Treatment Compliance in Adolescents after Attempted Suicide: A Two-Year Follow-Up Study

PubMed Central

Burns, Craig D.; Cortell, Ranon; Wagner, Barry M.

2008-01-01

Objective To describe mental health services utilization for adolescents after attempted suicide, explore factors related to treatment compliance, and determine the relationship between compliance and suicidality. Method Eighty-five adolescents (ages 13–18) who had attempted suicide and their families were recruited from four psychiatric hospitals and were evaluated for symptoms of psychopathology. Subsequent assessments were conducted every six months for two years to determine treatment utilization, treatment compliance (non-adherence to medication regimes or non-attendance of psychosocial treatments against provider advice), attitudes towards treatments utilized, and further suicide attempts and ideation. Results Adolescents with a disruptive behavior disorder diagnosis were less compliant with individual psychotherapy, as were those with a substance dependence other than alcohol or marijuana. Those with an affective/anxiety disorder diagnosis were less compliant with psychopharmacological interventions (6 months post attempt). Parental perception of treatment as helpful was predictive of greater compliance, while adolescents' attitudes towards treatment were not predictive of compliance. Finally, compliance with treatment was not generally predictive of future suicidality. Conclusion Interventions focused on increasing compliance with mental health treatment for adolescent suicide attempters should focus on specific child psychopathology, as well as parental attitudes towards treatment. PMID:18596554

AdChoices? Compliance with Online Behavioral Advertising Notice and Choice Requirements. Revised Version

DTIC Science & Technology

2011-10-07

further information and a means of opting out. Revised October 7, 2011. Keywords: Online behavioral advertising ; privacy; consumer choice; notice... consumers ’ activities online to target advertising .”1 The FTC has been examining ways to reduce the privacy concerns associated with OBA for over a decade...behavioral advertising practices that would foster transparency, knowledge and choice for consumers . As the FTC determines what to do next, it is

Norm compliance affects perceptual decisions through modulation of a starting point bias.

PubMed

Toelch, Ulf; Panizza, Folco; Heekeren, Hauke R

2018-03-01

Adaptive decisions in social contexts depend on both perceptual information and social expectations or norms. These are potentially in conflict when certain choices are beneficial for an individual, but societal rules mandate a different course of action. To resolve such a conflict, the reliability of information has to be balanced against potentially deleterious effects of non-compliance such as ostracism. In this study, we systematically investigated how interactions between perceptual and social influences affect decision-relevant cognitive processes. In a direction-of-motion discrimination task, participants received perceptual information alongside information on other players' choices. In addition, we created conflict scenarios where players' choices affected other participants' monetary rewards dependent on whether their choices were in line or against the opinion of the other players. Importantly, we altered the strength of this manipulation in two separate experiments by contrasting motivations of either preventing harm or providing a benefit to others. Behavioural analyses and computational models of perceptual decisions showed that participants successfully integrated perceptual with social information. Participants' reliance on social information was effectively modulated in conflict situations. Critically, these effects were augmented when the strength of social norms was increased, indexing conditions under which social norms effectively influence decisions. These results inform theories of social influence by providing an account of how higher order goals like social norm compliance affect perceptual decisions.

Norm compliance affects perceptual decisions through modulation of a starting point bias

PubMed Central

Panizza, Folco; Heekeren, Hauke R.

2018-01-01

Adaptive decisions in social contexts depend on both perceptual information and social expectations or norms. These are potentially in conflict when certain choices are beneficial for an individual, but societal rules mandate a different course of action. To resolve such a conflict, the reliability of information has to be balanced against potentially deleterious effects of non-compliance such as ostracism. In this study, we systematically investigated how interactions between perceptual and social influences affect decision-relevant cognitive processes. In a direction-of-motion discrimination task, participants received perceptual information alongside information on other players' choices. In addition, we created conflict scenarios where players’ choices affected other participants' monetary rewards dependent on whether their choices were in line or against the opinion of the other players. Importantly, we altered the strength of this manipulation in two separate experiments by contrasting motivations of either preventing harm or providing a benefit to others. Behavioural analyses and computational models of perceptual decisions showed that participants successfully integrated perceptual with social information. Participants' reliance on social information was effectively modulated in conflict situations. Critically, these effects were augmented when the strength of social norms was increased, indexing conditions under which social norms effectively influence decisions. These results inform theories of social influence by providing an account of how higher order goals like social norm compliance affect perceptual decisions. PMID:29657747

Evaluations of child transgressions, disciplinary choices, and expected child compliance in a no-cry and a crying infant condition in physically abusive and comparison mothers.

PubMed

Caselles, C E; Milner, J S

2000-04-01

Several components of a social information processing model of child physical abuse were tested. Abusive and comparison mothers' evaluations of children's transgressions, choices of disciplinary techniques, expectations for children's compliance following discipline, and appraisals of the appropriateness of disciplinary choice were examined in a no-cry and a crying-infant condition. Thirty physically abusive and 30 matched comparison mothers were individually matched on ethnic background, age, education, marital status, number of children, and cognitive ability. Mothers were asked to respond to questions related to vignettes describing children engaging in moral, conventional, and personal transgressions. As predicted, abusive, relative to comparison, mothers evaluated conventional and personal, but not moral, transgressions as more wrong, used more power assertion (physical and verbal force), expected less compliance from their own children, and appraised their own disciplinary responses as less appropriate. In contrast to expectations, there were no group by cry condition interaction effects on any of the study measures. The findings provide additional support for the view that abusive, relative to comparison, mothers are different in their evaluations and expectations of their own children's behaviors and that they more frequently select aversive disciplinary techniques. However, given the lack of an expected differential impact of a stressful condition on the cognitions and disciplinary choices in abusive mothers, additional research is needed.

The prevalence of, and factors related to, compliance with glove utilization among nurses in Hospital Universiti Sains Malaysia.

PubMed

Naing, L; Nordin, R; Musa, R

2001-09-01

Increasing risk of HIV infections among health care workers has been a continuing concern. The study was designed to identify the compliance of glove utilization, and factors related to non-compliance. A sample of 150 staff nurses were recruited from the study population of 550 nurses in Hospital Universiti Sains Malaysia. Data were collected by using a structured self-administered questionnaires. The response rate was 98.4%. The study revealed a low compliance (13.5%) of glove utilization (for all 9 procedures), which varied among different procedures (27-97%). Younger nurses and those with shorter duration of working experience had better knowledge of Universal Precautions. Nurses in intensive care unit and operation theatre were better in both knowledge and compliance of glove utilization. The three commonest misconceptions were identified as "selective use of gloves for high risk groups and suspected cases", and "tendency to depend on HIV prevalence". Nurses reported practical problems including administrative and personal related such as "stock irregularity" (46%), "glove not available at the emergency sites" (44%), and "reduction of tactile sensation" (39%). It was concluded that poor knowledge and practical problems were possible responsible factors for the low compliance. A good training for nurses comprising principle and practice of Universal Precautions, updated knowledge of blood and body fluid borne infections and risk and its management, will probably improve the compliance.

Rate of Compliance with Hand Hygiene by Dental Healthcare Personnel (DHCP) within a Dentistry Healthcare First Aid Facility

PubMed Central

de Amorim-Finzi, Marcília Batista; Cury, Mauro Vieira Cezar; Costa, Cláudio Rodrigues R.; dos Santos, Angelis Costa; de Melo, Geraldo Batista

2010-01-01

Objectives: To evaluate the compliance with the opportunities of hand hygiene by dentistry school healthcare professionals, as well as the higher choice products. Methods: Through direct observation, the oral healthcare team-professors, oral and maxillofacial surgery residents, graduation students-for daily care were monitored: before performing the first treatment of the shift, after snacks and meals, and after going to the bathroom (initial opportunities) as well as between patients’ care, and after ending the shift (following opportunities). Results: The professors’ category profited 78.4% of all opportunities while residents and graduation students did not reach 50.0% of compliance. Statistically significant data (P≤.05) were seen between categories: professors and residents, professors and graduation students, and between genders within the residents’ category. When opportunities were profited, the preferred choice for hand hygiene was water and soap (82.2%), followed by 70% alcohol (10.2%), and both (7.6%). Conclusions: Although gloves were worn in all procedures, we concluded that the hygiene compliance by these professionals was under the expectation. PMID:20613909

Effects of Title IV of the Clean Air Act Amendments of 1990 on Electric Utilities: An Update, The

EIA Publications

1997-01-01

Describes the strategies used to comply with the Acid Rain Program in 1995, the effect of compliance on SO2 emissions levels, the cost of compliance, and the effects of the program on coal supply and demand. It updates and expands the EIA report, Electric Utility Phase I Acid Rain Compliance Strategies for the Clean Air Act Amendments of 1990.

Utility-free heuristic models of two-option choice can mimic predictions of utility-stage models under many conditions

PubMed Central

Piantadosi, Steven T.; Hayden, Benjamin Y.

2015-01-01

Economists often model choices as if decision-makers assign each option a scalar value variable, known as utility, and then select the option with the highest utility. It remains unclear whether as-if utility models describe real mental and neural steps in choice. Although choices alone cannot prove the existence of a utility stage, utility transformations are often taken to provide the most parsimonious or psychologically plausible explanation for choice data. Here, we show that it is possible to mathematically transform a large set of common utility-stage two-option choice models (specifically ones in which dimensions are can be decomposed into additive functions) into a heuristic model (specifically, a dimensional prioritization heuristic) that has no utility computation stage. We then show that under a range of plausible assumptions, both classes of model predict similar neural responses. These results highlight the difficulties in using neuroeconomic data to infer the existence of a value stage in choice. PMID:25914613

Emissions trading comes of age as a strategic tool

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

Pospisil, R.

1996-03-01

Trading of emissions credits has quickly evolved from a curiosity to a viable compliance strategy for electric utilities and power-generating industrial firms. A sure sign that emissions trading has matured is the entry of power marketers onto the scene; in bundling pollution allowances with their electricity offerings, they are making their product more attractive - and stealing a page from the coal companies` strategy book to boot. Although most current activity involves credits for sulfur dioxide (SO{sub 2}), nitrogen oxide (NO{sub x}) trading is under way in certain areas as well, although NO{sub x} markets are local and thus slowermore » to develop. However, utilities see economic development potential in this area; some are providing NO{sub x} credits to their industrial customers to help them comply with environmental regulations - and to retain their loyalty when deregulation affords them a choice of electricity suppliers. This paper briefly discusses the issues related to emissions trading.« less

Work Smarter Not Harder: Utilizing an Environmental Management Information System to Meet Regulatory Compliance and Reporting Requirements for a Major Source Title V Facility

DTIC Science & Technology

2011-05-10

Environmental Management Information System to Meet Regulatory Compliance and Reporting Requirements for a Major Source Title V Facility. Tannis Danley...AND SUBTITLE Work Smarter Not Harder: Utilizing an Environmental Management Information System to Meet Regulatory Compliance and Reporting...Carson) – EMS (Hawaii Garrison, West Virginia National Guard) Environmental Management Information System (EMIS) National Defense Center for Energy and

Nutrition Knowledge and Food Choices of Elementary School Children.

ERIC Educational Resources Information Center

Kandiah, Jay; Jones, Charlotte

2002-01-01

Investigated the effect of a 3-week school-based nutrition education program on nutrition knowledge and healthy food choices of fifth graders randomly assigned to experimental or control group. Found that the experimental group exhibited a significant increase in nutrition knowledge from pretest to posttest and significant change in compliance in…

Vanilla Teaching as a Rational Choice: The Impact of Research and Compliance on Teacher Development

ERIC Educational Resources Information Center

Harland, Tony; Wald, Navé

2018-01-01

This paper examines the proposition that the quality of university teaching in the research-intensive university is affected by various compliance demands on academic work that are meant to either enhance or be complementary to teaching. These include holding academics to account for the quality of both research and teaching. Our research aims to…

Market-driven automotive industry compliance with fuel economy and greenhouse gas standards: Analysis based on consumer choice

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

Xie, Fei; Lin, Zhenhong

This paper explored factors that affect market-driven compliance with both Corporate Average Fuel Economy (CAFE) and greenhouse gas (GHG) standards (together called the National Program) in the United States for phase I 2012–2016 and phase II 2017–2025. We considered a consumer-choice-based simulation approach, using the MA3T model, to estimate the market acceptance of fuel efficiency (FE) technologies and alternative fuel technologies as reflected by new sales of light-duty vehicle (LDV). Because both full and extremely low FE valuations are common in the literature, we use a moderate assumption of a 10-year perceived vehicle lifetime at a 7% annual discount ratemore » in the baseline and include both extreme views (5 years and 15 years) in the sensitivity analysis. The study focuses on market-driven compliance and therefore excludes manufacturers’ cross-subsidization. The model results suggest that the LDV industry is able to comply with both standards even without cross-subsidization and with projected high technology cost, mainly thanks to the multiple credit programs and technology advancements. The compliance robustness, while encouraging, however is based on moderate market assumptions, such as Annual Energy Outlook 2016 Reference oil price projection and moderate FE consumer valuation. Finally, sensitivity analysis results reveal two significant risk factors for compliance: low oil prices and consumers’ FE undervaluation.« less

Market-driven automotive industry compliance with fuel economy and greenhouse gas standards: Analysis based on consumer choice

DOE PAGES

Xie, Fei; Lin, Zhenhong

2017-06-09

This paper explored factors that affect market-driven compliance with both Corporate Average Fuel Economy (CAFE) and greenhouse gas (GHG) standards (together called the National Program) in the United States for phase I 2012–2016 and phase II 2017–2025. We considered a consumer-choice-based simulation approach, using the MA3T model, to estimate the market acceptance of fuel efficiency (FE) technologies and alternative fuel technologies as reflected by new sales of light-duty vehicle (LDV). Because both full and extremely low FE valuations are common in the literature, we use a moderate assumption of a 10-year perceived vehicle lifetime at a 7% annual discount ratemore » in the baseline and include both extreme views (5 years and 15 years) in the sensitivity analysis. The study focuses on market-driven compliance and therefore excludes manufacturers’ cross-subsidization. The model results suggest that the LDV industry is able to comply with both standards even without cross-subsidization and with projected high technology cost, mainly thanks to the multiple credit programs and technology advancements. The compliance robustness, while encouraging, however is based on moderate market assumptions, such as Annual Energy Outlook 2016 Reference oil price projection and moderate FE consumer valuation. Finally, sensitivity analysis results reveal two significant risk factors for compliance: low oil prices and consumers’ FE undervaluation.« less

Status and Trends in the U.S. Voluntary Green Power Market (2013 Data)

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

Heeter, J.; Belyeu, K.; Kuskova-Burns, K.

Voluntary green power markets are those in which consumers and institutions voluntarily purchase renewable energy to match their electricity needs. This report surveys utilities, competitive suppliers, renewable energy certificate (REC) marketers, and, for the first time, the community choice aggregation market. This report finds that the voluntary market totaled 62 million megawatt-hours in 2013. Approximately 5.4 million customers are purchasing green power. This report presents data and analysis on voluntary market sales and customer participation, products and premiums, green pricing marketing, and administrative expenses. The report also details trends in REC tracking systems, REC pricing in voluntary and compliance markets,more » community and crowd-funded solar, and interest in renewable energy by the information and communication technologies sector.« less

40 CFR 72.43 - Phase I reduced utilization plans.

Code of Federal Regulations, 2011 CFR

2011-07-01

... (CONTINUED) PERMITS REGULATION Acid Rain Compliance Plan and Compliance Options § 72.43 Phase I reduced... any Acid Rain emissions limitation or emissions reduction requirements during Phase I; and (ii) Meets... this section shall include in the Acid Rain permit application for the unit a reduced utilization plan...

40 CFR 72.43 - Phase I reduced utilization plans.

Code of Federal Regulations, 2013 CFR

2013-07-01

... (CONTINUED) PERMITS REGULATION Acid Rain Compliance Plan and Compliance Options § 72.43 Phase I reduced... any Acid Rain emissions limitation or emissions reduction requirements during Phase I; and (ii) Meets... this section shall include in the Acid Rain permit application for the unit a reduced utilization plan...

40 CFR 72.43 - Phase I reduced utilization plans.

Code of Federal Regulations, 2014 CFR

2014-07-01

... (CONTINUED) PERMITS REGULATION Acid Rain Compliance Plan and Compliance Options § 72.43 Phase I reduced... any Acid Rain emissions limitation or emissions reduction requirements during Phase I; and (ii) Meets... this section shall include in the Acid Rain permit application for the unit a reduced utilization plan...

40 CFR 72.43 - Phase I reduced utilization plans.

Code of Federal Regulations, 2012 CFR

2012-07-01

... (CONTINUED) PERMITS REGULATION Acid Rain Compliance Plan and Compliance Options § 72.43 Phase I reduced... any Acid Rain emissions limitation or emissions reduction requirements during Phase I; and (ii) Meets... this section shall include in the Acid Rain permit application for the unit a reduced utilization plan...

40 CFR 72.43 - Phase I reduced utilization plans.

Code of Federal Regulations, 2010 CFR

2010-07-01

... (CONTINUED) PERMITS REGULATION Acid Rain Compliance Plan and Compliance Options § 72.43 Phase I reduced... any Acid Rain emissions limitation or emissions reduction requirements during Phase I; and (ii) Meets... this section shall include in the Acid Rain permit application for the unit a reduced utilization plan...

A social choice-based methodology for treated wastewater reuse in urban and suburban areas.

PubMed

Mahjouri, Najmeh; Pourmand, Ehsan

2017-07-01

Reusing treated wastewater for supplying water demands such as landscape and agricultural irrigation in urban and suburban areas has become a major water supply approach especially in regions struggling with water shortage. Due to limited available treated wastewater to satisfy all water demands, conflicts may arise in allocating treated wastewater to water users. Since there is usually more than one decision maker and more than one criterion to measure the impact of each water allocation scenario, effective tools are needed to combine individual preferences to reach a collective decision. In this paper, a new social choice (SC) method, which can consider some indifference thresholds for decision makers, is proposed for evaluating and ranking treated wastewater and urban runoff allocation scenarios to water users in urban and suburban areas. Some SC methods, namely plurality voting, Borda count, pairwise comparisons, Hare system, dictatorship, and approval voting, are applied for comparing and evaluating the results. Different scenarios are proposed for allocating treated wastewater and urban runoff to landscape irrigation, agricultural lands as well as artificial recharge of aquifer in the Tehran metropolitan Area, Iran. The main stakeholders rank the proposed scenarios based on their utilities using two different approaches. The proposed method suggests ranking of the scenarios based on the stakeholders' utilities and considering the scores they assigned to each scenario. Comparing the results of the proposed method with those of six different SC methods shows that the obtained ranks are mostly in compliance with the social welfare.

[Kidney patients: aspects related to compliance with renal treatment].

PubMed

Caraballo Nazario, G L; Lebrón de avilés, C; Dávila Torres, R R; Burgos Calderón, R

2001-12-01

The Objective of this study was identify the aspects related with the adherence of medical treatment recommended to the patients that received hemodialysis in the tertiary public hospital. A non experimental transectional correlation design was utilized in this study. Fifty-three patients constituted the population study. A structure interview was utilized to gathered the data. Descriptive statistics and Chi-square tests were utilized to analysis. The response rate was 91.0%. The 75.0% of patients not compliance with the medical treatment. Significant association between compliance variable and educational level was encountered (p < or = 0.05). This study provides important findings to will develops educative intervention in the Renal Unit, directed to improve the adherence of the patient with medical treatment.

Using economic evaluations to make formulary coverage decisions. So much for guidelines.

PubMed

Anis, A H; Gagnon, Y

2000-07-01

It is mandatory for drug manufacturers requesting formulary inclusion under the British Columbia (BC) provincial drug plan to submit a pharmacoeconomic analysis according to published guidelines. These submissions are reviewed by the Pharmacoeconomic Initiative (PI) of BC. To assess the compliance of submitted studies with specific criteria outlined in the guidelines, to assess the methodological quality of individual submissions, and to demonstrate the importance of submitting guidelines-compliant pharmacoeconomic analyses. All submissions between January 1996 and April 1999 assessed by the PI of BC were included. Submissions were reviewed according to a checklist to establish compliance with respect to choice of comparator drug, study perspective, sensitivity analysis, analytical horizon and discounting. Submissions were examined for association between analytical technique and author, and between source of submission and compliance. Association between compliance and recommendation for approval was also examined. 95 applications were reviewed. Seven submitted no analyses. There were 25 cost-comparison/consequence, 14 cost-effectiveness, 11 cost-minimisation, 9 cost-utility/benefit and 29 budget-impact analyses. 65 of these 88 submissions failed to comply with guidelines. Of these, 45% used an inappropriate comparator drug, 61% lacked a sensitivity analysis, 73% used a third-party payer and excluded a societal perspective, 66% did not provide a long term evaluation and 25% did not specify any time horizon. 80% of noncompliant studies were cost-comparison/consequence or budget-impact analyses (p < 0.001, Fisher's Exact). Of 25 cost-comparison/consequence and 29 budget-impact analyses, 19 (76%) and 24 (83%), respectively, were industry-conducted, whereas cost-effectiveness (11 of 14) and cost-utility/benefit (6 of 9) analyses were mostly subcontracted to private consultants or academics (p < 0.001, Fisher's Exact). 74% of all submissions (compliant and noncompliant) were not recommended by the PI for listing as a provincial drug plan benefit, 16% received approval for restricted benefit and 9% were recommended as full benefit. 80% of the noncompliant submissions were not recommended (p = 0.06, Fisher's Exact test). Moreover, a strong association between type of analysis and type of recommendation was found (p = 0.03, Fisher's Exact test). Cost-comparison/consequence and budget-impact analyses were less likely to be recommended. IMPLICATIONS OF FINDINGS: Our findings show poor compliance with guidelines, especially among industry-conducted studies. Possible explanations are lack of expertise in pharmacoeconomics and/or scepticism regarding the importance of guidelines and submission quality in decision making. As corroborated by the strong associations between type of recommendation and compliance, and between type of recommendation and type of analysis, these 2 characteristics have a significant impact on decision making.

Control approach development for variable recruitment artificial muscles

NASA Astrophysics Data System (ADS)

Jenkins, Tyler E.; Chapman, Edward M.; Bryant, Matthew

2016-04-01

This study characterizes hybrid control approaches for the variable recruitment of fluidic artificial muscles with double acting (antagonistic) actuation. Fluidic artificial muscle actuators have been explored by researchers due to their natural compliance, high force-to-weight ratio, and low cost of fabrication. Previous studies have attempted to improve system efficiency of the actuators through variable recruitment, i.e. using discrete changes in the number of active actuators. While current variable recruitment research utilizes manual valve switching, this paper details the current development of an online variable recruitment control scheme. By continuously controlling applied pressure and discretely controlling the number of active actuators, operation in the lowest possible recruitment state is ensured and working fluid consumption is minimized. Results provide insight into switching control scheme effects on working fluids, fabrication material choices, actuator modeling, and controller development decisions.

Engineering Large Animal Species to Model Human Diseases.

PubMed

Rogers, Christopher S

2016-07-01

Animal models are an important resource for studying human diseases. Genetically engineered mice are the most commonly used species and have made significant contributions to our understanding of basic biology, disease mechanisms, and drug development. However, they often fail to recreate important aspects of human diseases and thus can have limited utility as translational research tools. Developing disease models in species more similar to humans may provide a better setting in which to study disease pathogenesis and test new treatments. This unit provides an overview of the history of genetically engineered large animals and the techniques that have made their development possible. Factors to consider when planning a large animal model, including choice of species, type of modification and methodology, characterization, production methods, and regulatory compliance, are also covered. © 2016 by John Wiley & Sons, Inc. Copyright © 2016 John Wiley & Sons, Inc.

7 CFR 1724.50 - Compliance with National Electrical Safety Code (NESC).

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 11 2013-01-01 2013-01-01 false Compliance with National Electrical Safety Code (NESC... UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE ELECTRIC ENGINEERING, ARCHITECTURAL SERVICES AND DESIGN POLICIES AND PROCEDURES Electric System Design § 1724.50 Compliance with National Electrical Safety Code...

7 CFR 1724.50 - Compliance with National Electrical Safety Code (NESC).

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 11 2010-01-01 2010-01-01 false Compliance with National Electrical Safety Code (NESC... UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE ELECTRIC ENGINEERING, ARCHITECTURAL SERVICES AND DESIGN POLICIES AND PROCEDURES Electric System Design § 1724.50 Compliance with National Electrical Safety Code...

7 CFR 1724.50 - Compliance with National Electrical Safety Code (NESC).

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 11 2011-01-01 2011-01-01 false Compliance with National Electrical Safety Code (NESC... UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE ELECTRIC ENGINEERING, ARCHITECTURAL SERVICES AND DESIGN POLICIES AND PROCEDURES Electric System Design § 1724.50 Compliance with National Electrical Safety Code...

7 CFR 1724.50 - Compliance with National Electrical Safety Code (NESC).

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 11 2012-01-01 2012-01-01 false Compliance with National Electrical Safety Code (NESC... UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE ELECTRIC ENGINEERING, ARCHITECTURAL SERVICES AND DESIGN POLICIES AND PROCEDURES Electric System Design § 1724.50 Compliance with National Electrical Safety Code...

7 CFR 1724.50 - Compliance with National Electrical Safety Code (NESC).

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 11 2014-01-01 2014-01-01 false Compliance with National Electrical Safety Code (NESC... UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE ELECTRIC ENGINEERING, ARCHITECTURAL SERVICES AND DESIGN POLICIES AND PROCEDURES Electric System Design § 1724.50 Compliance with National Electrical Safety Code...

Factors Involved in Access and Utilization of Adult Hearing Healthcare: A Systematic Review

PubMed Central

Barnett, Margaret; Hixon, Brian; Okwiri, Neville; Irungu, Catherine; Ayugi, John; Thompson, Robin; Shinn, Jennifer B.; Bush, Matthew L.

2016-01-01

Objective/Hypothesis Hearing loss is a public health concern yet hearing healthcare disparities exist and influence utilization of rehabilitation services. The objective of this review was to systematically analyze the published literature on motivators, barriers, and compliance factors affecting adult patient access and utilization of hearing rehabilitation healthcare. Data Sources and Study Eligibility Criteria Pubmed, PsychINFO, CINAHL, Web of Science were searched for relevant articles. Eligible studies were those containing original, peer-reviewed research in English pertaining to factors affecting adult hearing healthcare access and utilization of hearing aids and cochlear implantation. The search encompassed 1990-2015. Study Appraisal and Synthesis Methods Two investigators independently reviewed all articles and extracted data. Specific variables regarding access to care and compliance to recommended care were extracted from each study. Results Thirty articles were reviewed. The factors affecting access and utilization of hearing rehabilitation could be classified into motivators, barriers, and compliance in treatment or device use. The key motivators to seek care include degree of hearing loss, self-efficacy, family support, and self-recognition of hearing loss. The primary barriers to care were financial limitations, stigma of hearing devices, inconvenience, competing chronic health problems, and unrealistic expectations. Compliance is most affected by self-efficacy, education level, and engagement in the rehabilition process. Conclusion Accessing hearing healthcare is complicated by multiple factors. Considering the current climate in healthcare policy and legislation towards improved access of care, a deeper understanding of motivators, barriers and compliance factors can aid in delivery of effective and efficient hearing healthcare. PMID:27545324

Factors involved in access and utilization of adult hearing healthcare: A systematic review.

PubMed

Barnett, Margaret; Hixon, Brian; Okwiri, Neville; Irungu, Catherine; Ayugi, John; Thompson, Robin; Shinn, Jennifer B; Bush, Matthew L

2017-05-01

Hearing loss is a public health concern, yet hearing healthcare disparities exist and influence utilization of rehabilitation services. The objective of this review was to systematically analyze the published literature on motivators, barriers, and compliance factors affecting adult patient access and utilization of hearing rehabilitation healthcare. Pubmed, PsychINFO, CINAHL, and Web of Science were searched for relevant articles. Eligible studies were those containing original, peer-reviewed research in English pertaining to factors affecting adult hearing healthcare access and utilization of hearing aids and cochlear implantation. The search encompassed 1990 to 2015. Two investigators independently reviewed all articles and extracted data. Specific variables regarding access to care and compliance to recommended care were extracted from each study. Thirty articles were reviewed. The factors affecting access and utilization of hearing rehabilitation could be classified into motivators, barriers, and compliance in treatment or device use. The key motivators to seek care include degree of hearing loss, self-efficacy, family support, and self-recognition of hearing loss. The primary barriers to care were financial limitations, stigma of hearing devices, inconvenience, competing chronic health problems, and unrealistic expectations. Compliance is most affected by self-efficacy, education level, and engagement in the rehabilitation process. Accessing hearing healthcare is complicated by multiple factors. Considering the current climate in healthcare policy and legislation toward improved access of care, a deeper understanding of motivators, barriers, and compliance factors can aid in delivery of effective and efficient hearing healthcare. Laryngoscope, 127:1187-1194, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Effects of electronic prescribing on formulary compliance and generic drug utilization in the ambulatory care setting: a retrospective analysis of administrative claims data.

PubMed

Ross, S Michael; Papshev, Diana; Murphy, Erin L; Sternberg, David J; Taylor, Jeffrey; Barg, Ronald

2005-06-01

Electronic prescribing (e-prescribing) provides formulary information at the point of care. The objective of this study was to assess the effects of e-prescribing on formulary compliance and generic utilization. This was a retrospective analysis of pharmacy claims data from a large national managed care organization. A sample of 95 providers using predominantly e-prescribing was randomly selected (e-prescriber group). A matched sample of 95 traditional prescribers was selected (traditional prescriber group), matched to the e-prescriber group by zip code and medical specialty. A total of 110,975 paid pharmacy claims, for the 12 months from August 1, 2001, through July 31, 2002, were analyzed to assess the effect of e-prescribing on formulary compliance and generic utilization. All paid pharmacy claims were examined for each group; for the e-prescriber group, this included all claims, not just those prescribed using an e-prescribing device. A written qualitative survey was distributed to physicians and office managers to assess e-prescribing usage, sources of formulary information, and effects of e-prescribing on office resources. Both predominantly e-prescribers and traditional prescribers demonstrated high levels of formulary compliance, 83.2% versus 82.8%, respectively (P=0.32). Formulary compliance for these groups did not differ from the overall prescriber population (82.0%). There was not a difference in generic drug utilization rates between e-prescribers and traditional prescribers (absolute rates 37.3% versus 36.9%, P=0.18). Qualitative survey responses supported previously reported research indicating reductions in calls both to and from pharmacies for prescription orders. An examination of paid pharmacy claims from a large, national managed care organization demonstrated no differences between predominantly e-prescribers and traditional prescribers in measures of formulary compliance or generic drug utilization. Future studies should examine keystroke data at the point of care to observe more detail about drug selection methods.

Compliance, normality, and the patient on peritoneal dialysis.

PubMed

McCarthy, Alexandra; Shaban, Ramon; Boys, Jennifer; Winch, Sarah

2010-01-01

Monitoring and enhancing patient compliance with peritoneal dialysis (PD) is a recurring and problematic theme in the renal literature. A growing body of literature also argues that a failure to understand the patient's perspective of compliance may be contributing to these problems. The aim of this study was to understand the concept of compliance with PD from the patient's perspective. Using the case study approach recommended by Stake (1995), five patients on PD consented to in-depth interviews that explored the meaning of compliance in the context of PD treatment and lifestyle regimens recommended by health professionals. Participants also discussed factors that influenced their choices to follow, disregard, or refine these regimens. Results indicate that health professionals acting in alignment with individual patient needs and wishes, and demonstrating an awareness of the constraints under which patients operate and the strengths they bring to their treatment, may be the most significant issues to consider with respect to definitions of PD compliance and the development of related compliance interventions. Aspects of compliance that promoted relative normality were also important to the participants in this study and tended to result in greater concordance with health professionals' advice.

Utilization of Compliance-Gaining Strategies: A Research Note.

ERIC Educational Resources Information Center

Baglan, Thomas; And Others

1986-01-01

Examined the use of compliance-gaining strategies among a group of environmentalists. Results indicated that prosocial strategies were used more often than anti-social strategies across all situations. (SRT)

Impact of stress and mitigating information on evaluations, attributions, affect, disciplinary choices, and expectations of compliance in mothers at high and low risk for child physical abuse.

PubMed

De Paúl, Joaquín; Asla, Nagore; Pérez-Albéniz, Alicia; de Cádiz, Bárbara Torres-Gómez

2006-08-01

The objective is to know if high-risk mothers for child physical abuse differ in their evaluations, attributions, negative affect, disciplinary choices for children's behavior, and expectations of compliance. The effect of a stressor and the introduction of mitigating information are analyzed. Forty-seven high-risk and 48 matched low-risk mothers participated in the study. Mothers' information processing and disciplinary choices were examined using six vignettes depicting a child engaging in different transgressions. A four-factor design with repeated measures on the last two factors was used. High-risk mothers reported more hostile intent, global and internal attributions, more use of power assertion discipline, and less induction. A risk group by child transgression interaction and a risk group by mitigating information interaction were found. Results support the social information-processing model of child physical abuse, which suggests that high-risk mothers process child-related information differently and use more power assertive and less inductive disciplinary techniques.

Electric Utility Phase I Acid Rain Compliance Strategies for the Clean Air Act Amendments of 1990

EIA Publications

1994-01-01

The Acid Rain Program is divided into two time periods; Phase I, from 1995 through 1999, and Phase II, starting in 2000. Phase I mostly affects power plants that are the largest sources of SO2 and NOx . Phase II affects virtually all electric power producers, including utilities and nonutilities. This report is a study of the effects of compliance with Phase I regulations on the costs and operations of electric utilities, but does not address any Phase II impacts.

45 CFR 12.14 - Compliance inspections and reports.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 45 Public Welfare 1 2013-10-01 2013-10-01 false Compliance inspections and reports. 12.14 Section 12.14 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION DISPOSAL AND UTILIZATION OF SURPLUS REAL PROPERTY FOR PUBLIC HEALTH PURPOSES § 12.14 Compliance inspections and reports. The Department will make or have made such...

Teratology studies in the rat.

PubMed

Leroy, Mariline; Allais, Linda

2013-01-01

The rat is the rodent species of choice for the regulatory safety testing of xenobiotics, such as medicinal products, food additives, and other chemicals. Many decades of experience and extensive data have accumulated for both general and developmental toxicology investigations in this species. The high fertility and large litter size of the rat are advantages for teratogenicity testing. The study designs are well defined in the regulatory guidelines and are relatively standardized between testing laboratories across the world. Teratology studies address maternal- and embryo-toxicity following exposure during the period of organogenesis. This chapter describes the design and conduct of a teratology study in the rat in compliance with the regulatory guidelines. The procedures for the handling and housing of the pregnant animals, the caesarean examinations and the sampling of fetuses for morphological examinations are described. The utility and design of preliminary studies and the inclusion of satellite animals in the main study for toxicokinetic sampling are discussed.

Understanding patient compliance and persistence with osteoporosis therapy.

PubMed

Gold, Deborah T

2011-04-01

Chronic non-terminal diseases, including postmenopausal osteoporosis, are associated with poor treatment compliance and persistence. The longer a patient with osteoporosis complies and persists with treatment, the lower the risk of fracture. Retrospective studies with emphasis on real-world data have led to a greater understanding of the factors affecting medication compliance and persistence, and their association with improved treatment outcomes. However, these data do not contain information about patient choices of medication or patient commitment to particular medication regimens. Patient preferences can affect compliance and persistence behaviours. While recent evidence questions the importance of dosing regimen in patient preferences, other recent data show that medication efficacy and safety remain the most important determinants of patient preference. Informed patient decision making about treatment options, adverse effects and outcomes can have a beneficial impact on medication-taking behaviour. Healthcare professionals play a crucial role in the management of factors associated with poor compliance and persistence with osteoporosis therapies. Education about disease consequences and differences among treatment options, as well as treatment monitoring and positive reinforcement, are crucial to improving medication compliance and persistence in osteoporotic patients.

Effects of cross-bridge compliance on the force-velocity relationship and muscle power output

PubMed Central

Fenwick, Axel J.; Wood, Alexander M.

2017-01-01

Muscles produce force and power by utilizing chemical energy through ATP hydrolysis. During concentric contractions (shortening), muscles generate less force compared to isometric contractions, but consume greater amounts of energy as shortening velocity increases. Conversely, more force is generated and less energy is consumed during eccentric muscle contractions (lengthening). This relationship between force, energy use, and the velocity of contraction has important implications for understanding muscle efficiency, but the molecular mechanisms underlying this behavior remain poorly understood. Here we used spatially-explicit, multi-filament models of Ca2+-regulated force production within a half-sarcomere to simulate how force production, energy utilization, and the number of bound cross-bridges are affected by dynamic changes in sarcomere length. These computational simulations show that cross-bridge binding increased during slow-velocity concentric and eccentric contractions, compared to isometric contractions. Over the full ranges of velocities that we simulated, cross-bridge cycling and energy utilization (i.e. ATPase rates) increased during shortening, and decreased during lengthening. These findings are consistent with the Fenn effect, but arise from a complicated relationship between velocity-dependent cross-bridge recruitment and cross-bridge cycling kinetics. We also investigated how force production, power output, and energy utilization varied with cross-bridge and myofilament compliance, which is impossible to address under typical experimental conditions. These important simulations show that increasing cross-bridge compliance resulted in greater cross-bridge binding and ATPase activity, but less force was generated per cross-bridge and throughout the sarcomere. These data indicate that the efficiency of force production decreases in a velocity-dependent manner, and that this behavior is sensitive to cross-bridge compliance. In contrast, significant effects of myofilament compliance on force production were only observed during isometric contractions, suggesting that changes in myofilament compliance may not influence power output during non-isometric contractions as greatly as changes in cross-bridge compliance. These findings advance our understanding of how cross-bridge and myofilament properties underlie velocity-dependent changes in contractile efficiency during muscle movement. PMID:29284062

Effects of cross-bridge compliance on the force-velocity relationship and muscle power output.

PubMed

Fenwick, Axel J; Wood, Alexander M; Tanner, Bertrand C W

2017-01-01

Muscles produce force and power by utilizing chemical energy through ATP hydrolysis. During concentric contractions (shortening), muscles generate less force compared to isometric contractions, but consume greater amounts of energy as shortening velocity increases. Conversely, more force is generated and less energy is consumed during eccentric muscle contractions (lengthening). This relationship between force, energy use, and the velocity of contraction has important implications for understanding muscle efficiency, but the molecular mechanisms underlying this behavior remain poorly understood. Here we used spatially-explicit, multi-filament models of Ca2+-regulated force production within a half-sarcomere to simulate how force production, energy utilization, and the number of bound cross-bridges are affected by dynamic changes in sarcomere length. These computational simulations show that cross-bridge binding increased during slow-velocity concentric and eccentric contractions, compared to isometric contractions. Over the full ranges of velocities that we simulated, cross-bridge cycling and energy utilization (i.e. ATPase rates) increased during shortening, and decreased during lengthening. These findings are consistent with the Fenn effect, but arise from a complicated relationship between velocity-dependent cross-bridge recruitment and cross-bridge cycling kinetics. We also investigated how force production, power output, and energy utilization varied with cross-bridge and myofilament compliance, which is impossible to address under typical experimental conditions. These important simulations show that increasing cross-bridge compliance resulted in greater cross-bridge binding and ATPase activity, but less force was generated per cross-bridge and throughout the sarcomere. These data indicate that the efficiency of force production decreases in a velocity-dependent manner, and that this behavior is sensitive to cross-bridge compliance. In contrast, significant effects of myofilament compliance on force production were only observed during isometric contractions, suggesting that changes in myofilament compliance may not influence power output during non-isometric contractions as greatly as changes in cross-bridge compliance. These findings advance our understanding of how cross-bridge and myofilament properties underlie velocity-dependent changes in contractile efficiency during muscle movement.

Policy compliance of smokers on a tobacco-free university campus.

PubMed

Russette, Helen C; Harris, Kari Jo; Schuldberg, David; Green, Linda

2014-01-01

To explore factors influencing compliance with campus tobacco policies and strategies to increase compliance. Sixty tobacco smokers (April 2012). A 22-item intercept-interview with closed- and open-ended questions was conducted with smokers in adjacent compliant and noncompliant areas at 1 university with a 100% tobacco ban. Data were analyzed using descriptive statistics and content analysis. Most reported that the smoking policy was not enforced. Noncompliant smokers had less knowledge of locations where tobacco use was permitted and were more likely to identify their smoking location as compliant and had knowingly violated the policy. Choice of location to smoke was related to convenience and a desire to follow the policy. Smokers recommended consequences for noncompliance and structures that accommodated smoking to increase adherence to the tobacco ban. Additional education, environmental, and contingency strategies are needed to increase compliance with the policy banning tobacco use on this campus.

Evidence for surprise minimization over value maximization in choice behavior

PubMed Central

Schwartenbeck, Philipp; FitzGerald, Thomas H. B.; Mathys, Christoph; Dolan, Ray; Kronbichler, Martin; Friston, Karl

2015-01-01

Classical economic models are predicated on the idea that the ultimate aim of choice is to maximize utility or reward. In contrast, an alternative perspective highlights the fact that adaptive behavior requires agents’ to model their environment and minimize surprise about the states they frequent. We propose that choice behavior can be more accurately accounted for by surprise minimization compared to reward or utility maximization alone. Minimizing surprise makes a prediction at variance with expected utility models; namely, that in addition to attaining valuable states, agents attempt to maximize the entropy over outcomes and thus ‘keep their options open’. We tested this prediction using a simple binary choice paradigm and show that human decision-making is better explained by surprise minimization compared to utility maximization. Furthermore, we replicated this entropy-seeking behavior in a control task with no explicit utilities. These findings highlight a limitation of purely economic motivations in explaining choice behavior and instead emphasize the importance of belief-based motivations. PMID:26564686

Money Earlier or Later? Simple Heuristics Explain Intertemporal Choices Better than Delay Discounting1

PubMed Central

Marzilli Ericson, Keith M.; White, John Myles; Laibson, David; Cohen, Jonathan D.

2015-01-01

Heuristic models have been proposed for many domains of choice. We compare heuristic models of intertemporal choice, which can account for many of the known intertemporal choice anomalies, to discounting models. We conduct an out-of-sample, cross-validated comparison of intertemporal choice models. Heuristic models outperform traditional utility discounting models, including models of exponential and hyperbolic discounting. The best performing models predict choices by using a weighted average of absolute differences and relative (percentage) differences of the attributes of the goods in a choice set. We conclude that heuristic models explain time-money tradeoff choices in experiments better than utility discounting models. PMID:25911124

Hypnotic relaxation vs amitriptyline for tension-type headache: let the patient choose.

PubMed

Ezra, Yacov; Gotkine, Marc; Goldman, Sylvie; Adahan, Haim Moshe; Ben-Hur, Tamir

2012-05-01

Although both pharmacological and behavioral interventions may relieve tension-type headache, data are lacking regarding treatment preference, long-term patient compliance, and feasibility of behavioral intervention in a standard neurological outpatient clinic setting. To describe patient choice, long-term compliance, and clinical outcome in a neurological clinic setting where patients are given the choice of the approach they wish to pursue. Patients presenting to the headache clinic with a diagnosis of tension-type headache that justified prophylactic therapy (frequent episodic tension-type headache or chronic tension-type headache) were given the choice of amitriptyline (AMT) treatment or hypnotic relaxation (HR), and were treated accordingly. Patients were given the option to cross-over to the other treatment group at each visit. HR was performed during standard length neurology clinic appointments by a neurologist trained to perform hypnosis (Y.E.). Follow-up interviews were performed between 6 and 12 months following treatment initiation to evaluate patient compliance, changes in headache frequency or severity, and quality-of-life parameters. Ninety-eight patients were enrolled, 92 agreed to receive prophylactic therapy of some kind. Fifty-three (57.6%) patients chose HR of which 36 (67.9%) actually initiated this treatment, while 39 (42.4%) chose pharmacological therapy with AMT of which 25 (64.1%) patients actually initiated therapy. Patients with greater analgesic use were more likely to opt for AMT (P= .0002). Eleven of the patients initially choosing AMT and 2 of the patients initially choosing HR crossed over to the other group. Seventy-four percent of the patients in the HR group and 58% of patients in the AMT group had a 50% reduction in the frequency of headaches (P= .16). Long-term adherence to treatment with HR exceeded that of AMT. At the end of the study period, 26 of 47 patients who tried HR compared with 10 of 27 who tried AMT continued receiving their initial treatment. HR treatment was a more popular choice among patients. Patients choosing HR reported greater symptom relief than those choosing AMT and were found to have greater treatment compliance. Patients receiving HR were less likely to change treatments. HR practiced by a neurologist is feasible in a standard neurological outpatient clinic setting; HR training should be considered for neurologists involved in headache treatment. © 2011 American Headache Society.

Factors affecting patient compliance with compressive brace therapy for pectus carinatum.

PubMed

Kang, Du-Young; Jung, Junho; Chung, Sangho; Cho, Jinkyung; Lee, Sungsoo

2014-12-01

The aim of this study was to identify factors affecting patient compliance with brace therapy for pectus carinatum. Eighty-six pectus carinatum patients who started brace therapy from August 2008 to November 2011 were included in this study. Patients were divided into two groups: patients who wore the brace for ≥6 months (compliance group) or patients who wore the brace for <6 months (non-compliance group). Factors affecting patient compliance were assessed at the last day of follow-up with a multiple-choice questionnaire. The questionnaire comprised seven items: pain at compression site, skin problems on compression area, confidence in brace treatment, shame, discomfort, initial result of bracing treatment and total number of factors affecting patient compliance. Eighty-six patients completed the survey, including seven (8.1%) female patients and 79 (91.9%) male patients, with a mean age of 12.0 years at the time of treatment (range, 3-20 years). The initial result of the compression period (P <0.001) and total number of factors affecting patient compliance (P <0.05) were significant predictors of patient compliance. An initial successful result of the compression period may increase patient compliance during treatment for pectus carinatum. Additional efforts to decrease pain, skin problems, shame and discomfort, and to give confidence may be beneficial in increasing compliance with bracing treatment. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Water and Sewage Utilities Sector (NAICS 2213)

EPA Pesticide Factsheets

Environmental regulation information for water utilities, including drinking and wastewater treatment facilities. Includes links to NESHAP for POTW, compliance information, and information about pretreatment programs.

7 CFR 1730.20 - General.

Code of Federal Regulations, 2013 CFR

2013-01-01

... and maintaining an Emergency Restoration Plan (ERP), maintaining records of the physical, cyber and... ELECTRIC SYSTEM OPERATIONS AND MAINTENANCE Operations and Maintenance Requirements § 1730.20 General. Each... and maintain its system in compliance with prudent utility practice, in compliance with its loan...

7 CFR 1730.20 - General.

Code of Federal Regulations, 2012 CFR

2012-01-01

... and maintaining an Emergency Restoration Plan (ERP), maintaining records of the physical, cyber and... ELECTRIC SYSTEM OPERATIONS AND MAINTENANCE Operations and Maintenance Requirements § 1730.20 General. Each... and maintain its system in compliance with prudent utility practice, in compliance with its loan...

7 CFR 1730.20 - General.

Code of Federal Regulations, 2011 CFR

2011-01-01

... and maintaining an Emergency Restoration Plan (ERP), maintaining records of the physical, cyber and... ELECTRIC SYSTEM OPERATIONS AND MAINTENANCE Operations and Maintenance Requirements § 1730.20 General. Each... and maintain its system in compliance with prudent utility practice, in compliance with its loan...

7 CFR 1730.20 - General.

Code of Federal Regulations, 2014 CFR

2014-01-01

... and maintaining an Emergency Restoration Plan (ERP), maintaining records of the physical, cyber and... ELECTRIC SYSTEM OPERATIONS AND MAINTENANCE Operations and Maintenance Requirements § 1730.20 General. Each... and maintain its system in compliance with prudent utility practice, in compliance with its loan...

GHX, Broadlane form latest e-commerce linkup.

PubMed

2002-08-01

Broadlane agreed in June to connect its electronic commerce system to the supplier-owned site run by GHX. As a result, contract compliance could either improve or be more easily evaded, depending on hospitals' response to the wider choice of suppliers.

Money earlier or later? Simple heuristics explain intertemporal choices better than delay discounting does.

PubMed

Ericson, Keith M Marzilli; White, John Myles; Laibson, David; Cohen, Jonathan D

2015-06-01

Heuristic models have been proposed for many domains involving choice. We conducted an out-of-sample, cross-validated comparison of heuristic models of intertemporal choice (which can account for many of the known intertemporal choice anomalies) and discounting models. Heuristic models outperformed traditional utility-discounting models, including models of exponential and hyperbolic discounting. The best-performing models predicted choices by using a weighted average of absolute differences and relative percentage differences of the attributes of the goods in a choice set. We concluded that heuristic models explain time-money trade-off choices in experiments better than do utility-discounting models. © The Author(s) 2015.

Can adherence to dietary guidelines address excess caloric intake? An empirical assessment for the UK.

PubMed

Srinivasan, C S

2013-12-01

The facilitation of healthier dietary choices by consumers is a key element of government strategies to combat the rising incidence of obesity in developed and developing countries. Public health campaigns to promote healthier eating often target compliance with recommended dietary guidelines for consumption of individual nutrients such as fats and added sugars. This paper examines the association between improved compliance with dietary guidelines for individual nutrients and excess calorie intake, the most proximate determinant of obesity risk. We apply quantile regressions and counterfactual decompositions to cross-sectional data from the National Diet and Nutrition Survey (2000-01) to assess how excess calorie consumption patterns in the UK are likely to change with improved compliance with dietary guidelines. We find that the effects of compliance vary significantly across different quantiles of calorie consumption. Our results show that compliance with dietary guidelines for individual nutrients, even if successfully achieved, is likely to be associated with only modest shifts in excess calorie consumption patterns. Consequently, public health campaigns that target compliance with dietary guidelines for specific nutrients in isolation are unlikely to have a significant effect on the obesity risk faced by the population. Copyright © 2013 Elsevier B.V. All rights reserved.

Dopamine Reward Prediction Error Responses Reflect Marginal Utility

PubMed Central

Stauffer, William R.; Lak, Armin; Schultz, Wolfram

2014-01-01

Summary Background Optimal choices require an accurate neuronal representation of economic value. In economics, utility functions are mathematical representations of subjective value that can be constructed from choices under risk. Utility usually exhibits a nonlinear relationship to physical reward value that corresponds to risk attitudes and reflects the increasing or decreasing marginal utility obtained with each additional unit of reward. Accordingly, neuronal reward responses coding utility should robustly reflect this nonlinearity. Results In two monkeys, we measured utility as a function of physical reward value from meaningful choices under risk (that adhered to first- and second-order stochastic dominance). The resulting nonlinear utility functions predicted the certainty equivalents for new gambles, indicating that the functions’ shapes were meaningful. The monkeys were risk seeking (convex utility function) for low reward and risk avoiding (concave utility function) with higher amounts. Critically, the dopamine prediction error responses at the time of reward itself reflected the nonlinear utility functions measured at the time of choices. In particular, the reward response magnitude depended on the first derivative of the utility function and thus reflected the marginal utility. Furthermore, dopamine responses recorded outside of the task reflected the marginal utility of unpredicted reward. Accordingly, these responses were sufficient to train reinforcement learning models to predict the behaviorally defined expected utility of gambles. Conclusions These data suggest a neuronal manifestation of marginal utility in dopamine neurons and indicate a common neuronal basis for fundamental explanatory constructs in animal learning theory (prediction error) and economic decision theory (marginal utility). PMID:25283778

48 CFR 52.241-1 - Electric Service Territory Compliance Representation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 2 2010-10-01 2010-10-01 false Electric Service Territory Compliance Representation. 52.241-1 Section 52.241-1 Federal Acquisition Regulations System FEDERAL... utility franchises or service territories established pursuant to State statute, State regulation, or...

7 CFR 1924.107 - Utilities.

Code of Federal Regulations, 2010 CFR

2010-01-01

... under this subpart must have adequate, economic, safe, energy efficient, dependable utilities with... wastewater systems are in compliance with the current provisions of the Safe Drinking Water Act and the Clean...

7 CFR 1924.107 - Utilities.

Code of Federal Regulations, 2011 CFR

2011-01-01

... under this subpart must have adequate, economic, safe, energy efficient, dependable utilities with... wastewater systems are in compliance with the current provisions of the Safe Drinking Water Act and the Clean...

7 CFR 1924.107 - Utilities.

Code of Federal Regulations, 2012 CFR

2012-01-01

... under this subpart must have adequate, economic, safe, energy efficient, dependable utilities with... wastewater systems are in compliance with the current provisions of the Safe Drinking Water Act and the Clean...

7 CFR 1924.107 - Utilities.

Code of Federal Regulations, 2013 CFR

2013-01-01

... under this subpart must have adequate, economic, safe, energy efficient, dependable utilities with... wastewater systems are in compliance with the current provisions of the Safe Drinking Water Act and the Clean...

7 CFR 1924.107 - Utilities.

Code of Federal Regulations, 2014 CFR

2014-01-01

... under this subpart must have adequate, economic, safe, energy efficient, dependable utilities with... wastewater systems are in compliance with the current provisions of the Safe Drinking Water Act and the Clean...

Hard Choices for Individual Situations.

ERIC Educational Resources Information Center

Landon, Bruce

This paper focuses on faculty use of a decision-making process for complex situations. The analysis part of the process describes and compares course management software focusing on: technical specifications, instructional design values,tools and features, ease of use, and standards compliance. The extensive comparisons provide faculty with…

Dopamine reward prediction error responses reflect marginal utility.

PubMed

Stauffer, William R; Lak, Armin; Schultz, Wolfram

2014-11-03

Optimal choices require an accurate neuronal representation of economic value. In economics, utility functions are mathematical representations of subjective value that can be constructed from choices under risk. Utility usually exhibits a nonlinear relationship to physical reward value that corresponds to risk attitudes and reflects the increasing or decreasing marginal utility obtained with each additional unit of reward. Accordingly, neuronal reward responses coding utility should robustly reflect this nonlinearity. In two monkeys, we measured utility as a function of physical reward value from meaningful choices under risk (that adhered to first- and second-order stochastic dominance). The resulting nonlinear utility functions predicted the certainty equivalents for new gambles, indicating that the functions' shapes were meaningful. The monkeys were risk seeking (convex utility function) for low reward and risk avoiding (concave utility function) with higher amounts. Critically, the dopamine prediction error responses at the time of reward itself reflected the nonlinear utility functions measured at the time of choices. In particular, the reward response magnitude depended on the first derivative of the utility function and thus reflected the marginal utility. Furthermore, dopamine responses recorded outside of the task reflected the marginal utility of unpredicted reward. Accordingly, these responses were sufficient to train reinforcement learning models to predict the behaviorally defined expected utility of gambles. These data suggest a neuronal manifestation of marginal utility in dopamine neurons and indicate a common neuronal basis for fundamental explanatory constructs in animal learning theory (prediction error) and economic decision theory (marginal utility). Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

Confidence of compliance: a Bayesian approach for percentile standards.

PubMed

McBride, G B; Ellis, J C

2001-04-01

Rules for assessing compliance with percentile standards commonly limit the number of exceedances permitted in a batch of samples taken over a defined assessment period. Such rules are commonly developed using classical statistical methods. Results from alternative Bayesian methods are presented (using beta-distributed prior information and a binomial likelihood), resulting in "confidence of compliance" graphs. These allow simple reading of the consumer's risk and the supplier's risks for any proposed rule. The influence of the prior assumptions required by the Bayesian technique on the confidence results is demonstrated, using two reference priors (uniform and Jeffreys') and also using optimistic and pessimistic user-defined priors. All four give less pessimistic results than does the classical technique, because interpreting classical results as "confidence of compliance" actually invokes a Bayesian approach with an extreme prior distribution. Jeffreys' prior is shown to be the most generally appropriate choice of prior distribution. Cost savings can be expected using rules based on this approach.

7 CFR 4290.508 - Compliance with non-discrimination laws and regulations applicable to federally-assisted programs.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 15 2010-01-01 2010-01-01 false Compliance with non-discrimination laws and... the Department of Agriculture (Continued) RURAL BUSINESS-COOPERATIVE SERVICE AND RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE RURAL BUSINESS INVESTMENT COMPANY (âRBICâ) PROGRAM Managing the...

Practical problems which women encounter with available contraception in Australia.

PubMed

Weisberg, E

1994-06-01

Australian women face major difficulties with contraception because of the limited range of choices, the need for meticulous attention to compliance with most available methods and because of cost limitations for a significant minority of the population. The most commonly used methods are oral contraceptive pills and barrier methods, and each has substantial compliance problems which can be minimized with care and counselling. There is an urgent need for a wider range of options in Australia and for good information and publicity about them. Present progress in this direction gives some hope for the near future.

Trust and the Compliance-Reliance Paradigm: The Effects of Risk, Error Bias, and Reliability on Trust and Dependence.

PubMed

Chancey, Eric T; Bliss, James P; Yamani, Yusuke; Handley, Holly A H

2017-05-01

This study provides a theoretical link between trust and the compliance-reliance paradigm. We propose that for trust mediation to occur, the operator must be presented with a salient choice, and there must be an element of risk for dependence. Research suggests that false alarms and misses affect dependence via two independent processes, hypothesized as trust in signals and trust in nonsignals. These two trust types manifest in categorically different behaviors: compliance and reliance. Eighty-eight participants completed a primary flight task and a secondary signaling system task. Participants evaluated their trust according to the informational bases of trust: performance, process, and purpose. Participants were in a high- or low-risk group. Signaling systems varied by reliability (90%, 60%) within subjects and error bias (false alarm prone, miss prone) between subjects. False-alarm rate affected compliance but not reliance. Miss rate affected reliance but not compliance. Mediation analyses indicated that trust mediated the relationship between false-alarm rate and compliance. Bayesian mediation analyses favored evidence indicating trust did not mediate miss rate and reliance. Conditional indirect effects indicated that factors of trust mediated the relationship between false-alarm rate and compliance (i.e., purpose) and reliance (i.e., process) but only in the high-risk group. The compliance-reliance paradigm is not the reflection of two types of trust. This research could be used to update training and design recommendations that are based upon the assumption that trust causes operator responses regardless of error bias.

Do recommendations for institutional food service result in better food service? A study of compliance in Danish hospitals and nursing homes from 1995 to 2002-2003.

PubMed

Mikkelsen, B E; Beck, A M; Lassen, A

2007-01-01

Since 1995, significant efforts by authorities and researchers have been directed towards addressing the nutritional problems in Danish hospitals and nursing homes. The purpose of this study was to investigate whether the increased focus on nutritional problems in patients and nursing home residents has resulted in measurable progress. A questionnaire-based study was carried out among foodservice managers in Danish hospitals (n=96) and nursing homes (n=898) in 1995 and 2002/3 (n=90) and (n=682), respectively. The study used compliance with selected issues in the official Danish recommendations for institutional food service as an indicator for progress. The issues included: using nutrient calculated recipes/menus, offering menu choice options, using feedback routines on acceptability of menus, maintaining nutritional steering committees, employing food and nutrition contact persons, employing official recommendations and offering choice between three different menu energy levels. Hospitals had a higher compliance compared to nursing homes. In 1995, this was the case for all questions asked and differences were statistically significant. Also in 2002/3, hospitals had a higher compliance, except in the case of established feedback routines. Differences were statistically significant. The results indicate that nutritional care is higher on the agenda in hospital, than in nursing homes. However, very little progress can be seen in compliance when results are analysed over the 8-year period. The only progress for nursing homes was that more homes had implemented feedback routines on acceptability of food service in 2002/3 than in 1995. The difference was statistically significant. For hospitals, however, no progress was found between 1995 and 2002/3. The attempts to improve the nutritional status of hospital patients and nursing home residents seem to have failed. Still, the initiatives taken to improve the situation seem relevant. Especially the nursing homes might benefit from advantage of these experiences.

A framework for estimating health state utility values within a discrete choice experiment: modeling risky choices.

PubMed

Robinson, Angela; Spencer, Anne; Moffatt, Peter

2015-04-01

There has been recent interest in using the discrete choice experiment (DCE) method to derive health state utilities for use in quality-adjusted life year (QALY) calculations, but challenges remain. We set out to develop a risk-based DCE approach to derive utility values for health states that allowed 1) utility values to be anchored directly to normal health and death and 2) worse than dead health states to be assessed in the same manner as better than dead states. Furthermore, we set out to estimate alternative models of risky choice within a DCE model. A survey was designed that incorporated a risk-based DCE and a "modified" standard gamble (SG). Health state utility values were elicited for 3 EQ-5D health states assuming "standard" expected utility (EU) preferences. The DCE model was then generalized to allow for rank-dependent expected utility (RDU) preferences, thereby allowing for probability weighting. A convenience sample of 60 students was recruited and data collected in small groups. Under the assumption of "standard" EU preferences, the utility values derived within the DCE corresponded fairly closely to the mean results from the modified SG. Under the assumption of RDU preferences, the utility values estimated are somewhat lower than under the assumption of standard EU, suggesting that the latter may be biased upward. Applying the correct model of risky choice is important whether a modified SG or a risk-based DCE is deployed. It is, however, possible to estimate a probability weighting function within a DCE and estimate "unbiased" utility values directly, which is not possible within a modified SG. We conclude by setting out the relative strengths and weaknesses of the 2 approaches in this context. © The Author(s) 2014.

No Sweat.

ERIC Educational Resources Information Center

Strickland, Gary

2001-01-01

Explains how changes in school design in the last 10 years have caused heating, ventilation, and cooling system (HVAC) designers to reexamine their choice of classroom unit ventilators (UV). The influence of indoor lighting systems, insulation, indoor air quality, energy code compliance, and HVAC system design on UV decision making are also…

Student Choice and Student Engagement

ERIC Educational Resources Information Center

Travis, Joellyn Marie

2017-01-01

The focus of this study was school transformation to accommodate "new literacies, skills, and dispositions that students need to flourish in a networked world" (Richardson, 2016, p. ix). Many schools operate within a traditional model developed during the Industrial Revolution to fit the need for efficiency and compliance (Robinson &…

The Utility of a Paired-Choice Preference Assessment in Predicting Reinforcer Effectiveness for an Infant

ERIC Educational Resources Information Center

Rush, Karena S.; Kurtz, Patricia F.; Lieblein, Tara L.; Chin, Michelle D.

2005-01-01

This study examined the utility of a paired-choice preference assessment in predicting reinforcer efficacy for a 13-month old with a history of prenatal drug exposure. First, two paired-choice assessments were conducted one week apart, using the same items. A high level of correspondence between the two assessments was observed. Next, a reinforcer…

Feasibility and Acceptability of Utilizing a Smartphone Based Application to Monitor Outpatient Discharge Instruction Compliance in Cardiac Disease Patients around Discharge from Hospitalization

PubMed Central

Layton, Aimee M.; Whitworth, James; Peacock, James; Bartels, Matthew N.; Jellen, Patricia A.; Thomashow, Byron M.

2014-01-01

The purpose of this study was to determine the feasibility and acceptability of utilizing a smartphone based application to monitor compliance in patients with cardiac disease around discharge. For 60 days after discharge, patients' medication compliance, physical activity, follow-up care, symptoms, and reading of education material were monitored daily with the application. 16 patients were enrolled in the study (12 males, 4 females, age 55 ± 18 years) during their hospital stay. Five participants were rehospitalized during the study and did not use the application once discharged. Seven participants completed 1–30 days and four patients completed >31 days. For those 11 patients, medication reminders were utilized 37% (1–30-day group) and 53% (>31-day group) of the time, education material was read 44% (1–30) and 53% (>31) of the time, and physical activity was reported 25% (1–30) and 42% (>31) of the time. Findings demonstrated that patients with stable health utilized the application, even if only minimally. Patients with decreased breath sounds by physical exam and who reported their health as fair to poor on the day of discharge were less likely to utilize the application. Acceptability of the application to report health status varied among the stable patients. PMID:25574165

EPA enforcement at a crossroads

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

Humphreys, S.L.

1994-10-15

Environmental enforcement policy in the US is at a crossroads today, faced with a choice of two competing approaches for achieving the country's environmental goals. On the one hand is the federal government's current push to beef up enforcement of environmental laws by increasing the severity of criminal sanctions and general enforcement activities. On the other hand is the growing trend in many environmental regulations to incentivize voluntary compliance by encouraging pollution prevention and self-auditing. Although these two approaches are not inherently incompatible, there is growing concern that the government's current emphasis on criminal enforcement may severely undermine the goalmore » of voluntary compliance by creating an overly adversarial relationship between government and industry and by placing corporate managers at risk of incurring personal liability when they attempt to ferret out environmental compliance problems.« less

78 FR 41932 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-12

... organizational capacity to provide health care services. Medicaid enrollees use the information collected and reported to make informed choices regarding health care, including how to access health care services and... contracting process with managed care entities, as well as its compliance oversight role. We use the...

42 CFR 423.410 - Waiver of certain requirements to expand choice.

Code of Federal Regulations, 2010 CFR

2010-10-01

... AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Organization Compliance with State Law and Preemption by Federal Law § 423.410 Waiver of certain requirements... than those required by Federal Law. The application by a State of any grounds other than those required...

Human-like Compliance for Dexterous Robot Hands

NASA Technical Reports Server (NTRS)

Jau, Bruno M.

1995-01-01

This paper describes the Active Electromechanical Compliance (AEC) system that was developed for the Jau-JPL anthropomorphic robot. The AEC system imitates the functionality of the human muscle's secondary function, which is to control the joint's stiffness: AEC is implemented through servo controlling the joint drive train's stiffness. The control strategy, controlling compliant joints in teleoperation, is described. It enables automatic hybrid position and force control through utilizing sensory feedback from joint and compliance sensors. This compliant control strategy is adaptable for autonomous robot control as well. Active compliance enables dual arm manipulations, human-like soft grasping by the robot hand, and opens the way to many new robotics applications.

Renewable Energy Implementation Analysis and Recommendations to Meet District of Columbia's Renewable Portfolio Standard (RPS) Expansion Act

NASA Astrophysics Data System (ADS)

DuBrey, Stephen

Due to federal mandates, there is an increasing demand to advance renewable energy in the District of Columbia (D.C.) to deliver power. Utilities must find ways to achieve objectives while avoiding costly alternative compliance payments. In 2016, the District of Columbia's Renewable Portfolio Standard (RPS) Expansion Act made significant amendments expanding renewable energy source requirements to 50% by 2032 and solar requirements to 5% by 2032, while current utility renewable energy percentages are at 4% and solar is at ˜0.1%. With the RPS mandate, utilities will need to improve and enhance facilitation of the interconnection of renewable energy within the power delivery system. This study will focus on the evaluation and implementation of various renewable energy systems in the District of Columbia. The main objective is to analyze the best feasible options available to meet RPS targets. If electricity suppliers are unable to meet requirements, suppliers must pay both renewable energy credits (RECs) and alternative compliance fees (ACFs) and the financial burden of compliance will ultimately be passed on to customers of the electricity suppliers. This study will also review and present the cost-effective means of REC's can be used for RPS compliance and results will provide policymakers a better understanding of how to address renewable energy requirements locally in the District.

40 CFR 52.1677 - Compliance schedules.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 1, 1973, of his intent to utilize either low-sulfur fuel or stack gas desulfurization to meet the...) of this section who elects low-sulfur fuel shall be subject to the following compliance schedule: (i) November 1, 1973—Submit to the Administrator a projection of the amount of fuel, by types, that will be...

Near-perfect compliance with SCIP Inf-9 had no effect on catheter utilization or urinary tract infections at an academic medical center.

PubMed

Kaplan, Jennifer A; Carter, Jonathan T

2018-01-01

The Joint Commission's SCIP Inf-9 mandated early removal of indwelling urinary catheters (IUCs), but the impact of compliance on catheter-associated urinary tract infection (CAUTI) and postoperative urinary retention (POUR) are unknown. Retrospective pre- and post-intervention study at a single tertiary academic medical center of all patients undergoing general surgery procedures with an IUC placed at the time of surgery who were admitted for at least two days before and after a Best Practice Advisory was put in place to improve compliance with SCIP Inf-9. A total of 1036 patients were included (468 pre-intervention; 568 post-intervention). POUR occurred in 13% of patients and CAUTI in 0.8%. There was no change in POUR, CAUTI, or catheter utilization after the Best Practice Advisory was initiated. Both POUR and CAUTI predicted longer lengths of stay. Near-perfect SCIP Inf-9 compliance had no effect on the CAUTI rate at our institution. Copyright © 2017 Elsevier Inc. All rights reserved.

Social signals of safety and risk confer utility and have asymmetric effects on observers' choices.

PubMed

Chung, Dongil; Christopoulos, George I; King-Casas, Brooks; Ball, Sheryl B; Chiu, Pearl H

2015-06-01

Individuals' risk attitudes are known to guide choices about uncertain options. However, in the presence of others' decisions, these choices can be swayed and manifest as riskier or safer behavior than one would express alone. To test the mechanisms underlying effective social 'nudges' in human decision-making, we used functional neuroimaging and a task in which participants made choices about gambles alone and after observing others' selections. Against three alternative explanations, we found that observing others' choices of gambles increased the subjective value (utility) of those gambles for the observer. This 'other-conferred utility' was encoded in ventromedial prefrontal cortex, and these neural signals predicted conformity. We further identified a parametric interaction with individual risk preferences in anterior cingulate cortex and insula. These data provide a neuromechanistic account of how information from others is integrated with individual preferences that may explain preference-congruent susceptibility to social signals of safety and risk.

76 FR 35209 - Orlando Utilities Commission; Notice of Filing

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-16

... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Docket No. NJ11-12-001] Orlando Utilities Commission; Notice of Filing Take notice that on May 26, 2011, Orlando Utilities Commission submitted its tariff filing per 35.17(b): Amendment to Compliance Filing to be effective 4/15/2011. Any...

78 FR 78352 - Orlando Utilities Commission; Notice of Filing

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-26

... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Docket No. NJ14-4-000] Orlando Utilities Commission; Notice of Filing Take notice that on December 18, 2013, Orlando Utilities Commission submitted its tariff filing per 35.28(e): Order No. 1000 Further Regional Compliance Filing to be effective...

76 FR 25685 - Orlando Utilities Commission; Notice of Filing

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-05

... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Docket No. NJ11-12-000] Orlando Utilities Commission; Notice of Filing Take notice that on April 15, 2011, Orlando Utilities Commission submitted its tariff filing per 35.25(e): Order 890 compliance to be effective 4/15/2011. Any person...

Evaluating Professionalism, Practice-Based Learning and Improvement, and Systems-Based Practice: Utilization of a Compliance Form and Correlation with Conflict Styles

PubMed Central

Ogunyemi, Dotun; Eno, Michelle; Rad, Steve; Fong, Alex; Alexander, Carolyn; Azziz, Ricardo

2010-01-01

Objective The purpose of this article was to develop and determine the utility of a compliance form in evaluating and teaching the Accreditation Council for Graduate Medical Education competencies of professionalism, practice-based learning and improvement, and systems-based practice. Methods In 2006, we introduced a 17-item compliance form in an obstetrics and gynecology residency program. The form prospectively monitored residents on attendance at required activities (5 items), accountability of required obligations (9 items), and completion of assigned projects (3 items). Scores were compared to faculty evaluations of residents, resident status as a contributor or a concerning resident, and to the residents' conflict styles, using the Thomas-Kilmann Conflict MODE Instrument. Results Our analysis of 18 residents for academic year 2007–2008 showed a mean (standard error of mean) of 577 (65.3) for postgraduate year (PGY)-1, 692 (42.4) for PGY-2, 535 (23.3) for PGY-3, and 651.6 (37.4) for PGY-4. Non-Hispanic white residents had significantly higher scores on compliance, faculty evaluations on interpersonal and communication skills, and competence in systems-based practice. Contributing residents had significantly higher scores on compliance compared with concerning residents. Senior residents had significantly higher accountability scores compared with junior residents, and junior residents had increased project completion scores. Attendance scores increased and accountability scores decreased significantly between the first and second 6 months of the academic year. There were positive correlations between compliance scores with competing and collaborating conflict styles, and significant negative correlations between compliance with avoiding and accommodating conflict styles. Conclusions Maintaining a compliance form allows residents and residency programs to focus on issues that affect performance and facilitate assessment of the ACGME competencies. Postgraduate year, behavior, and conflict styles appear to be associated with compliance. A lack of association with faculty evaluations suggests measurement of different perceptions of residents' behavior. PMID:21976093

Evaluating professionalism, practice-based learning and improvement, and systems-based practice: utilization of a compliance form and correlation with conflict styles.

PubMed

Ogunyemi, Dotun; Eno, Michelle; Rad, Steve; Fong, Alex; Alexander, Carolyn; Azziz, Ricardo

2010-09-01

The purpose of this article was to develop and determine the utility of a compliance form in evaluating and teaching the Accreditation Council for Graduate Medical Education competencies of professionalism, practice-based learning and improvement, and systems-based practice. In 2006, we introduced a 17-item compliance form in an obstetrics and gynecology residency program. The form prospectively monitored residents on attendance at required activities (5 items), accountability of required obligations (9 items), and completion of assigned projects (3 items). Scores were compared to faculty evaluations of residents, resident status as a contributor or a concerning resident, and to the residents' conflict styles, using the Thomas-Kilmann Conflict MODE Instrument. Our analysis of 18 residents for academic year 2007-2008 showed a mean (standard error of mean) of 577 (65.3) for postgraduate year (PGY)-1, 692 (42.4) for PGY-2, 535 (23.3) for PGY-3, and 651.6 (37.4) for PGY-4. Non-Hispanic white residents had significantly higher scores on compliance, faculty evaluations on interpersonal and communication skills, and competence in systems-based practice. Contributing residents had significantly higher scores on compliance compared with concerning residents. Senior residents had significantly higher accountability scores compared with junior residents, and junior residents had increased project completion scores. Attendance scores increased and accountability scores decreased significantly between the first and second 6 months of the academic year. There were positive correlations between compliance scores with competing and collaborating conflict styles, and significant negative correlations between compliance with avoiding and accommodating conflict styles. Maintaining a compliance form allows residents and residency programs to focus on issues that affect performance and facilitate assessment of the ACGME competencies. Postgraduate year, behavior, and conflict styles appear to be associated with compliance. A lack of association with faculty evaluations suggests measurement of different perceptions of residents' behavior.

The demand for statin: the effect of copay on utilization and compliance.

PubMed

Thiebaud, Patrick; Patel, Bimal V; Nichol, Michael B

2008-01-01

Increasing drug costs in the US have prompted employers and insurers alike to turn to higher drug copays for cost containment. The effect of rising copays on compliance with statins (HMG-CoA reductase inhibitors) treatment has received surprisingly little attention in the applied literature. This paper uses pharmacy claims data from a commercially insured adult population to determine the effect of copay change on compliance at the individual level. Fixed effect logit and Poisson regressions estimate the effect of copays on monthly likelihood of high compliance and average monthly days of supply respectively. Higher copays reduce compliance among statin users, with less compliant patients responding more strongly to copay change than compliant patients. These results suggest that specific financial incentives given to less compliant patients could improve compliance with statin treatment at a relatively low cost. Copyright (c) 2007 John Wiley & Sons, Ltd.

Reciprocity in computer-human interaction: source-based, norm-based, and affect-based explanations.

PubMed

Lee, Seungcheol Austin; Liang, Yuhua Jake

2015-04-01

Individuals often apply social rules when they interact with computers, and this is known as the Computers Are Social Actors (CASA) effect. Following previous work, one approach to understand the mechanism responsible for CASA is to utilize computer agents and have the agents attempt to gain human compliance (e.g., completing a pattern recognition task). The current study focuses on three key factors frequently cited to influence traditional notions of compliance: evaluations toward the source (competence and warmth), normative influence (reciprocity), and affective influence (mood). Structural equation modeling assessed the effects of these factors on human compliance with computer request. The final model shows that norm-based influence (reciprocity) increased the likelihood of compliance, while evaluations toward the computer agent did not significantly influence compliance.

The child brain computes and utilizes internalized maternal choices

PubMed Central

Lim, Seung-Lark; Cherry, J. Bradley C.; Davis, Ann M.; Balakrishnan, S. N.; Ha, Oh-Ryeong; Bruce, Jared M.; Bruce, Amanda S.

2016-01-01

As children grow, they gradually learn how to make decisions independently. However, decisions like choosing healthy but less-tasty foods can be challenging for children whose self-regulation and executive cognitive functions are still maturing. We propose a computational decision-making process in which children estimate their mother's choices for them as well as their individual food preferences. By employing functional magnetic resonance imaging during real food choices, we find that the ventromedial prefrontal cortex (vmPFC) encodes children's own preferences and the left dorsolateral prefrontal cortex (dlPFC) encodes the projected mom's choices for them at the time of children's choice. Also, the left dlPFC region shows an inhibitory functional connectivity with the vmPFC at the time of children's own choice. Our study suggests that in part, children utilize their perceived caregiver's choices when making choices for themselves, which may serve as an external regulator of decision-making, leading to optimal healthy decisions. PMID:27218420

Discrete choice experiment to evaluate factors that influence preferences for antibiotic prophylaxis in pediatric oncology.

PubMed

Regier, Dean A; Diorio, Caroline; Ethier, Marie-Chantal; Alli, Amanda; Alexander, Sarah; Boydell, Katherine M; Gassas, Adam; Taylor, Jonathan; Kellow, Charis; Mills, Denise; Sung, Lillian

2012-01-01

Bacterial and fungal infections in pediatric oncology patients cause morbidity and mortality. The clinical utility of antimicrobial prophylaxis in children is uncertain and the personal utility of these agents is disputed. Objectives were to use a discrete choice experiment to: (1) describe the importance of attributes to parents and healthcare providers when deciding between use and non-use of antibacterial and antifungal prophylaxis; and (2) estimate willingness-to-pay for prophylactic strategies. Attributes were chances of infection, death and side effects, route of administration and cost of pharmacotherapy. Respondents were randomized to a discrete choice experiment outlining hypothetical treatment options to prevent antibacterial or antifungal infections. Each respondent was presented 16 choice tasks and was asked to choose between two unlabeled treatment options and an opt-out alternative (no prophylaxis). 102 parents and 60 healthcare providers participated. For the antibacterial discrete choice experiment, frequency of administration was significantly associated with utility for parents but not for healthcare providers. Increasing chances of infection, death, side effects and cost were all significantly associated with decreased utility for parents and healthcare providers in both the antibacterial and antifungal discrete choice experiment. Parental willingness-to-pay was higher than healthcare providers for both strategies. Chances of infection, death, side effects and costs were all significantly associated with utility. Parents have higher willingness-to-pay for these strategies compared with healthcare providers. This knowledge can help to develop prophylaxis programs.

Rapid motif compliance scoring with match weight sets.

PubMed

Venezia, D; O'Hara, P J

1993-02-01

Most current implementations of motif matching in biological sequences have sacrificed the generality of weight matrix scoring for shorter runtimes. The program MOTIF incorporates a weight matrix and a rapid, backtracking tree-search algorithm to score motif compliance with greatly enhanced performance while placing no constraints on the motif. In addition, any positions within a motif can be marked as 'inviolate', thereby requiring an exact match. MOTIF allows a choice of regular expression formats and can use both motif and sequence libraries as either targets or queries. Nucleic acid sequences can optionally be translated by MOTIF in any frame(s) and used against peptide motifs.

Participation rate or informed choice? Rethinking the European key performance indicators for mammography screening.

PubMed

Strech, Daniel

2014-03-01

Despite the intensive controversies about the likelihood of benefits and harms of mammography screening almost all experts conclude that the choice to screen or not to screen needs to be made by the individual patient who is adequately informed. However, the "European guideline for quality assurance in breast cancer screening and diagnosis" specifies a participation rate of 70% as the key performance indicator for mammography screening. This paper argues that neither the existing evidence on benefits and harms, nor survey research with women, nor compliance rates in clinical trials, nor cost-effectiveness ratios justify participation rates as a reasonable performance indicator for preference-sensitive condition such as mammography screening. In contrast, an informed choice rate would be more reasonable. Further research needs to address the practical challenges in assessing informed choice rates. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Hand hygiene for the prevention of nosocomial infections.

PubMed

Kampf, Günter; Löffler, Harald; Gastmeier, Petra

2009-10-01

The WHO regards hand hygiene as an essential tool for the prevention of nosocomial infection, but compliance in clinical practice is often low. The relevant scientific literature and national and international evidence-based recommendations (Robert Koch Institute [Germany], WHO) were evaluated. Hygienic hand disinfection has better antimicrobial efficacy than hand-washing and is the procedure of choice to be performed before and after manual contact with patients. The hands should be washed, rather than disinfected, only when they are visibly soiled. Skin irritation is quite common among healthcare workers and is mainly caused by water, soap, and prolonged wearing of gloves. Compliance can be improved by training, by placing hand-rub dispensers at the sites where they are needed, and by physicians setting a good example for others. Improved compliance in hand hygiene, with proper use of alcohol-based hand rubs, can reduce the nosocomial infection rate by as much as 40%.

Quality of life, compliance, safety and effectiveness in fit older metastatic colorectal patients with cancer treated in first-line with chemotherapy plus cetuximab: A restrospective analysis from the ObservEr study.

PubMed

Rosati, Gerardo; Pinto, Carmine; Di Fabio, Francesca; Chiara, Silvana; Lolli, Ivan R; Ruggeri, Enzo M; Ciuffreda, Libero; Ferrara, Raimondo; Antonuzzo, Lorenzo; Adua, Daniela; Racca, Patrizia; Bilancia, Domenico; Benincasa, Elena; Stroppolo, Maria Elena; Di Costanzo, Francesco

2018-05-01

The influence of age (<70 years and ≥70 years) was retrospectively studied on the quality of life (QoL), incidence of side effects (including skin reactions) and efficacy of chemotherapy plus cetuximab in patients with KRAS wild type (WT) metastatic colorectal cancer (mCRC). 225 patients of the Observed study (PS 0-1) were retrieved based on age (< 70 and ≥70 years) and evaluated through EORTC QLQ-C30 and DLQI questionnaires. The two patient groups (141 < 70 and 84 ≥ 70 years, respectively) were balanced with no differences in any of the clinical and pathological characteristics considered. Both groups underwent similar type of first-line chemotherapy plus cetuximab, treatment duration and compliance. Cetuximab therapy caused similar incidence of side effects and impact on QoL in older and younger patients. No difference was observed in progression free survival (PFS) and in disease control rates between the two patient populations. Median overall survival (OS) was higher in patients <70 (27 months, 95% CI: 22.7-31.27) than in patients ≥70 (19 months, 95% CI: 14.65-23.35) (p = 0.002), which is likely due to higher proportions of metastatic resection (27.0% vs 8.3%; p = 0.001) and utilization of second-line therapy in younger group (58.9% vs 42.9%; p = 0.028). The current data suggest that fit older patients with mCRC can be safely treated with a cetuximab-based therapy, as QoL and safety profile do not seem to be affected by age. In addition, age did not impact the choice of chemotherapy to be associated to cetuximab and treatment compliance. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

40 CFR 1502.23 - Cost-benefit analysis.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 32 2010-07-01 2010-07-01 false Cost-benefit analysis. 1502.23 Section... § 1502.23 Cost-benefit analysis. If a cost-benefit analysis relevant to the choice among environmentally... compliance with section 102(2)(B) of the Act the statement shall, when a cost-benefit analysis is prepared...

40 CFR 1502.23 - Cost-benefit analysis.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 33 2014-07-01 2014-07-01 false Cost-benefit analysis. 1502.23 Section... § 1502.23 Cost-benefit analysis. If a cost-benefit analysis relevant to the choice among environmentally... compliance with section 102(2)(B) of the Act the statement shall, when a cost-benefit analysis is prepared...

Creative Non-Compliance in East Harlem Schools.

ERIC Educational Resources Information Center

Fleigel, Seymour

This paper describes a program that has evolved in District No. 4 in the East Harlem area of Manhattan (New York). There, a system of "choice" at the junior high school level is possible due in part to the latitude afforded local school districts under the current decentralized system of authority. The program permits students and…

Research monitoring by US medical institutions to protect human subjects: compliance or quality improvement?

PubMed

de Jong, Jean Philippe; van Zwieten, Myra C B; Willems, Dick L

2013-04-01

In recent years, to protect the rights and welfare of human subjects, institutions in the USA have begun to set up programmes to monitor ongoing medical research. These programmes provide routine, onsite oversight, and thus go beyond existing oversight such as investigating suspected misconduct or reviewing paperwork provided by investigators. However, because of a lack of guidelines and evidence, institutions have had little guidance in setting up their programmes. To help institutions make the right choices, we used interviews and document analysis to study how and why 11 US institutions have set up their monitoring programmes. Although these programmes varied considerably, we were able to distinguish two general types. 'Compliance' programmes on the one hand were part of the institutional review board office and set up to ensure compliance with regulations. Investigators' participation was mandatory. Monitors focused on documentation. Investigators could be disciplined, and could be obliged to take corrective actions. 'Quality-improvement' programmes on the other hand were part of a separate office. Investigators requested to be monitored. Monitors focused more on actual research conduct. Investigators and other parties received feedback on how to improve the research process. Although both types of programmes have their drawbacks and advantages, we argue that if institutions want to set up monitoring programmes, quality improvement is the better choice: it can help foster an atmosphere of trust between investigators and the institutional review board, and can help raise the standards for the protection of human subjects.

40 CFR 63.2378 - How do I demonstrate continuous compliance with the emission limitations, operating limits, and...

Code of Federal Regulations, 2011 CFR

2011-07-01

... emission limitations of this subpart apply during periods of SSM, except as provided in paragraphs (b)(2) and (3) of this section. However, if a SSM, or period of nonoperation of one portion of the affected... or utilized for achieving compliance with this subpart during periods of SSM while emissions are...

40 CFR 63.2378 - How do I demonstrate continuous compliance with the emission limitations, operating limits, and...

Code of Federal Regulations, 2012 CFR

2012-07-01

.... The emission limitations of this subpart apply during periods of SSM, except as provided in paragraphs (b)(2) and (3) of this section. However, if a SSM, or period of nonoperation of one portion of the... or utilized for achieving compliance with this subpart during periods of SSM while emissions are...

40 CFR 63.2378 - How do I demonstrate continuous compliance with the emission limitations, operating limits, and...

Code of Federal Regulations, 2014 CFR

2014-07-01

.... The emission limitations of this subpart apply during periods of SSM, except as provided in paragraphs (b)(2) and (3) of this section. However, if a SSM, or period of nonoperation of one portion of the... or utilized for achieving compliance with this subpart during periods of SSM while emissions are...

40 CFR 63.2378 - How do I demonstrate continuous compliance with the emission limitations, operating limits, and...

Code of Federal Regulations, 2013 CFR

2013-07-01

.... The emission limitations of this subpart apply during periods of SSM, except as provided in paragraphs (b)(2) and (3) of this section. However, if a SSM, or period of nonoperation of one portion of the... or utilized for achieving compliance with this subpart during periods of SSM while emissions are...

Vertical Compliance Trends in KBOS OPD Arrival Redesign

NASA Technical Reports Server (NTRS)

Stewart, Michael Jeffrey; Matthews, Bryan L.; Feary, Michael S.

2016-01-01

This report is a high-level summary of vertical compliance trends and overall rates of Area Navigation Optimized Profile Descent (RNAV OPD) utilization for Boston Logan International Airport. Specifically, we investigated trends from three RNAV OPDs and the subsequent redesigned iterations of those procedures: OOSHN3 to OOSHN4, ROBUC1 to ROBUC2, and QUABN3 to JFUND1.

7 CFR 1773.21 - Borrower's review and submission of the auditor's report, report on compliance and on internal...

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 12 2011-01-01 2011-01-01 false Borrower's review and submission of the auditor's report, report on compliance and on internal control over financial reporting, and management letter. 1773.21 Section 1773.21 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE ...

7 CFR 1773.21 - Borrower's review and submission of the auditor's report, report on compliance and on internal...

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 12 2014-01-01 2013-01-01 true Borrower's review and submission of the auditor's report, report on compliance and on internal control over financial reporting, and management letter. 1773.21 Section 1773.21 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE ...

7 CFR 1773.21 - Borrower's review and submission of the auditor's report, report on compliance and on internal...

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 12 2012-01-01 2012-01-01 false Borrower's review and submission of the auditor's report, report on compliance and on internal control over financial reporting, and management letter. 1773.21 Section 1773.21 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE ...

7 CFR 1773.21 - Borrower's review and submission of the auditor's report, report on compliance and on internal...

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 12 2013-01-01 2013-01-01 false Borrower's review and submission of the auditor's report, report on compliance and on internal control over financial reporting, and management letter. 1773.21 Section 1773.21 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE ...

75 FR 66430 - Proposed Collection; Comment Request for Foreign Based Importer Non-Filers Questionnaire

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-28

... Tax compliance has been fulfilled. Therefore, IDRS will be utilized to determine if filing compliance... required by the Paperwork Reduction Act of 1995, Public Law 104-13 (44 U.S.C. 3506(c)(2)(A)). Currently... are subject to U.S. Income Tax on income that is effectively connected with a U.S. trade or business...

Context influences decision-making in boys with attention-deficit/hyperactivity disorder: A comparison of traditional and novel choice-impulsivity paradigms.

PubMed

Patros, Connor H G; Alderson, R Matt; Lea, Sarah E; Tarle, Stephanie J

2017-02-01

Attention-deficit/hyperactivity disorder (ADHD) is characterized by an impaired ability to maintain attention and/or hyperactivity/impulsivity. Impulsivity is frequently defined as the preference for small, immediate rewards over larger, delayed rewards, and has been associated with a variety of negative outcomes such as risky behavior and academic difficulty. Extant studies have uniformly utilized the traditional paradigm of presenting two response choices, which limits the generalization of findings to scenarios in which children/adolescents are faced with dichotomous decisions. The current study is the first to examine the effect of manipulating the number of available response options on impulsive decision-making in boys with and without ADHD. A total of 39 boys (ADHD = 16, typically developing [TD] = 23) aged 8-12 years completed a traditional two-choice impulsivity task and a novel five-choice impulsivity task to examine the effect of manipulating the number of choice responses (two vs five) on impulsive decision-making. A five-choice task was utilized as it presents a more continuous array of choice options when compared to the typical two-choice task, and is comparable given its methodological similarity to the two-choice task. Results suggested that boys with ADHD were significantly more impulsive than TD boys during the two-choice task, but not during the five-choice task. Collectively, these findings suggest that ADHD-related impulsivity is not ubiquitous, but rather dependent on variation in demands and/or context. Further, these findings highlight the importance of examining ADHD-related decision-making within the context of alternative paradigms, as the exclusive utilization of two-choice tasks may promote inaccurate conceptualizations of the disorder.

Considering consumer choice in the economic evaluation of mandatory health programmes: a review.

PubMed

Parkinson, Bonny; Goodall, Stephen

2011-08-01

Governments are increasing their focus on mandatory public health programmes following positive economic evaluations of their impact. This review aims to examine whether loss of consumer choice should be included in economic evaluations of mandatory health programmes (MHP). A systematic literature review was conducted to identify economic evaluations of MHP, whether they discuss the impact on consumer choice and any methodological limitations. Overall 39 economic evaluations were identified, of which 10 discussed the loss of consumer choice and 6 attempted to place a value on the loss of consumer choice. Methodological limitations included: measuring the marginal cost of compliance, unavailability of price elasticity estimates, the impact of income effects, double counting health impacts, biased willingness-to-pay responses, and "protest" responses. Overall it was found that the inclusion of the loss of consumer choice rarely impacted on the final outcome of the study. The impact of MHP on the loss of consumer choice has largely been ignored in economic evaluations. Its importance remains uncertain due to its infrequent inclusion and significant methodological limitations. Further research regarding which methodology is best for valuing the loss of consumer choice and whether it is important to the final implementation decision is warranted. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Economic Choices Reveal Probability Distortion in Macaque Monkeys

PubMed Central

Lak, Armin; Bossaerts, Peter; Schultz, Wolfram

2015-01-01

Economic choices are largely determined by two principal elements, reward value (utility) and probability. Although nonlinear utility functions have been acknowledged for centuries, nonlinear probability weighting (probability distortion) was only recently recognized as a ubiquitous aspect of real-world choice behavior. Even when outcome probabilities are known and acknowledged, human decision makers often overweight low probability outcomes and underweight high probability outcomes. Whereas recent studies measured utility functions and their corresponding neural correlates in monkeys, it is not known whether monkeys distort probability in a manner similar to humans. Therefore, we investigated economic choices in macaque monkeys for evidence of probability distortion. We trained two monkeys to predict reward from probabilistic gambles with constant outcome values (0.5 ml or nothing). The probability of winning was conveyed using explicit visual cues (sector stimuli). Choices between the gambles revealed that the monkeys used the explicit probability information to make meaningful decisions. Using these cues, we measured probability distortion from choices between the gambles and safe rewards. Parametric modeling of the choices revealed classic probability weighting functions with inverted-S shape. Therefore, the animals overweighted low probability rewards and underweighted high probability rewards. Empirical investigation of the behavior verified that the choices were best explained by a combination of nonlinear value and nonlinear probability distortion. Together, these results suggest that probability distortion may reflect evolutionarily preserved neuronal processing. PMID:25698750

Economic choices reveal probability distortion in macaque monkeys.

PubMed

Stauffer, William R; Lak, Armin; Bossaerts, Peter; Schultz, Wolfram

2015-02-18

Economic choices are largely determined by two principal elements, reward value (utility) and probability. Although nonlinear utility functions have been acknowledged for centuries, nonlinear probability weighting (probability distortion) was only recently recognized as a ubiquitous aspect of real-world choice behavior. Even when outcome probabilities are known and acknowledged, human decision makers often overweight low probability outcomes and underweight high probability outcomes. Whereas recent studies measured utility functions and their corresponding neural correlates in monkeys, it is not known whether monkeys distort probability in a manner similar to humans. Therefore, we investigated economic choices in macaque monkeys for evidence of probability distortion. We trained two monkeys to predict reward from probabilistic gambles with constant outcome values (0.5 ml or nothing). The probability of winning was conveyed using explicit visual cues (sector stimuli). Choices between the gambles revealed that the monkeys used the explicit probability information to make meaningful decisions. Using these cues, we measured probability distortion from choices between the gambles and safe rewards. Parametric modeling of the choices revealed classic probability weighting functions with inverted-S shape. Therefore, the animals overweighted low probability rewards and underweighted high probability rewards. Empirical investigation of the behavior verified that the choices were best explained by a combination of nonlinear value and nonlinear probability distortion. Together, these results suggest that probability distortion may reflect evolutionarily preserved neuronal processing. Copyright © 2015 Stauffer et al.

Best practices in specialty pharmacy management.

PubMed

Patterson, Courtney J

2013-01-01

Specialty pharmacy is a growing area of research, utilization, and cost. Because of the unique nature of the diseases treated by specialty pharmaceuticals, such as cancer and rheumatoid arthritis, novel management approaches are needed. Advocate Physician Partners (APP) is an entity within the Advocate Health Care Health System in the Chicago and the central Illinois area. It coordinates the care management and managed care contracting between the Advocate Health Care System and more than 4,000 physicians on the medical staffs of Advocate hospitals. APP has experienced a per-member-per-month (PMPM) increase of less than  3% in oncology intravenous medications spend in 2012. This spend refers to the intravenous medications covered under the medical benefits for APP's health maintenance organization (HMO) population. The spend has consistently been less than national projections, and we believe this is tied to the adoption of several key best practices. Prior to instituting the best practices, the yearly percentage increases for oncology spending were 5.52% (2007 to 2008), 9.39% (2008 to 2009), and 5.29% (2009 to 2010). After instituting best practices during the first quarter of 2011, the increases in PMPM were 3.11% (2010 to 2011) and 2.11% (2011 to 2012), which were below previous years. To describe the best practices of specialty pharmacy management adopted by APP, specifically (a) establishing a content expert and governing bodies, (b) ensuring compliance with policies, and (c) providing educational resources. APP has several key result areas (KRAs). One KRA was compliance with appropriate utilization of intravenous oncology protocols for its HMO population. The protocols for each medication outline the appropriate indication and patient population. These protocols were developed and reviewed by the APP Pharmacy and Technology (PT) committee. The PT-approved indications reflect FDA indications and indications found in national guidelines. The APP KRA target for the utilization of protocols was 80%. The compliance for completing the protocols that correspond to these medications was calculated by tabulating the number of paid claims over the number of completed protocols, resulting in a compliance percentage. APP defined noncompliance as any utilization not outlined in the protocol. Another KRA was physician feedback. APP requires that physicians complete a certain number of continuing medical education (CME) programs provided by APP each year. Feedback from physicians, provided at the end of the CME, were tabulated and utilized for further programs. Additionally, APP strived to increase physician engagement by placing them in key roles that oversaw clinical and business aspects of the organization. In order to meet the KRAs, investigate inappropriate utilization, and become better involved in engaging oncology specialists, APP invested in an oncology clinical pharmacist position. The primary responsibility of the oncology clinical pharmacist was to be a specialty drug resource for the organization with a focus on provider education. The oncology clinical pharmacist was deemed the content expert who developed clinical protocols, educated providers, and encouraged compliance with organizational policies and procedures as it pertained to the KRAs. Since establishing the oncology clinical pharmacist position, APP has seen an increase in protocol compliance. Prior to the institution of this position, the protocol compliance was 62%. In less than 1 year after hiring the oncology clinical pharmacist, the compliance percentage spiked to over 80%. APP has several committees and boards that oversee the clinical and business aspects of the organization. By placing physicians in chairmanship positions of the committees, APP has seen the benefit of handling difficult patient decisions and increased compliance with policies. Lastly, extensive provider education has led to an improved physician satisfaction in the educational initiatives of APP. Greater than 80% of the physicians felt the CME content was relevant to their practices; the content would likely have a positive impact on their practices; and the clinical content was evidence based and accepted by the medical community. By hiring an oncology clinical pharmacist, engaging physicians by placing them in key roles, and providing more specialist-specific education, APP has improved its KRAs and compliance percentages. APP achieved success in containing expenditures for oncology intravenous medications by implementing key best practices combined with traditional management strategies.

Women, Men and Personal Sales: An Analysis of Sex Differences in Compliance Gaining Strategy Use.

ERIC Educational Resources Information Center

Sprowl, John

A study explored the effects of both the sales representative's and the target consumer's biological gender upon the persuasive strategy choice of the salesperson. Data from 204 salespeople responding to a 27-item questionnaire were collected over a 6-week period. The results indicate clear differences between men and women sales representatives…

Assessment "as" Learning in Music Education: The Risk of "Criteria Compliance" Replacing "Learning" in the Scandinavian Countries

ERIC Educational Resources Information Center

Ferm Almqvist, Cecilia; Vinge, John; Väkevä, Lauri; Zandén, Olle

2017-01-01

Recent reforms in England and the USA give evidence that teaching methods and content can change rapidly, given a strong external pressure, for example through economic incentives, inspections, school choice, and public display of schools' and pupils' performances. Educational activities in the Scandinavian countries have increasingly become…

Learning What to Want: Context-Sensitive Preference Learning

PubMed Central

Srivastava, Nisheeth; Schrater, Paul

2015-01-01

We have developed a method for learning relative preferences from histories of choices made, without requiring an intermediate utility computation. Our method infers preferences that are rational in a psychological sense, where agent choices result from Bayesian inference of what to do from observable inputs. We further characterize conditions on choice histories wherein it is appropriate for modelers to describe relative preferences using ordinal utilities, and illustrate the importance of the influence of choice history by explaining all major categories of context effects using them. Our proposal clarifies the relationship between economic and psychological definitions of rationality and rationalizes several behaviors heretofore judged irrational by behavioral economists. PMID:26496645

23 CFR 230.409 - Contract compliance review procedures.

Code of Federal Regulations, 2013 CFR

2013-04-01

..., written corrective action plans, PR-1391 or Manpower Utilization Reports, training requirements, previous... result in increased utilization of minorities and women? (iv) Is there impartiality in treatment of...) Have the contractor's efforts produced results? (f) Exit conference (Action R-6). (1) During the exit...

23 CFR 230.409 - Contract compliance review procedures.

Code of Federal Regulations, 2014 CFR

2014-04-01

..., written corrective action plans, PR-1391 or Manpower Utilization Reports, training requirements, previous... result in increased utilization of minorities and women? (iv) Is there impartiality in treatment of...) Have the contractor's efforts produced results? (f) Exit conference (Action R-6). (1) During the exit...

23 CFR 230.409 - Contract compliance review procedures.

Code of Federal Regulations, 2011 CFR

2011-04-01

..., written corrective action plans, PR-1391 or Manpower Utilization Reports, training requirements, previous... result in increased utilization of minorities and women? (iv) Is there impartiality in treatment of...) Have the contractor's efforts produced results? (f) Exit conference (Action R-6). (1) During the exit...

23 CFR 230.409 - Contract compliance review procedures.

Code of Federal Regulations, 2012 CFR

2012-04-01

..., written corrective action plans, PR-1391 or Manpower Utilization Reports, training requirements, previous... result in increased utilization of minorities and women? (iv) Is there impartiality in treatment of...) Have the contractor's efforts produced results? (f) Exit conference (Action R-6). (1) During the exit...

After the withdrawal of 'informed choice': the meanings and social effects of mothers' choice for HIV prevention in Senegal.

PubMed

Desclaux, Alice

2014-01-01

To prevent HIV transmission through breastfeeding, African health services in 1998 implemented the World Health Organization's approach of 'informed choice' when recommending infant feeding options to HIV-positive mothers. In 2010, 'informed choice' was withdrawn in favour of antiretroviral prophylaxis with breastfeeding. A 2010-11 ethnographic study conducted in Senegal among HIV-positive mothers revealed three broad responses to the withdrawal of choice and formula provision: 'resistance' from association members claiming the health system was responsible for providing formula to ensure efficient prevention; 'compliance' among mothers adopting 'protected breastfeeding' without complaints; and 'self-reliance' among women trying to obtain formula through other means without mentioning choice. These three responses shed light on the meanings attributed to choice and on the social impact of formula provision during the 'informed choice era.' The analysis shows that the top-down introduction of 'informed choice' as an ethical and management imperative was appropriated and re-signified locally, making space for new forms of sociality within medical and associative social spaces. These social forms could not easily be maintained after the withdrawal of formula provision; women who continue to exert choice do so silently. By focusing on the upheaval of social care arrangements after the introduction of prophylaxis by pharmaceuticals, this paper sheds light on the understudied local consequences of changes in public health policies and the social framing of 'choice' in low-income countries' health systems.

A randomized trial to determine the impact on compliance of a psychophysical peripheral cue based on the Elaboration Likelihood Model.

PubMed

Horton, Rachael Jane; Minniti, Antoinette; Mireylees, Stewart; McEntegart, Damian

2008-11-01

Non-compliance in clinical studies is a significant issue, but causes remain unclear. Utilizing the Elaboration Likelihood Model of persuasion, this study assessed the psychophysical peripheral cue 'Interactive Voice Response System (IVRS) call frequency' on compliance. 71 participants were randomized to once daily (OD), twice daily (BID) or three times daily (TID) call schedules over two weeks. Participants completed 30-item cognitive function tests at each call. Compliance was defined as proportion of expected calls within a narrow window (+/- 30 min around scheduled time), and within a relaxed window (-30 min to +4 h). Data were analyzed by ANOVA and pairwise comparisons adjusted by the Bonferroni correction. There was a relationship between call frequency and compliance. Bonferroni adjusted pairwise comparisons showed significantly higher compliance (p=0.03) for the BID (51.0%) than TID (30.3%) for the narrow window; for the extended window, compliance was higher (p=0.04) with OD (59.5%), than TID (38.4%). The IVRS psychophysical peripheral cue call frequency supported the ELM as a route to persuasion. The results also support OD strategy for optimal compliance. Models suggest specific indicators to enhance compliance with medication dosing and electronic patient diaries to improve health outcomes and data integrity respectively.

Status and perspectives of municipal solid waste incineration in China: A comparison with developed regions.

PubMed

Lu, Jia-Wei; Zhang, Sukun; Hai, Jing; Lei, Ming

2017-11-01

With the rapid expansion of municipal solid waste (MSW) incineration, the applicability, technical status, and future improvement of MSW incineration attract much attention in China. This paper aims to be a sensible response, with the aid of a comparison between China and some representative developed regions including the EU, the U.S., Japan, South Korea, and Taiwan area. A large number of up-to-date data and information are collected to quantitatively and impartially support the comparison, which covers a wider range of key points including spatial distribution, temporal evolution, technologies, emissions, and perspectives. Analysis results show that MSW incineration is not an outdated choice; however, policy making should prevent the potentially insufficient utilization of MSW incinerators. The structure of MSW incineration technologies is changing in China. The ratio of plants using fluidized bed is decreasing due to various realistic reasons. Decision-makers would select suitable combustion technologies by comprehensive assessments, rather than just by costs. Air pollution control systems are improved with the implementation of China's new emission standard. However, MSW incineration in China is currently blamed for substandard emissions. The reasons include the particular elemental compositions of Chinese MSW, the lack of operating experience, deficient fund for compliance with the emission standard, and the lack of reliable supervisory measures. Some perspectives and suggestions from both technical and managerial aspects are given for the compliance with the emission standard. This paper can provide strategic enlightenments for MSW management in China and other developing countries. Copyright © 2017 Elsevier Ltd. All rights reserved.

Studies on common illnesses and medical care utilization patterns of adolescents in Hong Kong.

PubMed

Lau, J T; Yu, A; Cheung, J C; Leung, S S

2000-12-01

To estimate the prevalences of common illnesses in Hong Kong adolescents, the sociodemographic and selected risk factors associated with these illnesses, and their health care utilization behavior and attitudes. A cross-sectional questionnaire survey of 3355 participating secondary school students (response rate = 98%). Self-reported 3-month prevalences were obtained for cough/cold/influenza (55.2%), digestive disorders (34.6%), accidental injuries (29.5%), headache/dizziness (23.6%), chronic anxiety/insomnia (20.1%), skin problems (9.5%), asthma (3.8%), liver disease (1.3%), and menstrual pain (13.8% of female students). Self-perceived poor health, smoking, and alcohol consumption were associated with many of these illnesses. Treatment choice depended on the illness suffered (e.g., most students with respiratory problems consulted medical practitioners, whereas most with chronic anxiety/insomnia did not). Many students lacked trust in their doctors, doctor-shopped, relied heavily on self-medication, did not comply with prescribed treatments, would not seek help about medical problems, felt they had insufficient access to health information, and wanted confidential health care. This study examined for the first time the common illnesses and health care utilization patterns of Hong Kong adolescents. Students with chronic anxiety/insomnia were much less likely to seek care, indicating a need for better education on mental health. Efforts to prevent smoking and alcohol consumption among adolescents need to be strengthened. The students' attitudes, poor compliance and help-seeking behaviors suggest suboptimal use of the health care system. Our findings are useful for international comparisons by medical practitioners, health care managers, and researchers.

The Role of Reciprocity in Verbally Persuasive Robots.

PubMed

Lee, Seungcheol Austin; Liang, Yuhua Jake

2016-08-01

The current research examines the persuasive effects of reciprocity in the context of human-robot interaction. This is an important theoretical and practical extension of persuasive robotics by testing (1) if robots can utilize verbal requests and (2) if robots can utilize persuasive mechanisms (e.g., reciprocity) to gain human compliance. Participants played a trivia game with a robot teammate. The ostensibly autonomous robot helped (or failed to help) the participants by providing the correct (vs. incorrect) trivia answers. Then, the robot directly asked participants to complete a 15-minute task for pattern recognition. Compared to no help, results showed that a robot's prior helping behavior significantly increased the likelihood of compliance (60 percent vs. 33 percent). Interestingly, participants' evaluations toward the robot (i.e., competence, warmth, and trustworthiness) did not predict compliance. These results also provided an insightful comparison showing that participants complied at similar rates with the robot and with computer agents. This result documents a clear empirically powerful potential for the role of verbal messages in persuasive robotics.

Association between pediatric home management plan of care compliance and asthma readmission.

PubMed

Zipkin, Ronen; Schrager, Sheree M; Nguyen, Eugene; Mamey, Mary Rose; Banuelos, Ingrid; Wu, Susan

2017-09-01

In 2007, The Joint Commission implemented three children's asthma care (CAC) measures to help improve the quality of care for patients admitted with asthma. Due to lack of consistent evidence showing a relationship between home management plan of care (HMPC) compliance and readmission rates, CAC-3 was retired in 2016. We aimed to understand the relationship between HMPC compliance and revisits to the hospital, and investigate which components of the HMPC, if any, were driving the effect. This was a retrospective cohort study at a quaternary care freestanding children's hospital, including patients between 2 and 17 years of age admitted with a primary diagnosis of asthma between January 1, 2006, and July 1, 2013. Bivariate and multiple logistic regression analyses examined effects of HMPC provider compliance on hospital readmission and emergency department utilization for asthma within 180 days of initial discharge, controlling for admission to the intensive care unit, age, gender, ethnicity, insurance type, and whether inhaled corticosteroids were prescribed. A total of 1,176 patients were included. Those discharged with an HMPC (n = 756, of which 84% were fully compliant) were found to have significantly lower readmission rates (7 vs. 11.9%; aOR = 0.63; 95% CI, 0.41-0.95) and ED revisit rates (aOR = 0.73; 95% CI, 0.56-0.96) within 180 days of discharge. Providing an HMPC upon discharge was found to be associated with decreased asthma readmission and ED utilization rates. This suggests that although HMPC is no longer a required measure, there may still be utility in continuing this practice.

Solomon design analysis of multiple-choice Rorschach animal content.

PubMed

Feigenbaum, D; Costello, R M

1975-10-01

The Solomon four-group design was used to study the effects of a persuasive message on a selected multiple-choice Rorschach index--animal content. The independent variable elicited behavior in a predictable manner. Pretesting as a main effect was not significant, but as an interactional effect obviated the effect of the persuasive message. Although knowledge of test rationale can elicit behavior that conforms to experimental demand characteristics, some subjects nonetheless acted in defiance of such information. A condition for defiance in this experimental arrangement, however, was pretesting. Other possibilities regarding the study of compliance behavior and the use of pathognomonic indicators were suggested. Ethical issues were raised.

41 CFR 60-2.16 - Placement goals.

Code of Federal Regulations, 2011 CFR

2011-07-01

... at least equal to the availability figure derived for women or minorities, as appropriate, for that... the utilization of a particular minority group or in the utilization of men or women of a particular... OFFICE OF FEDERAL CONTRACT COMPLIANCE PROGRAMS, EQUAL EMPLOYMENT OPPORTUNITY, DEPARTMENT OF LABOR 2...

The predictive validity of prospect theory versus expected utility in health utility measurement.

PubMed

Abellan-Perpiñan, Jose Maria; Bleichrodt, Han; Pinto-Prades, Jose Luis

2009-12-01

Most health care evaluations today still assume expected utility even though the descriptive deficiencies of expected utility are well known. Prospect theory is the dominant descriptive alternative for expected utility. This paper tests whether prospect theory leads to better health evaluations than expected utility. The approach is purely descriptive: we explore how simple measurements together with prospect theory and expected utility predict choices and rankings between more complex stimuli. For decisions involving risk prospect theory is significantly more consistent with rankings and choices than expected utility. This conclusion no longer holds when we use prospect theory utilities and expected utilities to predict intertemporal decisions. The latter finding cautions against the common assumption in health economics that health state utilities are transferable across decision contexts. Our results suggest that the standard gamble and algorithms based on, should not be used to value health.

Framing effects in medical situations: distinctions of attribute, goal and risky choice frames.

PubMed

Peng, Jiaxi; Jiang, Yuan; Miao, Danmin; Li, Rui; Xiao, Wei

2013-06-01

To verify whether three different framing effects (risky choice, attribute and goal) exist in simulated medical situations and to analyse any differences. Medical decision-making problems were established, relating to medical skill evaluation, patient compliance and a selection of treatment options. All problems were described in positive and negative frame conditions. Significantly more positive evaluations were made if the doctor's medical records were described as 'of 100 patients, 70 patients became better' compared with those described as 'of 100 patients, 30 patients didn't become better'. Doctor's advice described in a negative frame resulted in significantly more decisions to comply, compared with advice described in a positive frame. Treatment options described in terms of survival rates resulted in significantly more adventurous choices compared with options described in terms of mortality rates. Decision-making reversal appeared in the risky choice and attribute frames, but not the goal frame. Framing effects were shown to exist in simulated medical situations, but there were significant differences among the three kinds of such effects.

[Choice of therapy based on clinical setting].

PubMed

Paul, C; Bachelez, H

2011-12-01

The choice of therapy in psoriasis is a complex multidimensional process based on both patient-related and disease-related factors. Standardisation of inclusion criteria for clinical trials leads to the exclusion of large numbers of patients with special forms of psoriasis or presenting comorbidities that must nevertheless be dealt with in real-life situations. The main patient-related factors affecting choice of therapy are age, pregnancy for women and the desire to father children for men, renal and hepatic failure, the risk of infection and neoplasia, metabolic and both cardiovascular and psychiatric comorbidities, as well as compliance and lifestyle. Disease-related factors affecting choice of therapy include unstable lesions, acral sites (palms, soles, nails, face and scalp), erythrodermic psoriasis, pustular psoriasis, guttate psoriasis and associated psoriatic rheumatism. The therapeutic recommendations set out in this study are based upon a critical analysis of the literature and upon the actual therapeutic practice of the experts. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

Quality of care associated with common chronic diseases in a 9-state Medicaid population utilizing claims data: an evaluation of medication and health care use and costs.

PubMed

Priest, Julie L; Cantrell, C Ron; Fincham, Jack; Cook, Christopher L; Burch, Steven P

2011-02-01

The objective of this cross-sectional, retrospective study was to utilize claims data to establish a quality-of-care benchmark in a large multistate Medicaid population overall and by race. Quality of care and medication adherence (persistence and compliance) per national treatment guidelines, and health care costs/utilization were assessed across common chronic conditions in a large, 9-state Medicaid population. Overall, quality of care was suboptimal across conditions. Over 15% of asthma patients had ≥ 1 asthma-related emergency room/hospital event and 12% of chronic obstructive pulmonary disease patients had a Level II or III exacerbation. Only 36% of depression patients filled any antidepressant medication within 90 days of new episode. Only 45% of diabetes patients received ≥ 2 A1c tests. Patients who filled a prescription for any acceptable pharmacotherapy ranged from 35% (depression) to 83% (heart failure [HF]). Persistence for those filling any acceptable medication ranged from 16% (asthma) to 68% (HF). Compliance for patients filling ≥ 2 prescriptions ranged from 27% (asthma) to 75% (HF). Blacks had the lowest medication compliance and persistence for all conditions except hyperlipidemia. The results highlight the need to assess and improve quality across the spectrum of care, both overall and by race.

A behavioural and neural evaluation of prospective decision-making under risk

PubMed Central

Symmonds, Mkael; Bossaerts, Peter; Dolan, Raymond J.

2010-01-01

Making the best choice when faced with a chain of decisions requires a person to judge both anticipated outcomes and future actions. Although economic decision-making models account for both risk and reward in single choice contexts there is a dearth of similar knowledge about sequential choice. Classical utility-based models assume that decision-makers select and follow an optimal pre-determined strategy, irrespective of the particular order in which options are presented. An alternative model involves continuously re-evaluating decision utilities, without prescribing a specific future set of choices. Here, using behavioral and functional magnetic resonance imaging (fMRI) data, we studied human subjects in a sequential choice task and use these data to compare alternative decision models of valuation and strategy selection. We provide evidence that subjects adopt a model of re-evaluating decision utilities, where available strategies are continuously updated and combined in assessing action values. We validate this model by using simultaneously-acquired fMRI data to show that sequential choice evokes a pattern of neural response consistent with a tracking of anticipated distribution of future reward, as expected in such a model. Thus, brain activity evoked at each decision point reflects the expected mean, variance and skewness of possible payoffs, consistent with the idea that sequential choice evokes a prospective evaluation of both available strategies and possible outcomes. PMID:20980595

A behavioral and neural evaluation of prospective decision-making under risk.

PubMed

Symmonds, Mkael; Bossaerts, Peter; Dolan, Raymond J

2010-10-27

Making the best choice when faced with a chain of decisions requires a person to judge both anticipated outcomes and future actions. Although economic decision-making models account for both risk and reward in single-choice contexts, there is a dearth of similar knowledge about sequential choice. Classical utility-based models assume that decision-makers select and follow an optimal predetermined strategy, regardless of the particular order in which options are presented. An alternative model involves continuously reevaluating decision utilities, without prescribing a specific future set of choices. Here, using behavioral and functional magnetic resonance imaging (fMRI) data, we studied human subjects in a sequential choice task and use these data to compare alternative decision models of valuation and strategy selection. We provide evidence that subjects adopt a model of reevaluating decision utilities, in which available strategies are continuously updated and combined in assessing action values. We validate this model by using simultaneously acquired fMRI data to show that sequential choice evokes a pattern of neural response consistent with a tracking of anticipated distribution of future reward, as expected in such a model. Thus, brain activity evoked at each decision point reflects the expected mean, variance, and skewness of possible payoffs, consistent with the idea that sequential choice evokes a prospective evaluation of both available strategies and possible outcomes.

Rigorously testing multialternative decision field theory against random utility models.

PubMed

Berkowitsch, Nicolas A J; Scheibehenne, Benjamin; Rieskamp, Jörg

2014-06-01

Cognitive models of decision making aim to explain the process underlying observed choices. Here, we test a sequential sampling model of decision making, multialternative decision field theory (MDFT; Roe, Busemeyer, & Townsend, 2001), on empirical grounds and compare it against 2 established random utility models of choice: the probit and the logit model. Using a within-subject experimental design, participants in 2 studies repeatedly choose among sets of options (consumer products) described on several attributes. The results of Study 1 showed that all models predicted participants' choices equally well. In Study 2, in which the choice sets were explicitly designed to distinguish the models, MDFT had an advantage in predicting the observed choices. Study 2 further revealed the occurrence of multiple context effects within single participants, indicating an interdependent evaluation of choice options and correlations between different context effects. In sum, the results indicate that sequential sampling models can provide relevant insights into the cognitive process underlying preferential choices and thus can lead to better choice predictions. PsycINFO Database Record (c) 2014 APA, all rights reserved.

Hitting a High Note on Math Tests: Remembered Success Influences Test Preferences

ERIC Educational Resources Information Center

Finn, Bridgid; Miele, David B.

2016-01-01

Remembered utility is the retrospective evaluation about the pleasure and pain associated with a past experience. It can influence choices about repeating or avoiding similar situations in the future (Kahneman, 2000). A set of 5 experiments explored the remembered utility of effortful test episodes and how it impacted future test choices.…

7 CFR Exhibit E to Subpart E of... - List of Regional Offices, Office of Federal Contract Compliance Programs (OFCCP), U.S. Department...

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 12 2010-01-01 2010-01-01 false List of Regional Offices, Office of Federal Contract Compliance Programs (OFCCP), U.S. Department of Labor (USDL) E Exhibit E to Subpart E of Part 1901 Agriculture Regulations of the Department of Agriculture (Continued) RURAL HOUSING SERVICE, RURAL BUSINESS-COOPERATIVE SERVICE, RURAL UTILITIES SERVIC...

Low utilization of health care services following screening for hypertension in Dar es Salaam (Tanzania): a prospective population-based study

PubMed Central

Bovet, Pascal; Gervasoni, Jean-Pierre; Mkamba, Mashombo; Balampama, Marianna; Lengeler, Christian; Paccaud, Fred

2008-01-01

Background Drug therapy in high-risk individuals has been advocated as an important strategy to reduce cardiovascular disease in low income countries. We determined, in a low-income urban population, the proportion of persons who utilized health services after having been diagnosed as hypertensive and advised to seek health care for further hypertension management. Methods A population-based survey of 9254 persons aged 25–64 years was conducted in Dar es Salaam. Among the 540 persons with high blood pressure (defined here as BP ≥ 160/95 mmHg) at the initial contact, 253 (47%) had high BP on a 4th visit 45 days later. Among them, 208 were untreated and advised to attend health care in a health center of their choice for further management of their hypertension. One year later, 161 were seen again and asked about their use of health services during the interval. Results Among the 161 hypertensive persons advised to seek health care, 34% reported to have attended a formal health care provider during the 12-month interval (63% public facility; 30% private; 7% both). Antihypertensive treatment was taken by 34% at some point of time (suggesting poor uptake of health services) and 3% at the end of the 12-month follow-up (suggesting poor long-term compliance). Health services utilization tended to be associated with older age, previous history of high BP, being overweight and non-smoking, but not with education or wealth. Lack of symptoms and cost of treatment were the reasons reported most often for not attending health care. Conclusion Low utilization of health services after hypertension screening suggests a small impact of a patient-centered screen-and-treat strategy in this low-income population. These findings emphasize the need to identify and address barriers to health care utilization for non-communicable diseases in this setting and, indirectly, the importance of public health measures for primary prevention of these diseases. PMID:19087300

STATE ACID RAIN RESEARCH AND SCREENING SYSTEM - VERSION 1.0 USER'S MANUAL

EPA Science Inventory

The report is a user's manual that describes Version 1.0 of EPA's STate Acid Rain Research and Screening System (STARRSS), developed to assist utility regulatory commissions in reviewing utility acid rain compliance plans. It is a screening tool that is based on scenario analysis...

Developing an Indicator System for Schools of Choice: A Balanced Scorecard Approach

ERIC Educational Resources Information Center

Brown, Richard S.; Wohlstetter, Priscilla; Liu, Sunny

2008-01-01

This article describes the process of developing an indicator system that goes beyond a single indicator of school progress or performance. The system relies on a set of school indicators that uses data that public schools routinely report to state agencies for compliance purposes. The framework for the indicator system is based on the idea of…

The role of severity of obstructive sleep apnea measured by apnea-hypopnea index in predicting compliance with pressure therapy, a meta-analysis.

PubMed

Madbouly, Essam M; Nadeem, Rashid; Nida, Mahwish; Molnar, Janos; Aggarwal, Saurabh; Loomba, Rohit

2014-01-01

Obstructive sleep apnea (OSA) is associated with diabetes, hypertension, stroke, coronary artery disease, and premature death. Positive airway pressure (PAP) is the mainstay of therapy. Despite its effective treatment with PAP therapy, noncompliance remains high. Many factors determine compliance. The role of severity of OSA measured by the apnea-hypopnea index (AHI) remains controversial. Meta-analysis of studies examining this role of AHI was performed. A systematic review of the medical literature was conducted using PubMed and Cochrane library by utilizing different combinations of key words: sleep apnea, AHI, compliance, and nonadherence. Inclusion criteria were English articles; Studies with adult population; with 2 groups of patients (compliant and noncompliant); Studies utilizing objective definition of compliance (PAP usage of >4 hours per night for 70% of days or usage >5 d/wk and for >4 hours per night). Studies were analyzed by standard methods of meta-analysis. The studies were heterogeneous for AHI; therefore, the random effect model was used. Six hundred forty-one manuscripts were found. Of these, 230 were found to be appropriate for full text evaluation. Thirty-one met inclusion criteria. Twelve of these studies used objective criteria for PAP compliance and were hence included in meta-analysis. All the subjects had OSA determined by polysomnography, for whom PAP was employed. Compliance to PAP therapy was evaluated after a period of time ranging from 4 weeks to 8 years. There were 1438 subjects included in the meta-analysis; 886 subjects were PAP compliant, whereas 552 subjects were noncompliant. A greater AHI was found in PAP compliant patients. The mean difference between compliant and noncompliant groups was 5.9 (95% confidence interval: 0.19-11.67, P < 0.05). Patients with mild OSA are less likely to be compliant with PAP therapy. These patients should receive aggressive management particularly at the start of therapy with close follow-up to increase compliance.

Kolkata Paise Restaurant Problem: An Introduction

NASA Astrophysics Data System (ADS)

Ghosh, Asim; Biswas, Soumyajyoti; Chatterjee, Arnab; Chakrabarti, Anindya Sundar; Naskar, Tapan; Mitra, Manipushpak; Chakrabarti, Bikas K.

We discuss several stochastic optimization strategies in games with many players having large number of choices (Kolkata Paise Restaurant Problem) and two choices (minority game problem). It is seen that a stochastic crowd avoiding strategy gives very efficient utilization in KPR problem. A slightly modified strategy in the minority game problem gives full utilization but the dynamics stops after reaching full efficiency, thereby making the utilization helpful for only about half of the population (those in minority). We further discuss the ways in which the dynamics may be continued and the utilization becomes effective for all the agents keeping fluctuation arbitrarily small.

Campus Sexual Misconduct: Restorative Justice Approaches to Enhance Compliance With Title IX Guidance.

PubMed

Koss, Mary P; Wilgus, Jay K; Williamsen, Kaaren M

2014-07-01

Campus response to sexual violence is increasingly governed by federal law and administrative guidance such as the 1972 Title IX, the 2011 Dear Colleague Letter (DCL), and the 2013 Violence Against Women Act. Educational institutions are directed to expand disciplinary responses and establish coordinated action to eliminate sexual violence and remedy its effects. Compliance fosters a quasi-criminal justice approach not suited to all sexual misconduct and inconsistent with developing practice in student conduct management. This article envisions restorative justice (RJ) enhancements to traditional student conduct processes that maintain compliance, expand options, empower victim choice, and increase responsiveness to DCL aims. The article (1) defines sexual violence and sexual harassment within the DCL scope, (2) elaborates the DCL position on permissible alternative resolutions and differentiates mediation from RJ, (3) sequences action steps from case report to finalization, including both restorative and traditional justice pathways; and (4) discusses building support for innovation beginning with existing campus response. © The Author(s) 2014.

Effectiveness of an audience response system in teaching pharmacology to baccalaureate nursing students.

PubMed

Vana, Kimberly D; Silva, Graciela E; Muzyka, Diann; Hirani, Lorraine M

2011-06-01

It has been proposed that students' use of an audience response system, commonly called clickers, may promote comprehension and retention of didactic material. Whether this method actually improves students' grades, however, is still not determined. The purpose of this study was to evaluate whether a lecture format utilizing multiple-choice PowerPoint slides and an audience response system was more effective than a lecture format using only multiple-choice PowerPoint slides in the comprehension and retention of pharmacological knowledge in baccalaureate nursing students. The study also assessed whether the additional use of clickers positively affected students' satisfaction with their learning. Results from 78 students who attended lecture classes with multiple-choice PowerPoint slides plus clickers were compared with those of 55 students who utilized multiple-choice PowerPoint slides only. Test scores between these two groups were not significantly different. A satisfaction questionnaire showed that 72.2% of the control students did not desire the opportunity to use clickers. Of the group utilizing the clickers, 92.3% recommend the use of this system in future courses. The use of multiple-choice PowerPoint slides and an audience response system did not seem to improve the students' comprehension or retention of pharmacological knowledge as compared with those who used solely multiple-choice PowerPoint slides.

Compliance with medical regimens during adolescence.

PubMed

Litt, I F; Cuskey, W R

1980-02-01

In summary, compliance behavior among adolescents is complex and imcompletely understood. Although the study of compliance is important for understanding the adolescent's stage of psychological development, relationships with authority figures, and the beginning of the youngster's career as a consumer of health care, its ultimate importance lies in the prospect of improving the likelihood that medication will be utilized appropriately. The first step in the process involves systematic monitoring of compliance rather than doing so only when noncompliance is clinically suspected. When compliance is found to be problematic for an adolescent, resorting to "scare" techniques or re-education is rarely effective. A more positive outcome may be achieved by determining the circumstances under which the youngster was successful in complying and attempting to tailor-make the regimen accordingly. Barriers to compliance, such as the presence of side effects, previous negative experience with the medicine, and lack of conviction about the diagnosis of appropriateness of therapy, should always be explored. Other potential intervention strategies for improving compliance have been discussed. In the final analysis, however, as Jonson has noted, all strategies aimed at improving compliance must provide the patient with insight into his own situation and himself, as well as his capability of doing something other than conforming when he judges it best.

Legal approaches to promoting parental compliance with childhood immunization recommendations.

PubMed

Weithorn, Lois A; Reiss, Dorit Rubinstein

2018-01-10

Rates of vaccine-preventable diseases have increased in the United States in recent years, largely due to parental refusals of recommended childhood immunizations. Empirical studies have demonstrated a relationship between nonvaccination rates and permissive state vaccine exemption policies, indicating that legal reforms may promote higher immunization rates. This article reviews relevant data and considers the legal landscape. It analyzes federal and state Constitutional law, concluding that religious and personal belief exemptions to school-entry vaccine mandates are not constitutionally required. It identifies public health, bioethical, and policy considerations relevant to the choice among legal approaches employed by states to promote parental compliance. The article describes a range of legal tools that may help promote parental cooperation with immunization recommendations.

Restricting marketing to children: consensus on policy interventions to address obesity.

PubMed

Raine, Kim D; Lobstein, Tim; Landon, Jane; Kent, Monique Potvin; Pellerin, Suzie; Caulfield, Timothy; Finegood, Diane; Mongeau, Lyne; Neary, Neil; Spence, John C

2013-05-01

Obesity presents major challenges for public health and the evidence is strong. Lessons from tobacco control indicate a need for changing the policy and environments to make healthy choices easier and to create more opportunities for children to achieve healthy weights. In April 2011, the Alberta Policy Coalition for Chronic Disease Prevention convened a consensus conference on environmental determinants of obesity such as marketing of unhealthy foods and beverages to children. We examine the political environment, evidence, issues, and challenges of placing restrictions on marketing of unhealthy foods and beverages within Canada. We recommend a national regulatory system prohibiting commercial marketing of foods and beverages to children and suggest that effective regulations must set minimum standards, monitor compliance, and enact penalties for non-compliance.

Assigning values to intermediate health states for cost-utility analysis: theory and practice.

PubMed

Cohen, B J

1996-01-01

Cost-utility analysis (CUA) was developed to guide the allocation of health care resources under a budget constraint. As the generally stated goal of CUA is to maximize aggregate health benefits, the philosophical underpinning of this method is classic utilitarianism. Utilitarianism has been criticized as a basis for social choice because of its emphasis on the net sum of benefits without regard to the distribution of benefits. For example, it has been argued that absolute priority should be given to the worst off when making social choices affecting basic needs. Application of classic utilitarianism requires use of strength-of-preference utilities, assessed under conditions of certainty, to assign quality-adjustment factors to intermediate health states. The two methods commonly used to measure strength-of-preference utility, categorical scaling and time tradeoff, produce rankings that systematically give priority to those who are better off. Alternatively, von Neumann-Morgenstern utilities, assessed under conditions of uncertainty, could be used to assign values to intermediate health states. The theoretical basis for this would be Harsanyi's proposal that social choice be made under the hypothetical assumption that one had an equal chance of being anyone in society. If this proposal is accepted, as well as the expected-utility axioms applied to both individual choice and social choice, the preferred societal arrangement is that with the highest expected von Neumann-Morgenstern utility. In the presence of risk aversion, this will give some priority to the worst-off relative to classic utilitarianism. Another approach is to raise the values obtained by time-tradeoff assessments to a power a between 0 and 1. This would explicitly give priority to the worst off, with the degree of priority increasing as a decreases. Results could be presented over a range of a. The results of CUA would then provide useful information to those holding a range of philosophical points of view.

Measuring the loss of consumer choice in mandatory health programmes using discrete choice experiments.

PubMed

Parkinson, Bonny; Goodall, Stephen; Norman, Richard

2013-04-01

Economic evaluation of mandatory health programmes generally do not consider the utility impact of a loss of consumer choice upon implementation, despite evidence suggesting that consumers do value having the ability to choose. The primary aim of this study was to explore whether the utility impact of a loss of consumer choice from implementing mandatory health programmes can be measured using discrete choice experiments (DCEs). Three case studies were used to test the methodology: fortification of bread-making flour with folate, mandatory influenza vaccination of children, and the banning of trans-fats. Attributes and levels were developed from a review of the literature. An orthogonal, fractional factorial design was used to select the profiles presented to respondents to allow estimation of main effects. Overall, each DCE consisted of 64 profiles which were allocated to four versions of 16 profiles. Each choice task compared two profiles, one being voluntary and the other being mandatory, plus a 'no policy' option, thus each respondent was presented with eight choice tasks. For each choice task, respondents were asked which health policy they most preferred and least preferred. Data was analysed using a mixed logit model with correlated coefficients (200 Halton draws). The compensating variation required for introducing a programme on a mandatory basis (versus achieving the same health impacts with a voluntary programme) that holds utility constant was estimated. Responses were provided by 535 participants (a response rate of 83 %). For the influenza vaccination and folate fortification programmes, the results suggested that some level of compensation may be required for introducing the programme on a mandatory basis. Introducing a mandatory influenza vaccination programme required the highest compensation (Australian dollars [A$] 112.75, 95 % CI -60.89 to 286.39) compared with folate fortification (A$18.05, 95 % CI -3.71 to 39.80). No compensation was required for introducing the trans-fats programme (-A$0.22, 95 % CI -6.24 to 5.80) [year 2010 values]. In addition to the type of mandatory health programme, the compensation required was also found to be dependent on a number of other factors. In particular, the study found an association between the compensation required and stronger libertarian preferences. DCEs can be used to measure the utility impact of a loss of consumer choice. Excluding the utility impact of a loss of consumer choice from an economic evaluation taking a societal perspective may result in a sub-optimal, or incorrect, funding decision.

The Dependent Poisson Race Model and Modeling Dependence in Conjoint Choice Experiments

ERIC Educational Resources Information Center

Ruan, Shiling; MacEachern, Steven N.; Otter, Thomas; Dean, Angela M.

2008-01-01

Conjoint choice experiments are used widely in marketing to study consumer preferences amongst alternative products. We develop a class of choice models, belonging to the class of Poisson race models, that describe a "random utility" which lends itself to a process-based description of choice. The models incorporate a dependence structure which…

Domain-specific rationality in human choices: violations of utility axioms and social contexts.

PubMed

Wang, X T

1996-07-01

This study presents a domain-specific view of human decision rationality. It explores social and ecological domain-specific psychological mechanisms underlying choice biases and violations of utility axioms. Results from both the USA and China revealed a social group domain-specific choice pattern. The irrational preference reversal in a hypothetical life-death decision problem (a classical example of framing effects) was eliminated by providing a small group or family context in which most subjects favored a risky choice option regardless of the positive/negative framing of choice outcomes. The risk preference data also indicate that the subjective scope of small group domain is larger for Chinese subjects, suggesting that human choice mechanisms are sensitive to culturally specific features of group living. A further experiment provided evidence that perceived fairness might be one major factor regulating the choice preferences found in small group (kith-and-kin) contexts. Finally, the violation of the stochastic dominance axiom of the rational theory of choice was predicted and tested. The violations were found only when the "life-death" problem was presented in small group contexts; the strongest violation was found in a family context. These results suggest that human decisions and choices are regulated by domain-specific choice mechanisms designed to solve evolutionary recurrent and adaptively important problems.

Applying the Analytic Hierarchy Process to Oil Sands Environmental Compliance Risk Management

NASA Astrophysics Data System (ADS)

Roux, Izak Johannes, III

Oil companies in Alberta, Canada, invested $32 billion on new oil sands projects in 2013. Despite the size of this investment, there is a demonstrable deficiency in the uniformity and understanding of environmental legislation requirements that manifest into increased project compliance risks. This descriptive study developed 2 prioritized lists of environmental regulatory compliance risks and mitigation strategies and used multi-criteria decision theory for its theoretical framework. Information from compiled lists of environmental compliance risks and mitigation strategies was used to generate a specialized pairwise survey, which was piloted by 5 subject matter experts (SMEs). The survey was validated by a sample of 16 SMEs, after which the Analytic Hierarchy Process (AHP) was used to rank a total of 33 compliance risks and 12 mitigation strategy criteria. A key finding was that the AHP is a suitable tool for ranking of compliance risks and mitigation strategies. Several working hypotheses were also tested regarding how SMEs prioritized 1 compliance risk or mitigation strategy compared to another. The AHP showed that regulatory compliance, company reputation, environmental compliance, and economics ranked the highest and that a multi criteria mitigation strategy for environmental compliance ranked the highest. The study results will inform Alberta oil sands industry leaders about the ranking and utility of specific compliance risks and mitigations strategies, enabling them to focus on actions that will generate legislative and public trust. Oil sands leaders implementing a risk management program using the risks and mitigation strategies identified in this study will contribute to environmental conservation, economic growth, and positive social change.

Monkeys choose as if maximizing utility compatible with basic principles of revealed preference theory

PubMed Central

Pastor-Bernier, Alexandre; Plott, Charles R.; Schultz, Wolfram

2017-01-01

Revealed preference theory provides axiomatic tools for assessing whether individuals make observable choices “as if” they are maximizing an underlying utility function. The theory evokes a tradeoff between goods whereby individuals improve themselves by trading one good for another good to obtain the best combination. Preferences revealed in these choices are modeled as curves of equal choice (indifference curves) and reflect an underlying process of optimization. These notions have far-reaching applications in consumer choice theory and impact the welfare of human and animal populations. However, they lack the empirical implementation in animals that would be required to establish a common biological basis. In a design using basic features of revealed preference theory, we measured in rhesus monkeys the frequency of repeated choices between bundles of two liquids. For various liquids, the animals’ choices were compatible with the notion of giving up a quantity of one good to gain one unit of another good while maintaining choice indifference, thereby implementing the concept of marginal rate of substitution. The indifference maps consisted of nonoverlapping, linear, convex, and occasionally concave curves with typically negative, but also sometimes positive, slopes depending on bundle composition. Out-of-sample predictions using homothetic polynomials validated the indifference curves. The animals’ preferences were internally consistent in satisfying transitivity. Change of option set size demonstrated choice optimality and satisfied the Weak Axiom of Revealed Preference (WARP). These data are consistent with a version of revealed preference theory in which preferences are stochastic; the monkeys behaved “as if” they had well-structured preferences and maximized utility. PMID:28202727

Monkeys choose as if maximizing utility compatible with basic principles of revealed preference theory.

PubMed

Pastor-Bernier, Alexandre; Plott, Charles R; Schultz, Wolfram

2017-03-07

Revealed preference theory provides axiomatic tools for assessing whether individuals make observable choices "as if" they are maximizing an underlying utility function. The theory evokes a tradeoff between goods whereby individuals improve themselves by trading one good for another good to obtain the best combination. Preferences revealed in these choices are modeled as curves of equal choice (indifference curves) and reflect an underlying process of optimization. These notions have far-reaching applications in consumer choice theory and impact the welfare of human and animal populations. However, they lack the empirical implementation in animals that would be required to establish a common biological basis. In a design using basic features of revealed preference theory, we measured in rhesus monkeys the frequency of repeated choices between bundles of two liquids. For various liquids, the animals' choices were compatible with the notion of giving up a quantity of one good to gain one unit of another good while maintaining choice indifference, thereby implementing the concept of marginal rate of substitution. The indifference maps consisted of nonoverlapping, linear, convex, and occasionally concave curves with typically negative, but also sometimes positive, slopes depending on bundle composition. Out-of-sample predictions using homothetic polynomials validated the indifference curves. The animals' preferences were internally consistent in satisfying transitivity. Change of option set size demonstrated choice optimality and satisfied the Weak Axiom of Revealed Preference (WARP). These data are consistent with a version of revealed preference theory in which preferences are stochastic; the monkeys behaved "as if" they had well-structured preferences and maximized utility.

Nonlinear Socio-Ecological Dynamics and First Principles ofCollective Choice Behavior of ``Homo Socialis"

NASA Astrophysics Data System (ADS)

Sonis, M.

Socio-ecological dynamics emerged from the field of Mathematical SocialSciences and opened up avenues for re-examination of classical problems of collective behavior in Social and Spatial sciences. The ``engine" of this collective behavior is the subjective mental evaluation of level of utilities in the future, presenting sets of composite socio-economic-temporal-locational advantages. These dynamics present new laws of collective multi-population behavior which are the meso-level counterparts of the utility optimization individual behavior. The central core of the socio-ecological choice dynamics includes the following first principle of the collective choice behavior of ``Homo Socialis" based on the existence of ``collective consciousness": the choice behavior of ``Homo Socialis" is a collective meso-level choice behavior such that the relative changes in choice frequencies depend on the distribution of innovation alternatives between adopters of innovations. The mathematical basis of the Socio-Ecological Dynamics includes two complementary analytical approaches both based on the use of computer modeling as a theoretical and simulation tool. First approach is the ``continuous approach" --- the systems of ordinary and partial differential equations reflecting the continuous time Volterra ecological formalism in a form of antagonistic and/or cooperative collective hyper-games between different sub-sets of choice alternatives. Second approach is the ``discrete approach" --- systems of difference equations presenting a new branch of the non-linear discrete dynamics --- the Discrete Relative m-population/n-innovations Socio-Spatial Dynamics (Dendrinos and Sonis, 1990). The generalization of the Volterra formalism leads further to the meso-level variational principle of collective choice behavior determining the balance between the resulting cumulative social spatio-temporal interactions among the population of adopters susceptible to the choice alternatives and the cumulative equalization of the power of elites supporting different choice alternatives. This balance governs the dynamic innovation choice process and constitutes the dynamic meso-level counterpart of the micro-economic individual utility maximization principle.

Assessment methods and schedules for collecting daily process data on substance use related health behaviors: A randomized control study.

PubMed

Buu, Anne; Massey, Lynn S; Walton, Maureen A; Cranford, James A; Zimmerman, Marc A; Cunningham, Rebecca M

2017-09-01

Interactive voice response (IVR) and short message service (SMS) systems have been used to collect daily process data on substance use. Yet, their relative compliance, use patterns, and user experiences are unknown. Furthermore, recent studies presented the potential of a hybrid weekly protocol requiring recall of behaviors in past week right after the weekend, in order to reduce the concerns about low compliance and measurement reactivity associated with daily data collection and also provide high quality data on the peak of use. This study randomized substance users to four (2×2) assessment groups with different combinations of assessment methods (IVR or SMS) and schedules (daily or weekly). The compliance rates and use patterns during the experimental period of 90days and user experiences reported after the period were compared across the groups. When IVR was assigned, the weekly schedule generated a higher compliance rate than the daily schedule. When SMS was used, however, the assessment schedule did not have an effect on compliance. While both the daily and weekly surveys via IVR can be completed within a short time, the weekly survey administered via SMS took much longer than its daily counterpart. Such an increased time consumption may offset the benefit of a less frequent assessment schedule. IVR is a better choice for delivering the hybrid protocol of weekly collection of daily process data because of its higher compliance rate, shorter duration, and lower likelihood of interruption during data collection. Copyright © 2017 Elsevier B.V. All rights reserved.

Assessing the Utility of a Demand Assessment for Functional Analysis

ERIC Educational Resources Information Center

Roscoe, Eileen M.; Rooker, Griffin W.; Pence, Sacha T.; Longworth, Lynlea J.

2009-01-01

We evaluated the utility of an assessment for identifying tasks for the functional analysis demand condition with 4 individuals who had been diagnosed with autism. During the demand assessment, a therapist presented a variety of tasks, and observers measured problem behavior and compliance to identify demands associated with low levels of…

Optimizing urine drug testing for monitoring medication compliance in pain management.

PubMed

Melanson, Stacy E F; Ptolemy, Adam S; Wasan, Ajay D

2013-12-01

It can be challenging to successfully monitor medication compliance in pain management. Clinicians and laboratorians need to collaborate to optimize patient care and maximize operational efficiency. The test menu, assay cutoffs, and testing algorithms utilized in the urine drug testing panels should be periodically reviewed and tailored to the patient population to effectively assess compliance and avoid unnecessary testing and cost to the patient. Pain management and pathology collaborated on an important quality improvement initiative to optimize urine drug testing for monitoring medication compliance in pain management. We retrospectively reviewed 18 months of data from our pain management center. We gathered data on test volumes, positivity rates, and the frequency of false positive results. We also reviewed the clinical utility of our testing algorithms, assay cutoffs, and adulterant panel. In addition, the cost of each component was calculated. The positivity rate for ethanol and 3,4-methylenedioxymethamphetamine were <1% so we eliminated this testing from our panel. We also lowered the screening cutoff for cocaine to meet the clinical needs of the pain management center. In addition, we changed our testing algorithm for 6-acetylmorphine, benzodiazepines, and methadone. For example, due the high rate of false negative results using our immunoassay-based benzodiazepine screen, we removed the screening portion of the algorithm and now perform benzodiazepine confirmation up front in all specimens by liquid chromatography-tandem mass spectrometry. Conducting an interdisciplinary quality improvement project allowed us to optimize our testing panel for monitoring medication compliance in pain management and reduce cost. Wiley Periodicals, Inc.

Towards setting credible speed limits: Identifying factors that affect driver compliance on urban roads.

PubMed

Gargoum, Suliman A; El-Basyouny, Karim; Kim, Amy

2016-10-01

Road geometry, vehicle characteristics, and weather conditions are all factors that impact a driver's perception of a safe or credible speed and, consequently, the driver's decision on whether or not to comply with the posted speed limit. In fact, the role a road's environment plays in a driver's perception of a credible speed limit is a topic that has attracted the interest of many researchers in recent years. Despite that, not many studies have considered using empirical data to investigate what features of the road environment influence a driver's compliance choice. This paper aims to address this matter by exploring the relationships between features of the road surroundings (geometric, temporal factors, and weather conditions) and driver compliance with speed limits. The paper uses data from almost 600 different urban roads in the city of Edmonton, at which over 35 million vehicle spot speeds were collected. Compliance was represented using a categorical ordered response variable, and mixed-effects-logistic-regression models were fitted. Two different models were built, one for arterials and another for collector roads. In general, the findings show that the more restricted drivers become, particularly on arterials, the more likely drivers are to comply with speed limits; potential restrictions include on-street parking and the absence of lateral shoulders. Furthermore, higher traffic activity during peak hours, and presumably on shoulder weekdays, both increase the likelihood of compliance on arterials. Similarly, posted speed limits and traffic volume are both positively correlated with compliance on both arterial and collector roads. The findings of this research provide evidence of the existence of an empirical relationship between road features and compliance, highlighting the importance of setting credible speed limits on roads and the possibility of achieving higher compliance rates through modifications to the road environment. Copyright © 2016 Elsevier Ltd. All rights reserved.

Predicting Short-Term Remembering as Boundedly Optimal Strategy Choice.

PubMed

Howes, Andrew; Duggan, Geoffrey B; Kalidindi, Kiran; Tseng, Yuan-Chi; Lewis, Richard L

2016-07-01

It is known that, on average, people adapt their choice of memory strategy to the subjective utility of interaction. What is not known is whether an individual's choices are boundedly optimal. Two experiments are reported that test the hypothesis that an individual's decisions about the distribution of remembering between internal and external resources are boundedly optimal where optimality is defined relative to experience, cognitive constraints, and reward. The theory makes predictions that are tested against data, not fitted to it. The experiments use a no-choice/choice utility learning paradigm where the no-choice phase is used to elicit a profile of each participant's performance across the strategy space and the choice phase is used to test predicted choices within this space. They show that the majority of individuals select strategies that are boundedly optimal. Further, individual differences in what people choose to do are successfully predicted by the analysis. Two issues are discussed: (a) the performance of the minority of participants who did not find boundedly optimal adaptations, and (b) the possibility that individuals anticipate what, with practice, will become a bounded optimal strategy, rather than what is boundedly optimal during training. Copyright © 2015 Cognitive Science Society, Inc.

24 CFR 905.10 - Capital Fund formula (CFF).

Code of Federal Regulations, 2013 CFR

2013-04-01

... projects; (ii) Vacancy reduction; (iii) Addressing deferred maintenance needs and the replacement of obsolete utility systems and dwelling equipment; (iv) Planned code compliance; (v) Management improvements...

24 CFR 905.10 - Capital Fund formula (CFF).

Code of Federal Regulations, 2012 CFR

2012-04-01

... projects; (ii) Vacancy reduction; (iii) Addressing deferred maintenance needs and the replacement of obsolete utility systems and dwelling equipment; (iv) Planned code compliance; (v) Management improvements...

The importance of continuity in inhaler device choice for asthma and chronic obstructive pulmonary disease.

PubMed

Bjermer, Leif

2014-01-01

Inhaled therapies are central to the treatment of asthma and chronic obstructive pulmonary disease. Physicians consider many factors when selecting the most appropriate inhaler device, including device efficacy and the cost to the health care system. This review aims to discuss the factors that are important when considering inhaler devices and the importance of continuity in the choice of inhaler device. A large number of factors can contribute to therapeutic outcomes with inhalation devices. The inhalation technique is critical to treatment success and differs substantially between inhaler devices. Misuse of an inhaler is common, and thorough training of patients and physicians is important to ensure correct utilization. Patient satisfaction is an important consideration because it is significantly correlated with compliance and better outcomes. Financial pressures contribute to decision making: although selecting the less expensive inhaler device might reduce direct treatment costs, it can have a large impact on disease control and the patient's well-being. Switching may be associated with a poor inhalation technique, reduced disease control and quality of life, increased use of other treatments and health care resources, and a greater chance of unsuccessful treatment. Nonconsensual switches can result in patient discontent, reduced confidence in the medication, and uncertainty regarding the degree of disease control. It is recommended that patients with stable disease remain on their current device. If a switch is considered, the patient should be consulted and the physician should take into account the patient's preference, their ability to correctly use the device, and the availability of the preferred drug in the preferred device.

A practical method to test the validity of the standard Gumbel distribution in logit-based multinomial choice models of travel behavior

DOE PAGES

Ye, Xin; Garikapati, Venu M.; You, Daehyun; ...

2017-11-08

Most multinomial choice models (e.g., the multinomial logit model) adopted in practice assume an extreme-value Gumbel distribution for the random components (error terms) of utility functions. This distributional assumption offers a closed-form likelihood expression when the utility maximization principle is applied to model choice behaviors. As a result, model coefficients can be easily estimated using the standard maximum likelihood estimation method. However, maximum likelihood estimators are consistent and efficient only if distributional assumptions on the random error terms are valid. It is therefore critical to test the validity of underlying distributional assumptions on the error terms that form the basismore » of parameter estimation and policy evaluation. In this paper, a practical yet statistically rigorous method is proposed to test the validity of the distributional assumption on the random components of utility functions in both the multinomial logit (MNL) model and multiple discrete-continuous extreme value (MDCEV) model. Based on a semi-nonparametric approach, a closed-form likelihood function that nests the MNL or MDCEV model being tested is derived. The proposed method allows traditional likelihood ratio tests to be used to test violations of the standard Gumbel distribution assumption. Simulation experiments are conducted to demonstrate that the proposed test yields acceptable Type-I and Type-II error probabilities at commonly available sample sizes. The test is then applied to three real-world discrete and discrete-continuous choice models. For all three models, the proposed test rejects the validity of the standard Gumbel distribution in most utility functions, calling for the development of robust choice models that overcome adverse effects of violations of distributional assumptions on the error terms in random utility functions.« less

A practical method to test the validity of the standard Gumbel distribution in logit-based multinomial choice models of travel behavior

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

Ye, Xin; Garikapati, Venu M.; You, Daehyun

Most multinomial choice models (e.g., the multinomial logit model) adopted in practice assume an extreme-value Gumbel distribution for the random components (error terms) of utility functions. This distributional assumption offers a closed-form likelihood expression when the utility maximization principle is applied to model choice behaviors. As a result, model coefficients can be easily estimated using the standard maximum likelihood estimation method. However, maximum likelihood estimators are consistent and efficient only if distributional assumptions on the random error terms are valid. It is therefore critical to test the validity of underlying distributional assumptions on the error terms that form the basismore » of parameter estimation and policy evaluation. In this paper, a practical yet statistically rigorous method is proposed to test the validity of the distributional assumption on the random components of utility functions in both the multinomial logit (MNL) model and multiple discrete-continuous extreme value (MDCEV) model. Based on a semi-nonparametric approach, a closed-form likelihood function that nests the MNL or MDCEV model being tested is derived. The proposed method allows traditional likelihood ratio tests to be used to test violations of the standard Gumbel distribution assumption. Simulation experiments are conducted to demonstrate that the proposed test yields acceptable Type-I and Type-II error probabilities at commonly available sample sizes. The test is then applied to three real-world discrete and discrete-continuous choice models. For all three models, the proposed test rejects the validity of the standard Gumbel distribution in most utility functions, calling for the development of robust choice models that overcome adverse effects of violations of distributional assumptions on the error terms in random utility functions.« less

The effects of utility evaluations, biomedical knowledge and modernization on intention to exclusively use biomedical health facilities among rural households in Mozambique.

PubMed

Mukolo, Abraham; Cooil, Bruce; Victor, Bart

2015-08-01

In resource-limited settings, the choice between utilizing biomedical health services and/or traditional healers is critical to the success of the public health mission. In the literature, this choice has been predicted to be influenced by three major factors: knowledge about biomedical etiologies; cultural modernization; and rational choice. The current study investigated all three of these predicted determinants, applying data from a general household survey conducted in 2010 in Zambézia Province of Mozambique involving 1045 randomly sampled rural households. Overall, more respondents (N = 802) intended to continue to supplement their biomedical healthcare with traditional healer services in comparison with those intending to utilize biomedical care exclusively (N = 243). The findings strongly supported the predicted association between rational utility (measured as satisfaction with the quality of service and results from past care) with the future intention to continue to supplement or utilize biomedical care exclusively. Odds of moving away from supplementation increase by a factor of 2.5 if the respondent reported seeing their condition improve under government/private biomedical care. Odds of staying with supplementation increase by a factor 3.1 if the respondent was satisfied with traditional care and a factor of 16 if the condition had improved under traditional care. Modernization variables (education, income, religion, and Portuguese language skills) were relevant and provided a significant component of the best scientific model. Amount of biomedical knowledge was not a significant predictor of choice. There was a small effect on choice from knowing the limitations of biomedical care. The findings have implications for public healthcare promotion activities in areas where biomedical care is introduced as an alternative to traditional healing. Copyright © 2015 Elsevier Ltd. All rights reserved.

Quantifying the Level of Cross-State Renewable Energy Transactions

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

Jenny Heeter, Philipp Beiter, Francisco Flores-Espino, David Hurlbut, Chang Liu

2015-02-01

This analysis provides first-ever assessment of the extent to which renewable energy is crossing state borders to be used to meet renewable portfolio standard (RPS) requirements. Two primary methods for data collection are Renewable Energy Certificate (REC) tracking and power flow estimates. Data from regional REC tracking systems, state agencies, and utility compliance reports help understand how cross-state transactions have been used to meet RPS compliance. Data on regional renewable energy flow use generator-specific information primarily sourced from EIA, SNL Energy, and FERC Form 1 filings. The renewable energy examined through this method may or may not have actually beenmore » used to meet RPS compliance.« less

Y2K compliance readiness and contingency planning.

PubMed

Stahl, S; Cohan, D

1999-09-01

As the millennium approaches, discussion of "Y2K compliance" will shift to discussion of "Y2K readiness." While "compliance" focuses on the technological functioning of one's own computers, "readiness" focuses on the operational planning required in a world of interdependence, in which the functionality of one's own computers is only part of the story. "Readiness" includes the ability to cope with potential Y2K failures of vendors, suppliers, staff, banks, utility companies, and others. Administrators must apply their traditional skills of analysis, inquiry and diligence to the manifold imaginable challenges which Y2K will thrust upon their facilities. The SPICE template can be used as a systematic tool to guide planning for this historic event.

7 CFR 4280.305 - Nondiscrimination and compliance with other Federal laws.

Code of Federal Regulations, 2011 CFR

2011-01-01

...) RURAL BUSINESS-COOPERATIVE SERVICE AND RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE LOANS AND... status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal...

Are prescription drug insurance choices consistent with expected utility theory?

PubMed

Bundorf, M Kate; Mata, Rui; Schoenbaum, Michael; Bhattacharya, Jay

2013-09-01

To determine the extent to which people make choices inconsistent with expected utility theory when choosing among prescription drug insurance plans and whether tabular or graphical presentation format influences the consistency of their choices. Members of an Internet-enabled panel chose between two Medicare prescription drug plans. The "low variance" plan required higher out-of-pocket payments for the drugs respondents usually took but lower out-of-pocket payments for the drugs they might need if they developed a new health condition than the "high variance" plan. The probability of a change in health varied within subjects and the presentation format (text vs. graphical) and the affective salience of the clinical condition (abstract vs. risk related to specific clinical condition) varied between subjects. Respondents were classified based on whether they consistently chose either the low or high variance plan. Logistic regression models were estimated to examine the relationship between decision outcomes and task characteristics. The majority of respondents consistently chose either the low or high variance plan, consistent with expected utility theory. Half of respondents consistently chose the low variance plan. Respondents were less likely to make discrepant choices when information was presented in graphical format. Many people, although not all, make choices consistent with expected utility theory when they have information on differences among plans in the variance of out-of-pocket spending. Medicare beneficiaries would benefit from information on the extent to which prescription drug plans provide risk protection. PsycINFO Database Record (c) 2013 APA, all rights reserved.

Measuring tactile cues at the fingerpad for object compliances harder and softer than the skin

PubMed Central

Hauser, Steven C.; Gerling, Gregory J.

2016-01-01

Distinguishing an object’s compliance, into percepts of “softness” and “hardness,” is crucial to our ability to grasp and manipulate it. Biomechanical cues at the skin’s surface such as contact area and force rate have been thought to help encode compliance. However, no one has directly measured contact area with compliant materials, and few studies have considered compliances softer than the fingerpad. Herein, we developed a novel method to precisely measure the area in contact between compliant stimuli and the fingerpad, at given levels of force and displacement. To determine the method’s robustness, we conducted psychophysical and biomechanical experiments with human subjects. The results indicate that cues including contact area at stimulus peak force of 3 Newtons, force rate over stimulus movement and at peak force, displacement and/or time to reach peak force may help in discriminating compliances while the directional spread of contact area is less important. Between softer and harder compliances, some cues were slightly more evident, though not yet definitively. Based upon the method’s utility, the next step is to conduct broader experiments to distill the mixture of cues that encode compliance. The importance of such work lies in building haptic displays, for example, to render virtual tissues. PMID:27331072

Identification of factors involved in medication compliance: incorrect inhaler technique of asthma treatment leads to poor compliance

PubMed Central

Darbà, Josep; Ramírez, Gabriela; Sicras, Antoni; García-Bujalance, Laura; Torvinen, Saku; Sánchez-de la Rosa, Rainel

2016-01-01

Objective To identify the impact of delivery device of inhaled corticosteroids and long-acting β2-agonist (ICS/LABA) on asthma medication compliance, and investigate other factors associated with compliance. Materials and methods We conducted a retrospective and multicenter study based on a review of medical registries of asthmatic patients treated with ICS/LABA combinations (n=2,213) whose medical devices were either dry powder inhalers (DPIs, such as Accuhaler®, Turbuhaler®, and NEXThaler®) or pressurized metered-dose inhalers (pMDI). Medication compliance included persistence outcomes through 18 months and medication possession ratios. Data on potential confounders of treatment compliance such as asthma exacerbations, comorbidities, demographic characteristics, and health care resource utilization were also explored. Results The probability of asthma medication compliance in case of DPIs was lower compared to pMDIs, which suggests that inhaler devices influence inhalation therapies. There were additional confounding factors that were considered as explanatory variables of compliance. A worse measure of airflow obstruction (forced expiration volume in 1 second), comorbidities and general practitioner (GP) consultations more than once per month decreased the probability of compliance. Within comorbidities, alcoholism was positively associated with compliance. Patients of 29–39, 40–50, and 51–61 age groups or suffering from more than two exacerbations during the study period were more likely to comply with their medication regime. The effects of DPIs toward compliance varied with the different DPIs. For instance, Accuhaler® had a greater negative effect on compliance compared to Turbuhaler® and Nexthaler® in cases of patients who suffered exacerbations. We found that GP consultations reduced the probability of medication compliance for patients treated with formoterol/budesonide combination. For retired patients, visiting the GP increased the probability of medication compliance. Conclusion We concluded that inhaler devices influence patients’ compliance for long-term asthma medication. The impact of Accuhaler®, Turbuhaler®, and NEXThaler® on medication compliance was negative. We also identified some confounders of medication compliance such as patient’s age, severity of asthma, comorbidities, and health care costs. PMID:26929605

Behavioral Variability of Choices versus Structural Inconsistency of Preferences

ERIC Educational Resources Information Center

Regenwetter, Michel; Davis-Stober, Clintin P.

2012-01-01

Theories of rational choice often make the structural consistency assumption that every decision maker's binary strict preference among choice alternatives forms a "strict weak order". Likewise, the very concept of a "utility function" over lotteries in normative, prescriptive, and descriptive theory is mathematically equivalent to strict weak…

Optimal Decision Stimuli for Risky Choice Experiments: An Adaptive Approach.

PubMed

Cavagnaro, Daniel R; Gonzalez, Richard; Myung, Jay I; Pitt, Mark A

2013-02-01

Collecting data to discriminate between models of risky choice requires careful selection of decision stimuli. Models of decision making aim to predict decisions across a wide range of possible stimuli, but practical limitations force experimenters to select only a handful of them for actual testing. Some stimuli are more diagnostic between models than others, so the choice of stimuli is critical. This paper provides the theoretical background and a methodological framework for adaptive selection of optimal stimuli for discriminating among models of risky choice. The approach, called Adaptive Design Optimization (ADO), adapts the stimulus in each experimental trial based on the results of the preceding trials. We demonstrate the validity of the approach with simulation studies aiming to discriminate Expected Utility, Weighted Expected Utility, Original Prospect Theory, and Cumulative Prospect Theory models.

Aging and loss decision making: increased risk aversion and decreased use of maximizing information, with correlated rationality and value maximization.

PubMed

Kurnianingsih, Yoanna A; Sim, Sam K Y; Chee, Michael W L; Mullette-Gillman, O'Dhaniel A

2015-01-01

We investigated how adult aging specifically alters economic decision-making, focusing on examining alterations in uncertainty preferences (willingness to gamble) and choice strategies (what gamble information influences choices) within both the gains and losses domains. Within each domain, participants chose between certain monetary outcomes and gambles with uncertain outcomes. We examined preferences by quantifying how uncertainty modulates choice behavior as if altering the subjective valuation of gambles. We explored age-related preferences for two types of uncertainty, risk, and ambiguity. Additionally, we explored how aging may alter what information participants utilize to make their choices by comparing the relative utilization of maximizing and satisficing information types through a choice strategy metric. Maximizing information was the ratio of the expected value of the two options, while satisficing information was the probability of winning. We found age-related alterations of economic preferences within the losses domain, but no alterations within the gains domain. Older adults (OA; 61-80 years old) were significantly more uncertainty averse for both risky and ambiguous choices. OA also exhibited choice strategies with decreased use of maximizing information. Within OA, we found a significant correlation between risk preferences and choice strategy. This linkage between preferences and strategy appears to derive from a convergence to risk neutrality driven by greater use of the effortful maximizing strategy. As utility maximization and value maximization intersect at risk neutrality, this result suggests that OA are exhibiting a relationship between enhanced rationality and enhanced value maximization. While there was variability in economic decision-making measures within OA, these individual differences were unrelated to variability within examined measures of cognitive ability. Our results demonstrate that aging alters economic decision-making for losses through changes in both individual preferences and the strategies individuals employ.

Hand hygiene: product preference and compliance.

PubMed

Tanner, Judith; Mistry, Neetesh

Hospitals are trying to improve patient hand hygiene by providing handwashing products at the bedside. Patients' compliance with handwashing depends on their satisfaction with hygiene products but no one has looked at which products patients prefer. Research on this will help hospitals target hand hygiene more appropriately and effectively. To explore patient satisfaction with hand hygiene products and identify those that are most popular. Two hundred patients were given five hand hygiene products to evaluate. These represent the interventions most widely used by patients in hospitals: alcohol foams, alcohol wipes, wet cloths with antiseptic solutions, bowls of soapy water and mobile sinks. Alcohol foam achieved the highest mean satisfaction score and was significantly more popular than the other products. Alcohol foam was the most popular choice regardless of age, sex, dexterity, mobility and religion.

Restricting marketing to children: Consensus on policy interventions to address obesity

PubMed Central

Raine, Kim D; Lobstein, Tim; Landon, Jane; Kent, Monique Potvin; Pellerin, Suzie; Caulfield, Timothy; Finegood, Diane; Mongeau, Lyne; Neary, Neil; Spence, John C

2013-01-01

Obesity presents major challenges for public health and the evidence is strong. Lessons from tobacco control indicate a need for changing the policy and environments to make healthy choices easier and to create more opportunities for children to achieve healthy weights. In April 2011, the Alberta Policy Coalition for Chronic Disease Prevention convened a consensus conference on environmental determinants of obesity such as marketing of unhealthy foods and beverages to children. We examine the political environment, evidence, issues, and challenges of placing restrictions on marketing of unhealthy foods and beverages within Canada. We recommend a national regulatory system prohibiting commercial marketing of foods and beverages to children and suggest that effective regulations must set minimum standards, monitor compliance, and enact penalties for non-compliance. PMID:23447026

OLED integrated silicon membranes for light-modulation devices

NASA Astrophysics Data System (ADS)

Cheneler, David; Vervaeke, Michael; Thienpont, Hugo; Lambertini, Vito G.; Brignone, Mauro

2014-05-01

Organic light-emitting diodes (OLEDs) are most frequently used for display purposes and while they have also been utilized in sensing applications, their innate compliance has not previously been exploited for these applications. However, in this manuscript it is shown that OLEDs are compatible with microfabrication methods used in the production of micro mechanical devices. In particular it is shown that the compliance of OLEDs can be utilized in, and not limited to, a new generation of opto-mechanical pressure sensors. A fabrication process for a light-modulating pressure sensor is described. Prototypes were fabricated and tested and the response compared to an analytical theory developed by the authors. It is shown with simple circuitry, a resolution of 11.4 Pa up to 350 kPa is attainable using this technology.

Cumulative Weighing of Time in Intertemporal Tradeoffs

PubMed Central

2016-01-01

We examine preferences for sequences of delayed monetary gains. In the experimental literature, two prominent models have been advanced as psychological descriptions of preferences for sequences. In one model, the instantaneous utilities of the outcomes in a sequence are discounted as a function of their delays, and assembled into a discounted utility of the sequence. In the other model, the accumulated utility of the outcomes in a sequence is considered along with utility or disutility from improvement in outcome utilities and utility or disutility from the spreading of outcome utilities. Drawing on three threads of evidence concerning preferences for sequences of monetary gains, we propose that the accumulated utility of the outcomes in a sequence is traded off against the duration of utility accumulation. In our first experiment, aggregate choice behavior provides qualitative support for the tradeoff model. In three subsequent experiments, one of which incentivized, disaggregate choice behavior provides quantitative support for the tradeoff model in Bayesian model contests. One thread of evidence motivating the tradeoff model is that, when, in the choice between two single dated outcomes, it is conveyed that receiving less sooner means receiving nothing later, preference for receiving more later increases, but when it is conveyed that receiving more later means receiving nothing sooner, preference is left unchanged. Our results show that this asymmetric hidden-zero effect is indeed driven by those supporting the tradeoff model. The tradeoff model also accommodates all remaining evidence on preferences for sequences of monetary gains. PMID:27560853

Suboptimal choice in rats: incentive salience attribution promotes maladaptive decision-making

PubMed Central

Chow, Jonathan J; Smith, Aaron P; Wilson, A George; Zentall, Thomas R; Beckmann, Joshua S

2016-01-01

Stimuli that are more predictive of subsequent reward also function as better conditioned reinforcers. Moreover, stimuli attributed with incentive salience function as more robust conditioned reinforcers. Some theories have suggested that conditioned reinforcement plays an important role in promoting suboptimal choice behavior, like gambling. The present experiments examined how different stimuli, those attributed with incentive salience versus those without, can function in tandem with stimulus-reward predictive utility to promote maladaptive decision-making in rats. One group of rats had lights associated with goal-tracking as the reward-predictive stimuli and another had levers associated with sign-tracking as the reward-predictive stimuli. All rats were first trained on a choice procedure in which the expected value across both alternatives was equivalent but differed in their stimulus-reward predictive utility. Next, the expected value across both alternatives was systematically changed so that the alternative with greater stimulus-reward predictive utility was suboptimal in regard to primary reinforcement. The results demonstrate that in order to obtain suboptimal choice behavior, incentive salience alongside strong stimulus-reward predictive utility may be necessary; thus, maladaptive decision-making can be driven more by the value attributed to stimuli imbued with incentive salience that reliably predict a reward rather than the reward itself. PMID:27993692

Suboptimal choice in rats: Incentive salience attribution promotes maladaptive decision-making.

PubMed

Chow, Jonathan J; Smith, Aaron P; Wilson, A George; Zentall, Thomas R; Beckmann, Joshua S

2017-03-01

Stimuli that are more predictive of subsequent reward also function as better conditioned reinforcers. Moreover, stimuli attributed with incentive salience function as more robust conditioned reinforcers. Some theories have suggested that conditioned reinforcement plays an important role in promoting suboptimal choice behavior, like gambling. The present experiments examined how different stimuli, those attributed with incentive salience versus those without, can function in tandem with stimulus-reward predictive utility to promote maladaptive decision-making in rats. One group of rats had lights associated with goal-tracking as the reward-predictive stimuli and another had levers associated with sign-tracking as the reward-predictive stimuli. All rats were first trained on a choice procedure in which the expected value across both alternatives was equivalent but differed in their stimulus-reward predictive utility. Next, the expected value across both alternatives was systematically changed so that the alternative with greater stimulus-reward predictive utility was suboptimal in regard to primary reinforcement. The results demonstrate that in order to obtain suboptimal choice behavior, incentive salience alongside strong stimulus-reward predictive utility may be necessary; thus, maladaptive decision-making can be driven more by the value attributed to stimuli imbued with incentive salience that reliably predict a reward rather than the reward itself. Copyright © 2016 Elsevier B.V. All rights reserved.

Process measures to improve perioperative prophylactic antibiotic compliance: quality and financial implications.

PubMed

Sutherland, Tori; Beloff, Jennifer; Lightowler, Marie; Liu, Xiaoxia; Nascimben, Luigino; Urman, Richard D

2014-01-01

The Surgical Care Improvement Project (SCIP) was launched in 2005. The core prophylactic perioperative antibiotic guidelines were created because of recognition of the impact of proper perioperative prophylaxis on an estimated annual 1 million inpatient days and $1.6 billion in excess health care costs that are secondary to preventable surgical site infections. There is a need to create low-cost, standardized processes on an institutional level to improve compliance with prophylactic antibiotic administration. The impact of interventions on provider compliance with SCIP inpatient antibiotic guidelines and net financial gain or loss to a large tertiary center were assessed. A single hospital was able to significantly improve their SCIP compliance and emphasis on patient safety within a year of intervention implementation. The hospital earned an additional $290,612 in 2011 and $209,096 in 2012 for reinvestment in patient safety initiatives. Low-cost interventions aimed at educating providers that utilize existing infrastructure result in improved SCIP compliance and patient safety. As a secondary gain, there were hundreds of thousands of dollars in annual cost savings. The impact of compliance on infection rates is inferred but requires further study.

Matching point-of care devices to clinicians for positive outcomes.

PubMed

Utterback, Karen; Waldo, Billie H

2005-07-01

Home care clinicians' use of point-of-care (POC) technology has increased 63% in the past 5 years. Although there are more POC system choices, matching the right device to each clinician's role is a challenge. This article clarifies the uses of laptop or notebook computer, personal digital assistants (PDAs), telephony, or automated telehealth, suggesting ways these technologies can result in clinical efficiencies, care coordination, and regulatory compliance.

Valuing SF-6D Health States Using a Discrete Choice Experiment.

PubMed

Norman, Richard; Viney, Rosalie; Brazier, John; Burgess, Leonie; Cronin, Paula; King, Madeleine; Ratcliffe, Julie; Street, Deborah

2014-08-01

SF-6D utility weights are conventionally produced using a standard gamble (SG). SG-derived weights consistently demonstrate a floor effect not observed with other elicitation techniques. Recent advances in discrete choice methods have allowed estimation of utility weights. The objective was to produce Australian utility weights for the SF-6D and to explore the application of discrete choice experiment (DCE) methods in this context. We hypothesized that weights derived using this method would reflect the largely monotonic construction of the SF-6D. We designed an online DCE and administered it to an Australia-representative online panel (n = 1017). A range of specifications investigating nonlinear preferences with respect to additional life expectancy were estimated using a random-effects probit model. The preferred model was then used to estimate a preference index such that full health and death were valued at 1 and 0, respectively, to provide an algorithm for Australian cost-utility analyses. Physical functioning, pain, mental health, and vitality were the largest drivers of utility weights. Combining levels to remove illogical orderings did not lead to a poorer model fit. Relative to international SG-derived weights, the range of utility weights was larger with 5% of health states valued below zero. s. DCEs can be used to investigate preferences for health profiles and to estimate utility weights for multi-attribute utility instruments. Australian cost-utility analyses can now use domestic SF-6D weights. The comparability of DCE results to those using other elicitation methods for estimating utility weights for quality-adjusted life-year calculations should be further investigated. © The Author(s) 2013.

Water quality, compliance, and health outcomes among utilities implementing Water Safety Plans in France and Spain.

PubMed

Setty, Karen E; Kayser, Georgia L; Bowling, Michael; Enault, Jerome; Loret, Jean-Francois; Serra, Claudia Puigdomenech; Alonso, Jordi Martin; Mateu, Arnau Pla; Bartram, Jamie

2017-05-01

Water Safety Plans (WSPs), recommended by the World Health Organization since 2004, seek to proactively identify potential risks to drinking water supplies and implement preventive barriers that improve safety. To evaluate the outcomes of WSP application in large drinking water systems in France and Spain, we undertook analysis of water quality and compliance indicators between 2003 and 2015, in conjunction with an observational retrospective cohort study of acute gastroenteritis incidence, before and after WSPs were implemented at five locations. Measured water quality indicators included bacteria (E. coli, fecal streptococci, total coliform, heterotrophic plate count), disinfectants (residual free and total chlorine), disinfection by-products (trihalomethanes, bromate), aluminum, pH, turbidity, and total organic carbon, comprising about 240K manual samples and 1.2M automated sensor readings. We used multiple, Poisson, or Tobit regression models to evaluate water quality before and after the WSP intervention. The compliance assessment analyzed exceedances of regulated, recommended, or operational water quality thresholds using chi-squared or Fisher's exact tests. Poisson regression was used to examine acute gastroenteritis incidence rates in WSP-affected drinking water service areas relative to a comparison area. Implementation of a WSP generally resulted in unchanged or improved water quality, while compliance improved at most locations. Evidence for reduced acute gastroenteritis incidence following WSP implementation was found at only one of the three locations examined. Outcomes of WSPs should be expected to vary across large water utilities in developed nations, as the intervention itself is adapted to the needs of each location. The approach may translate to diverse water quality, compliance, and health outcomes. Copyright © 2017 Elsevier GmbH. All rights reserved.

Assessment of emergency general surgery care based on formally developed quality indicators.

PubMed

Ingraham, Angela; Nathens, Avery; Peitzman, Andrew; Bode, Allison; Dorlac, Gina; Dorlac, Warren; Miller, Preston; Sadeghi, Mahsa; Wasserman, Deena D; Bilimoria, Karl

2017-08-01

Emergency general surgery outcomes vary widely across the United States. The utilization of quality indicators can reduce variation and assist providers in administering care aligned with established recommendations. Previous quality indicators have not focused on emergency general surgery patients. We identified indicators of high-quality emergency general surgery care and assessed patient- and hospital-level compliance with these indicators. We utilized a modified Delphi technique (RAND Appropriateness Methodology) to develop quality indicators. Through 2 rankings, an expert panel ranked potential quality indicators for validity. We then examined historic compliance with select quality indicators after 4 nonelective procedures (cholecystectomy, appendectomy, colectomy, small bowel resection) at 4 academic centers. Of 25 indicators rated as valid, 13 addressed patient-level quality and 12 addressed hospital-level quality. Adherence with 18 indicators was assessed. Compliance with performing a cholecystectomy for acute cholecystitis within 72 hours of symptom onset ranged from 45% to 76%. Compliance with surgery start times within 3 hours from the decision to operate for uncontained perforated viscus ranged from 20% to 100%. Compliance with exploration of patients with small bowel obstructions with ischemia/impending perforation within 3 hours of the decision to operate was 0% to 88%. For 3 quality indicators (auditing 30-day unplanned readmissions/operations for patients previously managed nonoperatively, monitoring time to source control for intra-abdominal infections, and having protocols for bypass/transfer), none of the hospitals were compliant. Developing indicators for providers to assess their performance provides a foundation for specific initiatives. Adherence to quality indicators may improve the quality of emergency general surgery care provided for which current outcomes are potentially modifiable. Copyright © 2017 Elsevier Inc. All rights reserved.

Predicting Short-Term Remembering as Boundedly Optimal Strategy Choice

ERIC Educational Resources Information Center

Howes, Andrew; Duggan, Geoffrey B.; Kalidindi, Kiran; Tseng, Yuan-Chi; Lewis, Richard L.

2016-01-01

It is known that, on average, people adapt their choice of memory strategy to the subjective utility of interaction. What is not known is whether an individual's choices are "boundedly optimal." Two experiments are reported that test the hypothesis that an individual's decisions about the distribution of remembering between internal and…

Understanding the College Choice Process of United States Military-Affiliated Transfer Students

ERIC Educational Resources Information Center

Ives, Emily Joanne

2017-01-01

This study examined the college choice process of transfer student veterans who are currently enrolled in a public research university. The research presented in this dissertation utilized both quantitative and qualitative strategies to identify key factors in students' college choice process. This study focuses on the following two research…

The College-Choice Process of High Achieving Freshmen: A Comparative Case Study

ERIC Educational Resources Information Center

Dale, Amanda

2010-01-01

The purpose of this study was to examine the college-choice process of high achieving students. Employing current literature and previous research, it combined current models of college choice and the influential factors identified throughout the literature while utilizing the concept of bounded rationality to create a conceptual framework to…

Effects of Computer-Assisted Instruction in Using Formal Decision-Making Strategies to Choose a College Major.

ERIC Educational Resources Information Center

Mau, Wei-Cheng; Jepsen, David A.

1992-01-01

Compared decision-making strategies and college major choice among 113 first-year students assigned to Elimination by Aspects Strategy (EBA), Subjective Expected Utility Strategy (SEU), and control groups. "Rational" EBA students scored significantly higher on choice certainty; lower on choice anxiety and career indecision than "rational"…

Understanding For-Profit College and Community College Choice through Rational Choice

ERIC Educational Resources Information Center

Iloh, Constance; Tierney, William G.

2014-01-01

Background/Context: Scarce research has been conducted examining why students choose to attend higher priced for-profit institutions over community colleges. The authors suggest that increased national concern over proprietary higher education warrants an in-depth comparative case study of the choice factors utilized by for-profit and community…

Metro passengers’ route choice model and its application considering perceived transfer threshold

PubMed Central

Jin, Fanglei; Zhang, Yongsheng; Liu, Shasha

2017-01-01

With the rapid development of the Metro network in China, the greatly increased route alternatives make passengers’ route choice behavior and passenger flow assignment more complicated, which presents challenges to the operation management. In this paper, a path sized logit model is adopted to analyze passengers’ route choice preferences considering such parameters as in-vehicle time, number of transfers, and transfer time. Moreover, the “perceived transfer threshold” is defined and included in the utility function to reflect the penalty difference caused by transfer time on passengers’ perceived utility under various numbers of transfers. Next, based on the revealed preference data collected in the Guangzhou Metro, the proposed model is calibrated. The appropriate perceived transfer threshold value and the route choice preferences are analyzed. Finally, the model is applied to a personalized route planning case to demonstrate the engineering practicability of route choice behavior analysis. The results show that the introduction of the perceived transfer threshold is helpful to improve the model’s explanatory abilities. In addition, personalized route planning based on route choice preferences can meet passengers’ diversified travel demands. PMID:28957376

7 CFR 4288.104 - Compliance with other laws and regulations.

Code of Federal Regulations, 2014 CFR

2014-01-01

...-COOPERATIVE SERVICE AND RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel... biofuel producers must comply with other applicable Federal, State, and local laws, including, but not...

7 CFR 4288.104 - Compliance with other laws and regulations.

Code of Federal Regulations, 2012 CFR

2012-01-01

...-COOPERATIVE SERVICE AND RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel... biofuel producers must comply with other applicable Federal, State, and local laws, including, but not...

7 CFR 4288.104 - Compliance with other laws and regulations.

Code of Federal Regulations, 2013 CFR

2013-01-01

...-COOPERATIVE SERVICE AND RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel... biofuel producers must comply with other applicable Federal, State, and local laws, including, but not...

Cost and consequences of noncompliance with osteoporosis treatment among women initiating therapy.

PubMed

Modi, Ankita; Siris, Ethel S; Tang, Jackson; Sen, Shuvayu

2015-04-01

The objective was to evaluate compliance with osteoporosis (OP) treatments and determine the fracture and healthcare burden associated with noncompliance. This retrospective analysis of a US claims database identified women initiating an OP medication from 1 January 2002 to 30 June 2009. Patients were ≥55 years and had ≥1 pharmacy claim for a bisphosphonate or non-bisphosphonate (raloxifene, calcitonin, teriparatide); the index date was the first pharmacy claim. There were three study periods: baseline (12 months pre-index); compliance period (0-12 months post-index); and follow-up period (12-24 months post-index). Medication possession ratio (MPR) was calculated during the compliance period to differentiate two cohorts: compliant (MPR ≥ 80%) and noncompliant (MPR < 80%). Outcomes during follow-up were modeled by logistic regression (presence of fracture), Poisson regression (healthcare utilization incidence rate) and gamma regression (healthcare costs), all adjusted for patient demographic and clinical characteristics. Overall, 685,505 women initiating OP therapy were identified and 57,913 (8.4%) met the inclusion criteria: only 23,430 (40.5%) were compliant and 34,483 (59.5%) were noncompliant. Mean age was 64 years. Noncompliance was associated with a 20% higher risk of any fracture (odds ratio: 1.20, 95% CI = 1.07-1.35), a higher incidence rate ratio (IRR) for inpatient utilization (IRR: 1.26, 95% CI = 1.19-1.34) and a lower rate of outpatient utilization (IRR: 0.97, 95% CI = 0.95-0.98). Noncompliant patients had 13% higher medical costs (cost ratio: 1.13, 95% CI = 1.06-1.21) than compliant patients. Inclusion in this study required 36 months of continuous healthcare coverage. Thus, the results are primarily applicable to a stable, managed care population and may not be generalizable to other populations. Noncompliance with OP therapy was associated with a higher risk of fracture, higher all-cause medical costs and a higher frequency of inpatient service utilization. Additional research is needed to identify barriers to compliance with OP therapy.

Managing community acquired pneumonia in the elderly - the next generation of pharmacotherapy on the horizon.

PubMed

Amalakuhan, B; Echevarria, K L; Restrepo, M I

2017-08-01

Community acquired pneumonia (CAP) is associated with high rates of morbidity and mortality, especially among the elderly. Antibiotic treatment for CAP in the elderly is particularly challenging for many reasons, including compliance issues, immunosuppression, polypharmacy and antimicrobial resistance. There are few available antibiotics that are able to address these concerns. Areas covered: After a systematic review of the current literature, we describe seven novel antibiotics that are currently in advanced stages of development (phase 3 and beyond) and show promise for the treatment of CAP in those over the age of 65. These antibiotics are: Solithromycin, Pristinamycin, Nemonaxacin, Lefamulin, Omadacycline, Ceftobiprole and Delafloxacin. Using a novel conceptual framework designed by the present authors, known as the 'San Antonio NIPS model', we evaluate their strengths and weaknesses based on their ability to address the unique challenges that face the elderly. Expert opinion: All seven antibiotics have potential value for effective utilization in the elderly, but to varying degrees based on their NIPS model score. The goal of this model is to reorganize a clinician's focus on antibiotic choices in the elderly and bring attention to a seldom discussed topic that may potentially become a health-care crisis in the next decade.

A transmission security framework for email-based telemedicine.

PubMed

Caffery, Liam J; Smith, Anthony C

2010-01-01

Encryption is used to convert an email message to an unreadable format thereby securing patient privacy during the transmission of the message across the Internet. Two available means of encryption are: public key infrastructure (PKI) used in conjunction with ordinary email and secure hypertext transfer protocol (HTTPS) used by secure web-mail applications. Both of these approaches have advantages and disadvantages in terms of viability, cost, usability and compliance. The aim of this study was develop an instrument to identify the most appropriate means of encrypting email communication for telemedicine. A multi-method approach was used to construct the instrument. Technical assessment and existing bodies of knowledge regarding the utility of PKI were analyzed, along with survey results from users of Queensland Health's Child and Youth Mental Health Service secure web-mail service. The resultant decision support model identified that the following conditions affect the choice of encryption technology: correspondent's risk perception, correspondent's identification to the security afforded by encryption, email-client used by correspondents, the tolerance to human error and the availability of technical resources. A decision support model is presented as a flow chart to identify the most appropriate encryption for a specific email-based telemedicine service.

Monitoring dietary intake and physical activity electronically: feasibility, usability, and ecological validity of a mobile-based Ecological Momentary Assessment tool.

PubMed

Spook, Jorinde Eline; Paulussen, Theo; Kok, Gerjo; Van Empelen, Pepijn

2013-09-24

Despite the growing body of research on complex lifestyle behaviors (eg, Dietary Intake [DI] and Physical Activity [PA]), monitoring of these behaviors has been hampered by a lack of suitable methods. A possible solution to this deficiency is mobile-based Ecological Momentary Assessment (mEMA), which enables researchers to collect data on participants' states in real-time by means of a smartphone application. However, feasibility, usability, and ecological validity need to be anticipated and managed in order to enhance the validity of mEMA. To examine the feasibility, usability, and ecological validity of a mEMA application (app) with regard to DI and PA among Dutch vocational education students. The students (n=30) participated in the mEMA study for seven consecutive days. They downloaded the mEMA app on their smartphone. Feasibility and usability of the mEMA app were evaluated by completing an online evaluation after seven days of participation. Ecological validity was measured by assessing the degree to which the content of the mEMA app approximated the real-world setting that was being examined, through several multiple-choice questions. Compliance rates, as registered by the mEMA app, declined 46% over a seven-day period, while self-reported compliance, as measured with an online evaluation questionnaire afterwards, indicated a smaller decrease in compliance (29%). The students evaluated the mEMA app as feasible and usable. Ecological validity analyses showed that all DI and almost all PA multiple-choice options were covered with the compound response categories. The mEMA app offers the opportunity to assess complex health behaviors (eg, DI and PA) in real-time settings, in which specifically routinized behaviors are involved. However, the mEMA app faced several challenges that needed to be overcome in order to improve its validity. Overall, the present study showed that the mEMA app is a usable and ecologically valid tool to measure DI and PA behaviors among vocational education students, but compliance is still limited.

Factors influencing the surgery intentions and choices of women with early breast cancer: the predictive utility of an extended theory of planned behaviour

PubMed Central

2013-01-01

Background Women diagnosed with early breast cancer (stage I or II) can be offered the choice between mastectomy or breast conservation surgery with radiotherapy due to equivalence in survival rates. A wide variation in the surgical management of breast cancer and a lack of theoretically guided research on this issue highlight the need for further research into the factors influencing women’s choices. An extended Theory of Planned Behaviour (TPB) could provide a basis to understand and predict women’s surgery choices. The aims of this study were to understand and predict the surgery intentions and choices of women newly diagnosed with early breast cancer, examining the predictive utility of an extended TPB. Methods Sixty-two women recruited from three UK breast clinics participated in the study; 48 women, newly diagnosed with early breast cancer, completed online questionnaires both before their surgery and after accessing an online decision support intervention (BresDex). Questionnaires assessed views about breast cancer and the available treatment options using items designed to measure constructs of an extended TPB (i.e., attitudes, subjective norms, perceived behavioural control, and anticipated regret), and women’s intentions to choose mastectomy or BCS. Objective data were collected on women’s choice of surgery via the clinical breast teams. Multiple and logistic regression analyses examined predictors of surgery intentions and subsequent choice of surgery. Results The extended TPB accounted for 69.9% of the variance in intentions (p <.001); attitudes and subjective norms were significant predictors. Including additional variables revealed anticipated regret to be a more important predictor than subjective norms. Surgery intentions significantly predicted surgery choices (p <.01). Conclusions These findings demonstrate the utility of an extended TPB in predicting and understanding women’s surgery intentions and choices for early breast cancer. Understanding these factors should help to identify key components of interventions to support women while considering their surgery options. PMID:23962230

Optimal Decision Stimuli for Risky Choice Experiments: An Adaptive Approach

PubMed Central

Cavagnaro, Daniel R.; Gonzalez, Richard; Myung, Jay I.; Pitt, Mark A.

2014-01-01

Collecting data to discriminate between models of risky choice requires careful selection of decision stimuli. Models of decision making aim to predict decisions across a wide range of possible stimuli, but practical limitations force experimenters to select only a handful of them for actual testing. Some stimuli are more diagnostic between models than others, so the choice of stimuli is critical. This paper provides the theoretical background and a methodological framework for adaptive selection of optimal stimuli for discriminating among models of risky choice. The approach, called Adaptive Design Optimization (ADO), adapts the stimulus in each experimental trial based on the results of the preceding trials. We demonstrate the validity of the approach with simulation studies aiming to discriminate Expected Utility, Weighted Expected Utility, Original Prospect Theory, and Cumulative Prospect Theory models. PMID:24532856

Where Would You Go for Your Next Hospitalization?

PubMed Central

Jung, Kyoungrae; Feldman, Roger; Scanlon, Dennis

2014-01-01

We examine the effects of diverse dimensions of hospital quality – including consumers’ perceptions of unobserved attributes – on future hospital choice. We utilize consumers’ stated preference weights to obtain hospital-specific estimates of perceptions about unmeasured attributes such as reputation. We report three findings. First, consumers’ perceptions of reputation and medical services contribute substantially to utility for a hospital choice. Second, consumers tend to select hospitals with high clinical quality scores even before the scores are publicized. However, the effect of clinical quality on hospital choice is relatively small. Third, satisfaction with a prior hospital admission has a large impact on future hospital choice. Our findings suggest that including measures of consumers’ experience in report cards may increase their responsiveness to publicized information, but other strategies are needed to overcome the large effects of consumers’ beliefs about other quality attributes. PMID:21665300

System compliance dictates the effect of composite filler content on polymerization shrinkage stress.

PubMed

Wang, Zhengzhi; Chiang, Martin Y M

2016-04-01

The effect of filler content in dental restorative composites on the polymerization shrinkage stress (PS) is not straightforward and has caused much debate in the literature. Our objective in this study was to clarify the PS/filler content relationship based on analytical and experimental approaches, so that guidelines for materials comparison in terms of PS and clinical selection of dental composites with various filler content can be provided. Analytically, a simplified model based on linear elasticity was utilized to predict PS as a function of filler content under various compliances of the testing system, a cantilever beam-based instrument used in this study. The predictions were validated by measuring PS of composites synthesized using 50/50 mixtures of two common dimethacrylate resins with a variety of filler contents. Both experiments and predictions indicated that the influence of filler content on the PS highly depended on the compliance of the testing system. Within the clinic-relevant range of compliances and for the specific sample configuration tested, the PS increased with increasing filler content at low compliance of instrument, while increasing the compliance caused the effect of filler content on the PS to gradually diminish. Eventually, at high compliance, the PS inverted and decreased with increasing filler content. This compliance-dependent effect of filler content on PS suggests: (1) for materials comparison in terms of PS, the specific compliance at which the comparison being done should always be reported and (2) clinically, composites with relatively lower filler content could be selected for such cavities with relatively lower compliance (e.g. a Class-I cavity with thick tooth walls or the basal part in a cavity) and vice versa in order to reduce the final PS. Published by Elsevier Ltd.

Specification of the utility function in discrete choice experiments.

PubMed

van der Pol, Marjon; Currie, Gillian; Kromm, Seija; Ryan, Mandy

2014-03-01

The specification of the utility function has received limited attention within the discrete choice experiment (DCE) literature. This lack of investigation is surprising given that evidence from the contingent valuation literature suggests that welfare estimates are sensitive to different specifications of the utility function. This study investigates the effect of different specifications of the utility function on results within a DCE. The DCE elicited the public's preferences for waiting time for hip and knee replacement and estimated willingness to wait (WTW). The results showed that the WTW for the different patient profiles varied considerably across the three different specifications of the utility function. Assuming a linear utility function led to much higher estimates of marginal rates of substitution (WTWs) than with nonlinear specifications. The goodness-of-fit measures indicated that nonlinear specifications were superior. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

17 CFR 229.405 - (Item 405) Compliance with section 16(a) of the Exchange Act.

Code of Federal Regulations, 2010 CFR

2010-04-01

....C. 78l), every closed-end investment company registered under the Investment Company Act of 1940 (15 U.S.C. 80a-1 et seq.), and every holding company registered pursuant to the Public Utility Holding... or section 17 of the Public Utility Holding Company Act (“reporting person”) that failed to file on a...

78 FR 6317 - Public Utility District No. 1 Chelan County; Notice of Application for Amendment of License and...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-30

...: The project is located on the Chelan River in Chelan County near the City of Chelan, Washington. g..., Licensing and Compliance Manager, Public Utility District No. 1 of Chelan County, 327 North Wenatchee Ave., Wenatchee, Washington 98801. Phone: 888-663-8121, ext 4180. Email: [email protected] . i. FERC Contact...

76 FR 25318 - Public Utility District No. 1 Chelan County; Notice of Application for Amendment of License and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-04

...: The project is located on the Chelan River in Chelan County near the City of Chelan, Washington. g..., Licensing and Compliance Manager, Public Utility District No. 1 of Chelan County, 327 North Wenatchee Ave., Wenatchee, Washington 98801. Phone: (888) 663-8121, ext 4180. e-mail: [email protected] . i. FERC...

Social signals of safety and risk confer utility and have asymmetric effects on observers’ choices

PubMed Central

Chung, Dongil; Ball, Sheryl B; Chiu, Pearl H

2015-01-01

Individuals’ risk attitudes are known to guide choices about uncertain options. However, in the presence of others’ decisions, these choices can be swayed and manifest as riskier or safer behavior than one would express alone. To test the mechanisms underlying effective social ‘nudges’ in human decision-making, we used functional neuroimaging and a task in which participants made choices about gambles alone and after observing others’ selections. Against three alternative explanations, we found that observing others’ choices of gambles increased the subjective value (utility) of those gambles for the observer. This ‘other-conferred utility’ was encoded in ventromedial prefrontal cortex, and these neural signals predicted conformity. We further identified a parametric interaction with individual risk preferences in anterior cingulate cortex and insula. These data provide a neuromechanistic account of how information from others is integrated with individual preferences that may explain preference-congruent susceptibility to social signals of safety and risk. PMID:25984890

A Healthy Eating Identity is Associated with Healthier Food Choice Behaviors Among U.S. Army Soldiers.

PubMed

Jayne, Julianna M; Frongillo, Edward A; Torres-McGehee, Toni M; Emerson, Dawn M; Glover, Saundra H; Blake, Christine E

2018-04-04

Promoting healthy eating among Soldiers is a priority to the Army due to the link between nutrition and performance. The Army typically uses nutrition education to encourage Soldiers to make healthier food choices with low emphasis on other psychosocial determinants of food choice behaviors. Drill Sergeant Candidates (n = 575) completed surveys assessing nutrition knowledge, eating identity type, and food choice behaviors including fruit and vegetable intake, skipping meals, and eating out frequency. In multiple linear regression models using full-information maximum likelihood estimation while controlling for race/ethnicity, education, and marital status, we examined relationships between nutrition knowledge, a healthy eating identity, and Soldiers' food choice behaviors. The study was approved by the Department of Defense and University of South Carolina's Institutional Review Boards. A healthy eating identity was positively associated with greater fruit and vegetable consumption (p < 0.05), and negatively associated with skipping meals and eating out frequency (p < 0.05). Nutrition knowledge was negatively associated with skipping meals (p < 0.05). Findings suggest that fostering a healthy eating identity may be more effective for promoting healthy food choice behaviors than nutrition education alone. Determining if various points in a Soldier's career could be leveraged to influence a healthy eating identity and behaviors could be an important strategy to improve compliance with health promotion programs.

Changes of heart: the switch-value method for assessing value uncertainty.

PubMed

John, Leslie K; Fischhoff, Baruch

2010-01-01

Medical choices often evoke great value uncertainty, as patients face difficult, unfamiliar tradeoffs. Those seeking to aid such choices must be able to assess patients' ability to reduce that uncertainty, to reach stable, informed choices. The authors demonstrate a new method for evaluating how well people have articulated their preferences for difficult health decisions. The method uses 2 evaluative criteria. One is internal consistency, across formally equivalent ways of posing a choice. The 2nd is compliance with principles of prospect theory, indicating sufficient task mastery to respond in predictable ways. Subjects considered a hypothetical choice between noncurative surgery and palliative care, posed by a brain tumor. The choice options were characterized on 6 outcomes (e.g., pain, life expectancy, treatment risk), using a drug facts box display. After making an initial choice, subjects indicated their willingness to switch, given plausible changes in the outcomes. These changes involved either gains (improvements) in the unchosen option or losses (worsening) in the chosen one. A 2 x 2 mixed design manipulated focal change (gains v. losses) within subjects and change order between subjects. In this demonstration, subjects' preferences were generally consistent 1) with one another: with similar percentages willing to switch for gains and losses, and 2) with prospect theory, requiring larger gains than losses, to make those switches. Informed consent requires understanding decisions well enough to articulate coherent references. The authors' method allows assessing individuals' success in doing so.

Utility functions predict variance and skewness risk preferences in monkeys

PubMed Central

Genest, Wilfried; Stauffer, William R.; Schultz, Wolfram

2016-01-01

Utility is the fundamental variable thought to underlie economic choices. In particular, utility functions are believed to reflect preferences toward risk, a key decision variable in many real-life situations. To assess the validity of utility representations, it is therefore important to examine risk preferences. In turn, this approach requires formal definitions of risk. A standard approach is to focus on the variance of reward distributions (variance-risk). In this study, we also examined a form of risk related to the skewness of reward distributions (skewness-risk). Thus, we tested the extent to which empirically derived utility functions predicted preferences for variance-risk and skewness-risk in macaques. The expected utilities calculated for various symmetrical and skewed gambles served to define formally the direction of stochastic dominance between gambles. In direct choices, the animals’ preferences followed both second-order (variance) and third-order (skewness) stochastic dominance. Specifically, for gambles with different variance but identical expected values (EVs), the monkeys preferred high-variance gambles at low EVs and low-variance gambles at high EVs; in gambles with different skewness but identical EVs and variances, the animals preferred positively over symmetrical and negatively skewed gambles in a strongly transitive fashion. Thus, the utility functions predicted the animals’ preferences for variance-risk and skewness-risk. Using these well-defined forms of risk, this study shows that monkeys’ choices conform to the internal reward valuations suggested by their utility functions. This result implies a representation of utility in monkeys that accounts for both variance-risk and skewness-risk preferences. PMID:27402743

Utility functions predict variance and skewness risk preferences in monkeys.

PubMed

Genest, Wilfried; Stauffer, William R; Schultz, Wolfram

2016-07-26

Utility is the fundamental variable thought to underlie economic choices. In particular, utility functions are believed to reflect preferences toward risk, a key decision variable in many real-life situations. To assess the validity of utility representations, it is therefore important to examine risk preferences. In turn, this approach requires formal definitions of risk. A standard approach is to focus on the variance of reward distributions (variance-risk). In this study, we also examined a form of risk related to the skewness of reward distributions (skewness-risk). Thus, we tested the extent to which empirically derived utility functions predicted preferences for variance-risk and skewness-risk in macaques. The expected utilities calculated for various symmetrical and skewed gambles served to define formally the direction of stochastic dominance between gambles. In direct choices, the animals' preferences followed both second-order (variance) and third-order (skewness) stochastic dominance. Specifically, for gambles with different variance but identical expected values (EVs), the monkeys preferred high-variance gambles at low EVs and low-variance gambles at high EVs; in gambles with different skewness but identical EVs and variances, the animals preferred positively over symmetrical and negatively skewed gambles in a strongly transitive fashion. Thus, the utility functions predicted the animals' preferences for variance-risk and skewness-risk. Using these well-defined forms of risk, this study shows that monkeys' choices conform to the internal reward valuations suggested by their utility functions. This result implies a representation of utility in monkeys that accounts for both variance-risk and skewness-risk preferences.

Real-time data acquisition and alerts may reduce reaction time and improve perfusionist performance during cardiopulmonary bypass.

PubMed

Beck, J R; Fung, K; Lopez, H; Mongero, L B; Argenziano, M

2015-01-01

Delayed perfusionist identification and reaction to abnormal clinical situations has been reported to contribute to increased mortality and morbidity. The use of automated data acquisition and compliance safety alerts has been widely accepted in many industries and its use may improve operator performance. A study was conducted to evaluate the reaction time of perfusionists with and without the use of compliance alert. A compliance alert is a computer-generated pop-up banner on a pump-mounted computer screen to notify the user of clinical parameters outside of a predetermined range. A proctor monitored and recorded the time from an alert until the perfusionist recognized the parameter was outside the desired range. Group one included 10 cases utilizing compliance alerts. Group 2 included 10 cases with the primary perfusionist blinded to the compliance alerts. In Group 1, 97 compliance alerts were identified and, in group two, 86 alerts were identified. The average reaction time in the group using compliance alerts was 3.6 seconds. The average reaction time in the group not using the alerts was nearly ten times longer than the group using computer-assisted, real-time data feedback. Some believe that real-time computer data acquisition and feedback improves perfusionist performance and may allow clinicians to identify and rectify potentially dangerous situations. © The Author(s) 2014.

Interactions between energy efficiency and emission trading under the 1990 Clean Air Act Amendments

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

Hillsman, E.L.; Alvic, D.R.

1994-08-01

The 1990 Clean Air Act Amendments affect electric utilities in numerous ways. The feature that probably has received the greatest attention is the provision to let utilities trade emissions of sulfur dioxide (SO{sub 2}), while at the same time requiring them to reduce S0{sub 2} emissions in 2000 by an aggregate 43%. The emission trading system was welcomed by many as a way of reducing the cost of reducing emissions, by providing greater flexibility than past approaches. This report examines some of the potential interactions between trading emissions and increasing end-use energy efficiency. The analysis focuses on emission trading inmore » the second phase of the trading program, which begins in 2000. The aggregate effects, calculated by an emission compliance and trading model, turn out to be rather small. Aggressive improvement of end-use efficiency by all utilities might reduce allowance prices by $22/ton (1990 dollars), which is small compared to the reduction that has occurred in the estimates of future allowance prices and when compared to the roughly $400/ton price we estimate as a base case. However, the changes in the allowance market that result are large enough to affect some compliance decisions. If utilities in only a few states improve end-use efficiency aggressively, their actions may not have a large effect on the price of an allowance, but they could alter the demand for allowances and thereby the compliance decisions of utilities in other states. The analysis shows how improving electricity end-use efficiency in some states can cause smaller emission reductions in other states, relative to what would have happened without the improvements. Such a result, while not surprising given the theory behind the emission trading system, is upsetting to people who view emissions, environmental protection, and energy efficiency in moral rather than strictly economic terms.« less

Risk-dependent reward value signal in human prefrontal cortex

PubMed Central

Tobler, Philippe N.; Christopoulos, George I.; O'Doherty, John P.; Dolan, Raymond J.; Schultz, Wolfram

2009-01-01

When making choices under uncertainty, people usually consider both the expected value and risk of each option, and choose the one with the higher utility. Expected value increases the expected utility of an option for all individuals. Risk increases the utility of an option for risk-seeking individuals, but decreases it for risk averse individuals. In 2 separate experiments, one involving imperative (no-choice), the other choice situations, we investigated how predicted risk and expected value aggregate into a common reward signal in the human brain. Blood oxygen level dependent responses in lateral regions of the prefrontal cortex increased monotonically with increasing reward value in the absence of risk in both experiments. Risk enhanced these responses in risk-seeking participants, but reduced them in risk-averse participants. The aggregate value and risk responses in lateral prefrontal cortex contrasted with pure value signals independent of risk in the striatum. These results demonstrate an aggregate risk and value signal in the prefrontal cortex that would be compatible with basic assumptions underlying the mean-variance approach to utility. PMID:19369207

Encoding of marginal utility across time in the human brain.

PubMed

Pine, Alex; Seymour, Ben; Roiser, Jonathan P; Bossaerts, Peter; Friston, Karl J; Curran, H Valerie; Dolan, Raymond J

2009-07-29

Marginal utility theory prescribes the relationship between the objective property of the magnitude of rewards and their subjective value. Despite its pervasive influence, however, there is remarkably little direct empirical evidence for such a theory of value, let alone of its neurobiological basis. We show that human preferences in an intertemporal choice task are best described by a model that integrates marginally diminishing utility with temporal discounting. Using functional magnetic resonance imaging, we show that activity in the dorsal striatum encodes both the marginal utility of rewards, over and above that which can be described by their magnitude alone, and the discounting associated with increasing time. In addition, our data show that dorsal striatum may be involved in integrating subjective valuation systems inherent to time and magnitude, thereby providing an overall metric of value used to guide choice behavior. Furthermore, during choice, we show that anterior cingulate activity correlates with the degree of difficulty associated with dissonance between value and time. Our data support an integrative architecture for decision making, revealing the neural representation of distinct subcomponents of value that may contribute to impulsivity and decisiveness.

Implementation of a commercial-grade dedication program - Benefits and lessons learned

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

Harrington, M.; MacFarlane, I.

1991-01-01

The recent issuance of industry guidelines, the Nuclear Management and Resources Council procurement initiative, and a US Nuclear Regulatory Commission NRC generic letter on commercial-grade item dedication (CGD) has been viewed by many utility managers and executives as only adding to the existing burden of compliance with regulatory requirements. While the incorporation of these documents into existing CGD programs has created additional costs, the resulting enhanced dedication programs have also produced benefits beyond regulatory compliance, and some lessons have been learned. This paper discusses the benefits and the lessons learned during implementation of an enhanced CGD program at New Hampshiremore » Yankee's (NHY's) Seabrook nuclear plant. Based on NHY's experience, it is believed that the benefits described in this paper can be realized by other utilities implementing CGD programs.« less

The Crisis of Civil-Military Relations in Venezuela: Testing Rational Choice, Cultural, and Institutional Theories

DTIC Science & Technology

1999-12-01

1998, 36. Aguero, Felipe, "Soldiers, Civilians, and Democracy: Post -Franco Spain in Comparative Perspective," Baltimore, John Hopkins University...breakdown, transition, and consolidation, they have ignored the period of compliance or post -transitional political peace.18 The second aspect that...of works focused on the post -transitional and post -consolidation period. This becomes a limitation for this thesis because of the lack of empirical

They're NICE and Neat, but Are They Useful? A Grounded Theory of Clinical Psychologists' Beliefs About and Use of NICE Guidelines.

PubMed

Court, Alex John; Cooke, Anne; Scrivener, Amanda

2017-07-01

Guidelines are ubiquitous but inconsistently used in UK mental health services. Clinical psychologists are often influential in guideline development and implementation, but opinion within the profession is divided. This study utilized grounded theory methodology to examine clinical psychologists' beliefs about and use of NICE guidelines. Eleven clinical psychologists working in the NHS were interviewed. The overall emerging theme was; NICE guidelines are considered to have benefits but to be fraught with dangers. Participants were concerned that guidelines can create an unhelpful illusion of neatness. They managed the tension between the helpful and unhelpful aspects of guidelines by relating to them in a flexible manner. The participants reported drawing on specialist skills such as idiosyncratic formulation and integration. However, due to the pressures and dominant discourses within services they tended to practice in ways that prevent these skills from being recognized. This led to fears that their professional identity was threatened, which impacted upon perceptions of the guidelines. To our knowledge, the theoretical framework presented in this paper is the first that attempts to explain why NICE guidelines are not consistently utilized in UK mental health services. The current need for services to demonstrate 'NICE compliance' may be leading to a perverse incentive for clinical psychologists in particular to do one thing but say another and for specialist skills to be obscured. If borne out by future studies, this represents a threat to continued quality improvement and also to the profession. Copyright © 2016 John Wiley & Sons, Ltd. Guidelines have many benefits, but the current pressure for services to be 'NICE compliant' may be having unintended negative as well as positive effects. Lack of implementation may be partly the result of active choice by clinicians concerned to use the full range of professional skills and to offer flexibility and choice to service users. The current context is creating a perverse incentive for clinicians to say one thing but do another. This is problematic for services and a potential threat to the profession of clinical psychology. Copyright © 2016 John Wiley & Sons, Ltd.

Aspirin for Evidence-Based Preeclampsia Prevention trial: influence of compliance on beneficial effect of aspirin in prevention of preterm preeclampsia.

PubMed

Wright, David; Poon, Liona C; Rolnik, Daniel L; Syngelaki, Argyro; Delgado, Juan Luis; Vojtassakova, Denisa; de Alvarado, Mercedes; Kapeti, Evgenia; Rehal, Anoop; Pazos, Andrea; Carbone, Ilma Floriana; Dutemeyer, Vivien; Plasencia, Walter; Papantoniou, Nikos; Nicolaides, Kypros H

2017-12-01

The Aspirin for Evidence-Based Preeclampsia Prevention trial was a multicenter study in women with singleton pregnancies. Screening was carried out at 11-13 weeks' gestation with an algorithm that combines maternal factors and biomarkers (mean arterial pressure, uterine artery pulsatility index, and maternal serum pregnancy-associated plasma protein A and placental growth factor). Those with an estimated risk for preterm preeclampsia of >1 in 100 were invited to participate in a double-blind trial of aspirin (150 mg/d) vs placebo from 11-14 until 36 weeks' gestation. Preterm preeclampsia with delivery at <37 weeks' gestation, which was the primary outcome, occurred in 1.6% (13/798) participants in the aspirin group, as compared with 4.3% (35/822) in the placebo group (odds ratio in the aspirin group, 0.38; 95% confidence interval, 0.20 to 0.74). We sought to examine the influence of compliance on the beneficial effect of aspirin in prevention of preterm preeclampsia in the Aspirin for Evidence-Based Preeclampsia Prevention trial. This was a secondary analysis of data from the trial. The proportion of prescribed tablets taken was used as an overall measure of compliance. Logistic regression analysis was used to estimate the effect of aspirin on the incidence of preterm preeclampsia according to compliance of <90% and ≥90%, after adjustment for the estimated risk of preterm preeclampsia at screening and the participating center. The choice of cut-off of 90% was based on an exploratory analysis of the treatment effect. Logistic regression analysis was used to investigate predictors of compliance ≥90% among maternal characteristics and medical history. Preterm preeclampsia occurred in 5/555 (0.9%) participants in the aspirin group with compliance ≥90%, in 8/243 (3.3%) of participants in the aspirin group with compliance <90%, in 22/588 (3.7%) of participants in the placebo group with compliance ≥90%, and in 13/234 (5.6%) of participants in the placebo group with compliance <90%. The odds ratio in the aspirin group for preterm preeclampsia was 0.24 (95% confidence interval, 0.09-0.65) for compliance ≥90% and 0.59 (95% confidence interval, 0.23-1.53) for compliance <90%. Compliance was positively associated with family history of preeclampsia and negatively associated with smoking, maternal age <25 years, Afro-Caribbean and South Asian racial origin, and history of preeclampsia in a previous pregnancy. The beneficial effect of aspirin in the prevention of preterm preeclampsia appears to depend on compliance. Copyright © 2017 Elsevier Inc. All rights reserved.

Compliance with guidelines in patients with ST-segment elevation myocardial infarction after implementation of specific guidelines for emergency care: results of RESCA+31 registry.

PubMed

Sandouk, Abbas; Ducassé, Jean-Louis; Grolleau, Sabrina; Azéma, Olivier; Elbaz, Meyer; Farah, Bruno; Tidjane, Amir; Kelly-Irving, Michelle; Charpentier, Sandrine

2012-05-01

Guidelines emphasize the implementation of local networks with prehospital emergency medical systems to improve the management of patients with ST-segment elevation myocardial infarction (STEMI); they also define the choice of reperfusion strategies and adjunctive treatments. To assess the compliance of STEMI emergency care with current French guidelines in a large area of France and to identify predictors of compliance with guidelines. The RESCA+31 registry was a 2-year, multicentre, prospective, multidisciplinary study, including 512 consecutive patients with STEMI evolving within 12 hours managed by emergency physicians in the prehospital system or emergency department. Data were recorded during the emergency phase and after admission to cardiology. First medical contact (FMC) was prehospital emergency care for 80% of patients; 97% received reperfusion treatment and 98% were admitted to a cardiology intensive care unit (CICU) with a catheterization laboratory. The mortality rate was 5%. Guidelines were complied with in 41% of patients for reperfusion strategies, in 47% for adjunctive treatments and in 23% for both. The only factor independently associated with guideline compliance was FMC by prehospital emergency system. In 52% of cases, emergency physicians underestimated the delay between FMC and admission to a CICU. Despite the implementation of a network, compliance with guidelines for reperfusion strategies and adjunctive treatments was insufficient in our area. However, very few patients did not receive reperfusion therapy and the mortality rate was low. Efforts should be made to improve the estimation of delay before primary percutaneous coronary intervention. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

Neuronal Reward and Decision Signals: From Theories to Data

PubMed Central

Schultz, Wolfram

2015-01-01

Rewards are crucial objects that induce learning, approach behavior, choices, and emotions. Whereas emotions are difficult to investigate in animals, the learning function is mediated by neuronal reward prediction error signals which implement basic constructs of reinforcement learning theory. These signals are found in dopamine neurons, which emit a global reward signal to striatum and frontal cortex, and in specific neurons in striatum, amygdala, and frontal cortex projecting to select neuronal populations. The approach and choice functions involve subjective value, which is objectively assessed by behavioral choices eliciting internal, subjective reward preferences. Utility is the formal mathematical characterization of subjective value and a prime decision variable in economic choice theory. It is coded as utility prediction error by phasic dopamine responses. Utility can incorporate various influences, including risk, delay, effort, and social interaction. Appropriate for formal decision mechanisms, rewards are coded as object value, action value, difference value, and chosen value by specific neurons. Although all reward, reinforcement, and decision variables are theoretical constructs, their neuronal signals constitute measurable physical implementations and as such confirm the validity of these concepts. The neuronal reward signals provide guidance for behavior while constraining the free will to act. PMID:26109341

42 CFR 423.150 - Scope.

Code of Federal Regulations, 2014 CFR

2014-10-01

... PROGRAM (CONTINUED) VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Cost Control and Quality Improvement... utilization management programs, quality assurance measures and systems, and medication therapy management... organization (QIO) activities. (f) Compliance deemed on the basis of accreditation. (g) Accreditation...

42 CFR 423.150 - Scope.

Code of Federal Regulations, 2012 CFR

2012-10-01

... PROGRAM (CONTINUED) VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Cost Control and Quality Improvement... utilization management programs, quality assurance measures and systems, and medication therapy management... organization (QIO) activities. (f) Compliance deemed on the basis of accreditation. (g) Accreditation...

42 CFR 423.150 - Scope.

Code of Federal Regulations, 2011 CFR

2011-10-01

... PROGRAM VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Cost Control and Quality Improvement Requirements... utilization management programs, quality assurance measures and systems, and medication therapy management... organization (QIO) activities. (f) Compliance deemed on the basis of accreditation. (g) Accreditation...

42 CFR 423.150 - Scope.

Code of Federal Regulations, 2013 CFR

2013-10-01

... PROGRAM (CONTINUED) VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Cost Control and Quality Improvement... utilization management programs, quality assurance measures and systems, and medication therapy management... organization (QIO) activities. (f) Compliance deemed on the basis of accreditation. (g) Accreditation...

7 CFR 1980.341 - Inspections of construction and compliance reviews.

Code of Federal Regulations, 2010 CFR

2010-01-01

... HOUSING SERVICE, RURAL BUSINESS-COOPERATIVE SERVICE, RURAL UTILITIES SERVICE, AND FARM SERVICE AGENCY... subpart A of part 1924. (c) Water and water/waste disposal. The Lender will see that the water and water...

7 CFR 1980.341 - Inspections of construction and compliance reviews.

Code of Federal Regulations, 2011 CFR

2011-01-01

... HOUSING SERVICE, RURAL BUSINESS-COOPERATIVE SERVICE, RURAL UTILITIES SERVICE, AND FARM SERVICE AGENCY... subpart A of part 1924. (c) Water and water/waste disposal. The Lender will see that the water and water...

77 FR 27797 - Request for Certification of Compliance-Rural Industrialization Loan and Grant Program

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-11

... 4279-2) for the following: Applicant/Location: Samoa Tuna Processors, Inc. Principal Product/Purpose... improvements, replace machinery and equipment and utilities repairs and other upgrades. The plant will be...

Coverage, compliance and factors associated with utilization of iron supplementation during pregnancy in eight rural districts of Ethiopia: a cross-sectional study

PubMed Central

2014-01-01

Background Despite the efforts to reduce iron deficiency during pregnancy, information on the coverage and factors associated with utilization of iron supplements is lacking. The study is intended to assess the coverage, compliance and factors associated with the use of prenatal iron supplements in eight rural districts of Ethiopia. Methods The study comprised two independent surveys conducted among pregnant women (n = 414) and women who gave birth in the preceding year of the survey (n = 1573). In both cases, respondents were selected using multistage sampling technique and data were collected via structured questionnaire. Predictors of iron supplement utilization (ranked categories of number of prenatal supplements taken) were identified using ordinal logistic regression. The outputs of the analysis are given using adjusted Odds Ratio (OR) with 95% Confidence Interval (CI). Results Among women who gave birth in the preceding year, 35.4% (95% CI: 31.3-39.5) were given/prescribed prenatal iron supplement during the index pregnancy and only 3.5% were supplemented for the recommended 91 or more days. Compared to women who had 4 or more ANC visits, those with 0, 1, 2 and 3 visits had 0.04, 0.33, 0.50 and 0.60 times less odds of iron supplement utilization, respectively. Women lacking comprehensive knowledge of anemia (OR = 0. 75 (95% CI: 0.57-0.97)) and those who weren’t informed about the importance of iron supplementation during the pregnancy (OR = 0. 05 (95% CI: 0.04-0.07)) had significantly lower utilization. On the other hand, in pregnant women the prevalence of anemia was 33.2%. Among pregnant women who were given/prescribed supplements, the average level of compliance was 74.9% and about 25.1% had less than 70% adherence. The leading reported reasons for non-adherence were side-effects (63.3%) and forgetfulness (16.7%). Conclusion Promoting early and frequent ANC, enhancing the quality of ANC counseling and promoting the knowledge of women on anemia are essential strategies for improving the utilization of iron supplements. PMID:24930036

Dental Student Academic Integrity in U.S. Dental Schools: Current Status and Recommendations for Enhancement.

PubMed

Graham, Bruce S; Knight, G William; Graham, Linda

2016-01-01

Cheating incidents in 2006-07 led U.S. dental schools to heighten their efforts to enhance the environment of academic integrity in their institutions. The aims of this study were to document the measures being used by U.S. dental schools to discourage student cheating, determine the current incidence of reported cheating, and make recommendations for enhancing a culture of integrity in dental education. In late 2014-early 2015, an online survey was distributed to academic deans of all 61 accredited U.S. dental schools that had four classes of dental students enrolled; 50 (82%) responded. Among measures used, 98% of respondents reported having policy statements regarding student academic integrity, 92% had an Honor Code, 96% provided student orientation to integrity policies, and most used proctoring of final exams (91%) and tests (93%). Regarding disciplinary processes, 27% reported their faculty members only rarely reported suspected cheating (though required in 76% of the schools), and 40% disseminated anonymous results of disciplinary hearings. A smaller number of schools (n=36) responded to the question about student cheating than to other questions; those results suggested that reported cheating had increased almost threefold since 1998. The authors recommend that schools add cheating case scenarios to professional ethics curricula; disseminate outcomes of cheating enforcement actions; have students sign a statement attesting to compliance with academic integrity policies at every testing activity; add curricular content on correct writing techniques to avoid plagiarism; require faculty to distribute retired test items; acquire examination-authoring software programs to enable faculty to generate new multiple-choice items and different versions of the same multiple-choice tests; avoid take-home exams when assessing independent student knowledge; and utilize student assessment methods directly relevant to clinical practice.

Conceptual model and economic experiments to explain nonpersistence and enable mechanism designs fostering behavioral change.

PubMed

Djawadi, Behnud Mir; Fahr, René; Turk, Florian

2014-12-01

Medical nonpersistence is a worldwide problem of striking magnitude. Although many fields of studies including epidemiology, sociology, and psychology try to identify determinants for medical nonpersistence, comprehensive research to explain medical nonpersistence from an economics perspective is rather scarce. The aim of the study was to develop a conceptual framework that augments standard economic choice theory with psychological concepts of behavioral economics to understand how patients' preferences for discontinuing with therapy arise over the course of the medical treatment. The availability of such a framework allows the targeted design of mechanisms for intervention strategies. Our conceptual framework models the patient as an active economic agent who evaluates the benefits and costs for continuing with therapy. We argue that a combination of loss aversion and mental accounting operations explains why patients discontinue with therapy at a specific point in time. We designed a randomized laboratory economic experiment with a student subject pool to investigate the behavioral predictions. Subjects continue with therapy as long as experienced utility losses have to be compensated. As soon as previous losses are evened out, subjects perceive the marginal benefit of persistence lower than in the beginning of the treatment. Consequently, subjects start to discontinue with therapy. Our results highlight that concepts of behavioral economics capture the dynamic structure of medical nonpersistence better than does standard economic choice theory. We recommend that behavioral economics should be a mandatory part of the development of possible intervention strategies aimed at improving patients' compliance and persistence behavior. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

The effects of a time-based intervention on experienced middle-aged rats

PubMed Central

Peterson, Jennifer R.; Kirkpatrick, Kimberly

2016-01-01

Impulsive behavior is a common symptom in Attention Deficit Hyperactivity Disorder, schizophrenia, drug abuse, smoking, obesity and compulsive gambling. Stable levels of impulsive choice have been found in humans and rats and a recent study reported significant test-retest reliability of impulsive choice behavior after 1 and 5 months in rats. Time-based behavioral interventions have been successful in decreasing impulsive choices. These interventions led to improvements in the ability to time and respond more appropriately to adventitious choices. The current study examined the use of a time-based intervention in experienced, middle-aged rats. This intervention utilized a variable interval schedule previously found to be successful in improving timing and decreasing impulsive choice. This study found that the intervention led to a decrease in impulsive choices and there was a significant correlation between the improvement in self-control and post-intervention temporal precision in middle-aged rats. Although there were no overall group difference in bisection performance, individual differences were observed, suggesting an improvement in timing. This is an important contribution to the field because previous studies have utilized only young rats and because previous research indicates a decrease in general timing abilities with age. PMID:27826006

Aging and loss decision making: increased risk aversion and decreased use of maximizing information, with correlated rationality and value maximization

PubMed Central

Kurnianingsih, Yoanna A.; Sim, Sam K. Y.; Chee, Michael W. L.; Mullette-Gillman, O’Dhaniel A.

2015-01-01

We investigated how adult aging specifically alters economic decision-making, focusing on examining alterations in uncertainty preferences (willingness to gamble) and choice strategies (what gamble information influences choices) within both the gains and losses domains. Within each domain, participants chose between certain monetary outcomes and gambles with uncertain outcomes. We examined preferences by quantifying how uncertainty modulates choice behavior as if altering the subjective valuation of gambles. We explored age-related preferences for two types of uncertainty, risk, and ambiguity. Additionally, we explored how aging may alter what information participants utilize to make their choices by comparing the relative utilization of maximizing and satisficing information types through a choice strategy metric. Maximizing information was the ratio of the expected value of the two options, while satisficing information was the probability of winning. We found age-related alterations of economic preferences within the losses domain, but no alterations within the gains domain. Older adults (OA; 61–80 years old) were significantly more uncertainty averse for both risky and ambiguous choices. OA also exhibited choice strategies with decreased use of maximizing information. Within OA, we found a significant correlation between risk preferences and choice strategy. This linkage between preferences and strategy appears to derive from a convergence to risk neutrality driven by greater use of the effortful maximizing strategy. As utility maximization and value maximization intersect at risk neutrality, this result suggests that OA are exhibiting a relationship between enhanced rationality and enhanced value maximization. While there was variability in economic decision-making measures within OA, these individual differences were unrelated to variability within examined measures of cognitive ability. Our results demonstrate that aging alters economic decision-making for losses through changes in both individual preferences and the strategies individuals employ. PMID:26029092

48 CFR 908.7101-2 - Consolidated acquisition of new vehicles by General Services Administration.

Code of Federal Regulations, 2013 CFR

2013-10-01

... GSA's online vehicle purchasing system (AutoChoice). (b) Orders for all motor vehicles shall be submitted utilizing GSA's on-line system (Auto Choice), in accordance with FPMR 41 CFR 101-26.501...

48 CFR 908.7101-2 - Consolidated acquisition of new vehicles by General Services Administration.

Code of Federal Regulations, 2014 CFR

2014-10-01

... GSA's online vehicle purchasing system (AutoChoice). (b) Orders for all motor vehicles shall be submitted utilizing GSA's on-line system (Auto Choice), in accordance with FPMR 41 CFR 101-26.501...

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

OShaughnessy, Eric J; Volpi, Christina M; Heeter, Jenny S

Annual report of sales and number of customers in voluntary green power markets, including utility green pricing programs, utility green partnerships, competitive suppliers, unbundled renewable energy certificates, community choice aggregations, power purchase agreements, and community solar.

The Impact of Anesthesia-Influenced Process Measure Compliance on Length of Stay: Results From an Enhanced Recovery After Surgery for Colorectal Surgery Cohort.

PubMed

Grant, Michael C; Pio Roda, Claro M; Canner, Joseph K; Sommer, Philip; Galante, Daniel; Hobson, Deborah; Gearhart, Susan; Wu, Christopher L; Wick, Elizabeth

2018-05-17

Process measure compliance has been associated with improved outcomes in enhanced recovery after surgery (ERAS) programs. Herein, we sought to assess the impact of compliance with measures directly influenced by anesthesiology in an ERAS for colorectal surgery cohort. From January 2013 to April 2015, data from 1140 consecutive patients were collected for all patients before (pre-ERAS) and after (ERAS) implementation of an ERAS program. Compliance with 9 specific process measures directly influenced by the anesthesiologist or acute pain service was analyzed to determine the impact on hospital length of stay (LOS). Process measure compliance was associated with a stepwise reduction in LOS. Patients who received >4 process measures (high compliance) had a significantly shorter LOS (incident rate ratio [IRR], 0.77; 95% CI, 0.70-0.85); P < .001) compared to low compliance (0-2 process measures) counterparts. Multivariable regression suggests that utilization of multimodal nausea and vomiting prophylaxis (IRR, 0.78; 95% CI, 0.68-0.89; P < .001), scheduled postoperative nonsteroidal pain medication use (IRR, 0.76; 95% CI, 0.67-0.85; P < .001), and strict adherence to a postoperative opioid administration (IRR, 0.58; 95% CI, 0.51-0.67; P < .001) protocol for breakthrough pain were independently associated with reduced LOS. Our findings suggest that increased compliance with process measures directly influenced by the anesthesiologists and in concert with a formal anesthesia protocol is associated with reduced LOS. Engaging anesthesiology colleagues throughout the surgical encounter increases the overall value of perioperative care.

The Athletic Trainer's Role in Modifying Nutritional Behaviors of Adolescent Athletes: Putting Theory into Practice

PubMed Central

Hackman, Robert M.; Katra, Jane E.; Geertsen, Susan M.

1992-01-01

Nutritional practices influence athletic performance and recovery from injury. The athletic trainer is ideally positioned to effect dietary changes with adolescent athletes—a group at high-risk for nutritional imbalances. Research shows that young adults generally do not change dietary practices when given factual nutrition and health information. This article provides a variety of behavior change strategies, based on models derived from health education and health psychology, which are likely to influence dietary choices. Promoting self-efficacy by enhancing perception of choice and control, peer modeling, cooperative support networks, goal-setting techniques, and behavioral self-monitoring may provide the motivational framework necessary to enhance dietary compliance. Dietary behavior change techniques are a valuable part of an athletic trainer's resources. PMID:16558172

Accounting for substitution and spatial heterogeneity in a labelled choice experiment.

PubMed

Lizin, S; Brouwer, R; Liekens, I; Broeckx, S

2016-10-01

Many environmental valuation studies using stated preferences techniques are single-site studies that ignore essential spatial aspects, including possible substitution effects. In this paper substitution effects are captured explicitly in the design of a labelled choice experiment and the inclusion of different distance variables in the choice model specification. We test the effect of spatial heterogeneity on welfare estimates and transfer errors for minor and major river restoration works, and the transferability of river specific utility functions, accounting for key variables such as site visitation, spatial clustering and income. River specific utility functions appear to be transferable, resulting in low transfer errors. However, ignoring spatial heterogeneity increases transfer errors. Copyright © 2016 Elsevier Ltd. All rights reserved.

Circuit compliance compensation in lung protective ventilation.

PubMed

Masselli, Grazia Maria Pia; Silvestri, Sergio; Sciuto, Salvatore Andrea; Cappa, Paolo

2006-01-01

Lung protective ventilation utilizes low tidal volumes to ventilate patients with severe lung pathologies. The compensation of breathing circuit effects, i.e. those induced by compressible volume of the circuit, results particularly critical in the calculation of the actual tidal volume delivered to patient's respiratory system which in turns is responsible of the level of permissive hypercapnia. The present work analyzes the applicability of the equation for circuit compressible volume compensation in the case of pressure and volume controlled lung protective ventilation. Experimental tests conducted in-vitro show that the actual tidal volume can be reliably estimated if the compliance of the breathing circuit is measured with the same parameters and ventilation technique that will be utilized in lung protective ventilation. Differences between volume and pressure controlled ventilation are also quantitatively assessed showing that pressure controlled ventilation allows a more reliable compensation of breathing circuit compressible volume.

Gender differences in health care utilization and outcome of respiratory tuberculosis in Alexandria.

PubMed

Kamel, M I; Rashed, S; Foda, N; Mohie, A; Loutfy, M

2003-07-01

A study of gender differences in health care utilization and outcome of respiratory tuberculosis was carried out in Alexandria, Egypt. A cohort of 334 patients was followed-up for 8 months; 69.2% of cases were males. The pattern of tuberculosis symptoms was similar for both sexes. Women started treatment earlier than men. Women had significantly lower scores in knowledge, beliefs and attitudes about tuberculosis than men. Compliance was unsatisfactory for both sexes. Men tended to be more adherent to drugs and to sputum and X-ray examinations but there were no sex differences in compliance with health education and medical examinations. No significant sex differences in treatment outcome were found: the overall cure rate was 60.5% and treatment failure was 4.8%. Multiple regression analysis showed satisfaction with medical care was the only significant predictor of treatment failure.

New insights in the use of immunoglobulins for the management of immune deficiency (PID) patients

PubMed Central

Krivan, Gergely; Jolles, Stephen; Granados, Eduardo Lopes; Paolantonacci, Phillipe; Ouaja, Rabye; Cissé, Ousmane Alfa; Bernatowska, Ewa

2017-01-01

Immunoglobulin replacement therapy (IRT) is standard treatment for patients with primary immunodeficiency (PID). Because most of the patients with PID will require long life-time immunoglobulin replacement therapy, the quality of the prescribed products is of utmost importance. The IRT is generally administered either intravenously (abbreviated IVIG), or subcutaneously (abbreviated SCIG). Both routes have been demonstrated to be effective. The preferred route may vary at different times during a given patient’s life. Options are therefore not fixed and the choice of route for immunoglobulin therapy will depend on several factors, including patient characteristics, clinical indication, venous access, side effects, rural or remote location, treatment compliance and patient preference. Many years ago, immunoglobulin therapy was associated with side effects which may compromise patient’s compliance and quality of life of the patients. Most of the side effects were related to impurities. Recently, major advances in the manufacturing process have been made and new processes, such as the Quality by design (QbD) approach were added into the manufacturing steps to ensure patients tolerability and safety. Due to the improved purity of the immunoglobulin products obtained by these processes, the incidence of side effects is lower, while the ways of administration of Ig therapy and the choice of the regimen has widened to suit patient’s preference and needs. PMID:29181272

Semiparametric Thurstonian Models for Recurrent Choices: A Bayesian Analysis

ERIC Educational Resources Information Center

Ansari, Asim; Iyengar, Raghuram

2006-01-01

We develop semiparametric Bayesian Thurstonian models for analyzing repeated choice decisions involving multinomial, multivariate binary or multivariate ordinal data. Our modeling framework has multiple components that together yield considerable flexibility in modeling preference utilities, cross-sectional heterogeneity and parameter-driven…

A Decision Making Analysis of Persuasive Argumentation and the Choice Shift Effect

ERIC Educational Resources Information Center

Vinokur, Amiram; And Others

1975-01-01

A subjective expected utility (SEU) decision-making analysis was performed on the content of arguments generated by subjects privately or during group discussion in response to choice-dilemmas shown to shift toward risk and caution. (Editor)

Accommodations for Multiple Choice Tests

ERIC Educational Resources Information Center

Trammell, Jack

2011-01-01

Students with learning or learning-related disabilities frequently struggle with multiple choice assessments due to difficulty discriminating between items, filtering out distracters, and framing a mental best answer. This Practice Brief suggests accommodations and strategies that disability service providers can utilize in conjunction with…

Risky Choice with Heuristics: Reply to Birnbaum (2008), Johnson, Schulte-Mecklenbeck, and Willemsen (2008), and Rieger and Wang (2008)

ERIC Educational Resources Information Center

Brandstatter, Eduard; Gigerenzer, Gerd; Hertwig, Ralph

2008-01-01

E. Brandstatter, G. Gigerenzer, and R. Hertwig (2006) showed that the priority heuristic matches or outperforms modifications of expected utility theory in predicting choice in 4 diverse problem sets. M. H. Birnbaum (2008) argued that sets exist in which the opposite is true. The authors agree--but stress that all choice strategies have regions of…

Information Systems Education in Kenya: Students' Specialization Choice Trends (A Case Study of Kenya Polytechnic University College)

ERIC Educational Resources Information Center

Ndede-Amadi, Atieno A.

2013-01-01

The objective of this study was to determine the time and level of Information Systems (IS) awareness among Kenyan university students and the choice of IS as a field of specialization. The study posited that the choice of a field of specialization is dependent upon a student's awareness of its existence, its utilization in the real world, its…

Modification of Tamoxifen Effectiveness by Gene Polymorphisms and Other Drugs

DTIC Science & Technology

2010-05-01

study) Mr. Ahern’s three dissertation studies utilize the nationwide medical registries of Denmark to evaluate associations between prescription drugs...K Antagonists and Cancer Risk” component of the SOW. This study utilizes heart valve transplant as a proxy for treatment with a VKA, since actual...after a medication has been paid for and dispensed, we expect prescription compliance to be high. An earlier validation study of hor- mone replacement

Compliance with NICE guidance on the use of anti-TNFalpha agents in ankylosing spondylitis: an east and west Midlands regional audit.

PubMed

Rees, Frances; Peffers, Gillian; Bell, Carolyn; Obrenovic, Karen; Sandhu, Ravinder; Packham, Jonathan; Erb, Nicola

2012-08-01

Here we report on an audit performed to examine compliance with National Institute for Health and Clinical Excellence (NICE) guidelines for the use of anti-tumour necrosis factor alpha (anti-TNFalpha) in treating patients with ankylosing spondylitis (AS). Data from 17 rheumatology centres across the Midlands were collected prospectively from patients with AS attending outpatient clinics and retrospectively in patients receiving anti-TNFalpha but not attending outpatient clinics during the audit. In total, 80% of the 416 patients for whom data were collected were male. Of the 238 patients recruited prospectively, 41% were receiving anti-TNFalpha. Reviewing all patients on anti-TNFalpha (N=275), pre-treatment assessments 12 weeks apart were documented in 55% of patients. After anti-TNFalpha treatment had started, regular 12-weekly assessments occurred in 46% of patients. Therefore, compliance with NICE guidance was found to vary among centres. Based on our audit, clinical capacity, and clinical or patient choice might be influencing the suboptimal adherence seen in assessment timing suggested by NICE guidelines relating to the use of anti-TNFalpha in treating patients with AS.

Encoding of marginal utility across time in the human brain

PubMed Central

Pine, Alex; Seymour, Ben; Roiser, Jonathan P; Bossaerts, Peter; Friston, Karl J.; Curran, H. Valerie; Dolan, Raymond J.

2010-01-01

Marginal utility theory prescribes the relationship between the objective property of the magnitude of rewards and their subjective value. Despite its pervasive influence, however, there is remarkably little direct empirical evidence for such a theory of value, let alone of its neurobiological basis. We show that human preferences in an inter-temporal choice task are best described by a model that integrates marginally diminishing utility with temporal discounting. Using functional magnetic resonance imaging (fMRI), we show that activity in the dorsal striatum encodes both the marginal utility of rewards, over and above that which can be described by their magnitude alone, and the discounting associated with increasing time. In addition, our data show that dorsal striatum may be involved in integrating subjective valuation systems inherent to time and magnitude, thereby providing an overall metric of value used to guide choice behaviour. Furthermore, during choice we show that anterior cingulate activity correlates with the degree of difficulty associated with dissonance between value and time. Our data support an integrative architecture for decision-making, revealing the neural representation of distinct subcomponents of value that may contribute to impulsivity and decisiveness. PMID:19641120

[Use the Markov-decision tree model to optimize vaccination strategies of hepatitis E among women aged 15 to 49].

PubMed

Chen, Z M; Ji, S B; Shi, X L; Zhao, Y Y; Zhang, X F; Jin, H

2017-02-10

Objective: To evaluate the cost-utility of different hepatitis E vaccination strategies in women aged 15 to 49. Methods: The Markov-decision tree model was constructed to evaluate the cost-utility of three hepatitis E virus vaccination strategies. Parameters of the models were estimated on the basis of published studies and experience of experts. Both methods on sensitivity and threshold analysis were used to evaluate the uncertainties of the model. Results: Compared with non-vaccination group, strategy on post-screening vaccination with rate as 100%, could save 0.10 quality-adjusted life years per capital in the women from the societal perspectives. After implementation of screening program and with the vaccination rate reaching 100%, the incremental cost utility ratio (ICUR) of vaccination appeared as 5 651.89 and 6 385.33 Yuan/QALY, respectively. Vaccination post to the implementation of a screening program, the result showed better benefit than the vaccination rate of 100%. Results from the sensitivity analysis showed that both the cost of hepatitis E vaccine and the inoculation compliance rate presented significant effects. If the cost were lower than 191.56 Yuan (RMB) or the inoculation compliance rate lower than 0.23, the vaccination rate of 100% strategy was better than the post-screening vaccination strategy, otherwise the post-screening vaccination strategy appeared the optimal strategy. Conclusion: Post-screening vaccination for women aged 15 to 49 from social perspectives seemed the optimal one but it had to depend on the change of vaccine cost and the rate of inoculation compliance.

Participants' responsibilities in clinical research.

PubMed

Resnik, David B; Ness, Elizabeth

2012-12-01

Discussions on the ethics and regulation of clinical research have a great deal to say about the responsibilities of investigators, sponsors, research institutions and institutional review boards, but very little about the responsibilities of research participants. In this article, we discuss the responsibilities of participants in clinical research. We argue that competent adult participants are responsible for complying with study requirements and fulfilling other obligations they undertake when they make an informed choice to enroll in a study. These responsibilities are based on duties related to promise-keeping, avoiding harm to one's self or others, beneficence and reciprocity. Investigators and research staff should inform participants about their responsibilities during the consent process, and should stress the importance of fulfilling study requirements. They should address any impediments to compliance, and they may provide participants with financial incentives for meeting study requirements. In very rare cases, coercive measures may be justified to prevent immanent harm to others resulting from non-compliance with study requirements.

Subspecialty Utilization in the Navy: A Longitudinal Analysis of Unrestricted Line Officers Who Graduated from the Naval Postgraduate School

DTIC Science & Technology

1993-03-01

in the study. 2 The highest ratio was 21.3:1 for Pilots (1310). Among the hypothesized reasons for low utilization rates are that the officers...34DoD Compliance" by gender reveal that women officers are utilized in an appropriate subspecialty at a rate that is close to 100 percent. This is true...NFOs (1320) with 94.4 percent. Analysis by gender revealed that women accounted for one of every seven officers in the 1985 cohort. Female officers were

40 CFR 401.11 - General definitions.

Code of Federal Regulations, 2012 CFR

2012-07-01

..., radioactive materials, heat, wrecked or discarded equipment, rock, sand, cellar dirt and industrial, municipal... interstate commerce; and intrastate lakes, rivers, and streams which are utilized for industrial purposes by..., person, territorial seas, contiguous zone, biological monitoring, schedule of compliance, and industrial...

40 CFR 401.11 - General definitions.

Code of Federal Regulations, 2013 CFR

2013-07-01

..., radioactive materials, heat, wrecked or discarded equipment, rock, sand, cellar dirt and industrial, municipal... interstate commerce; and intrastate lakes, rivers, and streams which are utilized for industrial purposes by..., person, territorial seas, contiguous zone, biological monitoring, schedule of compliance, and industrial...

40 CFR 401.11 - General definitions.

Code of Federal Regulations, 2014 CFR

2014-07-01

..., radioactive materials, heat, wrecked or discarded equipment, rock, sand, cellar dirt and industrial, municipal... interstate commerce; and intrastate lakes, rivers, and streams which are utilized for industrial purposes by..., person, territorial seas, contiguous zone, biological monitoring, schedule of compliance, and industrial...

Sex differences in the Kimchi-Palmer task revisited: Global reaction times, but not number of global choices differ between adult men and women.

PubMed

Scheuringer, Andrea; Pletzer, Belinda

2016-10-15

Research, directly assessing sex-dependent differences in global versus local processing is sparse, but predominantly suggesting that men show a stronger global processing bias than women. Utilizing the Kimchi-Palmer task however, sex differences in the number of global choices can only be found in children, but not in adults. In the current study 52 men and 46 women completed a computerized version of the Kimchi Palmer task, in order to investigate whether sex-differences in global-local processing in the Kimchi-Palmer task are reflected in choice reaction times rather than choices per se. While no sex differences were found in the number of global choices, we found that especially women are faster in making local choices than men, while men are faster in making global choices than women. We did not find support for the assumption that this sex difference was modulated by menstrual cycle phase of women, since the difference between reaction times to global and local choices was consistent across the menstrual cycle of women. Accordingly there was no relationship between progesterone and global-local processing in the Kimchi-Palmer task. However, like in studies utilizing the Navon task, testosterone was positively related to the number of global choices in both men and women. To our knowledge, this is the first study including reaction times as outcome measure in a Kimchi Palmer paradigm and also the first study demonstrating sex differences in the Kimchi Palmer task in adults. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Food labels promote healthy choices by a decision bias in the amygdala.

PubMed

Grabenhorst, Fabian; Schulte, Frank P; Maderwald, Stefan; Brand, Matthias

2013-07-01

Food labeling is the major health policy strategy to counter rising obesity rates. Based on traditional economic theory, such strategies assume that detailed nutritional information will necessarily help individuals make better, healthier choices. However, in contrast to the well-known utility of labels in food marketing, evidence for the efficacy of nutritional labeling is mixed. Psychological and behavioral economic theories suggest that successful marketing strategies activate automatic decision biases and emotions, which involve implicit emotional brain systems. Accordingly, simple, intuitive food labels that engage these neural systems could represent a promising approach for promoting healthier choices. Here we used functional MRI to investigate this possibility. Healthy, mildly hungry subjects performed a food evaluation task and a food choice task. The main experimental manipulation was to pair identical foods with simple labels that emphasized either taste benefits or health-related food properties. We found that such labels biased food evaluations in the amygdala, a core emotional brain system. When labels biased the amygdala's evaluations towards health-related food properties, the strength of this bias predicted behavioral shifts towards healthier choices. At the time of decision-making, amygdala activity encoded key decision variables, potentially reflecting active amygdala participation in food choice. Our findings underscore the potential utility of food labeling in health policy and indicate a principal role for emotional brain systems when labels guide food choices. Copyright © 2013 Elsevier Inc. All rights reserved.

Consumer Behavior in the Choice of Mode of Transport: A Case Study in the Toledo-Madrid Corridor

PubMed Central

Muro-Rodríguez, Ana I.; Perez-Jiménez, Israel R.; Gutiérrez-Broncano, Santiago

2017-01-01

Within the context of the consumption of goods or services the decisions made by individuals involve the choice between a set of discrete alternatives, such as the choice of mode of transport. The methodology for analyzing the consumer behavior are the models of discrete choice based on the Theory of Random Utility. These models are based on the definition of preferences through a utility function that is maximized. These models also denominated of disaggregated demand derived from the decision of a set of individuals, who are formalized by the application of probabilistic models. The objective of this study is to determine the behavior of the consumer in the choice of a service, namely of transport services and in a short-distance corridor, such as Toledo-Madrid. The Toledo-Madrid corridor is characterized by being short distance, with high speed train available within the choice options to get the airport, along with the bus and the car. And where offers of HST and aircraft services can be proposed as complementary modes. By applying disaggregated transport models with revealed preference survey data and declared preferences, one can determine the most important variables involved in the choice and determine the arrangements for payment of individuals. These payment provisions may condition the use of certain transport policies to promote the use of efficient transportation. PMID:28676776

Consumer Behavior in the Choice of Mode of Transport: A Case Study in the Toledo-Madrid Corridor.

PubMed

Muro-Rodríguez, Ana I; Perez-Jiménez, Israel R; Gutiérrez-Broncano, Santiago

2017-01-01

Within the context of the consumption of goods or services the decisions made by individuals involve the choice between a set of discrete alternatives, such as the choice of mode of transport. The methodology for analyzing the consumer behavior are the models of discrete choice based on the Theory of Random Utility. These models are based on the definition of preferences through a utility function that is maximized. These models also denominated of disaggregated demand derived from the decision of a set of individuals, who are formalized by the application of probabilistic models. The objective of this study is to determine the behavior of the consumer in the choice of a service, namely of transport services and in a short-distance corridor, such as Toledo-Madrid. The Toledo-Madrid corridor is characterized by being short distance, with high speed train available within the choice options to get the airport, along with the bus and the car. And where offers of HST and aircraft services can be proposed as complementary modes. By applying disaggregated transport models with revealed preference survey data and declared preferences, one can determine the most important variables involved in the choice and determine the arrangements for payment of individuals. These payment provisions may condition the use of certain transport policies to promote the use of efficient transportation.

Pulse wave velocity in the microcirculation reflects both vascular compliance and resistance: Insights from computational approaches.

PubMed

Pan, Qing; Wang, Ruofan; Reglin, Bettina; Fang, Luping; Yan, Jing; Cai, Guolong; Kuebler, Wolfgang M; Pries, Axel R; Ning, Gangmin

2018-05-05

PWV is the speed of pulse wave propagation through the circulatory system. mPWV emerges as a novel indicator of hypertension, yet it remains unclear how different vascular properties affect mPWV. We aim to identify the biomechanical determinants of mPWV. A 1D model was used to simulate PWV in a rat mesenteric microvascular network and, for comparison, in a human macrovascular arterial network. Sensitivity analysis was performed to assess the relationship between PWV and vascular compliance and resistance. The 1D model enabled adequate simulation of PWV in both micro- and macrovascular networks. Simulated arterial PWV changed as a function of vascular compliance but not resistance, in that arterial PWV varied at a rate of 0.30 m/s and -6.18 × 10 -3  m/s per 10% increase in vascular compliance and resistance, respectively. In contrast, mPWV depended on both vascular compliance and resistance, as it varied at a rate of 2.79 and -2.64 cm/s per 10% increase in the respective parameters. The present study identifies vascular compliance and resistance in microvascular networks as critical determinants of mPWV. We anticipate that mPWV can be utilized as an effective indicator for the assessment of microvascular biomechanical properties. © 2018 John Wiley & Sons Ltd.

Role of illness perceptions and medication beliefs on medication compliance of elderly hypertensive cohorts.

PubMed

Rajpura, Jigar R; Nayak, Rajesh

2014-02-01

Poor compliance with antihypertensive medications is one possible reason why its success in clinical trials has not been translated into everyday practice. In addition, medication noncompliance in elderly leads to increased hospitalizations, physician visits, and higher health care costs. The study assessed influence of illness perceptions and medications beliefs on medication compliance of elderly hypertensive cohorts. A cross-sectional survey research design, utilizing self-administered health surveys, was adapted to address key study objectives. Conceptualized associations among the study variables were explored to assess their individual as well as their collective impact on the medication compliance. A total of 78 (66%) study samples were found to be noncompliant with their medications. Analysis revealed that perceptions about illness and beliefs about medication jointly played a significant role in the prediction of medication compliance (F = 5.966, P < .05; R (2) = .212). Significant bivariate correlations were observed between Morisky's test score versus Brief Illness Perception Questionnaire measure (r = .332, P = .001), Beliefs of Medication Questionnaire (BMQ) differential score (r = .301, P = .001), and BMQ components, such as specific necessity (r = .250, P = .008), specific concern (r = -.231, P = .001), and general overuse (r = -.342, P = .001). The findings provide practical basis for designing interventions and programs aimed at compliance building in elderly populations having hypertension by incorporating the value and importance of patient perceptions of illness and medications in order to achieve desired patient outcomes.

Central Appalachia: Production potential of low-sulfur coal

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

Watkins, J.

The vast preponderance of eastern US low sulfur and 1.2-lbs SO{sub 2}/MMBtu compliance coal comes from a relatively small area composed of 14 counties located in eastern Kentucky, southern West Virginia and western Virginia. These 14 counties accounted for 68% of all Central Appalachian coal production in 1989 as well as 85% of all compliance coal shipped to electric utilities from this region. A property-by-property analysis of total production potential in 10 of the 14 counties (Floyd, Knott, Letcher, Harlan, Martin and Pike in Kentucky and Boone, Kanawha, Logan and Mingo in West Virginia) resulted in the following estimates ofmore » active and yet to be developed properties: (1) total salable reserves for all sulfur levels were 5.9 billion tons and (2) 1.2-lbs. SO{sub 2}/MMBtu compliance'' reserves totaled 2.38 billion tons. This potential supply of compliance coal is adequate to meet the expanded utility demand expected under acid rain for the next 20 years. Beyond 2010, compliance supplies will begin to reach depletion levels in some areas of the study region. A review of the cost structure for all active mines was used to categorize the cost structure for developing potential supplies. FOB cash costs for all active mines in the ten counties ranged from $15 per ton to $35 per ton and the median mine cost was about $22 per ton. A total of 47 companies with the ability to produce and ship coal from owned or leased reserves are active in the ten-county region. Identified development and expansion projects controlled by active companies are capable of expanding the region's current production level by over 30 million tons per year over the next twenty years. Beyond this period the issue of reserve depletion for coal of all sulfur levels in the ten county region will become a pressing issue. 11 figs., 12 tabs.« less

Spectacle Compliance among Adolescents: A Qualitative Study from Southern India.

PubMed

Narayanan, Anuradha; Kumar, Shuba; Ramani, Krishna Kumar

2017-05-01

To understand the perceptions of adolescents and their parents about spectacle compliance of adolescents in Southern India. Using a qualitative snapshot design, three focus group discussions were conducted each with parents and adolescents studying in schools located in and around Chennai, Tamil Nadu. Purposive sampling technique was used in the selection of participants. Separate focus group guides were developed for parents and adolescents. All focus group discussions were conducted in the school premises and audio recorded. These audio files were then transcribed verbatim and then translated into English. A framework analytical approach was used for data analysis that involved gaining familiarity with the data to identify a thematic framework. Two major themes that emerged were (1) perceptions on barriers to spectacle compliance that was further subdivided into physical, psychological, and societal barriers; and (2) solutions to improve spectacle use. Barriers identified included scars on the nose, unattractive frames contributing to poor appeal, adolescents feeling discriminated and set apart, fears of injury to eyes, lack of parental involvement, and negative attitudes of society toward those wearing spectacles. Solutions given by the stakeholders included provision of lightweight, well-fitting, trendy frames of adolescents' choice, importance and need for periodical eye examinations, including teachers in encouraging spectacle use and preventing bullying and teasing by other adolescents, provision of free spectacles along with periodic replacement, and inclusion of awareness sessions on spectacle use for both parents and adolescents. The study has identified both barriers and solutions for improving spectacle compliance among school adolescents from the viewpoint of the stakeholders involved. Implementing the solutions suggested by the stakeholders through planned intervention programs could possibly help in ensuring better compliance of spectacle use among school adolescents.

Differential response of peripheral arterial compliance-related indices to a vasoconstrictive stimulus.

PubMed

Guerrisi, Maria; Vannucci, Italo; Toschi, Nicola

2009-01-01

Peripheral arterial elastic properties are greatly affected by cardiovascular as well as other pathologies, and their assessment can provide useful diagnostic indicators. The photoplethysmographic technique can provide finger blood volume and pressure waveforms non-invasively, which can then be processed statically or beat-to-beat to characterize parameters of the vessel wall mechanics. We employ an occlusion-deflation protocol in 48 healthy volunteers to study peripheral artery compliance-related indices over positive and negative transmural pressure values as well as under the influence of a valid vasoconstrictor (cigarette smoking). We calculate beat-to-beat indices (compliance index CI, distensibility index DI, three viscoelastic model parameters (compliance C, viscosity R and inertia L), pressure-volume loop areas A and damping factor DF as well as symmetrical (C(max)) and asymmetrical (C(A)(max)) static compliance estimates, and their distributions over transmural pressure. All distributions are bell-shaped and centred on negative transmural pressure values. Distribution heights were significantly lower in the smoking group (w.r.t. the non-smoking group) for C, CI, DI and significantly higher in R and DF. The estimated volume signal time lag was also significantly lower in the smoking group. Left and right distribution widths were significantly different in all parameters/groups but DI (both groups), C(A)(max), A (smoking group) and L (non-smoking group), and positions of maxima/minima were significantly altered in C(A)(max), R and DF. C, DF and CI are seen to be most sensitive under this protocol, while C(max) and C(A)(max) are seen to be insensitive. These quantities provide complementary, time- and transmural pressure-dependent information about arterial wall mechanics, and the choice of index should depend on the physiological conditions at hand as well as relevant time resolution and transmural pressure range.

Generation of structural topologies using efficient technique based on sorted compliances

NASA Astrophysics Data System (ADS)

Mazur, Monika; Tajs-Zielińska, Katarzyna; Bochenek, Bogdan

2018-01-01

Topology optimization, although well recognized is still widely developed. It has gained recently more attention since large computational ability become available for designers. This process is stimulated simultaneously by variety of emerging, innovative optimization methods. It is observed that traditional gradient-based mathematical programming algorithms, in many cases, are replaced by novel and e cient heuristic methods inspired by biological, chemical or physical phenomena. These methods become useful tools for structural optimization because of their versatility and easy numerical implementation. In this paper engineering implementation of a novel heuristic algorithm for minimum compliance topology optimization is discussed. The performance of the topology generator is based on implementation of a special function utilizing information of compliance distribution within the design space. With a view to cope with engineering problems the algorithm has been combined with structural analysis system Ansys.

Revisiting the Effect of Anthropomorphizing a Social Cause Campaign.

PubMed

Williams, Lisa A; Masser, Barbara; Sun, Jessie

2015-01-01

Recent research suggests that anthropomorphism can be harnessed as a tool to boost intentions to comply with social cause campaigns. Drawing on the human tendency to extend moral concern to entities portrayed as humanlike, it has been argued that adding personified features to a social campaign elevates anticipated guilt at failing to comply, and this subsequently boosts intentions to comply with that campaign. The present research aimed to extend extant research by disentangling the effects of emotional and non-emotional anthropomorphism, and differentiating amongst other emotional mechanisms of the anthropomorphism-compliance effect (namely, anticipated pride and anticipated regret). Experiment 1 (N = 294) compared the effectiveness of positive, negative, and emotionally-neutral anthropomorphized campaign posters for boosting campaign compliance intentions against non-anthropomorphized posters. We also measured potential mechanisms including anticipated guilt, regret, and pride. Results failed to support the anthropomorphism-compliance effect, and no changes in anticipated emotion according to anthropomorphism emerged. Experiments 2 (N = 150) and 3 (N = 196) represented further tests of the anthropomorphism-compliance effect. Despite high statistical power and efforts to closely replicate the conditions under which the anthropomorphism-compliance effect had been previously observed, no differences in compliance intention or anticipated emotion according to anthropomorphism emerged. A meta-analysis of the effects of anthropomorphism on compliance and anticipated emotion across the three experiments revealed effect size estimates that did not differ significantly from zero. The results of these three experiments suggest that the anthropomorphism-compliance effect is fragile and perhaps subject to contextual and idiographic influences. Thus, this research provides important insight and impetus for future research on the applied and theoretical utility of anthropomorphizing social cause campaigns.

Revisiting the Effect of Anthropomorphizing a Social Cause Campaign

PubMed Central

Williams, Lisa A.; Masser, Barbara; Sun, Jessie

2015-01-01

Recent research suggests that anthropomorphism can be harnessed as a tool to boost intentions to comply with social cause campaigns. Drawing on the human tendency to extend moral concern to entities portrayed as humanlike, it has been argued that adding personified features to a social campaign elevates anticipated guilt at failing to comply, and this subsequently boosts intentions to comply with that campaign. The present research aimed to extend extant research by disentangling the effects of emotional and non-emotional anthropomorphism, and differentiating amongst other emotional mechanisms of the anthropomorphism-compliance effect (namely, anticipated pride and anticipated regret). Experiment 1 (N = 294) compared the effectiveness of positive, negative, and emotionally-neutral anthropomorphized campaign posters for boosting campaign compliance intentions against non-anthropomorphized posters. We also measured potential mechanisms including anticipated guilt, regret, and pride. Results failed to support the anthropomorphism-compliance effect, and no changes in anticipated emotion according to anthropomorphism emerged. Experiments 2 (N = 150) and 3 (N = 196) represented further tests of the anthropomorphism-compliance effect. Despite high statistical power and efforts to closely replicate the conditions under which the anthropomorphism-compliance effect had been previously observed, no differences in compliance intention or anticipated emotion according to anthropomorphism emerged. A meta-analysis of the effects of anthropomorphism on compliance and anticipated emotion across the three experiments revealed effect size estimates that did not differ significantly from zero. The results of these three experiments suggest that the anthropomorphism-compliance effect is fragile and perhaps subject to contextual and idiographic influences. Thus, this research provides important insight and impetus for future research on the applied and theoretical utility of anthropomorphizing social cause campaigns. PMID:26406494

Mean-deviation analysis in the theory of choice.

PubMed

Grechuk, Bogdan; Molyboha, Anton; Zabarankin, Michael

2012-08-01

Mean-deviation analysis, along with the existing theories of coherent risk measures and dual utility, is examined in the context of the theory of choice under uncertainty, which studies rational preference relations for random outcomes based on different sets of axioms such as transitivity, monotonicity, continuity, etc. An axiomatic foundation of the theory of coherent risk measures is obtained as a relaxation of the axioms of the dual utility theory, and a further relaxation of the axioms are shown to lead to the mean-deviation analysis. Paradoxes arising from the sets of axioms corresponding to these theories and their possible resolutions are discussed, and application of the mean-deviation analysis to optimal risk sharing and portfolio selection in the context of rational choice is considered. © 2012 Society for Risk Analysis.

Using partial site aggregation to reduce bias in random utility travel cost models

NASA Astrophysics Data System (ADS)

Lupi, Frank; Feather, Peter M.

1998-12-01

We propose a "partial aggregation" strategy for defining the recreation sites that enter choice sets in random utility models. Under the proposal, the most popular sites and sites that will be the subject of policy analysis enter choice sets as individual sites while remaining sites are aggregated into groups of similar sites. The scheme balances the desire to include all potential substitute sites in the choice sets with practical data and modeling constraints. Unlike fully aggregate models, our analysis and empirical applications suggest that the partial aggregation approach reasonably approximates the results of a disaggregate model. The partial aggregation approach offers all of the data and computational advantages of models with aggregate sites but does not suffer from the same degree of bias as fully aggregate models.

Housing First, Consumer Choice, and Harm Reduction for Homeless Individuals With a Dual Diagnosis

PubMed Central

Tsemberis, Sam; Gulcur, Leyla; Nakae, Maria

2004-01-01

Objectives. We examined the longitudinal effects of a Housing First program for homeless, mentally ill individuals’ on those individuals’ consumer choice, housing stability, substance use, treatment utilization, and psychiatric symptoms. Methods. Two hundred twenty-five participants were randomly assigned to receive housing contingent on treatment and sobriety (control) or to receive immediate housing without treatment prerequisites (experimental). Interviews were conducted every 6 months for 24 months. Results. The experimental group obtained housing earlier, remained stably housed, and reported higher perceived choice. Utilization of substance abuse treatment was significantly higher for the control group, but no differences were found in substance use or psychiatric symptoms. Conclusions. Participants in the Housing First program were able to obtain and maintain independent housing without compromising psychiatric or substance abuse symptoms. PMID:15054020

Marine Fuel Choice For Ocean Going Vessels Within Emission Control Areas

EIA Publications

2015-01-01

The U.S. Energy Information Administration (EIA) contracted with Leidos Corporation to analyze the impact on ocean-going vessel fuel usage of the International Convention for the Prevention of Pollution from Ships (MARPOL) emissions control areas in North America and the Caribbean. EIA plans to update the upcoming Annual Energy Outlook 2016 to include a new methodology for calculating the amount of fuel consumption by ocean-going vessels traveling though North American and Caribbean emissions control areas, including the impact of compliance strategies.

Interdependent Utilities: How Social Ranking Affects Choice Behavior

PubMed Central

Bault, Nadège; Coricelli, Giorgio; Rustichini, Aldo

2008-01-01

Organization in hierarchical dominance structures is prevalent in animal societies, so a strong preference for higher positions in social ranking is likely to be an important motivation of human social and economic behavior. This preference is also likely to influence the way in which we evaluate our outcome and the outcome of others, and finally the way we choose. In our experiment participants choose among lotteries with different levels of risk, and can observe the choice that others have made. Results show that the relative weight of gains and losses is the opposite in the private and social domain. For private outcomes, experience and anticipation of losses loom larger than gains, whereas in the social domain, gains loom larger than losses, as indexed by subjective emotional evaluations and physiological responses. We propose a theoretical model (interdependent utilities), predicting the implication of this effect for choice behavior. The relatively larger weight assigned to social gains strongly affects choices, inducing complementary behavior: faced with a weaker competitor, participants adopt a more risky and dominant behavior. PMID:18941538

The fuel tax compliance unit : an evaluation and analysis of results.

DOT National Transportation Integrated Search

2004-01-01

Kentucky utilized TEA-21 federal funds to create an innovative pilot program to identify the best practices and methods for auditing taxpayers of transportation related taxes. This program involved a four-year experimental program called the Fuel Tax...

40 CFR 64.2 - Applicability.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 16 2014-07-01 2014-07-01 false Applicability. 64.2 Section 64.2 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) COMPLIANCE ASSURANCE MONITORING § 64.2 Applicability. (a) General applicability. Except for backup utility units that...

40 CFR 64.2 - Applicability.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 16 2012-07-01 2012-07-01 false Applicability. 64.2 Section 64.2 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) COMPLIANCE ASSURANCE MONITORING § 64.2 Applicability. (a) General applicability. Except for backup utility units that...

40 CFR 64.2 - Applicability.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 15 2010-07-01 2010-07-01 false Applicability. 64.2 Section 64.2 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) COMPLIANCE ASSURANCE MONITORING § 64.2 Applicability. (a) General applicability. Except for backup utility units that...

Simulation-based medical education training improves short and long-term competency in, and knowledge of central venous catheter insertion: A before and after intervention study.

PubMed

Cartier, Vanessa; Inan, Cigdem; Zingg, Walter; Delhumeau, Cecile; Walder, Bernard; Savoldelli, Georges L

2016-08-01

Multimodal educational interventions have been shown to improve short-term competency in, and knowledge of central venous catheter (CVC) insertion. To evaluate the effectiveness of simulation-based medical education training in improving short and long-term competency in, and knowledge of CVC insertion. Before and after intervention study. University Geneva Hospital, Geneva, Switzerland, between May 2008 and January 2012. Residents in anaesthesiology aware of the Seldinger technique for vascular puncture. Participants attended a half-day course on CVC insertion. Learning objectives included work organization, aseptic technique and prevention of CVC complications. CVC insertion competency was tested pretraining, posttraining and then more than 2 years after training (sustainability phase). The primary study outcome was competency as measured by a global rating scale of technical skills, a hand hygiene compliance score and a checklist compliance score. Secondary outcome was knowledge as measured by a standardised pretraining and posttraining multiple-choice questionnaire. Statistical analyses were performed using paired Student's t test or Wilcoxon signed-rank test. Thirty-seven residents were included; 18 were tested in the sustainability phase (on average 34 months after training). The average global rating of skills was 23.4 points (±SD 4.08) before training, 32.2 (±4.51) after training (P < 0.001 for comparison with pretraining scores) and 26.5 (±5.34) in the sustainability phase (P = 0.040 for comparison with pretraining scores). The average hand hygiene compliance score was 2.8 (±1.0) points before training, 5.0 (±1.04) after training (P < 0.001 for comparison with pretraining scores) and 3.7 (±1.75) in the sustainability phase (P = 0.038 for comparison with pretraining scores). The average checklist compliance was 14.9 points (±2.3) before training, 19.9 (±1.06) after training (P < 0.001 for comparison with pretraining scores) and 17.4 (±1.41) (P = 0.002 for comparison with pretraining scores). The percentage of correct answers in the multiple-choice questionnaire increased from 76.0% (±7.9) before training to 87.7% (±4.4) after training (P < 0.001). Simulation-based medical education training was effective in improving short and long-term competency in, and knowledge of CVC insertion.

How General are Risk Preferences? Choices under Uncertainty in Different Domains*

PubMed Central

Einav, Liran; Finkelstein, Amy; Pascu, Iuliana; Cullen, Mark R.

2011-01-01

We analyze the extent to which individuals’ choices over five employer-provided insurance coverage decisions and one 401(k) investment decision exhibit systematic patterns, as would be implied by a general utility component of risk preferences. We provide evidence consistent with an important domain-general component that operates across all insurance choices. We find a considerably weaker relationship between one's insurance decisions and 401(k) asset allocation, although this relationship appears larger for more “financially sophisticated” individuals. Estimates from a stylized coverage choice model suggest that up to thirty percent of our sample makes choices that may be consistent across all six domains. PMID:24634517

Utilizing Lean Six Sigma Methodology to Improve the Authored Works Command Approval Process at Naval Medical Center San Diego.

PubMed

Valdez, Michelle M; Liwanag, Maureen; Mount, Charles; Rodriguez, Rechell; Avalos-Reyes, Elisea; Smith, Andrew; Collette, David; Starsiak, Michael; Green, Richard

2018-03-14

Inefficiencies in the command approval process for publications and/or presentations negatively impact DoD Graduate Medical Education (GME) residency programs' ability to meet ACGME scholarly activity requirements. A preliminary review of the authored works approval process at Naval Medical Center San Diego (NMCSD) disclosed significant inefficiency, variation in process, and a low level of customer satisfaction. In order to facilitate and encourage scholarly activity at NMCSD, and meet ACGME requirements, the Executive Steering Council (ESC) chartered an interprofessional team to lead a Lean Six Sigma (LSS) Rapid Improvement Event (RIE) project. Two major outcome metrics were identified: (1) the number of authored works submissions containing all required signatures and (2) customer satisfaction with the authored works process. Primary metric baseline data were gathered utilizing a Clinical Investigations database tracking publications and presentations. Secondary metric baseline data were collected via a customer satisfaction survey to GME faculty and residents. The project team analyzed pre-survey data and utilized LSS tools and methodology including a "gemba" (environment) walk, cause and effect diagram, critical to quality tree, voice of the customer, "muda" (waste) chart, and a pre- and post-event value stream map. The team selected an electronic submission system as the intervention most likely to positively impact the RIE project outcome measures. The number of authored works compliant with all required signatures improved from 52% to 100%. Customer satisfaction rated as "completely or mostly satisfied" improved from 24% to 97%. For both outcomes, signature compliance and customer satisfaction, statistical significance was achieved with a p < 0.0001. This RIE project utilized LSS methodology and tools to improve signature compliance and increase customer satisfaction with the authored works approval process, leading to 100% signature compliance, a comprehensive longitudinal repository of all authored work requests, and a 97% "completely or mostly satisfied" customer rating of the process.

Side Effects in Time Discounting Procedures: Fixed Alternatives Become the Reference Point

PubMed Central

2016-01-01

Typical research on intertemporal choice utilizes a two-alternative forced choice (2AFC) paradigm requiring participants to choose between a smaller sooner and larger later payoff. In the adjusting-amount procedure (AAP) one of the alternatives is fixed and the other is adjusted according to particular choices made by the participant. Such a method makes the alternatives unequal in status and is speculated to make the fixed alternative a reference point for choices, thereby affecting the decision made. The current study shows that fixing different alternatives in the AAP influences discount rates in intertemporal choices. Specifically, individuals’ (N = 283) choices were affected to just the same extent by merely fixing an alternative as when choices were preceded by scenarios explicitly imposing reference points. PMID:27768759

General displaced SU(1, 1) number states: Revisited

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

Dehghani, A., E-mail: alireza.dehghani@gmail.com, E-mail: a-dehghani@tabrizu.ac.ir

2014-04-15

The most general displaced number states, based on the bosonic and an irreducible representation of the Lie algebra symmetry of su(1, 1) and associated with the Calogero-Sutherland model are introduced. Here, we utilize the Barut-Girardello displacement operator instead of the Klauder-Perelomov counterpart, to construct new kind of the displaced number states which can be classified in nonlinear coherent states regime, too, with special nonlinearity functions. They depend on two parameters, and can be converted into the well-known Barut-Girardello coherent and number states, respectively, depending on which of the parameters equal to zero. A discussion of the statistical properties of thesemore » states is included. Significant are their squeezing properties and anti-bunching effects which can be raised by increasing the energy quantum number. Depending on the particular choice of the parameters of the above scenario, we are able to determine the status of compliance with flexible statistics. Major parts of the issue is spent on something that these states, in fact, should be considered as new kind of photon-added coherent states, too. Which can be reproduced through an iterated action of a creation operator on new nonlinear Barut-Girardello coherent states. Where the latter carry, also, outstanding statistical features.« less

Evaluation of Game Engines for Cross-Platform Development of Mobile Serious Games for Health.

PubMed

Kleinschmidt, Carina; Haag, Martin

2016-01-01

Studies have shown that serious games for health can improve patient compliance and help to increase the quality of medical education. Due to a growing availability of mobile devices, especially the development of cross-platform mobile apps is helpful for improving healthcare. As the development can be highly time-consuming and expensive, an alternative development process is needed. Game engines are expected to simplify this process. Therefore, this article examines the question whether using game engines for cross-platform serious games for health can simplify the development compared to the development of a plain HTML5 app. At first, a systematic review of the literature was conducted in different databases (MEDLINE, ACM and IEEE). Afterwards three different game engines were chosen, evaluated in different categories and compared to the development of a HTML5 app. This was realized by implementing a prototypical application in the different engines and conducting a utility analysis. The evaluation shows that the Marmalade engine is the best choice for development in this scenario. Furthermore, it is obvious that the game engines have great benefits against plain HTML5 development as they provide components for graphics, physics, sounds, etc. The authors recommend to use the Marmalade Engine for a cross-platform mobile Serious Game for Health.

Prospect relativity: how choice options influence decision under risk.

PubMed

Stewart, Neil; Chater, Nick; Stott, Henry P; Reimers, Stian

2003-03-01

In many theories of decision under risk (e.g., expected utility theory, rank-dependent utility theory, and prospect theory), the utility of a prospect is independent of other options in the choice set. The experiments presented here show a large effect of the available options, suggesting instead that prospects are valued relative to one another. The judged certainty equivalent for a prospect is strongly influenced by the options available. Similarly, the selection of a preferred prospect is strongly influenced by the prospects available. Alternative theories of decision under risk (e.g., the stochastic difference model, multialternative decision field theory, and range frequency theory), where prospects are valued relative to one another, can provide an account of these context effects.

Security practices and regulatory compliance in the healthcare industry.

PubMed

Kwon, Juhee; Johnson, M Eric

2013-01-01

Securing protected health information is a critical responsibility of every healthcare organization. We explore information security practices and identify practice patterns that are associated with improved regulatory compliance. We employed Ward's cluster analysis using minimum variance based on the adoption of security practices. Variance between organizations was measured using dichotomous data indicating the presence or absence of each security practice. Using t tests, we identified the relationships between the clusters of security practices and their regulatory compliance. We utilized the results from the Kroll/Healthcare Information and Management Systems Society telephone-based survey of 250 US healthcare organizations including adoption status of security practices, breach incidents, and perceived compliance levels on Health Information Technology for Economic and Clinical Health, Health Insurance Portability and Accountability Act, Red Flags rules, Centers for Medicare and Medicaid Services, and state laws governing patient information security. Our analysis identified three clusters (which we call leaders, followers, and laggers) based on the variance of security practice patterns. The clusters have significant differences among non-technical practices rather than technical practices, and the highest level of compliance was associated with hospitals that employed a balanced approach between technical and non-technical practices (or between one-off and cultural practices). Hospitals in the highest level of compliance were significantly managing third parties' breaches and training. Audit practices were important to those who scored in the middle of the pack on compliance. Our results provide security practice benchmarks for healthcare administrators and can help policy makers in developing strategic and practical guidelines for practice adoption.

Security practices and regulatory compliance in the healthcare industry

PubMed Central

Kwon, Juhee; Johnson, M Eric

2013-01-01

Objective Securing protected health information is a critical responsibility of every healthcare organization. We explore information security practices and identify practice patterns that are associated with improved regulatory compliance. Design We employed Ward's cluster analysis using minimum variance based on the adoption of security practices. Variance between organizations was measured using dichotomous data indicating the presence or absence of each security practice. Using t tests, we identified the relationships between the clusters of security practices and their regulatory compliance. Measurement We utilized the results from the Kroll/Healthcare Information and Management Systems Society telephone-based survey of 250 US healthcare organizations including adoption status of security practices, breach incidents, and perceived compliance levels on Health Information Technology for Economic and Clinical Health, Health Insurance Portability and Accountability Act, Red Flags rules, Centers for Medicare and Medicaid Services, and state laws governing patient information security. Results Our analysis identified three clusters (which we call leaders, followers, and laggers) based on the variance of security practice patterns. The clusters have significant differences among non-technical practices rather than technical practices, and the highest level of compliance was associated with hospitals that employed a balanced approach between technical and non-technical practices (or between one-off and cultural practices). Conclusions Hospitals in the highest level of compliance were significantly managing third parties’ breaches and training. Audit practices were important to those who scored in the middle of the pack on compliance. Our results provide security practice benchmarks for healthcare administrators and can help policy makers in developing strategic and practical guidelines for practice adoption. PMID:22955497

Race, Inequality of Opportunity, and School Choice

ERIC Educational Resources Information Center

Darby, Derrick; Saatcioglu, Argun

2015-01-01

Both neoliberals and liberals call for mitigating inequality of educational opportunity stemming from circumstances beyond an individual's control. In this article, we challenge the wisdom of making equality of opportunity hinge on emphasizing the distinction rather than the relationship between choices and circumstances. We utilize an empirical…

Strength and Performance Enhancement of Bonded Joints by Spatial Tailoring of Adhesive Compliance via 3D Printing.

PubMed

Kumar, S; Wardle, Brian L; Arif, Muhamad F

2017-01-11

Adhesive bonding continues to emerge as a preferred route for joining materials with broad applications including advanced structures, microelectronics, biomedical systems, and consumer goods. Here, we study the mechanics of deformation and failure of tensile-loaded single-lap joints with a compliance-tailored adhesive. Tailoring of the adhesive compliance redistributes stresses and strains to reduce both shear and peel concentrations at the ends of the adhesive that determine failure of the joint. Utilizing 3D printing, the modulus of the adhesive is spatially varied along the bondlength. Experimental strength testing, including optical strain mapping, reveals that the strain redistribution results in a greater than 100% increase in strength and toughness concomitant with a 50% increase in strain-to-break while maintaining joint stiffness. The tailoring demonstrated here is immediately realizable in a broad array of 3D printing applications, and the level of performance enhancement suggests that compliance tailoring of the adhesive is a generalizable route for achieving superior performance of joints in other applications, such as advanced structural composites.

A constrained multinomial Probit route choice model in the metro network: Formulation, estimation and application

PubMed Central

Zhang, Yongsheng; Wei, Heng; Zheng, Kangning

2017-01-01

Considering that metro network expansion brings us with more alternative routes, it is attractive to integrate the impacts of routes set and the interdependency among alternative routes on route choice probability into route choice modeling. Therefore, the formulation, estimation and application of a constrained multinomial probit (CMNP) route choice model in the metro network are carried out in this paper. The utility function is formulated as three components: the compensatory component is a function of influencing factors; the non-compensatory component measures the impacts of routes set on utility; following a multivariate normal distribution, the covariance of error component is structured into three parts, representing the correlation among routes, the transfer variance of route, and the unobserved variance respectively. Considering multidimensional integrals of the multivariate normal probability density function, the CMNP model is rewritten as Hierarchical Bayes formula and M-H sampling algorithm based Monte Carlo Markov Chain approach is constructed to estimate all parameters. Based on Guangzhou Metro data, reliable estimation results are gained. Furthermore, the proposed CMNP model also shows a good forecasting performance for the route choice probabilities calculation and a good application performance for transfer flow volume prediction. PMID:28591188

Incorporating environmental attitudes in discrete choice models: an exploration of the utility of the awareness of consequences scale.

PubMed

Hoyos, David; Mariel, Petr; Hess, Stephane

2015-02-01

Environmental economists are increasingly interested in better understanding how people cognitively organise their beliefs and attitudes towards environmental change in order to identify key motives and barriers that stimulate or prevent action. In this paper, we explore the utility of a commonly used psychometric scale, the awareness of consequences (AC) scale, in order to better understand stated choices. The main contribution of the paper is that it provides a novel approach to incorporate attitudinal information into discrete choice models for environmental valuation: firstly, environmental attitudes are incorporated using a reinterpretation of the classical AC scale recently proposed by Ryan and Spash (2012); and, secondly, attitudinal data is incorporated as latent variables under a hybrid choice modelling framework. This novel approach is applied to data from a survey conducted in the Basque Country (Spain) in 2008 aimed at valuing land-use policies in a Natura 2000 Network site. The results are relevant to policy-making because choice models that are able to accommodate underlying environmental attitudes may help in designing more effective environmental policies. Copyright © 2014 Elsevier B.V. All rights reserved.

State of the Voluntary Green Power Market (2016 Data)

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

OShaughnessy, Eric J; Heeter, Jenny S; Cook, Jeffrey J

Annual report of sales and number of customers in voluntary green power markets, including utility green pricing programs, utility green partnerships, competitive suppliers, unbundled renewable energy certificates, community choice aggregations, power purchase agreements, and community solar.

Technical Assistance Document for Complying with the Toxicity Characteristics Rule and Implementing the Toxicity Characteristic Leaching Procedure

EPA Pesticide Factsheets

The goal of this document is to assist the regulated community to make proper utilization of the Toxicity Characteristic Leaching Procedure (TCLP) to demonstrate compliance with the Toxicity Characteristic (TC) and Land Ban Regulations.

24 CFR 92.504 - Participating jurisdiction responsibilities; written agreements; on-site inspection.

Code of Federal Regulations, 2014 CFR

2014-04-01

... employee compensation and benefits; employee education, training, and travel; rent; utilities... and written agreements, and taking appropriate action when performance problems arise. The use of... responsibility. The performance and compliance of each contractor, State recipient, and subrecipient must be...

75 FR 2591 - Petition for Waiver of Compliance

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-15

... on vital microprocessor-based systems. CSXT proposes to verify and test signal locking systems controlled by microprocessor-based equipment by use of alternative procedures every 4 years after initial... vital microprocessor-based systems. These systems utilize programmed logic equations in lieu of relays...

Impact of different nasal masks on CPAP therapy for obstructive sleep apnea: a randomized comparative trial.

PubMed

Neuzeret, Pierre-Charles; Morin, Laurent

2017-11-01

Patient interface is important for the success of continuous positive airway pressure (CPAP), but few trials have examined the influence of mask choice on CPAP adherence. To compare the impact of different nasal masks on CPAP in patients with newly-diagnosed obstructive sleep apnea (OSA). OSA patients were randomized in a 2:3 ratio to receive CPAP via different first-line nasal masks: ResMed Mirage FX® (MFX) or control mask (Fisher & Paykel Zest ® , HC407 ® or Philips EasyLife ® ). Mask acceptance, CPAP compliance and Home Care Provider (HCP) interventions were compared between groups after 3 months of CPAP therapy using modified intent-to-treat (mITT; after exclusion of patients with mouth leaks during CPAP initiation) and on-treatment (OT; CPAP adherent) analyses. Of 285 randomized patients, 90 requiring a full-face mask were excluded, leaving 195 and 151 in the mITT and OT analyses, respectively. Mask acceptance rate was higher in the MFX versus control group (mITT: 79% vs 68%, P = 0.067; OT: 90% vs 76%, P = 0.022). CPAP compliance was higher (5.9 ± 1.8 vs 5.1 ± 1.6 h/night, P = 0.011) and nasal mask issue-related HCP visits lower (3% vs 17%, P = 0.006) in the MFX group. Nasal mask failures due to mask discomfort (5% vs 1%) or unintentional leakage (5% vs 0%) were higher in control vs MFX group. Mask acceptance was significantly associated with fewer mask leaks (P = 0.002) and higher pressure therapy (P = 0.042). This study highlights differences between nasal masks for CPAP delivery and shows that initial mask selection can influence adherence and healthcare utilization during CPAP. © 2016 ResMed Germany Inc. The Clinical Respiratory Journal published by John Wiley & Sons Ltd.

Methods for Performing Survival Curve Quality-of-Life Assessments.

PubMed

Sumner, Walton; Ding, Eric; Fischer, Irene D; Hagen, Michael D

2014-08-01

Many medical decisions involve an implied choice between alternative survival curves, typically with differing quality of life. Common preference assessment methods neglect this structure, creating some risk of distortions. Survival curve quality-of-life assessments (SQLA) were developed from Gompertz survival curves fitting the general population's survival. An algorithm was developed to generate relative discount rate-utility (DRU) functions from a standard survival curve and health state and an equally attractive alternative curve and state. A least means squared distance algorithm was developed to describe how nearly 3 or more DRU functions intersect. These techniques were implemented in a program called X-Trade and tested. SQLA scenarios can portray realistic treatment choices. A side effect scenario portrays one prototypical choice, to extend life while experiencing some loss, such as an amputation. A risky treatment scenario portrays procedures with an initial mortality risk. A time trade scenario mimics conventional time tradeoffs. Each SQLA scenario yields DRU functions with distinctive shapes, such as sigmoid curves or vertical lines. One SQLA can imply a discount rate or utility if the other value is known and both values are temporally stable. Two SQLA exercises imply a unique discount rate and utility if the inferred DRU functions intersect. Three or more SQLA results can quantify uncertainty or inconsistency in discount rate and utility estimates. Pilot studies suggested that many subjects could learn to interpret survival curves and do SQLA. SQLA confuse some people. Compared with SQLA, standard gambles quantify very low utilities more easily, and time tradeoffs are simpler for high utilities. When discount rates approach zero, time tradeoffs are as informative and easier to do than SQLA. SQLA may complement conventional utility assessment methods. © The Author(s) 2014.

M-OSCE as a method to measure dental hygiene students' critical thinking: a pilot study.

PubMed

McComas, Martha J; Wright, Rebecca A; Mann, Nancy K; Cooper, Mary D; Jacks, Mary E

2013-04-01

Educators in all academic disciplines have been encouraged to utilize assessment strategies to evaluate students' critical thinking. The purpose of this study was to assess the viability of the modified objective structured clinical examination (m-OSCE) to evaluate critical thinking in dental hygiene education. This evaluation utilized a convenience sample of senior dental hygiene students. Students participated in the m-OSCE in which portions of a patient case were revealed at four stations. The exam consisted of multiple-choice questions intended to measure students' ability to utilize critical thinking skills. Additionally, there was one fill-in-the-blank question and a treatment plan that was completed at the fifth station. The results of this study revealed that the m-OSCE did not reliably measure dental hygiene students' critical thinking. Statistical analysis found no satisfactory reliability within the multiple-choice questions and moderately reliable results within the treatment planning portion of the examination. In addition, the item analysis found gaps in students' abilities to transfer clinical evidence/data to basic biomedical knowledge as demonstrated through the multiple-choice questioning results. This outcome warrants further investigation of the utility of the m-OSCE, with a focus on modifications to the evaluation questions, grading rubric, and patient case.

The Probabilistic Nature of Preferential Choice

ERIC Educational Resources Information Center

Rieskamp, Jorg

2008-01-01

Previous research has developed a variety of theories explaining when and why people's decisions under risk deviate from the standard economic view of expected utility maximization. These theories are limited in their predictive accuracy in that they do not explain the probabilistic nature of preferential choice, that is, why an individual makes…

Would You Rather (WYR), with a Sexual Health Twist!

ERIC Educational Resources Information Center

Rosen, Brittany; McNeill, Elisa Beth; Wilson, Kelly

2014-01-01

Would You Rather (WYR), with a Sexual Health Twist! teaching technique uses two youth games, "Would you rather…" and Twister®, to actively engage students in developing decision-making skills regarding human sexuality. Utilizing the "Would you rather" choices, the teacher provides a short scenario with two difficult choices.…

Why Choose Online Learning: Relationship of Existing Factors and Chronobiology

ERIC Educational Resources Information Center

Luo, Yi; Pan, Rui; Choi, Jea H.; Mellish, Linda; Strobel, Johannes

2011-01-01

Existing research on choice of online learning utilized factors such as perceived level of control, independence, and satisfaction, yet the relationship among these factors is under-researched. Due to the value of "learning anytime," biological factors underlying "choice of time" might provide additional insights. This article…

Load sharing in bioinspired fibrillar adhesives with backing layer interactions and interfacial misalignment

NASA Astrophysics Data System (ADS)

Bacca, Mattia; Booth, Jamie A.; Turner, Kimberly L.; McMeeking, Robert M.

2016-11-01

Bio-inspired fibrillar adhesives rely on the utilization of short-range intermolecular forces harnessed by intimate contact at fibril tips. The combined adhesive strength of multiple fibrils can only be utilized if equal load sharing (ELS) is obtained at detachment. Previous investigations have highlighted that mechanical coupling of fibrils through a compliant backing layer gives rise to load concentration and the nucleation and propagation of interfacial flaws. However, misalignment of the adhesive and contacting surface has not been considered in theoretical treatments of load sharing with backing layer interactions. Alignment imperfections are difficult to avoid for a flat-on-flat interfacial configuration. In this work we demonstrate that interfacial misalignment can significantly alter load sharing and the kinematics of detachment in a model adhesive system. Load sharing regimes dominated by backing layer interactions and misalignment are revealed, the transition between which is controlled by the misalignment angle, fibril separation, and fibril compliance. In the regime dominated by misalignment, backing layer deformation can counteract misalignment giving rise to improved load sharing when compared to an identical fibrillar array with a rigid backing layer. This result challenges the conventional belief that stiffer (and thinner) backing layers consistently reduce load concentration among fibrils. Finally, we obtain analytically the fibril compliance distribution required to harness backing layer interactions to obtain ELS. Through fibril compliance optimization, ELS can be obtained even with misalignment. However, since misalignment is typically not deterministic, it is of greater practical significance that the array optimized for perfect alignment exhibits load sharing superior to that of a homogeneous array subject to misalignment. These results inform the design of fibrillar arrays with graded compliance capable of exhibiting improved load sharing over large areas.

Assessment of wastewater treatment facility compliance with decreasing ammonia discharge limits using a regression tree model.

PubMed

Suchetana, Bihu; Rajagopalan, Balaji; Silverstein, JoAnn

2017-11-15

A regression tree-based diagnostic approach is developed to evaluate factors affecting US wastewater treatment plant compliance with ammonia discharge permit limits using Discharge Monthly Report (DMR) data from a sample of 106 municipal treatment plants for the period of 2004-2008. Predictor variables used to fit the regression tree are selected using random forests, and consist of the previous month's effluent ammonia, influent flow rates and plant capacity utilization. The tree models are first used to evaluate compliance with existing ammonia discharge standards at each facility and then applied assuming more stringent discharge limits, under consideration in many states. The model predicts that the ability to meet both current and future limits depends primarily on the previous month's treatment performance. With more stringent discharge limits predicted ammonia concentration relative to the discharge limit, increases. In-sample validation shows that the regression trees can provide a median classification accuracy of >70%. The regression tree model is validated using ammonia discharge data from an operating wastewater treatment plant and is able to accurately predict the observed ammonia discharge category approximately 80% of the time, indicating that the regression tree model can be applied to predict compliance for individual treatment plants providing practical guidance for utilities and regulators with an interest in controlling ammonia discharges. The proposed methodology is also used to demonstrate how to delineate reliable sources of demand and supply in a point source-to-point source nutrient credit trading scheme, as well as how planners and decision makers can set reasonable discharge limits in future. Copyright © 2017 Elsevier B.V. All rights reserved.

Order of Presentation of Dimensions Does Not Systematically Bias Utility Weights from a Discrete Choice Experiment.

PubMed

Norman, Richard; Kemmler, Georg; Viney, Rosalie; Pickard, A Simon; Gamper, Eva; Holzner, Bernhard; Nerich, Virginie; King, Madeleine

2016-12-01

Discrete choice experiments (DCEs) are increasingly used to value aspects of health. An issue with their adoption is that results may be sensitive to the order in which dimensions of health are presented in the valuation task. Findings in the literature regarding order effects are discordant at present. To quantify the magnitude of order effect of quality-of-life (QOL) dimensions within the context of a DCE designed to produce country-specific value sets for the EORTC Quality of Life Utility Measure-Core 10 dimensions (QLU-C10D), a new utility instrument derived from the widely used cancer-specific QOL questionnaire, the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30. The DCE comprised 960 choice sets, divided into 60 versions of 16 choice sets, with each respondent assigned to a version. Within each version, the order of QLU-C10D QOL dimensions was randomized, followed by life duration in the last position. The DCE was completed online by 2053 individuals in France and Germany. We analyzed the data with a series of conditional logit models, adjusted for repeated choices within respondent. We used F tests to assess order effects, correcting for multiple hypothesis testing. Each F test failed to reject the null hypothesis of no position effect: 1) all QOL order positions considered jointly; 2) last QOL position only; 3) first QOL position only. Furthermore, the order coefficients were small relative to those of the QLU-C10D QOL dimension levels. The order of presentation of QOL dimensions within a DCE designed to provide utility weights for the QLU-C10D had little effect on level coefficients of those QOL dimensions. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Compliance program data management system for The Idaho National Engineering Laboratory/Environmental Protection Agency

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

Hertzler, C.L.; Poloski, J.P.; Bates, R.A.

1988-01-01

The Compliance Program Data Management System (DMS) developed at the Idaho National Engineering Laboratory (INEL) validates and maintains the integrity of data collected to support the Consent Order and Compliance Agreement (COCA) between the INEL and the Environmental Protection Agency (EPA). The system uses dBase III Plus programs and dBase III Plus in an interactive mode to enter, store, validate, manage, and retrieve analytical information provided on EPA Contract Laboratory Program (CLP) forms and CLP forms modified to accommodate 40 CFR 264 Appendix IX constituent analyses. Data analysis and presentation is performed utilizing SAS, a statistical analysis software program. Archivingmore » of data and results is performed at appropriate stages of data management. The DMS is useful for sampling and analysis programs where adherence to EPA CLP protocol, along with maintenance and retrieval of waste site investigation sampling results is desired or requested. 3 refs.« less

Dispensing behaviour of pharmacies in prescription drug markets.

PubMed

Guhl, Dennis; Stargardt, Tom; Schneider, Udo; Fischer, Katharina E

2016-02-01

We aim to investigate pharmacies' dispensing behaviour under the existing dispensing regulations in Germany. Using administrative data, we performed a cross-sectional retrospective study to analyse whether the competitive environment and pharmacy characteristics, i.e., organisation, lead to dispensing choices aimed at by third-party payers. We specified generalised linear models with the share of imported pharmaceuticals, generic share, and share of preferred brands as dependent variables. The final dataset contained 49,260,902 prescriptions from 16,797 pharmacies. The average share of imported pharmaceuticals across the pharmacies was 18.4% (standard deviation (SD) 8.8), the average generic share was 92.8% (SD 2.1), and compliance with preferred brands was 81.3% (SD 5.9). Pharmacies with little competition used fewer imported pharmaceuticals (p<0.001), generics (p<0.001) and preferred brands (p<0.001); less organised pharmacies yielded similar results. The difference in outcomes between pharmacies in the first and 4th quartiles of the pharmacy organisation variable is 17.4% vs. 17.0% for share of imported pharmaceuticals, 92.8% vs. 92.7% for generic share and 81.9% vs. 81.1% for compliance with preferred brands. We show that pharmacies' dispensing choices meet the aims of payers at high levels. However, dispensing behaviour varies between pharmacies. Increasing competition among pharmacies and targeting pharmacies with high shares of bill auditing seem viable options to improving dispensing behaviour as defined by payers. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Health and nutrition content claims on Australian fast-food websites.

PubMed

Wellard, Lyndal; Koukoumas, Alexandra; Watson, Wendy L; Hughes, Clare

2017-03-01

To determine the extent that Australian fast-food websites contain nutrition content and health claims, and whether these claims are compliant with the new provisions of the Australia New Zealand Food Standards Code ('the Code'). Systematic content analysis of all web pages to identify nutrition content and health claims. Nutrition information panels were used to determine whether products with claims met Nutrient Profiling Scoring Criteria (NPSC) and qualifying criteria, and to compare them with the Code to determine compliance. Australian websites of forty-four fast-food chains including meals, bakery, ice cream, beverage and salad chains. Any products marketed on the websites using health or nutrition content claims. Of the forty-four fast-food websites, twenty (45 %) had at least one claim. A total of 2094 claims were identified on 371 products, including 1515 nutrition content (72 %) and 579 health claims (28 %). Five fast-food products with health (5 %) and 157 products with nutrition content claims (43 %) did not meet the requirements of the Code to allow them to carry such claims. New provisions in the Code came into effect in January 2016 after a 3-year transition. Food regulatory agencies should review fast-food websites to ensure compliance with the qualifying criteria for nutrition content and health claim regulations. This would prevent consumers from viewing unhealthy foods as healthier choices. Healthy choices could be facilitated by applying NPSC to nutrition content claims. Fast-food chains should be educated on the requirements of the Code regarding claims.

Valuing the benefits of weight loss programs: an application of the discrete choice experiment.

PubMed

Roux, Larissa; Ubach, Christina; Donaldson, Cam; Ryan, Mandy

2004-08-01

Obesity is a leading health threat. Determination of optimal therapies for long-term weight loss remains a challenge. Evidence suggests that successful weight loss depends on the compliance of weight loss program participants with their weight loss efforts. Despite this, little is known regarding the attributes influencing such compliance. The purpose of this study was to assess, using a discrete choice experiment (DCE), the relative importance of weight loss program attributes to its participants and to express these preferences in terms of their willingness to pay for them. A DCE survey explored the following weight loss program attributes in a sample of 165 overweight adults enrolled in community weight loss programs: cost, travel time required to attend, extent of physician involvement (e.g., none, monthly, every 2 weeks), components (e.g., diet, exercise, behavior change) emphasized, and focus (e.g., group, individual). The rate at which participants were willing to trade among attributes and the willingness to pay for different configurations of combined attributes were estimated using regression modeling. All attributes investigated appeared to be statistically significant. The most important unit change was "program components emphasized" (e.g., moving from diet only to diet and exercise). The majority of participants were willing to pay for weight loss programs that reflected their preferences. The DCE tool was useful in quantifying and understanding individual preferences in obesity management and provided information that could help to maximize the efficiency of existing weight loss programs or the design of new programs.

Looking at patients' choices through the lens of expected utility: a critique and research agenda.

PubMed

Russell, Louise B; Schwartz, Alan

2012-01-01

The expected utility framework underlies much research in medical decision making. Because the framework requires decisions to be decomposed into probabilities of states and the values of those states, researchers have investigated the two components separately from each other and from patients' actual decisions. The authors propose that it would be productive to focus more research on the relationships among risk perceptions, outcome valuations, and choices in the same decision makers. They outline exploratory analyses based on two existing national surveys, the Medical Expenditure Panel Survey and the Joint Canada/United States Survey of Health.

Physicians' preference for controller medication in mild persistent asthma.

PubMed

Bakirtas, Arzu; Kutlu, Ali; Baccioglu, Ayse; Erkekol, Ferda Oner; Bavbek, Sevim; Kalayci, Omer

2017-10-01

Although the asthma guidelines recommend inhaled corticosteroids(ICS) or leukotriene receptor antagonists-(LTRAs) for the treatment of mild persistent asthma, factors governing the physicians' preference are unknown. We aimed to investigate the preference of physicians for the controller medication and the factors governing their choice. A self-administered questionnaire composed of 16 questions that aimed to determine the preference of the physicians for the first choice controller medication in mild persistent asthma and physician and patient related factors that may be associated with this selection was e-mailed to the members of the Turkish National Society of Allergy and Clinical Immunology and distributed to participants in the 21st congress. Of the 670 questionnaires, there were 51% participants and 336 of them were complete enough to be included in the analysis. Low dose ICS was preferred as the first choice controller medication for mild persistent asthma by 84.5% of the physicians. The reasons for physicians' preference were different for ICS and LTRA. In the logistic regression analysis, use of asthma guidelines (OR:3.5, 95%CI:1.3-9.3, p = 0.01), alignment in guidelines (OR:2.9, 95%CI:1.4-5.8, p = 0.002) and the opinion that it is a more effective (OR:2.3, 95%CI:1.1-4.8, p = 0.02) were independently associated with ICS preference. Being a pediatrician (OR:5.4, 95%CI: 2.7-10.5, p < 0.001) and the opinion that it has better patient compliance (OR:4.4, 95%CI: 1.6-12.0, p = 0.004) were independently associated with LTRA preference. Surveyed Turkish physicians, the majority of whom were specialists, preferred ICS over LTRA as controller medication in mild persistent asthma. Asthma guidelines, training background (pediatrician versus not) and perceived efficacy and patient compliance appeared to influence their preferences. Copyright © 2017. Published by Elsevier Ltd.

Selection bias between 2 Medicare capitated benefit programs.

PubMed

Leutz, Walter; Brody, Kathleen K; Nonnenkamp, Lucy L; Perrin, Nancy A

2007-04-01

To assess enrollment selection bias between a standard Medicare health maintenance organization (HMO) and a higher-priced social health maintenance organization (SHMO) offering full prescription drug and unique home-based and community-based benefits and to assess how adverse selection was handled through SHMO finances. Kaiser Permanente Northwest offered the dual-choice option in the greater Portland region from 1985 to 2002. Analysis focused on 3 "choice points" when options were clear and highlighted for beneficiaries. Data collected included age and sex, utilization 1 year before and after the choice points, health status data at enrollment (1999-2002 only), mortality, and cost and revenues. Data were extracted from health plan databases. Hospital, pharmacy, and nursing facility utilization for 1 year before and after the choice points are compared for HMO and SHMO choosers. Health and functional status data are compared from 1999 to 2002. Utilization and mortality data are controlled by age and sex. SHMO joiners evidenced adverse selection, while healthier members tended to stay in the HMO, with leaner benefits. Despite adverse selection, the health plan maintained margins in the SHMO, assisted by frailty-adjusted Medicare payments and member premiums. This high-low option strategy sought to offer the "right care at the right time" and may be a model for managed care organizations to serve aging and disabled beneficiaries under Medicare's new special needs plan option.

42 CFR 423.165 - Compliance deemed on the basis of accreditation.

Code of Federal Regulations, 2014 CFR

2014-10-01

... AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) VOLUNTARY MEDICARE PRESCRIPTION DRUG..., national accreditation organization approved by CMS; and (2) The accreditation organization uses the...) Access to covered drugs, as provided under §§ 423.120 and 423.124. (2) Drug utilization management...

42 CFR 423.165 - Compliance deemed on the basis of accreditation.

Code of Federal Regulations, 2013 CFR

2013-10-01

... AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) VOLUNTARY MEDICARE PRESCRIPTION DRUG..., national accreditation organization approved by CMS; and (2) The accreditation organization uses the...) Access to covered drugs, as provided under §§ 423.120 and 423.124. (2) Drug utilization management...

42 CFR 423.165 - Compliance deemed on the basis of accreditation.

Code of Federal Regulations, 2012 CFR

2012-10-01

... AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) VOLUNTARY MEDICARE PRESCRIPTION DRUG..., national accreditation organization approved by CMS; and (2) The accreditation organization uses the...) Access to covered drugs, as provided under §§ 423.120 and 423.124. (2) Drug utilization management...

EFFECTS OF CHANGING DISINFECTANTS ON LEAD AND COPPER RELEASE– A REVIEW

EPA Science Inventory

More utilities are using chloramines in place of free chlorine for greater residual stability and better compliance with both the Total Coliform Rule (TCR) and more stringent requirements of the Disinfectants/Disinfection By-Products Rule (D/DBPR). However, new information about ...

THE ACID RAIN NOX PROGRAM

EPA Science Inventory

Between 350,000 and 400,000 tons of annual NOx emissions have been eliminated as a result of Phase I of the Acid Rain NOx Program. As expected. the utilities have chosen emissions averaging as the primary compliance option. This reflects that, in general, NO x reductions have ...

What It Takes to Excel as a Physician Executive in Healthcare Today.

ERIC Educational Resources Information Center

Bachrach, David J.

1998-01-01

As the health care system changes, new opportunities for physician executives include chief medical officer, director of medical education, health insurance compliance officer, utilization review officer, chief medical information officer, and chief executive officer of the physician-hospital organization. (JOW)

24 CFR 55.27 - Documentation.

Code of Federal Regulations, 2010 CFR

2010-04-01

... FLOODPLAIN MANAGEMENT Procedures for Making Determinations on Floodplain Management § 55.27 Documentation. (a... outside the floodplain, but within the local housing market area, the local public utility service area..., documentation of compliance with this part must be included as a part of the record of decision (or...

76 FR 9768 - Public Utility District No. 1 Chelan County; Notice of Application for Amendment of License and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-22

... is located on the Chelan River in Chelan County near the City of Chelan, Washington. g. Filed... Compliance Manager at P.O. Box 1231, Wenatchee, Washington. Phone: (509) 663-8121. i. FERC Contact: Patricia...

MORPHOLOGICAL, MINERALOGICAL, AND CHEMICAL CHARACTERIZATION OF THREE IRON TUBERCLES FROM AN IRON PIPE

EPA Science Inventory

Water utilities adjust water quality treatment procedures to minimize corrosion and to remain in compliance with local, state, and federal regulations. Some treatment changes though can adversely affect tubercle stability and cause red water and/or other related problems. Therefo...

Diet as a system: an observational study investigating a multi-choice system of moderately restricted low-protein diets.

PubMed

Piccoli, Giorgina Barbara; Nazha, Marta; Capizzi, Irene; Vigotti, Federica Neve; Scognamiglio, Stefania; Consiglio, Valentina; Mongilardi, Elena; Bilocati, Marilisa; Avagnina, Paolo; Versino, Elisabetta

2016-12-07

There is no single, gold-standard, low-protein diet (LPD) for CKD patients; the best compliance is probably obtained by personalization. This study tests the hypothesis that a multiple choice diet network allows patients to attain a good compliance level, and that, in an open-choice system, overall results are not dependent upon the specific diet, but upon the clinical characteristics of the patients. Observational study: Three LPD options were offered to all patients with severe or rapidly progressive CKD: vegan diets supplemented with alpha-ketoacids and essential aminoacids; protein-free food in substitution of normal bread and pasta; other (traditional, vegan non supplemented and tailored). Dialysis-free follow-up and survival were analyzed by Kaplan Meier curves according to diet, comorbidity and age. Compliance and metabolic control were estimated in 147 subjects on diet at March 2015, with recent complete data, prescribed protein intake 0.6 g/Kg/day. Protein intake was assessed by Maroni Mitch formula. Four hundreds and forty nine patients followed a LPD in December, 2007- March, 2015 (90% moderately restricted LPDs, 0.6 g/Kg/day of protein, 10% at lower targets); age (median 70 (19-97)) and comorbidity (Charlson index: 7) characterized our population as being in line with the usual CKD European population. Median e-GFR at start of the diet was 20 mL/min, 33.2% of the patients were diabetics. Baseline data differ significantly across diets: protein-free schemas are preferred by older, high-comorbidity patients (median age 76 years, Charlson index 8, GFR 20.5 mL/min, Proteinuria: 0.3 g/day), supplemented vegan diets by younger patients with lower GFR and higher proteinuria (median age 65 years, Charlson index 6, GFR 18.9 mL/min; Proteinuria: 1.2 g/day); other diets are chosen by an intermediate population (median age 71 years, Charlson index 6; GFR 22.5 mL/min; Proteinuria: 0.9 g/day); (p <0.001 for age, Charlson index, proteinuria, GFR). Adherence was good, only 1.1% of the patients were lost to follow-up and protein intake was at target in most of the cases with no differences among LPDs (protein intake: 0.47 (0.26-0.86) g/Kg/day). After adjustment for confounders, and/or selection of similar populations, no difference in mortality or dialysis start was observed on the different LPDs. Below the threshold of e-GFR 15 mL/min, 50% of the patients remain dialysis free for at least two years. A multiple choice LPD system may allow reaching good adherence, without competition among diets, and with promising results in terms of dialysis-free follow-up. The advantages with respect to a non-customized approach deserve confirmation in further comparative studies or RCTs.

Fall Protection Procedures for Sealing Bulk Waste Shipments by Rail Cars at Formerly Utilized Sites Remedial Action Program (FUSRAP) Sites - 13509

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

Boyle, J.D.; Fort, E. Joseph; Lorenz, William

2013-07-01

Rail-cars loaded with radioactive materials must be closed and fastened to comply with United States Department of Transportation (DOT) requirements before they shipped. Securing waste shipments in a manner that meets these regulations typically results in the use of a sealable rail-car liner. Workers accessing the tops of the 2.74 m high rail-cars to seal and inspect liners for compliance prior to shipment may be exposed to a fall hazard. Relatively recent revisions to the Fall Protection requirements in the Safety and Health Requirements Manual (EM385-1-1, U.S. Army Corps of Engineers) have necessitated modifications to the fall protection systems previouslymore » employed for rail-car loading at Formerly Utilized Sites Remedial Action Program (FUSRAP) sites. In response these projects have developed site-specific procedures to protect workers and maintain compliance with the improved fall protection regulations. (authors)« less

Poor hospital infection control practice in hand hygiene, glove utilization, and usage of tourniquets.

PubMed

Sacar, Suzan; Turgut, Huseyin; Kaleli, Ilknur; Cevahir, Nural; Asan, Ali; Sacar, Mustafa; Tekin, Koray

2006-11-01

Hospital-acquired infection often occurs because of lapses in accepted standards of practice on the part of health care personnel. The aim of this study is to attract attention on poor hospital infection control practice in venepuncture and use of tourniquets and emphasize the importance of hand hygiene. Overall compliance with hygiene during usage of tourniquets and routine patient care before and after implementation of a hospital infection control measures was evaluated. According to the questionnaire, only 26.9% of respondents always washed their hands both before and after venepuncture. In the second step of the study, based on direct observation, hands were washed both before and after venepuncture on only 41 (45.1%) occasions. Failure to remove gloves after patient contact was observed on 23.1% occasions. Our survey reveals poor infection control practice in hand hygiene, glove utilization, and usage of tourniquets and the implementation of infection control measures produced a moderate improvement in compliance with them.

The Priority Heuristic: Making Choices Without Trade-Offs

PubMed Central

Brandstätter, Eduard; Gigerenzer, Gerd; Hertwig, Ralph

2010-01-01

Bernoulli's framework of expected utility serves as a model for various psychological processes, including motivation, moral sense, attitudes, and decision making. To account for evidence at variance with expected utility, we generalize the framework of fast and frugal heuristics from inferences to preferences. The priority heuristic predicts (i) Allais' paradox, (ii) risk aversion for gains if probabilities are high, (iii) risk seeking for gains if probabilities are low (lottery tickets), (iv) risk aversion for losses if probabilities are low (buying insurance), (v) risk seeking for losses if probabilities are high, (vi) certainty effect, (vii) possibility effect, and (viii) intransitivities. We test how accurately the heuristic predicts people's choices, compared to previously proposed heuristics and three modifications of expected utility theory: security-potential/aspiration theory, transfer-of-attention-exchange model, and cumulative prospect theory. PMID:16637767

Utilizing Additional Measures of High School Academic Preparation to Support Students in Their Math Self-Assessment

ERIC Educational Resources Information Center

Fong, Kristen E.; Melguizo, Tatiana

2017-01-01

This study describes student behavior through the actual assessment and placement (A&P) process. It then uses an alternative A&P policy that utilizes an additional measure that assesses prior math preparedness alongside subtest choice. Utilizing data from a community college that allows its' students to choose the assessment subtest used…

The expert consensus guideline series. Optimizing pharmacologic treatment of psychotic disorders. Introduction: methods, commentary, and summary.

PubMed

Kane, John M; Leucht, Stefan; Carpenter, Daniel; Docherty, John P

2003-01-01

A growing number of atypical antipsychotics are available for clinicians to choose from in the treatment of psychotic disorders. However, a number of important questions concerning medication selection, dosing and dose equivalence, and the management of inadequate response, compliance problems, and relapse have not been adequately addressed by clinical trials. To aid clinical decision-making, a consensus survey of expert opinion on the pharmacologic treatment of psychotic disorders was undertaken to address questions not definitively answered in the research literature. Based on a literature review, a written survey was developed with 60 questions and 994 options. Approximately half of the options were scored using a modified version of the RAND 9-point scale for rating the appropriateness of medical decisions. For the other options, the experts were asked to write in answers (e.g., average doses) or check a box to indicate their preferred answer. The survey was sent to 50 national experts on the pharmacologic treatment of psychotic disorders, 47 (94%) of whom completed it. In analyzing the responses to items rated on the 9-point scale, consensus on each option was defined as a non random distribution of scores by chi-square "goodness-of-fit"test. We assigned a categorical rank (first line/preferred choice,second line/alternate choice, third line/usually inappropriate) to each option based on the 95% confidence interval around the mean rating. Guideline tables indicating preferred treatment strategies were then developed for key clinical situations. The expert panel reached consensus on 88% of the options rated on the 9-point scale. The experts overwhelmingly endorsed the atypical antipsychotics for the treatment of psychotic disorders. Risperidone was the top choice for first-episode and multi-episode patients, with the other newer atypicals rated first line or high second line depending on the clinical situation. Clozapine and a long-acting injectable atypical (when available)were other high second line options for multi-episode patients. The expert's dosing recommendations agreed closely with the package inserts for the drugs, and their estimates of dose equivalence among the antipsychotics followed a linear pattern. The experts considered 3-6 weeks an adequate antipsychotic trial, but would wait a little longer (4-10 weeks) before making a major change in treatment regimen if there is a partial response. The experts recommended trying to improve response by increasing the dose of atypical and depot antipsychotics before switching to a different agent; there was less agreement about increasing the dose of conventional antipsychotics before switching, probably because of concern about side effects at higher doses. If it is decided to switch because of inadequate response, risperidone was the expert's first choice to switch to, no matter what drug was initially tried. Although there was some disparity in the expert's recommendations concerning how many agents to try before switching to clozapine, the expert's responses suggest that switching to clozapine should be Clozapine was also the antipsychotic of choice for patients with suicidal behavior. When switching oral antipsychotics,the experts considered cross-titration the preferred strategy. When switching to an injectable antipsychotic, the experts stressed the importance of continuing the oral antipsychotic until therapeutic levels of the injectable agent are achieved. The experts considered psychosocial interventions the first choice strategy for partially compliant patients, with pharmacologic interventions the first choice for patients with clear evidence of noncompliance. However, because it can be difficult to distinguish partially compliant from noncompliant patients, the editors recommended combining psychosocial and pharmacologic interventions to improve compliance whenever possible. When patients relapse because of compliance problems or if there is any doubt about compliance, the experts recommended the use of a long-acting injectable antipsychotic and would select an injectable atypical when this option becomes available. The experts would also consider using an injectable atypical antipsychotic (when available) in many clinical situations that do not involve compliance problems. The experts stressed the importance of monitoring for health problems-especially obesity, diabetes, cardiovascular problems,HIV risk behaviors, medical complications of substance abuse, heavy smoking and its effects, hypertension, and amenorrhea-in patients being treated with antipsychotics. Although many patients are prescribed adjunctive treatments,multiple antipsychotics, and combinations of different classes of drugs (e.g., antipsychotics plus mood stabilizers or antidepressants) in an effort to enhance response, the experts gave little support to any of these strategies, with the exception of antidepressants for patients with dysphoria/depression, antidepressants or ECT for patients with suicidal behavior, and mood stabilizers for patients with aggression/violence. When asked about indicators of remission and recovery, the experts considered acute improvement in psychotic symptoms the most important indicator of remission, whereas they considered more sustained improvement in multiple outcome domains (e.g., occupational/educational functioning, peer relationships,independent living) important in assessing recovery. The experts reached a high level of consensus on many of the key treatment questions in the survey. Within the limits of expert opinion and with the expectation that future research data will take precedence, these guidelines provide direction for addressing common clinical dilemmas that arise in the pharmacologic treatment of psychotic disorders. They can be used to inform clinicians and educate patients regarding the relative merits of a variety of interventions. Clinicians should keep in mind that no guidelines can address the complexities involved in the care of each individual patient and that sound clinical judgment based on clinical experience should be used in applying these recommendations.

The effect of choice on the physiology of emotion: an affective startle modulation study.

PubMed

Genevsky, Alexander; Gard, David E

2012-04-01

The affective startle modulation task has been an important measure in understanding physiological aspects of emotion and motivational responses. Research utilizing this method has relied primarily on a 'passive' viewing paradigm, which stands in contrast to everyday life where much of emotion and motivation involves some active choice or agency. The present study investigated the role of choice on the physiology of emotion. Eighty-four participants were randomized into 'choice' (n=44) or 'no-choice' (n=40) groups distinguished by the ability to choose between stimuli. EMG eye blink responses were recorded in both anticipation and stimulus viewing. Results indicated a significant attenuation of the startle magnitude in choice condition trials (relative to no-choice) across all picture categories and probe times. We interpret these findings as an indication that the act of choice may decrease one's defensive response, or conversely, lacking choice may heighten the defensive response. Implications for future research are discussed. Copyright © 2012 Elsevier B.V. All rights reserved.

Changes in Healthcare Utilization After Etanercept Initiation in Patients with Rheumatoid Arthritis: A Retrospective Claims Analysis.

PubMed

Accortt, Neil A; Schenfeld, Jennifer; Chang, Eunice; Papoyan, Elya; Broder, Michael S

2017-09-01

Effective treatment for rheumatoid arthritis (RA) may lead to lower overall and RA-related healthcare utilization. We evaluated healthcare utilization before and after initiation of the tumor necrosis factor inhibitor etanercept in patients with moderate to severe RA. This retrospective cohort study used data from the MarketScan ® claims database. Data from adult patients with RA newly exposed to etanercept between January 1, 2010 and December 31, 2013 were analyzed. Patients had at least one inpatient or outpatient claim for RA and at least one claim for etanercept (first claim was index date). Etanercept compliance was determined on the basis of proportion of days covered (PDC). Primary outcome was change in overall and RA-related healthcare utilization in the year before and year after etanercept initiation. McNemar's test and paired t test, respectively, were used to determine statistical significance for dichotomous and continuous variables. Data from 6737 patients were analyzed; mean age was 49.8 years and 77.3% were female. Overall outpatient services, office visits, outpatient hospital services, laboratory visits, and emergency department visits were significantly lower in the post-index period compared to pre-index. RA-related pharmacotherapy use (oral corticosteroids, opioid analgesics, nonsteroidal anti-inflammatory drugs, and nonbiologic disease-modifying antirheumatic drugs) was significantly lower in the post-index period compared to pre-index. Rates of RA-related total joint arthroplasty, joint reconstructions, and soft tissue procedures were similar in pre-index and post-index periods. High etanercept compliance (PDC ≥80%) was associated with significantly lower rates of RA-related outpatient services, office visits, diagnostic imaging studies, and joint reconstructions compared with noncompliance. Overall healthcare utilization decreased after etanercept initiation. Patients who were most compliant with etanercept had significantly lower utilization than less compliant patients. Amgen, Inc.

Considerations in the Choice of an Internet Search Tool.

ERIC Educational Resources Information Center

Vaughan, Jason

1999-01-01

Describes a survey conducted among library school graduate students and librarians at the University of North Carolina at Chapel Hill that investigated factors that play a role in information professionals' choice of Internet search tools. Utility functions and ease of use are discussed and the original online survey is appended. (Author/LRW)

Lessons without Limit: How Free-Choice Learning Is Transforming Education.

ERIC Educational Resources Information Center

Falk, John H.; Dierking, Lynn D.

This book advocates establishing "learning systems" that utilize all the educational resources of communities to connect and extend learning opportunities across a lifetime. The following are among the topics discussed: (1) the essence of lifelong learning and a learning society; (2) how and why people engage in free-choice learning; (3)…

FormScanner: Open-Source Solution for Grading Multiple-Choice Exams

ERIC Educational Resources Information Center

Young, Chadwick; Lo, Glenn; Young, Kaisa; Borsetta, Alberto

2016-01-01

The multiple-choice exam remains a staple for many introductory physics courses. In the past, people have graded these by hand or even flaming needles. Today, one usually grades the exams with a form scanner that utilizes optical mark recognition (OMR). Several companies provide these scanners and particular forms, such as the eponymous…

Helping Latina/o Students Navigate the College Choice Process: Considerations for Secondary School Counselors

ERIC Educational Resources Information Center

Martinez, Melissa A.

2013-01-01

This qualitative study utilized interviews with 20 Latina/o high school seniors and five secondary school counselors in South Texas to further understand how counselors help Latina/o students navigate their college choice process. Findings indicate counselors provided students with access to college information and facilitated university…

Understanding Customer Product Choices: A Case Study Using the Analytical Hierarchy Process

Treesearch

Robert L. Smith; Robert J. Bush; Daniel L. Schmoldt

1996-01-01

The Analytical Hierarchy Process (AHP) was used to characterize the bridge material selection decisions of highway officials across the United States. Understanding product choices by utilizing the AHP allowed us to develop strategies for increasing the use of timber in bridge construction. State Department of Transportation engineers, private consulting engineers, and...

Pricing Policy and the College Choice Process. AIR Forum Paper 1978.

ERIC Educational Resources Information Center

Chapman, Randall G.

A presentation of a conceptual framework for viewing the admissions management process in higher education institutions and a discussion of the pricing policy process, particularly of private colleges and universities, precedes an examination of the stochastic utility model, a statistical model of the college choice process. Using student choice…

Nonadherence to immunosuppressive therapy in kidney transplant recipients: can technology help?

PubMed

Nerini, Erika; Bruno, Fulvio; Citterio, Franco; Schena, Francesco P

2016-10-01

End-stage kidney disease is a life-threatening condition that compels patients to accept either dialysis or transplant. Kidney transplantation is the best choice for patients with end-stage kidney disease because it ensures higher quality of life and longer survival rates than other choices, with less cost for the healthcare system. However, in order for renal recipients to maintain the functioning graft they must take lifelong immunosuppressive medications, with possible side effects and low medication adherence. It is known that low medication adherence in kidney transplant recipients may cause poor outcomes, chronic graft rejection, and graft failure. In this review, the authors give an overview of nonadherence in the transplant setting. In addition, they analyze the role of different technologies as an aid to improve adherence, with a focus on mobile-phone based solutions to monitor and enhance kidney transplant recipient compliance.

Negotiating roadblocks to IDS-physician equity joint ventures.

PubMed

Dubow, S F; Benoff, M

1998-09-01

Integrated delivery systems (IDSs) may find that forming an equity joint venture relationship with a physician group practice is the best way to integrate physicians into their networks. IDSs have a choice between two basic equity structures: affiliated group practice, in which a management services organization (MSO) handles all practice management infrastructure and the physician group is a physician-only organization; and integrated group practice, in which the physician group encompasses both the physician practice and the administrative infrastructure. The choice of equity structure and how it should be implemented hinge on several legal issues, including the existence of a corporate-practice-of-medicine statute in the IDS's state, compliance with the Federal antikickback statute and Stark laws, and various issues regarding the IDS's tax-exempt status. IDSs also should consider pragmatic issues, particularly those associated with aligning the economic incentives of the two partners.

77 FR 23514 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-19

... purchaser, prior to or at the time of purchase, a signed document acknowledging the restrictions on... with. This requirement enhances the Commission's ability to monitor utilization of and compliance with... does not include in the estimate of average burden hours the time preparing registration statements and...

77 FR 47847 - Proposed Data Collections Submitted for Public Comment and Recommendations

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-10

...] Proposed Data Collections Submitted for Public Comment and Recommendations In compliance with the... investigation and the usefulness of recommendations; data are collected from 100 state and local health... on both the timeliness and the practical utility of the recommendations from the investigation by...

14 CFR 23.333 - Flight envelope.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 1 2011-01-01 2011-01-01 false Flight envelope. 23.333 Section 23.333... STANDARDS: NORMAL, UTILITY, ACROBATIC, AND COMMUTER CATEGORY AIRPLANES Structure Flight Loads § 23.333 Flight envelope. (a) General. Compliance with the strength requirements of this subpart must be shown at...

14 CFR 23.333 - Flight envelope.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 1 2013-01-01 2013-01-01 false Flight envelope. 23.333 Section 23.333... STANDARDS: NORMAL, UTILITY, ACROBATIC, AND COMMUTER CATEGORY AIRPLANES Structure Flight Loads § 23.333 Flight envelope. (a) General. Compliance with the strength requirements of this subpart must be shown at...

14 CFR 23.333 - Flight envelope.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 1 2012-01-01 2012-01-01 false Flight envelope. 23.333 Section 23.333... STANDARDS: NORMAL, UTILITY, ACROBATIC, AND COMMUTER CATEGORY AIRPLANES Structure Flight Loads § 23.333 Flight envelope. (a) General. Compliance with the strength requirements of this subpart must be shown at...

14 CFR 23.333 - Flight envelope.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Flight envelope. 23.333 Section 23.333... STANDARDS: NORMAL, UTILITY, ACROBATIC, AND COMMUTER CATEGORY AIRPLANES Structure Flight Loads § 23.333 Flight envelope. (a) General. Compliance with the strength requirements of this subpart must be shown at...

14 CFR 23.333 - Flight envelope.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 1 2014-01-01 2014-01-01 false Flight envelope. 23.333 Section 23.333... STANDARDS: NORMAL, UTILITY, ACROBATIC, AND COMMUTER CATEGORY AIRPLANES Structure Flight Loads § 23.333 Flight envelope. (a) General. Compliance with the strength requirements of this subpart must be shown at...

PROCEEDINGS: EIGHTH SYMPOSIUM ON THE TRANSFER AND UTILIZATION OF PARTICULATE CONTROL TECHNOLOGY - VOLUME 1. ELECTROSTATIC PRECIPITATORS

EPA Science Inventory

The two-volume proceedings describe the latest research and development efforts to improve particulate control devices, while treating traditional concerns of operational cost and compliance. Overall, particulate control remains a key issue in the cost and applicability of furnac...

24 CFR 8.57 - Procedure for effecting compliance.

Code of Federal Regulations, 2010 CFR

2010-04-01

... this part may be effected by the suspension or termination of or refusal to grant or to continue... assurance or other contractual undertaking; (2) The initiation of debarment proceedings pursuant to 2 CFR... an award official from utilizing appropriate procedures and sanctions established under the program...

3D Chlorine and Monochloramine Penetration and Nitrifying Biofilm Activity and Viability: Periodic Chlorine Switch Implications

EPA Science Inventory

Biofilm formation in drinking water distribution systems has been associated with water quality degradation and may result in non-compliance with existing regulations. United States water utilities report biofilm survival and regrowth despite disinfectant presence, and systems t...

40 CFR 92.9 - Compliance with emission standards.

Code of Federal Regulations, 2011 CFR

2011-07-01

... technology (e.g., catalyst). For HC, THCE, NMHC, CO, NOX. and PM, additive deterioration factors shall be... locomotives or locomotive engines utilizing aftertreatment technology (e.g., catalyst). For HC, THCE, NMHC, CO... certificates of conformity from EPA that allow the manufacturer or remanufacturer to introduce into commerce...

Comparison between Monochloramine and Free Chlorine in Biofilm using Microelectrodes: Penetration, Activity and Viability

EPA Science Inventory

Biofilm in drinking water systems is undesirable and may result in water quality degradation and subsequent non-compliance with existing regulations; therefore, effective biofilm control is desirable to maintain public health. For this purpose, drinking water utilities may use ei...

14 CFR 23.1310 - Power source capacity and distribution.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 1 2012-01-01 2012-01-01 false Power source capacity and distribution. 23... Equipment General § 23.1310 Power source capacity and distribution. (a) Each installation whose functioning... power supply system, distribution system, or other utilization system. (b) In determining compliance...

14 CFR 23.1310 - Power source capacity and distribution.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 1 2014-01-01 2014-01-01 false Power source capacity and distribution. 23... Equipment General § 23.1310 Power source capacity and distribution. (a) Each installation whose functioning... power supply system, distribution system, or other utilization system. (b) In determining compliance...

14 CFR 23.1310 - Power source capacity and distribution.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 1 2013-01-01 2013-01-01 false Power source capacity and distribution. 23... Equipment General § 23.1310 Power source capacity and distribution. (a) Each installation whose functioning... power supply system, distribution system, or other utilization system. (b) In determining compliance...

42 CFR 423.165 - Compliance deemed on the basis of accreditation.

Code of Federal Regulations, 2011 CFR

2011-10-01

... AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Cost..., national accreditation organization approved by CMS; and (2) The accreditation organization uses the...) Access to covered drugs, as provided under §§ 423.120 and 423.124. (2) Drug utilization management...

76 FR 71958 - Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-21

... Security Education Program, DoD. ACTION: Notice. SUMMARY: In compliance with Section 3506(c)(2)(A) of the.../National Security Education Program announces the proposed extension of a public information collection and... burden of the proposed information collection; (c) ways to enhance the quality, utility, and clarity of...

43. VIEW OF TURBINE HALL LOOKING WEST NORTHWEST FROM THE ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

43. VIEW OF TURBINE HALL LOOKING WEST NORTHWEST FROM THE MEZZANINE. IN THE CENTER OF THE PHOTOGRAPHS ARE THREE FREQUENCY CONVERTERS INSTALLED IN 1983. THE FREQUENCY CONVERTERS SUPPLEMENTED COS COB POWER. DURING THE TRANSITION TO UTILITY POWER CONVERTERS USED UTILITY INPUT POWER AT 60 CYCLES TO OUTPUT 25 CYCLE POWER FOR RAILROAD OPERATIONS. THE INTERIM SYSTEM INCREASED RELIABILITY AND ALLOWED COMPLIANCE WITH BOILER EMISSION LIMITATIONS. - New York, New Haven & Hartford Railroad, Cos Cob Power Plant, Sound Shore Drive, Greenwich, Fairfield County, CT

Interventions to improve hand hygiene compliance in patient care.

PubMed

Gould, Dinah J; Moralejo, Donna; Drey, Nicholas; Chudleigh, Jane H

2010-09-08

Health care-associated infection is a major cause of morbidity and mortality. Hand hygiene is regarded as an effective preventive measure. To update the review done in 2007, to assess the short and longer-term success of strategies to improve hand hygiene compliance and to determine whether a sustained increase in hand hygiene compliance can reduce rates of health care-associated infection. We conducted electronic searches of: the Cochrane Central Register of Controlled Trials; the Cochrane Effective Practice and Organisation of Care Group specialised register of trials; MEDLINE; PubMed; EMBASE; CINAHL; and the BNI. Originally searched to July 2006, for the update databases were searched from August 2006 until November 2009. Randomised controlled trials, controlled clinical trials, controlled before and after studies, and interrupted time series analyses meeting explicit entry and quality criteria used by the Cochrane Effective Practice and Organisation of Care Group were eligible for inclusion. Studies reporting indicators of hand hygiene compliance and proxy indicators such as product use were considered. Self-reported data were not considered a valid measure of compliance. Studies to promote hand hygiene compliance as part of a care bundle approach were included, providing data relating specifically to hand hygiene were presented separately. Studies were excluded if hand hygiene was assessed in simulations, non-clinical settings or the operating theatre setting. Two reviewers independently extracted data and assessed data quality. Four studies met the criteria for the review: two from the original review and two from the update. Two studies evaluated simple education initiatives, one using a randomized clinical trial design and the other a controlled before and after design. Both measured hand hygiene compliance by direct observation. The other two studies were both interrupted times series studies. One study presented three separate interventions within the same paper: simple substitutions of product and two multifaceted campaigns, one of which included involving practitioners in making decisions about choice of hand hygiene products and the components of the hand hygiene program. The other study also presented two separate multifaceted campaigns, one of which involved application of social marketing theory. In these two studies follow-up data collection continued beyond twelve months, and a proxy measure of hand hygiene compliance (product use) was recorded. Microbiological data were recorded in one study. Hand hygiene compliance increased for one of the studies where it was measured by direct observation, but the results from the other study were not conclusive. Product use increased in the two studies in which it was reported, with inconsistent results reported for one initiative. MRSA incidence decreased in the one study reporting microbiological data. The quality of intervention studies intended to increase hand hygiene compliance remains disappointing. Although multifaceted campaigns with social marketing or staff involvement appear to have an effect, there is insufficient evidence to draw a firm conclusion. There remains an urgent need to undertake methodologically robust research to explore the effectiveness of soundly designed and implemented interventions to increase hand hygiene compliance.

Neural correlates of economic game playing.

PubMed

Krueger, Frank; Grafman, Jordan; McCabe, Kevin

2008-12-12

The theory of games provides a mathematical formalization of strategic choices, which have been studied in both economics and neuroscience, and more recently has become the focus of neuroeconomics experiments with human and non-human actors. This paper reviews the results from a number of game experiments that establish a unitary system for forming subjective expected utility maps in the brain, and acting on these maps to produce choices. Social situations require the brain to build an understanding of the other person using neuronal mechanisms that share affective and intentional mental states. These systems allow subjects to better predict other players' choices, and allow them to modify their subjective utility maps to value pro-social strategies. New results for a trust game are presented, which show that the trust relationship includes systems common to both trusting and trustworthy behaviour, but they also show that the relative temporal positions of first and second players require computations unique to that role.

Fitting observed and theoretical choices - women's choices about prenatal diagnosis of Down syndrome.

PubMed

Seror, Valerie

2008-05-01

Choices regarding prenatal diagnosis of Down syndrome - the most frequent chromosomal defect - are particularly relevant to decision analysis, since women's decisions are based on the assessment of their risk of carrying a child with Down syndrome, and involve tradeoffs (giving birth to an affected child vs procedure-related miscarriage). The aim of this study, based on face-to-face interviews with 78 women aged 25-35 with prior experience of pregnancy, was to compare the women' expressed choices towards prenatal diagnosis with those derived from theoretical models of choice (expected utility theory, rank-dependent theory, and cumulative prospect theory). The main finding obtained in this study was that the cumulative prospect model fitted the observed choices best: both subjective transformation of probabilities and loss aversion, which are basic features of the cumulative prospect model, have to be taken into account to make the observed choices consistent with the theoretical ones.

Box-Cox Mixed Logit Model for Travel Behavior Analysis

NASA Astrophysics Data System (ADS)

Orro, Alfonso; Novales, Margarita; Benitez, Francisco G.

2010-09-01

To represent the behavior of travelers when they are deciding how they are going to get to their destination, discrete choice models, based on the random utility theory, have become one of the most widely used tools. The field in which these models were developed was halfway between econometrics and transport engineering, although the latter now constitutes one of their principal areas of application. In the transport field, they have mainly been applied to mode choice, but also to the selection of destination, route, and other important decisions such as the vehicle ownership. In usual practice, the most frequently employed discrete choice models implement a fixed coefficient utility function that is linear in the parameters. The principal aim of this paper is to present the viability of specifying utility functions with random coefficients that are nonlinear in the parameters, in applications of discrete choice models to transport. Nonlinear specifications in the parameters were present in discrete choice theory at its outset, although they have seldom been used in practice until recently. The specification of random coefficients, however, began with the probit and the hedonic models in the 1970s, and, after a period of apparent little practical interest, has burgeoned into a field of intense activity in recent years with the new generation of mixed logit models. In this communication, we present a Box-Cox mixed logit model, original of the authors. It includes the estimation of the Box-Cox exponents in addition to the parameters of the random coefficients distribution. Probability of choose an alternative is an integral that will be calculated by simulation. The estimation of the model is carried out by maximizing the simulated log-likelihood of a sample of observed individual choices between alternatives. The differences between the predictions yielded by models that are inconsistent with real behavior have been studied with simulation experiments.

Regulatory considerations for pluripotent stem cell therapies.

PubMed

Carpenter, Melissa K

2017-01-01

The development of pluripotent stem cell (PSC) therapies is rapidly advancing, and a number of PSC-derived cell products are currently being tested in clinical trials. The biological complexity of these therapies results in specific challenges in complying with regulatory guidelines. This includes the choice of starting material, reproducible and consistent manufacturing, and preclinical safety and efficacy assessment of the PSC-derived product. This review discusses current US cell therapy regulations and strategies for compliance with these regulations when developing PSC-derived products. © 2017 Elsevier B.V. All rights reserved.

Patient choice modelling: how do patients choose their hospitals?

PubMed

Smith, Honora; Currie, Christine; Chaiwuttisak, Pornpimol; Kyprianou, Andreas

2018-06-01

As an aid to predicting future hospital admissions, we compare use of the Multinomial Logit and the Utility Maximising Nested Logit models to describe how patients choose their hospitals. The models are fitted to real data from Derbyshire, United Kingdom, which lists the postcodes of more than 200,000 admissions to six different local hospitals. Both elective and emergency admissions are analysed for this mixed urban/rural area. For characteristics that may affect a patient's choice of hospital, we consider the distance of the patient from the hospital, the number of beds at the hospital and the number of car parking spaces available at the hospital, as well as several statistics publicly available on National Health Service (NHS) websites: an average waiting time, the patient survey score for ward cleanliness, the patient safety score and the inpatient survey score for overall care. The Multinomial Logit model is successfully fitted to the data. Results obtained with the Utility Maximising Nested Logit model show that nesting according to city or town may be invalid for these data; in other words, the choice of hospital does not appear to be preceded by choice of city. In all of the analysis carried out, distance appears to be one of the main influences on a patient's choice of hospital rather than statistics available on the Internet.

Lipid based noninvasive vesicular formulation of cytarabine: Nanodeformable liposomes.

PubMed

Raj, Rakesh; Raj, Pooja Mongia; Ram, Alpana

2016-06-10

Leukemia is the common cause of death and worldwide incidence of this disease is increasing. Chemotherapy is the first choice for leukemia treatment, but the major limitations of standard therapy are its side effects and poor patient compliances. Therefore it is imperative to look for a therapeutic system with lesser side effects urgently to address the underlying causes of poor treatment outcomes. In such a scenario transdermal route for delivery of chemotherapeutic drugs could be a better alternative to provide sustained drug level, enhanced activity, self administration and better patient compliances. The present work is focus on the design of nanolipid based transdermal carrier, deformable liposomes bearing cytarabine as a model drug for effective delivery of drug with enhanced transdermal flux. Developed nanocarriers were characterized for their size, morphology, entrapment efficiency, skin penetration and irritation. It could be concluded that nanodeformable liposomes accentuated transdermal flux of cytarabine and could provide a new strategy for leukemia. Copyright © 2016 Elsevier B.V. All rights reserved.

A discrete choice experiment to obtain a tariff for valuing informal care situations measured with the CarerQol instrument.

PubMed

Hoefman, Renske J; van Exel, Job; Rose, John M; van de Wetering, E J; Brouwer, Werner B F

2014-01-01

Economic evaluations adopting a societal perspective need to include informal care whenever relevant. However, in practice, informal care is often neglected, because there are few validated instruments to measure and value informal care for inclusion in economic evaluations. The CarerQol, which is such an instrument, measures the impact of informal care on 7 important burden dimensions (CarerQol-7D) and values this in terms of general quality of life (CarerQol-VAS). The objective of the study was to calculate utility scores based on relative utility weights for the CarerQol-7D. These tariffs will facilitate inclusion of informal care in economic evaluations. The CarerQol-7D tariff was derived with a discrete choice experiment conducted as an Internet survey among the general adult population in the Netherlands (N = 992). The choice set contained 2 unlabeled alternatives described in terms of the 7 CarerQol-7D dimensions (level range: "no,"some," and "a lot"). An efficient experimental design with priors obtained from a pilot study (N = 104) was used. Data were analyzed with a panel mixed multinomial parameter model including main and interaction effects of the attributes. The utility attached to informal care situations was significantly higher when this situation was more attractive in terms of fewer problems and more fulfillment or support. The interaction term between the CarerQol-7D dimensions physical health and mental health problems also significantly explained this utility. The tariff was constructed by adding up the relative utility weights per category of all CarerQol-7D dimensions and the interaction term. We obtained a tariff providing standard utility scores for caring situations described with the CarerQol-7D. This facilitates the inclusion of informal care in economic evaluations.

Control and Effort Costs Influence the Motivational Consequences of Choice

PubMed Central

Sullivan-Toole, Holly; Richey, John A.; Tricomi, Elizabeth

2017-01-01

The act of making a choice, apart from any outcomes the choice may yield, has, paradoxically, been linked to both the enhancement and the detriment of intrinsic motivation. Research has implicated two factors in potentially mediating these contradictory effects: the personal control conferred by a choice and the costs associated with a choice. Across four experiments, utilizing a physical effort task disguised as a simple video game, we systematically varied costs across two levels of physical effort requirements (Low-Requirement, High-Requirement) and control over effort costs across three levels of choice (Free-Choice, Restricted-Choice, and No-Choice) to disambiguate how these factors affect the motivational consequences of choosing within an effortful task. Together, our results indicated that, in the face of effort requirements, illusory control alone may not sufficiently enhance perceptions of personal control to boost intrinsic motivation; rather, the experience of actual control may be necessary to overcome effort costs and elevate performance. Additionally, we demonstrated that conditions of illusory control, while otherwise unmotivating, can through association with the experience of free-choice, be transformed to have a positive effect on motivation. PMID:28515705

Non-compliance with ACS-COT recommended criteria for full trauma team activation is associated with undertriage deaths.

PubMed

Tignanelli, Christopher J; Vander Kolk, Wayne E; Mikhail, Judy N; Delano, Matthew J; Hemmila, Mark R

2017-11-21

The appropriate triage of acutely injured patients within a trauma system is associated with improved rates of mortality and optimal resource utilization. The American College of Surgeons Committee on Trauma (ACS-COT) put forward six minimum criteria (ACS-6) for full trauma team activation (TTA). We hypothesized that ACS-COT verified trauma center compliance with these criteria is associated with low under-triage rates and improved overall mortality. Data from a state-wide collaborative quality initiative was utilized. We used data collected from 2014 through 2016 at 29 ACS verified level 1 and 2 trauma centers. Inclusion criteria were: adult patients (≥16 years) and ISS ≥5. Quantitative data existed to analyze four of the ACS-6 criteria (ED SBP≤90 mmHg, respiratory compromise/intubation, central GSW, and GCS<9). Patients were considered to be under-triaged if they had major trauma (ISS>15) and did not receive a full TTA. 51,792 patients were included in the study. Compliance with ACS-6 minimum criteria for full TTA varied from 51% to 82%. Presence of any ACS-6 criteria was associated with a high intervention rate and significant risk of mortality (OR 16.7, 95% CI 15.2-18.3, p<0.001). Of the 1004 deaths that were not a full activation, 433 (43%) were classified as under-triaged, and 301 (30%) had at least one ACS-6 criteria present. Under-triaged patients with any ACS-6 criteria were more likely to die than those who were not under-triaged (30% vs 21%, p=0.001). GCS<9 and need for emergent intubation were the ACS-6 criteria most frequently associated with under-triage mortality. Compliance with ACS-COT minimum criteria for full TTA remains sub-optimal and undertriage is associated with increased mortality. This data suggests that the most efficient quality improvement measure around triage should be ensuring compliance with the ACS-6 criteria. This study suggests that practice pattern modification to more strictly adhere to the minimum ACS-COT criteria for full TTA will save lives. Diagnostic Tests or Criteria, Level III.

The effect of challenge and hindrance stressors on safety behavior and safety outcomes: a meta-analysis.

PubMed

Clarke, Sharon

2012-10-01

The significance of occupational stressors as a risk factor in accidents has long been recognized; however, the behavioral mechanisms underlying this relationship are currently not well-understood. Meta-analysis was utilized to test the relationships between occupational stressors (challenge and hindrance), safety behaviors (compliance and participation), and safety outcomes (occupational injuries and near-misses). It was hypothesized that hindrance stressors would have negative effects on both safety compliance and safety participation, and subsequently, safety outcomes, whereas challenge stressors would have positive effects. The hypotheses relating to hindrance stressors were supported, suggesting that hindrance stressors lead to a significant reduction in both compliance with safety rules and participation in safety-related activities. Hindrance stressors were also associated with higher levels of occupational injuries and near-misses. The relationship between hindrance stressors and occupational injuries was fully mediated by safety behaviors. However, the hypotheses related to challenge stressors were not supported. Challenge stressors had a nonsignificant, near-zero association with compliance and occupational injuries, a small negative association with participation, and a small positive association with near-misses. The theoretical and practical implications of the meta-analytic findings are discussed, as well as avenues for further research.

The Relationship Between Homework Compliance and Therapy Outcomes: An Updated Meta-Analysis.

PubMed

Mausbach, Brent T; Moore, Raeanne; Roesch, Scott; Cardenas, Veronica; Patterson, Thomas L

2010-10-01

The current study was an updated meta-analysis of manuscripts since the year 2000 examining the effects of homework compliance on treatment outcome. A total of 23 studies encompassing 2,183 subjects were included. Results indicated a significant relationship between homework compliance and treatment outcome suggesting a small to medium effect (r = .26; 95% CI = .19-.33). Moderator analyses were conducted to determine the differential effect size of homework on treatment outcome by target symptoms (e.g., depression; anxiety), source of homework rating (e.g., client; therapist), timing of homework rating (e.g., retroactive vs. contemporaneous), and type of homework rating (e.g., Likert; total homeworks completed). Results indicated that effect sizes were robust across target symptoms, but differed by source of homework rating, timing of homework rating, and type of homework rating. Specifically, studies utilizing combined client and therapist ratings of compliance had significantly higher mean effect size relative to those using therapist only assessments and those using objective assessments. Further, studies that rated the percentage of homeworks completed had a significantly lower mean effect size compared to studies using Likert ratings, and retroactive assessments had higher effect size than contemporaneous assessments.

The Relationship Between Homework Compliance and Therapy Outcomes: An Updated Meta-Analysis

PubMed Central

Moore, Raeanne; Roesch, Scott; Cardenas, Veronica; Patterson, Thomas L.

2010-01-01

The current study was an updated meta-analysis of manuscripts since the year 2000 examining the effects of homework compliance on treatment outcome. A total of 23 studies encompassing 2,183 subjects were included. Results indicated a significant relationship between homework compliance and treatment outcome suggesting a small to medium effect (r = .26; 95% CI = .19–.33). Moderator analyses were conducted to determine the differential effect size of homework on treatment outcome by target symptoms (e.g., depression; anxiety), source of homework rating (e.g., client; therapist), timing of homework rating (e.g., retroactive vs. contemporaneous), and type of homework rating (e.g., Likert; total homeworks completed). Results indicated that effect sizes were robust across target symptoms, but differed by source of homework rating, timing of homework rating, and type of homework rating. Specifically, studies utilizing combined client and therapist ratings of compliance had significantly higher mean effect size relative to those using therapist only assessments and those using objective assessments. Further, studies that rated the percentage of homeworks completed had a significantly lower mean effect size compared to studies using Likert ratings, and retroactive assessments had higher effect size than contemporaneous assessments. PMID:20930925

Social Conflict and Sex Equity in Education.

ERIC Educational Resources Information Center

Quantz, Richard A.

1983-01-01

Holds that male/female differences in such behavior characteristics as aggression, cooperation/competition, compliance, and anxiety are not innate, but rather are social strategies available to both sexes and utilized whenever reasonable. Suggests that the sex equity problems in education can be solved by eliminating differential treatment of boys…

76 FR 623 - Proposed Information Collection (Equal Opportunity Compliance Review Report) Activity: Comment...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-05

..., Department of Veterans Affairs. ACTION: Notice. SUMMARY: The Veterans Benefits Administration (VBA... pursuant to Section 3506(c)(2)(A) of the PRA. With respect to the following collection of information, VBA... performance of VBA's functions, including whether the information will have practical utility; (2) the...

76 FR 47055 - Emergency Restoration Plan (ERP)

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-04

... the Paperwork Reduction Act of 1995 (44 U.S.C. chapter 35). E-Government Act Compliance The Rural Utilities Service is committed to the E-Government Act, which requires government agencies in general to..., telephone (202) 720-1900 or e-mail to [email protected] . SUPPLEMENTARY INFORMATION: Executive Order...

UPDATE A COMPUTER MODEL, TITLED GENII-NESHAPS VERSION 2, FOR EVALUATING ATMOSPHERIC RELEASES OF RADIONUCLIDES.

EPA Science Inventory

The GENII System provides a state-of-the-art, fully documented set of programs for calculating radiation dose and risk from radionuclides released to the environment. The GENII-NESHAPs Edition can be utilized for assessing compliance with 40 CFR 61, Subparts H and I.

40 CFR 63.9990 - What are the subcategories of EGUs?

Code of Federal Regulations, 2012 CFR

2012-07-01

... coal or gasified solid oil-derived fuel. For purposes of compliance, monitoring, recordkeeping, and...) National Emission Standards for Hazardous Air Pollutants: Coal- and Oil-Fired Electric Utility Steam... equal to 8,300 Btu/lb, and (2) EGUs designed for low rank virgin coal. (b) Oil-fired EGUs are...

40 CFR 63.9990 - What are the subcategories of EGUs?

Code of Federal Regulations, 2013 CFR

2013-07-01

... coal or gasified solid oil-derived fuel. For purposes of compliance, monitoring, recordkeeping, and...) National Emission Standards for Hazardous Air Pollutants: Coal- and Oil-Fired Electric Utility Steam... equal to 8,300 Btu/lb, and (2) EGUs designed for low rank virgin coal. (b) Oil-fired EGUs are...

40 CFR 63.9990 - What are the subcategories of EGUs?

Code of Federal Regulations, 2014 CFR

2014-07-01

... coal or gasified solid oil-derived fuel. For purposes of compliance, monitoring, recordkeeping, and...) National Emission Standards for Hazardous Air Pollutants: Coal- and Oil-Fired Electric Utility Steam... equal to 8,300 Btu/lb, and (2) EGUs designed for low rank virgin coal. (b) Oil-fired EGUs are...

EXTRACTION AND SPECIATION OF ARSENIC CONTAINING DRINKING WATER TREATMENT SOLIDS BY IC-ICP-MS

EPA Science Inventory

In 2001, the U.S. Environmental Protection Agency (EPA) passed the Arsenic Rule, which established a maximum contaminant level of 105g/L. Compliance with this regulation has caused a number of drinking water utilities to investigate potential treatment options. The adsorption o...

76 FR 38189 - New Proposed Collection; Comment Request; Environmental Science Formative Research Methodology...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-29

...; Comment Request; Environmental Science Formative Research Methodology Studies for the National Children's Study SUMMARY: In compliance with the requirement of Section 3506(c)(2)(A) of the Paperwork Reduction... comment was received. The comment questioned the cost and utility of the study specifically and of...

77 FR 42316 - Agency Information Collection Activities: Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-18

... surveys to determine whether health care facilities meet Medicare and Clinical Laboratory Improvement... estimated burden; (3) ways to enhance the quality, utility, and clarity of the information to be collected... information about quality of care and facility compliance. Form Number: CMS-2567 (OCN 0938-0391). Frequency...

14 CFR 23.681 - Limit load static tests.

Code of Federal Regulations, 2011 CFR

2011-01-01

... AIRWORTHINESS STANDARDS: NORMAL, UTILITY, ACROBATIC, AND COMMUTER CATEGORY AIRPLANES Design and Construction Control Systems § 23.681 Limit load static tests. (a) Compliance with the limit load requirements of this... loading in the control system; and (2) Each fitting, pulley, and bracket used in attaching the system to...

14 CFR 23.681 - Limit load static tests.

Code of Federal Regulations, 2010 CFR

2010-01-01

... AIRWORTHINESS STANDARDS: NORMAL, UTILITY, ACROBATIC, AND COMMUTER CATEGORY AIRPLANES Design and Construction Control Systems § 23.681 Limit load static tests. (a) Compliance with the limit load requirements of this... loading in the control system; and (2) Each fitting, pulley, and bracket used in attaching the system to...

14 CFR 23.681 - Limit load static tests.

Code of Federal Regulations, 2014 CFR

2014-01-01

... AIRWORTHINESS STANDARDS: NORMAL, UTILITY, ACROBATIC, AND COMMUTER CATEGORY AIRPLANES Design and Construction Control Systems § 23.681 Limit load static tests. (a) Compliance with the limit load requirements of this... loading in the control system; and (2) Each fitting, pulley, and bracket used in attaching the system to...

14 CFR 23.681 - Limit load static tests.

Code of Federal Regulations, 2012 CFR

2012-01-01

... AIRWORTHINESS STANDARDS: NORMAL, UTILITY, ACROBATIC, AND COMMUTER CATEGORY AIRPLANES Design and Construction Control Systems § 23.681 Limit load static tests. (a) Compliance with the limit load requirements of this... loading in the control system; and (2) Each fitting, pulley, and bracket used in attaching the system to...

14 CFR 23.681 - Limit load static tests.

Code of Federal Regulations, 2013 CFR

2013-01-01

... AIRWORTHINESS STANDARDS: NORMAL, UTILITY, ACROBATIC, AND COMMUTER CATEGORY AIRPLANES Design and Construction Control Systems § 23.681 Limit load static tests. (a) Compliance with the limit load requirements of this... loading in the control system; and (2) Each fitting, pulley, and bracket used in attaching the system to...

Is Your School Y2K-OK?

ERIC Educational Resources Information Center

Bates, Martine G.

1999-01-01

The most vulnerable Y2K areas for schools are networked computers, free-standing personal computers, software, and embedded chips in utilities such as telephones and fire alarms. Expensive, time-consuming procedures and software have been developed for testing and bringing most computers into compliance. Districts need a triage prioritization…

77 FR 61007 - Agency Information Collection Activities; Proposed Collection: Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-05

... information; (c) ways to enhance the quality, utility, and clarity of the information to be collected; and (d... funding that would potentially impact the environment and to ensure that their decision- making processes... Information Collection Activities; Proposed Collection: Comment Request In compliance with the requirement for...

7 CFR 2.47 - Administrator, Rural Utilities Service.

Code of Federal Regulations, 2010 CFR

2010-01-01

...)), with respect to information gathering and access requests and orders; compliance with Federal health... of exposure to significant risk to human health; (iv) Section 104(j) of the Act (42 U.S.C. 9604(j... the selection of a response action and identifying and notifying potentially responsible parties; (x...

7 CFR 2.47 - Administrator, Rural Utilities Service.

Code of Federal Regulations, 2011 CFR

2011-01-01

...)), with respect to information gathering and access requests and orders; compliance with Federal health... of exposure to significant risk to human health; (iv) Section 104(j) of the Act (42 U.S.C. 9604(j... the selection of a response action and identifying and notifying potentially responsible parties; (x...

76 FR 64340 - Combined Notice of Filings #1

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-18

... that the Commission received the following electric rate filings: Docket Numbers: ER11-4042-001...: FERC Electric Rate Schedule No. 43--SFA Compliance Filing to be effective 9/28/2011. Filed Date: 10/05... Power, LLC submits tariff filing per 35: Columbia Utilities Power FERC Electric Tariff to be effective 9...

NASA Office of Small and Disadvantaged Business Utilization

NASA Technical Reports Server (NTRS)

2001-01-01

The Office of Small and Disadvantaged Business Utilization (OSDBU) within NASA promotes the utilization of small, disadvantaged, and women-owned small businesses in compliance with Federal laws, regulations, and policies. We assist such firms in obtaining contracts and subcontracts with NASA and its prime contractors. The OSDBU also facilitates the participation of small businesses in NASA's technology transfer and commercialization activities. Our driving philosophy is to consider small businesses as our products. Our customers are the NASA Enterprises, Field Centers, Functional Staff Offices, major prime contractors, and other large institutions. We hone the skills of our products to make them marketable to our customers in the performance of NASA missions.

Preclinical Determinants of Drug Choice under Concurrent Schedules of Drug Self-Administration

PubMed Central

Banks, Matthew L.; Negus, S. Stevens

2012-01-01

Drug self-administration procedures have played a critical role in the experimental analysis of psychoactive compounds, such as cocaine, for over 50 years. While there are numerous permutations of this procedure, this paper will specifically focus on choice procedures using concurrent schedules of intravenous drug self-administration. The aims of this paper are to first highlight the evolution of drug choice procedures and then review the subsequent preclinical body of literature utilizing these choice procedures to understand the environmental, pharmacological, and biological determinants of the reinforcing stimulus effects of drugs. A main rationale for this paper is our proposition that choice schedules are underutilized in investigating the reinforcing effects of drugs in assays of drug self-administration. Moreover, we will conclude with potential future directions and unexplored scientific space for the use of drug choice procedures. PMID:23243420

Trauma team utilization of universal precautions: if you see something, say something.

PubMed

Peponis, T; Cropano, M C; Larentzakis, A; van der Wilden, M G; Mejaddam, Y A; Sideris, C A; Michailidou, M; Fikry, K; Bramos, A; Janjua, S; Chang, Y; King, D R

2017-02-01

The risks deriving from the lack of compliance with universal safety precautions (USPs) are unequivocal. However, the adoption of these prophylactic precautions by healthcare providers remains unacceptably low. We hypothesized that trauma teams are not routinely adhering to USPs and that a brief educational intervention, followed by real-time peer feedback, would substantially improve compliance rates. This before-and-after interventional study took place in the resuscitation bay of a Level I Trauma Center during trauma team activations. Six USPs were examined: hand washing (before and after patient contact), use of gloves, gowns, eye protection, and masks. Surgery and Emergency Medicine attending physicians, residents, and nurses, who had direct patient contact, were included. Following 162 baseline observations, an educational intervention in the form of brief lectures was conducted, emphasizing the danger to self from dereliction of USPs. Subsequently, 167 post-intervention observations were made after a one-month period of knowledge decay. Finally, real-time feedback was provided by trauma team leaders and study staff. Adherence to prophylactic measures was recorded again. Baseline compliance rates were dismal. Only hand washing prior to patient interaction, the use of eye protection, and the use of masks improved significantly (p < 0.05) after the educational initiative. However, compliance rates remained suboptimal. No difference was noted regarding the three other USPs. Impressively, following real-time behavioral corrections, compliance improved to nearly 90 % for all USPs (p < 0.05). Compliance with OSHA-required USPs during trauma team activations is unacceptably low, but can be dramatically improved through simple educational interventions, combined with real-time peer feedback.

Integrating Genomic Resources with Electronic Health Records using the HL7 Infobutton Standard

PubMed Central

Overby, Casey Lynnette; Del Fiol, Guilherme; Rubinstein, Wendy S.; Maglott, Donna R.; Nelson, Tristan H.; Milosavljevic, Aleksandar; Martin, Christa L.; Goehringer, Scott R.; Freimuth, Robert R.; Williams, Marc S.

2016-01-01

Summary Background The Clinical Genome Resource (ClinGen) Electronic Health Record (EHR) Workgroup aims to integrate ClinGen resources with EHRs. A promising option to enable this integration is through the Health Level Seven (HL7) Infobutton Standard. EHR systems that are certified according to the US Meaningful Use program provide HL7-compliant infobutton capabilities, which can be leveraged to support clinical decision-making in genomics. Objectives To integrate genomic knowledge resources using the HL7 infobutton standard. Two tactics to achieve this objective were: (1) creating an HL7-compliant search interface for ClinGen, and (2) proposing guidance for genomic resources on achieving HL7 Infobutton standard accessibility and compliance. Methods We built a search interface utilizing OpenInfobutton, an open source reference implementation of the HL7 Infobutton standard. ClinGen resources were assessed for readiness towards HL7 compliance. Finally, based upon our experiences we provide recommendations for publishers seeking to achieve HL7 compliance. Results Eight genomic resources and two sub-resources were integrated with the ClinGen search engine via OpenInfobutton and the HL7 infobutton standard. Resources we assessed have varying levels of readiness towards HL7-compliance. Furthermore, we found that adoption of standard terminologies used by EHR systems is the main gap to achieve compliance. Conclusion Genomic resources can be integrated with EHR systems via the HL7 Infobutton standard using OpenInfobutton. Full compliance of genomic resources with the Infobutton standard would further enhance interoperability with EHR systems. PMID:27579472

[Utilization suitability of forest resources in typical forest zone of Changbai Mountains].

PubMed

Hao, Zhanqing; Yu, Deyong; Xiong, Zaiping; Ye, Ji

2004-10-01

Conservation of natural forest does not simply equal to no logging. The Northeast China Forest Region has a logging quota of mature forest as part of natural forest conservation project. How to determine the logging spots rationally and scientifically is very important. Recent scientific theories of forest resources management advocate that the utilization of forest resources should stick to the principle of sustaining use, and pay attention to the ecological function of forest resources. According to the logging standards, RS and GIS techniques can be used to detect the precise location of forest resources and obtain information of forest areas and types, and thus, provide more rational and scientific support for space choice about future utilization of forest resources. In this paper, the Lushuihe Forest Bureau was selected as a typical case in Changbai Mountains Forest Region to assess the utilization conditions of forest resources, and some advices on spatial choice for future management of forest resources in the study area were offered.

Organization and Visualization for Initial Analysis of Forced-Choice Ipsative Data

ERIC Educational Resources Information Center

Cochran, Jill A.

2015-01-01

Forced-choice ipsative data are common in personality, philosophy and other preference-based studies. However, this type of data inherently contains dependencies that are challenging for usual statistical analysis. In order to utilize the structure of the data as a guide for analysis rather than as a challenge to manage, a visualisation tool was…

Sophisticated Approval Voting, Ignorance Priors, and Plurality Heuristics: A Behavioral Social Choice Analysis in a Thurstonian Framework

ERIC Educational Resources Information Center

Regenwetter, Michel; Ho, Moon-Ho R.; Tsetlin, Ilia

2007-01-01

This project reconciles historically distinct paradigms at the interface between individual and social choice theory, as well as between rational and behavioral decision theory. The authors combine a utility-maximizing prescriptive rule for sophisticated approval voting with the ignorance prior heuristic from behavioral decision research and two…

Determinants of School Choice: Understanding How Parents Choose Elementary Schools in Alberta

ERIC Educational Resources Information Center

Bosetti, Lynn

2004-01-01

Rational choice theory suggests that parents are utility maximizers who make decisions from clear value preferences, that they are able to demand effective action from local schools and teachers, and that they can be relied upon to pursue the best interests of their children. This paper presents a different perspective and argues that parents…

Preference on cash-choice task predicts externalizing outcomes in 17-year-olds.

PubMed

Sparks, Jordan C; Isen, Joshua D; Iacono, William G

2014-03-01

Delay-discounting, the tendency to prefer a smaller-sooner reward to a larger-later reward, has been associated with a range of externalizing behaviors. Laboratory delay-discounting tasks have emerged as a useful measure to index impulsivity and a proclivity towards externalizing pyschopathology. While many studies demonstrate the existence of a latent externalizing factor that is heritable, there have been few genetic studies of delay-discounting. Further, the increased vulnerability for risky behavior in adolescence makes adolescent samples an attractive target for future research, and expeditious, ecologically-valid delay-discounting measures are helpful in this regard. The primary goal of this study was to help validate the utility of a "cash-choice" measure for use in a sample of older adolescents. We used a sample of 17-year-old twins (n = 791) from the Minnesota Twin Family Enrichment study. Individuals who chose the smaller-sooner reward were more likely to have used a range of addictive substances, engaged in sexual intercourse, and earned lower GPAs. Best fitting biometric models from univariate analyses supported the heritability of cash-choice and externalizing, but bivariate modeling results indicated that the correlation between cash-choice and externalizing was determined largely by shared environmental influences, thus failing to support cash-choice as a possible endophenotype for externalizing in this age group. Our findings lend further support to the utility of cash-choice as a measure of individual differences in decision making and suggest that, by late adolescence, this task indexes shared environmental risk for externalizing behavior.

Antibiotic Prescribing Practices for Prevention of Surgical Site Infections in Australia: Increased Uptake of National Guidelines after Surveillance and Reporting and Impact on Infection Rates.

PubMed

Bull, Ann L; Worth, Leon J; Spelman, Tim; Richards, Michael J

2017-10-01

Antimicrobial prophylaxis is the single most effective intervention to reduce risk of surgical site infections (SSIs); however, prescribing practices should be aligned with accepted and recommended surgical antibiotic prophylaxis (SAP) regimens to be effective. As part of a comprehensive surveillance network, SAP data are collated and analyzed for compliance with recommendations. Results are reported to hospitals for quality improvement purposes. In this study, statewide results were analyzed to ascertain changes over time and whether improved compliance was associated with a reduction in risk for SSI. A standardized tool for monitoring SAP and SSIs was used in Victorian healthcare facilities. For the current study, data submitted for the period 2003-2015 were analyzed. Compliance with national recommendations (Australian Therapeutic Guidelines-Antibiotic) was used as the reference standard for antibiotic selection, timing, and duration Results: A total of 144,075 surgical procedures were surveyed during the study period. During this period, the proportion of patients receiving antibiotic agents according to national guidelines increased. Across all surgical groups, the odds ratio (OR) for appropriate SAP choice increased by 13%/year. Greatest improvement was seen for colorectal procedures (19%/year), with the smallest change observed for cholecystectomy and cardiac operations (9%/year). The OR for receiving an antibiotic agent at the recommended time increased by 12%/year and the odds of the antibiotic agent being discontinued within 24 hours by 27%/year. Non-compliance with a recommended SAP agent and timing was associated with an increased risk of SSI across all procedure groups (OR 1.33, 95% confidence interval 1.24-1.43). Sustained improvements in prescribing practices for SAP have been demonstrated through a comprehensive surveillance and reporting system. Non-compliance with SAP guidelines is associated with an increased risk for SSI. Quality improvement programs must focus on uptake and implementation of evidence-based guidelines.

A RCT study of Rivaroxaban, low-molecular-weight heparin, and sequential medication regimens for the prevention of venous thrombosis after internal fixation of hip fracture.

PubMed

Tang, Yilun; Wang, Kunzheng; Shi, Zhibin; Yang, Pei; Dang, Xiaoqian

2017-08-01

The guidelines for the prevention of venous thromboembolism in orthopedic surgeries have reached a consensus on the postoperative conventional anticoagulation. However, the choice of anticoagulant drugs is yet controversial. The use of the drug rivaroxaban is expensive. Since the compliance of patients with low-molecular-weight heparin is considerably low, a cost-effective, efficacious and convenient anticoagulant program is essential. The present study investigated the efficacy, safety, patient compliance, and cost-effectiveness of low-molecular-weight heparin with sequential Rivaroxaban anticoagulant therapy in patients with a hip fracture, following internal fixation. A total of 287 patients with hip fractures were randomized into three groups: Rivaroxaban alone, Enoxaparin alone, and Enoxaparin followed by Rivaroxaban. The primary endpoint was the incidence of postoperative VTE, whereas the secondary endpoints were the compliance and treatment costs. Adverse reactions included bleeding and wound complications. The incidences of VTE were 5.21%, 14.74%, and 10.42% in the Rivaroxaban, low-molecular-weight heparin, and sequential therapy groups, respectively. The VTE-related mortality rates were 0%, 1.05%, and 1.04%. The average hospital stay was 12±8,15±7, and 11±5d, whereas the compliance rates of the three groups were 82.3%, 71.6%, and 88.5%, respectively. The incidences of adverse incisions were 14.6%, 4.2%, and 6.3% for the three groups examined. The effects and the incidence of postoperative bleeding in the treatment of low-molecular-weight heparin followed by Rivaroxaban did not differ significantly from that of Rivaroxaban alone. However, the postoperative drainage, the cost of treatment and the incidence of VTE reduced significantly, whereas the incidences of adverse incisions and the patient compliance were increased. ChiCTR-INR-17010495. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Determinants of Quality of Life in Lung Cancer Patients.

PubMed

Hung, Hsiu-Yu; Wu, Li-Min; Chen, Kang-Pan

2018-05-01

To examine the relationships of self-care, symptoms, and a variety of demographic factors to quality of life (QOL), and to identify determinants of QOL in lung cancer patients undergoing chemotherapy. A cross-sectional, correlational study. 159 patients with lung cancer undergoing chemotherapy were recruited from three southern hospitals in Taiwan. Four instruments were used: the Quality of Life Questionnaire Core 30-item (QLQ-C30), M.D. Anderson Symptom Inventory (MDASI), Memorial Symptom Assessment Scale-Short Form (MSAS-SF), and Self-Care Behavior Scale (SCBS). Lung cancer patients rated lower scores of self-care behaviors on food choice and nutrition maintenance, regular exercise and sleep, and medical compliance. Being younger, having spouses as main caregivers, having food choice and nutrition maintenance, and getting regular exercise and sleep were associated with better QOL. Degree of interference with life, age, food choice and nutrition maintenance, and psychological symptoms were found to predict functional QOL and accounted for 43% of total variance. The findings identified factors influencing QOL and provided evidence for designing an intervention to enhance QOL in lung cancer patients undergoing chemotherapy. The findings may be useful for guiding intervention development for early detection and management of symptom interference with daily living, and place greater focus on patient self-care to promote food choice and nutrition maintenance, especially in older patients and those whose caregivers are not their spouses. © 2018 Sigma Theta Tau International.

The Priority Heuristic: Making Choices without Trade-Offs

ERIC Educational Resources Information Center

Brandstatter, Eduard; Gigerenzer, Gerd; Hertwig, Ralph

2006-01-01

Bernoulli's framework of expected utility serves as a model for various psychological processes, including motivation, moral sense, attitudes, and decision making. To account for evidence at variance with expected utility, the authors generalize the framework of fast and frugal heuristics from inferences to preferences. The priority heuristic…

Report of health and environmental effects of increased coal utilization by the Committee on Health and Environmental Effects of Increased Coal Utilization.

PubMed

1980-06-01

The National Energy Plan announced by President Carter on April 29, 1977 proposed a significant increase in the utilization of the vast domestic deposits of coal to replace the dwindling supplies of oil and natural gas, and increasingly expensive oil from foreign sources, to meet national energy needs. At the same time, in recognition of possible adverse health and ecological consequences of increased coal production and use, the President announced that a special committee would be formed to study this aspect of the National Energy Plan. The Committee held a series of public meetings during November and December 1977 to review a number of special papers on particular problems associated with increased coal utilization. These papers, which were prepared by scientists of the US Environmental Protection Agency; the Department of Energy; the HEW National Institute for Occupational Safety and Health, and the National Institute of Environmental Health Sciences; New York University; and Vanderbilt University; provided essential background information for the deliberations of the Committee and were published in EHP Vol. 33, pp. 127-314, 1979. One paper by A. P. Altschuler et al. is published in this volume of EHP. The Committee's basic finding was that it is safe to proceed with plans to increase the utilization of coal if the following environmental and safety policies are adhered to:* Compliance with Federal and State air, water, and solid waste regulations* Universal adoption and successful operation of best available control technology on new facilities* Compliance with reclamation standards* Compliance with mine health and safety standards* Judicious siting of coal-fired facilitiesThe Committee concluded that, even with the best mitigation policies, there will be some adverse health and environmental effects from the dramatic increase in coal use. However, these will not impact all regions and individuals uniformly. The Committee identified six major areas of uncertainty and concern requiring further investigation if the nation is to minimize undesirable consequences of increased coal utilization now, and in the future. Two critical health issues of concern are air pollution health effects and coal mine worker health and safety. Two critical environmental issues are global effects of carbon dioxide in the atmosphere and acid fallout. Two additional important issues of concern are trace elements in the environment and reclamation of arid land.Finally, because of the inadequate data and methodology used in the study of these matters, the Committee strongly recommended the establishment of an improved national environmental data collection, modeling and monitoring system.

Demographic and socioeconomic disparity in nutrition: application of a novel Correlated Component Regression approach

PubMed Central

Alkerwi, Ala'a; Vernier, Céderic; Sauvageot, Nicolas; Crichton, Georgina E; Elias, Merrill F

2015-01-01

Objectives This study aimed to examine the most important demographic and socioeconomic factors associated with diet quality, evaluated in terms of compliance with national dietary recommendations, selection of healthy and unhealthy food choices, energy density and food variety. We hypothesised that different demographic and socioeconomic factors may show disparate associations with diet quality. Study design A nationwide, cross-sectional, population-based study. Participants A total of 1352 apparently healthy and non-institutionalised subjects, aged 18–69 years, participated in the Observation of Cardiovascular Risk Factors in Luxembourg (ORISCAV-LUX) study in 2007–2008. The participants attended the nearest study centre after a telephone appointment, and were interviewed by trained research staff. Outcome measures Diet quality as measured by 5 dietary indicators, namely, recommendation compliance index (RCI), recommended foods score (RFS), non-recommended foods score (non-RFS), energy density score (EDS), and dietary diversity score (DDS). The novel Correlated Component Regression (CCR) technique was used to determine the importance and magnitude of the association of each socioeconomic factor with diet quality, in a global analytic approach. Results Increasing age, being male and living below the poverty threshold were predominant factors associated with eating a high energy density diet. Education level was an important factor associated with healthy and adequate food choices, whereas economic resources were predominant factors associated with food diversity and energy density. Conclusions Multiple demographic and socioeconomic circumstances were associated with different diet quality indicators. Efforts to improve diet quality for high-risk groups need an important public health focus. PMID:25967988

Implementing a Mediterranean-Style Diet Outside the Mediterranean Region.

PubMed

Murphy, Karen J; Parletta, Natalie

2018-05-04

Populations surrounding the Mediterranean basin have traditionally reaped health benefits from a Mediterranean diet (MedDiet), which may benefit Westernized countries plagued by chronic disease. But is it feasible to implement beyond the Mediterranean? To answer this question, we present evidence from randomized controlled trials that achieved high dietary compliance rates with subsequent physical and mental health benefits. In the 1960s, the Seven Countries Study identified dietary qualities of Mediterranean populations associated with healthy aging and longevity. The PREDIMED study confirmed reductions in CVD-related mortality with a MedDiet; a meta-analysis in over 4.7 million people showed reduced mortality, CVD-related mortality, and reduced risk of Parkinson's and Alzheimer's disease. Continually emerging research supports the MedDiet's benefits for chronic diseases including metabolic syndrome, cancers, liver disease, type 2 diabetes, depression, and anxiety. We summarize components of studies outside the Mediterranean that achieved high compliance to a Med-style diet: dietitian led, dietary education, goal setting, mindfulness; recipe books, meal plans, and food checklists; food hampers; regular contact between volunteers and staff through regular cooking classes; clinic visits; and recipes that are simple, palatable, and affordable. The next step is testing the MedDiet's feasibility in the community. Potential obstacles include access to dietetic/health care professionals, high meat intake, pervasive processed foods, and fast food outlets. For Western countries to promote a Med-style diet, collective support from government, key stakeholders and policy makers, food industry, retailers, and health professionals is needed to ensure the healthiest choice is the easiest choice.

[Study on application of low altitude remote sensing to Chinese herb medicinal sustainable utilization].

PubMed

Zhou, Ying-Qun; Chen, Shi-Lin; Zhao, Run-Huai; Xie, Cai-Xiang; Li, Ying

2008-04-01

Sustainable utilization and bio-diversity protection of traditional Chinese medicine (TCM) have been a hotspot of the TCM study at present, in which the choice of appropriate method is one of the primary problems confronted. This paper described the technical system, equipment and image processing of low altitude remote sensing, and analyzed its future application in Chinese herb medicinal sustainable utilization.

Developing and testing a decision model for predicting influenza vaccination compliance.

PubMed Central

Carter, W B; Beach, L R; Inui, T S; Kirscht, J P; Prodzinski, J C

1986-01-01

Influenza vaccination has long been recommended for elderly high-risk patients, yet national surveys indicate that vaccination compliance rates are remarkably low (20 percent). We conducted a study to model prospectively the flu shot decisions and subsequent behavior of an elderly and/or chronically diseased (at high risk for complications of influenza) ambulatory care population at the Seattle VA Medical Center. Prior to the 1980-81 flu shot season, a random (stratified by disease) sample of 63 patients, drawn from the total population of high-risk patients in the general medicine clinic, was interviewed to identify patient-defined concerns regarding flu shots. Six potential consequences of influenza and nine of vaccination were emphasized by patients and provided the content for a weighted hierarchical utility model questionnaire. The utility model provides an operational framework for (1) obtaining subjective value and relative importance judgments from patients; (2) combining these judgments to obtain a prediction of behavioral intention and behavior for each patient; and, if the model is valid (predictive of behavior), (3) identifying those factors which are most salient to patient's decisions and subsequent behavior. Prior to the 1981-82 flu season, the decision model questionnaire was administered to 350 other high-risk patients from the same general medicine clinic population. The decision model correctly predicted behavioral intention for 87 percent and vaccination behavior for 82 percent of this population and, more importantly, differentiated shot "takers" and "nontakers" along several attitudinal dimensions that suggest specific content areas for clinical compliance intervention strategies. PMID:3949541

Effect of a rehabilitation-based chronic disease management program targeting severe COPD exacerbations on readmission patterns.

PubMed

Lalmolda, C; Coll-Fernández, R; Martínez, N; Baré, M; Teixidó Colet, M; Epelde, F; Monsó, E

2017-01-01

Pulmonary rehabilitation (PR) is recommended after a severe COPD exacerbation, but its short- and long-term effects on health care utilization have not been fully established. The aims of this study were to evaluate patient compliance with a chronic disease management (CDM) program incorporating home-based exercise training as the main component after a severe COPD exacerbation and to determine its effects on health care utilization in the following year. COPD patients with a severe exacerbation were included in a case-cohort study at admission. An intervention group participated in a nurse-supervised CDM program during the 2 months after discharge, comprising of home-based PR with exercise components directly supervised by a physiotherapist, while the remaining patients followed usual care. Nineteen of the twenty-one participants (90.5%) were compliant with the CDM program and were compared with 29 usual-care patients. Compliance with the program was associated with statistically significant reductions in admissions due to respiratory disease in the following year (median [interquartile range]: 0 [0-1] vs 1 [0-2.5]; P =0.022) and in days of admission (0 [0-7] vs 7 [0-12]; P =0.034), and multiple linear regression analysis confirmed the protective effect of the CDM program (β coefficient -0.785, P =0.014, and R 2 =0.219). A CDM program incorporating exercise training for COPD patients without limiting comorbidities after a severe exacerbation achieves high compliance and reduces admissions in the year following after the intervention.

Learning from the implementation of residential optional time of use pricing in the United States electricity industry

NASA Astrophysics Data System (ADS)

Li, Xibao

Residential time-of-use (TOU) rates have been in practice in the U.S. since the 1970s. However, for institutional, political, and regulatory reasons, only a very small proportion of residential customers are actually on these schedules. In this thesis, I explore why this is the case by empirically investigating two groups of questions: (1) On the "supply" side: Do utilities choose to offer TOU rates in residential sectors on their own initiative if state commissions do not order them to do so? Since utilities have other options, what is the relationship between the TOU rate and other alternatives? To answer these questions, I survey residential tariffs offered by more than 100 major investor-owned utilities, study the impact of various factors on utilities' rate-making behavior, and examine utility revealed preferences among four rate options: seasonal rates, inverted block rates, demand charges, and TOU rates. Estimated results suggest that the scale of residential sectors and the revenue contribution from residential sectors are the only two significant factors that influence utility decisions on offering TOU rates. Technical and economic considerations are not significant statistically. This implies that the little acceptance of TOU rates is partly attributed to utilities' inadequate attention to TOU rate design. (2) On the "demand" side: For utilities offering TOU tariffs, why do only a very small proportion of residential customers choose these tariffs? What factors influence customer choices? Unlike previous studies that used individual-level experimental data, this research employs actual aggregated information from 29 utilities offering optional TOU rates. By incorporating neo-classical demand analysis into an aggregated random coefficient logit model, I investigate the impact of both price and non-price tariff characteristics and non-tariff factors on customer choice behavior. The analysis indicates that customer pure tariff preference (which captures the effect of all unincluded factors) is a crucial obstacle to the public acceptance of TOU tariffs. Besides rate levels, non-price tariff characteristics and non-tariff factors are also important in influencing customer choice. It is observed that high income home owners have very different preferences than others.

Active stabilization to prevent surge in centrifugal compression systems

NASA Technical Reports Server (NTRS)

Epstein, Alan H.; Greitzer, Edward M.; Simon, Jon S.; Valavani, Lena

1993-01-01

This report documents an experimental and analytical study of the active stabilization of surge in a centrifugal engine. The aims of the research were to extend the operating range of a compressor as far as possible and to establish the theoretical framework for the active stabilization of surge from both an aerodynamic stability and a control theoretic perspective. In particular, much attention was paid to understanding the physical limitations of active stabilization and how they are influenced by control system design parameters. Previously developed linear models of actively stabilized compressors were extended to include such nonlinear phenomena as bounded actuation, bandwidth limits, and robustness criteria. This model was then used to systematically quantify the influence of sensor-actuator selection on system performance. Five different actuation schemes were considered along with four different sensors. Sensor-actuator choice was shown to have a profound effect on the performance of the stabilized compressor. The optimum choice was not unique, but rather shown to be a strong function of some of the non-dimensional parameters which characterize the compression system dynamics. Specifically, the utility of the concepts were shown to depend on the system compliance to inertia ratio ('B' parameter) and the local slope of the compressor speedline. In general, the most effective arrangements are ones in which the actuator is most closely coupled to the compressor, such as a close-coupled bleed valve inlet jet, rather than elsewhere in the flow train, such as a fuel flow modulator. The analytical model was used to explore the influence of control system bandwidth on control effectiveness. The relevant reference frequency was shown to be the compression system's Helmholtz frequency rather than the surge frequency. The analysis shows that control bandwidths of three to ten times the Helmholtz frequency are required for larger increases in the compressor flow range. This has important implications for implementation in gas turbine engines since the Helmholtz frequencies can be over 100 Hz, making actuator design extremely challenging.

Planform, aero-structural, and flight control optimization for tailless morphing aircraft

NASA Astrophysics Data System (ADS)

Molinari, Giulio; Arrieta, Andres F.; Ermanni, Paolo

2015-04-01

Tailless airplanes with swept wings rely on variations of the spanwise lift distribution to provide controllability in roll, pitch and yaw. Conventionally, this is achieved utilizing multiple control surfaces, such as elevons, on the wing trailing edge. As every flight condition requires different control moments (e.g. to provide pitching moment equilibrium), these surfaces are practically permanently displaced. Due to their nature, causing discontinuities, corners and gaps, they bear aerodynamic penalties, mostly in terms of shape drag. Shape adaptation, by means of chordwise morphing, has the potential of varying the lift of a wing section by deforming its profile in a way that minimizes the resulting drag. Furthermore, as the shape can be varied differently along the wingspan, the lift distribution can be tailored to each specific flight condition. For this reason, tailless aircraft appear as a prime choice to apply morphing techniques, as the attainable benefits are potentially significant. In this work, we present a methodology to determine the optimal planform, profile shape, and morphing structure for a tailless aircraft. The employed morphing concept is based on a distributed compliance structure, actuated by Macro Fiber Composite (MFC) piezoelectric elements. The multidisciplinary optimization is performed considering the static and dynamic aeroelastic behavior of the resulting structure. The goal is the maximization of the aerodynamic efficiency while guaranteeing the controllability of the plane, by means of morphing, in a set of flight conditions.

A review of game-theoretic models of road user behaviour.

PubMed

Elvik, Rune

2014-01-01

This paper reviews game-theoretic models that have been developed to explain road user behaviour in situations where road users interact with each other. The paper includes the following game-theoretic models: 1.A general model of the interaction between road users and their possible reaction to measures improving safety (behavioural adaptation).2.Choice of vehicle size as a Prisoners’ dilemma game.3.Speed choice as a co-ordination game.4.Speed compliance as a game between drivers and the police.5.Merging into traffic from an acceleration lane as a mixed-strategy game.6.Choice of level of attention in following situations as an evolutionary game.7.Choice of departure time to avoid congestion as variant of a Prisoners’ dilemma game.8.Interaction between cyclists crossing the road and car drivers.9.Dipping headlights at night well ahead of the point when glare becomes noticeable.10.Choice of evasive action in a situation when cars are on collision course. The models reviewed are different in many respects, but a common feature of the models is that they can explain how informal norms of behaviour can develop among road users and be sustained even if these informal norms violate the formal regulations of the traffic code. Game-theoretic models are not applicable to every conceivable interaction between road users or to situations in which road users choose behaviour without interacting with other road users. Nevertheless, it is likely that game-theoretic models can be applied more widely than they have been until now. Copyright © 2013 Elsevier Ltd. All rights reserved.

Nutrieconomic model can facilitate healthy and low-cost food choices.

PubMed

Primavesi, Laura; Caccavelli, Giovanna; Ciliberto, Alessandra; Pauze, Emmanuel

2015-04-01

Promotion of healthy eating can no longer be postponed as a priority, given the alarming growth rate of chronic degenerative diseases in Western countries. We elaborated a nutrieconomic model to assess and identify the most nutritious and affordable food choices. Seventy-one food items representing the main food categories were included and their nationally representative prices monitored. Food composition was determined using CRA-NUT (Centro di Ricerca per gli Alimenti e la Nutrizione) and IEO (Istituto Europeo di Oncologia) databases. To define food nutritional quality, the mean adequacy ratio and mean excess ratio were combined. Both prices and nutritional quality were normalised for the edible food content and for the recommended serving sizes for the Italian adult population. Stores located in different provinces throughout Italy. Not applicable. Cereals and legumes presented very similar nutritional qualities and prices per serving. Seasonal fruits and vegetables presented differentiated nutritional qualities and almost equal prices. Products of animal origin showed similar nutritional qualities and varied prices: the best nutrieconomic choices were milk, oily fish and poultry for the dairy products, fish and meat groups, respectively. Analysing two balanced weekly menus, our nutrieconomic model was able to note a significant decrease in cost of approximately 30 % by varying animal-protein sources without affecting nutritional quality. Healthy eating does not necessarily imply spending large amounts of money but rather being able to make nutritionally optimal choices. The nutrieconomic model is an innovative and practical way to help consumers make correct food choices and nutritionists increase the compliance of their patients.

Using a discrete choice experiment to value the QLU-C10D: feasibility and sensitivity to presentation format.

PubMed

Norman, R; Viney, R; Aaronson, N K; Brazier, J E; Cella, D; Costa, D S J; Fayers, P M; Kemmler, G; Peacock, S; Pickard, A S; Rowen, D; Street, D J; Velikova, G; Young, T A; King, M T

2016-03-01

To assess the feasibility of using a discrete choice experiment (DCE) to value health states within the QLU-C10D, a utility instrument derived from the QLQ-C30, and to assess clarity, difficulty, and respondent preference between two presentation formats. We ran a DCE valuation task in an online panel (N = 430). Respondents answered 16 choice pairs; in half of these, differences between dimensions were highlighted, and in the remainder, common dimensions were described in text and differing attributes were tabulated. To simplify the cognitive task, only four of the QLU-C10D's ten dimensions differed per choice set. We assessed difficulty and clarity of the valuation task with Likert-type scales, and respondents were asked which format they preferred. We analysed the DCE data by format with a conditional logit model and used Chi-squared tests to compare other responses by format. Semi-structured telephone interviews (N = 8) explored respondents' cognitive approaches to the valuation task. Four hundred and forty-nine individuals were recruited, 430 completed at least one choice set, and 422/449 (94 %) completed all 16 choice sets. Interviews revealed that respondents found ten domains difficult but manageable, many adopting simplifying heuristics. Results for clarity and difficulty were identical between formats, but the "highlight" format was preferred by 68 % of respondents. Conditional logit parameter estimates were monotonic within domains, suggesting respondents were able to complete the DCE sensibly, yielding valid results. A DCE valuation task in which only four of the QLU-C10D's ten dimensions differed in any choice set is feasible for deriving utility weights for the QLU-C10D.

Probabilistic choice models in health-state valuation research: background, theories, assumptions and applications.

PubMed

Arons, Alexander M M; Krabbe, Paul F M

2013-02-01

Interest is rising in measuring subjective health outcomes, such as treatment outcomes that are not directly quantifiable (functional disability, symptoms, complaints, side effects and health-related quality of life). Health economists in particular have applied probabilistic choice models in the area of health evaluation. They increasingly use discrete choice models based on random utility theory to derive values for healthcare goods or services. Recent attempts have been made to use discrete choice models as an alternative method to derive values for health states. In this article, various probabilistic choice models are described according to their underlying theory. A historical overview traces their development and applications in diverse fields. The discussion highlights some theoretical and technical aspects of the choice models and their similarity and dissimilarity. The objective of the article is to elucidate the position of each model and their applications for health-state valuation.

College Choice of Minority Students Admitted to Institutions in the Council for Christian Colleges and Universities

ERIC Educational Resources Information Center

Confer, Christopher; Mamiseishvili, Ketevan

2012-01-01

The study examined the factors that affected minority students' choice to enroll at private four-year faith-based institutions in the Council of Christian Colleges and Universities (CCCU) in the United States. The study utilized the data from the College Board's Admitted Student Questionnaire PLUS (ASQ PLUS) survey. The final sample included 283…

Application of a Utility Analysis to Evaluate a Novel Assessment Tool for Clinically Oriented Physiology and Pharmacology

ERIC Educational Resources Information Center

Cramer, Nicholas; Asmar, Abdo; Gorman, Laurel; Gros, Bernard; Harris, David; Howard, Thomas; Hussain, Mujtaba; Salazar, Sergio; Kibble, Jonathan D.

2016-01-01

Multiple-choice questions are a gold-standard tool in medical school for assessment of knowledge and are the mainstay of licensing examinations. However, multiple-choice questions items can be criticized for lacking the ability to test higher-order learning or integrative thinking across multiple disciplines. Our objective was to develop a novel…

Tuition Tax Deductions and Parent School Choice: A Case Study of Minnesota.

ERIC Educational Resources Information Center

Darling-Hammond, Linda; Kirby, Sheila Nataraj

This report presents the results of one of the first empirical investigations of how a tax subsidy for tuition costs actually influences parents' school choices. It provides data about subsidy costs, utilization, and effects in Minnesota, the first state to have a tuition subsidy pass judicial review at all levels of the court system. The study…

A Systematic Assessment of "None of the Above" on Multiple Choice Tests in a First Year Psychology Classroom

ERIC Educational Resources Information Center

Pachai, Matthew V.; DiBattista, David; Kim, Joseph A.

2015-01-01

Multiple choice writing guidelines are decidedly split on the use of "none of the above" (NOTA), with some authors discouraging and others advocating its use. Moreover, empirical studies of NOTA have produced mixed results. Generally, these studies have utilized NOTA as either the correct response or a distractor and assessed its effect…

An Analysis of Discourse-Pragmatic and Grammatical Constraints on the Acquisition and Development of Referential Choice in Child English

ERIC Educational Resources Information Center

Hughes, Mary E.

2011-01-01

This dissertation investigates how discourse-pragmatics informs children's choice of referential forms. Three studies utilizing naturalistic data examine the role that six discourse-pragmatic features play in the acquisition of referential forms in a non-null subject language, English. The influence of child-directed speech on development is also…

A New Consequence of Simpson's Paradox: Stable Cooperation in One-Shot Prisoner's Dilemma from Populations of Individualistic Learners

ERIC Educational Resources Information Center

Chater, Nick; Vlaev, Ivo; Grinberg, Maurice

2008-01-01

Theories of choice in economics typically assume that interacting agents act individualistically and maximize their own utility. Specifically, game theory proposes that rational players should defect in one-shot prisoners' dilemmas (PD). Defection also appears to be the inevitable outcome for agents who learn by reinforcement of past choices,…

School Choice Considerations and the Role of Social Media as Perceived by Computing Students: Evidence from One University in Manila

ERIC Educational Resources Information Center

Lansigan, Rolando R.; Moraga, Shirley D.; Batalla, Ma. Ymelda C.; Bringula, Rex P.

2016-01-01

This descriptive study utilized a validated questionnaire that gathered data from freshmen of two different school years. Demographic profile, marketers (i.e., source of information of students about the school), influencers (i.e., significant others that persuaded them to enroll in the school), level of school choice, and level of consideration…

Flavored Anesthetic Masks for Inhalational Induction in Children.

PubMed

Gupta, Aakriti; Mathew, Preethy Joseph; Bhardwaj, Neerja

2017-10-01

To evaluate the clinical efficacy of masking the odor of inhalational agents using fruit flavors on the anxiety behavior and compliance of children for inhalational induction. A prospective randomized double blind, placebo controlled study was conducted on 60 unpremedicated children in the age group of 4-12 y. Thirty children received anesthetic masks smeared with a flavor of child's choice while the other 30 children were induced using masks without flavor. Anxiety was assessed using modified Yale Pre-operative Anxiety Scale (mYPAS) in the pre-op room and during inhalational induction. Mask acceptance was graded by Induction Compliance Checklist (ICC). The cost-effectiveness of flavored anesthetic masks was compared to that of commercially available pre-scented masks. The baseline anxiety in the two groups was comparable. The number of children demonstrating high levels of anxiety at anesthetic induction was similar in flavored and non-flavored mask groups (p 0.45). The compliance to mask induction was also equally good (p 0.99). The authors found significant difference in the cost of flavored mask (INR 56.45 per mask) as compared to commercially available pre-scented masks (INR 660 per mask). The authors observed a placebo effect that reduced the pre-op anxiety in the control group which probably made the quality of induction equivalent with flavored and non-flavored masks. Therefore, using a flavored anesthetic mask is cost-effective than using a commercially available pre-scented mask.

[Nursing role in prevention of Ventilator Associated Pneumonia: Spanish project "Neumonìa Zero"].

PubMed

Pinto, Cristina; Reig Valero, Roberto; Iadeluca, Antonio; Lomuscio, Sonia; Caldarulo, Tiziana; Sponton, Anna

2015-01-01

The incidence of Ventilator Associated Pneumonia (VAP) varies between 8 and 28% on patients with invasive mechanical ventilation, and it is associated with high mortality rates. The international literature indicates that the VAP has some risk factors that cannot be changed and some other that are closely related to nursing care procedures. The aim of this study is to analyze compliance level to the protocol of nursing prevention of the VAP in the ICU of "General Hospital" in Castellon de la Plana (Spain) within the project "Neumonía Zero". The data were collected during the months of May and June 2012 through direct observation which lasted 33 days. 5 check lists based on international recommendations were used for the objective evaluation on the adoption of preventive treatments. 58 patients in invasive mechanical ventilation and 43 ICU nurses were enrolled. Compliance procedure showed no significant differences among each other with an average adhesion of 78% of the observations. The observations trend shows a tendency of improvement in accordance with the checklists of cuff pressure and of the inclination of the bed head. An incidence rate of VAP 13,37/1000 was observed. In conclusion, direct observation showed good compliance to the protocols used in the ward. The obtained data allows to re-direct educational choices and assume a systematic application of this methodology with an important contribution to nursing.

The priority heuristic: making choices without trade-offs.

PubMed

Brandstätter, Eduard; Gigerenzer, Gerd; Hertwig, Ralph

2006-04-01

Bernoulli's framework of expected utility serves as a model for various psychological processes, including motivation, moral sense, attitudes, and decision making. To account for evidence at variance with expected utility, the authors generalize the framework of fast and frugal heuristics from inferences to preferences. The priority heuristic predicts (a) the Allais paradox, (b) risk aversion for gains if probabilities are high, (c) risk seeking for gains if probabilities are low (e.g., lottery tickets), (d) risk aversion for losses if probabilities are low (e.g., buying insurance), (e) risk seeking for losses if probabilities are high, (f) the certainty effect, (g) the possibility effect, and (h) intransitivities. The authors test how accurately the heuristic predicts people's choices, compared with previously proposed heuristics and 3 modifications of expected utility theory: security-potential/aspiration theory, transfer-of-attention-exchange model, and cumulative prospect theory. ((c) 2006 APA, all rights reserved).

7 CFR 2.47 - Administrator, Rural Utilities Service.

Code of Federal Regulations, 2013 CFR

2013-01-01

... Reauthorization Act of 1986 (42 U.S.C. 9601 et seq.). (13) Administer the Distance Learning and Medical Link...)), with respect to information gathering and access requests and orders; compliance with Federal health... of exposure to significant risk to human health; (iv) Section 104(j) of the Act (42 U.S.C. 9604(j...

7 CFR 2.47 - Administrator, Rural Utilities Service.

Code of Federal Regulations, 2014 CFR

2014-01-01

... U.S.C. 9601 et seq.). (13) Administer the Distance Learning and Medical Link Programs (7 U.S.C... access requests and orders; compliance with Federal health and safety standards and wage and labor... (42 U.S.C. 9604(i)(11)), with respect to the reduction of exposure to significant risk to human health...

7 CFR 2.47 - Administrator, Rural Utilities Service.

Code of Federal Regulations, 2012 CFR

2012-01-01

... Reauthorization Act of 1986 (42 U.S.C. 9601 et seq.). (13) Administer the Distance Learning and Medical Link...)), with respect to information gathering and access requests and orders; compliance with Federal health... of exposure to significant risk to human health; (iv) Section 104(j) of the Act (42 U.S.C. 9604(j...

PROCEEDINGS: EIGHTH SYMPOSIUM ON THE TRANSFER AND UTILIZATION OF PARTICULATE CONTROL TECHNOLOGY - VOLUME 2. BAGHOUSES AND PARTICULATE CONTROL FOR NEW APPLICATIONS

EPA Science Inventory

The two-volume proceedings describe the latest research and development efforts to improve particulate control devices, while treating traditional concerns of operational cost and compliance. Overall, particulate control remains a key issue in the cost and applicability of furnac...

76 FR 36468 - Approval and Promulgation of Air Quality Implementation Plans; North Carolina: Clean Smokestacks Act

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-22

... Generate Electricity and to Provide for Recovery by Electric Utilities of the Costs of Achieving Compliance... generate 25 or more megawatts of electricity: Progress Energy Carolinas, Inc. (Progress Energy) and Duke Power, a division of Duke Energy Corporation (Duke Energy). Although the emission caps apply...

USING MICROELECTRODES AND LIVE/DEAD BACLIGHT TO COMPARE PENETRATION, ACTIVITY, AND VIABILITY WITHIN NITRIFYING BIOFILM SUBJECTED TO FREE CHLORINE MONOCHLORAMINE, AND PHOSPHATE - Poster

EPA Science Inventory

Many utilities have used monochloramine as a secondary disinfectant for regulation compliance. Along with the addition of chloramine comes the risk of nitrification. Nitrification in drinking water distribution systems may result in degradation of water quality and non-complian...

ANNUAL REPORT, 1965-66, TO UNITED STATES BUREAU OF INDIAN AFFAIRS.

ERIC Educational Resources Information Center

POEHLMAN, CHAS.

IN COMPLIANCE WITH REGULATION, THIS REPORT IS SUBMITTED TO SHOW UTILIZATION OF JOHNSON-O'MALLEY FUNDS IN NEVADA FOR FISCAL YEAR 1965-66. THE REPORT CONSISTS OF--A SHORT EVALUATION WHICH INDICATES A CONTINUING NEED FOR MAXIMUM FUND ASSISTANCE IN SCHOOL LUNCH PROGRAMS AND SPECIAL PROGRAMS (COUNSELING, SUPERVISING STUDY SITUATIONS, ETC.), AN…

USING MICROELECTRODES AND LIVE/DEAD BACLIGHT TO COMPARE PENETRATION, ACTIVITY, AND VIABILITY WITHIN NITRIFYING BIOFILM SUBJECTED TO FREE CHLORINE, MONOCHLORAMINE, AND PHOSPHATE - Abstract

EPA Science Inventory

Many utilities have used monochloramine as a secondary disinfectant for regulation compliance. Along with the addition of chloramine comes the risk of nitrification. Nitrification in drinking water distribution systems may result in degradation of water quality and non-complian...

40 CFR Table 7 to Subpart Uuuuu of... - Demonstrating Continuous Compliance

Code of Federal Regulations, 2013 CFR

2013-07-01

... Table 7 to Subpart UUUUU of Part 63 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... Utility Steam Generating Units Pt. 63, Subpt. UUUUU, Table 7 Table 7 to Subpart UUUUU of Part 63... emissions limit in Table 1 or 2, or PM (or its alternative emission limits) applicable emissions limit in...

40 CFR Table 7 to Subpart Uuuuu of... - Demonstrating Continuous Compliance

Code of Federal Regulations, 2014 CFR

2014-07-01

... Table 7 to Subpart UUUUU of Part 63 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... Utility Steam Generating Units Pt. 63, Subpt. UUUUU, Table 7 Table 7 to Subpart UUUUU of Part 63... emissions limit in Table 1 or 2, or PM (or its alternative emission limits) applicable emissions limit in...

40 CFR Table 7 to Subpart Uuuuu of... - Demonstrating Continuous Compliance

Code of Federal Regulations, 2012 CFR

2012-07-01

... Table 7 to Subpart UUUUU of Part 63 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED... Utility Steam Generating Units Pt. 63, Subpt. UUUUU, Table 7 Table 7 to Subpart UUUUU of Part 63... applicable emissions limit in Table 1 or 2 Calculating the results of the testing in units of the applicable...

76 FR 38401 - National Institute of Child Health and Human Development; Revision to Proposed Collection...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-30

... Methodology Studies for the National Children's Study SUMMARY: In compliance with the requirement of Section... comments expressed support for the broad scope of the study. The written comments were identical and questioned the cost and utility of the study specifically and of federally funded biomedical research overall...

40 CFR 63.10685 - What are the requirements for the control of contaminants from scrap?

Code of Federal Regulations, 2010 CFR

2010-07-01

... Area Sources: Electric Arc Furnace Steelmaking Facilities Standards and Compliance Requirements § 63..., lead, and free organic liquids. For metallic scrap utilized in the EAF at your facility, you must... scrap at your facility subject to paragraph (a)(1) of this section and other scrap subject to paragraph...

40 CFR 63.10685 - What are the requirements for the control of contaminants from scrap?

Code of Federal Regulations, 2011 CFR

2011-07-01

... Area Sources: Electric Arc Furnace Steelmaking Facilities Standards and Compliance Requirements § 63..., lead, and free organic liquids. For metallic scrap utilized in the EAF at your facility, you must... scrap at your facility subject to paragraph (a)(1) of this section and other scrap subject to paragraph...

US Accreditation in Mexico: Quality in Higher Education as Symbol, Performance and Translation

ERIC Educational Resources Information Center

Blanco-Ramirez, Gerardo

2015-01-01

Quality practices in higher education involve more than mere compliance with standards and technical mandates; given the complexity of the decisions involved in quality in higher education, this concept, quality, can be analyzed as symbol and performance. This paper utilizes translation as heuristic to analyze the implementation of US…

77 FR 56857 - Notice of Proposed Information Collection for Public Comment; Public Housing Mortgage Program and...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-14

... affected agencies concerning the proposed collection of information to: (1) Evaluate whether the proposed... whether the information will have practical utility; (2) evaluate the accuracy of the agency's estimate of... descriptive of the range of transactions that would be reviewed under this collection for compliance with...

An Application of the Equal Pay Act to Higher Education.

ERIC Educational Resources Information Center

Green, Debra H.

1981-01-01

The applicability of legal principles governing equal pay and sex discrimination in university settings is discussed. The most objective mechanism that a university can utilize to achieve compliance with the Equal Pay Act would be implementation of a salary system that relies on experience, formal education, and time in grade. (MLW)

14 CFR 23.307 - Proof of structure.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Proof of structure. 23.307 Section 23.307... STANDARDS: NORMAL, UTILITY, ACROBATIC, AND COMMUTER CATEGORY AIRPLANES Structure General § 23.307 Proof of structure. (a) Compliance with the strength and deformation requirements of § 23.305 must be shown for each...

Mind the Gap: Accounting Information Systems Curricula Development in Compliance with IFAC Standards in a Developing Country

ERIC Educational Resources Information Center

Aleqab, Mahmoud Mohmad Ahmad; Nurunnabi, Mohammad; Adel, Dalia

2015-01-01

The authors examine the consistency between the current practices in designing and teaching accounting information systems (AIS) curricula and the International Federation of Accountants (IFAC) requirements for International Education Practice Statement 2 and International Education Standards 2. Utilizing a survey and interviews data in Jordan,…

40 CFR 63.10009 - May I use emissions averaging to comply with this subpart?

Code of Federal Regulations, 2013 CFR

2013-07-01

...-Fired Electric Utility Steam Generating Units Testing and Initial Compliance Requirements § 63.10009 May... TBtu, as appropriate for the pollutant) or gross electrical output basis (MWh or GWh, as appropriate... lb/gross electrical output, Hermi = Hourly emissions rate (e.g., lb/MMBtu, lb/MWh) from CEMS or...

Importance of Fe and Mn Pipe Deposits to Lead and Copper Rule Compliance - abstract

EPA Science Inventory

When Madison, WI exceeded the lead Action Level in 1992, residential and off-line tests suggested that lead release into the water was more complex than a lead solubility mechanism. The water utility chose to address the Lead and Copper Rule (LCR) exceedance by implementing full ...

Choice Experiments to Quantify Preferences for Health and Healthcare: State of the Practice.

PubMed

Mühlbacher, Axel; Johnson, F Reed

2016-06-01

Stated-preference methods increasingly are used to quantify preferences in health economics, health technology assessment, benefit-risk analysis and health services research. The objective of stated-preference studies is to acquire information about trade-off preferences among treatment outcomes, prioritization of clinical decision criteria, likely uptake or adherence to healthcare products and acceptability of healthcare services or policies. A widely accepted approach to eliciting preferences is discrete-choice experiments. Patient, physician, insurant or general-public respondents choose among constructed, experimentally controlled alternatives described by decision-relevant features or attributes. Attributes can represent complete health states, sets of treatment outcomes or characteristics of a healthcare system. The observed pattern of choice reveals how different respondents or groups of respondents implicitly weigh, value and assess different characteristics of treatments, products or services. An important advantage of choice experiments is their foundation in microeconomic utility theory. This conceptual framework provides tests of internal validity, guidance for statistical analysis of latent preference structures, and testable behavioural hypotheses. Choice experiments require expertise in survey-research methods, random-utility theory, experimental design and advanced statistical analysis. This paper should be understood as an introduction to setting up a basic experiment rather than an exhaustive critique of the latest findings and procedures. Where appropriate, we have identified topics of active research where a broad consensus has not yet been established.

The potential cost savings of implementing an inter-utility NO{sub x} trading program

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

Siegel, S.; Kalagnanam, J.

1995-12-31

Technology based standards such as RACT, which require the installation of a Reasonably Available Control Technology on a boiler by boiler basis have been the dominant factor driving electric utility NO{sub x} compliance plans. In this paper, the authors examine the cost savings of implementing NO{sub x} trading, an alternative market based strategy for reducing the emissions of nitrogen oxides (NO{sub x}) to achieve NO{sub x} reduction goals set under Title IV of the 1990 Clean Air Act. In order to estimate the potential cost savings of inter-utility NO{sub x} trading, the authors have used a combinatorial optimization approach tomore » identify boiler retrofits and operating parameters which yield efficient (i.e., the most cost effective) NO{sub x} abatement. In the formulation, annual emissions at individual boilers which are expensive to abate may exceed RACT levels by up to a factor of two thus allowing for trades with boilers which can abate in a more cost effective manner. The authors constrain total emissions in a trading region to be at or below the level obtained had all the boilers adopted RACT. Increasing the flexibility with which trades can occur has two main effects: (1) the cost effectiveness of meeting an aggregate reduction goal increases and (2) the spatial distribution of emissions shift relative to what it would have been under a strict RACT based compliance strategy. The authors estimate the magnitude of these effects for two Eastern electric utilities making intra and inter-utility NO{sub x} trades. Results indicate that the cost effectiveness of meeting RACT level reduction can be increased by as much as 38% under certain trading regimes.« less

The potential cost savings of implementing an inter-utility NO{sub x} trading program

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

Siegel, S.; Kalagnanam, J.

1995-10-01

Technology based standards such as RACT, which require the installation of a (R)easonably (A)vailable (C)ontrol (T)echnology on a boiler by boiler basis have been the dominant factor driving electric utility NO{sub x} compliance plans. In this paper, the authors examine the cost savings of implementing NO{sub x} trading, an alternative market based strategy for reducing the emissions of nitrogen oxides (NO{sub x}) to achieve NO{sub x} reduction goals set under Title IV of the 1990 Clean Air Act. In order to estimate the potential cost savings of inter-utility NO{sub x} trading, they use a combinatorial optimization approach to identify boilermore » retrofits and operating parameters which yield efficient (i.e., the most cost effective) NO{sub x} abatement strategies. In their formulation, annual emissions at individual boilers which are expensive to abate may exceed RACT levels by up to a factor of two thus allowing for trades with boilers which can abate in a more cost effective manner. They constrain total emissions in a trading region to be at or below the level obtained had all the boilers adopted RACT. Increasing the flexibility with which trades can occur has two main effects: (1) the cost effectiveness of meeting an aggregate reduction goal increases and (2) the spatial distribution of emissions shift relative to what it would have been under a strict RACT based compliance strategy. They estimate the magnitude of these effects for two Eastern electric utilities making intra- and inter-utility NO{sub x} trades. Results indicate that the cost effectiveness of meeting RACT level reduction can be increased by as much as 38% under certain trading regimes.« less

Poor Dietary Guidelines Compliance among Low-Income Women Eligible for Supplemental Nutrition Assistance Program-Education (SNAP-Ed).

PubMed

Jun, Shinyoung; Thuppal, Sowmyanarayanan V; Maulding, Melissa K; Eicher-Miller, Heather A; Savaiano, Dennis A; Bailey, Regan L

2018-03-08

The Supplemental Nutrition Assistance Program-Education (SNAP-Ed) program aims to improve nutritional intakes of low-income individuals (<185% poverty threshold). The objective of this study was to describe the compliance with Dietary Guidelines for Americans (DGA) recommendations for fruits, vegetables, and whole grains among SNAP-Ed eligible ( n = 3142) and ineligible ( n = 3168) adult women (19-70 years) nationwide and SNAP-Ed participating women in Indiana ( n = 2623), using the NHANES 2007-2012 and Indiana SNAP-Ed survey data, respectively. Sensitivity analysis further stratified women by race/ethnicity and by current SNAP participation (<130% poverty threshold). Nationally, lower-income women were less likely to meet the fruit (21% vs. 25%) and vegetable (11% vs. 19%) guidelines than higher-income women, but did not differ on whole grains, which were ~5% regardless of income. The income differences in fruit and vegetable intakes were driven by non-Hispanic whites. Fewer SNAP-Ed-eligible U.S. women met fruit (21% vs. 55%) and whole grain (4% vs. 18%) but did not differ for vegetable recommendations (11% vs. 9%) when compared to Indiana SNAP-Ed women. This same trend was observed among current SNAP participants. Different racial/ethnic group relationships with DGA compliance were found in Indiana compared to the nation. Nevertheless, most low-income women in the U.S. are at risk of not meeting DGA recommendations for fruits (79%), vegetables (89%), and whole grains (96%); SNAP-Ed participants in Indiana had higher compliance with DGA recommendations. Increased consumption of these three critical food groups would improve nutrient density, likely reduce calorie consumption by replacing high calorie choices, and improve fiber intakes.

A New mHealth application to support treatment of sleep apnoea patients.

PubMed

Isetta, Valentina; Torres, Marta; González, Kevin; Ruiz, Concepción; Dalmases, Mireia; Embid, Cristina; Navajas, Daniel; Farré, Ramon; Montserrat, Josep M

2017-01-01

Introduction Continuous positive airway pressure (CPAP) is the first-choice treatment for obstructive sleep apnoea (OSA), but adherence is frequently suboptimal. Innovative, patient-centred interventions are, therefore, needed to enhance compliance. Due to its low cost and ubiquity, mobile health (mHealth) technology seems particularly suited for this purpose. We endeavoured to develop an mHealth application called "APPnea," aimed at promoting patient self-monitoring of CPAP treatment. We then assessed the feasibility and acceptability of APPnea in a group of OSA patients. Methods Consecutive OSA patients used APPnea for six weeks. APPnea gave patients daily reminders to answer three questions about their OSA treatment (CPAP use, physical activity, and diet) and prompted them to upload their body weight weekly. Answers were saved to a secure server for further analysis. After completing the study, patients gave their anonymous opinions about APPnea. Results We enrolled 60 patients with OSA receiving CPAP treatment. The mean age was 56 ± 10 years and the apnoea-hypopnea index was 47 ± 25 events/hour. In total, 63% of participants completed the daily questionnaire for more than 66% of the study period. Objective CPAP compliance was generally high (5.3 ± 1.6 hours/night). In a subset of 38 patients naïve to CPAP, those who used APPnea regularly had significantly higher CPAP compliance. Satisfaction levels were high for the majority of users. Conclusion This mHealth intervention is not only feasible but also satisfactory to patients. Although larger randomized trials and cost-effectiveness studies should be performed, this study shows that APPnea could promote participation and improve compliance among patients with OSA, thereby improving outcomes.

The impact of subliminal haptic perception on the preference discrimination of roughness and compliance.

PubMed

Hilsenrat, Marcos; Reiner, Miriam

2011-06-30

It is well known that unaware exposure to a visual stimulus increases the preferability of the associated object. In this study we examine whether the same phenomena occur for haptic stimuli. Using a touch-enabled virtual environment, we tested whether people that touch two virtual surfaces, which differ by imperceptible differences in roughness or compliance, tend to choose rougher or smoother, softer or stiffer surfaces, in accordance with their natural tendency. In forced choice preference tests, participants were first asked to choose between two surfaces that differ by roughness/stiffness. Stimuli strength was above the aware perception limit. Then, the same test was performed for differences in stimuli strength, which was below the limit of awareness. Finally, we carried out a recognition test: participants were asked to choose between the surfaces presented in the previous step, and point at the smoother or softer surface, respectively. For each stimulus, two groups of 26 subjects participated. Results show that in the unaware preference tests, participants selected the surface in accordance with the aware preference tests, with significant difference from chance (59.5%, and 60.2% for roughness and compliance as a stimulus, respectively). The recognition tests in both experiments were at chance level, suggesting that participants were unaware of the difference in stimuli. These results show that subliminal perception of roughness and compliance strength affects texture preferences. Research data suggest that the amygdala is central in regulating emotional processing of visual stimuli, even if it is presented subliminally. Thus, the results of this study raise the question whether the amygdala also modulates emotional haptic stimuli when they are subliminally perceived. Copyright © 2011 Elsevier Inc. All rights reserved.

The effect of choice on the physiology of emotion: An affective startle modulation study

PubMed Central

Genevsky, Alexander; Gard, David E.

2014-01-01

The affective startle modulation task has been an important measure in understanding physiological aspects of emotion and motivational responses. Research utilizing this method has relied primarily on a ‘passive’ viewing paradigm, which stands in contrast to everyday life where much of emotion and motivation involves some active choice or agency. The present study investigated the role of choice on the physiology of emotion. Eighty-four participants were randomized into ‘choice’ (n=44) or ‘no-choice’ (n=40) groups distinguished by the ability to choose between stimuli. EMG eye blink responses were recorded in both anticipation and stimulus viewing. Results indicated a significant attenuation of the startle magnitude in choice condition trials (relative to no-choice) across all picture categories and probe times. We interpret these findings as an indication that the act of choice may decrease one’s defensive response, or conversely, lacking choice may heighten the defensive response. Implications for future research are discussed. PMID:22285891

Choice Inconsistencies among the Elderly: Evidence from Plan Choice in the Medicare Part D Program: Comment.

PubMed

Ketcham, Jonathan D; Kuminoff, Nicolai V; Powers, Christopher A

2016-12-01

Consumers' enrollment decisions in Medicare Part D can be explained by Abaluck and Gruber’s (2011) model of utility maximization with psychological biases or by a neoclassical version of their model that precludes such biases. We evaluate these competing hypotheses by applying nonparametric tests of utility maximization and model validation tests to administrative data. We find that 79 percent of enrollment decisions from 2006 to 2010 satisfied basic axioms of consumer theory under the assumption of full information. The validation tests provide evidence against widespread psychological biases. In particular, we find that precluding psychological biases improves the structural model's out-of-sample predictions for consumer behavior.

The Attraction Effect Modulates Reward Prediction Errors and Intertemporal Choices.

PubMed

Gluth, Sebastian; Hotaling, Jared M; Rieskamp, Jörg

2017-01-11

Classical economic theory contends that the utility of a choice option should be independent of other options. This view is challenged by the attraction effect, in which the relative preference between two options is altered by the addition of a third, asymmetrically dominated option. Here, we leveraged the attraction effect in the context of intertemporal choices to test whether both decisions and reward prediction errors (RPE) in the absence of choice violate the independence of irrelevant alternatives principle. We first demonstrate that intertemporal decision making is prone to the attraction effect in humans. In an independent group of participants, we then investigated how this affects the neural and behavioral valuation of outcomes using a novel intertemporal lottery task and fMRI. Participants' behavioral responses (i.e., satisfaction ratings) were modulated systematically by the attraction effect and this modulation was correlated across participants with the respective change of the RPE signal in the nucleus accumbens. Furthermore, we show that, because exponential and hyperbolic discounting models are unable to account for the attraction effect, recently proposed sequential sampling models might be more appropriate to describe intertemporal choices. Our findings demonstrate for the first time that the attraction effect modulates subjective valuation even in the absence of choice. The findings also challenge the prospect of using neuroscientific methods to measure utility in a context-free manner and have important implications for theories of reinforcement learning and delay discounting. Many theories of value-based decision making assume that people first assess the attractiveness of each option independently of each other and then pick the option with the highest subjective value. The attraction effect, however, shows that adding a new option to a choice set can change the relative value of the existing options, which is a violation of the independence principle. Using an intertemporal choice framework, we tested whether such violations also occur when the brain encodes the difference between expected and received rewards (i.e., the reward prediction error). Our results suggest that neither intertemporal choice nor valuation without choice adhere to the independence principle. Copyright © 2017 the authors 0270-6474/17/370371-12$15.00/0.

1980 scrubber highlights: dry-process startups, dual-alkali progress highlight scrubber advances

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

Not Available

1981-06-01

A survey of electric utilities reports scrubbers on 13% of existing capacity and estimates 29% by 1990, but compliance with the New Source Performance Standards may raise the total even higher. Dry scrubbers at two Northern States Power installations show test performances that indicate sound design and report modest manpower requirements. Other utilities are ordering demonstration dry-scrubber units, although orders for wet scrubbers continue to do well. A new dual-alkali scrubber is performing well at three installations in terms of availability and sulfur-dioxide-removal efficiency. A full-scale utility dump site test will identify any hazardous materials in pollution control ash andmore » sludge wastes. (DCK)« less

A survey of United States dental hygienists' knowledge, attitudes, and practices with infection control guidelines.

PubMed

Garland, Kandis V

2013-06-01

To assess knowledge, attitudes and practices of U.S. dental hygienists with infection control guidelines (ICG). Research has shown improved compliance with specific aspects of dental ICG is needed. This study supports the American Dental Hygienists' Association National Research Agenda's Occupational Health and Safety objective to investigate methods to decrease errors, risks and or hazards in health care. Data are needed to assess compliance, prevention and behavioral issues with current ICG practices. A proportional stratified random sample (n=2,500) was recruited for an online survey. Descriptive statistics summarized demographic characteristics and knowledge, attitudes and practices responses. Spearman's rho correlations determined relationships between knowledge, attitudes and practices responses (p<0.05). Dominant themes were identified from open-ended responses. A 31% response rate (n=765) was attained. Respondents agreed/strongly agreed with familiarity with ICG (86%) and believed ICG are relevant to their patients (88%). Responses indicated low compliance (rarely/never used) with handpiece sterilization (n=209, 31%), utility glove use (n=317, 47%), and pre-procedural rinsing (n=324, 48%). Significant relationships were found between ICG implementation and access to necessary supplies (rs=0.549), supervisors' expectations for using ICG (rs=0.529) and no time to use (rs=-0.537). Themes from comments indicated time is a barrier, and respondents' perceived a need for involvement of all co-workers. Dental hygienists are adhering with most aspects of the ICG. High compliance with ICG among respondents in this study was associated with positive safety beliefs and practices, whereas lower compliance with ICG was associated with less positive safety beliefs and practices. A safety culture appears to be a factor in compliance with ICG.

Prevention of falls in acute hospital settings: a multi-site audit and best practice implementation project.

PubMed

Stephenson, Matthew; Mcarthur, Alexa; Giles, Kristy; Lockwood, Craig; Aromataris, Edoardo; Pearson, Alan

2016-02-01

To assess falls prevention practices in Australian hospitals and implement interventions to promote best practice. A multi-site audit using eight evidence-based audit criteria. Following a baseline audit, barriers to compliance were identified and targeted. Two follow-up audit cycles assessed the sustainability of practice change. Nine acute care hospitals around Australia, including a mix of public and private. One medical ward and one surgical ward from each hospital were involved. A clinical leader from each hospital, trained in evidence implementation, conducted the audits and implementation strategies in their setting. Multi-component falls prevention interventions were utilized, designed to target specific barriers to compliance identified at each hospital. Common interventions involved staff and patient education. Percentage compliance with falls prevention audit criteria and change in compliance between baseline and follow-up audits. Fall rate data were also analysed. Mean overall compliance at baseline across all hospitals was 50.4% (range 30.8-76.6%). At the first follow-up, this had increased to 74.5% (range 59.4-87.4%), which was sustained at the second follow-up (74.1%, range 48.6-84.4%). There were no statistically significant differences between compliance rates in medical versus surgical wards or in private versus public hospitals. Despite sustained practice improvement, reported fall rates remained unchanged. The focus on staff education possibly led to improved reporting of falls, which may explain the apparent lack of effect on fall rates. Clinical audit and feedback is an effective strategy to promote quality improvement in falls prevention practices in acute hospital settings. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

British Military surgical key performance indicators: time for an update?

PubMed

Marsden, Max Er; Sharrock, A E; Hansen, C L; Newton, N J; Bowley, D M; Midwinter, M

2016-10-01

Key performance indicators (KPIs) are metrics that compare actual care against an ideal structure, process or outcome standard. KPIs designed to assess performance in deployed military surgical facilities have previously been published. This study aimed to review the overall performance of surgical trauma care for casualties treated at Role 3 Camp Bastion, Medical Treatment Facility, Afghanistan, in light of the existing Defence Medical Services (DMS) KPIs. The secondary aims were to assess the utility of the surgical KPIs and make recommendations for future surgical trauma care review. Data on 22 surgical parameters were prospectively collected for 150 injured patients who had primary surgery at Camp Bastion between 1 May 2013 and 20 August 2013. Additional information for these patients was obtained using the Joint Theatre Trauma Register. The authors assessed data recording, applicability and compliance with the KPIs. Median data recording was 100% (IQR 98%-100%), median applicability was 56% (IQR 10%-99%) and median compliance was 78% (IQR 58%-93%). One KPI was not applicable to any patient in our population. Eleven KPIs achieved >80% compliance, five KPIs had 80%-60% compliance and five KPIs had <60% compliance. Recommendations are made for minor modifications to the current KPIs. 78% compliance with the DMS KPIs provides a snapshot of the performance of the surgical aspect of military trauma care in 2013. The KPIs highlight areas for improvement in service delivery. Individual KPI development should be driven by evidence and reflect advances in practice and knowledge. A method of stakeholder consultation, and sequential refinement following evidence review, may be the right process to develop the future set of DMS KPIs. 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/

Measuring stroke patients' exercise preferences using a discrete choice experiment.

PubMed

Geidl, Wolfgang; Knocke, Katja; Schupp, Wilfried; Pfeifer, Klaus

2018-03-30

Physical activity post stroke improves health, yet physical inactivity is highly prevalent. Tailored exercise programs considering physical activity preferences are a promising approach to promote physical activity. Therefore, this study seeks to measure exercise preferences of stroke survivors. Stroke survivors conducted a discrete choice experiment (DCE). DCE was presented in a face-to-face interview where patients had to choose eight times between two different exercise programs. Exercise programs differed by characteristics, with the six attributes under consideration being social situation, location, type of exercise, intensity, frequency, and duration. Utilities of the exercise attributes were estimated with a logit choice model. Stroke survivors (n=103, mean age: 67, SD=13.0; 60% male) show significant differences in the rated utilities of the exercise attributes (P<0.001). Participants had strong preferences for light and moderate intense physical activity and favored shorter exercise sessions. Stroke survivors have remarkable exercise preferences especially for intensity and duration of exercise. Results contribute to the tailoring of physical activity programs after stroke thereby facilitating maintenance of physical activity.

For Third Enrollment Period, Marketplaces Expand Decision Support Tools To Assist Consumers.

PubMed

Wong, Charlene A; Polsky, Daniel E; Jones, Arthur T; Weiner, Janet; Town, Robert J; Baker, Tom

2016-04-01

The design of the Affordable Care Act's online health insurance Marketplaces can improve how consumers make complex health plan choices. We examined the choice environment on the state-based Marketplaces and HealthCare.gov in the third open enrollment period. Compared to previous enrollment periods, we found greater adoption of some decision support tools, such as total cost estimators and integrated provider lookups. Total cost estimators differed in how they generated estimates: In some Marketplaces, consumers categorized their own utilization, while in others, consumers answered detailed questions and were assigned a utilization profile. The tools available before creating an account (in the window-shopping period) and afterward (in the real-shopping period) differed in several Marketplaces. For example, five Marketplaces provided total cost estimators to window shoppers, but only two provided them to real shoppers. Further research is needed on the impact of different choice environments and on which tools are most effective in helping consumers pick optimal plans. Project HOPE—The People-to-People Health Foundation, Inc.

The influence of ethical values and food choice motivations on intentions to purchase sustainably sourced foods.

PubMed

Dowd, Kylie; Burke, Karena J

2013-10-01

This study examined a three-step adaptation of the Theory of Planned Behaviour (TPB) applied to the intention of consumers to purchase sustainably sourced food. The sample consisted of 137 participants, of which 109 were female, who were recruited through a farmers market and an organic produce outlet in an Australian capital city. Participants completed an online questionnaire containing the TPB scales of attitude, subjective norms, perceived behavioural control and intention; measures of positive moral attitude and ethical self identity; and food choice motives. Hierarchical multiple regression was used to examine the predictive utility of the TPB in isolation (step 1) and the TPB expanded to include the constructs of moral attitude and ethical self-identity (step 2). The results indicated the expansion of the TPB to include these constructs added significantly to the predictive model measuring intention to purchase sustainably sourced food. The third step in the adaptation utilised this expanded TPB model and added a measure of retail channel (where consumers reported buying fresh produce) and 9 food choice motives, in order to assess the predictive utility of the inclusion of choice motivations in this context. Of the 8 food choice motives examined, only health and ethical values significantly predicted intention to purchase sustainably sourced food. However, with the addition of food choice motives, ethical self-identity was no longer a significant predictor of intention to purchase sustainably sourced food. Overall the adapted TPB model explained 76% of the variance in intention to purchase sustainably sourced food. Copyright © 2013 Elsevier Ltd. All rights reserved.

INDIVIDUAL DIFFERENCES IN IMPULSIVE CHOICE AND TIMING IN RATS

PubMed Central

Galtress, Tiffany; Garcia, Ana; Kirkpatrick, Kimberly

2012-01-01

Individual differences in impulsive choice behavior have been linked to a variety of behavioral problems including substance abuse, smoking, gambling, and poor financial decision-making. Given the potential importance of individual differences in impulsive choice as a predictor of behavioral problems, the present study sought to measure the extent of individual differences in a normal sample of hooded Lister rats. Three experiments utilized variations of a delay discounting task to measure the degree of variation in impulsive choice behavior across individual rats. The individual differences accounted for 22–55% of the variance in choice behavior across the three experiments. In Experiments 2 and 3, the individual differences were still apparent when behavior was measured across multiple choice points. Large individual differences in the rate of responding, and modest individual differences in timing of responding were also observed during occasional peak trials. The individual differences in timing and rate, however, did not correlate consistently with individual differences in choice behavior. This suggests that a variety of factors may affect choice behavior, response rate, and response timing. PMID:22851792

Pilot Preference, Compliance, and Performance With an Airborne Conflict Management Toolset

NASA Technical Reports Server (NTRS)

Doble, Nathan A.; Barhydt, Richard; Krishnamurthy, Karthik

2005-01-01

A human-in-the-loop experiment was conducted at the NASA Ames and Langley Research Centers, investigating the En Route Free Maneuvering component of a future air traffic management concept termed Distributed Air/Ground Traffic Management (DAG-TM). NASA Langley test subject pilots used the Autonomous Operations Planner (AOP) airborne toolset to detect and resolve traffic conflicts, interacting with subject pilots and air traffic controllers at NASA Ames. Experimental results are presented, focusing on conflict resolution maneuver choices, AOP resolution guidance acceptability, and performance metrics. Based on these results, suggestions are made to further improve the AOP interface and functionality.

Social capital, outpatient care utilization and choice between different levels of health facilities in rural and urban areas of Bhutan.

PubMed

Herberholz, Chantal; Phuntsho, Sonam

2018-06-18

This study examines the factors that explain outpatient care utilization and the choice between different levels of health facilities in Bhutan, focusing on individual social capital, given Bhutan's geography of remote and sparsely populated areas. The more isolated the living, the more important individual social capital may become. Standard factors proposed by the Andersen model of healthcare utilization serve as control variables. Data for 2526 households from the 2012 Bhutan Living Standards Survey, which contains a social capital module covering structural, cognitive and output dimensions of social capital, are used. The results from the logistic regression analysis show that individual social capital is positively related with the probability of seeking treatment when ill or injured. Informal social contacts and perceived help and support are most important in rural areas, whereas specific trust matters in urban areas. The explanatory power of the model using a subset of the data for urban areas only, however, is very low as most predisposing and enabling factors are insignificant, which is not surprising though in view of better access to health facilities in urban areas and the fact that healthcare is provided free of charge in Bhutan. Multinomial regression results further show that structural and output dimensions of social capital influence the likelihood of seeking care at secondary or tertiary care facilities relative to primary care facilities. Moreover, economic status and place of residence are significantly associated with healthcare utilization and choice of health facility. The findings with respect to social capital suggest that strategizing and organizing social capital may help improve healthcare utilization in Bhutan. Copyright © 2018 Elsevier Ltd. All rights reserved.

A random utility model of delay discounting and its application to people with externalizing psychopathology.

PubMed

Dai, Junyi; Gunn, Rachel L; Gerst, Kyle R; Busemeyer, Jerome R; Finn, Peter R

2016-10-01

Previous studies have demonstrated that working memory capacity plays a central role in delay discounting in people with externalizing psychopathology. These studies used a hyperbolic discounting model, and its single parameter-a measure of delay discounting-was estimated using the standard method of searching for indifference points between intertemporal options. However, there are several problems with this approach. First, the deterministic perspective on delay discounting underlying the indifference point method might be inappropriate. Second, the estimation procedure using the R2 measure often leads to poor model fit. Third, when parameters are estimated using indifference points only, much of the information collected in a delay discounting decision task is wasted. To overcome these problems, this article proposes a random utility model of delay discounting. The proposed model has 2 parameters, 1 for delay discounting and 1 for choice variability. It was fit to choice data obtained from a recently published data set using both maximum-likelihood and Bayesian parameter estimation. As in previous studies, the delay discounting parameter was significantly associated with both externalizing problems and working memory capacity. Furthermore, choice variability was also found to be significantly associated with both variables. This finding suggests that randomness in decisions may be a mechanism by which externalizing problems and low working memory capacity are associated with poor decision making. The random utility model thus has the advantage of disclosing the role of choice variability, which had been masked by the traditional deterministic model. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Population Preferences for Health Care in Liberia: Insights for Rebuilding a Health System

PubMed Central

Kruk, Margaret E; Rockers, Peter C; Tornorlah Varpilah, S; Macauley, Rose

2011-01-01

Objective To quantify the influence of health system attributes, particularly quality of care, on preferences for health clinics in Liberia, a country with a high burden of disease that is rebuilding its health system after 14 years of civil war. Data Sources/Study Setting Informed by focus group discussions, a discrete choice experiment (DCE) was designed to assess preferences for structure and process of care at health clinics. The DCE was fielded in rural, northern Liberia as part of a 2008 population-based survey on health care utilization. Data Collection The survey response rate was 98 percent with DCE data available for 1,431 respondents. Mixed logit models were used to estimate the influence of six attributes on choice of hypothetical clinics for a future illness. Principal Findings Participants' choice of clinic was most influenced by provision of a thorough physical exam and consistent availability of medicines. Respectful treatment and government (versus NGO) management marginally increased utility, whereas waiting time was not significant. Conclusions Liberians value technical quality of care over convenience, courtesy, and public management in selecting clinics for curative care. This suggests that investments in improved competence of providers and availability of medicines may increase population utilization of essential services as well as promote better clinical outcomes. PMID:21517835

Population preferences for health care in liberia: insights for rebuilding a health system.

PubMed

Kruk, Margaret E; Rockers, Peter C; Tornorlah Varpilah, S; Macauley, Rose

2011-12-01

OBJECTIVE. To quantify the influence of health system attributes, particularly quality of care, on preferences for health clinics in Liberia, a country with a high burden of disease that is rebuilding its health system after 14 years of civil war. DATA SOURCES/STUDY SETTING. Informed by focus group discussions, a discrete choice experiment (DCE) was designed to assess preferences for structure and process of care at health clinics. The DCE was fielded in rural, northern Liberia as part of a 2008 population-based survey on health care utilization. DATA COLLECTION. The survey response rate was 98 percent with DCE data available for 1,431 respondents. Mixed logit models were used to estimate the influence of six attributes on choice of hypothetical clinics for a future illness. PRINCIPAL FINDINGS. Participants' choice of clinic was most influenced by provision of a thorough physical exam and consistent availability of medicines. Respectful treatment and government (versus NGO) management marginally increased utility, whereas waiting time was not significant. CONCLUSIONS. Liberians value technical quality of care over convenience, courtesy, and public management in selecting clinics for curative care. This suggests that investments in improved competence of providers and availability of medicines may increase population utilization of essential services as well as promote better clinical outcomes. © Health Research and Educational Trust.

Improved compliance with reporting standards: A retrospective analysis of Intersocietal Accreditation Commission Nuclear Cardiology Laboratories.

PubMed

Maddux, P Tim; Farrell, Mary Beth; Ewing, Joseph A; Tilkemeier, Peter L

2018-06-01

In 2011, Tilkemeier et al reported significant nuclear cardiology laboratory noncompliance with reporting standards. The aim of this study was to identify and examine noncompliant reporting elements with the Intersocietal Accreditation Commission Nuclear/PET (IAC) Reporting Standards and to compare compliance between 2008 and 2014. This was a retrospective study of compliance with 18 reporting elements utilizing accreditation findings from all laboratories applying for accreditation in 2008 and 2014. 1816 labs applying for initial or subsequent accreditation were analyzed for compliance. The mean reporting noncompliance per lab decreased from 2008 to 2014 (2.48 ± 2.67 to 1.24 ± 1.79, P < .001). Noncompliance decreased across lab types, labs with Certification Board of Nuclear Cardiology physicians on staff, and by geographic region (P < .001). Overall severity of reporting issues decreased. Facilities with compliant reports increased from 35.0% in 2008 to 57.1% in 2014 (P < .001). Continuing medical education, accreditation, and other instructional activities aimed at improving nuclear cardiology reporting appear to have made a positive impact over time with the number and severity of noncompliance decreased. More labs are now compliant with the IAC Standards and, thus, reporting guidelines. However, the need for continued educational efforts remains.

Porter's Five Competitive Forces Framework and Other Factors That Influence the Choice of Response Strategies Adopted by Public Universities in Kenya

ERIC Educational Resources Information Center

Mathooko, Francis M.; Ogutu, Martin

2015-01-01

Purpose: The purpose of this paper is to establish the extent to which Porter's five competitive forces (PFCF) framework, among other factors drive the choice of response strategies adopted by public universities in Kenya. Design/Methodology/Approach: The study design was descriptive and utilized a cross-sectional survey of all the public…

The Effects of Frequency of Media Utilization on Decision Making of Media Choice

ERIC Educational Resources Information Center

Gotoh, Yasushi

2014-01-01

The purpose of this study is to use the Analytic Hierarchy Process in order to identify how frequency of media use in daily life affects decision-making in media choice. 276 university students took part in this research, They were asked to prioritize their ways of obtaining information about current affairs using sets of media such as TV, books,…

Rescaling quality of life values from discrete choice experiments for use as QALYs: a cautionary tale

PubMed Central

Flynn, Terry N; Louviere, Jordan J; Marley, Anthony AJ; Coast, Joanna; Peters, Tim J

2008-01-01

Background Researchers are increasingly investigating the potential for ordinal tasks such as ranking and discrete choice experiments to estimate QALY health state values. However, the assumptions of random utility theory, which underpin the statistical models used to provide these estimates, have received insufficient attention. In particular, the assumptions made about the decisions between living states and the death state are not satisfied, at least for some people. Estimated values are likely to be incorrectly anchored with respect to death (zero) in such circumstances. Methods Data from the Investigating Choice Experiments for the preferences of older people CAPability instrument (ICECAP) valuation exercise were analysed. The values (previously anchored to the worst possible state) were rescaled using an ordinal model proposed previously to estimate QALY-like values. Bootstrapping was conducted to vary artificially the proportion of people who conformed to the conventional random utility model underpinning the analyses. Results Only 26% of respondents conformed unequivocally to the assumptions of conventional random utility theory. At least 14% of respondents unequivocally violated the assumptions. Varying the relative proportions of conforming respondents in sensitivity analyses led to large changes in the estimated QALY values, particularly for lower-valued states. As a result these values could be either positive (considered to be better than death) or negative (considered to be worse than death). Conclusion Use of a statistical model such as conditional (multinomial) regression to anchor quality of life values from ordinal data to death is inappropriate in the presence of respondents who do not conform to the assumptions of conventional random utility theory. This is clearest when estimating values for that group of respondents observed in valuation samples who refuse to consider any living state to be worse than death: in such circumstances the model cannot be estimated. Only a valuation task requiring respondents to make choices in which both length and quality of life vary can produce estimates that properly reflect the preferences of all respondents. PMID:18945358

Teaching and Evaluation Materials Utilizing Multiple Representations in Mechanics

ERIC Educational Resources Information Center

Savinainen, A.; Nieminen, P.; Makynen, A.; Viiri, J.

2013-01-01

In this paper, we present materials and teaching ideas utilizing multiple representations in the contexts of kinematics and the force concept. These ideas and materials are substantiated by evidence and can be readily used in teaching with no special training. In addition, we briefly discuss two multiple-choice tests based on physics education…

Interpersonal Relations: A Choice-Theoretic Framework.

ERIC Educational Resources Information Center

Couvillion, L. Michael; Eckstein, Daniel G.

The microeconomic theory relating to utility and cost is applied to the "risk," and the possible "payoff" relative to relationships with others. A good measure of utility is the need or want-satisfying power of an alternative. For the analysis of interpersonal relationships, the needs delineated by Maslow (i.e. food, shelter, belongingness, love,…

Gender Disparities in Sciences: The Question of Parental Influence on Children's Self-Concept and Utility-Value

ERIC Educational Resources Information Center

Makwinya, Noel M.; Hofman, Roelande H.

2015-01-01

Self-concept and utility-values are thought to influence differences in choices, participation and performance in schools-careers between students of different genders and ages. This study was investigating existence of gender differences in such constructs regarding science. Further, the study investigated whether development of such constructs…

An analysis of integrated health care for Internet Use Disorders in adolescents and adults.

PubMed

Lindenberg, Katajun; Szász-Janocha, Carolin; Schoenmaekers, Sophie; Wehrmann, Ulrich; Vonderlin, Eva

2017-12-01

Background and aims Although first treatment approaches for Internet Use Disorders (IUDs) have proven to be effective, health care utilization remained low. New service models focus on integrated health care systems, which facilitate access and reduce burdens of health care utilization, and stepped-care interventions, which efficiently provide individualized therapy. Methods An integrated health care approach for IUD intended to (a) be easily accessible and comprehensive, (b) cover a variety of comorbid syndromes, and (c) take heterogeneous levels of impairment into account was investigated in a one-armed prospective intervention study on n = 81 patients, who were treated from 2012 to 2016. Results First, patients showed significant improvement in Compulsive Internet Use over time, as measured by hierarchical linear modeling. Effect sizes of outcome change from baseline to 6-month follow-up ranged from d = 0.48 to d = 1.46. Second, differential effects were found depending on patients' compliance, demonstrating that high compliance resulted in significantly higher rates of change. Third, patients referred to minimal interventions did not differ significantly in amount of change from patients referred to intensive psychotherapy. Discussion Tailored interventions result in higher efficiency through optimized resource allocation and equal amounts of symptom change in all treatment conditions. Moreover, comprehensive, low-threshold interventions seem to increase health service utilization.

Productivity, Quality, and Patient Satisfaction

PubMed Central

Fairchild, David G; McLoughlin, Karen Sax; Gharib, Soheyla; Horsky, Jan; Portnow, Michelle; Richter, James; Gagliano, Nancy; Bates, David W

2001-01-01

CONTEXT Although few data are available, many believe that part-time primary care physicians (PCPs) are less productive and provide lower quality care than full-time PCPs. Some insurers exclude part-time PCPs from their provider networks. OBJECTIVE To compare productivity, qualtiy of preventive care, patient satisfaction, and risk-adjusted resource utilization of part-time and full-time PCPs. DESIGN Retrospective cohort study. SETTING Boston. PARTICIPANTS PCPs affiliated with 2 academic outpatient primary care networks. MEASUREMENTS PCP productivity, patient satisfaction, resource utilization, and compliance with screening guidelines. RESULTS Part-time PCP productivity was greater than that of full-time PCPs (2.1 work relative value units (RVUs)/bookable clinical hour versus 1.3 work RVUs/bookable clinical hour, P < .01). A similar proportion of part-time PCPs (80%) and full-time PCPs (75%) met targets for mammography, Pap smears, and cholesterol screening (P = .67). After adjusting for clinical case mix, practice location, gender, board certification status, and years in practice, resource utilization of part-time PCPs ($138 [95% confidence interval (CI), $108 to $167]) was similar to that of full-time PCPs ($139 [95% CI, $108 to $170], P = .92). Patient satisfation was similar for part-time and full-time PCPs. CONCLUSIONS In these academic primary care practices, rates of patient satisfaction, compliance with screenig guidelines, and resource utilization were similar for part-time PCPs compared to full-time PCPs. Productivity per clinical hour was markedly higher for part-time PCPs are atleast as efficient as full-time PCPs and that the quality of their work is similar. PMID:11679033

System implications of the ambulance arrival-to-patient contact interval on response interval compliance.

PubMed

Campbell, J P; Gratton, M C; Salomone, J A; Lindholm, D J; Watson, W A

1994-01-01

In some emergency medical services (EMS) system designs, response time intervals are mandated with monetary penalties for noncompliance. These times are set with the goal of providing rapid, definitive patient care. The time interval of vehicle at scene-to-patient access (VSPA) has been measured, but its effect on response time interval compliance has not been determined. To determine the effect of the VSPA interval on the mandated code 1 (< 9 min) and code 2 (< 13 min) response time interval compliance in an urban, public-utility model system. A prospective, observational study used independent third-party riders to collect the VSPA interval for emergency life-threatening (code 1) and emergency nonlife-threatening (code 2) calls. The VSPA interval was added to the 9-1-1 call-to-dispatch and vehicle dispatch-to-scene intervals to determine the total time interval from call received until paramedic access to the patient (9-1-1 call-to-patient access). Compliance with the mandated response time intervals was determined using the traditional time intervals (9-1-1 call-to-scene) plus the VSPA time intervals (9-1-1 call-to-patient access). Chi-square was used to determine statistical significance. Of the 216 observed calls, 198 were matched to the traditional time intervals. Sixty-three were code 1, and 135 were code 2. Of the code 1 calls, 90.5% were compliant using 9-1-1 call-to-scene intervals dropping to 63.5% using 9-1-1 call-to-patient access intervals (p < 0.0005). Of the code 2 calls, 94.1% were compliant using 9-1-1 call-to-scene intervals. Compliance decreased to 83.7% using 9-1-1 call-to-patient access intervals (p = 0.012). The addition of the VSPA interval to the traditional time intervals impacts system response time compliance. Using 9-1-1 call-to-scene compliance as a basis for measuring system performance underestimates the time for the delivery of definitive care. This must be considered when response time interval compliances are defined.

Incorporating social impact on new product adoption in choice modeing: A case study in green vehicles

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

He, Lin; Wang, Mingxian; Chen, Wei

While discrete choice analysis is prevalent in capturing consumer preferences and describing their choice behaviors in product design, the traditional choice modeling approach assumes that each individual makes independent decisions, without considering the social impact. However, empirical studies show that choice is social - influenced by many factors beyond engineering performance of a product and consumer attributes. To alleviate this limitation, we propose a new choice modeling framework to capture the dynamic influence from social networks on consumer adoption of new products. By introducing social influence attributes into a choice utility function, social network simulation is integrated with the traditionalmore » discrete choice analysis in a three-stage process. Our study shows the need for considering social impact in forecasting new product adoption. Using hybrid electric vehicles as an example, our work illustrates the procedure of social network construction, social influence evaluation, and choice model estimation based on data from the National Household Travel Survey. Our study also demonstrates several interesting findings on the dynamic nature of new technology adoption and how social networks may influence hybrid electric vehicle adoption. (C) 2014 Elsevier Ltd. All rights reserved« less

Strategies for monitoring the bacteriological quality of water supply in distribution systems

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

Geldreich, E.E.; Goodrich, J.A.; Clark, R.M.

1989-01-01

Monitoring strategies for characterizing the bacteriological quality of water in the distribution system require a complete understanding of a variety of interrelated aspects that include treated water quality, water-supply retention in storage and infrastructure deterioration in the distribution system. A study of field data from several water-supply utilities was used to highlight some innovative interpretations of compliance monitoring data. Major perceptions include: The use of a 5% coliform frequency of occurrence limit highlights compliance significance in those situations where there are clusters of positive samples containing less than 4 coliforms per 100 mL. Unfortunately, this presence/absence concept does not providemore » any indication of the magnitude of a contamination event.« less