Wilcoxon signed rank test. The difference in the rates of marginal adaptation was tested between the groups using Chi-square/Fisher's exact test. Bleaching led to statistically significant color change at cervical (CE), middle and incisal (IE) regions when direct and indirect composites were compared (P < 0.05). During intra-group comparison, direct CLV's showed significant color change at CE and IE regions when ΔE was compared at 180 days and 284 days (CE 10 vs. CE 30, P = 0.008, IE 10 vs. IE 30, P = 0.003). No significant differences were found when within group comparison was made for indirect laminates. Intergroup comparison between the groups showed significant difference in marginal adaptation at CE margin at all.time points (at baseline, P = 0.005; at 180 days, P = 0.007; 194 days, P = 0.025; at 284 days, P = 0.067). After bleaching, indirect CLVs performed better in terms of color stability whereas direct CLVs performed better in terms of marginal adaptation. Indirect composites should be preferred to direct composites as veneering materials as they have better color stability. Special attention should be given to their marginal adaptation especially in the CE region. Bleaching should be avoided in patients with composite restorations in the mouth.

"I sleep better at night:" How peer review of radiation treatment plans indirectly improves quality of care across radiation treatment programs.

PubMed

Brundage, Michael D; Hart, Margaret; O'Donnell, Jennifer; Reddeman, Lindsay; Gutierrez, Eric; Foxcroft, Sophie; Warde, Padraig

Peer review of radiation oncology treatment plans is increasingly recognized as an important component of quality assurance in radiation treatment planning and delivery. Peer review of treatment plans can directly improve the quality of those plans and can also have indirect effects on radiation treatment programs. We undertook a systematic, qualitative approach to describing the indirect benefits of peer review, factors that were seen to facilitate or act as barriers to the implementation of peer review, and strategies to address these barriers across a provincial jurisdiction of radiation oncology programs (ROPs). Semistructured qualitative interviews were held with radiation oncology department heads and radiation therapy managers (or delegates) in all 14 ROPs in Ontario, Canada. We used a theoretically guided phenomenological qualitative approach to design and analyze the interview content. Themes were recorded by 2 independent reviewers, and any discordance was resolved by consensus. A total of 28 interviews were completed with 32 interviewees. Twenty-two unique themes addressed perceived benefits of peer review, relating to either peer review structure (n = 3), process (n = 9), or outcome (n = 10). Of these 22 themes, 19 related to indirect benefits to ROPs. In addition, 18 themes related to factors that facilitated peer review activities and 30 themes related to key barriers to implementing peer review were identified. Findings were consistent with, and enhanced the understanding of, previous survey-based assessments of the benefits and challenges of implementing peer review programs. Although challenges and concerns regarding the implementation of peer review were evident, the indirect benefits to radiation programs are numerous, far outweigh the implementation challenges, and strongly complement the direct individual-patient benefits that result from peer review quality assurance of radiation treatment plans. Copyright © 2016. Published by Elsevier Inc.

Direct and indirect medical costs incurred by Canadian patients with rheumatoid arthritis: a 12 year study.

PubMed

Clarke, A E; Zowall, H; Levinton, C; Assimakopoulos, H; Sibley, J T; Haga, M; Shiroky, J; Neville, C; Lubeck, D P; Grover, S A; Esdaile, J M

1997-06-01

To perform the first prospective longitudinal study of direct (health services utilized) and indirect costs (diminished productivity represented by income loss) incurred by patients with rheumatoid arthritis (RA) in Saskatoon and Montreal, followed for up to 12 and 4 years, respectively. 1063 patients reported on health status, health services utilization, and diminished productivity every 6 months. Annual direct costs were $3788 (1994 Canadian dollars) in the late 1980s and $4656 in the early 1990s. Given that the average age exceeded 60 years, few participated in labor force activities or considered themselves disabled from the labor force and their indirect costs were substantially less, $2165 in the late 1980s and $1597 in the early 1990s. Institutional stays and medications made up at least 80% of total direct costs. Lengths of stay in acute care facilities remained constant, but the rate of hospitalization increased in the early 1990s, increasing average hospital costs per patient from $1563 in the late 1980s to $2023 in the early 1990s. For nonacute care facilities, rate of admission as well as length of stay increased over time, increasing costs per patient in Saskatoon 5-fold, from $291 to $1605. Those with greater functional disability incurred substantially higher direct and those under 65 years incurred higher indirect costs. Direct costs are higher than indirect costs. The major component is due to institutional stays that, in contrast to other direct cost components, is increased in the older and more disabled. Measures to reduce longterm disability by earlier, more aggressive intervention have the potential to produce considerable cost savings. However, it is unknown which strategies will have the greatest effect on outcome and accordingly, how resources can be optimally allocated.

Household illness, poverty and physical and emotional child abuse victimisation: findings from South Africa's first prospective cohort study.

PubMed

Meinck, Franziska; Cluver, Lucie D; Boyes, Mark E

2015-05-01

Physical and emotional abuse of children is a large scale problem in South Africa, with severe negative outcomes for survivors. Although chronic household illness has shown to be a predictor for physical and emotional abuse, no research has thus far investigated the different pathways from household chronic illness to child abuse victimisation in South Africa. Confidential self-report questionnaires using internationally utilised measures were completed by children aged 10-17 (n = 3515, 56.7% female) using door-to-door sampling in randomly selected areas in rural and urban locations of South Africa. Follow-up surveys were conducted a year later (96.7% retention rate). Using multiple mediation analyses, this study investigated direct and indirect effects of chronic household illness (AIDS or other illness) on frequent (monthly) physical and emotional abuse victimisation with poverty and extent of the ill person's disability as hypothesised mediators. For children in AIDS-ill families, a positive direct effect on physical abuse was obtained. In addition, positive indirect effects through poverty and disability were established. For boys, a positive direct and indirect effect of AIDS-illness on emotional abuse through poverty were detected. For girls, a positive indirect effect through poverty was observed. For children in households with other chronic illness, a negative indirect effect on physical abuse was obtained. In addition, a negative indirect effect through poverty and positive indirect effect through disability was established. For boys, positive and negative indirect effects through poverty and disability were found respectively. For girls, a negative indirect effect through poverty was observed. These results indicate that children in families affected by AIDS-illness are at higher risk of child abuse victimisation, and this risk is mediated by higher levels of poverty and disability. Children affected by other chronic illness are at lower risk for abuse victimisation unless they are subject to higher levels of household disability. Interventions aiming to reduce poverty and increase family support may help prevent child abuse in families experiencing illness in South Africa.

Cost of stroke in Australia from a societal perspective: results from the North East Melbourne Stroke Incidence Study (NEMESIS).

PubMed

Dewey, H M; Thrift, A G; Mihalopoulos, C; Carter, R; Macdonell, R A; McNeil, J J; Donnan, G A

2001-10-01

Accurate information about resource use and costs of stroke is necessary for informed health service planning. The purpose of this study was to determine the patterns of resource use among stroke patients and to estimate the total costs (direct service use and indirect production losses) of stroke (excluding SAH) in Australia for 1997. An incidence-based cost-of-illness model was developed, incorporating data obtained from the North East Melbourne Stroke Incidence Study (NEMESIS). The costs of stroke during the first year after stroke and the present value of total lifetime costs of stroke were estimated. The total first-year costs of all first-ever-in-a lifetime strokes (SAH excluded) that occurred in Australia during 1997 were estimated to be A$555 million (US$420 million), and the present value of lifetime costs was estimated to be A$1.3 billion (US$985 million). The average cost per case during the first 12 months and over a lifetime was A$18 956 (US$14 361) and A$44 428 (US$33 658), respectively. The most important categories of cost during the first year were acute hospitalization (A$154 million), inpatient rehabilitation (A$150 million), and nursing home care (A$63 million). The present value of lifetime indirect costs was estimated to be A$34 million. Similar to other studies, hospital and nursing home costs contributed most to the total cost of stroke (excluding SAH) in Australia. Inpatient rehabilitation accounts for approximately 27% of total first-year costs. Given the magnitude of these costs, investigation of the cost-effectiveness of rehabilitation services should become a priority in this community.

Simulated effects of proposed Arkansas Valley Conduit on hydrodynamics and water quality for projected demands through 2070, Pueblo Reservoir, southeastern Colorado

USGS Publications Warehouse

Ortiz, Roderick F.

2013-01-01

The purpose of the Arkansas Valley Conduit (AVC) is to deliver water for municipal and industrial use within the boundaries of the Southeastern Colorado Water Conservancy District. Water supplied through the AVC would serve two needs: (1) to supplement or replace existing poor-quality water to communities downstream from Pueblo Reservoir; and (2) to meet a portion of the AVC participants’ projected water demands through 2070. The Bureau of Reclamation (Reclamation) initiated an Environmental Impact Statement (EIS) to address the potential environmental consequences associated with constructing and operating the proposed AVC, entering into a conveyance contract for the Pueblo Dam north-south outlet works interconnect (Interconnect), and entering into a long-term excess capacity master contract (Master Contract). Operational changes, as a result of implementation of proposed EIS alternatives, could change the hydrodynamics and water-quality conditions in Pueblo Reservoir. An interagency agreement was initiated between Reclamation and the U.S. Geological Survey to accurately simulate hydrodynamics and water quality in Pueblo Reservoir for projected demands associated with four of the seven proposed EIS alternatives. The four alternatives submitted to the USGS for scenario simulation included various combinations (action or no action) of the proposed Arkansas Valley Conduit, Master Contract, and Interconnect options. The four alternatives were the No Action, Comanche South, Joint Use Pipeline North, and Master Contract Only. Additionally, scenario simulations were done that represented existing conditions (Existing Conditions scenario) in Pueblo Reservoir. Water-surface elevations, water temperature, dissolved oxygen, dissolved solids, dissolved ammonia, dissolved nitrate, total phosphorus, total iron, and algal biomass (measured as chlorophyll-a) were simulated. Each of the scenarios was simulated for three contiguous water years representing a wet, average, and dry annual hydrologic cycle. Each selected simulation scenario also was evaluated for differences in direct/indirect effects and cumulative effects on a particular scenario. Analysis of the results for the direct/indirect- and cumulative-effects analyses indicated that, in general, the results were similar for most of the scenarios and comparisons in this report focused on results from the direct/indirect-effects analyses. Scenario simulations that represented existing conditions in Pueblo Reservoir were compared to the No Action scenario to assess changes in water quality from current demands (2006) to projected demands in 2070. Overall, comparisons of the results between the Existing Conditions and the No Action scenarios for water-surface elevations, water temperature, and dissolved oxygen, dissolved solids, dissolved ammonia, dissolved nitrate, total phosphorus, and total iron concentrations indicated that the annual median values generally were similar for all three simulated years. Additionally, algal groups and chlorophyll-a concentrations (algal biomass) were similar for the Existing Conditions and the No Action scenarios at site 7B in the epilimnion for the simulated period (Water Year 2000 through 2002). The No Action scenario also was compared individually to the Comanche South, Joint Use Pipeline North, and Master Contract Only scenarios. These comparisons were made to describe changes in the annual median, 85th percentile, or 15th percentile concentration between the No Action scenario and each of the other three simulation scenarios. Simulated water-surface elevations, water temperature, dissolved oxygen, dissolved solids, dissolved ammonia, dissolved nitrate, total phosphorus, total iron, algal groups, and chlorophyll-a concentrations in Pueblo Reservoir generally were similar between the No Action scenario and each of the other three simulation scenarios.

A global portrait of the manganese industry-A socioeconomic perspective.

PubMed

Clarke, Carl; Upson, Sophie

2017-01-01

In 2013/14, Risk & Policy Analysts Ltd undertook the first global study on the socio-economic value of Manganese (Mn). Based on a top-down analysis of the key supply chains for Mn, it outlined the economic importance of Mn ore and alloys in terms of their direct and indirect economic value, as well as their effects on employment (jobs and wages). In 2013, global production of Mn ore was worth an estimated US$ 10.2-11.1 billion. Taking into account multiplier effects in the supply chain, the total economic value of Mn ore production globally in 2013 is estimated at US$ 21-23 billion. Direct employment related to Mn ore production is estimated at 44,000-78,000 people worldwide (with total wages estimated at US$ 2.7-4.6 billion per year), plus 33,000-59,000 jobs are created through indirect and induced employment effects. Meanwhile, the production of Mn alloy contributes around US$ 23 billion per year to the global economy (based on global production of around 19 million mt and 2013 market prices). In total, the value of Mn alloy production worldwide, taking into account downstream multiplier effects in the supply chain, is estimated at around US$ 146 billion per year. Direct employment related to Mn alloy production is estimated at 67,000-86,000 jobs worldwide (with total wages estimated at US$ 613-796 million per year), plus 217,000-278,000 jobs created through indirect & induced employment effects. In addition, numerous industries/sectors, products and/or applications are heavily dependent on Mn production and use. Mn is a critical raw material input and alloying element for the steel industry, for which there are no known alternatives. It can be argued that without Mn the entire steel industry (based on the current physico-chemical properties of steel) would not exist and, as a result, the value of the steel industry - an estimated US$ 964 billion to US$ 1446 billion in 2013 - is reliant on the continued supply and use of Mn. Besides its use in steel, Mn is also a critical element in the manufacture of dry cell and other batteries (notably, those used in electric vehicles) and the production of aluminium alloys (e.g. for beverage cans). Mn is also a micronutrient needed for plant growth and plays a vital role in agricultural production. It is also essential for maintaining the health and well-being of the human body and is used in food supplements and medicines. Furthermore, its use in developing applications (such as advanced steel products in automotive applications and batteries for electric vehicles) has the potential to provide socio-economic and environmental benefits in the future through enhancing vehicle safety and reducing fuel use/emissions. Copyright © 2016 Elsevier B.V. All rights reserved.

The Effects of Direct and Indirect Speech Acts on Native English and ESL Speakers' Perception of Teacher Written Feedback

ERIC Educational Resources Information Center

Baker, Wendy; Hansen Bricker, Rachel

2010-01-01

This study explores how second language (L2) learners perceive indirect (hedging or indirect speech acts) and direct written teacher feedback. Though research suggests that indirect speech acts may be more difficult to interpret than direct speech acts ([Champagne, 2001] and [Holtgraves, 1999]), using indirect speech acts is often encouraged in…

The COMMAND trial of cognitive therapy to prevent harmful compliance with command hallucinations: predictors of outcome and mediators of change.

PubMed

Birchwood, Max; Dunn, Graham; Meaden, Alan; Tarrier, Nicholas; Lewis, Shon; Wykes, Til; Davies, Linda; Michail, Maria; Peters, Emmanuelle

2017-12-05

Acting on harmful command hallucinations is a major clinical concern. Our COMMAND CBT trial approximately halved the rate of harmful compliance (OR = 0.45, 95% CI 0.23-0.88, p = 0.021). The focus of the therapy was a single mechanism, the power dimension of voice appraisal, was also significantly reduced. We hypothesised that voice power differential (between voice and voice hearer) was the mediator of the treatment effect. The trial sample (n = 197) was used. A logistic regression model predicting 18-month compliance was used to identify predictors, and an exploratory principal component analysis (PCA) of baseline variables used as potential predictors (confounders) in their own right. Stata's paramed command used to obtain estimates of the direct, indirect and total effects of treatment. Voice omnipotence was the best predictor although the PCA identified a highly predictive cognitive-affective dimension comprising: voices' power, childhood trauma, depression and self-harm. In the mediation analysis, the indirect effect of treatment was fully explained by its effect on the hypothesised mediator: voice power differential. Voice power and treatment allocation were the best predictors of harmful compliance up to 18 months; post-treatment, voice power differential measured at nine months was the mediator of the effect of treatment on compliance at 18 months.

Developing and Testing a Robust, Multi-Scale Framework for the Recovery of Longleaf Pine Understory Communities

DTIC Science & Technology

2015-05-01

Model averaging for species richness on post-agricultural sites (1000 m2) with a landscape radius of 150 m. Table 3.4.8. Model selection for species ... richness on post-agricultural sites (1000 m2) with a landscape radius of 150 m. Table 3.4.9. Model averaging for proportion of reference species on...Direct, indirect, and total standardized effects on species richness . Table 4.1.1. Species and number of seeds added to the experimental plots at

Why CMV is a candidate for elimination and then eradication.

PubMed

Griffiths, Paul D; Mahungu, Tabitha

2016-07-01

Cytomegalovirus (CMV) is well-known for the end organ diseases (EODs) it causes following viraemic dissemination in immunocompromised hosts. These are termed the direct effects of CMV, where a diagnosis can be made in an individual patient. In addition, CMV is associated with indirect effects where populations can be seen to be disadvantaged compared to those without CMV. These indirect effects have been described in solid organ transplants, bone marrow transplants, advanced HIV, people admitted to intensive care units, the elderly and the general population. We summarise the evidence that associates CMV with its direct effects following congenital infection, solid organ transplantation, bone marrow transplantation and advanced HIV as well as its indirect effects in all patient populations. We propose that the greatest worldwide burden of CMV comes from its indirect effects. Control of this infection at the population level is being sought through the development of vaccines to control EODs where cost effectiveness is expected. We propose that the financial case for universal immunisation will be enhanced even further by the potential benefits vaccines may produce against the indirect effects of CMV.

Methodological evaluation of indirect calorimetry data in lean and obese rats.

PubMed

Rafecas, I; Esteve, M; Fernández-López, J A; Remesar, X; Alemany, M

1993-11-01

1. The applicability of current indirect calorimetry formulae to the study of energy and substrate balances on obese rats has been evaluated. The energy consumption of series of 60-day rats of Wistar, lean and obese Zucker stock were studied by means of direct and indirect calorimetry, and by establishing their energy balance through measurement of food intake and retention. Calorimetric studies encompassed a 24 h period, with gas and heat output measurements every 2 or 5 min, respectively, for direct and indirect calorimetry. 2. The analysis of fat composition (diet, whole rat, and synthesized and oxidized fat) showed only small variations that had only a limited effect on the overall energy equation parameters. 3. A gap in the nitrogen balance, which represents a urinary N excretion lower than the actual protein oxidized, resulted in significant deviations in the estimation of carbohydrate and lipid oxidized when using the equations currently available for indirect calorimetry. 4. Analysis of the amino acid composition of diet and rat protein as well as of the portion actually oxidized, and correcting for the nitrogen gap allowed the establishment of a set of equations that gave better coincidence of the calculated data with the measured substrate balance. 5. The measured heat output of all rats was lower than the estimated values calculated by means of either indirect calorimetry of direct energy balance measurement; the difference corresponded to the energy lost in water evaporation, and was in the range of one-fifth of total energy produced in the three rat stocks. 6. Wistar rats showed a biphasic circadian rhythm of substrate utilization, with alternate lipid synthesis/degradation that reversed that of carbohydrate, concordant with nocturnal feeding habits. Zucker rats did not show this rhythm; obese rats synthesized large amounts of fat during most of the light period, consuming fat at the end of the dark period, which suggests more diurnal feeding habits. Lean Zucker rats showed a similar, but less marked pattern. 7. The results obtained indicate that lean and obese rats can be studied using the same indirect calorimetry formulae provided that there is an adequate measure of protein oxidation and the composition of diet does not differ.

Long-term Bond Strength between Layering Indirect Composite Material and Zirconia Coated with Silicabased Ceramics.

PubMed

Fushiki, Ryosuke; Komine, Futoshi; Honda, Junichi; Kamio, Shingo; Blatz, Markus B; Matsumura, Hideo

2015-06-01

This study evaluated the long-term shear bond strength between an indirect composite material and a zirconia framework coated with silica-based ceramics, taking the effect of different primers into account. A total of 165 airborne-particle abraded zirconia disks were subjected to one of three pretreatments: no pretreatment (ZR-AB), airborne-particle abrasion of zirconia coated with feldspathic porcelain (ZR-PO-AB), and 9.5% hydrofluoric acid etching of zirconia coated with feldspathic porcelain (ZR-PO-HF). An indirect composite material (Estenia C&B) was then bonded to the zirconia disks after they were treated with one of the following primers: Clearfil Photo Bond (CPB), Clearfil Photo Bond with Clearfil Porcelain Bond Activator (CPB + Activator), Estenia Opaque Primer (EOP), Porcelain Liner M Liquid B (PLB), or no priming (CON, control group). Shear bond strength was tested after 100,000 thermocycles, and the data were analyzed using the Steel-Dwass U-test (α = 0.05). For ZR-PO-AB and ZR-PO-HF specimens, bond strength was highest in the CPB+Activator group (25.8 MPa and 22.4 MPa, respectively). Bond strengths were significantly lower for ZR-AB specimens in the CON and PLB groups and for ZR-PO-AB specimens in the CON, CPB, and EOP groups. Combined application of a hydrophobic phosphate monomer (MDP) and silane coupling agent enhanced the long-term bond strength of indirect composite material to a zirconia coated with silica-based ceramics.

Evaluating Cardiovascular Health Disparities Using Estimated Race/Ethnicity: A Validation Study.

PubMed

Bykov, Katsiaryna; Franklin, Jessica M; Toscano, Michele; Rawlins, Wayne; Spettell, Claire M; McMahill-Walraven, Cheryl N; Shrank, William H; Choudhry, Niteesh K

2015-12-01

Methods of estimating race/ethnicity using administrative data are increasingly used to examine and target disparities; however, there has been no validation of these methods using clinically relevant outcomes. To evaluate the validity of the indirect method of race/ethnicity identification based on place of residence and surname for assessing clinically relevant outcomes. A total of 2387 participants in the Post-MI Free Rx Event and Economic Evaluation (MI FREEE) trial who had both self-reported and Bayesian Improved Surname Geocoding method (BISG)-estimated race/ethnicity information available. We used tests of interaction to compare differences in the effect of providing full drug coverage for post-MI medications on adherence and rates of major vascular events or revascularization for white and nonwhite patients based upon self-reported and indirect racial/ethnic assignment. The impact of full coverage on clinical events differed substantially when based upon self-identified race (HR=0.97 for whites, HR=0.65 for nonwhites; interaction P-value=0.05); however, it did not differ among race/ethnicity groups classified using indirect methods (HR=0.87 for white and nonwhites; interaction P-value=0.83). The impact on adherence was the same for self-reported and BISG-estimated race/ethnicity for 2 of the 3 medication classes studied. Quantitatively and qualitatively different results were obtained when indirectly estimated race/ethnicity was used, suggesting that these techniques may not accurately describe aspects of race/ethnicity related to actual health behaviors.

Nutrition as an important mediator of the impact of background variables on outcome in middle childhood

PubMed Central

Kitsao-Wekulo, Patricia; Holding, Penny; Taylor, H. Gerry; Abubakar, Amina; Kvalsvig, Jane; Connolly, Kevin

2013-01-01

Adequate nutrition is fundamental to the development of a child's full potential. However, the extent to which malnutrition affects developmental and cognitive outcomes in the midst of co-occurring risk factors remains largely understudied. We sought to establish if the effects of nutritional status varied according to diverse background characteristics as well as to compare the relative strength of the effects of poor nutritional status on language skills, motor abilities, and cognitive functioning at school age. This cross-sectional study was conducted among school-age boys and girls resident in Kilifi District in Kenya. We hypothesized that the effects of area of residence, school attendance, household wealth, age and gender on child outcomes are experienced directly and indirectly through child nutritional status. The use of structural equation modeling (SEM) allowed the disaggregation of the total effect of the explanatory variables into direct effects (effects that go directly from one variable to another) and indirect effects. Each of the models tested for the four child outcomes had a good fit. However, the effects on verbal memory apart from being weaker than for the other outcomes, were not mediated through nutritional status. School attendance was the most influential predictor of nutritional status and child outcomes. The estimated models demonstrated the continued importance of child nutritional status at school-age. PMID:24298246

Risk factors and mediating pathways of loneliness and social support in community-dwelling older adults.

PubMed

Schnittger, Rebecca I B; Wherton, Joseph; Prendergast, David; Lawlor, Brian A

2012-01-01

To develop biopsychosocial models of loneliness and social support thereby identifying their key risk factors in an Irish sample of community-dwelling older adults. Additionally, to investigate indirect effects of social support on loneliness through mediating risk factors. A total of 579 participants (400 females; 179 males) were given a battery of biopsychosocial assessments with the primary measures being the De Jong Gierveld Loneliness Scale and the Lubben Social Network Scale along with a broad range of secondary measures. Bivariate correlation analyses identified items to be included in separate psychosocial, cognitive, biological and demographic multiple regression analyses. The resulting model items were then entered into further multiple regression analyses to obtain overall models. Following this, bootstrapping mediation analyses was conducted to examine indirect effects of social support on the subtypes (emotional and social) of loneliness. The overall model for (1) emotional loneliness included depression, neuroticism, perceived stress, living alone and accommodation type, (2) social loneliness included neuroticism, perceived stress, animal naming and number of grandchildren and (3) social support included extraversion, executive functioning (Trail Making Test B-time), history of falls, age and whether the participant drives or not. Social support influenced emotional loneliness predominantly through indirect means, while its effect on social loneliness was more direct. These results characterise the biopsychosocial risk factors of emotional loneliness, social loneliness and social support and identify key pathways by which social support influences emotional and social loneliness. These findings highlight issues with the potential for consideration in the development of targeted interventions.

Tensile-strain effect of inducing the indirect-to-direct band-gap transition and reducing the band-gap energy of Ge

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

Inaoka, Takeshi, E-mail: inaoka@phys.u-ryukyu.ac.jp; Furukawa, Takuro; Toma, Ryo

By means of a hybrid density-functional method, we investigate the tensile-strain effect of inducing the indirect-to-direct band-gap transition and reducing the band-gap energy of Ge. We consider [001], [111], and [110] uniaxial tensility and (001), (111), and (110) biaxial tensility. Under the condition of no normal stress, we determine both normal compression and internal strain, namely, relative displacement of two atoms in the primitive unit cell, by minimizing the total energy. We identify those strain types which can induce the band-gap transition, and evaluate the critical strain coefficient where the gap transition occurs. Either normal compression or internal strain operatesmore » unfavorably to induce the gap transition, which raises the critical strain coefficient or even blocks the transition. We also examine how each type of tensile strain decreases the band-gap energy, depending on its orientation. Our analysis clearly shows that synergistic operation of strain orientation and band anisotropy has a great influence on the gap transition and the gap energy.« less

Family support in the transition to adulthood in Portugal--its effects on identity capital development, uncertainty management and psychological well-being.

PubMed

Oliveira, José Egídio; Mendonça, Marina; Coimbra, Susana; Fontaine, Anne Marie

2014-12-01

In a familistic southern European society such as the Portuguese, the family has historically played a prominent role in supporting the negotiation of transition pathways into adulthood. The present study aimed at capturing (1) the relative weight of parental financial support and autonomy support in contributing to the youngsters' psychological well-being (PWB), and (2) the mediating role of identity capital and uncertainty management in this relationship. A total of 620 participants completed measures of parental support, identity capital, uncertainty management and PWB. Autonomy support was found to be the strongest predictor of PWB, both directly and indirectly through its effects on identity capital and the use of target focused uncertainty management strategies. Conversely, financial support evidenced only a minor indirect impact through the mediation of tangible identity capital. Autonomy stimulation may constitute one of the most developmentally determinant family challenges in assisting the process of coming of age in Portugal. Copyright © 2014 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

A longitudinal study of interpersonal relationships among lesbian, gay, and bisexual adolescents and young adults: Mediational pathways from attachment to romantic relationship quality

PubMed Central

Starks, Tyrel J.; Newcomb, Michael E.; Mustanski, Brian

2016-01-01

The current study examined the potential for mental health to mediate associations between earlier attachment to parents and peers and later relationship adjustment during adolescence and young adulthood in a sample of sexual minority youth. Secondarily, the study examined associations between peer and parental attachment and relationship/dating milestones. Participants included 219 lesbian, gay, and bisexual youth who participated in six waves of data collection over 3.5 years. Parental attachment was associated with an older age of dating initiation, while peer attachment was associated with longer relationship length. Both peer and parental attachment were significantly associated with mental health in later adolescence and young adulthood. Mental health mediated the association between peer attachment and main partner relationship quality. While the total indirect effect of parental attachment on main partner relationship quality was statistically significant, specific indirect effects were not. Implications for the application of attachment theory and integration of interpersonal factors into mental health intervention with sexual minority youth are discussed. PMID:26108898

Time perspective and medication adherence among individuals with hypertension or diabetes mellitus.

PubMed

Sansbury, Brittany; Dasgupta, Abhijit; Guthrie, Lori; Ward, Michael

2014-04-01

The study determined if time perspective was associated with medication adherence among people with hypertension and diabetes. Using the Health Beliefs Model, we used path analysis to test direct and indirect effects of time perspective and health beliefs on adherence among 178 people who participated in a community-based survey near Washington, D.C. We measured three time perspectives (future, present fatalistic, and present hedonistic) with the Zimbardo Time Perspective Inventory and medication adherence by self-report. The total model demonstrated a good fit (RMSEA=0.17, 90% CI [0.10, 0.28], p=0.003; comparative fit index=0.91). Future time perspective and age showed direct effects on increased medication adherence; an increase by a single unit in future time perspective was associated with a 0.32 standard deviation increase in reported adherence. There were no significant indirect effects of time perspective with reported medication adherence through health beliefs. The findings provide the first evidence that time perspective plays an under-recognized role as a psychological motivator in medication adherence. Patient counseling for medication adherence may be enhanced if clinicians incorporate consideration of the patient's time perspective. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

What’s the good of education on our overall quality of life? A simultaneous equation model of education and life satisfaction for Australia

PubMed Central

Powdthavee, Nattavudh; Lekfuangfu, Warn N.; Wooden, Mark

2017-01-01

Many economists and educators favour public support for education on the premise that education improves the overall quality of life of citizens. However, little is known about the different pathways through which education shapes people’s satisfaction with life overall. One reason for this is because previous studies have traditionally analysed the effect of education on life satisfaction using single-equation models that ignore interrelationships between different theoretical explanatory variables. In order to advance our understanding of how education may be related to overall quality of life, the current study estimates a structural equation model using nationally representative data for Australia to obtain the direct and indirect associations between education and life satisfaction through five different adult outcomes: income, employment, marriage, children, and health. Although we find the estimated direct (or net) effect of education on life satisfaction to be negative and statistically significant in Australia, the total indirect effect is positive, sizeable and statistically significant for both men and women. This implies that misleading conclusions regarding the influence of education on life satisfaction might be obtained if only single-equation models were used in the analysis. PMID:28713668

Accounting for the various contributions to pyroelectricity in lead zirconate titanate thin films

NASA Astrophysics Data System (ADS)

Hanrahan, B.; Espinal, Y.; Neville, C.; Rudy, R.; Rivas, M.; Smith, A.; Kesim, M. T.; Alpay, S. P.

2018-03-01

An understanding of the pyroelectric coefficient and particularly its relationship with the applied electric field is critical to predicting the device performance for infrared imaging, energy harvesting, and solid-state cooling devices. In this work, we compare direct measurements of the pyroelectric effect under pulsed heating to the indirect extraction of the pyroelectric coefficient from adiabatic hysteresis loops and predictions from Landau-Devonshire theory for PbZr0.52Ti0.48O3 (PZT 52/48) on platinized silicon substrates. The differences between these measurements are explained through a series of careful measurements that quantify the magnitude and direction of the secondary and field-induced pyroelectric effects. The indirect measurement is shown to be up to 25% of the direct measurement at high fields, while the direct measurements and theoretical predictions converge at high fields as the film approaches a mono-domain state. These measurements highlight the importance of directly measuring the pyroelectric response in thin films, where non-intrinsic effects can be a significant proportion of the total observed pyroelectricity. Material and operating conditions are also discussed which could simultaneously maximize all contributions to pyroelectricity.

Mothers and meals. The effects of mothers' meal planning and shopping motivations on children's participation in family meals.

PubMed

McIntosh, William Alex; Kubena, Karen S; Tolle, Glen; Dean, Wesley R; Jan, Jie-sheng; Anding, Jenna

2010-12-01

Participation in family meals has been associated with benefits for health and social development of children. The objective of the study was to identify the impact of mothers' work of caring through planning regularly scheduled meals, shopping and cooking, on children's participation in family meals. Parents of children aged 9-11 or 13-15 years from 300 Houston families were surveyed about parents' work, meal planning for and scheduling of meals, motivations for food purchases, importance of family meals, and children's frequency of eating dinner with their families. The children were interviewed about the importance of eating family meals. Hypotheses were tested using path analysis to calculate indirect and total effects of variables on the outcome variable of frequency of children eating dinner with their family. Mothers' belief in the importance of family meals increased likelihood of children eating dinner with families by increasing likelihood that mothers planned dinner and that dinners were regularly scheduled. Mothers' perception of time pressures on meal preparation had a negative, indirect effect on the frequency of children's participation in family dinners by reducing mothers' meal planning. Copyright © 2010 Elsevier Ltd. All rights reserved.

Air pollution control and decreasing new particle formation lead to strong climate warming

NASA Astrophysics Data System (ADS)

Makkonen, R.; Asmi, A.; Kerminen, V.-M.; Boy, M.; Arneth, A.; Hari, P.; Kulmala, M.

2011-09-01

The number of cloud droplets determines several climatically relevant cloud properties. A major cause for the high uncertainty in the indirect aerosol forcing is the availability of cloud condensation nuclei (CCN), which in turn is highly sensitive to atmospheric new particle formation. Here we present the effect of new particle formation on anthropogenic aerosol forcing in present-day (year 2000) and future (year 2100) conditions. The total aerosol forcing (-1.61 W m-2 in year 2000) is simulated to be greatly reduced in the future, to -0.23 W m-2, mainly due to decrease in SO2 emissions and resulting decrease in new particle formation. With the total aerosol forcing decreasing in response to air pollution control measures taking effect, warming from increased greenhouse gas concentrations can potentially increase at a very rapid rate.

Psychosocial Health Disparities Among Black Bisexual Men in the U.S.: Effects of Sexuality Nondisclosure and Gay Community Support.

PubMed

Friedman, M Reuel; Bukowski, Leigh; Eaton, Lisa A; Matthews, Derrick D; Dyer, Typhanye V; Siconolfi, Dan; Stall, Ron

2018-04-05

Compared with Black gay men, Black bisexual men experience psychosocial health disparities, including depression, polydrug use, physical assault, and intimate partner violence (IPV). Black bisexual men are also less likely to disclose their sexuality, which may result in them receiving less sexual minority community support, exacerbating psychosocial health disparities. We assessed relationships between bisexual behavior, bisexual identity, sexuality nondisclosure, gay community support, and psychosocial morbidities among Black men who have sex with men (MSM). Between 2014 and 2017, survey data were collected from Black MSM ≥ 18 years old (n = 4430) at Black Pride events in six U.S. cities. We differentiated between bisexual-identified men reporting past-year sex with men and women (bisexual MSMW, 8.4%); gay-identified men reporting sex with men only (gay MSMO, 73.1%); gay MSMW (8.0%); and bisexual MSMO (8.4%). Multivariable regressions contrasted these groups by psychosocial morbidities, sexuality nondisclosure, and gay community support. Structural equation models assessed total, direct, and indirect effects. Compared with gay MSMO, bisexual MSMW and gay MSMW were significantly more likely to report polydrug use, depression symptoms, IPV, physical assault, sexuality nondisclosure, and lack of gay community support. Lack of gay community support had significant indirect effects on the relationships between bisexual behavior and psychosocial morbidity (p < .001) and between bisexual identity and psychosocial morbidity (p < .001). Sexuality nondisclosure had significant indirect effects on relationships between bisexual behavior (p < .001), bisexual identity (p < .001), and lack of gay community support. Psychosocial health disparities experienced by Black bisexual men are associated with both bisexual behavior and bisexual identity. Interventions decreasing biphobia will facilitate opportunities for protective sexuality disclosure and access to sexual minority community support.

Unpacking socio-economic risks for reading and academic self-concept in primary school: Differential effects and the role of the preschool home learning environment.

PubMed

Crampton, Alexandria; Hall, James

2017-09-01

Uncertainty remains concerning how children's reading and academic self-concept are related and how these are differentially affected by social disadvantage and home learning environments. To contrast the impacts of early socio-economic risks and preschool home learning environments upon British children's reading abilities and academic self-concept between 7 and 10 years. n = 3,172 British children aged 3-10 years and their families. A secondary analysis of the nationally representative UK EPPE database. Multilevel structural equation modelling calculated the direct, indirect, and total impacts of early socio-economic risks (0-3 years) and preschool home learning environments (3-5 years) upon children's reading ability and academic self-concept between 7 and 10 years. Early socio-economic risk had different effects upon children's reading ability and academic self-concept. Early socio-economic risks affected children's reading at ages 7 and 10 both directly and indirectly via effects upon preschool home learning environments. By contrast, early socio-economic risks had only indirect effects upon children's academic self-concept via less stimulating home learning environments in the preschool period and by limiting reading abilities early on in primary school. Although the impacts of early socio-economic risks are larger and more easily observed upon reading than upon academic self-concept, they can impact both by making it less likely that children will experience enriching home learning environments during the preschool period. This has implications for social policymakers, early educators, and interventionists. Intervening early and improving preschool home learning environments can do more than raise children's reading abilities; secondary benefits may also be achievable upon children's self-concept. © 2017 The British Psychological Society.

Is serum bilirubin associated with the severity of Guillain-Barré syndrome?

PubMed

Li, Xiaohong; Li, Wenchao; Shi, Xiang; Mo, Lijun; Luo, Yuzhen; Qin, Liuqun; Yang, Zheng; Mo, Wuning

2018-07-01

Our aim was to assess the correlation between serum bilirubin levels and Guillain-Barré syndrome (GBS). One hundred and one newly diagnosed patients with Guillain-Barré syndrome and 111 healthy age- and sex-matched individuals in the First Affiliated Hospital of Guangxi Medical University (Guangxi, China) from June 2012 to May 2017 were included in this study. Clinical characteristics and laboratory parameters of Guillain-Barré syndrome patients and healthy controls were retrospectively analysed. Serum bilirubin levels in Guillain-Barré syndrome patients were significantly lower as compared with those in healthy controls (p < 0.001); besides, log C-reactive protein and erythrocyte sedimentation rate were significantly higher. We found that there was a negative correlation between GBS disability scale scores and total bilirubin, direct bilirubin, indirect bilirubin (r = -0.541, P < 0.001; r = -0.403, P < 0.001; r = -0.526, P < 0.001), respectively. Among patients with GBS, serum total bilirubin, direct bilirubin, and indirect bilirubin levels were independently associated with Guillain-Barré syndrome disability scale scores in multiple linear regression analysis, respectively. We observed that serum bilirubin levels were lower in patients with Guillain-Barré syndrome, and suggested total bilirubin, direct bilirubin, and indirect bilirubin were independently and inversely associated with Guillain-Barré syndrome severity.

The Role of Mediators in the Indirect Effects of Religiosity on Therapeutic Compliance in African Migrant HIV-Positive Patients.

PubMed

Mambet Doue, Constance; Roussiau, Nicolas

2016-12-01

This research investigates the indirect effects of religiosity (practice and belief) on therapeutic compliance in 81 HIV-positive patients who are migrants from sub-Saharan Africa (23 men and 58 women). Using analyses of mediation and standard multiple regression, including a resampling procedure by bootstrapping, the role of these mediators (magical-religious beliefs and nonuse of toxic substances) was tested. The results show that, through magical-religious beliefs, religiosity has a negative indirect effect, while with the nonuse of toxic substances, religious practice has a positive indirect effect. Beyond religiosity, the role of mediators is highlighted in the interaction with therapeutic compliance.

Utility loss and indirect costs after stroke in Sweden.

PubMed

Lindgren, Peter; Glader, Eva-Lotta; Jönsson, Bengt

2008-04-01

Currently little data exist on the development of quality of life over time in patients suffering from stroke, in particular using instruments that can be adapted in economic studies. The purpose of the study was to assess the utility loss and indirect costs following a stroke in Sweden. A cross-sectional mail survey. In collaboration with the National Stroke registry (RIKS-STROKE), a questionnaire consisting of the EuroQol-5D and questions regarding the present working status and the status prior to the stroke was mailed to patients below 76 years of age at six participating centres. The questionnaire was mailed to 393 patients in total, divided into groups with 3, 6, 9 or 12 months having passed since the stroke. The EuroQol-5D scores were converted to utility scores using the UK social tariff. Indirect costs were valued according to the average salary+employer contributions. A total of 275 questionnaires (70%) were returned. Utility scores were similar over time: 0.65, 0.75, 0.63, and 0.67 at 3, 6, 9 and 12 months, respectively. Regression analyses revealed a tendency for lower utility scores among women, but no significant differences overall. Among patients in the working ages, a stroke caused 18.5 work weeks lost, corresponding to an indirect cost of 120,000 Swedish Kronor (SEK) (13,200euro, 95% confidence interval 82,541-160,050 SEK, 9080-17 605euro). Stroke causes a significant reduction in utility and causes high indirect costs. A substantial improvement was not noted over time, which is important to consider in economic models.

Assessment of the first indirect radiative effect of ammonium-sulfate-nitrate aerosols in East Asia

NASA Astrophysics Data System (ADS)

Han, Xiao; Zhang, Meigen; Skorokhod, Andrei

2017-11-01

A physically based cloud nucleation parameterization was introduced into an optical properties/radiative transfer module incorporated with the off-line air quality modeling system Regional Atmospheric Modeling System (RAMS)-Models-3 Community Multi Scale Air Quality (CMAQ) to investigate the distribution features of the first indirect radiative effects of sulfate, nitrate, and ammonium-sulfate-nitrate (ASN) over East Asia for the years of 2005, 2010, and 2013. The relationship between aerosol particles and cloud droplet number concentration could be properly described by this parameterization because the simulated cloud fraction and cloud liquid water path were generally reliable compared with Moderate Resolution Imaging Spectroradiometer (MODIS) retrieved data. Simulation results showed that the strong effect of indirect forcing was mainly concentrated in Southeast China, the East China Sea, the Yellow Sea, and the Sea of Japan. The highest indirect radiative forcing of ASN reached -3.47 W m-2 over Southeast China and was obviously larger than the global mean of the indirect forcing of all anthropogenic aerosols. In addition, sulfate provided about half of the contribution to the ASN indirect forcing effect. However, the effect caused by nitrate was weak because the mass burden of nitrate was very low during summer, whereas the cloud fraction was the highest. The analysis indicated that even though the interannual variation of indirect forcing magnitude generally followed the trend of aerosol mass burden from 2005 to 2013, the cloud fraction was an important factor that determined the distribution pattern of indirect forcing. The heaviest aerosol loading in North China did not cause a strong radiative effect because of the low cloud fraction over this region.

Improving organic aerosol treatments in CESM/CAM5: Development, application, and evaluation

NASA Astrophysics Data System (ADS)

Glotfelty, Timothy; He, Jian; Zhang, Yang

2017-06-01

New treatments for organic aerosol (OA) formation have been added to a modified version of the CESM/CAM5 model (CESM-NCSU). These treatments include a volatility basis set treatment for the simulation of primary and secondary organic aerosols (SOAs), a simplified treatment for organic aerosol (OA) formation from glyoxal, and a parameterization representing the impact of new particle formation (NPF) of organic gases and sulfuric acid. With the inclusion of these new treatments, the concentration of oxygenated organic aerosol increases by 0.33 µg m-3 and that of primary organic aerosol (POA) decreases by 0.22 µg m-3 on global average. The decrease in POA leads to a reduction in the OA direct effect, while the increased OOA increases the OA indirect effects. Simulations with the new OA treatments show considerable improvement in simulated SOA, oxygenated organic aerosol (OOA), organic carbon (OC), total carbon (TC), and total organic aerosol (TOA), but degradation in the performance of HOA. In simulations of the current climate period, despite some deviations from observations, CESM-NCSU with the new OA treatments significantly improves the magnitude, spatial pattern, seasonal pattern of OC and TC, as well as, the speciation of TOA between POA and OOA. Sensitivity analysis reveals that the inclusion of the organic NPF treatment impacts the OA indirect effects by enhancing cloud properties. The simulated OA level and its impact on the climate system are most sensitive to choices in the enthalpy of vaporization and wet deposition of SVOCs, indicating that accurate representations of these parameters are critical for accurate OA-climate simulations.

Improving organic aerosol treatments in CESM/CAM5: Development, application, and evaluation

PubMed Central

Glotfelty, Timothy; He, Jian

2017-01-01

Abstract New treatments for organic aerosol (OA) formation have been added to a modified version of the CESM/CAM5 model (CESM‐NCSU). These treatments include a volatility basis set treatment for the simulation of primary and secondary organic aerosols (SOAs), a simplified treatment for organic aerosol (OA) formation from glyoxal, and a parameterization representing the impact of new particle formation (NPF) of organic gases and sulfuric acid. With the inclusion of these new treatments, the concentration of oxygenated organic aerosol increases by 0.33 µg m−3 and that of primary organic aerosol (POA) decreases by 0.22 µg m−3 on global average. The decrease in POA leads to a reduction in the OA direct effect, while the increased OOA increases the OA indirect effects. Simulations with the new OA treatments show considerable improvement in simulated SOA, oxygenated organic aerosol (OOA), organic carbon (OC), total carbon (TC), and total organic aerosol (TOA), but degradation in the performance of HOA. In simulations of the current climate period, despite some deviations from observations, CESM‐NCSU with the new OA treatments significantly improves the magnitude, spatial pattern, seasonal pattern of OC and TC, as well as, the speciation of TOA between POA and OOA. Sensitivity analysis reveals that the inclusion of the organic NPF treatment impacts the OA indirect effects by enhancing cloud properties. The simulated OA level and its impact on the climate system are most sensitive to choices in the enthalpy of vaporization and wet deposition of SVOCs, indicating that accurate representations of these parameters are critical for accurate OA‐climate simulations. PMID:29104733

A scoping review of indirect comparison methods and applications using individual patient data.

PubMed

Veroniki, Areti Angeliki; Straus, Sharon E; Soobiah, Charlene; Elliott, Meghan J; Tricco, Andrea C

2016-04-27

Several indirect comparison methods, including network meta-analyses (NMAs), using individual patient data (IPD) have been developed to synthesize evidence from a network of trials. Although IPD indirect comparisons are published with increasing frequency in health care literature, there is no guidance on selecting the appropriate methodology and on reporting the methods and results. In this paper we examine the methods and reporting of indirect comparison methods using IPD. We searched MEDLINE, Embase, the Cochrane Library, and CINAHL from inception until October 2014. We included published and unpublished studies reporting a method, application, or review of indirect comparisons using IPD and at least three interventions. We identified 37 papers, including a total of 33 empirical networks. Of these, only 9 (27 %) IPD-NMAs reported the existence of a study protocol, whereas 3 (9 %) studies mentioned that protocols existed without providing a reference. The 33 empirical networks included 24 (73 %) IPD-NMAs and 9 (27 %) matching adjusted indirect comparisons (MAICs). Of the 21 (64 %) networks with at least one closed loop, 19 (90 %) were IPD-NMAs, 13 (68 %) of which evaluated the prerequisite consistency assumption, and only 5 (38 %) of the 13 IPD-NMAs used statistical approaches. The median number of trials included per network was 10 (IQR 4-19) (IPD-NMA: 15 [IQR 8-20]; MAIC: 2 [IQR 3-5]), and the median number of IPD trials included in a network was 3 (IQR 1-9) (IPD-NMA: 6 [IQR 2-11]; MAIC: 2 [IQR 1-2]). Half of the networks (17; 52 %) applied Bayesian hierarchical models (14 one-stage, 1 two-stage, 1 used IPD as an informative prior, 1 unclear-stage), including either IPD alone or with aggregated data (AD). Models for dichotomous and continuous outcomes were available (IPD alone or combined with AD), as were models for time-to-event data (IPD combined with AD). One in three indirect comparison methods modeling IPD adjusted results from different trials to estimate effects as if they had come from the same, randomized, population. Key methodological and reporting elements (e.g., evaluation of consistency, existence of study protocol) were often missing from an indirect comparison paper.

Indirect Effects of Global Change: From Physiological and Behavioral Mechanisms to Ecological Consequences.

PubMed

Gunderson, Alex R; Tsukimura, Brian; Stillman, Jonathon H

2017-07-01

A major focus of current ecological research is to understand how global change makes species vulnerable to extirpation. To date, mechanistic ecophysiological analyses of global change vulnerability have focused primarily on the direct effects of changing abiotic conditions on whole-organism physiological traits, such as metabolic rate, locomotor performance, cardiac function, and critical thermal limits. However, species do not live in isolation within their physical environments, and direct effects of climate change are likely to be compounded by indirect effects that result from altered interactions with other species, such as competitors and predators. The Society for Integrative and Comparative Biology 2017 Symposium "Indirect Effects of Global Change: From Physiological and Behavioral Mechanisms to Ecological Consequences" was designed to synthesize multiple approaches to investigating the indirect effects of global change by bringing together researchers that study the indirect effects of global change from multiple perspectives across habitat, type of anthropogenic change, and level of biological organization. Our goal in bringing together researchers from different backgrounds was to foster cross-disciplinary insights into the mechanistic bases and higher-order ecological consequences of indirect effects of global change, and to promote collaboration among fields. © The Author 2017. Published by Oxford University Press on behalf of the Society for Integrative and Comparative Biology. All rights reserved. For permissions please email: journals.permissions@oup.com.

Interannual bumble bee abundance is driven by indirect climate effects on floral resource phenology.

PubMed

Ogilvie, Jane E; Griffin, Sean R; Gezon, Zachariah J; Inouye, Brian D; Underwood, Nora; Inouye, David W; Irwin, Rebecca E

2017-12-01

Climate change can influence consumer populations both directly, by affecting survival and reproduction, and indirectly, by altering resources. However, little is known about the relative importance of direct and indirect effects, particularly for species important to ecosystem functioning, like pollinators. We used structural equation modelling to test the importance of direct and indirect (via floral resources) climate effects on the interannual abundance of three subalpine bumble bee species. In addition, we used long-term data to examine how climate and floral resources have changed over time. Over 8 years, bee abundances were driven primarily by the indirect effects of climate on the temporal distribution of floral resources. Over 43 years, aspects of floral phenology changed in ways that indicate species-specific effects on bees. Our study suggests that climate-driven alterations in floral resource phenology can play a critical role in governing bee population responses to global change. © 2017 John Wiley & Sons Ltd/CNRS.

Mediating effects of nocturnal blood pressure and morning surge on the contributions of arterial stiffness and sodium intake to morning blood pressure: A path analysis.

PubMed

Lee, Hyung Tak; Park, Jin-Kyu; Choi, Sung Yong; Choi, Bo Youl; Kim, Mi Kyung; Mori, Mari; Yamori, Yukio; Lim, Young Hyo; Shin, Jinho

2016-01-01

The aim of this study was to evaluate the mediating effects of nocturnal blood pressure (BP) and morning surge on the contribution of arterial stiffness and sodium intake to morning BP in a middle-aged general population. The study included 124 subjects aged 30-59 years, from rural Yeoju County, Gyeonggi Province, South Korea. Ambulatory BP monitoring, 24 h urinary sodium excretion (24 h UNa) and brachial-ankle pulse wave velocity (baPWV) measurements were performed in all subjects. The mean ± SD age was 48.1 ± 8.2 years and the proportion of male subjects was 41.1%. After adjusting for covariates, morning systolic blood pressure (SBP) was significantly correlated with morning surge [coefficient = 0.761, 95% confidence interval (CI) 0.651-0.872, p < 0.001], nocturnal SBP (coefficient = 0.576, 95% CI 0.454-0.698, p < 0.001) and baPWV (coefficient = 3.550, 95% CI 1.447-5.653, p = 0.001). Path analysis modeling revealed that baPWV had significant direct (0.035, p = 0.013) and indirect effects (0.042, p = 0.012) on morning SBP. The indirect effect mediated by nocturnal SBP was statistically significant (0.054, p = 0.005), but the indirect effect mediated by the morning surge was not significant. The 24 h UNa had no significant direct or indirect effects on morning SBP. baPWV had significant direct and indirect effects on morning SBP. The indirect effect was mediated by nocturnal SBP, but not by morning surge. The 24 h UNa had neither significant direct nor indirect effects on morning SBP.

Assessing the indirect effects due to natural hazards on a mesoscale

NASA Astrophysics Data System (ADS)

Pfurtscheller, C.; Schwarze, R.

2009-04-01

Measuring indirect economic costs and other effects from natural hazards, especially floods in alpine and other mountainous regions, are a necessary part of a comprehensive economic assessment. Their omission seriously affects the relative economic benefits of structural or non structural measures of flood defence. Surpassing controversial, IO-model-based economic estimates, analysing indirect economic effects lead to the key question of identifying and evaluating the drivers of indirect economic effects and resilience to system effects in the regional economy, i.e. at the meso-level. This investigation takes place for the catastrophic floods in summer 2005 in the provinces of Tyrol and Vorarlberg, Austria, which caused an estimated € 670 Mio direct loss on private and public assets and severe interruptions in lifeline services. The paper starts out with differentiating the concept of indirect economic costs from direct costs, examing different temporal (short vs. long-term) and spatial (macro-, meso- vs. microeconomic) system boundaries. It surveys common theories of economic resilience and vulnerability at the regional economy level. Indirect effects at the regional economy level can be defined as interferences of the economic exchange of goods and services triggered by breakdowns of transport lines and critical production inputs. The extent and persistence of indirect effects of natural hazards is not only by parameters of the extreme event, such as duration and amplitude of the flood, but much more by resilience parameters of the regional economy such as size of enterprises, the network structure (linkages) of the regional economy, availability of insurance and relief funds, and the stock of inventory. These effects can only be dissected by means of expert judgement and event studies. This paper presents the results of a survey conducted among business practioneers, members of chamber of commerce, civil protection agencies to identify and scale the drivers of indirect costs triggered by floods on a local and regional scale. We develop a risk point scale and explain how it can be nested into IO-model-based economic tools such as the HAZUS indirect economic loss calculator

Estimating the Societal Benefits of THA After Accounting for Work Status and Productivity: A Markov Model Approach.

PubMed

Koenig, Lane; Zhang, Qian; Austin, Matthew S; Demiralp, Berna; Fehring, Thomas K; Feng, Chaoling; Mather, Richard C; Nguyen, Jennifer T; Saavoss, Asha; Springer, Bryan D; Yates, Adolph J

2016-12-01

Demand for total hip arthroplasty (THA) is high and expected to continue to grow during the next decade. Although much of this growth includes working-aged patients, cost-effectiveness studies on THA have not fully incorporated the productivity effects from surgery. We asked: (1) What is the expected effect of THA on patients' employment and earnings? (2) How does accounting for these effects influence the cost-effectiveness of THA relative to nonsurgical treatment? Taking a societal perspective, we used a Markov model to assess the overall cost-effectiveness of THA compared with nonsurgical treatment. We estimated direct medical costs using Medicare claims data and indirect costs (employment status and worker earnings) using regression models and nonparametric simulations. For direct costs, we estimated average spending 1 year before and after surgery. Spending estimates included physician and related services, hospital inpatient and outpatient care, and postacute care. For indirect costs, we estimated the relationship between functional status and productivity, using data from the National Health Interview Survey and regression analysis. Using regression coefficients and patient survey data, we ran a nonparametric simulation to estimate productivity (probability of working multiplied by earnings if working minus the value of missed work days) before and after THA. We used the Australian Orthopaedic Association National Joint Replacement Registry to obtain revision rates because it contained osteoarthritis-specific THA revision rates by age and gender, which were unavailable in other registry reports. Other model assumptions were extracted from a previously published cost-effectiveness analysis that included a comprehensive literature review. We incorporated all parameter estimates into Markov models to assess THA effects on quality-adjusted life years and lifetime costs. We conducted threshold and sensitivity analyses on direct costs, indirect costs, and revision rates to assess the robustness of our Markov model results. Compared with nonsurgical treatments, THA increased average annual productivity of patients by USD 9503 (95% CI, USD 1446-USD 17,812). We found that THA increases average lifetime direct costs by USD 30,365, which were offset by USD 63,314 in lifetime savings from increased productivity. With net societal savings of USD 32,948 per patient, total lifetime societal savings were estimated at almost USD 10 billion from more than 300,000 THAs performed in the United States each year. Using a Markov model approach, we show that THA produces societal benefits that can offset the costs of THA. When comparing THA with other nonsurgical treatments, policymakers should consider the long-term benefits associated with increased productivity from surgery. Level III, economic and decision analysis.

Parkinson Symptoms and Health Related Quality of Life as Predictors of Costs: A Longitudinal Observational Study with Linear Mixed Model Analysis

PubMed Central

Martinez-Martín, Pablo; Rodriguez-Blazquez, Carmen; Paz, Silvia; Forjaz, Maria João; Frades-Payo, Belén; Cubo, Esther; de Pedro-Cuesta, Jesús; Lizán, Luis

2015-01-01

Objective To estimate the magnitude in which Parkinson’s disease (PD) symptoms and health- related quality of life (HRQoL) determined PD costs over a 4-year period. Materials and Methods Data collected during 3-month, each year, for 4 years, from the ELEP study, included sociodemographic, clinical and use of resources information. Costs were calculated yearly, as mean 3-month costs/patient and updated to Spanish €, 2012. Mixed linear models were performed to analyze total, direct and indirect costs based on symptoms and HRQoL. Results One-hundred and seventy four patients were included. Mean (SD) age: 63 (11) years, mean (SD) disease duration: 8 (6) years. Ninety-three percent were HY I, II or III (mild or moderate disease). Forty-nine percent remained in the same stage during the study period. Clinical evaluation and HRQoL scales showed relatively slight changes over time, demonstrating a stable group overall. Mean (SD) PD total costs augmented 92.5%, from €2,082.17 (€2,889.86) in year 1 to €4,008.6 (€7,757.35) in year 4. Total, direct and indirect cost incremented 45.96%, 35.63%, and 69.69% for mild disease, respectively, whereas increased 166.52% for total, 55.68% for direct and 347.85% for indirect cost in patients with moderate PD. For severe patients, cost remained almost the same throughout the study. For each additional point in the SCOPA-Motor scale total costs increased €75.72 (p = 0.0174); for each additional point on SCOPA-Motor and the SCOPA-COG, direct costs incremented €49.21 (p = 0.0094) and €44.81 (p = 0.0404), respectively; and for each extra point on the pain scale, indirect costs increased €16.31 (p = 0.0228). Conclusions PD is an expensive disease in Spain. Disease progression and severity as well as motor and cognitive dysfunctions are major drivers of costs increments. Therapeutic measures aimed at controlling progression and symptoms could help contain disease expenses. PMID:26698860

Parkinson Symptoms and Health Related Quality of Life as Predictors of Costs: A Longitudinal Observational Study with Linear Mixed Model Analysis.

PubMed

Martinez-Martín, Pablo; Rodriguez-Blazquez, Carmen; Paz, Silvia; Forjaz, Maria João; Frades-Payo, Belén; Cubo, Esther; de Pedro-Cuesta, Jesús; Lizán, Luis

2015-01-01

To estimate the magnitude in which Parkinson's disease (PD) symptoms and health- related quality of life (HRQoL) determined PD costs over a 4-year period. Data collected during 3-month, each year, for 4 years, from the ELEP study, included sociodemographic, clinical and use of resources information. Costs were calculated yearly, as mean 3-month costs/patient and updated to Spanish €, 2012. Mixed linear models were performed to analyze total, direct and indirect costs based on symptoms and HRQoL. One-hundred and seventy four patients were included. Mean (SD) age: 63 (11) years, mean (SD) disease duration: 8 (6) years. Ninety-three percent were HY I, II or III (mild or moderate disease). Forty-nine percent remained in the same stage during the study period. Clinical evaluation and HRQoL scales showed relatively slight changes over time, demonstrating a stable group overall. Mean (SD) PD total costs augmented 92.5%, from € 2,082.17 (€ 2,889.86) in year 1 to € 4,008.6 (€ 7,757.35) in year 4. Total, direct and indirect cost incremented 45.96%, 35.63%, and 69.69% for mild disease, respectively, whereas increased 166.52% for total, 55.68% for direct and 347.85% for indirect cost in patients with moderate PD. For severe patients, cost remained almost the same throughout the study. For each additional point in the SCOPA-Motor scale total costs increased € 75.72 (p = 0.0174); for each additional point on SCOPA-Motor and the SCOPA-COG, direct costs incremented € 49.21 (p = 0.0094) and € 44.81 (p = 0.0404), respectively; and for each extra point on the pain scale, indirect costs increased € 16.31 (p = 0.0228). PD is an expensive disease in Spain. Disease progression and severity as well as motor and cognitive dysfunctions are major drivers of costs increments. Therapeutic measures aimed at controlling progression and symptoms could help contain disease expenses.

Videolaryngoscopy versus direct laryngoscopy for tracheal intubation in children (excluding neonates).

PubMed

Abdelgadir, Ibtihal S; Phillips, Robert S; Singh, Davinder; Moncreiff, Michael P; Lumsden, Joanne L

2017-05-24

Direct laryngoscopy is the method currently used for tracheal intubation in children. It occasionally offers unexpectedly poor laryngeal views. Indirect laryngoscopy involves visualizing the vocal cords by means other than obtaining a direct sight, with the potential to improve outcomes. We reviewed the current available literature and performed a meta-analysis to compare direct versus indirect laryngoscopy, or videolaryngoscopy, with regards to efficacy and adverse effects. To assess the efficacy of indirect laryngoscopy, or videolaryngoscopy, versus direct laryngoscopy for intubation of children with regards to intubation time, number of attempts at intubation, and adverse haemodynamic responses to endotracheal intubation. We also assessed other adverse responses to intubation, such as trauma to oral, pharyngeal, and laryngeal structures, and we assessed vocal cord view scores. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and trial registers (www.clinicaltrials.gov and www.controlledtrials) in November 2015. We reran the search in January 2017. We added new studies of potential interest to a list of 'Studies awaiting classification' and will incorporate them into formal review findings during the review update. We performed reference checking and citation searching and contacted the authors of unpublished data to ask for more information. We applied no language restrictions. We included only randomized controlled trials. Participants were children aged 28 days to 18 years. Investigators performed intubations using any type of indirect laryngoscopes, or videolaryngoscopes, versus direct laryngoscopes. We used Cochrane standard methodological procedures. Two review authors independently reviewed titles, extracted data, and assessed risk of bias. We included 12 studies (803 children) in this review and meta-analysis. We identified three studies that are awaiting classification and two ongoing studies.Trial results show that a longer intubation time was required when indirect laryngoscopy, or videolaryngoscopy, was used instead of direct laryngoscopy (12 trials; n = 798; mean difference (MD) 5.49 seconds, 95% confidence interval (CI) 1.37 to 9.60; I 2 = 90%; very low-quality evidence). Researchers found no significant differences between direct and indirect laryngoscopy on assessment of success of the first attempt at intubation (11 trials; n = 749; risk ratio (RR) 0.96, 95% CI 0.91 to 1.02; I 2 = 67%; low-quality evidence) and observed that unsuccessful intubation (five trials; n = 263) was significantly increased in the indirect laryngoscopy, or videolaryngoscopy, group (RR 4.93, 95% CI 1.33 to 18.31; I 2 = 0%; low-quality evidence). Five studies reported the effect of intubation on oxygen saturation (n = 272; very low-quality evidence). Five children had desaturation during intubation: one from the direct laryngoscopy group and four from the indirect laryngoscopy, or videolaryngoscopy, group.Two studies (n = 100) reported other haemodynamic responses to intubation (very low-quality evidence). One study reported a significant increase in heart rate five minutes after intubation in the indirect laryngoscopy group (P = 0.007); the other study found that the heart rate change in the direct laryngoscopy group was significantly less than the heart rate change in the indirect laryngoscopy, or videolaryngoscopy, group (P < 0.001). A total of five studies (n = 244; very low-quality evidence) looked at evidence of trauma resulting from intubation. Investigators reported that only two children from the direct laryngoscopy group had trauma compared with no children in the indirect laryngoscopy, or videolaryngoscopy, group.Use of indirect laryngoscopy, or videolaryngoscopy, improved the percentage of glottic opening (five trials; n = 256). Studies noted no significant difference in Cormack and Lehane score (C&L) grade 1 (three trials; n = 190; RR 1.06, 95% CI 0.93 to 1.21; I 2 = 59%). Evidence suggests that indirect laryngoscopy, or videolaryngoscopy, leads to prolonged intubation time with an increased rate of intubation failure when compared with direct laryngoscopy (very low-quality evidence due to imprecision, inconsistency, and study limitations). Review authors had difficulty reaching conclusions on adverse haemodynamic responses and other adverse effects of intubation, as only a few children were reported to have these outcomes. Use of indirect laryngoscopy, or videolaryngoscopy, might lead to improved vocal cord view, but marked heterogeneity between studies made it difficult for review authors to reach conclusions on this outcome.

Filaggrin loss-of-function mutations are associated with food allergy in childhood and adolescence.

PubMed

Venkataraman, Devasmitha; Soto-Ramírez, Nelís; Kurukulaaratchy, Ramesh J; Holloway, John W; Karmaus, Wilfried; Ewart, Susan L; Arshad, S Hasan; Erlewyn-Lajeunesse, Mich

2014-10-01

Filaggrin is an epidermal protein that has a role in skin barrier function. Filaggrin loss-of-function (FLG-LOF) mutations are a significant risk factor for eczema and atopy, but their association with food allergy (FA) is less clear. We explored the longitudinal relationship between 3 common FLG-LOF mutations and FA using the Isle of Wight birth cohort. FA diagnosis was based on recognized allergic reactions within 4 hours after exposure to known food allergens. Food allergen sensitization (FAS) was identified by using skin prick tests conducted between 1 and 18 years of age to a range of food allergens. Three FLG mutations were genotyped in 1150 (79%) of 1456 children. The temporal relationships between FA, FAS, and eczema in children with FLG mutations were explored by using path analysis with total, direct, and indirect effect models. There was a significant total effect of FLG-LOF mutations on the risk of FA in later childhood at the ages of 10 (odds ratio, 31.46; 95% CI, 2.86 to >100) and 18 (odds ratio, 4.25; 95% CI, 1.55-11.61) years. Path analysis showed that there was no direct effect of FLG-LOF mutations on FA at any age; however, an indirect effect was found on FA at all ages through eczema and FAS in the earlier years. FLG-LOF mutations are associated with FA in older children through eczema and FAS during early childhood. Our results highlight a biologically plausible pathway, which suggests that skin barrier function is important in the development and persistence of FA. Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Correlates of Condom-use Self-efficacy on the EPPM-based Integrated Model among Chinese College Students.

PubMed

Jin, Shan Shan; Bu, Kai; Chen, Fang Fang; Xu, Hui Fang; Li, Yi; Zhao, Dong Hui; Xu, Fang; Li, Jing Yan; Han, Meng Jie; Wang, Ning; Wang, Lu

2017-02-01

To explore the predictors of condom-use self-efficacy in Chinese college students according to the extended parallel process model (EPPM)-based integrated model. A total of 3,081 college students were anonymously surveyed through self-administered questionnaires in Guangzhou and Harbin, China. A structural equation model was applied to assess the integrated model. Among the participants, 1,387 (46.7%) were male, 1,586 (53.3%) were female, and the average age was 18.6 years. The final integrated model was acceptable. Apart from the direct effect (r = 0.23), perceived severity had two indirect effects on condom-use self-efficacy through the attitude to HIV education (r = 0.40) and intention to engage in premarital sex (r = -0.16), respectively. However, the perceived susceptibility mediated through the intention to engage in premarital sex (intent-to-premarital-sex) had a poor indirect impact on condom-use self-efficacy (total effect was -0.06). Furthermore, attitude toward HIV health education (r = 0.49) and intent-to-premarital-sex (r = -0.31) had a strong direct effect on condom-use self-efficacy. In addition, male students perceived higher susceptibility, stronger intent-to-premarital-sex, and lower condom-use self-efficacy than female students. The integrated model may be used to assess the determinants of condom-use self-efficacy among Chinese college students. Future research should focus on raising the severity perception, HIV-risk-reduction motivation, and the premarital abstinence intention among college students. Furthermore, considering the gender differences observed in the present survey, single-sex HIV education is required in school-based HIV/sex intervention. Copyright © 2017 The Editorial Board of Biomedical and Environmental Sciences. Published by China CDC. All rights reserved.

Biofuels done right: land efficient animal feeds enable large environmental and energy benefits.

PubMed

Dale, Bruce E; Bals, Bryan D; Kim, Seungdo; Eranki, Pragnya

2010-11-15

There is an intense ongoing debate regarding the potential scale of biofuel production without creating adverse effects on food supply. We explore the possibility of three land-efficient technologies for producing food (actually animal feed), including leaf protein concentrates, pretreated forages, and double crops to increase the total amount of plant biomass available for biofuels. Using less than 30% of total U.S. cropland, pasture, and range, 400 billion liters of ethanol can be produced annually without decreasing domestic food production or agricultural exports. This approach also reduces U.S. greenhouse gas emissions by 670 Tg CO₂-equivalent per year, or over 10% of total U.S. annual emissions, while increasing soil fertility and promoting biodiversity. Thus we can replace a large fraction of U.S. petroleum consumption without indirect land use change.

Pathways linking regional hyperintensities in the brain and slower gait.

PubMed

Bolandzadeh, Niousha; Liu-Ambrose, Teresa; Aizenstein, Howard; Harris, Tamara; Launer, Lenore; Yaffe, Kristine; Kritchevsky, Stephen B; Newman, Anne; Rosano, Caterina

2014-10-01

Cerebral white matter hyperintensities (WMHs) are involved in the evolution of impaired mobility and executive functions. Executive functions and mobility are also associated. Thus, WMHs may impair mobility directly, by disrupting mobility-related circuits, or indirectly, by disrupting circuits responsible for executive functions. Understanding the mechanisms underlying impaired mobility in late life will increase our capacity to develop effective interventions. To identify regional WMHs most related to slower gait and to examine whether these regional WMHs directly impact mobility, or indirectly by executive functions. Cross-sectional study. Twenty-one WMH variables (i.e., total WMH volume and WMHs in 20 tracts), gait speed, global cognition (Modified Mini-Mental State Examination; 3MS), and executive functions and processing speed (Digit-Symbol Substitution Test; DSST) were assessed. An L1-L2 regularized regression (i.e., Elastic Net model) identified the WMH variables most related to slower gait. Multivariable linear regression models quantified the association between these WMH variables and gait speed. Formal tests of mediation were also conducted. Community-based sample. Two hundred fifty-three adults (mean age: 83years, 58% women, 41% black). Gait speed. In older adults with an average gait speed of 0.91m/sec, total WMH volume, WMHs located in the right anterior thalamic radiation (ATRR) and frontal corpuscallosum (CCF) were most associated with slower gait. There was a >10% slower gait for each standard deviation of WMH in CCF, ATRR or total brain (standardized beta in m/sec [p value]: -0.11 [p=0.046], -0.15 [p=0.007] and -0.14 [p=0.010], respectively). These associations were substantially and significantly attenuated after adjustment for DSST. This effect was stronger for WMH in CCF than for ATRR or total WMH (standardized beta in m/sec [p value]: -0.07 [p=0.190], -0.12 [p=0.024] and -0.10 [p=0.049], respectively). Adjustment for 3MS did not change these associations. The mediation analyses also found that DSST significantly mediated the associations between WMHs and gait speed. Our models were adjusted for age, sex, BMI, quadriceps strength, years of education, standing height, and prevalent hypertension. The impact, direct or indirect, of WMHs on gait speed depended on their location and was mediated by executive function. Thus, multi-faceted interventions targeting executive control functions as well as motor functions, such as balance and strength training, are candidates to the maintenance of mobility across the lifespan. Copyright © 2014 Elsevier Inc. All rights reserved.

Intervening to reduce workplace sitting: mediating role of social-cognitive constructs during a cluster randomised controlled trial.

PubMed

Hadgraft, Nyssa T; Winkler, Elisabeth A H; Healy, Genevieve N; Lynch, Brigid M; Neuhaus, Maike; Eakin, Elizabeth G; Dunstan, David W; Owen, Neville; Fjeldsoe, Brianna S

2017-03-06

The Stand Up Victoria multi-component intervention successfully reduced workplace sitting time in both the short (three months) and long (12 months) term. To further understand how this intervention worked, we aimed to assess the impact of the intervention on four social-cognitive constructs, and examined whether these constructs mediated intervention effects on workplace sitting time at 3 and 12 months post-baseline. Two hundred and thirty one office-based workers (14 worksites, single government employer) were randomised to intervention or control conditions by worksite. The intervention comprised organisational, environmental, and individual level elements. Participant characteristics and social-cognitive constructs (perceived behavioural control, barrier self-efficacy, perceived organisational norms and knowledge) were measured through a self-administered online survey at baseline, 3 months and 12 months. Workplace sitting time (min/8 h day) was measured with the activPAL3 device. Single multi-level mediation models were performed for each construct at both time points. There were significant intervention effects at 3 months on perceived behavioural control, barrier self-efficacy and perceived organisational norms. Effects on perceived organisational norms were not significant at 12 months. Perceived behavioural control significantly mediated intervention effects at 3 months, accounting for a small portion of the total effect (indirect effect: -8.6 min/8 h day, 95% CI: -18.5, -3.6 min; 7.5% of total effect). At 12 months, barrier self-efficacy significantly mediated the intervention effects on workplace sitting time (indirect effect: -10.3 min/8 h day, 95% CI: -27.3, -2.2; 13.9% of total effect). No significant effects were observed for knowledge at either time point. Strategies that aim to increase workers' perceived control and self-efficacy over their sitting time may be helpful components of sedentary behaviour interventions in the workplace. However, social-cognitive factors only partially explain variation in workplace sitting reduction. Understanding the importance of other levels of influence (particularly interpersonal and environmental) for initiating and maintaining workplace sedentary behaviour change will be informative for intervention development and refinement. This study was prospectively registered with the Australian New Zealand Clinical Trials register ( ACTRN12611000742976 ) on 15 July 2011.

Role of clouds, aerosols, and aerosol-cloud interaction in 20th century simulations with GISS ModelE2

NASA Astrophysics Data System (ADS)

Nazarenko, L.; Rind, D. H.; Bauer, S.; Del Genio, A. D.

2015-12-01

Simulations of aerosols, clouds and their interaction contribute to the major source of uncertainty in predicting the changing Earth's energy and in estimating future climate. Anthropogenic contribution of aerosols affects the properties of clouds through aerosol indirect effects. Three different versions of NASA GISS global climate model are presented for simulation of the twentieth century climate change. All versions have fully interactive tracers of aerosols and chemistry in both the troposphere and stratosphere. All chemical species are simulated prognostically consistent with atmospheric physics in the model and the emissions of short-lived precursors [Shindell et al., 2006]. One version does not include the aerosol indirect effect on clouds. The other two versions include a parameterization of the interactive first indirect aerosol effect on clouds following Menon et al. [2010]. One of these two models has the Multiconfiguration Aerosol Tracker of Mixing state (MATRIX) that permits detailed treatment of aerosol mixing state, size, and aerosol-cloud activation. The main purpose of this study is evaluation of aerosol-clouds interactions and feedbacks, as well as cloud and aerosol radiative forcings, for the twentieth century climate under different assumptions and parameterizations for aerosol, clouds and their interactions in the climate models. The change of global surface air temperature based on linear trend ranges from +0.8°C to +1.2°C between 1850 and 2012. Water cloud optical thickness increases with increasing temperature in all versions with the largest increase in models with interactive indirect effect of aerosols on clouds, which leads to the total (shortwave and longwave) cloud radiative cooling trend at the top of the atmosphere. Menon, S., D. Koch, G. Beig, S. Sahu, J. Fasullo, and D. Orlikowski (2010), Black carbon aerosols and the third polar ice cap, Atmos. Chem. Phys., 10,4559-4571, doi:10.5194/acp-10-4559-2010. Shindell, D., G. Faluvegi, N. Unger, E. Aguilar, G.A. Schmidt, D.M. Koch, S.E. Bauer, and J.R. Miller (2006), Simulations of preindustrial, present-day, and 2100 conditions in the NASA GISS composition and climate model G-PUCCINI, Atmos. Chem. Phys., 6, 4427-4459.

Effect of surface treatment on bond strength between an indirect composite material and a zirconia framework.

PubMed

Komine, Futoshi; Fushiki, Ryosuke; Koizuka, Mai; Taguchi, Kohei; Kamio, Shingo; Matsumura, Hideo

2012-03-01

The present study evaluated the effect of various surface treatments for zirconia ceramics on shear bond strength between an indirect composite material and zirconia ceramics. In addition, we investigated the durability of shear bond strength by using artificial aging (20,000 thermocycles). A total of 176 Katana zirconia disks were randomly divided into eight groups according to surface treatment, as follows: group CON (as-milled); group GRD (wet-ground with 600-grit silicon carbide abrasive paper); groups 0.05, 0.1, 0.2, 0.4, and 0.6 MPa (airborne-particle abrasion at 0.05, 0.1, 0.2, 0.4, and 0.6 MPa, respectively); and group HF (9.5% hydrofluoric acid etching). Shear bond strength was measured at 0 thermocycles in half the specimens after 24-h immersion. The remaining specimens were subjected to 20,000 thermocycles before shear bond strength testing. Among the eight groups, the 0.1, 0.2, 0.4, and 0.6 MPa airborne-particle abraded groups had significantly higher bond strengths before and after thermocycling. The Mann-Whitney U-test revealed no significant difference in shear bond strength between 0 and 20,000 thermocycles, except in the 0.2 MPa group (P = 0.013). From the results of this study, use of airborne-particle abrasion at a pressure of 0.1 MPa or higher increases initial and durable bond strength between an indirect composite material and zirconia ceramics.

The Economics of Direct versus Indirect Cost Recovery in Sponsored Research. AIR Annual 1984 Forum Paper.

ERIC Educational Resources Information Center

Kutina, Kenneth L.; And Others

The effect of reduced reimbursements by the federal government for indirect research costs was analyzed for the typical academic medical center. The effects of simply cutting indirect cost reimbursement were contrasted with the impact of securing compensating levels of increased direct project support. To determine if the consequences differed as…

Developing an Item Bank to Measure Quality of Life in Individuals With Glaucoma, and the Results of the Interview With Patients: The Effect of Visual Function, Visual Field Progression Rate, Medical, and Surgical Treatments on Quality of Life.

PubMed

Matsuura, Masato; Hirasawa, Kazunori; Hirasawa, Hiroyo; Yanagisawa, Mieko; Murata, Hiroshi; Mayama, Chihiro; Asaoka, Ryo

2017-02-01

To construct a new item bank to measure quality of life (QOL) in glaucoma patients and to evaluate glaucoma patients' QOL using the item bank. An item bank of questions was generated through a literature review of QOL instruments useful for glaucoma patients. Using this item bank, a cognitive survey was performed on 203 patients with glaucoma (112 males and 91 females, 61.9±11.9 y old; mean±SD). The results were then analyzed using the Rasch analysis, and the Rasch-derived disability scores were predicted using linear modelling and the following clinical parameters: age, mean total deviation (mTD) in superior and inferior visual field (mTDsup/mTDinf), mTD progression rate, better visual acuity, worse visual acuity, number of eye drops administered per day, number of trabeculectomy procedures experienced in both eyes. A total of 23 questionnaires of QOL in glaucoma patients were identified resulting in an item bank of 187 questions related to the following tasks: reading/writing, walking, going out, eating and driving (direct disability) as well as questions concerned with worry/anxiety, social participation, and physical symptoms (indirect disability). In the optimal model for direct disability, age and mTDinf were identified as significant predictors, whereas number of eye drops administered per day and number of trabeculectomy experienced were included in the optimal model for indirect disability. A new item bank to measure QOL in glaucoma patients was developed and evaluated. Age and mTDinf were found to be related to direct disability while medical and surgical treatments were related to indirect disability.

Quantitative assessment of direct and indirect landslide risk along transportation lines in southern India

NASA Astrophysics Data System (ADS)

Jaiswal, P.; van Westen, C. J.; Jetten, V.

2010-06-01

A quantitative approach for landslide risk assessment along transportation lines is presented and applied to a road and a railway alignment in the Nilgiri hills in southern India. The method allows estimating direct risk affecting the alignments, vehicles and people, and indirect risk resulting from the disruption of economic activities. The data required for the risk estimation were obtained from historical records. A total of 901 landslides were catalogued initiating from cut slopes along the railway and road alignment. The landslides were grouped into three magnitude classes based on the landslide type, volume, scar depth, run-out distance, etc and their probability of occurrence was obtained using frequency-volume distribution. Hazard, for a given return period, expressed as the number of landslides of a given magnitude class per kilometre of cut slopes, was obtained using Gumbel distribution and probability of landslide magnitude. In total 18 specific hazard scenarios were generated using the three magnitude classes and six return periods (1, 3, 5, 15, 25, and 50 years). The assessment of the vulnerability of the road and railway line was based on damage records whereas the vulnerability of different types of vehicles and people was subjectively assessed based on limited historic incidents. Direct specific loss for the alignments (railway line and road), vehicles (train, bus, lorry, car and motorbike) was expressed in monetary value (US), and direct specific loss of life of commuters was expressed in annual probability of death. Indirect specific loss (US) derived from the traffic interruption was evaluated considering alternative driving routes, and includes losses resulting from additional fuel consumption, additional travel cost, loss of income to the local business, and loss of revenue to the railway department. The results indicate that the total loss, including both direct and indirect loss, from 1 to 50 years return period, varies from US 90 840 to US 779 500 and the average annual total loss was estimated as US 35 000. The annual probability of a person most at risk travelling in a bus, lorry, car, motorbike and train is less than 10-4/annum in all the time periods considered. The detailed estimation of direct and indirect risk will facilitate developing landslide risk mitigation and management strategies for transportation lines in the study area.

Effect of a temperature gradient on Sphagnum fallax and its associated living microbial communities: a study under controlled conditions.

PubMed

Jassey, Vincent E J; Gilbert, Daniel; Binet, Philippe; Toussaint, Marie-Laure; Chiapusio, Geneviève

2011-03-01

Microbial communities living in Sphagnum are known to constitute early indicators of ecosystem disturbances, but little is known about their response (including their trophic relationships) to climate change. A microcosm experiment was designed to test the effects of a temperature gradient (15, 20, and 25°C) on microbial communities including different trophic groups (primary producers, decomposers, and unicellular predators) in Sphagnum segments (0-3 cm and 3-6 cm of the capitulum). Relationships between microbial communities and abiotic factors (pH, conductivity, temperature, and polyphenols) were also studied. The density and the biomass of testate amoebae in Sphagnum upper segments increased and their community structure changed in heated treatments. The biomass of testate amoebae was linked to the biomass of bacteria and to the total biomass of other groups added and, thus, suggests that indirect effects on the food web structure occurred. Redundancy analysis revealed that microbial assemblages differed strongly in Sphagnum upper segments along a temperature gradient in relation to abiotic factors. The sensitivity of these assemblages made them interesting indicators of climate change. Phenolic compounds represented an important explicative factor in microbial assemblages and outlined the potential direct and (or) indirect effects of phenolics on microbial communities.

Effect of indirect non-thermal plasma on particle size distribution and composition of diesel engine particles

NASA Astrophysics Data System (ADS)

Linbo, GU; Yixi, CAI; Yunxi, SHI; Jing, WANG; Xiaoyu, PU; Jing, TIAN; Runlin, FAN

2017-11-01

To explore the effect of the gas source flow rate on the actual diesel exhaust particulate matter (PM), a test bench for diesel engine exhaust purification was constructed, using indirect non-thermal plasma technology. The effects of different gas source flow rates on the quantity concentration, composition, and apparent activation energy of PM were investigated, using an engine exhaust particle sizer and a thermo-gravimetric analyzer. The results show that when the gas source flow rate was large, not only the maximum peak quantity concentrations of particles had a large drop, but also the peak quantity concentrations shifted to smaller particle sizes from 100 nm to 80 nm. When the gas source flow rate was 10 L min-1, the total quantity concentration greatly decreased where the removal rate of particles was 79.2%, and the variation of the different mode particle proportion was obvious. Non-thermal plasma (NTP) improved the oxidation ability of volatile matter as well as that of solid carbon. However, the NTP gas source rate had little effects on oxidation activity of volatile matter, while it strongly influenced the oxidation activity of solid carbon. Considering the quantity concentration and oxidation activity of particles, a gas source flow rate of 10 L min-1 was more appropriate for the purification of particles.

Direct and indirect costs of nonfatal road traffic injuries in Iran: A population-based study.

PubMed

Karimi, Hasti; Soleyman-Jahi, Saeed; Hafezi-Nejad, Nima; Rahimi-Movaghar, Afarin; Amin-Esmaeili, Masoumeh; Sharifi, Vandad; Hajebi, Ahmad; Saadat, Soheil; Akbari Sari, Ali; Rahimi-Movaghar, Vafa

2017-05-19

The objective of this study was to assess the incidence rate as well as direct and indirect costs of nonfatal road traffic injuries (RTIs) in Iran in 2011. Data from the 2011 national household survey were used. In this survey, data on demographics, history, and costs of injury were obtained in 2 steps: first, direct face-to-face interview and second, telephone calls. We estimated the incidence rate of nonfatal RTIs in this year. The direct costs included medical care as well as nonmedical costs paid by the patient or insurance services. The indirect costs were estimated by considering the cost of absence from work or education. We also used logistic regression analyses to investigate risk factors of nonfatal RTIs. We found 76 nonfatal RTI cases (0.96%) out of 7,886 whole reference study cases. These 76 injured patients had a history of RTI in the preceding 3 months. The annual incidence of RTIs was estimated at 3.84%. The mean age of RTI cases was 28.5 ± 10.6 and 88.16% of them were male. Male gender was a major risk factor (odds ratio [OR] = 9.64, 95% confidence interval [CI], 4.79-19.41) and marriage was a protective factor (OR = 0.44, 95% CI, 0.28-0.70) for RTI. The medians of direct, indirect, and total costs were US$214, US$163, and US$387, respectively. The total cost of nonfatal RTIs in Iran was estimated at 1.29% of the gross domestic product (GDP) in 2011. In Iran, nonfatal RTIs imposed a total cost of almost US$7 billion to the country for one year. Extension and more serious implementation of preventive measurements seem necessary to decrease this notable burden of RTIs.

Burden of epilepsy: a prevalence-based cost of illness study of direct, indirect and intangible costs for epilepsy.

PubMed

Gao, Lan; Xia, Li; Pan, Song-Qing; Xiong, Tao; Li, Shu-Chuen

2015-02-01

We aimed to gauge the burden of epilepsy in China from a societal perspective by estimating the direct, indirect and intangible costs. Patients with epilepsy and controls were enrolled from two tertiary hospitals in China. Patients were asked to complete a Cost-of-Illness (COI), Willingness-to-Pay (WTP) questionnaires, two utility elicitation instruments and Mini Mental State Examination (MMSE). Healthy controls only completed WTP questionnaire, and utility instruments. Univariate analyses were performed to investigate the differences in cost on the basis of different variables, while multivariate analysis was undertaken to explore the predictors of cost/cost component. In total, 141 epilepsy patients and 323 healthy controls were recruited. The median total cost, direct cost and indirect cost due to epilepsy were US$949.29, 501.34 and 276.72, respectively. Particularly, cost of anti-epileptic drugs (AEDs) (US$394.53) followed by cost of investigations (US$59.34), cost of inpatient and outpatient care (US$9.62) accounted for the majority of the direct medical costs. While patients' (US$103.77) and caregivers' productivity costs (US$103.77) constituted the major component of indirect cost. The intangible costs in terms of WTP value (US$266.07 vs. 88.22) and utility (EQ-5D, 0.828 vs. 0.923; QWB-SA, 0.657 vs. 0.802) were both substantially higher compared to the healthy subjects. Epilepsy is a cost intensive disease in China. According to the prognostic groups, drug-resistant epilepsy generated the highest total cost whereas patients in seizure remission had the lowest cost. AED is the most costly component of direct medical cost probably due to 83% of patients being treated by new generation of AEDs. Copyright © 2014 Elsevier B.V. All rights reserved.

FY 2011 4th Quarter Metric: Estimate of Future Aerosol Direct and Indirect Effects

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

Koch, D

2011-09-21

The global and annual mean aerosol direct and indirect effects, relative to 1850 conditions, estimated from CESM simulations are 0.02 W m-2 and -0.39 W m-2, respectively, for emissions in year 2100 under the IPCC RCP8.5 scenario. The indirect effect is much smaller than that for 2000 emissions because of much smaller SO2 emissions in 2100; the direct effects are small due to compensation between warming by black carbon and cooling by sulfate.

The effects of temporal perspective on college students' energy drink consumption.

PubMed

Kim, Jarim; Anagondahalli, Deepa

2017-09-01

Consideration of future consequences (CFC) describes the extent to which individuals consider potential future outcomes of their present behaviors. This personality trait has been found to predict repetitive health behaviors. Research is yet to explore the role of health beliefs, which may mediate the relationship between CFC and self-directed health behaviors. Thus, this study examined how CFC affects energy drink-related health beliefs and consumption behavior. A cross-sectional correlational online survey with 1,050 college students was conducted. Key measures include the CFC Scale, health belief measures, and current energy drink consumption pattern. CFC was associated with energy drink consumption as well as several health beliefs. CFC had indirect effects on energy drink consumption through health beliefs, including perceived severity of consuming energy drinks (indirect effect estimate = -.191, 95% confidence interval [CI] [-.271, -.122]), perceived benefits of avoiding energy drinks (indirect effect estimate = -.108, 95% CI [-.174, -.050]), and perceived barriers in abstaining from energy drinks (energy level-related barriers, indirect effect estimate = -.274, 95% CI [-.387, -.181]; and socialization-related barriers, indirect effect estimate = .152, 95% CI [.078, .249]). As the first study to examine CFC's indirect effects on a self-directed health behavior through health beliefs, this study extended CFC's applicability by examining its role in the context of college students' energy drink consumption. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Warfare and children.

PubMed

Shann, Frank

2010-05-01

In 2007, 136 million children were born in the world, and 9.2 million died before they were 5 years old; 99.8% of these deaths were in developing countries, and 8.2 million were unnecessary. This is 23 000 unnecessary deaths every day. Approximately 0.2 million children die from the direct effects of war every year, and at least twice as many die from the indirect effects. However, most child deaths are caused by common childhood infections in communities that are not affected by war. In 2007, overseas development aid totalled only $104 billion, and world military expenditure totalled US$1339 billion. The 49 poorest countries in the world have a population of 1.3 billion; they spent only $27 per person on health in 2006, but the world spent $201 per person on military activity. The five permanent members of the United Nations Security Council account for 90% of weapons sales to developing countries, yet they are the very countries that have accepted responsibility for ensuring world security. Unfortunately, many governments in both rich and poor countries do not want to limit military spending - the vested interests that support military activity are too powerful. War is immensely harmful, but not primarily because of the horrible injuries, nor the large number of deaths it causes indirectly from infection, malnutrition, and social and political disruption. By far, the greatest harm comes from the diversion of huge amounts of money that could be used for beneficial development into harmful and destructive military activity.

Bearing Procurement Analysis Method by Total Cost of Ownership Analysis and Reliability Prediction

NASA Astrophysics Data System (ADS)

Trusaji, Wildan; Akbar, Muhammad; Sukoyo; Irianto, Dradjad

2018-03-01

In making bearing procurement analysis, price and its reliability must be considered as decision criteria, since price determines the direct cost as acquisition cost and reliability of bearing determine the indirect cost such as maintenance cost. Despite the indirect cost is hard to identify and measured, it has high contribution to overall cost that will be incurred. So, the indirect cost of reliability must be considered when making bearing procurement analysis. This paper tries to explain bearing evaluation method with the total cost of ownership analysis to consider price and maintenance cost as decision criteria. Furthermore, since there is a lack of failure data when bearing evaluation phase is conducted, reliability prediction method is used to predict bearing reliability from its dynamic load rating parameter. With this method, bearing with a higher price but has higher reliability is preferable for long-term planning. But for short-term planning the cheaper one but has lower reliability is preferable. This contextuality can give rise to conflict between stakeholders. Thus, the planning horizon needs to be agreed by all stakeholder before making a procurement decision.

Method 546: Determination of Total Microcystins and Nodularins in Drinking Water and Ambient Water by Adda Enzyme-Linked Immunosorbent Assay

EPA Pesticide Factsheets

This method is listed as Tier I for presumptive analysis of microcystins in water samples and Tier II all other environmental sample types. The method determines total microcystins and nodularins using an indirect competitive immunoassay (ELISA).

Enough to Go 'Round? Thinking Smart about Total Cost of Ownership

ERIC Educational Resources Information Center

McIntire, Todd

2006-01-01

Total cost of ownership or TCO refers to the life cycle of costs for technology, including both direct and indirect expenses. TCO includes costs incurred by capital (hardware, software, and facilities); administration and operation (planning, upgrade, replacement, and technical support); and end-user operation (staff development and user…

Pathways to delinquency and substance use among African American youth: Does future orientation mediate the effects of peer norms and parental monitoring?

PubMed

Marotta, Phillip L; Voisin, Dexter R

2017-10-01

The following study assessed whether future orientation mediated the effects of peer norms and parental monitoring on delinquency and substance use among 549 African American adolescents. Structural equation modeling computed direct and indirect (meditational) relationships between parental monitoring and peer norms through future orientation. Parental monitoring significantly correlated with lower delinquency through future orientation ( B = -.05, standard deviation = .01, p < .01). Future orientation mediated more than quarter (27.70%) of the total effect of parental monitoring on delinquency. Overall findings underscore the importance of strengthening resilience factors for African American youth, especially those who live in low-income communities.

Societal burden of cluster headache in the United States: a descriptive economic analysis.

PubMed

Ford, Janet H; Nero, Damion; Kim, Gilwan; Chu, Bong Chul; Fowler, Robert; Ahl, Jonna; Martinez, James M

2018-01-01

To estimate direct and indirect costs in patients with a diagnosis of cluster headache in the US. Adult patients (18-64 years of age) enrolled in the Marketscan Commercial and Medicare Databases with ≥2 non-diagnostic outpatient (≥30 days apart between the two outpatient claims) or ≥1 inpatient diagnoses of cluster headache (ICD-9-CM code 339.00, 339.01, or 339.02) between January 1, 2009 and June 30, 2014, were included in the analyses. Patients had ≥6 months of continuous enrollment with medical and pharmacy coverage before and after the index date (first cluster headache diagnosis). Three outcomes were evaluated: (1) healthcare resource utilization, (2) direct healthcare costs, and (3) indirect costs associated with work days lost due to absenteeism and short-term disability. Direct costs included costs of all-cause and cluster headache-related outpatient, inpatient hospitalization, surgery, and pharmacy claims. Indirect costs were based on an average daily wage, which was estimated from the 2014 US Bureau of Labor Statistics and inflated to 2015 dollars. There were 9,328 patients with cluster headache claims included in the analysis. Cluster headache-related total direct costs (mean [standard deviation]) were $3,132 [$13,396] per patient per year (PPPY), accounting for 17.8% of the all-cause total direct cost. Cluster headache-related inpatient hospitalizations ($1,604) and pharmacy ($809) together ($2,413) contributed over 75% of the cluster headache-related direct healthcare cost. There were three sub-groups of patients with claims associated with indirect costs that included absenteeism, short-term disability, and absenteeism + short-term disability. Indirect costs PPPY were $4,928 [$4,860] for absenteeism, $803 [$2,621] for short-term disability, and $3,374 [$3,198] for absenteeism + disability. Patients with cluster headache have high healthcare costs that are associated with inpatient admissions and pharmacy fulfillments, and high indirect costs associated with absenteeism and short-term disability.

Economic Burden of Herpes Zoster ("culebrilla") in Latin America.

PubMed

Rampakakis, Emmanouil; Pollock, Clare; Vujacich, Claudia; Toniolo Neto, Joao; Ortiz Covarrubias, Alejandro; Monsanto, Homero; Johnson, Kelly D

2017-05-01

Herpes zoster (HZ) is characterized by debilitating pain and blistering dermatomal rash. The most common complication of HZ is postherpetic neuralgia (PHN), a persistent pain that can substantially affect patients' quality of life. HZ has significant impact on patients' lives with considerable implications for healthcare systems and society. The purpose of this study was to evaluate the healthcare resource utilization (HCRU) and medical costs associated with HZ in Latin America. We conducted a pooled-analysis of three prospective cohort studies of HZ patients ≥50 years of age in Argentina (n=96); Brazil (n=145) and Mexico (n=142). Patients were recruited at different time-points during their HZ episode and were followed for six months. The incidence of PHN was defined as a worst ZBPI pain score of ≥3, persisting or appearing more than 90 days after the onset of rash. Work effectiveness was measured on a 100-point Likert scale where 100 was described as completely effective (able to work like before HZ began) and 0 as not effective at all. Direct costs included costs due to use of antiviral medications and all medical services used to treat HZ. Indirect cost was based on foregone earnings from patients due to work loss and presenteeism, and work loss by family caretakers. One-way sensitivity analysis was performed to assess the impact on total costs. All costs are reported in 2015 USD currency. 383 HZ patients were included and PHN incidence was 38.6%. The most commonly used resources were visits to the doctor's office (79.1% of patients), the emergency room (48.8%) and a specialist (37.9%); hospitalization was reported for 5.7% of patients. The overall direct cost per case was $763.19 USD, indirect cost was $701.40, for a total of $1,464.59 per HZ episode in Latin America. Total cost associated with HZ in patients with PHN was markedly higher compared to patients without PHN ($2,001.13 vs. $867.72, respectively) with indirect costs accounting for the most part of this difference. The sensitivity analysis was generally robust to changes in the assumptions made. HZ and its sequelae impose a substantial economic burden in Latin America which is expected to rise as the population ages and the number of HZ cases increases. The results support the need for early intervention, preventative strategies and improved disease management to reduce the HZ-associated disease burden in Latin America. Copyright © 2017 Merck Research Labs. Published by Elsevier Ltd.. All rights reserved.

Theory of mind in emerging reading comprehension: A longitudinal study of early indirect and direct effects.

PubMed

Atkinson, Lynette; Slade, Lance; Powell, Daisy; Levy, Joseph P

2017-12-01

The relation between children's theory of mind (ToM) and emerging reading comprehension was investigated in a longitudinal study over 2.5years. A total of 80 children were tested for ToM, decoding, language skills, and executive function (EF) at Time 1 (mean age=3;10 [years;months]). At Time 2 (mean age=6;03), children's word reading efficiency, language skills, and reading comprehension were measured. Mediation analysis showed that ToM at Time 1, when children were around 4years old, indirectly predicted Time 2 reading comprehension, when children were 6years old, via language ability after controlling for age, nonverbal ability, decoding, EF, and earlier language ability. Importantly, ToM at 4years also directly predicted reading comprehension 2.5years later at 6years. This is the first longitudinal study to show a direct contribution of ToM to reading comprehension in typical development. Findings are discussed in terms of the simple view of reading (SVR); ToM not only supports reading comprehension indirectly by facilitating language but also contributes to it directly over and above the SVR. The potential role of metacognition is considered when accounting for the direct contribution of early ToM to later reading comprehension. Copyright © 2017 Elsevier Inc. All rights reserved.

The Effect of Direct and Indirect Corrective Feedback on Iranian EFL Learners' Spelling Errors

ERIC Educational Resources Information Center

Ghandi, Maryam; Maghsoudi, Mojtaba

2014-01-01

The aim of the current study was to investigate the impact of indirect corrective feedback on promoting Iranian high school students' spelling accuracy in English (as a foreign language). It compared the effect of direct feedback with indirect feedback on students' written work dictated by their teacher from Chicken Soup for the Mother and…

Depression and pain: testing of serial multiple mediators.

PubMed

Wongpakaran, Tinakon; Wongpakaran, Nahathai; Tanchakvaranont, Sitthinant; Bookkamana, Putipong; Pinyopornpanish, Manee; Wannarit, Kamonporn; Satthapisit, Sirina; Nakawiro, Daochompu; Hiranyatheb, Thanita; Thongpibul, Kulvadee

2016-01-01

Despite the fact that pain is related to depression, few studies have been conducted to investigate the variables that mediate between the two conditions. In this study, the authors explored the following mediators: cognitive function, self-sacrificing interpersonal problems, and perception of stress, and the effects they had on pain symptoms among patients with depressive disorders. An analysis was performed on the data of 346 participants with unipolar depressive disorders. The 17-item Hamilton Depression Rating Scale, Mini-Mental State Examination, the pain subscale of the health-related quality of life (SF-36), the self-sacrificing subscale of the Inventory of Interpersonal Problems, and the Perceived Stress Scale were used. Parallel multiple mediator and serial multiple mediator models were used. An alternative model regarding the effect of self-sacrificing on pain was also proposed. Perceived stress, self-sacrificing interpersonal style, and cognitive function were found to significantly mediate the relationship between depression and pain, while controlling for demographic variables. The total effect of depression on pain was significant. This model, with an additional three mediators, accounted for 15% of the explained variance in pain compared to 9% without mediators. For the alternative model, after controlling for the mediators, a nonsignificant total direct effect level of self-sacrificing was found, suggesting that the effect of self-sacrificing on pain was based only on an indirect effect and that perceived stress was found to be the strongest mediator. Serial mediation may help us to see how depression and pain are linked and what the fundamental mediators are in the chain. No significant, indirect effect of self-sacrificing on pain was observed, if perceived stress was not part of the depression and/or cognitive function mediational chain. The results shown here have implications for future research, both in terms of testing the model and in clinical application.

Effects of eHealth Literacy on General Practitioner Consultations: A Mediation Analysis.

PubMed

Schulz, Peter Johannes; Fitzpatrick, Mary Anne; Hess, Alexandra; Sudbury-Riley, Lynn; Hartung, Uwe

2017-05-16

Most evidence (not all) points in the direction that individuals with a higher level of health literacy will less frequently utilize the health care system than individuals with lower levels of health literacy. The underlying reasons of this effect are largely unclear, though people's ability to seek health information independently at the time of wide availability of such information on the Internet has been cited in this context. We propose and test two potential mediators of the negative effect of eHealth literacy on health care utilization: (1) health information seeking and (2) gain in empowerment by information seeking. Data were collected in New Zealand, the United Kingdom, and the United States using a Web-based survey administered by a company specialized on providing online panels. Combined, the three samples resulted in a total of 996 baby boomers born between 1946 and 1965 who had used the Internet to search for and share health information in the previous 6 months. Measured variables include eHealth literacy, Internet health information seeking, the self-perceived gain in empowerment by that information, and the number of consultations with one's general practitioner (GP). Path analysis was employed for data analysis. We found a bundle of indirect effect paths showing a positive relationship between health literacy and health care utilization: via health information seeking (Path 1), via gain in empowerment (Path 2), and via both (Path 3). In addition to the emergence of these indirect effects, the direct effect of health literacy on health care utilization disappeared. The indirect paths from health literacy via information seeking and empowerment to GP consultations can be interpreted as a dynamic process and an expression of the ability to find, process, and understand relevant information when that is necessary. ©Peter Johannes Schulz, Mary Anne Fitzpatrick, Alexandra Hess, Lynn Sudbury-Riley, Uwe Hartung. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 16.05.2017.

The Contributing Risk of Tobacco Use for ARDS Development in Burn-Injured Adults With Inhalation Injury.

PubMed

Afshar, Majid; Netzer, Giora; Mosier, Michael J; Cooper, Richard S; Adams, William; Burnham, Ellen L; Kovacs, Elizabeth J; Durazo-Arvizu, Ramon; Kliethermes, Stephanie

2017-11-01

This study aims to determine the relationship between tobacco use, inhalation injury, and ARDS in burn-injured adults. This study was an observational cohort of 2,485 primary burn admissions to a referral burn center between January 1, 2008 and March 15, 2015. Subjects were evaluated by methods used to account for mediation and traditional approaches (multivariable logistic regression and propensity score analysis). Mediation analysis examined both the (1) indirect effect of tobacco use via inhalation injury as the mediator on ARDS development and (2) the direct effect of tobacco use alone on ARDS development. ARDS development occurred in 6.8% ( n = 170) of the cohort. Inhalation injury occurred in 5.0% ( n = 125) of the cohort, and ARDS developed in 48.8% ( n = 83) of the subjects with inhalation injury. Tobacco use was 2-fold more common in subjects with ARDS. In the mediated model, the direct effect of tobacco use on ARDS, including interaction between tobacco use and inhalation injury, was not significant (odds ratio [OR] 1.63, 95% CI 0.91-2.92, P = .10). However, the indirect effect of tobacco use via inhalation injury as the mediator was significant (OR 1.61, 95% CI 1.25-2.07, P < .001), and the proportion of the total effect of tobacco use operating through the mediator was 55.6%. In the non-mediation models (multivariable logistic regression and propensity score analysis), which controlled for inhalation injury and other covariables, the OR for the association between tobacco use and ARDS was 1.84 (95% CI 1.22-2.81, P < .001) and 1.69 (95% CI 1.04-2.75, P = .03), respectively. In mediation analysis, inhalation injury was the overwhelming predictor for ARDS development, whereas tobacco use has its strongest effect indirectly through inhalation injury. Patients with at least moderate inhalation injury are at greatest risk for ARDS development despite baseline risk factors like tobacco use. Copyright © 2017 by Daedalus Enterprises.

Using indirect covariance spectra to identify artifact responses in unsymmetrical indirect covariance calculated spectra.

PubMed

Martin, Gary E; Hilton, Bruce D; Blinov, Kirill A; Williams, Antony J

2008-02-01

Several groups of authors have reported studies in the areas of indirect and unsymmetrical indirect covariance NMR processing methods. Efforts have recently focused on the use of unsymmetrical indirect covariance processing methods to combine various discrete two-dimensional NMR spectra to afford the equivalent of the much less sensitive hyphenated 2D NMR experiments, for example indirect covariance (icv)-heteronuclear single quantum coherence (HSQC)-COSY and icv-HSQC-nuclear Overhauser effect spectroscopy (NOESY). Alternatively, unsymmetrical indirect covariance processing methods can be used to combine multiple heteronuclear 2D spectra to afford icv-13C-15N HSQC-HMBC correlation spectra. We now report the use of responses contained in indirect covariance processed HSQC spectra as a means for the identification of artifacts in both indirect covariance and unsymmetrical indirect covariance processed 2D NMR spectra. Copyright (c) 2007 John Wiley & Sons, Ltd.

AB064. Estimation of direct and indirect costs and quality of life of patients with chronic obstructive pulmonary disease and their burden on Greek Health System

PubMed Central

Zarogoulidou, Vasiliki; Arbanitidou-Bagiona, Maria; Papakosta, Despoina; Zarogoulidis, Paul; Porpodis, Konstantinos; Panagopoulou, Evaggelia; Chaidits, Athanasios Basileio; Kontakiotis, Theodore; Zarogoulidis, Konstantinos

2016-01-01

Background The aim of this study was to make an attempt to estimate the direct and indirect costs of chronic obstructive pulmonary disease since in Greece very few attempts have been done to measure these costs and data available are insufficient. Our research focused on evaluating these direct and indirect costs according to demographic factors, response to treatment, patient survival, quality of life and patient satisfaction from the health care services provided. Methods This study was performed in Pulmonary Department of Aristotle University of Thessaloniki, General Hospital “G. Papanikolaou” and 110 patients with chronic obstructive pulmonary disease were enrolled. The follow-up duration of the patients was two years from the time of diagnosis. First, for study purposes the calculation of direct and indirect costs were performed and their correlations with patients’ demographics (gender, age, profession, place of residence), number of exacerbations, response to treatment and survival. In parallel, every three months from the time of diagnosis patients’ quality of life was recorded, using questionnaires, which was also correlated with the direct and indirect costs of each disease under investigation. The exploration of patient satisfaction from the health services provided was performed once for each patient during the first hospital stay in the Pulmonary Department of Aristotle University of Thessaloniki, General Hospital “G. Papanikolaou”. Results The total mean costs per patient in a one year follow-up was: total mean direct cost: 3.889,08€, total mean indirect cost: 18.01€. In chronic obstructive pulmonary disease (COPD) higher costs were observed in patients over 70 years old, of secondary education and pensioners, while for bronchial asthma higher costs were observed mainly in women. The disease severity, the frequency of exacerbations and the need for hospitalization significantly increased the economic burden of Greek health care system. The increase of the medication and patients’ monitoring cost resulted in improved control of the disease. Patients with COPD showed stable or deteriorating quality of life during the 12 month period of time. At 24 months of follow-up, patients with COPD reported improved quality of life compared to diagnosis. Improved the quality of life was associated with increased direct and indirect costs. The increased costs that were partly the result of frequent examinations, treatments and visits to the doctor, seemed to have negatively affected the emotional state of patients. Improved quality of life in COPD patients was related with reduced direct and indirect costs. Patient satisfaction from the provided health services could not be assessed as there was no homogeneity among the questions of the questionnaire used for the study. Future research should be made for the development of a reliable tool for recording patient satisfaction from the provided health services in hospitals of our country. Conclusions The higher annual burden of COPD patients is probably due to the infectious exacerbations COPD patients experience, which usually leads them to hospitalization. Patients quality of life is influenced from a variety of factors and was correlated with direct or/and indirect hospitalisation and/or monitoring cost.

A Structural Equation Modeling Approach to Examining Factors Influencing Outcomes with Cochlear Implant in Mandarin-Speaking Children

PubMed Central

Chen, Yuan; Wong, Lena L. N.; Zhu, Shufeng; Xi, Xin

2015-01-01

Objective To examine the direct and indirect effects of demographical factors on speech perception and vocabulary outcomes of Mandarin-speaking children with cochlear implants (CIs). Methods 115 participants implanted before the age of 5 and who had used CI before 1 to 3 years were evaluated using a battery of speech perception and vocabulary tests. Structural equation modeling was used to test the hypotheses proposed. Results Early implantation significantly contributed to speech perception outcomes while having undergone a hearing aid trial (HAT) before implantation, maternal educational level (MEL), and having undergone universal newborn hearing screening (UNHS) before implantation had indirect effects on speech perception outcomes via their effects on age at implantation. In addition, both age at implantation and MEL had direct and indirect effects on vocabulary skills, while UNHS and HAT had indirect effects on vocabulary outcomes via their effects on age at implantation. Conclusion A number of factors had indirect and direct effects on speech perception and vocabulary outcomes in Mandarin-speaking children with CIs and these factors were not necessarily identical to those reported among their English-speaking counterparts. PMID:26348360

Indirect genetic effects from competition in the clonal herb Sedum album (Crassulaceae).

PubMed

Andersson, Stefan

2014-01-01

Recent years have seen increasing interest in indirect genetic effects, i.e. influences on the phenotype that depend on the genotype of other conspecific individuals; however, the empirical evidence for such effects is still limited, especially in wild plant species. The present study of the clonal herb Sedum album assessed direct and indirect genetic effects on performance-related traits in a 4-year experiment with clonally replicated genotypes, grown in pairs and differing in anthocyanin pigmentation to allow separation of individuals during data collection. In agreement with the existence of indirect genetic effects, the experimentally-paired plants not only expressed their own genotype but were also affected by the genotype of their pair mate. The effect of neighbour genotype explained up to one-fourth of the variation in performance and most likely resulted from competition, imposed by the close physical contact between paired individuals and the limiting conditions used in the garden environment. Indirect genetic effects from competition have the potential to enhance the efficacy of group-level selection relative to individual selection, given the nutrient-poor and spatially-confined substrate available to plants of S. album in the natural habitat.

The effect of different spectral shape parameterizations of cloud droplet size distribution on first and second aerosol indirect effects in NACR CAM5 and evaluation with satellite data

NASA Astrophysics Data System (ADS)

Wang, M.; Peng, Y.; Xie, X.; Liu, Y.

2017-12-01

Aerosol cloud interaction continues to constitute one of the most significant uncertainties for anthropogenic climate perturbations. The parameterization of cloud droplet size distribution and autoconversion process from large scale cloud to rain can influence the estimation of first and second aerosol indirect effects in global climate models. We design a series of experiments focusing on the microphysical cloud scheme of NCAR CAM5 (Community Atmospheric Model Version 5) in transient historical run with realistic sea surface temperature and sea ice. We investigate the effect of three empirical, two semi-empirical and one analytical expressions for droplet size distribution on cloud properties and explore the statistical relationships between aerosol optical thickness (AOT) and simulated cloud variables, including cloud top droplet effective radius (CDER), cloud optical depth (COD), cloud water path (CWP). We also introduce the droplet spectral shape parameter into the autoconversion process to incorporate the effect of droplet size distribution on second aerosol indirect effect. Three satellite datasets (MODIS Terra/ MODIS Aqua/ AVHRR) are used to evaluate the simulated aerosol indirect effect from the model. Evident CDER decreasing with significant AOT increasing is found in the east coast of China to the North Pacific Ocean and the east coast of USA to the North Atlantic Ocean. Analytical and semi-empirical expressions for spectral shape parameterization show stronger first aerosol indirect effect but weaker second aerosol indirect effect than empirical expressions because of the narrower droplet size distribution.

Gratitude mediates the effect of emotional intelligence on subjective well-being: A structural equation modeling analysis.

PubMed

Geng, Yuan

2016-11-01

This study investigated the relationship among emotional intelligence, gratitude, and subjective well-being in a sample of university students. A total of 365 undergraduates completed the emotional intelligence scale, the gratitude questionnaire, and the subjective well-being measures. The results of the structural equation model showed that emotional intelligence is positively associated with gratitude and subjective well-being, that gratitude is positively associated with subjective well-being, and that gratitude partially mediates the positive relationship between emotional intelligence and subjective well-being. Bootstrap test results also revealed that emotional intelligence has a significant indirect effect on subjective well-being through gratitude.

Developmental cascade models linking peer victimization, depression, and academic achievement in Chinese children.

PubMed

Liu, Junsheng; Bullock, Amanda; Coplan, Robert J; Chen, Xinyin; Li, Dan; Zhou, Ying

2018-03-01

This study explored the longitudinal relations among peer victimization, depression, and academic achievement in Chinese primary school students. Participants were N = 945 fourth-grade students (485 boys, 460 girls; M age  = 10.16 years, SD = 2 months) attending elementary schools in Shanghai, People's Republic of China. Three waves of data on peer victimization, depression, and academic achievement were collected from peer nominations, self-reports, and school records, respectively. The results indicated that peer victimization had both direct and indirect effects on later depression and academic achievement. Depression also had both direct and indirect negative effects on later academic achievement, but demonstrated only an indirect effect on later peer victimization. Finally, academic achievement had both direct and indirect negative effects on later peer victimization and depression. The findings show that there are cross-cultural similarities and differences in the various transactions that exist among peer victimization, depression, and academic achievement. Statement of contribution What is already known on this subject? Peer victimization directly and indirectly relates to depression and academic achievement. Depression directly and indirectly relates to academic achievement. Academic achievement directly and indirectly relates to depression. What the present study adds? A developmental cascade approach was used to assess the interrelations among peer victimization, depression, and academic achievement. Academic achievement mediates the relation between peer victimization and depression. Depression is related to peer victimization through academic achievement. Academic achievement directly and indirectly relates to peer victimization. Academic achievement is related to depression through peer victimization. © 2017 The British Psychological Society.

An invasive herbivore structures plant competitive dynamics.

PubMed

Wong, Lydia; Grainger, Tess Nahanni; Start, Denon; Gilbert, Benjamin

2017-11-01

Species interactions are central to our understanding of ecological communities, but may change rapidly with the introduction of invasive species. Invasive species can alter species interactions and community dynamics directly by having larger detrimental effects on some species than others, or indirectly by changing the ways in which native species compete among themselves. We tested the direct and indirect effects of an invasive aphid herbivore on a native aphid species and two host milkweed species. The invasive aphid caused a 10-fold decrease in native aphid populations, and a 30% increase in plant mortality (direct effects). The invasive aphid also increased the strength of interspecific competition between the two native plant hosts (indirect effects). By investigating the role that indirect effects play in shaping species interactions in native communities, our study highlights an understudied component of species invasions. © 2017 The Author(s).

Comparison of an indirect tri-planar myofascial release (MFR) technique and a hot pack for increasing range of motion.

PubMed

Kain, Jay; Martorello, Laura; Swanson, Edward; Sego, Sandra

2011-01-01

The purpose of the randomized clinical study was to scientifically assess which intervention increases passive range of motion most effectively: the indirect tri-planar myofascial release (MFR) technique or the application of hot packs for gleno-humeral joint flexion, extension, and abduction. A total of 31 participants from a sample of convenience were randomly assigned to examine whether or not MFR was as effective in increasing range of motion as hot packs. The sample consisted of students at American International College. Students were randomly assigned to two groups: hot pack application (N=13) or MFR technique (N=18). The independent variable was the intervention, either the tri-planar MFR technique or the hot pack application. Group one received the indirect tri-planar MFR technique once for 3min. Group two received one hot pack application for 20min. The dependent variables, passive gleno-humeral shoulder range of motion in shoulder flexion, shoulder extension, and shoulder abduction, were taken pre- and post-intervention for both groups. Data was analyzed through the use of a two-way factorial design with mixed-factors ANOVA. Prior to conducting the study, inter-rater reliability was established using three testers for goniometric measures. A 2 (type of intervention: hot packs or MFR) by 2 (pre-test or post-test) mixed-factors ANOVA was calculated. Significant increases in range of motion were found for flexion, extension and abduction when comparing pre-test scores to post-test scores. The results of the ANOVA showed that for passive range of motion no differences were found for flexion, extension and abduction between the effectiveness of hot packs and MFR. For each of the dependent variables measured, MFR was shown to be as effective as hot packs in increasing range of motion, supporting the hypothesis. Since there was no significant difference between the types of intervention, both the hot pack application and the MFR technique were found to be equally effective in increasing passive range of motion of the joint in flexion, extension, and abduction of the gleno-humeral joint. The indirect tri-planar intervention could be considered more effective as an intervention in terms of time spent with a patient and the number of patients seen in a 20-min period. No equipment is required to carry out the MFR intervention, whereby using a hot pack requires the hot pack, towels, and a hydraculator unit with the use of the indirect tri-planar intervention, a therapist could treat four to five patients in the time it would take for one standard hot pack treatment of 20min, less the hands-on intervention of the therapist. Copyright © 2009 Elsevier Ltd. All rights reserved.

An introduction to the indirect exposure assessment approach: modeling human exposure using microenvironmental measurements and the recent National Human Activity Pattern Survey.

PubMed Central

Klepeis, N E

1999-01-01

Indirect exposure approaches offer a feasible and accurate method for estimating population exposures to indoor pollutants, including environmental tobacco smoke (ETS). In an effort to make the indirect exposure assessment approach more accessible to people in the health and risk assessment fields, this paper provides examples using real data from (italic>a(/italic>) a week-long personal carbon monoxide monitoring survey conducted by the author; and (italic>b(/italic>) the 1992 to 1994 National Human Activity Pattern Survey (NHAPS) for the United States. The indirect approach uses measurements of exposures in specific microenvironments (e.g., homes, bars, offices), validated microenvironmental models (based on the mass balance equation), and human activity pattern data obtained from questionnaires to predict frequency distributions of exposure for entire populations. This approach requires fewer resources than the direct approach to exposure assessment, for which the distribution of monitors to a representative sample of a given population is necessary. In the indirect exposure assessment approach, average microenvironmental concentrations are multiplied by the total time spent in each microenvironment to give total integrated exposure. By assuming that the concentrations encountered in each of 10 location categories are the same for different members of the U.S. population (i.e., the NHAPS respondents), the hypothetical contribution that ETS makes to the average 24-hr respirable suspended particle exposure for Americans working their main job is calculated in this paper to be 18 microg/m3. This article is an illustrative review and does not contain an actual exposure assessment or model validation. Images Figure 3 Figure 4 PMID:10350522

The cost of headache disorders in Europe: the Eurolight project.

PubMed

Linde, M; Gustavsson, A; Stovner, L J; Steiner, T J; Barré, J; Katsarava, Z; Lainez, J M; Lampl, C; Lantéri-Minet, M; Rastenyte, D; Ruiz de la Torre, E; Tassorelli, C; Andrée, C

2012-05-01

Headache disorders are very common, but their monetary costs in Europe are unknown. We performed the first comprehensive estimation of how economic resources are lost to headache in Europe.   From November 2008 to August 2009, a cross-sectional survey was conducted in eight countries representing 55% of the adult EU population. Participation rates varied between 11% and 59%. In total, 8412 questionnaires contributed to this analysis. Using bottom-up methodology, we estimated direct (medications, outpatient health care, hospitalization and investigations) and indirect (work absenteeism and reduced productivity at work) annual per-person costs. Prevalence data, simultaneously collected and, for migraine, also derived from a systematic review, were used to impute national costs.   Mean per-person annual costs were €1222 for migraine (95% CI 1055-1389; indirect costs 93%), €303 for tension-type headache (TTH, 95% CI 230-376; indirect costs 92%), €3561 for medication-overuse headache (MOH, 95% CI 2487-4635; indirect costs 92%), and €253 for other headaches (95% CI 99-407; indirect costs 82%). In the EU, the total annual cost of headache amongst adults aged 18-65 years was calculated, according to our prevalence estimates, at €173 billion, apportioned to migraine (€111 billion; 64%), TTH (€21 billion; 12%), MOH (€37 billion; 21%) and other headaches (€3 billion; 2%). Using the 15% systematic review prevalence of migraine, calculated costs were somewhat lower (migraine €50 billion, all headache €112 billion annually).   Headache disorders are prominent health-related drivers of immense economic losses for the EU. This has immediate implications for healthcare policy. Health care for headache can be both improved and cost saving. © 2011 The Author(s). European Journal of Neurology © 2011 EFNS.

Using indirect comparisons to compare interventions within a Cochrane review: a tool for comparative effectiveness research.

PubMed

Agapova, Maria; Devine, Emily B; Nguyen, Hiep; Wolf, Fredric M; Inoue, Lurdes Y T

2014-07-01

Assessing relative performance among competing interventions is an important part of comparative effectiveness research. Bayesian indirect comparisons add information to existing Cochrane reviews, such as which intervention is likely to perform best. However, heterogeneity variance priors may influence results and, potentially, clinical guidance. We highlight the features of Bayesian indirect comparisons using a case study of a Cochrane review update in asthma care. The probability that one self-management educational intervention outperforms others is estimated. Simulation studies investigate the effect of heterogeneity variance prior distributions. Results suggest a 55% probability that individual education is best, followed by combination (39%) and group (6%). The intervention with few trials was sensitive to prior distributions. Bayesian indirect comparisons updates of Cochrane reviews are valuable comparative effectiveness research tools.

The societal burden of blindness secondary to retinopathy of prematurity in Lima, Peru.

PubMed

Dave, Hreem B; Gordillo, Luz; Yang, Zhou; Zhang, Monica S; Hubbard, G Baker; Olsen, Timothy W

2012-10-01

To determine the cost-effectiveness of laser treatment for retinopathy of prematurity (ROP) in Lima, Peru. A cost-of-illness study (in US dollars) to determine the direct cost of treatment, the indirect lifetime cost of blindness, and the quality-adjusted life years. The direct cost of ROP-related treatment was determined by reviewing data retrospectively from a social security sector hospital. The indirect cost was determined using national economic data of Peru published by the Central Information Agency (CIA), including the per capita gross domestic product, the sex-adjusted income distribution, and years spent in the work force. Indirect costs per child that were avoided by treatment were calculated using the known natural history of ROP vs evidence-based treatment. For ROP-related neonatal blindness in Peru, we estimate the total indirect cost saving at $197,753 per child and the direct cost of laser treatment at $2496 per child. The societal lifetime cost saving per child is estimated at $195,257. The mean annual income per educated adult in Peru is $8000 and treating 1 child is equivalent to employing 24 educated Peruvians per year. The generational cost savings for society is approximately $516 million, or the equivalent of 64,500 educated Peruvian work years. The societal burden of blindness far exceeds the costs of treatment per child. Proper screening and treatment of ROP prevents blindness and leads to substantial cost savings for society. Public health policy in Peru and other middle-income countries should consider financial impact when allocating healthcare resources. Copyright © 2012 Elsevier Inc. All rights reserved.

Establishment of reference intervals for serum thyroid-stimulating hormone, free and total thyroxine, and free and total triiodothyronine for the Beckman Coulter DxI-800 analyzers by indirect method using data obtained from Chinese population in Zhejiang Province, China.

PubMed

Wang, Yan; Zhang, Yu-Xia; Zhou, Yong-Lie; Xia, Jun

2017-07-01

In order to establish suitable reference intervals of thyroid-stimulating hormone (TSH), free (unbound) T4 (FT4), free triiodothyronine (FT3), total thyroxine (T4), and total triiodothyronine (T3) for the patients collected in Zhejiang, China, an indirect method was developed using the data from the people presented for routine health check-up. Fifteen thousand nine hundred and fifty-six person's results were reviewed. Box-Cox or Case Rank was used to transform the data to normal distribution. Tukey and Box-Plot methods were used to exclude the outliers. Nonparametric method was used to establish the reference intervals following the EP28-A3c guideline. Pearson correlation was used to evaluate the correlation between hormone levels and age, while Mann-Whitney U test was employed for quantification of concentration differences on the people who are younger and older than 50 years old. Reference intervals were 0.66-4.95 mIU/L (TSH), 8.97-14.71 pmol/L (FT4), 3.75-5.81 pmol/L (FT3), 73.45-138.93 nmol/L (total T4), and 1.24-2.18 nmol/L (total T3) in male; conversely, reference intervals for female were 0.72-5.84 mIU/L (TSH), 8.62-14.35 pmol/L (FT4), 3.59-5.56 pmol/L (FT3), 73.45-138.93 nmol/L (total T4), and 1.20-2.10 nmol/L (total T3). FT4, FT3, and total T3 levels in male and FT4 level in female had an inverse correlation with age. Total T4 and TSH levels in female were directly correlated. Significant differences in these hormones were also found between younger and older than 50 years old except FT3 in female. Indirect method can be applied for establishment of reference intervals for TSH, FT4, FT3, total T4, and total T3. The reference intervals are narrower than those previously established. Age factor should also be considered. © 2016 Wiley Periodicals, Inc.

Costs of epilepsy and cost-driving factors in children, adolescents, and their caregivers in Germany.

PubMed

Riechmann, Janna; Strzelczyk, Adam; Reese, Jens P; Boor, Rainer; Stephani, Ulrich; Langner, Cornelia; Neubauer, Bernd A; Oberman, Bettina; Philippi, Heike; Rochel, Michael; Seeger, Jürgen; Seipelt, Peter; Oertel, Wolfgang H; Dodel, Richard; Rosenow, Felix; Hamer, Hajo M

2015-09-01

To provide first data on the cost of epilepsy and cost-driving factors in children, adolescents, and their caregivers in Germany. A population-based, cross-sectional sample of consecutive children and adolescents with epilepsy was evaluated in the states of Hessen and Schleswig-Holstein (total of 8.796 million inhabitants) in all health care sectors in 2011. Data on socioeconomic status, course of epilepsy, and direct and indirect costs were recorded using patient questionnaires. We collected data from 489 children and adolescents (mean age ± SD 10.4 ± 4.2 years, range 0.5-17.8 years; 264 [54.0%] male) who were treated by neuropediatricians (n = 253; 51.7%), at centers for social pediatrics ("Sozialpaediatrische Zentren," n = 110, 22.5%) and epilepsy centers (n = 126; 25.8%). Total direct costs summed up to €1,619 ± €4,375 per participant and 3-month period. Direct medical costs were due mainly to hospitalization (47.8%, €774 ± €3,595 per 3 months), anticonvulsants (13.2%, €213 ± €363), and ancillary treatment (9.1%, €147 ± €344). The total indirect costs amounted to €1,231 ± €2,830 in mothers and to €83 ± €593 in fathers; 17.4% (n = 85) of mothers and 0.6% (n = 3) of fathers reduced their working hours or quit work because of their child's epilepsy. Independent cost-driving factors were younger age, symptomatic cause, and polytherapy with anticonvulsants. Older age, active epilepsy, symptomatic cause, and polytherapy were independent predictors of higher antiepileptic drug (AED) costs, whereas younger age, longer epilepsy duration, symptomatic cause, disability, and parental depression were independent predictors for higher indirect costs. Treatment of children and adolescents with epilepsy is associated with high direct costs due to frequent inpatient admissions and high indirect costs due to productivity losses in mothers. Direct costs are age-dependent and higher in patients with symptomatic epilepsy and polytherapy. Indirect costs are higher in the presence of a child's disability and parental depression. Wiley Periodicals, Inc. © 2015 International League Against Epilepsy.

Economic impact of multiple sclerosis disease-modifying drugs in an employed population: direct and indirect costs.

PubMed

Birnbaum, Howard G; Ivanova, Jasmina I; Samuels, Seth; Davis, Matthew; Cremieux, Pierre Y; Phillips, Amy L; Meletiche, Dennis

2009-04-01

The study objective is to compare the annual total medical and indirect costs of newly treated and untreated employees with multiple sclerosis (MS). A retrospective database analysis of employer medical, drug, and disability claims database (Ingenix Employer database, 1999-2005; 17 large US companies) was conducted for employees 18-64 years of age with > or =1 MS diagnosis after January 1, 2002. Employees with > or =1 MS disease-modifying drug (DMD) claim comprised the newly treated group; employees with MS but no DMD at any time comprised the untreated, comparison group. Index date was the day after the most recent claim (treated, DMD claim; untreated, MS claim) meeting the following requirements: continuous health coverage for 3 months before (baseline period) and 12 months after the index date (study period) and actively employed during baseline. Total medical costs and indirect (work loss) costs over the 1-year study period (2006 $US) were compared for DMD-treated and untreated MS employees, adjusting for baseline characteristics, including comorbidities. During the baseline, MS employees who became treated (n = 258) were younger (40.9 vs. 44.4 years, p < 0.0001) and had a higher proportion of women (72 vs. 62%, p = 0.007) than the untreated group of MS employees who never received DMD treatment (n = 322). The 3-month baseline MS-related medical costs were higher among treated MS employees ($2520 vs. $1012, p < 0.0001). There was a nonsignificant trend toward higher baseline non-MS-related medical costs in untreated versus treated MS employees. Risk-adjusted total annual medical costs ($4393 vs. $6187, p < 0.0001) and indirect costs ($2252 vs. $3053, p < 0.0001) were significantly lower for treated MS employees than for untreated MS employees. Initiation of MS disease-modifying drugs was associated with substantial significant medical and indirect savings for employees with MS. Study findings should be considered in the context of the study limitations (e.g., analytic focus on employees with at least 12-month follow-up; lack of clinical detail on MS severity).

Disease activity, quality of life and indirect costs of reduced productivity at work, generated by Polish patients with ankylosing spondylitis.

PubMed

Kawalec, Paweł; Malinowski, Krzysztof

2015-01-01

The aim of the study was to investigate the association between activity of ankylosing spondylitis (AS) and decrease in quality of life as well as productivity loss of affected patients in a specified group of patients in the Polish setting. An questionnaire survey was conducted using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) to assess disease activity, as well as the Work Productivity and Activity Impairment Questionnaires to assess productivity loss; quality of life was presented as utility calculated using the EuroQol 5 questionnaire and also measured on a visual analogue scale (VAS). Indirect costs were assessed with the human capital approach implying gross domestic product per capita or gross value added per worker in Poland in 2014 and were expressed in Polish zlotys (PLN) as well as in euros. Correlation was presented using Spearman's rank correlation coefficient. We performed our analysis based on 78 full questionnaires collected. A mean BASDAI score of 5.91 in the analysed group of patients was detected and mean utility of 0.5135 was observed. Average quality of life measured on the visual analogue scale was 46.55. Mean number of days off work was 45.26 days per year and mean on-the-job productivity loss was 49.29%. Average annual indirect costs per patient were €4241 (17 686 PLN) calculated using gross domestic product and €10 172 (42 417 PLN) estimated using gross value added. Total productivity loss was significantly correlated with disease activity (strong correlation of 0.6005) and utility (moderate correlation of -0.3698). Ankylosing spondylitis causes a great decrease in quality of life as well as patients' productivity loss associated with both absenteeism and presenteeism. The greater the disease activity is, the lower is the utility, the lower is the quality of life measured on the VAS, and the greater are the total annual indirect costs. Total indirect costs were negatively correlated with utility; although the association was moderate, it was significant.

Posthospital Discharge Medical Care Costs and Family Burden Associated with Osteoporotic Fracture Patients in China from 2011 to 2013

PubMed Central

Burge, Russel; Yang, Yicheng; Du, Fen; Lu, Tie; Huang, Qiang; Ye, Wenyu; Xu, Weihua

2015-01-01

Objectives. This study collected and evaluated data on the costs of outpatient medical care and family burden associated with osteoporosis-related fracture rehabilitation following hospital discharge in China. Materials and Methods. Data were collected using a patient questionnaire from osteoporosis-related fracture patients (N = 123) who aged 50 years and older who were discharged between January 2011 and January 2013 from 3 large hospitals in China. The survey captured posthospital discharge direct medical costs, indirect medical costs, lost work time for caregivers, and patient ambulatory status. Results. Hip fracture was the most frequent fracture site (62.6%), followed by vertebral fracture (34.2%). The mean direct medical care costs per patient totaled 3,910¥, while mean indirect medical costs totaled 743¥. Lost work time for unpaid family caregivers was 16.4 days, resulting in an average lost income of 3,233¥. The average posthospital direct medical cost, indirect medical cost, and caregiver lost income associated with a fracture patient totaled 7,886¥. Patients' ambulatory status was negatively impacted following fracture. Conclusions. Significant time and cost of care are placed on patients and caregivers during rehabilitation after discharge for osteoporotic fracture. It is important to evaluate the role and responsibility for creating the growing and inequitable burden placed on patients and caregivers following osteoporotic fracture. PMID:26221563

Example of cost calculations for an operating room and a post-anaesthesia care unit.

PubMed

Raft, J; Millet, F; Meistelman, C

2015-08-01

The aim of this study was to evaluate the cost of an operating room using data from our hospital. Using an accounting-based method helped us. Over the year 2012, the sum of direct and indirect expenses with cost sharing expenses allowed us to calculate the cost of the operating room (OR) and of the post-anaesthesia care unit (PACU). The cost of the OR and PACU was €10.8 per minute of time offered. Two thirds of the direct expenses were allocated to surgery and one third to anaesthesia. Indirect expenses were 25% of the direct expenses. The cost of medications and single use medical devises was €111.45 per anaesthesia. The total cost of anaesthesia (taking into account wages and indirect expenses) was €753.14 per anaesthesia as compared to the total cost of the anaesthesia. The part of medications and single use devices for anaesthesia was 14.8% of the total cost. Despite the difficulties facing cost evaluation, this model of calculation, assisted by the cost accounting controller, helped us to have a concrete financial vision. It also shows that a global reflexion is necessary during financial decision-making. Copyright © 2015 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

[Cost accounting for gastrectomy under critical path--the usefulness of direct accounting of personnel expenses and a guide to shortening hospital stay].

PubMed

Nozue, M; Maruyama, T; Imamura, F; Fukue, M

2000-08-01

In this study, cost accounting was made for a surgical case of gastrectomy according to critical path (path) and the economic contribution of the path was determined. In addition, changes in the cost percentage with changes in number of hospital days were simulated. Basically, cost accounting was done by means of cost accounting by departments, which meets the concept of direct cost accounting of administered accounts. Personnel expenses were calculated by means of both direct and indirect calculations. In the direct method, the total hours personnel participated were recorded for calculation. In the indirect method, personnel expenses were calculated from the ratio of the income of the surgical department to that of other departments. Purchase prices for all materials and drugs used were recorded to check buying costs. According to the direct calculating method, the personnel expenses came to approximately 300,000 yen, total cost was approximately 700,000 yen, and the cost percentage was 59%. According to the indirect method, the personnel expenses were approximately 540,000 yen and the total cost was approximately 940,000 yen, the cost percentage being 80%. A simulation study of changes in the cost with changes in hospital days revealed that the cost percentages were assessed to be approximately 53% in 19 hospital days and approximately 45% in 12 hospital days.

Acute Alcohol Consumption Elevates Serum Bilirubin, an Endogenous Antioxidant

PubMed Central

O’Malley, Stephanie S.; Gueorguieva, Ralitza; Wu, Ran; Jatlow, Peter I.

2015-01-01

Background Moderate alcohol consumption has been associated with both negative and favorable effects on health. The mechanisms responsible for reported favorable effects remain unclear. Higher (not necessarily elevated) concentrations of serum bilirubin, an antioxidant, have also been associated with reduced risk of cardiovascular disease and all-cause mortality. This study tests the hypothesis that single dose alcohol consumption elevates bilirubin providing a potential link between these observations. Methods 18 healthy individuals (8 cigarette smokers) were administered alcohol, calibrated to achieve blood concentrations of 20, 80 and 120 mg/dL, in random order in 3 laboratory sessions separated by a week. Each session was preceded by and followed by 5–7 days of alcohol abstinence. Serum bilirubin was measured at 7:45 am prior to drinking, at 2 pm, and at 7:45 the next morning. Mixed effects regression models compared baseline and 24 hr. post-drinking bilirubin concentrations. Results Total serum bilirubin (sum of indirect and direct) concentration increased significantly after drinking from baseline to 24 hours in non-smokers (from Mean=0.38, SD=0.24 to Mean=0.51 SD=0.30, F(1, 32.2) =24.24, p<.0001) but not in smokers (from Mean=0.25, SD=0.12 to Mean=0.26, SD=0.15, F(1, 31.1) =0.04, p=0.84). In nonsmokers the indirect bilirubin concentration and the ratio of indirect (unconjugated) to direct (conjugated) bilirubin also increased significantly. Conclusions Alcohol consumption leads to increases in serum bilirubin in nonsmokers. Considering the antioxidant properties of bilirubin, our findings suggest one possible mechanism for the reported association between alcohol consumption and reduced risk of some disorders that could be tested in future longitudinal studies. PMID:25707709

Childhood Physical and Sexual Abuse in Caribbean Young Adults and Its Association with Depression, Post-Traumatic Stress, and Skin Bleaching.

PubMed

James, Caryl; Seixas, Azizi A; Harrison, Abigail; Jean-Louis, Girardin; Butler, Mark; Zizi, Ferdinand; Samuels, Alafia

2016-01-01

The global prevalence of skin depigmentation/skin bleaching among blacks, estimated at 35%, is on the rise and is associated with a host of negative health and medical consequences. Current etiological approaches do not fully capture the emotional and psychological underpinnings of skin bleaching. The current study investigated the potential mediating role of depression, or post-traumatic stress symptoms (avoidance and hyperarousal) on the relationship between childhood physical and sexual abuse (CPSA) and skin bleaching. A total of 1226 university participants (ages 18-30 years and 63.4% female) from three Caribbean countries (Jamaica, Barbados, and Grenada) provided data for the current analysis. They all completed self-reported measures of general demographic information along with the short screening scale for posttraumatic stress disorder (DSM-IV), childhood trauma, and skin bleaching questions. The prevalence of skin bleaching in our study was 25.4%. Our findings showed that individuals who bleached their skin were more likely to have been abused as children (21.6% versus 13.5%, p<0.001), were more likely to have significant symptoms of trauma (34.1% versus 24.0%, p=0.005), and were more likely to have significant depression (43.7% versus 35.1%, p=0.032). We found that trauma-related hyperarousal symptoms positively mediated the relationship between childhood physical and sexual abuse and skin bleaching (Indirect Effect=0.03, p<0.05), while avoidance (Indirect Effect=0.000, p>0.05) and depressive (Indirect Effect=0.005, p>0.05) symptoms did not. The presence of trauma symptoms and childhood physical and sexual abuse (CPSA) may increase the likelihood of skin bleaching. Findings suggest that further exploration is needed to ascertain if the presence of skin bleaching warrants being also screened for trauma.

Comparative assessment of three in vitro exposure methods for combustion toxicity.

PubMed

Lestari, Fatma; Markovic, Boban; Green, Anthony R; Chattopadhyay, Gautam; Hayes, Amanda J

2006-01-01

A comparative assessment of three approaches for the use of human cells in vitro to investigate combustion toxicity was conducted. These included one indirect and two direct (passive and dynamic) exposure methods. The indirect method used an impinger system in which culture medium was used to trap the toxicants, whilst the direct exposure involved the use of a Horizontal Harvard Navicyte Chamber at the air/liquid interface. The cytotoxic effects of thermal decomposition products were assessed using the MTS (3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium) assay (Promega) on a selection of human cells including: HepG2, A549 and skin fibroblasts. A small scale laboratory fire test using a vertical tube furnace was designed for the generation of combustion products. Polymethyl methacrylate (PMMA) was selected as a model polymer to study the cytotoxic effects of combustion products. NOAEC (no observable adverse effect concentration), IC10 (10% inhibitory concentration), IC50 (50% inhibitory concentration) and TLC (total lethal concentration) values were determined from dose response curves. Assessment using the NRU (neutral red uptake) and ATP (adenosine triphosphate) assays on human lung derived cells (A549) was also undertaken. Comparison between in vitro cytotoxicity results against published toxicity data for PMMA combustion and predicted LC50 (50% lethal concentration) values calculated from identified compounds using GCMS (gas chromatography mass spectrometry) was determined. The results suggested that the indirect exposure method did not appear to simulate closely exposure via inhalation, whilst exposure at the air/liquid interface by using the dynamic method proved to be a more representative method of human inhalation. This exposure method may be a potential system for in vitro cytotoxicity testing in combustion toxicity. Copyright 2005 John Wiley & Sons, Ltd.

Direct and Indirect Effects of Pesticides on the Insidious Flower Bug (Hemiptera: Anthocoridae) Under Laboratory Conditions.

PubMed

Herrick, Nathan J; Cloyd, Raymond A

2017-06-01

Greenhouse producers are interested in integrating natural enemies along with pesticides to suppress western flower thrips, Frankliniella occidentalis (Pergande), populations. The insidious flower bug, Orius insidiosus (Say), is a commercially available natural enemy of western flower thrips. We conducted a series of laboratory experiments to determine the direct and indirect effects of 28 pesticides (insecticides, miticides, and fungicides), 4 pesticide mixtures, and 4 surfactants (36 total treatments plus a water control) on the adult O. insidiosus survival and predation on western flower thrips adults under laboratory conditions. The number of live and dead O. insidiosus adults was recorded after 24, 48, 72, and 96 h. The results of the study indicate that the fungicides (aluminum tris, azoxystrobin, fenhexamid, and kresoxim-methyl), insect growth regulators (azadirachtin, buprofezin, kinoprene, and pyriproxyfen), botanicals (Capsicum oleoresin extract, garlic oil, soybean oil; and rosemary, rosemary oil, peppermint oil, and cottonseed oil), and entomopathogenic fungi (Beauveria bassiana and Metarhizium anisopliae) were minimally directly harmful to adult O. insidiosus, with 80% to 100% adult survival. However, abamectin, spinosad, pyridalyl, chlorfenapyr, tau-fluvalinate, imidacloprid, dinotefuran, acetamiprid, and thiamethoxam directly affected O. insidiosus survival after 96 h (0-60% adult survival). The pesticide mixtures of abamectin + spinosad and chlorfenapyr + dinotefuran reduced adult survival (20% and 0%, respectively, after 48 h). Furthermore, the surfactants were not directly harmful to O. insidiosus adults. All western flower thrips adults were killed by the surviving adult O. insidiosus after 48 h, indicating no indirect effects of the pesticides on predation. © The Authors 2017. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Increased mortality risk among the visually impaired: the roles of mental well-being and preventive care practices.

PubMed

Zheng, D Diane; Christ, Sharon L; Lam, Byron L; Arheart, Kristopher L; Galor, Anat; Lee, David J

2012-05-14

Mechanisms by which visual impairment (VI) increases mortality risk are poorly understood. We estimated the direct and indirect effects of self-rated VI on risk of mortality through mental well-being and preventive care practice mechanisms. Using complete data from 12,987 adult participants of the 2000 Medical Expenditure Panel Survey with mortality linkage through 2006, we undertook structural equation modeling using two latent variables representing mental well-being and poor preventive care to examine multiple effect pathways of self-rated VI on all-cause mortality. Generalized linear structural equation modeling was used to simultaneously estimate pathways including the latent variables and Cox regression model, with adjustment for controls and the complex sample survey design. VI increased the risk of mortality directly after adjusting for mental well-being and other covariates (hazard ratio [HR] = 1.25 [95% confidence interval: 1.01, 1.55]). Poor preventive care practices were unrelated to VI and to mortality. Mental well-being decreased mortality risk (HR = 0.68 [0.64, 0.74], P < 0.001). VI adversely affected mental well-being (β = -0.54 [-0.65, -0.43]; P < 0.001). VI also increased mortality risk indirectly through mental well-being (HR = 1.23 [1.16, 1.30]). The total effect of VI on mortality including its influence through mental well-being was HR 1.53 [1.24, 1.90]. Similar but slightly stronger patterns of association were found when examining cardiovascular disease-related mortality, but not cancer-related mortality. VI increases the risk of mortality directly and indirectly through its adverse impact on mental well-being. Prevention of disabling ocular conditions remains a public health priority along with more aggressive diagnosis and treatment of depression and other mental health conditions in those living with VI.

Systematic Review of the Indirect Effect of Pneumococcal Conjugate Vaccine Dosing Schedules on Pneumococcal Disease and Colonization

PubMed Central

2014-01-01

Background: To aid decision making for pneumococcal conjugate vaccine (PCV) use in infant national immunization programs, we summarized the indirect effects of PCV on clinical outcomes among nontargeted age groups. Methods: We systematically reviewed the English literature on infant PCV dosing schedules published from 1994 to 2010 (with ad hoc addition of 2011 articles) for outcomes on children >5 years of age and adults including vaccine-type nasopharyngeal carriage (VT-NP), vaccine-type invasive pneumococcal disease (VT-IPD) and syndromic pneumonia. Results: Of 12,980 citations reviewed, we identified 21 VT-IPD, 6 VT-NP and 9 pneumonia studies. Of these 36, 21 (58%) included 3 primary doses plus PCV or pneumococcal polysaccharide vaccine (PPV23) booster schedule (3+1 or 3+PPV23), 5 (14%) 3+0, 9 (25%) 2+1 and 1 (3%) 2+0. Most (95%) were PCV7 studies. Among observational VT-IPD studies, all schedules (2+1, 3+0 and 3+1) demonstrated reductions in incidence among young adult groups. Among syndromic pneumonia observational studies (2+1, 3+0 and 3+1), only 3+1 schedules showed significant indirect impact. Of 2 VT-NP controlled trials (3+0 and 3+1) and 3 VT-NP observational studies (2+1, 3+1 and 3+PPV23), 3+1 and 3+PPV23 schedules showed significant indirect effect. The 1 study to directly compare between schedules was a VT-NP study (2+0 vs. 2+1), which found no indirect effect on older siblings and parents of vaccinated children with either schedule. Conclusions: Indirect benefit of a 3+1 infant PCV dosing schedule has been demonstrated for VT-IPD, VT-NP and syndromic pneumonia; 2+1 and 3+0 schedules have demonstrated indirect effect only for VT-IPD. The choice of optimal infant PCV schedule is limited by data paucity on indirect effects, especially a lack of head-to-head studies and studies of PCV10 and PCV13. PMID:24336058

Effect of heat stress on age at first calving of Japanese Black cows in Okinawa.

PubMed

Oikawa, Takuro

2017-03-01

Calving records from birth certificates of cows were analyzed to investigate the effect of heat stress on age at first calving (AFC) of Japanese Black cows. The data set covered 20 years (1990-2009) of calving records. Total number of records was 9279. Daily weather information from weather stations in the vicinity of the farms was used. Temperature-humidity index (THI) fitted to a linear model covered 30 days pre-insemination to 61 days post-insemination. Statistical analysis was conducted with procedures of SAS/STAT. Preliminary analysis showed that THI of the lowest temperature and humidity was most conducive to AFC. Covariance analysis, including main effect of sire, farm and year of insemination and covariates of THI on days showed that regression coefficients of THI on day -7, day -2 and day +31 were statistically significant. The estimated piecewise regression line showed different responses of AFC to THI on days: roof-shasped downward trend on day -7, hockey-stick shaped upward trend on day -2 and day +31. The difference among the estimated regression lines may be caused by direct and indirect factors on reproduction: indirect effect of reduced feed intake, failure of conception at previous insemination, direct effect of heat stress on oocyte and embryo development. © 2016 Japanese Society of Animal Science.

Powering up with indirect reciprocity in a large-scale field experiment.

PubMed

Yoeli, Erez; Hoffman, Moshe; Rand, David G; Nowak, Martin A

2013-06-18

A defining aspect of human cooperation is the use of sophisticated indirect reciprocity. We observe others, talk about others, and act accordingly. We help those who help others, and we cooperate expecting that others will cooperate in return. Indirect reciprocity is based on reputation, which spreads by communication. A crucial aspect of indirect reciprocity is observability: reputation effects can support cooperation as long as peoples' actions can be observed by others. In evolutionary models of indirect reciprocity, natural selection favors cooperation when observability is sufficiently high. Complimenting this theoretical work are experiments where observability promotes cooperation among small groups playing games in the laboratory. Until now, however, there has been little evidence of observability's power to promote large-scale cooperation in real world settings. Here we provide such evidence using a field study involving 2413 subjects. We collaborated with a utility company to study participation in a program designed to prevent blackouts. We show that observability triples participation in this public goods game. The effect is over four times larger than offering a $25 monetary incentive, the company's previous policy. Furthermore, as predicted by indirect reciprocity, we provide evidence that reputational concerns are driving our observability effect. In sum, we show how indirect reciprocity can be harnessed to increase cooperation in a relevant, real-world public goods game.

Two-step estimation in ratio-of-mediator-probability weighted causal mediation analysis.

PubMed

Bein, Edward; Deutsch, Jonah; Hong, Guanglei; Porter, Kristin E; Qin, Xu; Yang, Cheng

2018-04-15

This study investigates appropriate estimation of estimator variability in the context of causal mediation analysis that employs propensity score-based weighting. Such an analysis decomposes the total effect of a treatment on the outcome into an indirect effect transmitted through a focal mediator and a direct effect bypassing the mediator. Ratio-of-mediator-probability weighting estimates these causal effects by adjusting for the confounding impact of a large number of pretreatment covariates through propensity score-based weighting. In step 1, a propensity score model is estimated. In step 2, the causal effects of interest are estimated using weights derived from the prior step's regression coefficient estimates. Statistical inferences obtained from this 2-step estimation procedure are potentially problematic if the estimated standard errors of the causal effect estimates do not reflect the sampling uncertainty in the estimation of the weights. This study extends to ratio-of-mediator-probability weighting analysis a solution to the 2-step estimation problem by stacking the score functions from both steps. We derive the asymptotic variance-covariance matrix for the indirect effect and direct effect 2-step estimators, provide simulation results, and illustrate with an application study. Our simulation results indicate that the sampling uncertainty in the estimated weights should not be ignored. The standard error estimation using the stacking procedure offers a viable alternative to bootstrap standard error estimation. We discuss broad implications of this approach for causal analysis involving propensity score-based weighting. Copyright © 2018 John Wiley & Sons, Ltd.

Mediation analysis with multiple versions of the mediator.

PubMed

Vanderweele, Tyler J

2012-05-01

The causal inference literature has provided definitions of direct and indirect effects based on counterfactuals that generalize the approach found in the social science literature. However, these definitions presuppose well-defined hypothetical interventions on the mediator. In many settings, there may be multiple ways to fix the mediator to a particular value, and these various hypothetical interventions may have very different implications for the outcome of interest. In this paper, we consider mediation analysis when multiple versions of the mediator are present. Specifically, we consider the problem of attempting to decompose a total effect of an exposure on an outcome into the portion through the intermediate and the portion through other pathways. We consider the setting in which there are multiple versions of the mediator but the investigator has access only to data on the particular measurement, not information on which version of the mediator may have brought that value about. We show that the quantity that is estimated as a natural indirect effect using only the available data does indeed have an interpretation as a particular type of mediated effect; however, the quantity estimated as a natural direct effect, in fact, captures both a true direct effect and an effect of the exposure on the outcome mediated through the effect of the version of the mediator that is not captured by the mediator measurement. The results are illustrated using 2 examples from the literature, one in which the versions of the mediator are unknown and another in which the mediator itself has been dichotomized.

Mediation analysis with multiple versions of the mediator

PubMed Central

VanderWeele, Tyler J.

2013-01-01

The causal inference literature has provided definitions of direct and indirect effects based on counterfactuals that generalize the approach found in the social science literature. However, these definitions presuppose well defined hypothetical interventions on the mediator. In many settings there may be multiple ways to fix the mediator to a particular value and these different hypothetical interventions may have very different implications for the outcome of interest. In this paper we consider mediation analysis when multiple versions of the mediator are present. Specifically, we consider the problem of attempting to decompose a total effect of an exposure on an outcome into the portion through the intermediate and the portion through other pathways. We consider the setting in which there are multiple versions of the mediator but the investigator only has access to data on the particular measurement, not which version of the mediator may have brought that value about. We show that the quantity that is estimated as a natural indirect effect using only the available data does indeed have an interpretation as a particular type of mediated effect; however, the quantity estimated as a natural direct effect in fact captures both a true direct effect and an effect of the exposure on the outcome mediated through the effect of the version of the mediator that is not captured by the mediator measurement. The results are illustrated using two examples from the literature, one in which the versions of the mediator are unknown and another in which the mediator itself has been dichotomized. PMID:22475830

Population density of North American elk: effects on plant diversity.

PubMed

Stewart, Kelley M; Bowyer, R Terry; Kie, John G; Dick, Brian L; Ruess, Roger W

2009-08-01

Large, herbivorous mammals have profound effects on ecosystem structure and function and often act as keystone species in ecosystems they inhabit. Density-dependent processes associated with population structure of large mammals may interact with ecosystem functioning to increase or decrease biodiversity, depending on the relationship of herbivore populations relative to the carrying capacity (K) of the ecosystem. We tested for indirect effects of population density of large herbivores on plant species richness and diversity in a montane ecosystem, where increased net aboveground primary productivity (NAPP) in response to low levels of herbivory has been reported. We documented a positive, linear relationship between plant-species diversity and richness with NAPP. Structural equation modeling revealed significant indirect relationships between population density of herbivores, NAPP, and species diversity. We observed an indirect effect of density-dependent processes in large, herbivorous mammals and species diversity of plants through changes in NAPP in this montane ecosystem. Changes in species diversity of plants in response to herbivory may be more indirect in ecosystems with long histories of herbivory. Those subtle or indirect effects of herbivory may have strong effects on ecosystem functioning, but may be overlooked in plant communities that are relatively resilient to herbivory.

7 CFR 760.108 - Payment limitation.

Code of Federal Regulations, 2011 CFR

2011-01-01

...,000 total for the 2008 program year under ELAP, LFP, LIP, and SURE combined or (2) $100,000 for the... receive, directly or indirectly, more than: (1) $100,000 per program year total under ELAP, LFP, LIP, and..., LIP, SURE, and TAP if the individual's or entity's average adjusted gross income (AGI) exceeds $2.5...

77 FR 74449 - Water Quality Standards for the State of Florida's Lakes and Flowing Waters; Proposed Rule; Stay

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-14

... in this rulemaking. Entities discharging nitrogen or phosphorus to lakes and flowing waters of... nitrogen and phosphorus pollution in Florida's waters may be indirectly affected through implementation of... criteria in the form of total nitrogen, total phosphorus, nitrate+nitrite, and chlorophyll a for the...

Indirect effects of phorid fly parasitoids on the mechanisms of interspecific competition among ants.

PubMed

Morrison, Lloyd W

1999-10-01

Indirect effects, which occur when the impact of one species upon another requires the existence of an intermediary species, are apparently very common and may be of greater magnitude than direct effects. Behaviorally mediated indirect effects occur when one species affects the behavior of a second, which in turn affects how that species interacts with a third. I studied behaviorally mediated indirect effects on the mechanisms of competition in two congeneric fire ant species in the presence and absence of parasitoid phorid flies, which parasitized only one ant species. In observational and experimental field studies, the presence of native Texas phorid flies in the genus Pseudacteon decreased food retrieval by their host, Solenopsis geminata (F.), by as much as 50%. In the presence of phorid flies, many S. geminata workers assumed a stationary, curled defensive posture and did not forage. Although the phorid parasitoids had a relatively large effect on exploitative competition, there was no measurable effect on interference competition. Fierce interspecific aggression was observed between S. geminata and S. invicta Buren, and the presence of phorids had no effect on the outcome of these contests. The indirect effects of Pseudacteon parasitoids on Solenopsis fire ant resource retrieval appear to be larger than the direct effect of mortality. Some aspects of the foraging behavior of these Solenopsis species may be, in part, evolutionary adaptations to phorid parasitoid pressure. Because of the relatively large indirect effects, South American Pseudacteon phorids may be promising biocontrol agents of imported fire ants, S. invicta, in the USA. In a laboratory study, a single South American Pseudacteon female was able to significantly decrease food retrieval rates of a North American population of the imported fire ant, S. invicta.

The costs of breast cancer in a Mexican public health institution

PubMed Central

Gómez-Rico, Jacobo Alejandro; Altagracia-Martínez, Marina; Kravzov-Jinich, Jaime; Cárdenas-Elizalde, Rosario; Rubio-Poo, Consuelo

2008-01-01

Breast cancer (BC) is the second leading cause of death as a result of neoplasia in Mexico. This study aimed to identify the direct and indirect costs of treating female outpatients diagnosed with BC at a Mexican public hospital. A cross-sectional, observational, analytical study was conducted. A total of 506 medical records were analyzed and 102 were included in the cost analysis. The micro-costing process was used to estimate treatment costs. A 17-item questionnaire was used to obtain information on direct and indirect costs. Of the 102 women with BC included in the study, 92.2% (94) were at Stage II, and only 7.8% at Stage I. Total direct costs over six months for the 82 women who had modified radical mastectomy (MRM) surgury were US$733,821.15. Total direct costs for the 15 patients with conservative surgery (CS) were US$138,190.39. We found that the total economic burden in the study population was much higher for patients with MRM than for patients with CS. PMID:22312199

Direct and indirect effects of copper-contaminated sediments on the functions of model freshwater ecosystems.

PubMed

Gardham, Stephanie; Chariton, Anthony A; Hose, Grant C

2015-01-01

Copper is acutely toxic to, and directly affects, primary producers and decomposers, which are key players in essential processes such as the nutrient cycle in freshwater ecosystems. Even though the indirect effects of metals (for example effects due to changes in species interactions) may be more common than direct effects, little is known about the indirect effects of copper on primary producers and decomposers. The effects of copper on phytoplankton, macrophytes, periphyton and organic matter decomposition in an outdoor lentic mesocosm facility were assessed, and links between the responses examined. Copper directly decreased macrophyte growth, subsurface organic matter decomposition, and the potential for high phytoplankton Chlorophyll a concentrations. However, periphyton cover and organic matter decomposition on the surface of the sediment were stimulated by the presence of copper. These latter responses were attributed to indirect effects, due to a reduction in grazing pressure from snails, particularly Physa acuta, in the higher copper-contaminated mesocosms. This permitted the growth of periphyton and other heterotrophs, ultimately increasing decomposition at the sediment surface. The present study demonstrates the pronounced influence indirect effects may have on ecological function, findings that may not be observed in traditional laboratory studies (which utilize single species or simplistic communities).

Individual variation in behavioural plasticity: direct and indirect effects of boldness, exploration and sociability on habituation to predators in lizards.

PubMed

Rodríguez-Prieto, Iñaki; Martín, José; Fernández-Juricic, Esteban

2011-01-22

Little is known about the factors causing variation in behavioural plasticity and the interplay between personality and plasticity. Habituation to predators is a special case of behavioural plasticity. We investigated the direct and indirect effects of boldness, exploration and sociability traits on the habituation ability of Iberian wall lizards, considering exposure and sex effects. Individual boldness was consistent across several non-habituation contexts, but it did not significantly affect habituation. Exploration had a strong direct effect on habituation, with more exploratory individuals being able to habituate faster than less exploratory ones, probably because of their ability to assess risk better. Individual variation in habituation was also affected by sociability, but this was an indirect effect mediated by exposure to the predator. Less social individuals avoided refuges with conspecific cues, increasing exposure to the predator and eventually habituation. Finally, the direct effects of sex (females habituated faster than males) were opposite to its indirect effects through exposure. We conclude that risk assessment, instead of the proactivity-reactivity gradient usually considered in the literature, can affect behavioural plasticity through complex interactions between direct and indirect effects, including exploratory behaviour, degree of exposure to the predator and sex, which represent novel mechanisms generating inter-individual variation in plasticity.

Direct and indirect responses of a freshwater food web to a potent synthetic oestrogen

PubMed Central

Kidd, Karen A.; Paterson, Michael J.; Rennie, Michael D.; Podemski, Cheryl L.; Findlay, Dave L.; Blanchfield, Paul J.; Liber, Karsten

2014-01-01

Endocrine-disrupting chemicals (EDCs) in municipal effluents directly affect the sexual development and reproductive success of fishes, but indirect effects on invertebrate prey or fish predators through reduced predation or prey availability, respectively, are unknown. At the Experimental Lakes Area in northwestern Ontario, Canada, a long-term, whole-lake experiment was conducted using a before-after-control-impact design to determine both direct and indirect effects of the synthetic oestrogen used in the birth control pill, 17α-ethynyloestradiol (EE2). Algal, microbial, zooplankton and benthic invertebrate communities showed no declines in abundance during three summers of EE2 additions (5–6 ng l−1), indicating no direct toxic effects. Recruitment of fathead minnow (Pimephales promelas) failed, leading to a near-extirpation of this species both 2 years during (young-of-year, YOY) and 2 years following (adults and YOY) EE2 additions. Body condition of male lake trout (Salvelinus namaycush) and male and female white sucker (Catostomus commersonii) declined before changes in prey abundance, suggesting direct effects of EE2 on this endpoint. Evidence of indirect effects of EE2 was also observed. Increases in zooplankton, Chaoborus, and emerging insects were observed after 2 or 3 years of EE2 additions, strongly suggesting indirect effects mediated through the reduced abundance of several small-bodied fishes. Biomass of top predator lake trout declined by 23–42% during and after EE2 additions, most probably an indirect effect from the loss of its prey species, the fathead minnow and slimy sculpin (Cottus cognatus). Our results demonstrate that small-scale studies focusing solely on direct effects are likely to underestimate the true environmental impacts of oestrogens in municipal wastewaters and provide further evidence of the value of whole-ecosystem experiments for understanding indirect effects of EDCs and other aquatic stressors. PMID:25405967

Capillary and venous samples of total creatine kinase are similar after eccentric exercise.

PubMed

Knoblauch, Mark A; O'Connor, Daniel P; Clarke, Mark S F

2010-12-01

Circulating creatine kinase (CK) levels are often monitored as an indirect biomarker of muscle damage after resistive exercise. The purpose of the present investigation was to evaluate whether capillary whole-blood sampling, a simpler and less invasive method for obtaining a venous blood sample, would allow for a reliable measurement of total CK compared to venipuncture. Fifteen untrained subjects performed 50 maximal eccentric elbow extensions to induce muscle damage of the biceps brachii. Capillary (fingerstick) and venous whole-blood samples were collected contemporaneously at baseline and again at 24, 48, 72, and 96 hours post-exercise. Using a commercial CK analysis kit with a protocol modification to account for a reduced sample size, total CK activity of the capillary and venous samples was analyzed concurrently via spectrophotometry. Results indicated a 0.997 correlation between sampling sites for total CK, with disagreement between the venous and capillary samples estimated at <12% across the range of CK values. These findings indicate capillary sampling for total CK activity provides a valid alternative to venipuncture and should be considered by researchers, clinicians, and strength and conditioning specialists as an alternate sampling technique when indirectly evaluating muscle damage after exercise.

Do Leadership Style, Unit Climate, and Safety Climate Contribute to Safe Medication Practices?

PubMed

Farag, Amany; Tullai-McGuinness, Susan; Anthony, Mary K; Burant, Christopher

2017-01-01

This study aims at: examining if leadership style and unit climate predict safety climate; and testing the direct, indirect, and total effect of leadership style, unit climate, and safety climate on nurses' safe medication practices. The Institute of Medicine and nursing scholars propose that safety climate is a prerequisite to safety practices. However, there is limited empirical evidence about factors contributing to the development of safety climate and about the association with nurses' safe medication practices. This cross-sectional study used survey data from 246 RNs working in a Magnet® hospital. Leadership style and unit climate predicted 20% to 50% of variance on all safety climate dimensions. Model testing revealed the indirect impact of leadership style and unit climate on nurses' safe medication practices. Our hypothesized model explained small amount of the variance on nurses' safe medication practices. This finding suggests that nurses' safe medication practices are influenced by multiple contextual and personal factors that should be further examined.

Economic cost analysis of malaria case management at the household level during the malaria elimination phase in The People's Republic of China.

PubMed

Xia, Shang; Ma, Jin-Xiang; Wang, Duo-Quan; Li, Shi-Zhu; Rollinson, David; Zhou, Shui-Sen; Zhou, Xiao-Nong

2016-06-03

In China, malaria has been posing a significant economic burden on households. To evaluate malaria economic burden in terms of both direct and indirect costs has its meaning in improving the effectiveness of malaria elimination program in China. A number of study sites (eight counties in five provinces) were selected from the malaria endemic area in China, representing the different levels of malaria incidence, risk classification, economic development. A number of households with malaria cases (n = 923) were surveyed during the May to December in 2012 to collect information on malaria economic burden. Descriptive statistics were used to characterize the basic profiles of selected malaria cases in terms of their gender, age group, occupation and malaria type. The malaria economic costs were evaluated by direct and indirect costs. Comparisons were carried out by using the chi-square test (or Z-test) and the Mann-Whitney U test among malaria cases with reference to local/imported malaria patients, hospitalized/out patients, and treatment hospitals. The average cost of malaria per case was 1 691.23 CNY (direct cost was 735.41 CNY and indirect cost was 955.82 CNY), which accounted for 11.1 % of a household's total income. The average costs per case for local and imported malaria were 1 087.58 CNY and 4271.93 CNY, respectively. The average cost of a malaria patient being diagnosed and treated in a hospital at the county level or above (3 975.43 CNY) was 4.23 times higher than that of malaria patient being diagnosed and treated at a village or township hospital (938.80 CNY). This study found that malaria has been posing a significant economic burden on households in terms of direct and indirect costs. There is a need to improve the effectiveness of interventions in order to reduce the impact costs of malaria, especially of imported infections, in order to eliminate the disease in China.

Effect of L-Carnitine in Patients With Liver Cirrhosis on Energy Metabolism Using Indirect Calorimetry: A Pilot Study.

PubMed

Sakai, Yoshiyuki; Nishikawa, Hiroki; Enomoto, Hirayuki; Yoh, Kazunori; Iwata, Yoshinori; Hasegawa, Kunihiro; Nakano, Chikage; Kishino, Kyohei; Shimono, Yoshihiro; Takata, Ryo; Nishimura, Takashi; Aizawa, Nobuhiro; Ikeda, Naoto; Takashima, Tomoyuki; Ishii, Akio; Iijima, Hiroko; Nishiguchi, Shuhei

2016-12-01

L-carnitine supplementation has been suggested to show several favorable effects on patients with liver cirrhosis (LC). However, there have been no reports regarding the effect of L-carnitine on energy metabolism in patients with LC using indirect calorimetry which is a well-established method for assessing the degree of liver malnutrition. We examined the effect of L-carnitine in patients with LC on energy metabolism using indirect calorimetry. A total of 13 LC patients who are scheduled to be treated with L-carnitine (1,800 mg/day) were analyzed in this study. None of the patients previously received L-carnitine. An evaluation of the nutritional status was performed at the initiation of L-carnitine therapy and after 4 weeks of L-carnitine therapy. We evaluated the effect of L-carnitine on the nutritional status and energy metabolism by comparing various clinical variables at these two time points. In addition, the changes in the nutritional status of the patients were also evaluated using indirect calorimetry. After 4 weeks of L-carnitine treatment, for all cases, the mean substrate oxidation rates of carbohydrate (%C) increased from 37.6% to 48.2%, the mean substrate oxidation rates of fat (%F) decreased from 40.2% to 31.9% and the mean substrate oxidation rates of protein (%P) decreased from 22.2% to 19.9%. In a subgroup analysis of patients with baseline non-protein respiratory quotient (npRQ) < 0.85, the mean %C increased from 15.3% to 34.2%, the mean %F decreased from 59.9% to 45.1%, and the mean %P decreased from 24.8% to 20.6%. After 4 weeks of L-carnitine treatment, for all cases (n = 13), the mean value of npRQ increased in comparison with the baseline levels, although the difference was not significant (0.868 ± 0.060 vs. 0.838 ± 0.097, P = 0.19). Conversely, in patients with baseline npRQ < 0.85, the npRQ value significantly increased after 4 weeks treatment of L-carnitine compared with the baseline levels (0.827 ± 0.030 vs. 0.760 ± 0.043, P = 0.016). L-carnitine supplementation can be useful for improving energy metabolism, especially in patients who have an advanced LC status and lower baseline npRQ values.

Rosiglitazone and Fenofibrate Additive Effects on Lipids

DTIC Science & Technology

2011-10-01

Metabolic effects of trogiltazone on fructose-induced insulin resistance in the rat,” Diabetes, vol. 43, pp. 1435–1439, 1995. [3] T. P. Ciaraldi...re- mains unclear. It is possible that these agents indirectly alter plasma lipid and lipoprotein levels indirectly by improving insulin sensitivity...induced by TZDs remains unclear. It is possible that these agents indi- rectly alter plasma lipid and lipoprotein levels indirectly by improving insulin

The economic burden of human papillomavirus-related precancers and cancers in Sweden

PubMed Central

Silfverschiöld, Maria; Greiff, Lennart; Asciutto, Christine; Wennerberg, Johan; Lydryp, Marie-Louise; Håkansson, Ulf; Sparén, Pär; Borgfeldt, Christer

2017-01-01

Background High-risk (HR) human papillomavirus (HPV) infection is an established cause of malignant disease. We used a societal perspective to estimate the cost of HR HPV-related cervical, vulvar, vaginal, anal, and penile precancer and cancer, and oropharyngeal cancer in Sweden in 2006, 1 year before HPV vaccination became available in the country. Materials and methods This prevalence-based cost-of-illness study used diagnosis-specific data from national registries to determine the number of HR HPV-related precancers and cancers. The HR HPV-attributable fractions of these diseases were derived from a literature review and applied to the total burden to estimate HR HPV-attributable costs. Direct costs were based on health care utilization and indirect costs on loss of productivity due to morbidity (i.e., sick leave and early retirement) and premature mortality. Results The total annual cost of all HR HPV-attributable precancers and cancers was €94 million (€10.3/inhabitant). Direct costs accounted for €31.3 million (€3.4/inhabitant) of the total annual cost, and inpatient care amounted to €20.7 million of direct costs. Indirect costs made up €62.6 million (€6.9/inhabitant) of the total annual cost, and premature mortality amounted to €36 million of indirect costs. Cervical precancer and cancer was most costly (total annual cost €58.4 million). Among cancers affecting both genders, anal precancer and cancer, and oropharyngeal cancer were the most costly (€11.2 million and €11.9 million, respectively). For oropharyngeal cancer, males had the highest health care utilization and represented 71% of the total annual cost. Penile precancer and cancer was least costly (€2.6 million). Conclusion The economic burden of HR HPV-related precancers and cancers is substantial. The disease-related management and treatment costs we report are relevant as a point of reference for future economic evaluations investigating the overall benefits of HPV vaccination in females and males in Sweden. PMID:28651012

Cost of illness for cholera in a high risk urban area in Bangladesh: an analysis from household perspective

PubMed Central

2013-01-01

Background Cholera poses a substantial health burden to developing countries such as Bangladesh. In this study, the objective is to estimate the economic burden of cholera treatments incurred by households. The study was carried out in the context of a large vaccine trial in an urban area of Bangladesh. Methods The study used a combination of prospective and retrospective incidence-based cost analyses of cholera illness per episode per household. A total of 394 confirmed cholera hospitalized cases were identified and treated in the study area during June–October 2011. Households with cholera patients were interviewed within 15 days after discharge from hospitals or clinics. To estimate the total cost of cholera illness a structured questionnaire was used, which included questions on direct medical costs, non-medical costs, and the indirect costs of patients and caregivers. Results The average total household cost of treatment for an episode of cholera was US$30.40. Total direct and indirect costs constituted 24.6% (US$7.40) and 75.4% (US$23.00) of the average total cost, respectively. The cost for children under 5 years of age (US$21.50) was higher than that of children aged 5–14 years (US$17.50). The direct cost of treatment was similar for male and female patients, but the indirect cost was higher for males. Conclusion Our study suggests that by preventing one cholera episode (3 days on an average), we can avert a total cost of 2,278.50 BDT (US$30.40) per household. Among medical components, medicines are the largest cost driver. No clear socioeconomic gradient emerged from our study, but limited demographic patterns were observed in the cost of illness. By preventing cholera cases, large production losses can be reduced. PMID:24188717

Economic Burden of Hepatitis B Virus-Related Diseases: Evidence From Iran

PubMed Central

Keshavarz, Khosro; Kebriaeezadeh, Abbas; Alavian, Seyed Moayed; Akbari Sari, Ali; Abedin Dorkoosh, Farid; Keshvari, Maryam; Malekhosseini, Seyed Ali; Nikeghbalian, Saman; Nikfar, Shekoufeh

2015-01-01

Background: Hepatitis B infection is still the main cause of chronic liver disease in Iran, which is associated with significant economic and social costs. Objectives: This study aimed to estimate the financial burden caused by CHB infection and its complications in Iran. Patients and Methods: Prevalence-based and bottom-up approaches were used to collect the data. Data on direct medical costs were extracted from outpatient medical records in a referral gastroenterology and hepatology research center, inpatient medical records in several major hospitals in Tehran and Shiraz in 2013, and the self-reports of specialists. Data on direct non-medical and indirect costs were collected based on the patients’ self-reports through face-to-face interviews performed in the mentioned centers. To calculate the indirect costs, friction cost approach was used. To calculate the total cost-of-illness in Iran, the total cost per patient at each stage of the disease was estimated and multiplied by the total number of patients. Results: The total annual cost for the activate population of CHB patients and for those receiving treatment at various disease stages were respectively 450 million and 226 million dollars, with 64% and 70% of which allocated to direct costs respectively, and 36% and 30% to indirect costs respectively. The total direct costs alone for each group were respectively 1.17% and 0.6% of the total health expenditure. Furthermore, the cost spent on drugs encompasses the largest proportion of the direct medical cost for all stages of the disease. Conclusions: According to the perspectives of payers, patients, and community, CHB infection can be considered as one of the diseases with a substantial economic burden; the disease, specifically in extreme cases, can be too expensive and costly for patients. Therefore, patients should be protected against more severe stages of the disease through proper treatment and early diagnosis. PMID:25977694

Decadal trends in marine reserves reveal differential rates of change in direct and indirect effects

USGS Publications Warehouse

Babcock, R.C.; Shears, N.T.; Alcala, A.C.; Barrett, N.S.; Edgar, G.J.; Lafferty, K.D.; McClanahan, T.R.; Russ, G.R.

2010-01-01

Decadal-scale observations of marine reserves suggest that indirect effects on taxa that occur through cascading trophic interactions take longer to develop than direct effects on target species. Combining and analyzing a unique set of long-term time series of ecologic data in and out of fisheries closures from disparate regions, we found that the time to initial detection of direct effects on target species (+ or -SE) was 5.13 + or - 1.9 years, whereas initial detection of indirect effects on other taxa, which were often trait mediated, took significantly longer (13.1 + or - 2.0 years). Most target species showed initial direct effects, but their trajectories over time were highly variable. Many target species continued to increase, some leveled off, and others decreased. Decreases were due to natural fluctuations, fishing impacts from outside reserves, or indirect effects from target species at higher trophic levels. The average duration of stable periods for direct effects was 6.2 + or - 1.2 years, even in studies of more than 15 years. For indirect effects, stable periods averaged 9.1 + or - 1.6 years, although this was not significantly different from direct effects. Populations of directly targeted species were more stable in reserves than in fished areas, suggesting increased ecologic resilience. This is an important benefit of marine reserves with respect to their function as a tool for conservation and restoration.