Sample records for cost premiums long-term

  1. The Volatility of Long-term Bond Returns: Persistent Interest Shocks and Time-varying Risk Premiums

    DEFF Research Database (Denmark)

    Osterrieder, Daniela; Schotman, Peter C.

    are dominated by a level factor, which requires persistence in the spot interest rate. We find that a fractionally integrated process for the short rate plus a fractionally integrated specification for the price of risk leads to an analytically tractable almost affine term structure model that can explain...... the stylized facts. In a decomposition of long-term bond returns we find that the expectations component from the level factor is more volatile than the returns themselves. It therefore takes a volatile risk premium that is negatively correlated with innovations in the level factor to explain the volatility...

  2. Cost accounting in long term construction project management

    Directory of Open Access Journals (Sweden)

    Sabrina Versteg


    Full Text Available The aim of this study is to analyze the particularities that involve accounting and ways to control the revenue and costs of long-term engineering projects, in accordance with the accounting practices established by Technical Publication No. 17 (CPC 17. In order to achieve the research objectives, we performed a case study with a qualitative and quantitative approach through the collection of data and evidence from management reports and semi-structured interviews with two project coordinators and the accountant for the company that is the focus of the study. The results showed that the company under review applies accounting practices, according to the guideline of the CPC 17, in accounting for construction contracts, and achieves cost and revenue controls of these projects through project management and accounting control.

  3. A cost of long-term memory in Drosophila


    Mery, Frederic; Kawecki, Tadeusz J.


    Two distinct forms of consolidated associative memory are known in Drosophila: long-term memory and so-called anesthesia-resistant memory. Long-term memory is more stable, but unlike anesthesia-resistant memory, its formation requires protein synthesis. We show that flies induced to form long-term memory become more susceptible to extreme stress (such as desiccation). In contrast, induction of anesthesia-resistant memory had no detectable effect on desiccation resistance. This finding may hel...

  4. 45 CFR 152.21 - Premiums and cost-sharing. (United States)


    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Premiums and cost-sharing. 152.21 Section 152.21...-EXISTING CONDITION INSURANCE PLAN PROGRAM Benefits § 152.21 Premiums and cost-sharing. (a) Limitation on... the applicable standard risk rate that would apply to the coverage offered in the State or States. The...

  5. Long term warranty and after sales service concept, policies and cost models

    CERN Document Server

    Rahman, Anisur


    This volume presents concepts, policies and cost models for various long-term warranty and maintenance contracts. It offers several numerical examples for estimating costs to both the manufacturer and consumer. Long-term warranties and maintenance contracts are becoming increasingly popular, as these types of aftersales services provide assurance to consumers that they can enjoy long, reliable service, and protect them from defects and the potentially high costs of repairs. Studying long-term warranty and service contracts is important to manufacturers and consumers alike, as offering long-term warranty and maintenance contracts produce additional costs for manufacturers / service providers over the product’s service life. These costs must be factored into the price, or the manufacturer / dealer will incur losses instead of making a profit. On the other hand, the buyer / consumer needs to weigh the cost of maintaining it over its service life and to decide whether or not these policies are worth purchasing....

  6. Costs of quality management systems in long-term care organizations: an exploration.

    NARCIS (Netherlands)

    Wagner, C.; Merode, G.G. van; Oort, M. van


    The article describes a method for measuring and reporting the costs of quality management in 11 long-term care organizations (nursing homes, home health care organizations, and homes for the elderly) and a national survey in 489 organizations providing long-term care. Site visits and a

  7. Can home care services achieve cost savings in long-term care for older people? (United States)

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


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

  8. 47 CFR 52.32 - Allocation of the shared costs of long-term number portability. (United States)


    ... 47 Telecommunication 3 2010-10-01 2010-10-01 false Allocation of the shared costs of long-term...) COMMON CARRIER SERVICES (CONTINUED) NUMBERING Number Portability § 52.32 Allocation of the shared costs....21(h), of each regional database, as defined in § 52.21(1), shall recover the shared costs of long...

  9. Impact and contributors to cost of managing long term conditions in ...

    African Journals Online (AJOL)

    Journal of Community Medicine and Primary Health Care ... This study assessed the contributors to cost and financial implications for patients being managed for hypertension and/or diabetes in a tertiary hospital in Nigeria. Method: ... Keywords: Cost Of Care, Long Term Conditions, Hypertension, Diabetes, Access, Nigeria ...

  10. Costs of long-term carrying of extra mass in a songbird

    NARCIS (Netherlands)

    Atema, Els; van Noordwijk, Arie J.; Boonekamp, Jelle J.; Verhulst, Simon


    Iteroparous organisms face a trade-off between reproduction and survival, but knowledge of whether how and when costs of long-term increases in workload are paid is scant. We increased locomotion costs for a whole year by equipping male great tits with a backpack during breeding, removing the

  11. Costs of long-term carrying of extra mass in a songbird

    NARCIS (Netherlands)

    Atema, E.; Van Noordwijk, A.J.; Boonekamp, J. J.; Verhulst, S.


    Iteroparous organisms face a trade-off between reproduction and survival but knowledge of whether, how and when costs of long-term increases in workload are paid is scant. We increased locomotion costs for a whole year by equipping male great tits with a backpack during breeding, removing the

  12. Japan's universal long-term care system reform of 2005: containing costs and realizing a vision. (United States)

    Tsutsui, Takako; Muramatsu, Naoko


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

  13. Medicare long-term CPAP coverage policy: a cost-utility analysis. (United States)

    Billings, Martha E; Kapur, Vishesh K


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

  14. Long-term cost-effectiveness of disease management in systolic heart failure. (United States)

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


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

  15. Long-term health care utilisation and costs after spinal fusion in elderly patients

    DEFF Research Database (Denmark)

    Andersen, Thomas; Bünger, Cody; Søgaard, Rikke


    -term consequences of spinal fusion surgery in elderly patients on health care use and costs using a health care system perspective. METHODS: 194 patients undergoing spinal fusion between 2001 and 2005 (70 men, 124 women) with a mean age of 70 years (range 59-88) at surgery were included. Average length of follow......PURPOSE: Spinal fusion surgery rates in the elderly are increasing. Cost effectiveness analyses with relatively short-length follow-up have been performed. But the long-term effects in terms of health care use are largely unknown. The aim of the present study was to describe the long...

  16. Long-term benefit and cost-effectiveness analysis of screening for abdominal aortic aneurysms from a randomized controlled trial

    DEFF Research Database (Denmark)

    Lindholt, Jes S.; Sørensen, J; Søgaard, R


    The aim was to estimate long-term mortality benefits and cost-effectiveness of screening for abdominal aortic aneurysm (AAA) in men aged 64-73 years.......The aim was to estimate long-term mortality benefits and cost-effectiveness of screening for abdominal aortic aneurysm (AAA) in men aged 64-73 years....

  17. Direct and indirect costs and long-term survival of laparoscopic anterior resection for rectal cancer. (United States)

    Feng, Bo; Zhu, Qian-Lin; Xia, Yi; Lu, Ai-Guo; Wang, Ming-Liang; Li, Jian-Wen; Hu, Wei-Guo; Zang, Lu; Mao, Zhi-Hai; Dong, Feng; Ma, Jun-Jun; Zheng, Min-Hua


    Few studies evaluate the cost-effectiveness issues of laparoscopic anterior resection (LAR) for rectal cancer. This study evaluates direct and indirect costs of LAR and its long-term survival rate in rectal cancer patients. This prospective nonrandomized controlled trial included 2 endpoints (direct and indirect costs, and disease-free survival). From January 2003 to May 2005, rectal cancer patients admitted to our center were assigned to 2 groups: 87 patients underwent LAR (LAP), while 86 cases received open anterior resection (OPEN). The direct costs were prospectively evaluated. Main indirect cost is productivity loss. The data of direct costs, indirect costs, and the total costs were collected for the minimal cost analysis. Disease-free survival at 65 months in the LAP group and the OPEN group was 78.2% and 74.7%; there was no significant difference between the groups. Median direct costs were not significantly different between the LAP and the OPEN groups. Indirect costs of the LAP group were significantly lower than those of the OPEN group, while total costs were not significantly different. Cost percentage for operations, medications, and hospitalization were 75.90%, 11.28%, and 2.18% in the LAP group; while in the operation group, they were 54.50%, 29.09%, and 3.35%. Total economic budget for a patient receiving LAR was not significantly increased compared with the conservative method owing to its technical predominance, oncologic safety, as well as frequent bed turnover.

  18. Use of pulmonary artery catheter in coronary artery bypass graft. Costs and long-term outcomes.

    Directory of Open Access Journals (Sweden)

    Fei Xu

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

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

    Energy Technology Data Exchange (ETDEWEB)

    Van Dyke, J.


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

  20. Long-term cost-effectiveness of providing full coverage for preventive medications after myocardial infarction. (United States)

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


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

  1. A retrospective cost-analysis of additional homeopathic treatment in Germany: Long-term economic outcomes.

    Directory of Open Access Journals (Sweden)

    Julia K Ostermann

    Full Text Available This study aimed to provide a long-term cost comparison of patients using additional homeopathic treatment (homeopathy group with patients using usual care (control group over an observation period of 33 months.Health claims data from a large statutory health insurance company were analysed from both the societal perspective (primary outcome and from the statutory health insurance perspective (secondary outcome. To compare costs between patient groups, homeopathy and control patients were matched in a 1:1 ratio using propensity scores. Predictor variables for the propensity scores included health care costs and both medical and demographic variables. Health care costs were analysed using an analysis of covariance, adjusted for baseline costs, between groups both across diagnoses and for specific diagnoses over a period of 33 months. Specific diagnoses included depression, migraine, allergic rhinitis, asthma, atopic dermatitis, and headache.Data from 21,939 patients in the homeopathy group (67.4% females and 21,861 patients in the control group (67.2% females were analysed. Health care costs over the 33 months were 12,414 EUR [95% CI 12,022-12,805] in the homeopathy group and 10,428 EUR [95% CI 10,036-10,820] in the control group (p<0.0001. The largest cost differences were attributed to productivity losses (homeopathy: EUR 6,289 [6,118-6,460]; control: EUR 5,498 [5,326-5,670], p<0.0001 and outpatient costs (homeopathy: EUR 1,794 [1,770-1,818]; control: EUR 1,438 [1,414-1,462], p<0.0001. Although the costs of the two groups converged over time, cost differences remained over the full 33 months. For all diagnoses, homeopathy patients generated higher costs than control patients.The analysis showed that even when following-up over 33 months, there were still cost differences between groups, with higher costs in the homeopathy group.

  2. Readmission Rates and Long-Term Hospital Costs Among Survivors of In-Hospital Cardiac Arrest (United States)

    Chan, Paul S.; Nallamothu, Brahmajee K.; Krumholz, Harlan M.; Curtis, Lesley H.; Li, Yan; Hammill, Bradley G.; Spertus, John A.


    Background Although in-hospital cardiac arrest is common, little is known about readmission patterns and inpatient resource use among survivors of in-hospital cardiac arrest. Methods and Results Within a large national registry, we examined long-term inpatient utilization among 6972 adults ≥65 years who survived an in-hospital cardiac arrest. We examined 30-day and 1-year readmission rates and inpatient costs, overall and by patient demographics, hospital disposition (discharge destination), and neurological status at discharge. The mean age was 75.8 ± 7.0 years, 56% were men, and 12% were black. There were a total of 2005 readmissions during the first 30 days (cumulative incidence rate: 35 readmissions/100 patients [95% CI: 33–37]) and 8751 readmissions at 1 year (cumulative incidence rate: 185 readmissions/100 patients [95% CI: 177–190]). Overall, mean inpatient costs were $7,741 ± $2323 at 30 days and $18,629 ± $9411 at 1 year. Thirty-day inpatient costs were higher in patients of younger age (≥85 years: $6052 [reference]; 75–84 years: $7444 [adjusted cost ratio, 1.23 [1.06–1.42]; 65–74 years: $8291 [adjusted cost ratio, 1.37 [1.19–1.59]; both Pcardiac arrest have frequent readmissions and high follow-up inpatient costs. Readmissions and inpatient costs were higher in certain subgroups, including patients of younger age and black race. PMID:25351479

  3. Cost comparison of unit dose and traditional drug distribution in a long-term-care facility. (United States)

    Lepinski, P W; Thielke, T S; Collins, D M; Hanson, A


    Unit dose and traditional drug distribution systems were compared in a 352-bed long-term-care facility by analyzing nursing time, medication-error rate, medication costs, and waste. Time spent by nurses in preparing, administering, charting, and other tasks associated with medications was measured with a stop-watch on four different nursing units during six-week periods before and after the nursing home began using unit dose drug distribution. Medication-error rate before and after implementation of the unit dose system was determined by patient profile audits and medication inventories. Medication costs consisted of patient billing costs (acquisition cost plus fee) and cost of medications destroyed. The unit dose system required a projected 1507.2 hours less nursing time per year. Mean medication-error rates were 8.53% and 0.97% for the traditional and unit dose systems, respectively. Potential annual savings because of decreased medication waste with the unit dose system were $2238.72. The net increase in cost for the unit dose system was estimated at $615.05 per year, or approximately $1.75 per patient. The unit dose system appears safer and more time-efficient than the traditional system, although its costs are higher.

  4. Costs and Benefits of a Shared Digital Long-Term Preservation System

    Directory of Open Access Journals (Sweden)

    Esa-Pekka Keskitalo


    Full Text Available This paper describes the cost-benefit analysis of digital long-term preservation (LTP that was carried out in the context of the Finnish National Digital Library Project (NDL in 2010. The analysis was based on the assumption that as many as 200 archives, libraries, and museums will share an LTP system. The term ‘system’ shall be understood as encompassing not only information technology, but also human resources, organizational structures, policies and funding mechanisms. The cost analysis shows that an LTP system will incur, over the first 12 years, cumulative costs of €42 million, i.e. an average of €3.5 million per annum. Human resources and investments in information technology are the major cost factors. After the initial stages, the analysis predicts annual costs of circa €4 million. The analysis compared scenarios with and without a shared LTP system. The results indicate that a shared system will have remarkable benefits. At the development and implementation stages, a shared system shows an advantage of €30 million against the alternative scenario consisting of five independent LTP solutions. During the later stages, the advantage is estimated at €10 million per annum. The cumulative cost benefit over the first 12 years would amount to circa €100 million.

  5. A retrospective cost-analysis of additional homeopathic treatment in Germany: Long-term economic outcomes. (United States)

    Ostermann, Julia K; Witt, Claudia M; Reinhold, Thomas


    This study aimed to provide a long-term cost comparison of patients using additional homeopathic treatment (homeopathy group) with patients using usual care (control group) over an observation period of 33 months. Health claims data from a large statutory health insurance company were analysed from both the societal perspective (primary outcome) and from the statutory health insurance perspective (secondary outcome). To compare costs between patient groups, homeopathy and control patients were matched in a 1:1 ratio using propensity scores. Predictor variables for the propensity scores included health care costs and both medical and demographic variables. Health care costs were analysed using an analysis of covariance, adjusted for baseline costs, between groups both across diagnoses and for specific diagnoses over a period of 33 months. Specific diagnoses included depression, migraine, allergic rhinitis, asthma, atopic dermatitis, and headache. Data from 21,939 patients in the homeopathy group (67.4% females) and 21,861 patients in the control group (67.2% females) were analysed. Health care costs over the 33 months were 12,414 EUR [95% CI 12,022-12,805] in the homeopathy group and 10,428 EUR [95% CI 10,036-10,820] in the control group (pcost differences were attributed to productivity losses (homeopathy: EUR 6,289 [6,118-6,460]; control: EUR 5,498 [5,326-5,670], pcosts (homeopathy: EUR 1,794 [1,770-1,818]; control: EUR 1,438 [1,414-1,462], pcosts of the two groups converged over time, cost differences remained over the full 33 months. For all diagnoses, homeopathy patients generated higher costs than control patients. The analysis showed that even when following-up over 33 months, there were still cost differences between groups, with higher costs in the homeopathy group.

  6. Dancing bees improve colony foraging success as long-term benefits outweigh short-term costs.

    Directory of Open Access Journals (Sweden)

    Roger Schürch

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

  7. Dancing bees improve colony foraging success as long-term benefits outweigh short-term costs. (United States)

    Schürch, Roger; Grüter, Christoph


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

  8. Rapid, simple, and cost-effective treatments to achieve long-term hydrophilic PDMS surfaces (United States)

    Hemmilä, Samu; Cauich-Rodríguez, Juan V.; Kreutzer, Joose; Kallio, Pasi


    This paper describes rapid, simple, and cost-effective treatments for producing biocompatible and long-term hydrophilic polydimethylsiloxane (PDMS) surfaces identified in an experimental study investigating 39 treatments in all. The wetting of the surfaces was monitored during six months. Changes in surface morphology and chemical composition were also analyzed. Some of the treatments are presented here for the first time, while for earlier presented treatments the selection of investigated parameters was wider and the observation period for the surface wetting longer. The PDMS surfaces were modified by surface activation, physisorption, and synthesis of both “grafting to” and “grafting from” polymer brushes. In surface activation, the PDMS sample was exposed to oxygen plasma, with several combinations of exposure time and RF power. In the physisorption and synthesis of polymer brushes, three commercially available and biocompatible chemicals were used: 2-hydroxyethyl methacrylate (HEMA), polyethylene glycol (PEG), and polyvinylpyrrolidone (PVP). Thirty-three of the 39 treatments rendered the PDMS hydrophilic, and in 12 cases the hydrophilicity lasted at least six months. Seven of these long-term hydrophilic coatings supported a contact angle of 30° or less. Three of the long-lasting hydrophilic coatings required only minutes to prepare.

  9. Spatial dispersion of housing units as an important factor influencing long-term care operational costs

    Directory of Open Access Journals (Sweden)

    Norina Szander


    Full Text Available Over 90% of seniors prefer to age in place, which is an idea supported by the European Semesters on Long-Term Care strategic plans for member states, but they do not have the necessary innovation to improve the living of the elderly in a properly built environment with sustainable financing. The spatial dispersion of housing and density in a functional area should be particularly taken into consideration by facilities’ managers and medical care institutions offering housing, healthcare and other services for the elderly in planning the built environment and other facilities for seniors because the costs of logistics (material transport, nurse workload, costs of other service providers, and transport of seniors in the case of daily programmes greatly depend on it. Using data from a care centre in a Hungarian municipality, we simulated and optimised home healthcare routing and scheduling in various scenarios of spatial dispersion and changing density of clients. We modelled the rounds of caregivers visiting seniors in homecare as a multiple travelling salesman problem, and the solutions show the necessary workforce and service time requirements. The tool that enabled us to study the outputs of scenarios might help professionals forecast and plan for coming changes in the costs of nursing services caused by the growing number of seniors that may need help in maintaining their independence as long as possible, taking into account that the density and dispersion of households are also changing.

  10. Long-term medical costs and life expectancy of acute myeloid leukemia: a probabilistic decision model. (United States)

    Wang, Han-I; Aas, Eline; Howell, Debra; Roman, Eve; Patmore, Russell; Jack, Andrew; Smith, Alexandra


    Acute myeloid leukemia (AML) can be diagnosed at any age and treatment, which can be given with supportive and/or curative intent, is considered expensive compared with that for other cancers. Despite this, no long-term predictive models have been developed for AML, mainly because of the complexities associated with this disease. The objective of the current study was to develop a model (based on a UK cohort) to predict cost and life expectancy at a population level. The model developed in this study combined a decision tree with several Markov models to reflect the complexity of the prognostic factors and treatments of AML. The model was simulated with a cycle length of 1 month for a time period of 5 years and further simulated until age 100 years or death. Results were compared for two age groups and five different initial treatment intents and responses. Transition probabilities, life expectancies, and costs were derived from a UK population-based specialist registry-the Haematological Malignancy Research Network ( Overall, expected 5-year medical costs and life expectancy ranged from £8,170 to £81,636 and 3.03 to 34.74 months, respectively. The economic and health outcomes varied with initial treatment intent, age at diagnosis, trial participation, and study time horizon. The model was validated by using face, internal, and external validation methods. The results show that the model captured more than 90% of the empirical costs, and it demonstrated good fit with the empirical overall survival. Costs and life expectancy of AML varied with patient characteristics and initial treatment intent. The robust AML model developed in this study could be used to evaluate new diagnostic tools/treatments, as well as enable policy makers to make informed decisions. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  11. Long-term health and medical cost impact of smoking prevention in adolescence. (United States)

    Wang, Li Yan; Michael, Shannon L


    To estimate smoking progression probabilities from adolescence to young adulthood and to estimate long-term health and medical cost impacts of preventing smoking in today's adolescents. Using data from the National Longitudinal Study of Adolescent Health (Add Health), we first estimated smoking progression probabilities from adolescence to young adulthood. Then, using the predicted probabilities, we estimated the number of adolescents who were prevented from becoming adult daily smokers as a result of a hypothetical 1 percentage point reduction in the prevalence of ever smoking in today's adolescents. We further estimated lifetime medical costs saved and quality-adjusted life years (QALYs) gained as a result of preventing adolescents from becoming adult daily smokers. All costs were in 2010 dollars. Compared with never smokers, those who had tried smoking at baseline had higher probabilities of becoming current or former daily smokers at follow-up regardless of baseline grade or sex. A hypothetical 1 percentage point reduction in the prevalence of ever smoking in 24.5 million students in 7th-12th grades today could prevent 35,962 individuals from becoming a former daily smoker and 44,318 individuals from becoming a current daily smoker at ages 24-32 years. As a result, lifetime medical care costs are estimated to decrease by $1.2 billion and lifetime QALYs is estimated to increase by 98,590. Effective smoking prevention programs for adolescents go beyond reducing smoking prevalence in adolescence; they also reduce daily smokers in young adulthood, increase QALYs, and reduce medical costs substantially in later life. This finding indicates the importance of continued investment in effective youth smoking prevention programs. Published by Elsevier Inc.

  12. Making long-term economic growth more sustainable. Evaluating the costs and benefits

    Energy Technology Data Exchange (ETDEWEB)

    Islam, Sardar M.N.; Clarke, Matthew [Sustainable Economic Growth Program, Centre for Strategic Economic Studies, City Campus, Victoria University, PO Box 14428, Melbourne, Vic. (Australia); Munasinghe, Mohan [Munasinghe Institute for Development (MIND), Colombo (Sri Lanka)


    Currently, traditional development issues such as economic stagnation, poverty, hunger, and illness as well as newer challenges like environmental degradation and globalisation demand attention. Sustainable development, including its economic, environmental and social elements, is a key goal of decisionmakers. Optimal economic growth has also been a crucial goal of both development theorists and practitioners. This paper examines the conditions under which optimal growth might be sustainable, by assessing the costs and benefits of growth. Key environmental and social aspects are considered. The Ecol-Opt-Growth-1 model analyses economic-ecological interactions, including resource depletion, pollution, irreversibility, other environmental effects, and uncertainty. It addresses some important issues, including savings, investment, technical progress, substitutability of productive factors, intergenerational efficiency, equity, and policies to make economic growth more sustainable-a basic element of the sustainomics framework. The empirical results support growing concerns that costs of growth may outweigh its benefits, resulting in unsustainability. Basically, in a wide range of circumstances, long term economic growth is unsustainable due to increasing environmental damage. Nevertheless, the model has many options that can be explored by policy makers, to make the development path more sustainable, as advocated by sustainomics. One example suggests that government supported abatement programs are needed to move towards sustainable development, since the model runs without abatement were infeasible. The optimal rate of abatement increases over time. Abatement of pollution is necessary to improve ecosystem viability and increase sustainability. Further research is necessary to seek conditions under which alternative economic growth paths are likely to become sustainable.

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

    Energy Technology Data Exchange (ETDEWEB)

    LeBlance, R.J.; Allain, C.J.; Laughton, P.J.; Henry, J.G.


    The Greater Moncton Sewerage Commission's 115 000 m{sup 3}/d advanced, chemically assisted primary wastewater treatment facility located in New Brunswick, Canada, has developed an integrated, long term, sustainable, cost effective programme for the management and beneficial utilization of biosolids from lime stabilized raw sludge. The paper overviews biosolids production, lime stabilization, conveyance, and odour control followed by an indepth discussion of the wastewater sludge as a resource programme, namely: composting, mine site reclamation, landfill cover, land application for agricultural use, tree farming, sod farm base as a soil enrichment, topsoil manufacturing. The paper also addresses the issues of metals, pathogens, organic compounds, the quality control program along with the regulatory requirements. Biosolids capital and operating costs are presented. Research results on removal of metals from primary sludge using a unique biological process known as BIOSOL as developed by the University of Toronto, Canada to remove metals and destroy pathogens are presented. The paper also discusses an ongoing cooperative research project with the Universite de Moncton where various mixtures of plant biosolids are composted with low quality soil. Integration, approach to sustainability and ''cumulative effects'' as part of the overall biosolids management strategy is also discussed. (author)

  14. Success rate, costs and long-term stability of treatment with activator/headgear combinations. (United States)

    Hedlund, Camilla; Feldmann, Ingalill


    The aims of this study were to evaluate treatment outcome with activator-headgear combinations carried out by general dental practitioners, overall costs, long-term stability and patients' satisfaction with treatment outcome. Patients who were recommended to start treatment in 2006 were included in this study (n = 97). Inclusion criteria were: Class II Division 1 with at least half a cusp width distal molar relationship, overjet ≥ 6 mm and presence of dental records. Data were collected, pre-treatment, post-treatment and 3 years after treatment for those with favorable outcome. Patients at follow-up completed a questionnaire about satisfaction with treatment outcome, perceived pain and discomfort during treatment, and subjective need for additional treatment. Eighty-five patients were analyzed, 52 boys and 33 girls (mean age 11.2 years SD 1.39). Thirty-five patients had successful treatment outcome, 15 partially successful and 35 had an unsuccessful outcome. Total costs for all 85 patients amounted to SEK 1 405 000 including both direct and indirect costs. Thirty-eight patients participated in the 3-year follow-up. Treatment outcomes were then categorized as successful in 28 patients, partially successful in 9 patients and 1 patient was judged as unsuccessful. Median values on VAS (0-100) for overall satisfaction with treatment and treatment outcome were high, 78 and 84 respectively. Median value for perceived pain and discomfort during treatment was 42. Just over half of the patients had a favorable treatment outcome. Patients with favorable outcome were stable over time and satisfied with treatment.

  15. Long-Term Cost-Effectiveness of Transanal Irrigation in Patients with Neurogenic Bowel Dysfunction.

    Directory of Open Access Journals (Sweden)

    Anton Emmanuel

    Full Text Available People suffering from neurogenic bowel dysfunction (NBD and an ineffective bowel regimen often suffer from fecal incontinence (FI and related symptoms, which have a huge impact on their quality of life. In these situations, transanal irrigation (TAI has been shown to reduce these symptoms and improve quality of life.To investigate the long-term cost-effectiveness of initiating TAI in patients with NBD who have failed standard bowel care (SBC.A deterministic Markov decision model was developed to project the lifetime health economic outcomes, including quality-adjusted life years (QALYs, episodes of FI, urinary tract infections (UTIs, and stoma surgery when initiating TAI relative to continuing SBC. A data set consisting of 227 patients with NBD due to spinal cord injury (SCI, multiple sclerosis, spina bifida and cauda equina syndrome was used in the analysis. In the model a 30-year old individual with SCI was used as a base-case. A probabilistic sensitivity analysis was applied to evaluate the robustness of the model.The model predicts that a 30-year old SCI patient with a life expectancy of 37 years initiating TAI will experience a 36% reduction in FI episodes, a 29% reduction in UTIs, a 35% reduction in likelihood of stoma surgery and a 0.4 improvement in QALYs, compared with patients continuing SBC. A lifetime cost-saving of £21,768 per patient was estimated for TAI versus continuing SBC alone.TAI is a cost-saving treatment strategy reducing risk of stoma surgery, UTIs, episodes of FI and improving QALYs for NBD patients who have failed SBC.

  16. A long-term experimental study demonstrates the costs of begging that were not found over the short term.

    Directory of Open Access Journals (Sweden)

    Manuel Soler

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

  17. Are citizens not accurately informed about long-term societal costs of unsustainable travel or do they not care?

    NARCIS (Netherlands)

    Gärling, Tommy; Ettema, Dick; Friman, Margareta


    We argue that people think more about the short-term individual benefits of personal motorized travel than the long-term societal costs. One explanation is that people are more concerned about their own wellbeing and the wellbeing of their close relatives than the well-being of unknown others.

  18. Long-term outcomes and cost effectiveness of high-dose dexamethasone for cardiac surgery : A randomised trial

    NARCIS (Netherlands)

    Dieleman, J. M.; de Wit, G. A.; Nierich, A. P.; Rosseel, P. M.; van der Maaten, J. M.; Hofland, J.; Diephuis, J. C.; de Lange, F.; Boer, C.; Neslo, R. E.; Moons, K. G.; van Herwerden, L. A.; Tijssen, J. G.; Kalkman, C. J.; van Dijk, D.

    Prophylactic intra-operative administration of dexamethasone may improve short-term clinical outcomes in cardiac surgical patients. The purpose of this study was to evaluate long-term clinical outcomes and cost effectiveness of dexamethasone versus placebo. Patients included in the multicentre,

  19. What Are the Long-Term Economic Costs of Psychological Problems during Childhood? Fact Sheet (United States)

    Steinberg, Paul


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

  20. Positive illusions about the self: short-term benefits and long-term costs. (United States)

    Robins, R W; Beer, J S


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

  1. Risk-adjusted impact of administrative costs on the distribution of terminal wealth for long-term investment. (United States)

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


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

  2. Risk-Adjusted Impact of Administrative Costs on the Distribution of Terminal Wealth for Long-Term Investment (United States)

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


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

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

    Directory of Open Access Journals (Sweden)

    Montserrat Guillén


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

  4. A review of methods used in long-term cost-effectiveness models of diabetes mellitus treatment. (United States)

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


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

  5. A portable low-cost long-term live-cell imaging platform for biomedical research and education. (United States)

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


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

  6. Evaluation of the long-term cost-effectiveness of liraglutide therapy for patients with type 2 diabetes in France. (United States)

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


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

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

    NARCIS (Netherlands)

    Sabes-Figuera, R.; McCrone, P.; Bogic, M.; Ajdukovic, D.; Franciskovic, T.; Colombini, N.; Kucukalic, A.; Lecic-Tosevski, D.; Morina, N.; Popovski, M.; Schützwohl, M.; Priebe, S.


    Objective Exposure to war can negatively affect health and may impact on healthcare costs. Estimating these costs and identifying their predictors is important for appropriate service planning. We aimed to measure use of health services in an adult population who had experienced war in the

  8. Long-term cost-effectiveness of ticagrelor versus clopidogrel in acute coronary syndrome in Spain

    Directory of Open Access Journals (Sweden)

    E. Molina-Cuadrado


    Full Text Available Objective: To assess the cost-effectiveness relationship of Ticagrelor versus Clopidogrel for the management of acute coronary syndrome in Spain. Methods: The data from the PLATO study were used for the calculation of the events rate and health-related quality of life for Ticagrelor and Clopidogrel for the first 12 months, whereas the costs were obtained from Spanish sources. Quality of lifeadjusted survival and costs were estimated according to the fact that the patients did not suffer any thrombotic event (myocardial infarction or ictus or this one was not fatal. The lifetime cots, life years gained, and the quality of life-adjusted survival were estimated for both treatment arms. Incremental costeffectiveness ratios were assessed through the perspective of the Spanish healthcare system for 2013, by using a macro-costs strategy based on published literature and the survival tables for the Spanish population. Results: Treatment with Ticagrelor was associated to an incremental cost of 1,228 per year, an increase in 0.1652 life years gained, and 0.1365 years adjusted by quality of life, as compared to Clopidogrel. The cost for one quality of life-adjusted life year was 8,997 and the cost per one gained life year of 7,435 . The sensitivity analysis showed consistent results. Conclusions: Treatment of acute coronary syndrome for 12 months with Ticagrelor was associated with a cost per 1 life year of quality of life-adjusted cost below the cost-effectiveness limits generally accepted in Spain.

  9. Reproductive Flexibility: Genetic Variation, Genetic Costs and Long-Term Evolution in a Collembola (United States)

    Tully, Thomas; Ferrière, Régis


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

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

    Directory of Open Access Journals (Sweden)

    Ramon Sabes-Figuera

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

  11. Long-term costs and health impact of continued global fund support for antiretroviral therapy.

    Directory of Open Access Journals (Sweden)

    John Stover

    Full Text Available BACKGROUND: By the end of 2011 Global Fund investments will be supporting 3.5 million people on antiretroviral therapy (ART in 104 low- and middle-income countries. We estimated the cost and health impact of continuing treatment for these patients through 2020. METHODS AND FINDINGS: Survival on first-line and second-line ART regimens is estimated based on annual retention rates reported by national AIDS programs. Costs per patient-year were calculated from country-reported ARV procurement prices, and expenditures on laboratory tests, health care utilization and end-of-life care from in-depth costing studies. Of the 3.5 million ART patients in 2011, 2.3 million will still need treatment in 2020. The annual cost of maintaining ART falls from $1.9 billion in 2011 to $1.7 billion in 2020, as a result of a declining number of surviving patients partially offset by increasing costs as more patients migrate to second-line therapy. The Global Fund is expected to continue being a major contributor to meeting this financial need, alongside other international funders and domestic resources. Costs would be $150 million less in 2020 with an annual 5% decline in first-line ARV prices and $150-370 million less with a 5%-12% annual decline in second-line prices, but $200 million higher in 2020 with phase out of stavudine (d4T, or $200 million higher with increased migration to second-line regimens expected if all countries routinely adopted viral load monitoring. Deaths postponed by ART correspond to 830,000 life-years saved in 2011, increasing to around 2.3 million life-years every year between 2015 and 2020. CONCLUSIONS: Annual patient-level direct costs of supporting a patient cohort remain fairly stable over 2011-2020, if current antiretroviral prices and delivery costs are maintained. Second-line antiretroviral prices are a major cost driver, underscoring the importance of investing in treatment quality to improve retention on first-line regimens.

  12. A cost-effectiveness analysis of long-term intermittent catheterisation with hydrophilic and uncoated catheters

    DEFF Research Database (Denmark)

    Clark, J F; Mealing, S J; Scott, D A


    STUDY DESIGN: Cost-effectiveness analysisObjective:To establish a model to investigate the cost effectiveness for people with spinal cord injury (SCI), from a lifetime perspective, for the usage of two different single-use catheter designs: hydrophilic-coated (HC) and uncoated (UC). The model...... into consideration, as well as other catheter-related events. UTI event rates for the primary data set were based on data from hospital settings to ensure controlled and accurate reporting. A sensitivity analysis was applied to evaluate best- and worst-case scenarios. RESULTS: The model predicts that a 36-year-old...

  13. Long Term Potentials and Costs of RES - Part II: The Role of International Biomass Trade

    NARCIS (Netherlands)

    Hoefnagels, E.T.A.; Junginger, H.M.; Resch, G.; Panzer, C.


    This report investigated the impact of international transport on the total cost and greenhouse gas balance of solid woody biomass. For this purpose, a geospatial intermodal biomass transport model was developed in the ArcGIS 10.0 Network Analyst extension. This model has been complemented with data

  14. Out of the shadow: Long term cost development of intelligent sensor networks

    NARCIS (Netherlands)

    Fledderus, E.R; Kester, L.J.H.M.; Kranenburg-Bruinsma, K. van


    The paper addresses intelligent sensor networks (ISNs) as a special version of networked wireless robotics. The success of these networks is partly explained by the technical advances, but as well by cutting down costs of these networks. Using a functional breakdown of intelligent ISNs, the trends

  15. Changes in Cleanup Strategies and Long-Term Monitoring Costs for DOE FUSRAP Sites-17241

    Energy Technology Data Exchange (ETDEWEB)

    Castillo, Darina [U.S. Department of Energy, Office of Legacy Management; Carpenter, Cliff [U.S. Department of Energy, Office of Legacy Management; Roberts, Rebecca [Navarro Research and Engineering, Inc.; Young, Carl [Navarro Research and Engineering, Inc.


    LM is preparing for the transfer of 11 new FUSRAP sites within the next 10 years from USACE, many of which will have substantially greater LTSM requirements than the current Completed sites. LM is analyzing the estimates for the level of effort required to monitor the new sites in order to make more customized and accurate predictions of future life cycle costs and environmental liabilities of these sites.

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

    Directory of Open Access Journals (Sweden)

    Lewin GF


    Full Text Available Gill F Lewin,1,2 Helman S Alfonso,3 Janine J Alan41Faculty of Health Sciences, Curtin University, Perth, WA, Australia; 2Research Department, Silver Chain Group, Perth, WA, Australia; 3School of Population Health, University of Western Australia, Perth, WA, Australia; 4Faculty of Health Sciences, Curtin University, Perth, WA, AustraliaBackground: The objectives of this study were to determine whether older individuals who participated in a reablement (restorative program rather than immediately receiving conventional home care services had a reduced need for ongoing support and lower home care costs over the next 57 months (nearly 5 years.Materials and methods: Data linkage was used to examine retrospectively the service records of older individuals who had received a reablement service versus a conventional home care service to ascertain their use of home care services over time.Results: Individuals who had received a reablement service were less likely to use a personal care service throughout the follow-up period or any other type of home care over the next 3 years. This reduced use of home care services was associated with median cost savings per person of approximately AU $12,500 over nearly 5 years.Conclusion: The inclusion of reablement as the starting point for individuals referred for home care within Australia's reformed aged care system could increase the system's cost effectiveness and ensure that all older Australians have the opportunity to maximize their independence as they age.Keywords: restorative, older adults, community dwelling, service costs

  17. Long-term socio-economic consequences and health care costs of poliomyelitis

    DEFF Research Database (Denmark)

    Nielsen, Nete Munk; Kay, Lise; Wanscher, Benedikte


    Worldwide 10–20 million individuals are living with disabilities after acute poliomyelitis. However, very little is known about the socio-economic consequences and health care costs of poliomyelitis. We carried out a historical register-based study including 3606 individuals hospitalised for poli......Worldwide 10–20 million individuals are living with disabilities after acute poliomyelitis. However, very little is known about the socio-economic consequences and health care costs of poliomyelitis. We carried out a historical register-based study including 3606 individuals hospitalised...... for poliomyelitis in Copenhagen, Denmark 1940–1954, and 13,795 age and gender-matched Danes. Participants were followed from 1980 until 2012, and family, socio-economic conditions and health care costs were evaluated in different age groups using chi-squared tests, boot-strapped t tests or hazard ratios (HR...... survivors. The educational level among paralytic as well as non-paralytic polio survivors was higher than that among their controls, employment rate at the ages of 40, 50 and 60 years was slightly lower, whereas total income in the age intervals of 31–40, 41–50 and 51–60 years were similar to controls...

  18. Developments toward a low-cost approach for long-term, unattended vapor intrusion monitoring. (United States)

    Patel, Sanjay V; Tolley, William K


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



    Kliebenstein, James B.; Hurley, Sean P.; Larson, Ben; Honeyman, Mark


    Niche markets of agricultural products are experiencing rapid growth. One such market is organic pork. Organic production typically demands specific production conditions that can be cost increasing. This study evaluates the cost of organic pork production, seasonal differences in costs, and premiums necessary to induce continuous organic pork production. In the past few years, niche marketing has been a rapidly growing phenomenon in agriculture. One area that has experienced dramatic growth ...

  20. Long-term cost-effectiveness of home versus clinic-based management of chronic heart failure: the WHICH? study. (United States)

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


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

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

    DEFF Research Database (Denmark)

    Jennum, Poul; Christensen, Jakob; Ibsen, Rikke


    . Income was lower from employment, which in part was compensated by social security, sick pay, disability pension and unemployment benefit, sick pay (public-funded), disability pension, and other public transfers. Predicted health care costs 30 years after epilepsy onset were significantly higher among...... the epilepsy, those with epilepsy tended to have a lower level of education, to be less likely to be married, to be more likely to live alone, and to have higher divorce and unemployment rates, lower employment rates, and people with epilepsy were more likely to receive disability pension and social security...

  2. The Hidden Cost of Tourism: Detecting Long-term Effects of Tourism Using Behavioral Information

    Directory of Open Access Journals (Sweden)

    David Lusseau


    Full Text Available Increasingly, whales and dolphins are the focus of tourism activities in many coastal locations. Although these activities can affect individuals and populations of cetaceans, the biological significance and hence the cost of these impacts are as yet largely unknown. This study assessed the effects of boat interactions on the behavioral budget of two populations of bottlenose dolphins (Tersiops truncatus living in similar fjords but exposed to different levels of tourism activities. This comparison makes it possible to assess the costs of short-term avoidance strategies and the threshold at which those strategies are no longer effective. The effects of boat interactions were the same in both fjords. The resting state was the most sensitive to interactions; socializing was less sensitive. Short-term displacement was a typical response to boat exposure: dolphins were more likely to travel after an interaction with a vessel. Although the behavioral budgets of these populations were significantly altered during interactions with boats, their overall behavioral budgets were unchanged. Dolphins in Milford Sound actively avoided boat interactions, possibly to maintain their overall behavioral budget unchanged. This active avoidance led to avoidance of the area. Characteristics of dolphin-boat interactions in Milford Sound suggest that the advantages gained by short-term avoidance are lost if, on average, fewer than 68 min elapse between successive interactions with boats. If dolphin-boat interactions were more frequent than this, the dolphins switched to a longer-term response: area avoidance.

  3. The clinical effectiveness and cost-effectiveness of long-term weight management schemes for adults: a systematic review. (United States)

    Loveman, E; Frampton, G K; Shepherd, J; Picot, J; Cooper, K; Bryant, J; Welch, K; Clegg, A


    To assess the long-term clinical effectiveness and cost-effectiveness of multicomponent weight management schemes for adults in terms of weight loss and maintenance of weight loss. Bibliographic databases were searched from inception to December 2009, including the Cochrane Library, MEDLINE (Ovid), EMBASE (Ovid), and MEDLINE In-Process & Other Non-Indexed Citations. Bibliographies of related papers were screened, key conferences and symposia were searched and experts were contacted to identify additional published and unpublished references. For the clinical effectiveness review, two reviewers independently screened titles and abstracts for eligibility. Inclusion criteria were applied to the full text of retrieved papers by one reviewer and checked by a second reviewer using a pre-piloted inclusion flow chart. The studies were long-term randomised controlled trials (RCTs) of adult participants who were classified by body mass index as overweight or obese. Interventions were multicomponent weight management programmes (including diet, physical activity and behaviour change strategies) that assessed weight measures. Programmes that involved the use of over-the-counter medicines licensed in the UK were also eligible. For the cost-effectiveness review two reviewers independently screened studies for inclusion. Cost-effectiveness, cost-utility, cost-benefit or cost-consequence analyses were eligible. Data were extracted using a standardised and pre-piloted data extraction form. The quality of included studies was assessed using standard criteria. Studies were synthesised through a narrative review with full tabulation of results. A total of 3358 references were identified, of which 12 were included in the clinical effectiveness review. Five RCTs compared multicomponent interventions with non-active comparator groups. In general, weight loss appeared to be greater in the intervention groups than in the comparator groups. Two RCTs compared multicomponent interventions

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

    Energy Technology Data Exchange (ETDEWEB)

    Mubayi, V.


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

  5. The effect of pulmonary artery catheter use on costs and long-term outcomes of acute lung injury.

    Directory of Open Access Journals (Sweden)

    Gilles Clermont

    Full Text Available The pulmonary artery catheter (PAC remains widely used in acute lung injury (ALI despite known complications and little evidence of improved short-term mortality. Concurrent with NHLBI ARDS Clinical Trials Network Fluid and Catheters Treatment Trial (FACTT, we conducted a prospectively-defined comparison of healthcare costs and long-term outcomes for care with a PAC vs. central venous catheter (CVC. We explored if use of the PAC in ALI is justified by a beneficial cost-effectiveness profile.We obtained detailed bills for the initial hospitalization. We interviewed survivors using the Health Utilities Index Mark 2 questionnaire at 2, 6, 9 and 12 m to determine quality of life (QOL and post-discharge resource use. Outcomes beyond 12 m were estimated from federal databases. Incremental costs and outcomes were generated using MonteCarlo simulation.Of 1001 subjects enrolled in FACTT, 774 (86% were eligible for long-term follow-up and 655 (85% consented. Hospital costs were similar for the PAC and CVC groups ($96.8k vs. $89.2k, p = 0.38. Post-discharge to 12 m costs were higher for PAC subjects ($61.1k vs. 45.4k, p = 0.03. One-year mortality and QOL among survivors were similar in PAC and CVC groups (mortality: 35.6% vs. 31.9%, p = 0.33; QOL [scale: 0-1]: 0.61 vs. 0.66, p = 0.49. MonteCarlo simulation showed PAC use had a 75.2% probability of being more expensive and less effective (mean cost increase of $14.4k and mean loss of 0.3 quality-adjusted life years (QALYs and a 94.2% probability of being higher than the $100k/QALY willingness-to-pay threshold.PAC use increased costs with no patient benefit and thus appears unjustified for routine use in NCT00234767.

  6. Long-term clinical impact and cost-effectiveness of obeticholic acid for the treatment of primary biliary cholangitis. (United States)

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


    Primary biliary cholangitis (PBC) is a chronic, progressive autoimmune liver disease that mainly affects middle-aged women. Obeticholic acid (OCA), which was recently approved by the Food and Drug Administration for PBC treatment, has demonstrated positive effects on biochemical markers of liver function. Our objective was to evaluate the long-term clinical impact and cost-effectiveness of OCA as a second-line treatment for PBC in combination with ursodeoxycholic acid (UDCA) in adults with an inadequate response to UDCA. We developed a mathematical model to simulate the lifetime course of PBC patients treated with OCA+UDCA versus UDCA alone. Efficacy data were derived from the phase 3 PBC OCA International Study of Efficacy trial, and the natural history of PBC was informed by published clinical studies. Model outcomes were validated using the PBC Global Study. We found that in comparison with UDCA, OCA+UDCA could decrease the 15-year cumulative incidences of decompensated cirrhosis from 12.2% to 4.5%, hepatocellular carcinoma from 9.1% to 4.0%, liver transplants from 4.5% to 1.2%, and liver-related deaths from 16.2% to 5.7% and increase 15-year transplant-free survival from 61.1% to 72.9%. The lifetime cost of PBC treatment would increase from $63,000 to $902,000 (1,330% increment). The discounted quality-adjusted life years with UDCA and OCA+UDCA were 10.74 and 11.78, respectively, and the corresponding costs were $142,300 and $633,900, resulting in an incremental cost-effectiveness ratio of $473,400/quality-adjusted life year gained. The results were most sensitive to the cost of OCA. OCA is a promising new therapy to substantially improve the long-term outcomes of PBC patients, but at its current annual price of $69,350, it is not cost-effective using a willingness-to-pay threshold of $100,000/quality-adjusted life year; pricing below $18,450/year is needed to make OCA cost-effective. (Hepatology 2017;65:920-928). © 2016 by the American Association for the

  7. Long-term cost effectiveness of cardiac secondary prevention in primary care in the Republic of Ireland and Northern Ireland. (United States)

    Gillespie, Paddy; Murphy, Edel; Smith, Susan M; Cupples, Margaret E; Byrne, Molly; Murphy, Andrew W


    While cardiac secondary prevention in primary care is established practice, little is known about its long-term cost effectiveness. This study examines the cost effectiveness of a secondary prevention intervention in primary care in the Republic of Ireland and Northern Ireland over 6 years. An economic evaluation, based on a cluster randomised controlled trial of 903 patients with heart disease, was conducted 4.5 years after the intervention ceased to be delivered. Patients originally randomised to the control received usual practice while those randomised to the intervention received a tailored care package over the 1.5-year delivery period. Data on healthcare costs and quality adjusted life expectancy were used to undertake incremental cost utility analysis. Multilevel regression was used to estimate mean cost effectiveness and uncertainty was examined using cost effectiveness acceptability curves. At 6 years, there was a divergence in the results across jurisdictions. While the probability of the intervention being cost effective in the Republic of Ireland was 0.434, 0.232, 0.180, 0.150, 0.115 and 0.098 at selected threshold values of €5000, €15,000, €20,000, €25,000, €35,000 and €45,000, respectively, all equivalent probabilities for Northern Ireland equalled 1.000. Our findings suggest that the intervention in its current format is likely to be more cost effective than usual general practice care in Northern Ireland, but this is not the case in the Republic of Ireland.


    Directory of Open Access Journals (Sweden)

    Bazhenov Viktor Ivanovich


    Full Text Available The starting stage of the tender procedures in Russia with the participation of foreign suppliers dictates the feasibility of the developments for economical methods directed to comparison of technical solutions on the construction field. The article describes the example of practical Life Cycle Cost (LCC evaluations under respect of Present Value (PV determination. These create a possibility for investor to estimate long-term projects (indicated as 25 years as commercially profitable, taking into account inflation rate, interest rate, real discount rate (indicated as 5 %. For economic analysis air-blower station of WWTP was selected as a significant energy consumer. Technical variants for the comparison of blower types are: 1 - multistage without control, 2 - multistage with VFD control, 3 - single stage double vane control. The result of LCC estimation shows the last variant as most attractive or cost-effective for investments with economy of 17,2 % (variant 1 and 21,0 % (variant 2 under adopted duty conditions and evaluations of capital costs (Cic + Cin with annual expenditure related (Ce+Co+Cm. The adopted duty conditions include daily and seasonal fluctuations of air flow. This was the reason for the adopted energy consumption as, kW∙h: 2158 (variant 1,1743...2201 (variant 2, 1058...1951 (variant 3. The article refers to Europump guide tables in order to simplify sophisticated factors search (Cp /Cn, df, which can be useful for economical analyses in Russia. Example of evaluations connected with energy-efficient solutions is given, but this reference involves the use of materials for the cases with resource savings, such as all types of fuel. In conclusion follows the assent to use LCC indicator jointly with the method of determining discounted cash flows, that will satisfy the investor’s need for interest source due to technical and economical comparisons.

  9. Evaluating the long-term performance of low-cost adsorbents using small-scale adsorption column experiments. (United States)

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


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

  10. Cost-effectiveness of a long-term Internet-delivered worksite health promotion programme on physical activity and nutrition: A cluster randomized controlled trial

    NARCIS (Netherlands)

    S.J.W. Robroek (Suzan); S. Polinder (Suzanne); F.J. Bredt (Folef); A. Burdorf (Alex)


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

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

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


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

  12. The impact of technology availability on the timing and costs of emission reductions for achieving long-term climate targets

    NARCIS (Netherlands)

    van Vliet, J.; Hof, Andries|info:eu-repo/dai/nl/240412397; Mendoza Beltran, A.; van den Berg, M..; Deetman, S.; den Elzen, M.G.J.; Lucas, P.L.; van Vuuren, D.P.|info:eu-repo/dai/nl/11522016X


    While most long-term mitigation scenario studies build on a broad portfolio of mitigation technologies, there is quite some uncertainty about the availability and reduction potential of these technologies. This study explores the impacts of technology limitations on greenhouse gas emission

  13. Circumferential fusion is dominant over posterolateral fusion in a long-term perspective: cost-utility evaluation of a randomized controlled trial in severe, chronic low back pain

    DEFF Research Database (Denmark)

    Soegaard, Rikke; Bünger, Cody E; Christiansen, Terkel


    STUDY DESIGN: Cost-utility evaluation of a randomized, controlled trial with a 4- to 8-year follow-up. OBJECTIVE: To investigate the incremental cost per quality-adjusted-life-year (QALY) when comparing circumferential fusion to posterolateral fusion in a long-term, societal perspective. SUMMARY...... OF BACKGROUND DATA: The cost-effectiveness of circumferential fusion in a long-term perspective is uncertain but nonetheless highly relevant as the ISSLS prize winner 2006 in clinical studies reported the effect of circumferential fusion superior to the effect of posterolateral fusion. A recent trial found...... no significant difference between posterolateral and circumferential fusion reporting cost-effectiveness from a 2-year viewpoint. METHODS: A total of 146 patients were randomized to posterolateral or circumferential fusion and followed 4 to 8 years after surgery. The mean age of the cohort was 46 years (range...

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

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


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

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

    Directory of Open Access Journals (Sweden)

    Schwarzkopf Larissa


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

  16. Applying quality assurance in real time to compliant long-term periodontal maintenance patients utilizing cost-effectiveness and cost utility. (United States)

    Fardal, Øystein; Grytten, Jostein


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

  17. Change in healthcare utilization and costs following initiation of benzodiazepine therapy for long-term treatment of generalized anxiety disorder: a retrospective cohort study (United States)


    Background Selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and benzodiazepine anxiolytics are used in the US to treat generalized anxiety disorder (GAD). While benzodiazepines typically provide rapid symptomatic relief, long-term use is not recommended due to risks of dependency, sedation, falls, and accidents. Methods Using a US health insurance database, we identified all persons with GAD (ICD-9-CM diagnosis code 300.02) who began a long-term course of treatment (≥90 days) with a benzodiazepine anxiolytic between 1/1/2003 and 12/31/2007, We compared healthcare utilization and costs over the six-month periods preceding and following the date of treatment initiation (“pretreatment” and “post-treatment”, respectively), and focused attention on accident-related encounters (e.g., for treatment of fractures) and care received for other reasons possibly related benzodiazepine use (e.g., sedation, dizziness). Results A total of 866 patients met all study entry criteria; 25% of patients began treatment on an add-on basis (i.e., adjunctive to escitalopram, paroxetine, sertraline, or venlafaxine), while 75% of patients did not receive concomitant therapy. Mean total healthcare costs increased by $2334 between the pretreatment and post-treatment periods (from $4637 [SD=$9840] to $6971 [$17,002]; pbenzodiazepines increased by an average of $1099 ($1757 [$7656] vs $2856 [$14,836]; p=0.03). Conclusions Healthcare costs increase in patients with GAD beginning long-term (≥90 days) treatment with a benzodiazepine anxiolytic; a substantial proportion of this increase is attributable to care associated with accidents and other known sequelae of long-term benzodiazepine use. PMID:23088742

  18. Change in healthcare utilization and costs following initiation of benzodiazepine therapy for long-term treatment of generalized anxiety disorder: a retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Berger Ariel


    Full Text Available Abstract Background Selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and benzodiazepine anxiolytics are used in the US to treat generalized anxiety disorder (GAD. While benzodiazepines typically provide rapid symptomatic relief, long-term use is not recommended due to risks of dependency, sedation, falls, and accidents. Methods Using a US health insurance database, we identified all persons with GAD (ICD-9-CM diagnosis code 300.02 who began a long-term course of treatment (≥90 days with a benzodiazepine anxiolytic between 1/1/2003 and 12/31/2007, We compared healthcare utilization and costs over the six-month periods preceding and following the date of treatment initiation (“pretreatment” and “post-treatment”, respectively, and focused attention on accident-related encounters (e.g., for treatment of fractures and care received for other reasons possibly related benzodiazepine use (e.g., sedation, dizziness. Results A total of 866 patients met all study entry criteria; 25% of patients began treatment on an add-on basis (i.e., adjunctive to escitalopram, paroxetine, sertraline, or venlafaxine, while 75% of patients did not receive concomitant therapy. Mean total healthcare costs increased by $2334 between the pretreatment and post-treatment periods (from $4637 [SD=$9840] to $6971 [$17,002]; p Conclusions Healthcare costs increase in patients with GAD beginning long-term (≥90 days treatment with a benzodiazepine anxiolytic; a substantial proportion of this increase is attributable to care associated with accidents and other known sequelae of long-term benzodiazepine use.

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


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


    This study evaluates long-term stability of low-cost separators in single-chamber bottle-type microbial fuel cells with domestic wastewater. Low-cost separators tested in this study were nonwoven fabrics (NWF) of polypropylene (PP80, PP100), textile fabrics of polyphenylene sulfide (PPS), sulfonated polyphenylene sulfide (SPPS), and cellulose esters. NWF PP80 separator generated the highest power density of 280 mW/m2, which was higher than with ion-exchange membranes (cation exchange membrane...

  20. Individualized Therapy Is a Long-Term Cost-Effective Method Compared to Dose Intensification in Crohn's Disease Patients Failing Infliximab

    DEFF Research Database (Denmark)

    Steenholdt, Casper; Brynskov, Jørn; Thomsen, Ole Ø


    -defined interventions (n = 33). Accumulated costs, expressed as mean costs per patient, were based on the Danish National Patient Registry. RESULTS: At the scheduled week 20 follow-up study visit, response and remission rates were similar in all study subpopulations between patients treated by the algorithm......BACKGROUND: In Crohn's disease patients failing infliximab therapy, interventions defined by an algorithm based on infliximab and anti-infliximab antibody measurements have proven more cost-effective than intensifying the infliximab regimen. AIM: This study investigated long-term economic outcomes...... or by infliximab intensification. However, the sum of healthcare costs related to Crohn's disease was substantially lower (31 %) for patients randomized to algorithm-based interventions than infliximab intensification in the intention-to-treat population: $11,940 versus $17,236; p = 0.005. For per...

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

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


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

  2. The Long-Term Effectiveness and Cost Effectiveness of Organized versus Opportunistic Screening for Breast Cancer in Austria. (United States)

    Schiller-Fruehwirth, Irmgard; Jahn, Beate; Einzinger, Patrick; Zauner, Günther; Urach, Christoph; Siebert, Uwe


    In 2014, Austrian health authorities implemented an organized breast cancer screening program. Until then, there has been a long-standing tradition of opportunistic screening. To evaluate the cost-effectiveness of organized screening compared with opportunistic screening, as well as to identify factors influencing the clinical and economic outcomes. We developed and validated an individual-level state-transition model and assessed the health outcomes and costs of organized and opportunistic screening for 40-year-old asymptomatic women. The base-case analysis compared a scenario involving organized biennial screening with a scenario reflecting opportunistic screening practice for an average-risk woman aged 45 to 69 years. We applied an annual discount rate of 3% and estimated the incremental cost-effectiveness ratio in terms of the cost (2012 euros) per life-year gained (LYG) from a health care perspective. Deterministic and probabilistic sensitivity analyses were performed to assess uncertainty. Compared with opportunistic screening, an organized program yielded on average additional 0.0118 undiscounted life-years (i.e., 4.3 days) and cost savings of €41 per woman. In the base-case analysis, the incremental cost-effectiveness ratio of organized screening was approximately €20,000 per LYG compared with no screening. Assuming a willingness-to-pay threshold of €50,000 per LYG, there was a 70% probability that organized screening would be considered cost-effective. The attendance rate, but not the test accuracy of mammography, was an influential factor for the cost-effectiveness. The decision to adopt organized screening is likely an efficient use of limited health care resources in Austria. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  3. Medical costs of war in 2035: long-term care challenges for veterans of Iraq and Afghanistan. (United States)

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


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

  4. Vagus nerve stimulation therapy in a developing country: a long term follow up study and cost utility analysis. (United States)

    Aburahma, Samah K; Alzoubi, Firas Q; Hammouri, Hanan M; Masri, Amira


    To evaluate clinical outcomes, quality-adjusted life years (QALY), cost effectiveness and cost utility associated with VNS therapy in children with refractory epilepsy in a developing country. Retrospective review of all children who underwent VNS implantation at King Abdullah University Hospital and Jordan University Hospital in Jordan. Twenty eight patients (16 males) had implantation of the VNS therapy system between the years 2007 and 2011. Mean age at implantation was 9.4 years. Mean duration of epilepsy prior to implantation was 6.5 years. The most common seizure type was generalized tonic clonic seizures. Fifteen patients showed a 50% or more reduction in seizure frequency. There was a significant reduction in total number of seizures (p=0.002) and emergency room (ER) visits (p=0.042) after VNS therapy. Atonic seizures were more likely to respond than generalized tonic clonic seizures, p=0.034. Direct hospital costs prior to VNS implantation were analyzed in relation to ER visits and intensive care unit (ICU) admissions. Cost savings per patient did reduce the financial burden of the device by about 30%. There was a QALY gain per lifetime of 3.78 years for children and 1 year for adolescents. Response to VNS implantation in Jordan was favorable and similar to what has been previously reported. QALY gain and cost per QALY analysis were encouraging. Cost savings were related to reduction in seizure severity. In circumstances of limited resources as in developing countries, targeting patients with frequent utilization of health services would improve cost effectiveness. Copyright © 2014 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  5. What Drives Long Term Real Interest Rates in Brazil?

    Directory of Open Access Journals (Sweden)

    Adonias Evaristo da Costa Filho


    Full Text Available This paper investigates the drivers of long term real interest rates in Brazil. It is shown that long term yield on inflation linked bonds are driven by yields on 10 year interest rates of United States (US government bonds and 10 year risk premium, as measured by the Credit Default Swap (CDS. Long term interest rates in Brazil were on a downward trend, following US real rates and stable risk premium, until the taper tantrum in the first half of 2013. From then onwards, real interest rates rose due to the increase in US real rates in anticipation of the beginning of monetary policy normalization and, more recently, due to a sharp increase in Brazilian risk premium. Policy interest rates do not significantly affect long term real interest rates.

  6. A benefit-cost analysis of a long-term intervention on social and emotional learning in compulsory school

    Directory of Open Access Journals (Sweden)

    Alli Klapp


    Full Text Available There is growing evidence that social and emotional skills can be taught to students in school and teaching these skills can have a positive effect on later outcomes, such as better mental health and less drug use. This paper presents a benefit-cost analysis of a longitudinal social and emotional learning intervention in Sweden, using data for 663 students participating in the evaluation. Intervention costs are compared against treatment impact on self-reported drug use. Pre-test and post-test data are available. Since follow-up data for the participants´ drug use as adults is not available, informed projections have been made. Net present monetary values are calculated for the general public and society. The results show that students in the treatment group report decreasing use of drugs over the five year long intervention, the value of which easily outweighs the intervention costs.

  7. Cost effectiveness of interpersonal community psychiatric treatment for people with long-term severe non-psychotic mental disorders: protocol of a multi-centre randomized controlled trial. (United States)

    van Veen, Mark; Koekkoek, Bauke; Mulder, Niels; Postulart, Debby; Adang, Eddy; Teerenstra, Steven; Schoonhoven, Lisette; van Achterberg, Theo


    This study aims for health gain and cost reduction in the care for people with long-term non-psychotic psychiatric disorders. Present care for this population has a limited evidence base, is often open ended, little effective, and expensive. Recent epidemiological data shows that 43.5% of the Dutch are affected by mental illness during their life. About 80% of all patients receiving mental health services (MHS) have one or more non-psychotic disorders. Particularly for this group, long-term treatment and care is poorly developed. Care As Usual (CAU) currently is a form of low-structured treatment/care. Interpersonal Community Psychiatric Treatment (ICPT) is a structured treatment for people with long-term, non-psychotic disorders, developed together with patients, professionals, and experts. ICPT uses a number of evidence-based techniques and was positively evaluated in a controlled pilot study. Multi-centre cluster-randomized clinical trial: 36 professionals will be randomly allocated to either ICPT or CAU for an intervention period of 12 months, and a follow-up of 6 months. 180 Patients between 18-65 years of age will be included, who have been diagnosed with a non-psychotic psychiatric disorder (depressive, anxiety, personality or substance abuse disorder), have long-term (>2 years) or high care use (>1 outpatient contact per week or >2 crisis contacts per year or >1 inpatient admission per year), and who receive treatment in a specialized mental health care setting. The primary outcome variable is quality of life; secondary outcomes are costs, recovery, general mental health, therapeutic alliance, professional-perceived difficulty of patient, care needs and social contacts. No RCT, nor cost-effectiveness study, has been conducted on ICPT so far. The empirical base for current CAU is weak, if not absent. This study will fill this void, and generate data needed to improve daily mental health care. Netherlands Trial Register (NTR): 3988 . Registered 13th of May

  8. Agora Energiewende (2017). Future cost of onshore wind. Recent auction results, long-term outlook and implications for upcoming German auctions

    Energy Technology Data Exchange (ETDEWEB)

    Thomassen, Georg; Deutsch, Matthias


    The costs for electricity from renewable generation have been falling significantly in recent years, and record low bids at auctions around the world have grasped the attention of the public. Solar photovoltaics and offshore wind auctions, in particular, have attracted a lot of interest. The results for onshore wind, however, are just as impressive. The future cost development of onshore wind is of great relevance, since it is a key pillar of the energy system transformation in many parts of the world. However, the estimated long-term cost reductions vary significantly, as different studies value the cost drivers of wind differently. In Germany, the opaque and complex cost structure of onshore wind is the root of much controversy. International auction results with winning bids of less than half of the typical German pay rate left people questioning the costs of domestic wind power. However this discussion often fails to account adequately for differences in the quality of wind resources. In light of the upcoming, and first, German onshore wind auctions, we aim to contribute to the ongoing discussion by providing the necessary context for international auction results, a general outlook on the future cost of onshore wind, and by illustrating the existing potential and hindrances for cost reductions in the German market.

  9. Increased healthcare utilization costs following initiation of insulin treatment in type 2 diabetes: A long-term follow-up in clinical practice. (United States)

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


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

  10. Societal consequences of falls in the older population: Injuries, healthcare costs, and long-term reduced quality of life

    NARCIS (Netherlands)

    K.A. Hartholt (Klaas); E.F. van Beeck (Ed); S. Polinder (Suzanne); N. van der Velde (Nathalie); E.M.M. van Lieshout (Esther); M.J.M. Panneman (Martien); T.J.M. van der Cammen (Tischa); P. Patka (Peter)


    textabstractBACKGROUND:: Fall incidents are a major cause of morbidity and mortality in older adults. The aim of this cohort study was to determine the incidence, costs, and quality of life for fall-related injuries in the older Dutch population presenting at the emergency department. METHODS:: Data

  11. Managing Threat, Cost, and Incentive to Kill: The Short- and Long-Term Effects of Intervention in Mass Killings (United States)

    Kathman, Jacob D.; Wood, Reed M.


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

  12. A Benefit-Cost Analysis of a Long-Term Intervention on Social and Emotional Learning in Compulsory School (United States)

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


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

  13. Long-Term Cost-Effectiveness and Return-on-Investment of a Mindfulness-Based Worksite Intervention

    NARCIS (Netherlands)

    Dongen, J.M. van; Berkel, J. van; Boot, C.R.L.; Bosmans, J.E.; Proper, K.I.; Bongers, P.M.; Beek, A.J. van der; Tulder, M.W. van; Wier, M.F. van


    Objectives: The aim of this study was to conduct a cost-effectiveness and return-on-investment analysis comparing a mindfulness-based worksite intervention to usual practice. Methods: Two hundred fifty-seven governmental research institute employees were randomized to the intervention or control

  14. Long-term cardiovascular outcome, use of resources, and healthcare costs in patients with peripheral artery disease: results from a nationwide Swedish study. (United States)

    Hasvold, Pål; Nordanstig, Joakim; Kragsterman, Björn; Kristensen, Thomas; Falkenberg, Mårten; Johansson, Saga; Thuresson, Marcus; Sigvant, Birgitta


    Data on long-term healthcare costs of patients with peripheral artery disease (PAD) is limited, and the aim of this study was to investigate healthcare costs for PAD patients at a nationwide level. A cohort study including all incident patients diagnosed with PAD in the Swedish National Patient Register between 2006-2014, and linked to cause of death- and prescribed drug registers. Mean per-patient annual healthcare costs (2015 Euros [€]) (hospitalisations and out-patient visits) were divided into cardiovascular (CV), lower limb and non-CV related cost. Results were stratified by high and low CV risk. The study included 66,189 patients, with 221,953 observation-years. Mean total healthcare costs were €6,577, of which 26% was CV-related (€1,710), during the year prior to the PAD diagnosis. First year after PAD diagnosis, healthcare costs were €12,549, of which €3,824 (30%) was CV-related and €3,201 (26%) lower limb related. High-risk CV patients had a higher annual total healthcare and CV related costs compared to low risk CV patients during follow-up (€7,439 and €1,442 versus €4,063 and €838). Annual lower limb procedure costs were €728 in the PAD population, with lower limb revascularisations as key cost driver (€474). Non-CV related hospitalizations and outpatient visits were the largest cost contributors for PAD patients. There is a substantial increase in healthcare costs in the first year after being diagnosed with PAD, driven by PAD follow-up and lower limb related procedures. Among the CV-related costs, hospitalisations and outpatient visits related to PAD represented the largest costs.

  15. Long-term effects of penicillin resistance and fitness cost on pneumococcal transmission dynamics in a developed setting

    Directory of Open Access Journals (Sweden)

    Diana Tilevik


    Full Text Available Background: The increasing prevalence of penicillin non-susceptible pneumococci (PNSP throughout the world threatens successful treatment of infections caused by this important bacterial pathogen. The rate at which PNSP clones spread in the community is thought to mainly be determined by two key determinants; the volume of penicillin use and the magnitude of the fitness cost in the absence of treatment. The aim of the study was to determine the impacts of penicillin consumption and fitness cost on pneumococcal transmission dynamics in a developed country setting. Methods: An individual-based network model based on real-life demographic data was constructed and applied in a developed country setting (Sweden. A population structure with transmission of carriage taking place within relevant mixing groups, i.e. families, day care groups, school classes, and other close contacts, was considered to properly assess the transmission dynamics for susceptible and PNSP clones. Several scenarios were simulated and model outcomes were statistically analysed. Results: Model simulations predicted that with an outpatient penicillin use corresponding to the sales in Sweden 2010 (118 recipes per 1,000 inhabitants per year, the magnitude of a fitness cost for resistance must be at least 5% to offset the advantage of penicillin resistance. Moreover, even if there is a fitness cost associated with penicillin resistance, a considerable reduction of penicillin usage appears to be required to significantly decrease the incidence of PNSP in a community. Conclusion: The frequency of PNSP clones is hard to reverse by simply reducing the penicillin consumption even if there is a biological cost associated with resistance. However, because penicillin usage does promote further spread of PNSP clones, it is important to keep down penicillin consumption considering future resistance problems.

  16. The performance and long-term stability of low-cost separators in single-chamber bottle-type microbial fuel cells. (United States)

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


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

  17. Implications of the international reduction pledges on long-term energy system changes and costs in China and India

    DEFF Research Database (Denmark)

    Lucas, Paul L.; Shukla, P.R.; Chen, Wenying


    India and China with respect to the timing of emission reductions and the choice of mitigation measures relate to differences in projections of rapid economic change, capital stock turnover and technological development. Furthermore, depending on the way it is implemented, climate policy could increase......This paper analyses the impact of postponing global mitigation action on abatement costs and energy systems changes in China and India. It compares energy-system changes and mitigation costs from a global and two national energy-system models under two global emission pathways with medium...... indoor air pollution, but it is likely to provide synergies for energy security. These relations should be taken into account when designing national climate policies. © 2013 Elsevier Ltd. All rights reserved....

  18. Ulnar polydactyly: long-term outcomes and cost-effectiveness of surgical clip application in the newborn. (United States)

    Mills, Janith K; Ezaki, Marybeth; Oishi, Scott N


    Postaxial polydactyly type B (PAPD-B) refers to the nonfunctional, floppy extra digit on the ulnar border of the hand. Suture ligation is applied in the newborn unit if the base is narrow or pedunculated. However, wart-like scars, residual bumps, or neuromas are frequent complications. Wider-based extra digits are treated at a later age by surgical excision under general anesthesia. Surgical clip application expands the indications for PAPD treatment in the newborn unit or outpatient setting with lesser incidences of complications. A retrospective review identified 231 hands with PAPD-B in 132 newborns treated with surgical clips between January 1, 1996, and November 30, 2010, having a minimum of 2 years of follow-up. Medical records were queried for complications, revision procedures, and parent satisfaction. A relative cost survey compares the costs of surgical clips to surgery. In all, 16 extremities in 9 patients (7%) required surgical scar revision. No wound complications were noted.

  19. The evolution of size and cost of a hydrogen delivery infrastructure in Europe in the medium and long term

    Energy Technology Data Exchange (ETDEWEB)

    Tzimas, E.; Castello, P.; Peteves, S. [European Commission, DG Joint Research Centre, Institute for Energy, P.O. Box 2, 1755 ZG, Petten (Netherlands)


    The successful deployment of a hydrogen delivery (transmission and distribution) infrastructure will be critical for the widespread use of hydrogen. Estimates based on three scenarios that vary in the degree of hydrogen penetration in the European energy system indicate that between 1 and 4 million km of distribution pipelines, and up to 35 000 km of high-pressure transmission and 400 000 km of medium pressure sub-transmission pipelines may be needed by 2050. A truck fleet for the supply of liquefied hydrogen may reach the size of 3000-8000 vehicles. The cumulative capital necessary to build this infrastructure by 2050 may range between 700 and 2200 thousand million euros for the most optimistic scenario and is significantly lower for the other scenarios. Most of this will be needed for the development of the distribution network. These costs however represent a relatively small fraction (7.5-22%) of the annual gross value added of the energy sector. (author)

  20. Estimating the long-term costs of ischemic and hemorrhagic stroke for Australia: new evidence derived from the North East Melbourne Stroke Incidence Study (NEMESIS). (United States)

    Cadilhac, Dominique A; Carter, Rob; Thrift, Amanda G; Dewey, Helen M


    Stroke is associated with considerable societal costs. Cost-of-illness studies have been undertaken to estimate lifetime costs; most incorporating data up to 12 months after stroke. Costs of stroke, incorporating data collected up to 12 months, have previously been reported from the North East Melbourne Stroke Incidence Study (NEMESIS). NEMESIS now has patient-level resource use data for 5 years. We aimed to recalculate the long-term resource utilization of first-ever stroke patients and compare these to previous estimates obtained using data collected to 12 months. Population structure, life expectancy, and unit prices within the original cost-of-illness models were updated from 1997 to 2004. New Australian stroke survival and recurrence data up to 10 years were incorporated, as well as cross-sectional resource utilization data at 3, 4, and 5 years from NEMESIS. To enable comparisons, 1997 costs were inflated to 2004 prices and discounting was standardized. In 2004, 27 291 ischemic stroke (IS) and 4291 intracerebral hemorrhagic stroke (ICH) first-ever events were estimated. Average annual resource use after 12 months was AU$6022 for IS and AU$3977 for ICH. This is greater than the 1997 estimates for IS (AU$4848) and less than those for ICH (previously AU$10 692). The recalculated average lifetime costs per first-ever case differed for IS (AU$57 106 versus AU$52 855 [1997]), but differed more for ICH (AU$49 995 versus AU$92 308 [1997]). Basing lifetime cost estimates on short-term data overestimated the costs for ICH and underestimated those for IS. Patterns of resource use varied by stroke subtype and, overall, the societal cost impact was large.

  1. Deep Controlled Source Electro-Magnetic Sensing: A Cost Effective, Long-Term Tool for Sequestration Monitoring

    Energy Technology Data Exchange (ETDEWEB)

    LaBrecque, Douglas [Multi-Phase Technologies, LLC, Sparks, NV (United States); Brigham, Russell D. [Multi-Phase Technologies, LLC, Sparks, NV (United States); Schmidt-Hattenburger, Conny [GFZ German Research Centre for Geoscience, Potsdam (Germany); Um, Evan [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Petrov, Peter [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Daley, Thomas [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)


    The proposed system was designed to operate as a permanent, autonomous monitoring and data collection system that can provide much higher temporal data density than can be achieved economically with 3-Dimensional (3D) seismic surveys. It can operate over broad areas for long periods of time providing full 3D data sets on a monthly basis at a very low cost. By borrowing techniques commonly used in marine CSEM, structural information from background seismic surveys can be incorporated into the CSEM modeling to provide high resolution models of CO2 progression within reservoirs. The system uses borehole-based vertical-electric-dipole sources placed at reservoir depths in the formation. The electric and magnetic fields induced by this source are received on the surface using an array of stations. The project was conducted in three phases. Phase I demonstrated the feasibility of the system to collect static/reference data at the Ketzin CO2 storage pilot site in Germany. In Phase I, numerical modeling was used to determine the optimal configurations and requirements for sensor sensitivity and data accuracy. Based on the model results, existing hardware and software were modified. The CSEM system was then field tested at the Ketzin site. The data were imaged and the results were compared with independent studies of the reservoir and overburden geo-electrical characteristics. Phase II demonstrated the ability to provide sensitive, cost-effective measurement of changes in reservoir properties and changes in the overlying formations using a second round of measurements at the Ketzin site. A prototype autonomous recording system was developed and tested as a subset of the measurement points. Phase III of the project quantified the advantages (and disadvantages) of the fully autonomous data collection subsystems by comparing them with repeated measurements made with mobile stations. The Phase III also provided an additional time point in measuring post

  2. Cost-effectiveness analysis of protease inhibitor monotherapy vs. ongoing triple-therapy in the long-term management of HIV patients

    Directory of Open Access Journals (Sweden)

    Lars Oddershede


    Full Text Available Introduction: Protease inhibitors might be sufficient to maintain complete virological suppression when used as monotherapy for HIV-1-positive patients who have achieved sustained virological suppression on combination antiretroviral therapy (ART. The present study estimated the cost-effectiveness of a strategy of switching the ART to protease inhibitor monotherapy (PIM with prompt return to combination therapy in the event of viral load rebound compared to continuing the ongoing triple-therapy (OTT in the long-term management of HIV-1-positive patients. Materials and Methods: A within-trial cost-effectiveness analysis and modelling of lifetime cost-effectiveness was performed based on a randomized controlled trial of Protease Inhibitor monotherapy Versus Ongoing Triple-therapy (PIVOT. The setting was HIV outpatient care in the UK National Health Service, and the trial involved 587 patients, aged 18 years or more, who achieved sustained virological suppression and have a CD4+ cell count >100 cells/mm3. Outcomes were NHS costs (2012 UK pounds sterling and quality-adjusted life-years (QALY with comparative results presented as incremental cost-effectiveness ratios (ICERs. Results: Overall, PIM was cost-effective compared to OTT. PIM was cost-saving due to large savings in the ART drug costs while being no less effective in terms of QALYs in the within-trial analysis and only marginally less effective with modelling. In the base-case within-trial analysis, the incremental total cost per patient was −£6,424.11 (95% confidence interval:−£7,418.84 to −£5,429.38 and the incremental QALY was 0.0051 (95% confidence interval: −0.0479 to 0.0582 making PIM dominant compared to OTT. Multiple sensitivity analyses were conducted to assess the importance of assumptions surrounding drug costs, missing data, trial protocol driven costs and mortality. In all sensitivity analyses, PIM was cost-saving and no marked difference in QALY was observed

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

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


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

  4. Knee Joint Distraction Compared to Total Knee Arthroplasty for Treatment of End Stage Osteoarthritis: Simulating Long-Term Outcomes and Cost-Effectiveness. (United States)

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


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

  5. Long-term collections

    CERN Multimedia

    Collectes à long terme


    The Committee of the Long Term Collections (CLT) asks for your attention for the following message from a young Peruvian scientist, following the earthquake which devastated part of her country a month ago.

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

    Directory of Open Access Journals (Sweden)

    Shunichiro Shinagawa


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

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

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


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

  8. Construction Performance Optimization toward Green Building Premium Cost Based on Greenship Rating Tools Assessment with Value Engineering Method (United States)

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


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

  9. Cost-effectiveness of a low-calorie diet and orlistat for obese persons: modeling long-term health gains through prevention of obesity-related chronic diseases. (United States)

    van Baal, Pieter H M; van den Berg, Matthijs; Hoogenveen, Rudolf T; Vijgen, Sylvia M C; Engelfriet, Peter M


    Our study estimated the cost-effectiveness of pharmacologic treatment of obesity in combination with a low-calorie diet in The Netherlands. Costs and effects of a low-calorie diet-only intervention and of a low-calorie diet in combination with 1 year of orlistat were compared to no treatment. The RIVM Chronic Disease Model was used to project the differences in quality adjusted life years (QALYs) and lifetime health-care costs because of the effects of the interventions on body mass index (BMI) status. This was done by linking BMI status to the occurrence of obesity-related diseases and by relating quality of life to disease status. Probabilistic sensitivity analysis was employed to study the effect of uncertainty in the model parameters. In univariate sensitivity analysis, we assessed how sensitive the results were to several key assumptions. Incremental costs per QALY gained were Euro 17,900 for the low-calorie diet-only intervention compared to no intervention and Euro 58,800 for the low-calorie diet + orlistat compared to the low-calorie diet only. Assuming a direct relation between BMI and quality of life, these ratios decreased to Euro 6000 per QALY gained and Euro 24,100 per QALY gained. Costs per QALY gained were also sensitive to assumptions about long-term weight loss maintenance. Cost-effectiveness ratios of interventions aiming at weight reduction depend strongly on assumptions regarding the relation between BMI and quality of life. We recommend that a low-calorie diet should be the first option for policymakers in combating obesity.

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

    Directory of Open Access Journals (Sweden)

    Miller LE


    Full Text Available Larry E Miller,1 Michael J Sloniewsky,2 Thomas E Gibbons,3 Janice G Johnston,4 Kent D Vosler,4 Saad Nasir5 1Miller Scientific Consulting, Inc., Asheville, NC, 2RMG Holding, Inc., Florence, 3Doctors Care, PA, Columbia, SC, 4Arrowhead Health Centers, Glendale, AZ, 5Fidia Pharma USA Inc., Parsippany, NJ, USA Background: Given the poor long-term effectiveness of focused nonsurgical knee osteoarthritis (OA treatments, alternative therapies are needed for patients who have unsuccessfully exhausted nonsurgical options.Methods: A telephone interview was conducted in patients who participated in a single 8-week multimodal knee OA treatment program (mean follow-up: 3.7 years, range: 2.7–4.9 years. The program consisted of five intra-articular knee injections of sodium hyaluronate (Hyalgan®, with each injection given 1 week apart, structured physical therapy, knee bracing, and patient education. Clinical outcomes included knee pain severity, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC subscores, current medication use, and history of total knee arthroplasty. Base-case, subgroup, and sensitivity analyses were conducted to determine the incremental cost-effectiveness ratio (ICER of the treatment program with comparisons made to historical literature controls undergoing usual care. Results: A total of 218 patients (54% provided long-term follow-up data. Knee pain severity decreased 60% and WOMAC subscores decreased 33%–42% compared to baseline (all p<0.001. Total knee arthroplasty was performed in 22.8% (81/356 of knees during follow-up. The treatment program was highly cost-effective compared to usual care with a base-case ICER of $6,000 per quality-adjusted life year (QALY. Results of subgroup analyses, one-way deterministic sensitivity analyses, and second-order probabilistic sensitivity analyses resulted in ICERs ranging from $3,996 to $10,493 per QALY. The percentage of simulations with an ICER below willingness

  11. Long-Term Collections

    CERN Multimedia

    Comité des collectes à long terme


    It is the time of the year when our fireman colleagues go around the laboratory for their traditional calendars sale. A part of the money of the sales will be donated in favour of the long-term collections. We hope that you will welcome them warmly.

  12. Cost-Effectiveness of Long-Term Ticagrelor in Patients With Prior Myocardial Infarction: Results From the PEGASUS-TIMI 54 Trial. (United States)

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


    In patients with a myocardial infarction (MI) 1 to 3 years earlier, treatment with ticagrelor + low-dose aspirin (ASA) reduces the risk of cardiovascular (CV) death, MI, or stroke compared with low-dose aspirin alone, but at an increased risk of major bleeding. The authors evaluated cost-effectiveness of ticagrelor + low-dose ASA in patients with prior MI within the prior 3 years. The authors performed a prospective economic substudy alongside the PEGASUS-TIMI 54 (Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin-Thrombolysis In Myocardial Infarction 54) trial, which randomized 21,162 patients to ASA alone, ticagrelor 60 mg twice daily + low-dose ASA, or ticagrelor 90 mg twice daily + low-dose ASA. Medical resource use data were collected over a median 33-month follow-up. Costs were assessed from the U.S. health care system perspective. In-trial data relating to survival, utility, and costs were combined with lifetime projections to evaluate lifetime cost-effectiveness of the Food and Drug Administration-approved lower-dose ticagrelor regimen (60 mg twice daily). Hospitalization costs were similar for ticagrelor 60 mg and placebo ($2,262 vs. $2,333; 95% confidence interval for difference -$303 to $163; p = 0.54); after inclusion of a daily ticagrelor 60 mg cost of $10.52, total costs were higher for ticagrelor ($10,016 vs. $2,333; 95% CI: $7,441 to $7,930; p 1 prior MI, multivessel disease, diabetes, renal dysfunction (all with ICERs $50,000 to $70,000/QALY gained), patients age 1 year previously, long-term treatment with ticagrelor 60 mg + low-dose ASA yields a cost-effectiveness ratio suggesting intermediate value based on current guidelines. Ticagrelor appears to provide higher value for patients in several recognized high-risk subgroups. (Prevention of Cardiovascular Events [e.g., Death From Heart or Vascular Disease, Heart Attack, or Stroke] in Patients With

  13. 47 CFR 54.303 - Long term support. (United States)


    ... 47 Telecommunication 3 2010-10-01 2010-10-01 false Long term support. 54.303 Section 54.303... SERVICE Universal Service Support for High Cost Areas § 54.303 Long term support. (a) Beginning January 1... shall receive Long Term Support. Beginning July 1, 2004, no carrier shall receive Long Term Support. (b...

  14. Evaluation of a low-cost procedure for sampling, long-term storage, and extraction of RNA from blood for qPCR analyses

    DEFF Research Database (Denmark)

    Mærkedahl, Rasmus Baadsgaard; Frøkiær, Hanne; Lauritzen, Lotte


    Abstract Background: In large clinical trials, where RNA cannot be extracted immediately after sampling, preserving RNA in whole blood is a crucial initial step in obtaining robust qPCR data. The current golden standard for RNA preservation is costly and designed for time-consuming column-based RNA......-extraction. We investigated the use of lysis buffer for long-term storage of blood samples for qPCR analysis. Methods: Blood was collected from 13 healthy adults and diluted in MagMAX lysis/binding solution or PAXgene Blood RNA tubes and stored at -20 °C for 0, 1, or 4 months before RNA extraction...... by the matching method. RNA integrity, yield and purity were evaluated and the methods were compared by subsequent analyses of the gene expression levels of 18S, ACTB, IL1B, IL1RN, IL1R2, and PGK1 using qPCR. Results: The MagMAX system extracted 2.3-2.8 times more RNA per mL blood, with better performance...

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

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


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


    Directory of Open Access Journals (Sweden)



    Full Text Available The pure premium or risk premium is the premium that would exactly meet the expected cost of the risk covered ignoring management expenses, commissions, contingency loading, etc. Claim frequency rate and mean claim size are required for estimation in calculating risk premiums. In this study, we discussed to estimate claim frequency rate and mean claim size with several methods and calculated risk premiums. Data, which supported our study, is provided by insurance company involving with motor vehicle insurance.

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

    Directory of Open Access Journals (Sweden)

    Krämer, Alexander


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

  18. Long-term effectiveness and costs of a brief self-management intervention in women with pregnancy-related low back pain after delivery

    Directory of Open Access Journals (Sweden)

    Bastiaanssen Janneke M


    -line approach but further research is needed to draw inference on costs and to determine whether no care is a better option in the long term. Trial Registration [ISRCTN08477490

  19. Long-term effectiveness and costs of a brief self-management intervention in women with pregnancy-related low back pain after delivery. (United States)

    Bastiaenen, Caroline H G; de Bie, Rob A; Vlaeyen, Johan W S; Goossens, Mariëlle E J B; Leffers, Pieter; Wolters, Pieter M J C; Bastiaanssen, Janneke M; Brandt, Piet A van den; Essed, Gerard G M


    inference on costs and to determine whether no care is a better option in the long term. [ISRCTN08477490].

  20. Another Imaginary World: The ICER Claims for the Long-Term Cost-Effectiveness and Pricing of Vesicular Monoamine Transporter 2 (VMAT2 Inhibitors in Tardive Dyskinesia

    Directory of Open Access Journals (Sweden)

    Paul C. Langley


    Full Text Available The recently released value assessment of vesicular monoamine transporter 2 (VMAT2 inhibitors in tardive dyskinesia by the Institute for Clinical and Economic Review (ICER relies upon a long-term modeling exercise to support recommendations for what the ICER sees as the appropriate pricing for these products if prices are to be judged ‘cost-effective’. In this case, the recommendations are for a substantive price reduction of some 90% over WAC. Needless to say, this recommendation is unlikely to be welcomed with open arms by the respective manufacturers of valbenazine and deutetrabenazine. Unfortunately, as has been argued in a number of commentaries published over the past 18 months in INNOVATIONS in Pharmacy, the ICER endorsed health technology assessment methodology that underpins this exercise in building a modeled imaginary world to justify product pricing recommendations is fatally flawed: it does not meet the standards of normal science. Rather than addressing the issue of claims validation for VMAT2 products, the question of generating modeled evaluable claims, among others, for clinical, quality of life and resource utilization outcomes, the analysis focuses on claims that are neither credible nor evaluable and, of course, non-replicable. A more positive and useful approach would be for ICER to focus on a framework where claims could be assessed in the short term to provide feedback to health system decision makers, physicians and patients. Instead, we are asked to believe that we can model 20 or 30 years into the future to establish non-evaluable claims for pricing and, ultimately, access. Conflict of Interest: None   Type: Commentary

  1. Long-Term Collections

    CERN Multimedia

    Staff Association


    45 years helping in developing countries! CERN personnel have been helping the least fortunate people on the planet since 1971. How? With the Long-Term Collections! Dear Colleagues, The Staff Association’s Long-Term Collections (LTC) Committee is delighted to share this important milestone in the life of our Laboratory with you. Indeed, whilst the name of CERN is known worldwide for scientific discoveries, it also shines in the many humanitarian projects which have been supported by the LTC since 1971. Several schools and clinics, far and wide, carry its logo... Over the past 45 years, 74 projects have been supported (9 of which are still ongoing). This all came from a group of colleagues who wanted to share a little of what life offered them here at CERN, in this haven of mutual understanding, peace and security, with those who were less fortunate elsewhere. Thus, the LTC were born... Since then, we have worked as a team to maintain the dream of these visionaries, with the help of regular donat...

  2. Long-Term Collection

    CERN Multimedia

    Staff Association


    Dear Colleagues, As previously announced in Echo (No. 254), your delegates took action to draw attention to the projects of the Long-Term Collections (LTC), the humanitarian body of the CERN Staff Association. On Tuesday, 11 October, at noon, small Z-Cards were widely distributed at the entrances of CERN restaurants and we thank you all for your interest. We hope to have achieved an important part of our goal, which was to inform you, convince you and find new supporters among you. We will find out in the next few days! An exhibition of the LTC was also set up in the Main Building for the entire week. The Staff Association wants to celebrate the occasion of the Long-Term Collection’s 45th anniversary at CERN because, ever since 1971, CERN personnel have showed great support in helping the least fortunate people on the planet in a variety of ways according to their needs. On a regular basis, joint fundraising appeals are made with the Directorate to help the victims of natural disasters around th...

  3. Collectes à long terme

    CERN Multimedia

    Collectes à long terme


    En cette fin d’année 2014 qui approche à grands pas, le Comité des Collectes à Long Terme remercie chaleureusement ses fidèles donatrices et donateurs réguliers pour leurs contributions à nos actions en faveur des plus démunis de notre planète. C’est très important, pour notre Comité, de pouvoir compter sur l’appui assidu que vous nous apportez. Depuis plus de 40 ans maintenant, le modèle des CLT est basé principalement sur des actions à long terme (soit une aide pendant 4-5 ans par projet, mais plus parfois selon les circonstances), et sa planification demande une grande régularité de ses soutiens financiers. Grand MERCI à vous ! D’autres dons nous parviennent au cours de l’année, et ils sont aussi les bienvenus. En particulier, nous tenons à remercier...

  4. Long-term impact of self-financed rotavirus vaccines on rotavirus-associated hospitalizations and costs in the Valencia Region, Spain. (United States)

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


    Rotavirus vaccines are available in Spain from 2007. They are recommended by the Spanish Pediatric Association, but not funded by the National Health System (NHS) and its coverage rate reached 40-50%. The hospitalization rate reduction of rotavirus caused gastroenteritis (RVAGE) directly attributable to vaccination remains unclear due to the large differences described in published studies, ranging from 14 to 44.5% in children vaccination coverage. These results could be partly explained by variability in hospitalization policies, different study designs and the timeframe of observation. In addition, the direct economic impact of the reduction of hospitalizations has never been estimated. Therefore, there is a need to analyze the long-term impact of rotavirus vaccines on RVAGE and all cause gastroenteritis (AGE) hospitalizations and the national health system associated costs, minimizing potential confounders or biases. A population-based, ecological study using the hospital discharge registry's Minimum Basic Data Set (MBDS) and the vaccine register (SIV) was performed, among Valencia Region's children vaccine coverage and adjusted by the total hospitalization rate for all causes to avoid external biases. The impact of AGE-associated health care utilization in prevaccine (2003-2006) versus postvaccine (2008-2014) years was also assessed. After vaccines licensure, the incidence of RVAGE-associated hospitalizations decreased markedly. A general vaccine coverage-related reduction in RVAGE or AGE-hospitalizations risk was observed in all age groups. Compared with unvaccinated children, RVAGE hospitalization risk decreased by 67% (95% CI: 55-67), 71% (95% CI: 58-81) and 68% (95% CI: 18-92) in children 0, 1 and 4 years of age, respectively, with a vaccination coverage between 40 and 42%. Overall, the hospital related costs were reduced around EUR 6 Mill per 105 children in 7 years. Despite the low-medium vaccine coverage, the introduction of rotavirus vaccines had a

  5. 42 CFR 408.20 - Monthly premiums. (United States)


    ... September. (d) Limitation on increase of standard premium: 1987 and 1988. If there is no cost-of-living... for— (A) The fact that the cost-of-living increase was less than the increase in the standard premium... December 1968, to determine and promulgate the standard monthly premium for the 12-month period beginning...

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

    Directory of Open Access Journals (Sweden)

    Stefan Flasche


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


    CERN Multimedia



    ACKNOWLEDGMENTS The Long-Term Collections (CLT) committee would like to warmly thank its faithful donors who, year after year, support our actions all over the world. Without you, all this would not be possible. We would like to thank, in particular, the CERN Firemen’s Association who donated 5000 CHF in the spring thanks to the sale of their traditional calendar, and the generosity of the CERN community. A huge thank you to the firemen for their devotion to our cause. And thank you to all those who have opened their door, their heart, and their purses! Similarly, we warmly thank the CERN Yoga Club once again for its wonderful donation of 2000 CHF we recently received. We would also like to tell you that all our projects are running well. Just to remind you, we are currently supporting the activities of the «Réflexe-Partage» Association in Mali; the training centre of «Education et Développement» in Abomey, Benin; and the orphanage and ...

  8. 41 CFR 301-11.15 - What expenses may be considered part of the daily lodging cost when I rent on a long-term basis? (United States)


    ... considered part of the lodging cost: (a) The rental cost for a furnished dwelling; if unfurnished, the rental cost of the dwelling and the rental cost of appropriate and necessary furniture and appliances (e.g...

  9. Inclusion of environmental costs on a long-term expansion model of hydrothermal generation systems; Insercao dos custos ambientais em um modelo de expansao da geracao a longo prazo

    Energy Technology Data Exchange (ETDEWEB)

    Santos Henrique Luz


    This dissertation presents the development of a mathematical model to be used in the hydrothermal generation expansion planning taking into account uncertainties, the guarantee of energy supply and issues related to the social and environmental problems caused by the power sector. Named 'MELP Ambiental', it is a version of MELP, a model developed by Machado Junior (2000). The environmental valuation was based on results of previous studies. The analysis of the environmental costs scenarios showed that the inclusion of a variable linked to externalities implies in changes on the investment schedule. These changes decrease the total cost (economic and environmental) related to long-term power supply expansion. (author)

  10. Long-term home care scheduling

    DEFF Research Database (Denmark)

    Gamst, Mette; Jensen, Thomas Sejr

    In several countries, home care is provided for certain citizens living at home. The long-term home care scheduling problem is to generate work plans spanning several days such that a high quality of service is maintained and the overall cost is kept as low as possible. A solution to the problem...... provides detailed information on visits and visit times for each employee on each of the covered days. We propose a branch-and-price algorithm for the long-term home care scheduling problem. The pricing problem generates one-day plans for an employee, and the master problem merges the plans with respect...

  11. Long-Term Mechanical Ventilation. (United States)

    Sahetya, Sarina; Allgood, Sarah; Gay, Peter C; Lechtzin, Noah


    Although precise numbers are difficult to obtain, the population of patients receiving long-term ventilation has increased over the last 20 years, and includes patients with chronic lung diseases, neuromuscular diseases, spinal cord injury, and children with complex disorders. This article reviews the equipment and logistics involved with ventilation outside of the hospital. Discussed are common locations for long-term ventilation, airway and secretion management, and many of the potential challenges faced by individuals on long-term ventilation. Published by Elsevier Inc.

  12. Long-term effectiveness and cost-effectiveness of cognitive behavioural therapy as an adjunct to pharmacotherapy for treatment-resistant depression in primary care: follow-up of the CoBalT randomised controlled trial. (United States)

    Wiles, Nicola J; Thomas, Laura; Turner, Nicholas; Garfield, Kirsty; Kounali, Daphne; Campbell, John; Kessler, David; Kuyken, Willem; Lewis, Glyn; Morrison, Jill; Williams, Chris; Peters, Tim J; Hollinghurst, Sandra


    Cognitive behavioural therapy (CBT) is an effective treatment for people whose depression has not responded to antidepressants. However, the long-term outcome is unknown. In a long-term follow-up of the CoBalT trial, we examined the clinical and cost-effectiveness of cognitive behavioural therapy as an adjunct to usual care that included medication over 3-5 years in primary care patients with treatment-resistant depression. CoBalT was a randomised controlled trial done across 73 general practices in three UK centres. CoBalT recruited patients aged 18-75 years who had adhered to antidepressants for at least 6 weeks and had substantial depressive symptoms (Beck Depression Inventory [BDI-II] score ≥14 and met ICD-10 depression criteria). Participants were randomly assigned using a computer generated code, to receive either usual care or CBT in addition to usual care. Patients eligible for the long-term follow-up were those who had not withdrawn by the 12 month follow-up and had given their consent to being re-contacted. Those willing to participate were asked to return the postal questionnaire to the research team. One postal reminder was sent and non-responders were contacted by telephone to complete a brief questionnaire. Data were also collected from general practitioner notes. Follow-up took place at a variable interval after randomisation (3-5 years). The primary outcome was self-report of depressive symptoms assessed by BDI-II score (range 0-63), analysed by intention to treat. Cost-utility analysis compared health and social care costs with quality-adjusted life-years (QALYs). This study is registered with, number ISRCTN38231611. Between Nov 4, 2008, and Sept 30, 2010, 469 eligible participants were randomised into the CoBalT study. Of these, 248 individuals completed a long-term follow-up questionnaire and provided data for the primary outcome (136 in the intervention group vs 112 in the usual care group). At follow-up (median 45·5 months [IQR 42

  13. Long-Term Cost Effectiveness of Interferon-beta-1a in the Treatment of Relapsing-Remitting Multiple Sclerosis : An Econometric Model. (United States)

    Lepen, Claude; Coyle, Patricia; Vollmer, Timothy; Blumhardt, Lance; Lilliu, Hervé; Beresniak, Ariel


    To evaluate the cost effectiveness of subcutaneous interferon-beta-1a (IFNbeta-1a) 44mug three times weekly in relapsing-remitting multiple sclerosis (RRMS) using an econometric model. Data on RRMS patients treated with IFNbeta-1a 22 or 44mug subcutaneously three times weekly or placebo for up to 4 years were obtained from the Prevention of Relapses and disability by Interferon-beta-1a Subcutaneously in Multiple Sclerosis (PRISMS) study. The area under the Expanded Disability Status Scale (EDSS) score-time curve was used as a measure of disability and the effectiveness of therapy was expressed as EDSS-months of disability prevented. Costs were calculated for the UK and France, and results were projected to 10 and 20 years using a time series regression model. Over 10 years, treatment with IFNbeta-1a 44mug subcutaneously three times weekly prevented 121 EDSS-months of additional disability at a cost of Euros (euro)732 each (year of costing 2000). Over 20 years, 321 EDSS-months were saved at a cost of euro359 per month (year of costing 2000). This analysis indicated that IFNbeta-1a 44mug subcutaneously three times weekly is cost effective in RRMS and that treatment becomes increasingly cost effective over time.

  14. Long term complications of diabetes (United States)

    ... Long-term complications of diabetes To use the sharing features on this page, ... other tests. All these may help you keep complications of diabetes away. You will need to check your blood ...

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

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


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

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

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


    To evaluate the longitudinal value of a chronic disease management program, My Health Guardian (MHG), in reducing hospital utilization and costs over 4 years. The MHG program provides individualized support via telephonic nurse outreach and online tools for self-management, behavior change and well-being. In follow up to an initial 18-month analysis of MHG, the current study evaluated program impact over 4 years. A matched-cohort analysis retrospectively compared MHG participants with heart disease or diabetes (treatment, N = 4,948) to non-participants (comparison, N = 28,520) on utilization rates (hospital admission, readmission, total bed days) and hospital claims cost savings. Outcomes were evaluated using regression analyses, controlling for remaining demographic, disease, and pre-program admissions or cost differences between the study groups. Over the 4 year period, program participation resulted in significant reductions in hospital admissions (-11.4%, P costs (and savings) in Australia's risk equalization system for private insurers. Results confirm and extend prior program outcomes and support the longitudinal value of the MHG program in reducing hospital utilization and costs for individuals with heart disease or diabetes and demonstrate the increasing program effect with continued participation over time.

  17. Impact of hospitalizations for bronchiolitis in preterm infants on long-term health care costs in Italy: a retrospective case-control study

    Directory of Open Access Journals (Sweden)

    Roggeri DP


    Full Text Available Daniela Paola Roggeri,1 Alessandro Roggeri,1 Elisa Rossi,2 Salvatore Cataudella,2 Nello Martini,3 1ProCure Solutions, Nembro, Bergamo, 2CINECA Interuniversity Consortium, Bologna, 3Accademia Nazionale di Medicina, Rome, Italy Purpose: Bronchiolitis is an acute inflammatory injury of the bronchioles, and is the most frequent cause of hospitalization for lower respiratory tract infections in preterm infants. This was a retrospective, observational, case-control study conducted in Italy, based on administrative database analysis. The aim of this study was to evaluate differences in health care costs of preterm infants with and without early hospitalization for bronchiolitis. Patients and methods: Preterm infants born in the period between January 1, 2009 and December 31, 2010 and hospitalized for bronchiolitis in the first year of life were selected from the ARNO Observatory database and observed for the first 4 years of life. These preterm infants were compared (paired 1–3 with preterm infants who were not hospitalized for bronchiolitis in the first year of life and with similar characteristics. Only direct health care costs reimbursed by the Italian National Health Service were considered for this study (drugs, hospitalizations, and diagnostic/therapeutic procedures. Results: Of 40,823 newborns in the accrual period, 863 were preterm with no evidence of prophylaxis, and 22 preterm infants were hospitalized for bronchiolitis (cases and paired with 62 controls. Overall, cases had 74% higher average cost per infant in the first 4 years of life than controls (18,624€ versus 10,189€, respectively. The major cost drivers were hospitalizations, accounting for >90% in both the populations. The increase in total yearly health care cost between cases and controls remained substantial even in the fourth year of life for all cost items. A relevant increase in hospitalizations and drug consumption linked to respiratory tract diseases was noted in

  18. Integrating Long-Term and Short-Term Contracting in Beef Supply Chains


    Onur Boyabatlı; Paul R. Kleindorfer; Koontz, Stephen R.


    This paper analyzes the optimal procurement, processing, and production decisions of a meat-processing company (hereafter, a "packer") in a beef supply chain. The packer processes fed cattle to produce two beef products, program (premium) boxed beef and commodity boxed beef, in fixed proportions, but with downward substitution of the premium product for the commodity product. The packer can source input (fed cattle) from a contract market, where long-term contracts are signed in advance of th...

  19. Long-dated evaluation of the external costs of the nuclear; L'evaluation des couts externes a long terme de la filiere nucleaire: interets et limites

    Energy Technology Data Exchange (ETDEWEB)

    Le Dars, A.; Schneider, T


    Since the middle of the years 1990, the European Commission developed an ''ExternE'' methodology to propose an homogenous evaluation of the sanitary and environmental external costs of the various energy sectors in Europe. This document discusses the taking into account of the long-dated and analyzes the interests and the limits of the monetary evaluation, in terms of external costs, of the nuclear choice. It is organized in three chapters: 1. a presentation and a discussion on the various evaluation of the ''ExternE'' methodology; 2. a description of the available methods for the monetary evaluation of the long-dated impacts and more particularly the analysis of the monetary values actualization principle; 3. highlighted of the impacts for which the monetary evaluations exist. (A.L.B.)

  20. Design of a cost-effectiveness study within a randomized trial: the LIPID Trial for Secondary Prevention of IHD. Long-term Intervention with Pravastatin in Ischemic Heart disease. (United States)

    Glasziou, P P; Simes, R J; Hall, J; Donaldson, C


    The Long-term Intervention with Pravastatin in Ischemic Heart Disease (LIPID) trial is a double-blind, randomized, placebo-controlled trial evaluating the long-term effect of pravastatin on coronary mortality in patients with a previous myocardial infarction or unstable angina-ischemic heart disease (IHD). It is planned to run for at least five years with 9014 patients from 85 centers in Australia and New Zealand. The trial will monitor cause-specific mortality and major clinical events associated with each treatment. Running in parallel with the main study is a prospective economic analysis, the objectives of which are (1) to estimate the effectiveness of pravastatin compared with placebo in terms of survival, quality of life (QOL), and quality-adjusted life-years (QALY); (2) to estimate the resource usage associated with pravastatin compared with placebo-in particular, to study whether it alters resource usage through prevention of disease progression; and (3) to use this information for a cost-utility analysis with cost per quality-adjusted life-year as the unit of analysis. A novel aspect of the design is the use of a preliminary cost-effectiveness analysis, based on "best-guess" values, and a sensitivity analysis over plausible ranges to guide the choice of subsample size. Some data, such a mortality, days spent in hospital, major clinical events, and drug use, are being collected within the main LIPID trial. However, additional subsamples for the cost-effectiveness study will include information on quality of life, time off work, and resources used, such as time in hospital, procedures, and medications taken. The methods and sample sizes for these substudies have been a crucial issue in validity and feasibility.

  1. Several Factors Responsible For The Recent Slowdown In Premium Growth In Employer-Sponsored Insurance. (United States)

    Vistnes, Jessica; Selden, Thomas M; Zawacki, Alice


    Containing growth in health care spending is important to the long-term fiscal health of the United States. Researchers have been seeking to identify which factors behind the recent spending slowdown might continue to have an impact after the economy has fully recovered from the Great Recession (2007-09). We extended this inquiry by decomposing trends in the growth of private-sector employer-sponsored insurance premiums. Using data for 2001-13 from the Medical Expenditure Panel Survey-Insurance Component and a combination of cell- and regression-based decomposition methods, we found that the slowdown in premium growth that preceded the recession reflected declining growth rates in per policyholder premiums. For 2009-11, however, the dominant contributors to the slowdown were factors underlying declining employee enrollment: a sharp downturn in employment in 2009, followed by eroding offer and eligibility rates. Growth in per policyholder premiums slowed in 2012 and 2013 compared to the preceding few years. Like other researchers, we found that a substantial portion of premium growth remained unexplained. However, it is likely driven, in part, by growth in the underlying cost of medical care. Project HOPE—The People-to-People Health Foundation, Inc.

  2. Workshop on long-term contraceptives. (United States)


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

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

    Directory of Open Access Journals (Sweden)

    Burdorf Alex


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

  4. Long-term data archiving

    Energy Technology Data Exchange (ETDEWEB)

    Moore, David Steven [Los Alamos National Laboratory


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

  5. Service use and costs for people with long-term neurological conditions in the first year following discharge from in-patient neuro-rehabilitation: a longitudinal cohort study.

    Directory of Open Access Journals (Sweden)

    Diana Jackson

    Full Text Available BACKGROUND: Knowledge of the configuration and costs of community rehabilitation and support for people with long-term neurological conditions (LTNCs is needed to inform future service development and resource allocation. In a multicentre prospective cohort study evaluating community service delivery during the year post-discharge from in-patient neuro-rehabilitation, a key objective was to determine service use, costs, and predictors of these costs. METHODS: Patients consecutively admitted over one year to all nine London specialised (Level 1 in-patient neuro-rehabilitation units were recruited on discharge. They or their carers completed postal/web-based questionnaires at discharge and six and twelve months later, providing demographic data and measures of impairment, disability, service needs and provision. This paper describes health and social care service use, informal care and associated costs. Regression models using non-parametric boot-strapping identified predictors of costs over time. RESULTS: Overall, 152 patients provided consistent data. Mean formal service costs fell significantly from £13,290 (sd £19,369 during the first six months to £9,335 (sd £19,036 from six-twelve months, (t = 2.35, P<0.05, mainly due to declining health service use. At six months, informal care was received on average for 8.2 hours/day, mean cost £14,615 (sd 23,305, comprising 52% of overall care costs. By twelve months, it had increased to 8.8 hours per day, mean cost £15,468 (sd £25,534, accounting for 62% of overall care costs. Being younger and more disabled predicted higher formal care costs, explaining 32% and 30% of the variation in costs respectively at six and twelve months. CONCLUSION: Community services for people with LTNCs carry substantial costs that shift from health to social care over time, increasing the burden on families. Prioritising rehabilitation services towards those in greatest need could limit access to others needing on

  6. 47 CFR 32.4200 - Long term debt and funded debt. (United States)


    ... unmatured debt maturing more than one year from date of issue, issued by the company and not retired, and... agreement. This account shall also include such items as mortgage bonds, collateral trust bonds, income... more than one year from date of issue. (2) The premium associated with all classes of long-term debt...

  7. Modeling the Long-Term Cost-Effectiveness of IDegLira in Patients with Type 2 Diabetes Who are Failing To Meet Glycemic Targets on Basal Insulin Alone in The Netherlands. (United States)

    Hunt, Barnaby; Glah, Divina; van der Vliet, Maarten


    Insulin degludec/liraglutide (IDegLira) is the first basal insulin and glucagon-like peptide-1 receptor agonist (GLP-1 RA) in a single pen injection device, and a once-daily treatment option for patients with type 2 diabetes mellitus (T2DM) who are uncontrolled on basal insulin and require treatment intensification. The objective of this analysis was to evaluate the long-term cost-effectiveness of IDegLira versus basal-bolus therapy (insulin glargine U100 + 3× daily insulin aspart) for patients with T2DM uncontrolled on basal insulin [HbA1c >53 mmol/mol (>7%)] in the Netherlands. Cost-effectiveness analysis was performed using the validated IMS CORE Diabetes Model from a healthcare payer perspective. Outcomes were modeled over patient lifetimes in a cohort with baseline characteristics from the DUAL™ II trial. Treatment effect data were sourced from a statistical indirect comparison (pooled analysis) of IDegLira with basal-bolus therapy. Treatment with IDegLira resulted in mean increases in quality-adjusted life expectancy of 0.43 quality-adjusted life years versus basal-bolus therapy. Improved clinical outcomes resulted from fewer diabetes-related complications and a delayed time to their onset. IDegLira was associated with lower costs of EUR 4679 versus basal-bolus therapy, a result of lower pharmacy costs and avoided diabetes-related complications. Thus, IDegLira was dominant, i.e., both more effective and less costly than basal-bolus therapy. IDegLira is an effective treatment option to improve glycemic control without incurring an increased risk of hypoglycemia or weight gain. This analysis suggests that IDegLira is cost-effective versus basal-bolus therapy in patients with T2DM who are uncontrolled on basal insulin in the Netherlands. Novo Nordisk.

  8. Long term stability of power systems

    Energy Technology Data Exchange (ETDEWEB)

    Kundur, P.; Gao, B. [Powertech Labs. Inc., Surrey, BC (Canada)


    Power system long term stability is still a developing subject. In this paper we provide our perspectives and experiences related to long term stability. The paper begins with the description of the nature of the long term stability problem, followed by the discussion of issues related to the modeling and solution techniques of tools for long term stability analysis. Cases studies are presented to illustrate the voltage stability aspect and plant dynamics aspect of long term stability. (author) 20 refs., 11 figs.

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

    Nikfar, Shekoufeh; Kebriaeezadeh, Abbas; Dinarvand, Rassoul; Abdollahi, Mohammad; Sahraian, Mohammad-Ali; Henry, David; Akbari Sari, Ali


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

  10. Cost-Effectiveness of Different Interferon Beta Products for Relapsing-Remitting and Secondary Progressive Multiple Sclerosis: Decision Analysis Based on Long-Term Clinical Data and Switchable Treatments

    Directory of Open Access Journals (Sweden)

    Shekoufeh Nikfar


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

  11. Long-term cost effectiveness of early and sustained dual oral antiplatelet therapy with clopidogrel given for up to one year after percutaneous coronary intervention results: from the Clopidogrel for the Reduction of Events During Observation (CREDO) trial. (United States)

    Beinart, Sean C; Kolm, Paul; Veledar, Emir; Zhang, Zefeng; Mahoney, Elizabeth M; Bouin, Olivier; Gabriel, Sylvie; Jackson, Joseph; Chen, Roland; Caro, Jaime; Steinhubl, Steven; Topol, Eric; Weintraub, William S


    This study sought to evaluate the long-term cost effectiveness of a clopidogrel loading strategy before percutaneous coronary intervention (PCI) followed by continued treatment for one year. The Clopidogrel for the Reduction of Events During Observation (CREDO) trial, a randomized trial of 2,116 patients, showed the effectiveness of antiplatelet therapy with clopidogrel 300 mg before PCI and 75 mg daily for one year afterward compared with placebo load and placebo days 29 to 365 in reducing the combined risk of death, myocardial infarction, and stroke. All patients received clopidogrel on days 1 to 28 and aspirin on days 1 to 365. All hospitalizations were assigned a diagnosis-related group. Associated costs were estimated three ways (including professional costs): 1) Medicare costs, 2) MEDSTAT costs, and 3) blend with Medicare for those age > or = 65 years and MEDSTAT for those age <65 years. Clopidogrel 75 mg cost 3.22 dollars. Life expectancy in trial survivors was estimated using external data. Confidence intervals were assessed by bootstrap. The primary composite end point occurred in 89 (8.45%) clopidogrel patients and in 122 (11.48%) placebo patients (relative risk reduction [RRR] 26.9%; 95% confidence interval [CI] 3.9% to 44.4%). The number of life-years gained (LYG) with clopidogrel was 0.1526 (95% CI 0.0263 to 0.2838) using Framingham data and 0.1920 (95% CI 0.054 to 0.337) using Saskatchewan data. Average total costs were 664 dollars higher for the clopidogrel arm (95% CI -461 dollars to 1,784 dollars). The incremental cost-effectiveness ratios (ICERs) based on Framingham data ranged from 3,685 dollars/LYG to 4,353 dollars/LYG, with over 97% of bootstrap-derived ICER estimates below 50,000 dollars/LYG. The ICERs based on Saskatchewan data were 2,929 dollars/LYG to 3,460 dollars/LYG, with over 98% of estimates below 50,000 dollars/LYG. Platelet inhibition with clopidogrel loading before PCI followed by therapy for one year is highly cost effective.

  12. 49 CFR 260.17 - Credit risk premium analysis. (United States)


    ... 49 Transportation 4 2010-10-01 2010-10-01 false Credit risk premium analysis. 260.17 Section 260... Financial Assistance § 260.17 Credit risk premium analysis. (a) When Federal appropriations are not available to cover the total subsidy cost, the Administrator will determine the Credit Risk Premium...

  13. Explaining Bond and Equity Premium Puzzles Jointly in a DSGE Model


    Kaszab, Lorant; Marsal, Ales


    We introduce costly firm-entry a la Bilbiie et al. (2012) into a New Keynesian model with Epstein-Zin preferences and show that it can jointly account for a high mean value of bond and equity premium without compromising the fit of the model to first and second moments of key macroeconomic variables. In the standard New Keynesian model without entry it is easy to generate inflation risks on long-term nominal bonds when placing high coefficient on the output gap in the Taylor rule. Our model i...

  14. Navigating Long-Term Care

    Directory of Open Access Journals (Sweden)

    James D. Holt MD


    Full Text Available Americans over age 65 constitute a larger percentage of the population each year: from 14% in 2010 (40 million elderly to possibly 20% in 2030 (70 million elderly. In 2015, an estimated 66 million people provided care to the ill, disabled, and elderly in the United States. In 2000, according to the Centers for Disease Control and Prevention (CDC, 15 million Americans used some form of long-term care: adult day care, home health, nursing home, or hospice. In all, 13% of people over 85 years old, compared with 1% of those ages 65 to 74, live in nursing homes in the United States. Transitions of care, among these various levels of care, are common: Nursing home to hospital transfer, one of the best-studied transitions, occurs in more than 25% of nursing home residents per year. This article follows one patient through several levels of care.

  15. Being a long-term user of nicotine replacement therapy

    DEFF Research Database (Denmark)

    Borup, Gitte; Nørgaard, Lotte Stig; Tønnesen, Philip

    , regarding long-term NRT users’ experiences with continuing the use of NRT. Results from a survey study among long-term NRT-users, who had used NRT for 12 months or more, found that out of 92 former smokers 88 % wished to quit using NRT. The primary causes stated for wishing to quit were being tired...... of feeling addicted, cost of NRT products and fear of adverse health consequences. Aim of study • To get a thorough understanding of the lived experiences of nicotine dependent long-term NRT users. • To investigate what motivates or discourages quitting NRT. Method Semi-structured interviews with long...

  16. Variable-Rate Premiums (United States)

    Pension Benefit Guaranty Corporation — These interest rates are used to value vested benefits for variable rate premium purposes as described in PBGC's regulation on Premium Rates (29 CFR Part 4006) and...

  17. Decreasing Relative Risk Premium

    DEFF Research Database (Denmark)

    Hansen, Frank

    We consider the risk premium demanded by a decision maker with wealth x in order to be indifferent between obtaining a new level of wealth y1 with certainty, or to participate in a lottery which either results in unchanged present wealth or a level of wealth y2 > y1. We define the relative risk...... premium as the quotient between the risk premium and the increase in wealth y1–x which the decision maker puts on the line by choosing the lottery in place of receiving y1 with certainty. We study preferences such that the relative risk premium is a decreasing function of present wealth, and we determine...... relative risk premium in the small implies decreasing relative risk premium in the large, and decreasing relative risk premium everywhere implies risk aversion. We finally show that preferences with decreasing relative risk premium may be equivalently expressed in terms of certain preferences on risky...

  18. Long term study of mechanical

    Directory of Open Access Journals (Sweden)

    Ahmed M. Diab


    Full Text Available In this study, properties of limestone cement concrete containing different replacement levels of limestone powder were examined. It includes 0%, 5%, 10%, 15%, 20% and 25% of limestone powder as a partial replacement of cement. Silica fume was added incorporated with limestone powder in some mixes to enhance the concrete properties. Compressive strength, splitting tensile strength and modulus of elasticity were determined. Also, durability of limestone cement concrete with different C3A contents was examined. The weight loss, length change and cube compressive strength loss were measured for concrete attacked by 5% sodium sulfate using an accelerated test up to 525 days age. The corrosion resistance was measured through accelerated corrosion test using first crack time, cracking width and steel reinforcement weight loss. Consequently, for short and long term, the use of limestone up to 10% had not a significant reduction in concrete properties. It is not recommended to use blended limestone cement in case of sulfate attack. The use of limestone cement containing up to 25% limestone has insignificant effect on corrosion resistance before cracking.

  19. Curb Your Premium

    DEFF Research Database (Denmark)

    Amaral-Garcia, Sofia; Grembi, Veronica


    We study a policy aimed at increasing the level of information on medical malpractice costs and the risk exposure of local public healthcare providers. The policy is based on enhanced monitoring of medical malpractice claims by the level of government that rules providers in a multilevel institut......We study a policy aimed at increasing the level of information on medical malpractice costs and the risk exposure of local public healthcare providers. The policy is based on enhanced monitoring of medical malpractice claims by the level of government that rules providers in a multilevel...... Regions. Our results show that this information-enhancing policy reduces paid premiums by around 15%. This reduced-form effect might arise by higher bargaining power on the demand side or increased competition on the supply side of the insurance market. Validity tests show that our findings are not driven...

  20. Rising Long-term Interest Rates

    DEFF Research Database (Denmark)

    Hallett, Andrew Hughes

    Rather than chronicle recent developments in European long-term interest rates as such, this paper assesses the impact of increases in those interest rates on economic performance and inflation. That puts us in a position to evaluate the economic pressures for further rises in those rates......, the first question posed in this assignment, and the scope for overshooting (the second question), and then make some illustrative predictions of future interest rates in the euro area. We find a wide range of effects from rising interest rates, mostly small and mostly negative, focused on investment...... till the emerging European recovery is on a firmer basis and capable of overcoming increases in the cost of borrowing and shrinking fiscal space. There is also an implication that worries about rising/overshooting interest rates often reflect the fact that inflation risks are unequally distributed...

  1. The barriers to empowering niche-innovations in long-term care

    NARCIS (Netherlands)

    Cramer, Hendrik


    This thesis deals with innovative long-term care projects that aimed at changing long-term care delivery practices. Around the world, long-term care systems are pressured by an aging population, increasing costs and the scarcity of care professionals. Therefore, the concept of niches becomes ever

  2. Health Insurance Marketplaces: Premium Trends in Rural Areas. (United States)

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


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

  3. Clinical effectiveness and cost-effectiveness results from the randomised controlled Trial of Oral Mandibular Advancement Devices for Obstructive sleep apnoea-hypopnoea (TOMADO) and long-term economic analysis of oral devices and continuous positive airway pressure. (United States)

    Sharples, Linda; Glover, Matthew; Clutterbuck-James, Abigail; Bennett, Maxine; Jordan, Jake; Chadwick, Rebecca; Pittman, Marcus; East, Clare; Cameron, Malcolm; Davies, Mike; Oscroft, Nick; Smith, Ian; Morrell, Mary; Fox-Rushby, Julia; Quinnell, Timothy


    Obstructive sleep apnoea-hypopnoea (OSAH) causes excessive daytime sleepiness (EDS), impairs quality of life (QoL) and increases cardiovascular disease and road traffic accident risks. Continuous positive airway pressure (CPAP) treatment is clinically effective but undermined by intolerance, and its cost-effectiveness is borderline in milder cases. Mandibular advancement devices (MADs) are another option, but evidence is lacking regarding their clinical effectiveness and cost-effectiveness in milder disease. (1) Conduct a randomised controlled trial (RCT) examining the clinical effectiveness and cost-effectiveness of MADs against no treatment in mild to moderate OSAH. (2) Update systematic reviews and an existing health economic decision model with data from the Trial of Oral Mandibular Advancement Devices for Obstructive sleep apnoea-hypopnoea (TOMADO) and newly published results to better inform long-term clinical effectiveness and cost-effectiveness of MADs and CPAP in mild to moderate OSAH. A crossover RCT comparing clinical effectiveness and cost-effectiveness of three MADs: self-moulded [SleepPro 1™ (SP1); Meditas Ltd, Winchester, UK]; semibespoke [SleepPro 2™ (SP2); Meditas Ltd, Winchester, UK]; and fully bespoke [bespoke MAD (bMAD); NHS Oral-Maxillofacial Laboratory, Addenbrooke's Hospital, Cambridge, UK] against no treatment, in 90 adults with mild to moderate OSAH. All devices improved primary outcome [apnoea-hypopnoea index (AHI)] compared with no treatment: relative risk 0.74 [95% confidence interval (CI) 0.62 to 0.89] for SP1; relative risk 0.67 (95% CI 0.59 to 0.76) for SP2; and relative risk 0.64 (95% CI 0.55 to 0.76) for bMAD (p devices were cost-effective at £20,000/quality-adjusted life-year (QALY), with SP2 the best value below £39,800/QALY. A MEDLINE, EMBASE and Science Citation Index search updating two existing systematic reviews (one from November 2006 and the other from June 2008) to August 2013 identified 77 RCTs in adult OSAH

  4. The German Long-Term Care Insurance Program: Evolution and Recent Developments. (United States)

    Nadash, Pamela; Doty, Pamela; von Schwanenflügel, Matthias


    Since 1995, Germany has operated one of the longest-running public programs providing universal support for the cost of long term services and supports (LTSS). Its self-funding, social insurance approach provides basic supports to nearly all Germans. We discuss its design and development, including recent reforms expanding the program and ensuring its ongoing sustainability. The study reviews legislative and programmatic changes, using program data, as well as legislative documents and program reports. The program is widely accepted among citizens and has achieved many of its original goals: ensuring access to LTSS and reducing reliance on the locally-funded safety-net social assistance program, which can be used to cover nursing home costs. It also strengthened the LTSS provider infrastructure and expanded access to home care. Recent reforms have addressed some of the program's key issues: the benefit's decreasing value, the eligibility and benefit structure that largely excluded cognitive impairment, and the program's longer-term financial sustainability-particularly its ability to sustain newly expanded benefits, which provide stronger protections to caregivers, index-link benefits, and more systematically incorporate cognitive impairment via a new assessment system. It has addressed financing issues by increasing premiums, introducing subsidies for the purchase of private insurance, and creating a "demographic reserve fund." The reforms constitute a significant strengthening of the program, remarkable in an era of retrenchment. Overall, the program provides evidence for the financial viability of a social insurance model, although longer-term challenges may yet arise.

  5. Surgeons' Perspectives on Premium Implants in Total Joint Arthroplasty. (United States)

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


    Declining total joint arthroplasty reimbursement and rising implant prices have led many hospitals to restrict access to newer, more expensive total joint arthroplasty implants. The authors sought to understand arthroplasty surgeons' perspectives on implants regarding innovation, product launch, costs, and cost-containment strategies including surgeon gain-sharing and patient cost-sharing. Members of the International Congress for Joint Reconstruction were surveyed regarding attitudes about implant technology and costs. Descriptive and univariate analyses were performed. A total of 126 surgeons responded from all 5 regions of the United States. Although 76.9% believed new products advance technology in orthopedics, most (66.7%) supported informing patients that new implants lack long-term clinical data and restricting new implants to a small number of investigators prior to widespread market launch. The survey revealed that 66.7% would forgo gain-sharing incentives in exchange for more freedom to choose implants. Further, 76.9% believed that patients should be allowed to pay incremental costs for "premium" implants. Surgeons who believed that premium products advance orthopedic technology were more willing to forgo gain-sharing (P=.040). Surgeons with higher surgical volume (P=.007), those who believed implant companies should be allowed to charge more for new technology (Pinnovation advances the field but support discussing the "unproven" nature of new implants with patients. Many surgeons support alternative payment models permitting surgeons and patients to retain implant selection autonomy. Most respondents prioritized patient beneficence and surgeon autonomy above personal financial gain. [Orthopedics. 2017; 40(5):e825-e830.]. Copyright 2017, SLACK Incorporated.


    Directory of Open Access Journals (Sweden)

    Ewa Kułagowska


    Full Text Available The considerable proportion of the elderly, the chronically ill and the disabled in community is an economic and organizational challenge for the state social policy. It requires a large, steadily increasing financing from the public funds and creating an optional care model to fulfill the needs of citizens and guarantee high quality services. Development of the long-term care is one of the problems to be solved. This paper presents: – a long-term care forms, organization and tasks; – a role of long-term care but particularly home longterm care to protect health in Poland; – problems related with home long-term care functioning.

  7. Decreasing relative risk premium

    DEFF Research Database (Denmark)

    Hansen, Frank


    such that the corresponding relative risk premium is a decreasing function of present wealth, and we determine the set of associated utility functions. We find a new characterization of risk vulnerability and determine a large set of utility functions, closed under summation and composition, which are both risk vulnerable...... and have decreasing relative risk premium. We finally introduce the notion of partial risk neutral preferences on binary lotteries and show that partial risk neutrality is equivalent to preferences with decreasing relative risk premium...

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

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

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

  9. Premium cost optimization of operational and maintenance of green building in Indonesia using life cycle assessment method (United States)

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


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

  10. Long-term survival after perforated diverticulitis

    NARCIS (Netherlands)

    J. Vermeulen (Jan); M.P. Gosselink (Martijn Pieter); W.C.J. Hop (Wim); E. van der Harst (Erwin); B.E. Hansen (Bettina); G.H.H. Mannaerts (Guido); P-P. Coene (Peter Paul); W.F. Weidema (Wibo); J.F. Lange (Johan)


    textabstractAim: Short-term survival after emergency surgery for perforated diverticulitis is poor. Less is known about long-term survival. The aims of this study were to evaluate long-term survival after discharge from hospital and to identify factors associated with prognosis. Method: All patients

  11. Virtual Models of Long-Term Care (United States)

    Phenice, Lillian A.; Griffore, Robert J.


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

  12. The Long-Term Swap Rate and a General Analysis of Long-Term Interest Rates


    Francesca Biagini; Alessandro Gnoatto; Maximilian H\\"artel


    We introduce here for the first time the long-term swap rate, characterised as the fair rate of an overnight indexed swap with infinitely many exchanges. Furthermore we analyse the relationship between the long-term swap rate, the long-term yield, see [4], [5], and [25], and the long-term simple rate, considered in [8] as long-term discounting rate. We finally investigate the existence of these long-term rates in two term structure methodologies, the Flesaker-Hughston model and the linear-rat...

  13. Going Solar Yields Long-Term Economical, Educational Benefits (United States)

    von Moos, Brian


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

  14. Long term impacts of international outsourcing of manufacturing on sustainability

    DEFF Research Database (Denmark)

    Moosavirad, Seyed Hamed; Kara, Sami; Hauschild, Michael Zwicky


    International outsourcing seems to be a cost efficient way of production. However, there are serious concerns about its long term impacts on the environmental, social and economic sustainability. This paper aims to quantify these impacts by using input output analysis, linear programming and system...

  15. Vulnerable long-term psychiatric in- patients need screening for ...

    African Journals Online (AJOL)

    in-patient and out-patient services are offered. In addition to the acute in-patient services, there is a decreasing number of long- term in-patients who are either ...... Ringel J, Dobkin C, Truong K. The incremental inpatient costs associated with marijuana comorbidity. Drug & Alcohol. Dependence 2008; 92(1-3):248-57. 37.

  16. Long Term Incentives for Residential Customers Using Dynamic Tariff

    DEFF Research Database (Denmark)

    Huang, Shaojun; Wu, Qiuwei; Nielsen, Arne Hejde


    This paper reviews several grid tariff schemes, including flat tariff, time-of-use, time-varying tariff, demand charge and dynamic tariff (DT), from the perspective of the long term incentives. The long term incentives can motivate the owners of flexible demands to change their energy consumption...... behavior in such a way that the power system operation issues, such as system balance and congestion, can be alleviated. From the comparison study, including analysis and case study, the DT scheme outperforms the other tariff schemes in terms of cost saving and network operation condition improving....

  17. Employee responses to health insurance premium increases. (United States)

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


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

  18. Long-Term Ownership by Industrial Foundations

    DEFF Research Database (Denmark)

    Børsting, Christa Winther; Kuhn, Johan Moritz; Poulsen, Thomas


    in several respects. Foundations hold on to their shares for longer. Foundation-owned companies replace managers less frequently. They have more conservative capital structures with less leverage. Their companies survive longer. Their business decisions appear to be more long term. This paper supports...... in Denmark. Industrial foundations are independent legal entities without owners or members typically with the dual objective of preserving the company and using excess profits for charity. We use a unique Danish data set to examine the governance of foundation-owned companies. We show that they are long-term......Short-termism has become a serious concern for businesses and policy makers and this has inspired a search for governance arrangement to promote long term decision making. In this paper we study a particularly long-term ownership structure, which is fairly common in Northern Europe, particularly...

  19. Reforming long-term care in Europe

    National Research Council Canada - National Science Library

    Costa-i-Font, Joan


    .... Offers the very latest analysis of long-term care reform agendas in Europe. Compares countries comparatively less studied with the experiences of reform in Germany, the UK, Netherlands and Sweden...

  20. Long Term Care Minimum Data Set (MDS) (United States)

    U.S. Department of Health & Human Services — The Long-Term Care Minimum Data Set (MDS) is a standardized, primary screening and assessment tool of health status that forms the foundation of the comprehensive...

  1. Pituitary diseases : long-term clinical consequences

    NARCIS (Netherlands)

    Klaauw, Agatha Apolonia van der


    This thesis describes various studies during the long-term follow-up of patients after treatment for pituitary diseases. The focus of this thesis is acromegaly, growth hormone deficiency, sleep and quality of life. Various aspects are described.

  2. Long-term weight loss maintenance

    National Research Council Canada - National Science Library

    Wing, Rena R; Phelan, Suzanne


    ...% of initial body weight and maintaining the loss for at least 1 y. The National Weight Control Registry provides information about the strategies used by successful weight loss maintainers to achieve and maintain long-term weight loss...

  3. Manganese in long term paediatric parenteral nutrition.


    Reynolds, A P; Kiely, E; Meadows, N


    The current practice of providing manganese supplementation to neonates on long term parenteral nutrition is leading to a high incidence of hypermanganesaemia. Magnetic resonance imaging (MRI) studies in adults on long term manganese parenteral nutrition have shown changes in TI weighted MRI images and similar findings in a neonate receiving trace element supplementation are reported here. Whole blood manganese concentration in the infant was 1740 nmol/l (or 8.3 times upper reference limit). ...

  4. Long-term outcomes after severe shock. (United States)

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


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

  5. El coste de los cuidados de larga duración en la población española: análisis comparativo entre los años 1999 y 2008 || The Cost of Long-Term Care in the Spanish Population Comparative Analysis between 1999 and 2008

    Directory of Open Access Journals (Sweden)

    Alcañiz Zanón, Manuela


    Full Text Available Este trabajo analiza los costes de los cuidados de larga duración (CLD ligados a los individuos en situación de dependencia. El coste económico unitario de los servicios de cuidados de larga duración está relacionado con el tiempo esperado de necesidad de la atención y la intensidad de los servicios requeridos. Se ha estimado el coste individual esperado en CLD, desde el momento en que se inicia la dependencia, para la población española mayor de 65 años y separadamente para los hombres y las mujeres. Los datos utilizados corresponden a las dos grandes operaciones estadísticas sobre discapacidad y dependencia llevadas a cabo por el Instituto Nacional de Estadística (INE en 1999 y en 2008. También se han utilizado las tablas de mortalidad del INE y, con ellas, se han creado escenarios realistas para la longevidad. La posibilidad de reproducir el análisis para los años 1999 y 2008 ha permitido la comparación entre ambos años, así como el análisis de la tendencia registrada en la última década por la longevidad, la prevalencia de la dependencia y los costes esperados. Finalmente, hemos analizado, por un lado, el efecto del incremento de la esperanza de vida y de la prevalencia de la dependencia y, por otro, el efecto de la inflación sobre la evolución de los costes de los cuidados de larga duración. || This paper analyzes the cost of long-term care (LTC associated to individuals in dependence situation. The economic cost of care per unit of service is linked to the expected time of needed care and the intensity of required services. We have estimated the expected lifetime cost of LTC in dependence for individuals aged 65 years and above. Calculations have been made separately for men and women. The estimations have been done for year 1999 and 2008, respectively, using data from the two oficial surveys carried out by the Spanish Institute of Statistics (INE. Oficial mortality records and life table trends were used to create

  6. Long-term prisoner in prison isolation

    Directory of Open Access Journals (Sweden)

    Karolina Grudzińska


    Full Text Available Long-term prisoner belongs to a particular category of people who are imprisoned in prisons. On the one hand in this group are often heavily demoralized people who committed the most serious crimes, on the other hand it is a group of prisoners, who should be well thought out and programmed the impact of rehabilitation. The situation of man trapped for years poses in a complicated situation not only the prisoners, but also the entire prison staff. They have to take care of the fact that the prison isolation did not cause the state in which convicts form itself in learned helplessness and lack of skills for self-planning and decision-making. In addition, planning the rehabilitation impact of long-term prisoners should not be forgotten that these prisoners in the short or the long term will return to the libertarian environment therefore, should prevent any negative effects of long-term imprisonment. This article presents the main issues related to the execution of imprisonment against long-term prisoners. It is an attempt to systematize the knowledge of this category of people living in prison isolation.

  7. Long-term follow-up study and long-term care of childhood cancer survivors

    Directory of Open Access Journals (Sweden)

    Hyeon Jin Park


    Full Text Available The number of long-term survivors is increasing in the western countries due to remarkable improvements in the treatment of childhood cancer. The long-term complications of childhood cancer survivors in these countries were brought to light by the childhood cancer survivor studies. In Korea, the 5-year survival rate of childhood cancer patients is approaching 70%; therefore, it is extremely important to undertake similar long-term follow-up studies and comprehensive long-term care for our population. On the basis of the experiences of childhood cancer survivorship care of the western countries and the current Korean status of childhood cancer survivors, long-term follow-up study and long-term care systems need to be established in Korea in the near future. This system might contribute to the improvement of the quality of life of childhood cancer survivors through effective intervention strategies.

  8. Aspects of long - term intensive care


    Picková, Jana


    My thesis deals with aspects of long-term intensive care. The goal of my thesis is to determine the basic needs of patients and family preparedness aspects of intensive home care. Other stated goals is find out the possibility of returning patients to home care and also find out what is the use of basal stimulation in long-term intensive care department. In the theoretical part of my thesis are included the chapters about definition of intensive care and home intensive care, for the full comp...

  9. A Long-term Plan for Kalk

    DEFF Research Database (Denmark)


    In this case, the author demonstrates together with the owner-manager of KALK A/S, Mr Rasmus Jorgensen, how to use the Family Business Map to frame a constructive discussion about long-term planning. The Family Business Map is a tool for long-term planning in family firms developed by Professor...... Morten Bennedsen, INSEAD and Professor Joseph Fan, Chinese University of Hong Kong. It consists of 40 questions regarding assets in the family and roadblocks facing the family firm. The Family Business Map determines that the level of family assets in KALK is high, while the level of roadblocks is severe...

  10. The coevolution of long-term pair bonds and cooperation. (United States)

    Song, Z; Feldman, M W


    The evolution of social traits may not only depend on but also change the social structure of the population. In particular, the evolution of pairwise cooperation, such as biparental care, depends on the pair-matching distribution of the population, and the latter often emerges as a collective outcome of individual pair-bonding traits, which are also under selection. Here, we develop an analytical model and individual-based simulations to study the coevolution of long-term pair bonds and cooperation in parental care, where partners play a Snowdrift game in each breeding season. We illustrate that long-term pair bonds may coevolve with cooperation when bonding cost is below a threshold. As long-term pair bonds lead to assortative interactions through pair-matching dynamics, they may promote the prevalence of cooperation. In addition to the pay-off matrix of a single game, the evolutionarily stable equilibrium also depends on bonding cost and accidental divorce rate, and it is determined by a form of balancing selection because the benefit from pair-bond maintenance diminishes as the frequency of cooperators increases. Our findings highlight the importance of ecological factors affecting social bonding cost and stability in understanding the coevolution of social behaviour and social structures, which may lead to the diversity of biological social systems. © 2013 The Authors. Journal of Evolutionary Biology © 2013 European Society For Evolutionary Biology.

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

    Elhag, Hussein Adam

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

  12. Sensor System for Long-term Recording of Photovoltaic (PV) IV-curves

    DEFF Research Database (Denmark)

    Paasch, Kasper; Nymand, Morten; Haase, Frerk

    The purpose of this paper is to present a recording system for long-term investigation of PV panel dynamics under partial shading conditions. The system is intended to be a low-cost system deployable for stand-alone field use and long-term data recording at PV-plants. Passing clouds will affect...

  13. Work ability assessment of employees on long term sick leave in insurance medicine

    NARCIS (Netherlands)

    Sánchez Mendoza, P.M.


    Long-term sick leave generates high financial costs for society and causes personal suffering to patients and their families; however, crucial knowledge about the factors associated with long-term sick leave is still missing. This thesis is focused on factors relevant to the work ability assessment

  14. Long-term effects of directed forgetting. (United States)

    Hupbach, Almut


    The intention to forget reduces the accessibility of information in memory, which is commonly explained with temporary retrieval difficulties. Long-term effects have rarely been studied, and results are inconsistent. The present study re-assessed the long-term effects of directed forgetting (DF). Participants encoded a first list of items (L1), and were then instructed to forget or to remember this list. Immediately afterwards, all participants were presented with a second list to remember. In Experiment 1, memory for L1 and L2 was assessed after a 24-h delay. The forget cue reduced the number of items that were recalled from L1. Experiment 2 implemented a 12-h delay between encoding and test that was either filled with day-time wakefulness or night-time sleep. Replicating the findings of Exp. 1, recall of L1 was reduced in the forget in comparison to the remember condition. Sleep in comparison to wakefulness significantly strengthened L1 memory in the remember group only. Taken together, the present study shows that the intention to forget can have long-lasting consequences. This suggests that different mechanisms underlie the short- and long-term effects of DF, with long-term effects potentially reflecting the preferential consolidation of information that has been identified as important during encoding.

  15. Professionalism in Long-Term Care Settings (United States)

    Lubinski, Rosemary


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

  16. Long-term maintenance needs planning. (United States)


    This research contributes to Kentucky's knowledge base of long-term maintenance needs in two parts. Part I presents an estimate of the average revenue needed to maintain four categories of highway in the first fifteen years after each is built or res...

  17. Timber joints under long-term loading

    DEFF Research Database (Denmark)

    Feldborg, T.; Johansen, M.

    This report describes tests and results from stiffness and strength testing of splice joints under long-term loading. During two years of loading the spicimens were exposed to cyclically changing relative humidity. After the loading period the specimens were short-term tested. The connectors were...

  18. Long-Term Memory and Learning (United States)

    Crossland, John


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

  19. Long term consequences of early childhood malnutrition

    NARCIS (Netherlands)

    Kinsey, B.H.; Hoddinott, J; Alderman, H.


    This paper examines the impact of pre-school malnutrition on subsequent human capital formation in rural Zimbabwe using a maternal fixed effects - instrumental variables (MFE-IV) estimator with a long term panel data set. Representations of civil war and drought shocks are used to identify

  20. Long-Term Care Services for Veterans (United States)


    palliative care ,  adult day health care ,  homemaker/home health aide care ,  respite care , Long-Term Care Services for...8111A; §1785. 2 The VHA also provides dementia care ; transitional care ; health care workforce development; Geriatric Research Education, and...text (bold) = both VA and purchased community care . In addition, the VHA provides dementia care ; transitional care ; health care

  1. Long-term disability in anxiety disorders. (United States)

    Hendriks, Sanne M; Spijker, Jan; Licht, Carmilla M M; Hardeveld, Florian; de Graaf, Ron; Batelaan, Neeltje M; Penninx, Brenda W J H; Beekman, Aartjan T F


    This longitudinal study aims to investigate differences in long-term disability between social anxiety disorder (SAD), panic disorder with agoraphobia (PDA), panic disorder without agoraphobia (PD), generalized anxiety disorder (GAD) and multiple anxiety disorders (multiple AD), focusing on the effects of different course trajectories (remission, recurrence and chronic course) and specific symptom dimensions (anxiety arousal and avoidance behaviour). Data were used from participants with no psychiatric diagnosis (healthy controls, n = 647) or with a current anxiety disorder (SAD, n = 191; PDA, n = 90; PD, n = 84; GAD, n = 110; multiple AD, n = 480). Severity of anxiety arousal and avoidance behaviour symptoms was measured using the Beck Anxiety Inventory and the Fear Questionnaire. The World Health Organization Disability Assessment Schedule II was used to measure disability. Long-term disability was most prevalent in participants with SAD and multiple AD, and lowest in PDA and PD. GAD had an intermediate position. Anxiety arousal and avoidance behaviour were associated with more long-term disability in anxiety disorders than course trajectories. Various anxiety disorders have different disability levels over 4 years of time, therefore diagnostic distinction is important for treatment focus. Anxiety arousal and avoidance behaviour are major predictors for long-term disability in anxiety disorders.

  2. Comparative outcomes and cost-utility after surgical treatment of focal lumbar spinal stenosis compared with osteoarthritis of the hip or knee--part 1: long-term change in health-related quality of life. (United States)

    Rampersaud, Y Raja; Lewis, Stephen J; Davey, J Roderick; Gandhi, Rajiv; Mahomed, Nizar N


    It is well accepted that total hip and knee arthroplasty (THA/TKA) for osteoarthritis (OA) is associated with reliable and sustained improvements in postoperative health-related quality of life (HRQoL). Although several studies have demonstrated comparable outcomes with THA/TKA after surgical intervention for lumbar spinal stenosis (LSS), the sustainability of the outcome after LSS surgery compared with THA/TKA remains uncertain. The primary purpose of this study is to assess whether improvements in HRQoL after surgical management of focal lumbar spinal stenosis (FLSS) with or without spondylolisthesis are sustainable over the long term compared with that of THA/TKA for OA. Single-center, retrospective, longitudinal matched cohort study of prospectively collected outcomes, with a minimum of 5-year follow-up (FU). Patients who had primary one- to two-level spinal decompression with or without instrumented fusion for FLSS and THA/TKA for primary OA. Postoperative change from baseline to last FU in Short-Form 36 physical component summary (PCS) and mental component summary (MCS) scores among groups was used as the primary outcome measure. An age, sex-matched inception cohort of primary one- to two-level spinal decompression with or without instrumented fusion for FLSS (n=99) was compared with a cohort of primary THA (n=99) and TKA (n=99) for OA and followed for a minimum of 5 years. Linear regression was used for the primary analysis. Mean (percent) FUs in months were 80.5+16.04 (79%), 94.6+16.62 (92%), and 80.6+16.84 (85%) for the FLSS, THA, and TKA cohorts, respectively, with a range of 5 to 10 years for all three cohorts. The number of patients who have undergone revision including those lost to FU for the FLSS, THA, and TKA cohorts were n=20 (20.2%, same site [n=7] and adjacent segment [n=13]) requiring 27 operations, n=3 (3%, same site) requiring 5 operations, and n=8 (8.1%, same site) requiring 12 operations, respectively (p.1). Significant improvements in HRQo

  3. Long-term Outcomes Following Syme's Amputation. (United States)

    Finkler, Elissa S; Marchwiany, Daniel A; Schiff, Adam P; Pinzur, Michael S


    The metabolic cost of walking after Syme's ankle disarticulation amputation is minimally more than that for nonamputation. The ability to end weightbearing makes prosthetic fitting relatively simple, and very few patients require extensive rehabilitation or placement in a skilled nursing or rehabilitation facility. In spite of these potential benefits, there is a paucity of objective information on the actual long-term outcomes. Fifty-one patients were identified who underwent single-stage Syme's ankle disarticulation amputation with excision of the lateral and medial malleoli by a single surgeon during a 23-year period. None of these patients had sufficient tissue to allow amputation at the transmetatarsal or tarsometatarsal levels. Thirty-three underwent amputation due to a diabetic forefoot infection, 11 secondary to a crush injury, 3 for a nondiabetic infection, 3 for a noncorrectable acquired deformity, and 1 for neoplasm. The average age at surgery for the diabetic patients was 62.1 years (range, 36-81 years), with an average follow-up of 6.8 years (range, 4.0-11.6 years). The nondiabetic patients had an average age of 37.8 years (range, 21-65 years), with an average follow-up of 9.3 years (range, 2.2-25.0 years). Patients who were alive and could be contacted were invited to complete the Short Musculoskeletal Function Assessment (SMFA) questionnaire that was scored for functional, mobility, and bothersome indices. Seventeen of the 33 diabetic patients died. Four (12.1%) were converted to transtibial amputation. One of the nondiabetic patients died, and 1 (5.5%) was converted to transtibial amputation. Eleven of the 33 patients who were contacted completed the SMFA. All of these patients demonstrated favorable outcome scores in the mobility, functional, and bothersome indices (average mobility index of 17.2, functional index of 14.7, and bothersome index of 16.7 for nondiabetic patients compared to 34.7, 29.9, and 30.6 for diabetic patients, respectively

  4. The Present, Mid-Term, and Long-Term Supply Curves for Tellurium; and Updates in the Results from NREL's CdTe PV Module Manufacturing Cost Model (Presentation)

    Energy Technology Data Exchange (ETDEWEB)

    Woodhouse, M.; Goodrich, A.; Redlinger, M.; Lokanc, M.; Eggert, R.


    For those PV technologies that rely upon Te, In, and Ga, first-order observations and calculations hint that there may be resource constraints that could inhibit their successful deployment at a SunShot level. These are only first-order approximations, however, and the possibility for an expansion in global Te, In, and Ga supplies needs to be considered in the event that there are upward revisions in their demand and prices.In this study, we examine the current, mid-term, and long-term prospects of Tellurium (Te) for use in PV. We find that the current global supply base of Te would support <10 GW of annual traditional CdTe PV manufacturing production. But as for the possibility that the supply base for Te might be expanded, after compiling several preliminary cumulative availability curves we find that there may be significant upside potential in the supply base for this element - principally vis a vis increasing demand and higher prices. Primarily by reducing the Tellurium intensity in manufacturing and by increasing the recovery efficiency of Te in Cu refining processes, we calculate that it may prove affordable to PV manufacturers to expand the supply base for Te such that 100 GW, or greater, of annual CdTe PV production is possible in the 2030 - 2050 timeframe.

  5. Sexual selection enables long-term coexistence despite ecological equivalence. (United States)

    M'Gonigle, Leithen K; Mazzucco, Rupert; Otto, Sarah P; Dieckmann, Ulf


    Empirical data indicate that sexual preferences are critical for maintaining species boundaries, yet theoretical work has suggested that, on their own, they can have only a minimal role in maintaining biodiversity. This is because long-term coexistence within overlapping ranges is thought to be unlikely in the absence of ecological differentiation. Here we challenge this widely held view by generalizing a standard model of sexual selection to include two ubiquitous features of populations with sexual selection: spatial variation in local carrying capacity, and mate-search costs in females. We show that, when these two features are combined, sexual preferences can single-handedly maintain coexistence, even when spatial variation in local carrying capacity is so slight that it might go unnoticed empirically. This theoretical study demonstrates that sexual selection alone can promote the long-term coexistence of ecologically equivalent species with overlapping ranges, and it thus provides a novel explanation for the maintenance of species diversity.

  6. Long-term prevention of diabetic nephropathy

    DEFF Research Database (Denmark)

    Schjoedt, K J; Hansen, H P; Tarnow, L


    . Glycaemic control and blood pressure remained nearly unchanged. CONCLUSIONS/INTERPRETATION: In our outpatient clinic, the implementation of RAAS-blocking treatment in type 1 diabetic patients with microalbuminuria successfully reduced long-term progression to overt DN to a rate similar to those previously......AIMS/HYPOTHESIS: In type 1 diabetic patients with microalbuminuria not receiving antihypertensive treatment, an increase in urinary AER (UAER) of 6-14%/year and a risk of developing diabetic nephropathy (DN) of 3-30%/year have been reported. We audited the long-term effect of blocking the renin......-angiotensin-aldosterone system (RAAS) with an ACE inhibitor (ACEI) or angiotensin II receptor blocker (ARB) in microalbuminuric type 1 diabetic patients on progression of microalbuminuria and development of DN. METHODS: All patients with type 1 diabetes and persistent microalbuminuria (30-300 mg/24 h) were identified (n=227...

  7. Long-term opioid therapy in Denmark

    DEFF Research Database (Denmark)

    Birke, H; Ekholm, Ola; Sjøgren, P


    BACKGROUND: Longitudinal population-based studies of long-term opioid therapy (L-TOT) in chronic non-cancer pain (CNCP) patients are sparse. Our study investigated incidence and predictors for initiating L-TOT and changes in self-rated health, pain interference and physical activities in long......-term opioid users. METHODS: Data were obtained from the national representative Danish Health and Morbidity Surveys and The Danish National Prescription Registry. Respondents with no dispensed opioids the year before the survey were followed from 2000 and from 2005 until the end of 2012 (n = 12...... defined as those who were dispensed at least one opioid prescription in six separate months within a year. RESULTS: The incidence of L-TOT was substantially higher in CNCP patients at baseline than in others (9/1000 vs. 2/1000 person-years). Smoking behaviour and dispensed benzodiazepines were...

  8. Learning A Physical Long-term Predictor


    Ehrhardt, Sebastien; Monszpart, Aron; Mitra, Niloy J.; Vedaldi, Andrea


    Evolution has resulted in highly developed abilities in many natural intelligences to quickly and accurately predict mechanical phenomena. Humans have successfully developed laws of physics to abstract and model such mechanical phenomena. In the context of artificial intelligence, a recent line of work has focused on estimating physical parameters based on sensory data and use them in physical simulators to make long-term predictions. In contrast, we investigate the effectiveness of a single ...

  9. Long-term course of opioid addiction. (United States)

    Hser, Yih-Ing; Evans, Elizabeth; Grella, Christine; Ling, Walter; Anglin, Douglas


    Opioid addiction is associated with excess mortality, morbidities, and other adverse conditions. Guided by a life-course framework, we review the literature on the long-term course of opioid addiction in terms of use trajectories, transitions, and turning points, as well as other factors that facilitate recovery from addiction. Most long-term follow-up studies are based on heroin addicts recruited from treatment settings (mostly methadone maintenance treatment), many of whom are referred by the criminal justice system. Cumulative evidence indicates that opioid addiction is a chronic disorder with frequent relapses. Longer treatment retention is associated with a greater likelihood of abstinence, whereas incarceration is negatively related to subsequent abstinence. Over the long term, the mortality rate of opioid addicts (overdose being the most common cause) is about 6 to 20 times greater than that of the general population; among those who remain alive, the prevalence of stable abstinence from opioid use is low (less than 30% after 10-30 years of observation), and many continue to use alcohol and other drugs after ceasing to use opioids. Histories of sexual or physical abuse and comorbid mental disorders are associated with the persistence of opioid use, whereas family and social support, as well as employment, facilitates recovery. Maintaining opioid abstinence for at least five years substantially increases the likelihood of future stable abstinence. Recent advances in pharmacological treatment options (buprenorphine and naltrexone) include depot formulations offering longer duration of medication; their impact on the long-term course of opioid addiction remains to be assessed.

  10. Long term evolution 4G and beyond

    CERN Document Server

    Yacoub, Michel; Figueiredo, Fabrício; Tronco, Tania


    This book focus on Long Term Evolution (LTE) and beyond. The chapters describe different aspects of research and development in LTE, LTE-Advanced (4G systems) and LTE-450 MHz such as telecommunications regulatory framework, voice over LTE, link adaptation, power control, interference mitigation mechanisms, performance evaluation for different types of antennas, cognitive mesh network, integration of LTE network and satellite, test environment, power amplifiers and so on. It is useful for researchers in the field of mobile communications.

  11. Long-Term Hearing Results After Ossiculoplasty. (United States)

    Cox, Matthew D; Trinidade, Aaron; Russell, James Shep; Dornhoffer, John L


    To determine if the OOPS index is predictive of long-term hearing results after ossiculoplasty. Case series with retrospective chart review. Tertiary care otology practice. Adult and pediatric patients (3-88 years of age). Ossiculoplasty with cartilage tympanoplasty, with or without mastoidectomy. Primary outcome measures included short-term hearing results (pure-tone average air-bone gap [PTA-ABG] measured between 60 days and 1 year after surgery), long-term hearing results (PTA-ABG measured ≥5 years after surgery), and the rate of successful ABG closure to ≤20 dB. Secondary measures included the need for revision surgery, delayed tympanic membrane graft failure, worsening conductive hearing loss (after an initially satisfactory hearing result), and recurrence of cholesteatoma. There was no significant difference between adults and children for short-term hearing results (average post-op PTA-ABG was 18.9 dB vs. 19.8 dB, respectively; p = 0.544), long-term hearing results (average final PTA-ABG was 19.3 dB vs. 19.4 dB, respectively; p = 0.922), or rate of ABG closure to less than 20 dB (63.1% vs. 58.0%, p = 0.282). Spearman's rank-order correlation (ρ) identified a strong positive correlation between OOPS index score and average post-operative PTA-ABG (ρ = 0.983; p hearing outcomes in adult and pediatric patients undergoing ossiculoplasty in both the short term and the long term.

  12. Timber joints under long-term loading

    DEFF Research Database (Denmark)

    Feldborg, T.; Johansen, M.

    This report describes tests and results from stiffness and strength testing of splice joints under long-term loading. During two years of loading the spicimens were exposed to cyclically changing relative humidity. After the loading period the specimens were short-term tested. The connectors were...... integral nail-plates and nailed steel and plywood gussets. The report is intended for designers and researchers in timber engineering....

  13. Long-Term Trends in World Politics

    Directory of Open Access Journals (Sweden)

    George Modelski


    Full Text Available A revisit, and an extension, of the paper “From Leadership to Organization: The Evolution of Global Politics,” originally presented at the University of Zurich in 1993. Three long-term processes: the evolution of global politics (or political globalization; the rise and decline of world powers (the long cycle of global politics; and the emergence of the world system, have been reviewed and updated.

  14. Where is the value premium?

    NARCIS (Netherlands)

    Phalippou, L.


    The value premium is driven by 7 percent of the stock market. The 93 percent of market capitalization held most by institutional investors is value premium free. In contrast, in stocks held most by individual investors, the value premium, even when the stocks are value weighted, reaches a staggering

  15. Long-Term Monitoring Research Needs: A DOE Perspective (United States)

    Moore, B.; Davis, C. B.


    The U.S. Department of Energy's Office of Environmental Management is responsible for dealing with the nation's legacy of Cold War radioactive and hazardous waste and contamination. Major efforts are underway to deal with this legacy; these are expected to last up to decades and cost up to billions of dollars at some sites. At all sites, however, active remediation must eventually cease; if hazards then remain, the site must enter into a long-term stewardship mode. In this talk we discuss aspects of long-term monitoring pertinent to DOE sites, focusing on challenges to be faced, specific goals or targets to be met, and research needs to be addressed in order to enable DOE to meet its long-term stewardship obligations. DOE LTM research needs fall into three major categories: doing what we can do now much more efficiently; doing things we cannot do now; and proving the validity of our monitoring programs. Given the enormity of the DOE obligations, it will be highly desirable to develop much more efficient monitoring paradigms. Doing so will demand developing autonomous, remote monitoring networks of in situ sensors capable of replacing (or at least supplementing to a large extent) conventional groundwater and soil gas sampling and analysis programs. The challenges involved range from basic science (e.g., inventing in situ sensors for TCE that do not demand routine maintenance) to engineering (attaining superior reliability in data reporting in remote networks) to ergonomics (developing decent ways of selecting and presenting the "right" information from the monitoring network) to regulatory affairs (presenting convincing evidence that the more efficient systems actually provide superior monitoring). We explore these challenges in some detail, focusing on the "long" in long-term monitoring as it applies to DOE sites. Monitoring system performance validation and, ultimately, regulator and stakeholder acceptance of site closure and long-term stewardship plans depend

  16. Results of a Survey of Long-Term Archiving Implementations (United States)

    Gurman, Joseph B.; Spencer, Jennifer L.


    NASA’s Heliophysics Data Management Policy calls for discipline-specific “final archives,” which will be responsible for the long-term archiving and service of Heliophysics mission data. Long-term archival functions, such as periodic revalidation of the data and migration to newer storage media when appropriate, have never been part of the Solar Data Analysis Center core capabilities. We also recognize that the largest space solar physics data set, the SDO AIA and HMI data at the Stanford Joint Science and Operations Center (JSOC), will eventually need preservation and long-term access, as will the potentially much larger data archive of DKIST observations. We have carried out a study of data archiving best practices in other disciplines and organizations, including NASA’s Space Physics Data Facility (SPDF), the National Institute of Standards and Technology (NIST), and private industry, and report on the lessons learned and possible cost models. We seek input from the broader solar physics community on the relative value of various levels of preservation effort.

  17. Flexibility and reliability in long-term planning exercises dedicated to the electricity sector

    Energy Technology Data Exchange (ETDEWEB)

    Maizi, Nadia; Drouineau, Mathilde; Assoumou, Edi; Mazauric, Vincent


    Long-term planning models are useful to build plausible options for future energy systems and must consequently address the technological feasibility and associated cost of these options. This paper focuses on the electricity sector and on problems of flexibility and reliability in power systems in order to improve results provided by long-term planning exercises: flexibility needs are integrated as an additional criterion for new investment decisions and, reliability requirements are assessed through the level of electrical losses they induced and a related cost. These approaches are implemented in a long-term planning model and demonstrated through a study of the Reunion Island.

  18. Health in the long-term unemployed. (United States)

    Herbig, Britta; Dragano, Nico; Angerer, Peter


    Although the unemployment rate in Germany is currently low, more than a million persons in the country have been out of work for more than a year. In this review article, we address these persons' state of health, the effect of unemployment on health, and the influence of macroeconomic factors and social policy. This article is based on a selective review of pertinent literature in the PubMed database. Large-scale meta-analyses and systematic reviews have shown that the long-term unemployed have an at least twofold risk of mental illness, particularly depression and anxiety disorders, compared to employed persons. Their mortality is 1.6-fold higher. Unemployment seems to be not only an effect of illness, but also a cause of it (i.e., there is evidence for both selection and causality). Learned helplessness is an important psychological explanatory model. Limited evidence indicates that the long-term unemployed have a moderately elevated prevalence of alcoholism; unemployment can be both an effect and a cause of alcoholism. Unemployment also seems to be associated with higher risks of heart attack and stroke. Cancer can lead to loss of employment. The link between unemployment and poorer health is strengthened by macroeconomic crises and weakened by governmental social interventions. The long-term unemployed carry a markedly higher burden of disease, particularly mental illness, than employed persons and those who are unemployed only for a short time. The burden of disease increases with the duration of unemployment. The vicious circle of unemployment and disease can be broken only by the combined effects of generally available health care, special health-promoting measures among the unemployed, and social interventions.

  19. Long-term EARLINET dust observations (United States)

    Mona, Lucia; Amiridis, Vassilis; Amodeo, Aldo; Binietoglou, Ioannis; D'Amico, Giuseppe; Schwarz, Anja; Papagiannopoulos, Nikolaos; Papayannis, Alexandros; Sicard, Michael; Comeron, Adolfo; Pappalardo, Gelsomina


    Systematic observations of Saharan dust events over Europe are performed from May 2000 by EARLINET, the European Aerosol Research LIdar NETwork. EARLINET is a coordinated network of stations that make use of advanced lidar methods for the vertical profiling of aerosols. The backbone of EARLINET network is a common schedule for performing the measurements and the quality assurance of instruments/data. Particular attention is paid to monitoring the Saharan dust intrusions over the European continent. The geographical distribution of the EARLINET stations is particularly appealing for the dust observation, with stations located all around the Mediterranean and in the center of the Mediterranean (Italian stations) where dust intrusions are frequent, and with several stations in the central Europe where dust penetrates occasionally. All aerosol backscatter and extinction profiles related to observations collected during these alerts are grouped in the devoted "Saharan dust" category of the EARLINET database. This category consists of about 4700 files (as of December 2013). Case studies involving several stations around Europe selected from this long-term database have been provided the opportunity to investigate dust modification processes during transport over the continent. More important, the long term EARLINET dust monitoring allows the investigation of the horizontal and vertical extent of dust outbreaks over Europe and the climatological analysis of dust optical intensive and extensive properties at continental scale. This long-term database is also a unique tool for a systematic comparison with dust model outputs and satellite-derived dust products. Because of the relevance for both dust modeling and satellite retrievals improvement, results about desert dust layers extensive properties as a function of season and source regions are investigated and will be presented at the conference. First comparisons with models outputs and CALIPSO dust products will be

  20. Long-Term Recency in Anterograde Amnesia (United States)

    Talmi, Deborah; Caplan, Jeremy B.; Richards, Brian; Moscovitch, Morris


    Amnesia is usually described as an impairment of a long-term memory (LTM) despite an intact short-term memory (STM). The intact recency effect in amnesia had supported this view. Although dual-store models of memory have been challenged by single-store models based on interference theory, this had relatively little influence on our understanding and treatment of amnesia, perhaps because the debate has centred on experiments in the neurologically intact population. Here we tested a key prediction of single-store models for free recall in amnesia: that people with amnesia will exhibit a memory advantage for the most recent items even when all items are stored in and retrieved from LTM, an effect called long-term recency. People with amnesia and matched controls studied, and then free-recalled, word lists with a distractor task following each word, including the last (continual distractor task, CDFR). This condition was compared to an Immediate Free Recall (IFR, no distractors) and a Delayed Free Recall (DFR, end-of-list distractor only) condition. People with amnesia demonstrated the full long-term recency pattern: the recency effect was attenuated in DFR and returned in CDFR. The advantage of recency over midlist items in CDFR was comparable to that of controls, confirming a key prediction of single-store models. Memory deficits appeared only after the first word recalled in each list, suggesting the impairment in amnesia may emerge only as the participant’s recall sequence develops, perhaps due to increased susceptibility to output interference. Our findings suggest that interference mechanisms are preserved in amnesia despite the overall impairment to LTM, and challenge strict dual-store models of memory and their dominance in explaining amnesia. We discuss the implication of our findings for rehabilitation. PMID:26046770

  1. Long-Term Scenario of International Developments

    Directory of Open Access Journals (Sweden)

    Alexey I. Podberezkin


    Full Text Available This paper proposes an approach to long-term scenario building in international relations, based on the analysis of changes in the dialectics of war and peace. Long-term trends in the development of forms and manifestations of violence in international relations, as well as the methods and approaches to its control and management determines the development of international relations. In solving the methodological problem of long-term forecasting, it must be as-sumed that the mere mechanical extrapolation even in the medium term has no meaning. The key current trend in terms of political violence is a blurring of the distinction between war and peace. This trend can be described as networking of war. Network war theory is a model of military strategy in the context of postmodernism. As a model of the new economy based on information and high technologies demonstrates its superiority over traditional capitalist and socialist models of the industrial age, and network war claims qualitative superiority over previous strategic concept of the industrial era. In modern political networks violent and non-violent instruments of influence co-exist in undifferentiated form. Network politics becomes total. Victory in the network war is the fact that the opponent should become part of the network. Since the network is formed around shared values, the network war can be reduced to a war of values. The clash between the networks will most likely wear un-compromising nature, so that in the end there will be only one network. Uncompromising network war is like the uncompromising religious wars and clashes of civilizations.

  2. Long-term EEG in children. (United States)

    Montavont, A; Kaminska, A; Soufflet, C; Taussig, D


    Long-term video-EEG corresponds to a recording ranging from 1 to 24 h or even longer. It is indicated in the following situations: diagnosis of epileptic syndromes or unclassified epilepsy, pre-surgical evaluation for drug-resistant epilepsy, follow-up of epilepsy or in cases of paroxysmal symptoms whose etiology remains uncertain. There are some specificities related to paediatric care: a dedicated pediatric unit; continuous monitoring covering at least a full 24-hour period, especially in the context of pre-surgical evaluation; the requirement of presence by the parents, technician or nurse; and stronger attachment of electrodes (cup electrodes), the number of which is adapted to the age of the child. The chosen duration of the monitoring also depends on the frequency of seizures or paroxysmal events. The polygraphy must be adapted to the type and topography of movements. It is essential to have at least an electrocardiography (ECG) channel, respiratory sensor and electromyography (EMG) on both deltoids. There is no age limit for performing long-term video-EEG even in newborns and infants; nevertheless because of scalp fragility, strict surveillance of the baby's skin condition is required. In the specific context of pre-surgical evaluation, long-term video-EEG must record all types of seizures observed in the child. This monitoring is essential in order to develop hypotheses regarding the seizure onset zone, based on electroclinical correlations, which should be adapted to the child's age and the psychomotor development. Copyright © 2015. Published by Elsevier SAS.

  3. The long term stability of lidar calibrations

    DEFF Research Database (Denmark)

    Courtney, Michael; Gayle Nygaard, Nicolai

    Wind lidars are now used extensively for wind resource measurements. One of the requirements for the data to be accepted in support of project financing (so-called ‘banka-bility’) is to demonstrate the long-term stability of lidar cali-brations. Calibration results for six Leosphere WindCube li-dars......-ters pertaining in the different calibration periods. This is supported by sliding-window analyses of one lidar at one location where the same order of variation is observed as between pre-service and post-service calibrations....

  4. Transverse dimension and long-term stability. (United States)

    Vanarsdall, R L


    This article emphasizes the critical importance of the skeletal differential between the width of the maxilla and the width of the mandible. Undiagnosed transverse discrepancy leads to adverse periodontal response, unstable dental camouflage, and less than optimal dentofacial esthetics. Hundreds of adult retreatment patients corrected for significant maxillary transverse deficiency using surgically assisted maxillary expansion (similar to osseous distraction) has produced excellent stability. Eliciting tooth movement for children (orthopedics, lip bumper, Cetlin plate) in all three planes of space by muscles, eruption, and growth, develops the broader arch form (without the mechanical forces of fixed or removable appliances) and has also demonstrated impressive long term stability.

  5. Long-term population studies of seabirds. (United States)

    Wooller, R D; Bradley, J S; Croxall, J P


    Long-term studies of seabirds, some now 30-40 years old, have begun to reveal significant age-related changes in the survival and reproduction o f these long-lived animals. Evidence for density-dependent regulation of seabird numbers, however, remains sparse whereas unpredictable, disastrous breeding years may be an important influence. Critical evaluation will require better data on (1) the extent of movements of seabirds between colonies, (2) the characteristics of those individuals that contribute disproportionately to the next generation, and (3) the importance of year and/or cohort effects on population processes. Copyright © 1992. Published by Elsevier Ltd.

  6. Long Term Planning at IQ Metal

    DEFF Research Database (Denmark)


    This is a Danish version. This case about long term planning at the owner-managed manufacturing firm IQ Metal shows how the future management and ownership may be organized to utilize owner assets and minimize roadblocks. Initially, the owner-manager Bo Fischer Larsen explains how he acquired...... in The Owner Strategy Map into the questionnaire available on Lastly, the Owner Strategy Map's recommendation of how to organize the future management and ownership of IQ Metal is explained....

  7. Terminating a long-term clinical trial. (United States)

    Klimt, C R


    Long-term clinical trials often include more than one active treatment group. These may be discontinued independently if found to be ineffective or possibly harmful. Certain subgroups of patients may be discovered, in the course of a clinical trial, who do not respond satisfactorily and are, therefore, excluded during the course of a trial. Yet another kind of termination comes when we have a therapeutic breakthrough or when hope has to be abandoned for demonstrating beneficial effects for one, several, or all treatments included in a trial. Examples from the authors' experience are presented, as are successful and unsuccessful techniques in managing terminations of various types.

  8. Long term testing of PSI-membranes

    Energy Technology Data Exchange (ETDEWEB)

    Huslage, J.; Brack, H.P.; Geiger, F.; Buechi, F.N.; Tsukada, A.; Scherer, G.G. [Paul Scherrer Inst. (PSI), Villigen (Switzerland)


    Long term tests of PSI membranes based on radiation-grafted FEP and ETFE films were carried out and FEP-based membranes were evaluated by monitoring the in-situ membrane area resistance measured by a current pulse method. By modifying our irradiation procedure and using the double crosslinking concept we obtain reproducible membrane cell lifetimes (in term of in-situ membrane resistance) of greater than 5000 hours at 60-65{sup o}C. Preliminary tests at 80-85{sup o}C with lifetimes of greater than 2500 demonstrate the potential long term stability of PSI proton exchange membranes based on FEP over the whole operating temperature range of low-temperature polymer electrolyte fuel cells. Radiation grafted PSI membranes based on ETFE have better mechanical properties than those of the FEP membranes. Mechanical properties are particularly important in large area cells and fuel cell stacks. ETFE membranes have been tested successfully for approximately 1000 h in a 2-cell stack (100 cm{sup 2} active area each cell). (author) 4 figs., 4 refs.

  9. Institutionalization and Organizational Long-term Success

    Directory of Open Access Journals (Sweden)

    Denise L. Fleck


    Full Text Available Institutionalization processes have an ambivalent effect on organizational long-term success. Even though they foster organizational stability and permanence, they also bring about rigidity and resistance to change. As a result, successful organizations are likely to lose their competitive advantage over time. The paper addresses this issue through the investigation of the institutionalization processes of two long-lived companies: General Electric, a firm that has been a long-term success and its rival, Westinghouse, which was broken up after eleven decades of existence. The longitudinal, multilevel analysis of firms and industry has identified two different modes of organizational institutionalization. The reactive mode gives rise to rigidity and change resistance, much like institutional theory predicts; the proactive mode, on the other hand, neutralizes those negative effects of institutionalization processes. In the reactive mode, structure predominates. In the proactive mode, agency plays a major role in organizational institutionalization, and in managing the organization’s relations with the environment, clearly contributing to environmental institutionalization.

  10. Sleep facilitates long-term face adaptation. (United States)

    Ditye, Thomas; Javadi, Amir Homayoun; Carbon, Claus-Christian; Walsh, Vincent


    Adaptation is an automatic neural mechanism supporting the optimization of visual processing on the basis of previous experiences. While the short-term effects of adaptation on behaviour and physiology have been studied extensively, perceptual long-term changes associated with adaptation are still poorly understood. Here, we show that the integration of adaptation-dependent long-term shifts in neural function is facilitated by sleep. Perceptual shifts induced by adaptation to a distorted image of a famous person were larger in a group of participants who had slept (experiment 1) or merely napped for 90 min (experiment 2) during the interval between adaptation and test compared with controls who stayed awake. Participants' individual rapid eye movement sleep duration predicted the size of post-sleep behavioural adaptation effects. Our data suggest that sleep prevented decay of adaptation in a way that is qualitatively different from the effects of reduced visual interference known as 'storage'. In the light of the well-established link between sleep and memory consolidation, our findings link the perceptual mechanisms of sensory adaptation--which are usually not considered to play a relevant role in mnemonic processes--with learning and memory, and at the same time reveal a new function of sleep in cognition.

  11. Long-term environmental behaviour of radionuclides

    Energy Technology Data Exchange (ETDEWEB)

    Brechignac, F.; Moberg, L.; Suomela, M


    The radioactive pollution of the environment results from the atmospheric nuclear weapons testing (during the mid-years of twentieth century), from the development of the civilian nuclear industry and from accidents such as Chernobyl. Assessing the resulting radiation that humans might receive requires a good understanding of the long-term behaviour of radionuclides in the environment. This document reports on a joint European effort to advance this understanding, 3 multinational projects have been coordinated: PEACE, EPORA and LANDSCAPE. This report proposes an overview of the results obtained and they are presented in 6 different themes: (i) redistribution in the soil-plant system, (ii) modelling, (iii) countermeasures, (iv) runoff (v) spatial variations, and (vi) dose assessment. The long term behaviour of the radionuclides {sup 137}Cs, {sup 90}Sr and {sup 239-240}Pu is studied through various approaches, these approaches range from in-situ experiments designed to exploit past contamination events to laboratory simulations. A broad scope of different ecosystems ranging from arctic and boreal regions down to mediterranean ones has been considered. (A.C.)

  12. A long-term experimental case study of the ecological effectiveness and cost effectiveness of invasive plant management in achieving conservation goals: bitou bush control in booderee national park in eastern australia. (United States)

    Lindenmayer, David B; Wood, Jeff; MacGregor, Christopher; Buckley, Yvonne M; Dexter, Nicholas; Fortescue, Martin; Hobbs, Richard J; Catford, Jane A


    Invasive plant management is often justified in terms of conservation goals, yet progress is rarely assessed against these broader goals, instead focussing on short-term reductions of the invader as a measure of success. Key questions commonly remain unanswered including whether invader removal reverses invader impacts and whether management itself has negative ecosystem impacts. We addressed these knowledge gaps using a seven year experimental investigation of Bitou Bush, Chrysanthemoides monilifera subsp. rotundata. Our case study took advantage of the realities of applied management interventions for Bitou Bush to assess whether it is a driver or passenger of environmental change, and quantified conservation benefits relative to management costs of different treatment regimes. Among treatments examined, spraying with herbicide followed by burning and subsequent re-spraying (spray-fire-spray) proved the most effective for reducing the number of individuals and cover of Bitou Bush. Other treatment regimes (e.g. fire followed by spraying, or two fires in succession) were less effective or even exacerbated Bitou Bush invasion. The spray-fire-spray regime did not increase susceptibility of treated areas to re-invasion by Bitou Bush or other exotic species. This regime significantly reduced plant species richness and cover, but these effects were short-lived. The spray-fire-spray regime was the most cost-effective approach to controlling a highly invasive species and facilitating restoration of native plant species richness to levels characteristic of uninvaded sites. We provide a decision tree to guide management, where recommended actions depend on the outcome of post-treatment monitoring and performance against objectives. Critical to success is avoiding partial treatments and treatment sequences that may exacerbate invasive species impacts. We also show the value of taking advantage of unplanned events, such as wildfires, to achieve management objectives at

  13. A long-term experimental case study of the ecological effectiveness and cost effectiveness of invasive plant management in achieving conservation goals: bitou bush control in booderee national park in eastern australia.

    Directory of Open Access Journals (Sweden)

    David B Lindenmayer

    Full Text Available Invasive plant management is often justified in terms of conservation goals, yet progress is rarely assessed against these broader goals, instead focussing on short-term reductions of the invader as a measure of success. Key questions commonly remain unanswered including whether invader removal reverses invader impacts and whether management itself has negative ecosystem impacts. We addressed these knowledge gaps using a seven year experimental investigation of Bitou Bush, Chrysanthemoides monilifera subsp. rotundata. Our case study took advantage of the realities of applied management interventions for Bitou Bush to assess whether it is a driver or passenger of environmental change, and quantified conservation benefits relative to management costs of different treatment regimes. Among treatments examined, spraying with herbicide followed by burning and subsequent re-spraying (spray-fire-spray proved the most effective for reducing the number of individuals and cover of Bitou Bush. Other treatment regimes (e.g. fire followed by spraying, or two fires in succession were less effective or even exacerbated Bitou Bush invasion. The spray-fire-spray regime did not increase susceptibility of treated areas to re-invasion by Bitou Bush or other exotic species. This regime significantly reduced plant species richness and cover, but these effects were short-lived. The spray-fire-spray regime was the most cost-effective approach to controlling a highly invasive species and facilitating restoration of native plant species richness to levels characteristic of uninvaded sites. We provide a decision tree to guide management, where recommended actions depend on the outcome of post-treatment monitoring and performance against objectives. Critical to success is avoiding partial treatments and treatment sequences that may exacerbate invasive species impacts. We also show the value of taking advantage of unplanned events, such as wildfires, to achieve management

  14. A new model to evaluate the long-term cost effectiveness of orphan and highly specialised drugs following listing on the Australian Pharmaceutical Benefits Scheme: the Bosentan Patient Registry. (United States)

    Owen, Aj; Spinks, J; Meehan, A; Robb, T; Hardy, M; Kwasha, D; Wlodarczyk, J; Reid, Cm


    Pharmaceutical subsidy schemes are under increasing pressure to evaluate the cost effectiveness of new highly specialised and orphan drugs for universal subsidy. In the absence of longer-term outcome data, drug sponsors often present modelled data, which can carry a significant level of uncertainty over longer-term projections. Risk-sharing schemes between drug sponsor and government may provide an acceptable method of balancing the uncertainty of longer-term cost effectiveness with the public demand for equitable and timely access to new drugs. The Bosentan Patient Registry (BPR) is an example of a unique risk-sharing model utilised in Australia aiming to provide clinical evidence to support the modelled predictions, with the registry survival outcomes linked to future price. Concomitant medication, health and vital status data was collected from clinicians, government health departments and death registries. The BPR has identified a number of issues surrounding registry governance, ethics and patient privacy, and the collection of timely and accurate data, which need to be addressed for the development of a generic registry model for systematic evaluation. The success of a generic drug registry model based on the BPR will be enhanced by addressing a number of operational issues identified during the implementation of this project.

  15. 26 CFR 1.460-3 - Long-term construction contracts. (United States)


    ..., offshore drilling platforms, or unsevered natural products of land. An integral component to real property... the PCM and the cost allocation rules described in § 1.460-5(b) or (c) does not apply to any long-term... costs (including the cost of land, materials, and services), determined as of the close of the...

  16. Long-term opioid therapy in Denmark

    DEFF Research Database (Denmark)

    Birke, H; Ekholm, O; Sjøgren, P


    BACKGROUND: Longitudinal population-based studies of long-term opioid therapy (L-TOT) in chronic non-cancer pain (CNCP) patients are sparse. Our study investigated incidence and predictors for initiating L-TOT and changes in self-rated health, pain interference and physical activities in long...... defined as those who were dispensed at least one opioid prescription in six separate months within a year. RESULTS: The incidence of L-TOT was substantially higher in CNCP patients at baseline than in others (9/1000 vs. 2/1000 person-years). Smoking behaviour and dispensed benzodiazepines were...... individuals indicated a dose-response relationship between longer treatment duration and the risk of experiencing negative changes. CONCLUSIONS: Individuals on L-TOT seemed not to achieve the key goals of opioid therapy: pain relief, improved quality of life and functional capacity. SIGNIFICANCE: Long...

  17. [Enteral nutrition through long-term jejunostomy]. (United States)

    Fernández, T; Neira, P; Enríquez, C


    We present the case of a female patient suffering a peritonitis episode after subtotal gastrectomy due to gastric neoplasm in relation to lesser curvature necrosis extending to the anterior esophageal wall. This an uncommon andsevere complication that made mandatory further aggressive surgery: transection of the abdominal esophagus, transection of the gastric stump, and cervical esophagostomy with creation of a jejunostomy with a needle catheter for feeding. This digestive tube access technique is generally used during major abdominal post-surgery until oral intake is reestablished. Our patient has been 187 days with this therapy since reconstruction of the GI tract was ruled out due to tumoral infiltration of the colon and tumor recurrence at the gastrohepatic omentum. To date, there has been no complication from permanence and/or long-term use of this technique.

  18. Long-term stability of salivary cortisol

    DEFF Research Database (Denmark)

    Garde, A H; Hansen, Åse Marie


    The measurement of salivary cortisol provides a simple, non-invasive, and stress-free measure frequently used in studies of the hypothalamic-pituitary-adrenal axis activity. In research projects, samples are often required to be stored for longer periods of time either because of the protocol...... of the project or because of lack of funding for analysis. The aim of the present study was to explore the effects of long-term storage of samples on the amounts of measurable cortisol. Ten pools of saliva were collected on polyester Salivette tampons from five subjects. After centrifugation the samples were...... either stored in small vials or spiked to polyester Salivette tampons before analysis for cortisol using Spectria RIA kits. The effects of storage were evaluated by a linear regression model (mixed procedure) on a logarithmic scale. No effects on cortisol concentrations were found after storage of saliva...

  19. Autobiographical reasoning in long-term fandom

    Directory of Open Access Journals (Sweden)

    C. Lee Harrington


    Full Text Available We explore the social psychological processes through which fan-based experiences become situated in fans' larger life narratives. Drawing on original survey data with long-term U.S. soap opera fans, we examine how the psychological mechanism of autobiographical reasoning functions in fans' construction of self-narratives over time. The case study presented here is a subset of a larger investigation into the age-related structure of fans' activities, identities, and interpretive capacities. Situated at the intersections of gerontological (life span/life course theory and contemporary fan studies, our project mines relatively uninvestigated theoretical terrain. We conclude with a brief discussion of implications for future fan studies.

  20. Globalization: a long-term view. (United States)

    Suter, Keith


    The process of globalization is now the most important development in world affairs. It is the end of the world order dominated by nation states (or countries) and the beginning of an era in which national governments have to share their power with other entities, most notably transnational corporations (TNCs), inter-governmental organizations (IGOs) and non-governmental organizations (NGOs). The process has to be viewed in its long-term historical evolution. Unfortunately, the process was seen as a technical international law issue by most people so there was a lack of attention to ensuring that the process worked for the benefit of all of humanity. The current (belated) controversy, such as the 1999 Battle of Seattle, could be a window of opportunity for NGOs to encourage a more informed public debate on how to create proposals for a better world.

  1. Dynamics of long-term genomic selection

    Directory of Open Access Journals (Sweden)

    Jannink Jean-Luc


    Full Text Available Abstract Background Simulation and empirical studies of genomic selection (GS show accuracies sufficient to generate rapid gains in early selection cycles. Beyond those cycles, allele frequency changes, recombination, and inbreeding make analytical prediction of gain impossible. The impacts of GS on long-term gain should be studied prior to its implementation. Methods A simulation case-study of this issue was done for barley, an inbred crop. On the basis of marker data on 192 breeding lines from an elite six-row spring barley program, stochastic simulation was used to explore the effects of large or small initial training populations with heritabilities of 0.2 or 0.5, applying GS before or after phenotyping, and applying additional weight on low-frequency favorable marker alleles. Genomic predictions were from ridge regression or a Bayesian analysis. Results Assuming that applying GS prior to phenotyping shortened breeding cycle time by 50%, this practice strongly increased early selection gains but also caused the loss of many favorable QTL alleles, leading to loss of genetic variance, loss of GS accuracy, and a low selection plateau. Placing additional weight on low-frequency favorable marker alleles, however, allowed GS to increase their frequency earlier on, causing an initial increase in genetic variance. This dynamic led to higher long-term gain while mitigating losses in short-term gain. Weighted GS also increased the maintenance of marker polymorphism, ensuring that QTL-marker linkage disequilibrium was higher than in unweighted GS. Conclusions Losing favorable alleles that are in weak linkage disequilibrium with markers is perhaps inevitable when using GS. Placing additional weight on low-frequency favorable alleles, however, may reduce the rate of loss of such alleles to below that of phenotypic selection. Applying such weights at the beginning of GS implementation is important.

  2. Long-term reductions in tinnitus severity

    Directory of Open Access Journals (Sweden)

    Folmer Robert L


    Full Text Available Abstract Background This study was undertaken to assess long-term changes in tinnitus severity exhibited by patients who completed a comprehensive tinnitus management program; to identify factors that contributed to changes in tinnitus severity within this population; to contribute to the development and refinement of effective assessment and management procedures for tinnitus. Methods Detailed questionnaires were mailed to 300 consecutive patients prior to their initial appointment at the Oregon Health & Science University Tinnitus Clinic. All patients were then evaluated and treated within a comprehensive tinnitus management program. Follow-up questionnaires were mailed to the same 300 patients 6 to 36 months after their initial tinnitus clinic appointment. Results One hundred ninety patients (133 males, 57 females; mean age 57 years returned follow-up questionnaires 6 to 36 months (mean = 22 months after their initial tinnitus clinic appointment. This group of patients exhibited significant long-term reductions in self-rated tinnitus loudness, Tinnitus Severity Index scores, tinnitus-related anxiety and prevalence of current depression. Patients who improved their sleep patterns or Beck Depression Inventory scores exhibited greater reductions of tinnitus severity scores than patients who continued to experience insomnia and depression at follow-up. Conclusions Individualized tinnitus management programs that were designed for each patient contributed to overall reductions in tinnitus severity exhibited on follow-up questionnaires. Identification and treatment of patients experiencing anxiety, insomnia or depression are vital components of an effective tinnitus management program. Utilization of acoustic therapy also contributed to improvements exhibited by these patients.

  3. Relationship Status and Long-Term Care Facility Use in Later Life. (United States)

    Thomeer, Mieke Beth; Mudrazija, Stipica; Angel, Jacqueline L


    Most older adults prefer to "age in place" and avoid formal long-term care. Yet demographic shifts, including population aging and an increasing prevalence of remarried and unmarried older adults, could undermine these goals, making it important to consider carefully how and why relationship status relates to long-term care risk. We fit hazard models to a sample of adults aged 65 and older from eight waves (1998-2012) of the Health and Retirement Study (N = 21,564). We consider risk of any long-term care facility admission, as well as risk of long-duration stays. Widowed, divorced, and never married adults have the highest risks of long-term care admission. Remarried and partnered adults have similar risks of long-term care admission as continuously married adults. Relationship status is more important for men than for women, especially when considering long-duration stays. Relationship status is also more significant for non-Hispanic White and Hispanic adults compared with non-Hispanic Black adults. Economic resources and, to some extent, social ties partially explain the association between relationship status and long-term care use. By addressing the prohibitive costs of long-term care services which enable aging in place (e.g., home health care), relationship status disparities in long-term care may be reduced. Future studies should consider the link between long-term care facility use and relationship status in future cohorts as well as examine how relationship status structures access to a range of long-term care options. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail:

  4. Long-term potentiation and long-term depression: a clinical perspective

    Directory of Open Access Journals (Sweden)

    Timothy V.P. Bliss


    Full Text Available Long-term potentiation and long-term depression are enduring changes in synaptic strength, induced by specific patterns of synaptic activity, that have received much attention as cellular models of information storage in the central nervous system. Work in a number of brain regions, from the spinal cord to the cerebral cortex, and in many animal species, ranging from invertebrates to humans, has demonstrated a reliable capacity for chemical synapses to undergo lasting changes in efficacy in response to a variety of induction protocols. In addition to their physiological relevance, long-term potentiation and depression may have important clinical applications. A growing insight into the molecular mechanisms underlying these processes, and technological advances in non-invasive manipulation of brain activity, now puts us at the threshold of harnessing long-term potentiation and depression and other forms of synaptic, cellular and circuit plasticity to manipulate synaptic strength in the human nervous system. Drugs may be used to erase or treat pathological synaptic states and non-invasive stimulation devices may be used to artificially induce synaptic plasticity to ameliorate conditions arising from disrupted synaptic drive. These approaches hold promise for the treatment of a variety of neurological conditions, including neuropathic pain, epilepsy, depression, amblyopia, tinnitus and stroke.

  5. Automated long-term scheduling for the SOFIA airborne observatory (United States)

    Civeit, Thomas

    The NASA Stratospheric Observatory for Infrared Astronomy (SOFIA) is a joint US/German project to develop and operate a gyro-stabilized 2.5-meter telescope in a Boeing 747SP. SOFIA's first science observations were made in December 2010. During 2011, SOFIA accomplished 30 flights in the “ Early Science” program as well as a deployment to Germany. The next observing period, known as Cycle 1, is scheduled to begin in late fall 2012. It includes 46 science flights grouped in four multi-week observing campaigns spread through a 13-month span. Automation of the flight scheduling process offers a major challenge to the SOFIA mission operations. First because it is needed to mitigate its relatively high cost per unit observing time compared to space-borne missions. Second because automated scheduling techniques available for ground-based and space-based telescopes are inappropriate for an airborne observatory. Although serious attempts have been made in the past to solve part of the problem, until recently mission operations staff was still manually scheduling flights. We present in this paper a new automated solution for generating SOFIA's long-term schedules. We describe the constraints that should be satisfied to solve the SOFIA scheduling problem in the context of real operations. We establish key formulas required to efficiently calculate the aircraft course over ground when evaluating flight schedules. We describe the foundations of the SOFIA long-term scheduler, the constraint representation, and the random search based algorithm that generates observation and instrument schedules. Finally, we report on how the new long-term scheduler has been used in operations to date.

  6. Elevated rheumatoid factor and long term risk of rheumatoid arthritis

    DEFF Research Database (Denmark)

    Nielsen, Sune F; Bojesen, Stig E; Schnohr, Peter


    To test whether elevated concentration of rheumatoid factor is associated with long term development of rheumatoid arthritis.......To test whether elevated concentration of rheumatoid factor is associated with long term development of rheumatoid arthritis....

  7. Patent Citations and Financial Analysts’ Long-Term Growth Forecasts

    National Research Council Canada - National Science Library

    Jincheol Bae; Wonchang Hur; Jaehong Lee; Jaimin Goh


    ...’ innovation outputs, on financial analysts’ long-term growth forecasts for firms. We find that financial analysts are more likely to issue long-term forecasts for firms with higher patent citations...

  8. Long-term global nuclear energy and fuel cycle strategies

    Energy Technology Data Exchange (ETDEWEB)

    Krakowski, R.A. [Los Alamos National Lab., NM (United States). Technology and Safety Assessment Div.


    The Global Nuclear Vision Project is examining, using scenario building techniques, a range of long-term nuclear energy futures. The exploration and assessment of optimal nuclear fuel-cycle and material strategies is an essential element of the study. To this end, an established global E{sup 3} (energy/economics/environmental) model has been adopted and modified with a simplified, but comprehensive and multi-regional, nuclear energy module. Consistent nuclear energy scenarios are constructed using this multi-regional E{sup 3} model, wherein future demands for nuclear power are projected in price competition with other energy sources under a wide range of long-term demographic (population, workforce size and productivity), economic (price-, population-, and income-determined demand for energy services, price- and population-modified GNP, resource depletion, world-market fossil energy prices), policy (taxes, tariffs, sanctions), and top-level technological (energy intensity and end-use efficiency improvements) drivers. Using the framework provided by the global E{sup 3} model, the impacts of both external and internal drivers are investigated. The ability to connect external and internal drivers through this modeling framework allows the study of impacts and tradeoffs between fossil- versus nuclear-fuel burning, that includes interactions between cost, environmental, proliferation, resource, and policy issues.

  9. The perfused swine uterus model: long-term perfusion

    Directory of Open Access Journals (Sweden)

    Geisler Klaudija


    Full Text Available Abstract Background It has previously been shown that the viability of swine uteri can be maintained within the physiological range in an open perfusion model for up to 8 hours. The aim of this study was to assess medium- to long-term perfusion of swine uteri using a modified Krebs–Ringer bicarbonate buffer solution (KRBB in the established open perfusion model. Methods In an experimental study at an infertility institute, 30 swine uteri were perfused: group 1: n = 11, KRBB; group 2: n = 8, modified KRBB with drainage of perfusate supernatant; group 3: n = 11, modified KRBB with drainage of perfusate every 2 h and substitution with fresh medium. Modified and conventional KRBB were compared with regard to survival and contraction parameters: intrauterine pressure (IUP, area under the curve (AUC, and frequency of contractions (F. Results Modified KRBB showed significantly higher IUP, AUC, and F values than perfusion with conventional KRBB. In group 3, the organ survival time of up to 17 h, with a 98% rate of effective contraction time, differed significantly from group 1 (P  Conclusions Using modified KRBB in combination with perfusate substitution improves the open model for perfusion of swine uteri with regard to survival time and quality of contraction parameters. This model can be used for medium- to long-term perfusion of swine uteri, allowing further metabolic ex vivo studies in a cost-effective way and with little logistic effort.

  10. Reconciling change blindness with long-term memory for objects. (United States)

    Wood, Katherine; Simons, Daniel J


    How can we reconcile remarkably precise long-term memory for thousands of images with failures to detect changes to similar images? We explored whether people can use detailed, long-term memory to improve change detection performance. Subjects studied a set of images of objects and then performed recognition and change detection tasks with those images. Recognition memory performance exceeded change detection performance, even when a single familiar object in the postchange display consistently indicated the change location. In fact, participants were no better when a familiar object predicted the change location than when the displays consisted of unfamiliar objects. When given an explicit strategy to search for a familiar object as a way to improve performance on the change detection task, they performed no better than in a 6-alternative recognition memory task. Subjects only benefited from the presence of familiar objects in the change detection task when they had more time to view the prechange array before it switched. Once the cost to using the change detection information decreased, subjects made use of it in conjunction with memory to boost performance on the familiar-item change detection task. This suggests that even useful information will go unused if it is sufficiently difficult to extract.

  11. [Long-term outcome after hemispheric disconnection]. (United States)

    Bulteau, C; Dorfmüller, G; Fohlen, M; Jalin, C; Oliver, M-V; Delalande, O


    Hemispheric disconnection has been largely proposed for patients with severe epilepsy associated with a congenital or acquired hemispheric cerebral pathology. The classical procedure of anatomical hemispherectomy was progressively abandoned by neurosurgeons in order to avoid postoperative complications since then hemispherotomy techniques have been developed. Globally, with hemispheric disconnection, the rate of patients becoming seizure-free has been between 50 and 80%. The factors affecting seizure control have not been completely elucidated, but several authors suggested that differences in etiology as well as the hemispheric disconnection technique used may partially explain this variability. The percentage of seizure-free patients is higher with hemispherotomy techniques and in the group of patients with Rasmussen encephalitis, Sturge-Weber syndrome, and vascular insults. Depending on overall long-term progression, there is an improvement compared to preoperative status even if children exhibit heterogenous abilities. The lowest scores are observed for motor skills but communication and socialization are relatively well-preserved and strongly related to the duration of epilepsy: the longer the duration, the lower the scores were. Neuropsychological outcome following hemispheric disconnection makes it possible to study the development of hemispheric specialization during infancy and to provide information on cognitive recovery. Cerebral reorganization has been proved to exist in motor and language recovery. Ipsilateral corticospinal pathways seem to be involved in the movement of hemiplegic limbs. Everyday language can be supported by both hemispheres, but there is an early hemispheric specialization of the left hemisphere according to metaphonologic abilities.

  12. Long-Term Soft Denture Lining Materials (United States)

    Chladek, Grzegorz; Żmudzki, Jarosław; Kasperski, Jacek


    Long-term soft denture lining (LTSDL) materials are used to alleviate the trauma associated with wearing complete dentures. Despite their established clinical efficacy, the use of LTSDLs has been limited due to the unfavorable effects of the oral environment on some of their mechanical and performance characteristics. The unresolved issue of LTSDL colonization by Candida albicans is particularly problematic. Silicone-based LTSDL (SLTSDL) materials, which are characterized by more stable hardness, sorption and solubility than acrylic-based LTSDLs (ALTSDLs), are currently the most commonly used LTSDLs. However, SLTSDLs are more prone to debonding from the denture base. Moreover, due to their limitations, the available methods for determining bond strength do not fully reflect the actual stability of these materials under clinical conditions. SLTSDL materials exhibit favorable viscoelastic properties compared with ALTSDLs. Furthermore, all of the lining materials exhibit an aging solution-specific tendency toward discoloration, and the available cleansers are not fully effective and can alter the mechanical properties of LTSDLs. Future studies are needed to improve the microbiological resistance of LTSDLs, as well as some of their performance characteristics. PMID:28788163

  13. Alpine Soils as long-term Bioindicators (United States)

    Nestroy, O.


    Alpine soils as long-term bioindicators The introductory words concern the definitions and peculiarities of alpine soils and their position in the Austrian Soil Classification 2000 in comparison with the World Reference Base for Soil Resources 2006. The important parameters for genesis and threats for these soils in steep and high positions are discussed. It must be emphasized that the main threats are the very different kinds of erosion e.g. by water, wind and snow, and also by skiing (end of season) as well as and mountain-biking (mainly summer-sport). Due the very slow regeneration and - in this connection - due to the very slow changes of the soil entities, these soils give an utmost importance as a long-time bioindicator. With regard to the climate change one can assume an increase in the content of organic matter on site, but also an increase of erosion and mass movement on the other site, e. g. in kind of "plaiken" (soil slide) as result of an increasing intensity of rainfall. It lies partly in our hands to diminish the number and the intensity of the threats, we can influence the soil development, but the result to reach a new ecological equilibrium is very long - in case of alpine soil more than two generations.

  14. Long-term predictions using natural analogues

    Energy Technology Data Exchange (ETDEWEB)

    Ewing, R.C. [Univ. of New Mexico, Albuquerque, NM (United States)


    One of the unique and scientifically most challenging aspects of nuclear waste isolation is the extrapolation of short-term laboratory data (hours to years) to the long time periods (10{sup 3}-10{sup 5} years) required by regulatory agencies for performance assessment. The direct validation of these extrapolations is not possible, but methods must be developed to demonstrate compliance with government regulations and to satisfy the lay public that there is a demonstrable and reasonable basis for accepting the long-term extrapolations. Natural systems (e.g., {open_quotes}natural analogues{close_quotes}) provide perhaps the only means of partial {open_quotes}validation,{close_quotes} as well as data that may be used directly in the models that are used in the extrapolation. Natural systems provide data on very large spatial (nm to km) and temporal (10{sup 3}-10{sup 8} years) scales and in highly complex terranes in which unknown synergisms may affect radionuclide migration. This paper reviews the application (and most importantly, the limitations) of data from natural analogue systems to the {open_quotes}validation{close_quotes} of performance assessments.

  15. CERN Services for Long Term Data Preservation

    CERN Document Server

    Shiers, Jamie; Blomer, Jakob; Ganis, Gerardo; Dallmeier-Tiessen, Sunje; Simko, Tibor; Cancio Melia, German; CERN. Geneva. IT Department


    In this paper we describe the services that are offered by CERN for Long Term preservation of High Energy Physics (HEP) data, with the Large Hadron Collider (LHC) as a key use case. Data preservation is a strategic goal for European High Energy Physics (HEP), as well as for the HEP community worldwide and we position our work in this global content. Specifically, we target the preservation of the scientific data, together with the software, documentation and computing environment needed to process, (re-)analyse or otherwise (re-)use the data. The target data volumes range from hundreds of petabytes (PB – 10^15 bytes) to hundreds of exabytes (EB – 10^18 bytes) for a target duration of several decades. The Use Cases driving data preservation are presented together with metrics that allow us to measure how close we are to meeting our goals, including the possibility for formal certification for at least part of this work. Almost all of the services that we describe are fully generic – the exception being A...

  16. Model of long-term seismogenesis

    Directory of Open Access Journals (Sweden)

    D. Rhoades


    Full Text Available A three-stage faulting model explains the observed quantitative relations between long-term precursory seismicity, mainshocks and aftershocks. Seismogenesis starts with the formation of a major crack, culminates in the corresponding major fracture and earthquake, and ends with healing. Crack formation is a self-organised critical phenomenon, and shear fracture is a delayed sequel to crack formation. It is postulated that the major crack generates a set of minor cracks, just as, later, the major fracture generates a set of minor fractures. Fracturing of the minor cracks raises the average seismicity level. By Mogi’s uniformity criterion, the major earthquake is delayed until the minor fractures have healed and the stress-field has regained relative uniformity. In accord with the scaling principle, the model applies at all magnitude levels. The size of any given initial crack determines the scale of the ensuing seismogenic process. A graphical technique of cumulative magnitude analysis gives a quantitative representation of the seismicity aspects of the model. Examples are given for large earthquakes in a region of continental collision and a subduction region. The principle of hierarchy is exemplified by the seismogenesis of a M 5.9 mainshock occurring entirely within the precursory stage of a M 7.0 mainshock. The model is capable of accommodating a variety of proposed shorter-term precursory phenomena.

  17. Long-term outcome of neuroparacoccidioidomycosis treatment

    Directory of Open Access Journals (Sweden)

    Fabio Francesconi


    Full Text Available INTRODUCTION: Neuroparacoccidioidomycosis (NPCM is a term used to describe the invasion of the central nervous system by the pathogenic fungus Paracoccidioides brasiliensis. NPCM has been described sporadically in some case reports and small case series, with little or no focus on treatment outcome and long-term follow-up. METHODS: All patients with NPCM from January 1991 to December 2006 were analyzed and were followed until December 2009. RESULTS: Fourteen (3.8% cases of NPCM were identified out of 367 patients with paracoccidioidomycosis (PCM. A combination of oral fluconazole and sulfamethoxazole/trimethoprim (SMZ/TMP was the regimen of choice, with no documented death due to Paracoccidioides brasiliensis infection. Residual neurological deficits were observed in 8 patients. Residual calcification was a common finding in neuroimaging follow-up. CONCLUSIONS: All the patients in this study responded positively to the association of oral fluconazole and sulfamethoxazole/trimethoprim, a regimen that should be considered a treatment option in cases of NPCM. Neurological sequela was a relatively common finding. For proper management of these patients, anticonvulsant treatment and physical therapy support were also needed.

  18. Long term results of mandibular distraction

    Directory of Open Access Journals (Sweden)

    Batra Puneet


    Full Text Available Mandibular distraction osteogenesis has become a popular surgical modality due to its many advantages over conventional orthognathic surgical procedures. However, in spite of the technique having been used for over 15 years, no concrete long term results are available regarding the stability of results. We discuss the various studies which have reported either in favour or against the stablility of results after distraction. We report a series of 6 cases (3 unilateral and 3 bilateral distraction where distraction was carried out before puberty and followed them up to seven years after removal of distractors. This case series shows that results achieved by distraction osteogenesis are unstable or best unpredictable with respect to producing a permanent size increase in the mandible. The role of the distraction osteogenesis in overcoming the pterygomassetric sling is questionable. We suggest a multicenter study with adequate patient numbers treated with a similar protocol and documented after growth cessation to have meaningful conclusions on the debate of distraction osteogenesis versus orthognathic surgery.

  19. Long term results of childhood dysphonia treatment. (United States)

    Mackiewicz-Nartowicz, Hanna; Sinkiewicz, Anna; Bielecka, Arleta; Owczarzak, Hanna; Mackiewicz-Milewska, Magdalena; Winiarski, Piotr


    The aim of this study was to assess the long term results of treatment and rehabilitation of childhood dysphonia. This study included a group of adolescents (n=29) aged from 15 to 20 who were treated due to pediatric hyperfunctional dysphonia and soft vocal fold nodules during their pre-mutational period (i.e. between 5 and 12 years of age). The pre-mutational therapy was comprised of proper breathing pattern training, voice exercises and psychological counseling. Laryngostroboscopic examination and perceptual analysis of voice were performed in each patient before treatment and one to four years after mutation was complete. The laryngostroboscopic findings, i.e. symmetry, amplitude, mucosal wave and vocal fold closure, were graded with NAPZ scale, and the GRBAS scale was used for the perceptual voice analysis. Complete regression of the childhood dysphonia was observed in all male patients (n=14). Voice disorders regressed completely also in 8 out of 15 girls, but symptoms of dysphonia documented on perceptual scale persisted in the remaining seven patients. Complex voice therapy implemented in adolescence should be considered as either the treatment or preventive measure of persistent voice strain, especially in girls. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  20. Long term prediction of flood occurrence

    Directory of Open Access Journals (Sweden)

    C. Aguilar


    Full Text Available How long a river remembers its past is still an open question. Perturbations occurring in large catchments may impact the flow regime for several weeks and months, therefore providing a physical explanation for the occasional tendency of floods to occur in clusters. The research question explored in this paper may be stated as follows: can higher than usual river discharges in the low flow season be associated to a higher probability of floods in the subsequent high flow season? The physical explanation for such association may be related to the presence of higher soil moisture storage at the beginning of the high flow season, which may induce lower infiltration rates and therefore higher river runoff. Another possible explanation is persistence of climate, due to presence of long-term properties in atmospheric circulation. We focus on the Po River at Pontelagoscuro, whose catchment area amounts to 71 000 km2. We look at the stochastic connection between average river flows in the pre-flood season and the peak flows in the flood season by using a bivariate probability distribution. We found that the shape of the flood frequency distribution is significantly impacted by the river flow regime in the low flow season. The proposed technique, which can be classified as a data assimilation approach, may allow one to reduce the uncertainty associated to the estimation of the flood probability.

  1. Long term results of mandibular distraction. (United States)

    Batra, Puneet; Ryan, F S; Witherow, H; Calvert, M L


    Mandibular distraction osteogenesis has become a popular surgical modality due to its many advantages over conventional orthognathic surgical procedures. However, in spite of the technique having been used for over 15 years, no concrete long term results are available regarding the stability of results. We discuss the various studies which have reported either in favour or against the stablility of results after distraction. We report a series of 6 cases (3 unilateral and 3 bilateral distraction) where distraction was carried out before puberty and followed them up to seven years after removal of distractors. This case series shows that results achieved by distraction osteogenesis are unstable or best unpredictable with respect to producing a permanent size increase in the mandible. The role of the distraction osteogenesis in overcoming the pterygomassetric sling is questionable. We suggest a multicenter study with adequate patient numbers treated with a similar protocol and documented after growth cessation to have meaningful conclusions on the debate of distraction osteogenesis versus orthognathic surgery.

  2. TIA and Stroke: the long-term perspective

    NARCIS (Netherlands)

    Wijk, I. van


    Background Survival after stroke has improved, but little is known about the long-term risk of new vascular events and the functioning of long-term survivors. The main objective of this thesis was to evaluate the long-term perspective of these patients. Methods Two longitudinal studies were carried

  3. The long-term consequences of anaesthetic management | Sessler ...

    African Journals Online (AJOL)

    The long-term consequences of anaesthesia were not seriously considered until relatively recently. There is increasing evidence that some intraoperative anaesthetic management decisions have long-term consequences, and that others might as well. Keywords: long-term consequences; anaesthetic management ...

  4. The economics of long-term global climate change

    Energy Technology Data Exchange (ETDEWEB)


    This report is intended to provide an overview of economic issues and research relevant to possible, long-term global climate change. It is primarily a critical survey, not a statement of Administration or Department policy. This report should serve to indicate that economic analysis of global change is in its infancy few assertions about costs or benefits can be made with confidence. The state of the literature precludes any attempt to produce anything like a comprehensive benefit-cost analysis. Moreover, almost all the quantitative estimates regarding physical and economic effects in this report, as well as many of the qualitative assertions, are controversial. Section I provides background on greenhouse gas emissions and their likely climatic effects and on available policy instruments. Section II considers the costs of living with global change, assuming no substantial efforts to reduce greenhouse gas emissions. Section III considers costs of reducing these emissions, though the available literature does not contain estimates of the costs of policies that would, on the assumptions of current climate models, prevent climate change altogether. The individual sections are not entirely compartmentalized, but can be read independently if necessary.

  5. Premium growth and its effect on employer-sponsored insurance. (United States)

    Vistnes, Jessica; Selden, Thomas


    We use variation in premium inflation and general inflation across geographic areas to identify the effects of downward nominal wage rigidity on employers' health insurance decisions. Using employer level data from the 2000 to 2005 Medical Expenditure Panel Survey-Insurance Component, we examine the effect of premium growth on the likelihood that an employer offers insurance, eligibility rates among employees, continuous measures of employee premium contributions for both single and family coverage, and deductibles. We find that small, low-wage employers are less likely to offer health insurance in response to increased premium inflation, and if they do offer coverage they increase employee contributions and deductible levels. In contrast, larger, low-wage employers maintain their offers of coverage, but reduce eligibility for such coverage. They also increase employee contributions for single and family coverage, but not deductibles. Among high-wage employers, all but the largest increase deductibles in response to cost pressures.

  6. Scientific Understanding from Long Term Observations: Insights from the Long Term Ecological Research (LTER) Program (United States)

    Gosz, J.


    The network dedicated to Long Term Ecological Research (LTER) in the United States has grown to 24 sites since it was formed in 1980. Long-term research and monitoring are performed on parameters thatare basic to all ecosystems and are required to understand patterns, processes, and relationship to change. Collectively, the sites in the LTER Network provide opportunities to contrast marine, coastal, and continental regions, the full range of climatic gradients existing in North America, and aquatic and terrestrial habitats in a range of ecosystem types. The combination of common core areas and long-term research and monitoring in many habitats have allowed unprecedented abilities to understand and compare complex temporal and spatial dynamics associated with issues like climate change, effects of pollution, biodiversity and landuse. For example, McMurdo Dry Valley in the Antarctic has demonstrated an increase in glacier mass since 1993 which coincides with a period of cooler than normal summers and more than average snowfall. In contrast, the Bonanza Creek and Toolik Lake sites in Alaska have recorded a warming period unprecedented in the past 200 years. Nitrogen deposition effects have been identified through long-term watershed studies on biogeochemical cycles, especially at Coweeta Hydrological Lab, Harvard Forest, and the Hubbard Brook Experimental Forest. In aquatic systems, such as the Northern Temperate Lakes site, long-term data revealed time lags in effects of invaders and disturbance on lake communities. Biological recovery from an effect such as lake acidification was shown to lag behind chemical recovery. The long-term changes documented over 2 decades have been instrumental in influencing management practices in many of the LTER areas. In Puerto Rico, the Luquillo LTER demonstrated that dams obstruct migrations of fish and freshwater shrimp and water abstraction at low flows can completely obliterate downstream migration of juveniles and damage

  7. Energy in 2010 - 2020. Long term challenges; Energie 2010-2020. Les defis du long terme

    Energy Technology Data Exchange (ETDEWEB)

    Dessus, Benjamin [ed.] [Centre National de la Recherche Scientifique (CNRS), 75 - Paris (France)


    This report presents the results of a workshop intending to anticipate the long term challenges, to guide better the short term power options, to understand the available political, economical and technical assumptions for the prospective world situation, to give some strategic hints on the necessary transition. Indeed, the difficult issue which the workshop tried to tackle was how should we prepare to reveal the energetic challenge of the development of the eight to ten billion inhabitants of our Planet in the next century without jeopardizing its existence. The energetic problems, a hardcore of the international preoccupation of both growth and environment, as it was recently evidenced by the climatic conference in Kyoto, have ever been the object of a particular attention on the part of General Commissariat of Plan. Thus, the commission 'Energy in 2010 - 2020' has been instituted in April 1996 in order to update the works done in 1990 - 1991 by the commission 'Energy 2010'. Soon it occurred to this new commission the task of illuminating its works by a long term (2050 - 2100) world prospective analysis of the challenges and problems linked to energy, growth and environment. In conclusion, this document tried to find answers to questions like: - which are the risks the energy consumption augmentation entail? - can we control them by appropriate urbanism and transport policies or technological innovation?. Four options for immediate action are suggested: - the energy efficiency should become a priority objective of policies; -coping with the long term challenges requires acting at present; - building the transition between governmental leadership and market; - taking profit of all the possible synergies between short and long term planning.

  8. Glioblastoma multiforme with long term survival. (United States)

    Deb, Prabal; Sharma, Mehar Chand; Mahapatra, Ashok Kumar; Agarwal, Deepak; Sarkar, Chitra


    Glioblastoma multiforme (GBM) Patients generally have a dismal prognosis, with median survival of 10-12 months. GBM with long-term survival (LTS) of (3) > or = 5 years is rare, and no definite markers indicating better prognosis have been identified till date. The present study was undertaken to evaluate GBMs with LTS in order to identify additional correlates associated with favourable outcome. The cases were evaluated for relevant clinicopathological data, proliferation index and expression of tumortumour suppressor gene (p53 ), cyclin-dependant kinase-inhibitors (p27 and p16 ) and epidermal growth factor receptor (EGFR) proteins. Six cases of GBM with LTS with an average survival of 9 years (range 5-15 years) were identified. All were young patients with mean age of 27 years (range 8-45 years). Histology of three cases was consistent with conventional GBM, while two showed prominent oligodendroglial component admixed with GBM areas. One was a giant cell GBM, which progressed to gliosarcoma on recurrence. The mean MIB-1LI was 12% (range 6-20%). p53 was immunopositive in 4 out of 5 cases. EGFR and p27 were immunonegative in all, whereas p16 was immunonegative in 3 out of 5 cases. Currently, in the absence of specific molecular and genetic markers, GBM in young patients should be meticulously evaluated for foci of oligodendroglial component and/or giant cell elements, in addition to proliferative index and p53 expression, since these probably have prognostic connotations, as evident in this study. The role of p16 and p27 however needs better definition with study of more number of cases.

  9. Nutritional deficit and Long Term Potentiation alterations

    Directory of Open Access Journals (Sweden)

    M. Petrosino


    Full Text Available In the present work we examined the ability of prenatally malnourished offspring to produce and maintain long-term potentiation (LTP of the perforant path/dentate granule cell synapse in freely moving rats at 15,30, and 90 days of age. Population spike amplitude (PSA was calculated from dentate field potential recordings prior to and at 15, 30, 60 min. and 3, 5, 18 and 24 h following tetanization of the perforant pathway. All animals of both malnourished and well-nourished diet groups at 15 days of age showed potentiation of PSA measures but the measures obtained from 15-day-old prenatally malnourished animals were significantly less than that of age-matched, well-nourished controls. At 30 days of age, remarkable effect of tetanization was likely observed from PSA measures for this age group followed much the same pattern. At 90 days of age, PSA measures obtained from malnourished animals decreased from pretetanization levels immediately following tetanization. At this age, however, at three hours time recordings, this measure growing up to a level which did not differ significantly from that of the control group. These results indicate that the width of tetanization induced enhancement of dentate granule cell response in preweanling rats (15-day-old animals is signifacantly affected fromgestational protein malnutrition and this trend is kept in animals tested at 30 and 90 days of age. The fact, however, that considerable limitation in LTP generation was gained from prenatally malnourished animals at 90 days of age, implying that dietary rehabilitation starting at birth is an intervention strategy not capable to imbrove the effects of the gestational stress.

  10. Long term observations of Saturn's northern auroras (United States)

    Nichols, Jonathan


    Auroral emissions are a vital tool in diagnosing the dynamics of planetary magnetospheres. While SaturnA?s southern UV auroras have been observed with high-sensitivity cameras onboard the Hubble Space Telescope {HST}, the northern auroras have only been observed at very oblique angles. Our understanding of SaturnA?s auroral emissions is thus only half complete. However, Saturn has now passed equinox and is moving toward summer in the northern hemisphere, such that the northern auroras are now visible from Earth, and recent results from HST have indicated that SaturnA?s northern auroras are not simply mirror images of the southern. The changing seasons are also expected to result in significant changes in magnetospheric phenomena related to the auroras. Observing these changes is a specific goal of the Cassini Solstice Mission {CSM} and, since joint HST-Cassini observations have repeatedly proved to be invaluable, CSM operations are currently being planned specifically with joint HST observations in mind. The observations proposed here will thus execute over Cycles 18-20, and will address the following science questions:What is the morphology of SaturnA?s northern auroras? Do SaturnA?s auroras change with the planetA?s season? How are the auroral emissions of different wavelengths related?The importance of long term HST observations of SaturnA?s northern auroras are highlighted by the fact that recent key discoveries would have been missed without the multiyear archive of observations of the planetA?s southern auroras. The opportunity to obtain HST images while Cassini makes specifically-tailored supporting observations is an extremely valuable opportunity, and HST is the only instrument capable of providing sustained, high time resolution observations of Saturns auroral emission.

  11. Long term cultivation of larger benthic Foraminifera (United States)

    Wöger, Julia; Eder, Wolfgang; Kinoshita, Shunichi; Antonino, Briguglio; Carles, Ferrandes-Cañadell; Hohenegger, Johann


    Benthic Foraminifera are used in a variety of applications employing numerous different methods, i.e. ecological monitoring, studying the effects of ocean acidification, reconstructing palaeo-bathymetry or investigating palaeo-salinity and palaeo-temperature to name only a few. To refine our understanding of ecological influences on larger benthic foraminiferal biology and to review inferences from field observations, culture experiments have become an indispensable tool. While culture experiments on smaller benthic foraminifera have become increasingly frequent in the past century, reports of the cultivation of symbiont bearing larger Foraminifera are rare. Generally, cultivation experiments can be divided into two groups: Culturing of populations and cultivation of single specimens allowing individual investigation. The latter differ form the former by several restrictions resulting from the need to limit individual motility without abridging microenvironmental conditions in the Foraminiferans artificial habitat, necessary to enable the individual to development as unfettered as possible. In this study we present first experiences and preliminary results of the long-term cultivation of larger benthic Foraminifera conducted at the 'Tropical Biosphere Research Station Sesoko Island, University of the Ryukyus', Japan, trying to reproduce natural conditions as closely as possible. Individuals of three species of larger benthic Foraminifera (Heterostegina depressa, Palaeonummulites venosus and Operculina complanata) have been cultured since April 2014. At the time of the general assembly the cultivation experiments will have been going on for more than one year, with the aim to investigate growth rates, longevities and reproduction strategies for comparison with results statistically inferred from application of the of the 'natural laboratory' method. The most important factor influencing foraminiferal health and development was found to be light intensity and light

  12. Long term stability of atomic time scales (United States)

    Petit, Gérard; Arias, Elisa Felicitas


    International Atomic Time TAI gets its stability from some 400 atomic clocks worldwide that generate the free atomic scale EA L and its accuracy from a small number of primary frequency standards (PFS) which frequency measurements are used to steer the EAL frequency. Because TAI is computed in "real - time" (every month) and has operational constraints, it is not optimal and the BIPM computes in deferred time another time scale TT(BIPM), which is based on a weighted average of the evaluations of TAI frequency by the PFS. We show that a point has been reached where the stability of atomic time scales, the accuracy of primary frequency standards, and the capabilities of frequency transfer are approximately at a similar level, in the low 10 - 16 in relative frequency. The goal is now to reach and surpass 1x10 - 16 and the three fields are in various stages of advancement towards this aim. We review the stability and accuracy recently achieved by frequency standards, focusing on primary frequency standards on one hand, and on new secondary realizations e.g. based on optical transitions on the other hand. We study how these performances can translate to the performance of atomic time scales, and the possible implications of the availability of new high - accuracy frequency standards operating on a regular basis. Finally we show how time transfer is trying to keep up with the progresses of frequency standards. Time transfer is presently the limiting factor at short averaging time (e.g. 1 - 2 weeks) but it should not be limiting the long term stability of atomic time scales, which is the main need of many applications in astronomy.

  13. Perinatal respiratory infections and long term consequences

    Directory of Open Access Journals (Sweden)

    Luciana Indinnimeo


    Full Text Available Respiratory syncytial virus (RSV is the most important pathogen in the etiology of respiratory infections in early life. 50% of children are affected by RSV within the first year of age, and almost all children become infected within two years. Numerous retrospective and prospective studies linking RSV and chronic respiratory morbidity show that RSV bronchiolitis in infancy is followed by recurrent wheezing after the acute episod. According to some authors a greater risk of wheezing in children with a history of RSV bronchiolitis would be limited to childhood, while according to others this risk would be extended into adolescence and adulthood. To explain the relationship between RSV infection and the development of bronchial asthma or the clinical pathogenetic patterns related to a state of bronchial hyperreactivity, it has been suggested that RSV may cause alterations in the response of the immune system (immunogenic hypothesis, activating directly mast cells and basophils and changing the pattern of differentiation of immune cells present in the bronchial tree as receptors and inflammatory cytokines. It was also suggested that RSV infection can cause bronchial hyperreactivity altering nervous airway modulation, acting on nerve fibers present in the airways (neurogenic hypothesis.The benefits of passive immunoprophylaxis with palivizumab, which seems to represent an effective approach in reducing the sequelae of RSV infection in the short- and long-term period, strengthen the implementation of prevention programs with this drug, as recommended by the national guidelines of the Italian Society of Neonatology. Proceedings of the 11th International Workshop on Neonatology and Satellite Meetings · Cagliari (Italy · October 26th-31st, 2015 · From the womb to the adultGuest Editors: Vassilios Fanos (Cagliari, Italy, Michele Mussap (Genoa, Italy, Antonio Del Vecchio (Bari, Italy, Bo Sun (Shanghai, China, Dorret I. Boomsma (Amsterdam, the

  14. Long-term care in Israel: challenges and reform options. (United States)

    Chernichovsky, Dov; Koreh, Michal; Soffer, Sharon; Avrami, Shirley


    This paper has two objectives. The first is to examine the Israeli long-term care (LTC) system that is marked by rapidly increasing demands, and a multitude of public and private LTC arrangements. The second is to propose a reform to improve the system's efficiency and equity. The paper studies the LTC services in Israel, and the private-public composition in funding, fund holding, and provision of LTC. It focuses on structural deficiencies in the organization of each of these functions separately, and in combination. In many countries LTC has evolved in a patchwork fashion that at some point in time needs rethinking and rationalization. Israel is a case in point. In spite of numerous LTC arrangements supported by the state, in the absence of a comprehensive strategy, these have not generated a coherent system that can deal efficiently and equitably with existing and fast growing LTC needs, on the one hand, and the resources available to it, on the other. The current system is fragmented. It provides limited coverage and insufficient benefits in a troublesome fashion to public. The findings suggest that Israel can achieve at least in the short term, universal entitlement to LTC at lower financial and social cost, than the current costs of the system. In the medium and long term, the country will need to consider the trade between the burden of direct care on households or the tax burden of publicly supported and organized care. To remedy the situation the paper suggests a two-planked reform. The first is integration of the current fragmented publicly supported system while deciding on LTC either as a "social endeavor" under a separate authority responsible for implementing the public LTC budget, or as a "medical endeavor", putting this responsibility under the Israeli sickness funds. The second plank, building on the first, comprises extension of universal entitlement to LTC. Such an extension would increase public spending in the long term; simultaneously, it

  15. Long-term socioeconomic impacts of flooding in Bangladesh (United States)

    Jina, A.


    affected by hazards. In order to prevent households from falling further into, and potentially being trapped, in poverty, we argue that long-term impacts be considered in addition to the short-term that currently garner most policy attention. The hidden cost that we identify increases the estimated cost of these disasters, and also implies a new paradigm in disaster management policy - one that seeks to decrease vulnerability before an event, rather than deal with the consequences afterwards.;

  16. Assessing the Feasibility of Global Long-Term Mitigation Scenarios

    Directory of Open Access Journals (Sweden)

    Ajay Gambhir


    Full Text Available This study explores the critical notion of how feasible it is to achieve long-term mitigation goals to limit global temperature change. It uses a model inter-comparison of three integrated assessment models (TIAM-Grantham, MESSAGE-GLOBIOM and WITCH harmonized for socio-economic growth drivers using one of the new shared socio-economic pathways (SSP2, to analyse multiple mitigation scenarios aimed at different temperature changes in 2100, in order to assess the model outputs against a range of indicators developed so as to systematically compare the feasibility across scenarios. These indicators include mitigation costs and carbon prices, rates of emissions reductions and energy efficiency improvements, rates of deployment of key low-carbon technologies, reliance on negative emissions, and stranding of power generation assets. The results highlight how much more challenging the 2 °C goal is, when compared to the 2.5–4 °C goals, across virtually all measures of feasibility. Any delay in mitigation or limitation in technology options also renders the 2 °C goal much less feasible across the economic and technical dimensions explored. Finally, a sensitivity analysis indicates that aiming for less than 2 °C is even less plausible, with significantly higher mitigation costs and faster carbon price increases, significantly faster decarbonization and zero-carbon technology deployment rates, earlier occurrence of very significant carbon capture and earlier onset of global net negative emissions. Such a systematic analysis allows a more in-depth consideration of what realistic level of long-term temperature changes can be achieved and what adaptation strategies are therefore required.

  17. The ability to pay for long-term care in the Netherlands : A life-cycle perspective

    NARCIS (Netherlands)

    Hussem, Arjen; van Ewijk, Casper; ter Rele, Harry; Wong, Albert

    This paper uses synthetic life-cycle paths at the individual level to analyze the distribution of long-term care expenditures in the Netherlands. Using a comprehensive set of administrative data 20,000 synthetic life-cycle paths of household income and long-term care costs are constructed using the

  18. The barriers to nurturing and empowering long-term care experiments - lessons learnt to advance future healthcare projects

    NARCIS (Netherlands)

    Cramer, Hendrik; Dewulf, Geert P.M.R.; Voordijk, Johannes T.


    The objective of this study is to explore the barriers to nurturing and empowering subsidized long-term care experiments that try to deal with today's long-term care challenges such as an aging population and increasing healthcare costs. Nurturing is the process of planning, implementing, and

  19. Northern European long term climate archives

    Energy Technology Data Exchange (ETDEWEB)

    Hohl, Veronica [Stockholm Univ. (Sweden)


    The Swedish Nuclear Fuel and Waste Management Company is responsible for the management and disposal of Sweden's radioactive waste. It is intended to deposit the spent nuclear fuel in a deep geological repository. This repository shall keep the radiotoxic material separated from humans and the environment for extended periods, from decades to millennia and possibly to geological timescales. During this time perspective climate induced changes such as shore-level displacement and evolution of permafrost and ice sheets are expected to occur which may affect the repository. The possible occurrence, extent and duration of these long-term changes, are therefore of interest when considering the assessment of repository performance and safety. The main climate parameters determining both surface and subsurface conditions are temperature and precipitation. As a result of the last advance of the Weichselian ice sheet only few geological archives exist, which contain information on past climatic conditions in Sweden before c 16,000 years BP. The purpose of this literature review is to compile and evaluate available information from Scandinavian, Northern and Central European geological archives, which record climatic conditions during the Weichselian time period. The compilation provides paleotemperature data sets, which may be used to explore the possible evolution of periglacial permafrost in Sweden. This report is a synopsis of 22 publications detailing climatic and environmental changes during the Weichselian time period in Northwestern Europe based on quantified paleotemperature records. Some of the data is presented as temperature curves which were digitised specifically for this report. The time range covered by the different publications varies considerably. Only few authors dealt with the whole Weichselian period and the majority cover only a few thousand years. This however is not considered to influence the reliability of the archives. The reason for the

  20. Physical rehabilitation for older people in long-term care. (United States)

    Crocker, Tom; Forster, Anne; Young, John; Brown, Lesley; Ozer, Seline; Smith, Jane; Green, John; Hardy, Jo; Burns, Eileen; Glidewell, Elizabeth; Greenwood, Darren C


    investigated adverse effects, including death, morbidity, and other events. We synthesised estimates of the primary outcome with the mean difference; mortality data, with the risk ratio; and secondary outcomes, using vote-counting. We included 67 trials, involving 6300 participants. Fifty-one trials reported the primary outcome, a measure of activities of daily living. The estimated effects of physical rehabilitation at the end of the intervention were an improvement in Barthel Index (0 to 100) scores of six points (95% confidence interval (CI) 2 to 11, P = 0.008, seven studies), Functional Independence Measure (0 to 126) scores of five points (95% CI -2 to 12, P = 0.1, four studies), Rivermead Mobility Index (0 to 15) scores of 0.7 points (95% CI 0.04 to 1.3, P = 0.04, three studies), Timed Up and Go test of five seconds (95% CI -9 to 0, P = 0.05, seven studies), and walking speed of 0.03 m/s (95% CI -0.01 to 0.07, P = 0.1, nine studies). Synthesis of secondary outcomes suggested there is a beneficial effect on strength, flexibility, and balance, and possibly on mood, although the size of any such effect is unknown. There was insufficient evidence of the effect on other secondary outcomes. Based on 25 studies (3721 participants), rehabilitation does not increase risk of mortality in this population (risk ratio 0.95, 95% CI 0.80 to 1.13). However, it is possible bias has resulted in overestimation of the positive effects of physical rehabilitation. Physical rehabilitation for long-term care residents may be effective, reducing disability with few adverse events, but effects appear quite small and may not be applicable to all residents. There is insufficient evidence to reach conclusions about improvement sustainability, cost-effectiveness, or which interventions are most appropriate. Future large-scale trials are justified.

  1. 34 CFR 682.505 - Insurance premium. (United States)


    ... 34 Education 3 2010-07-01 2010-07-01 false Insurance premium. 682.505 Section 682.505 Education... § 682.505 Insurance premium. (a) General. The Secretary charges the lender an insurance premium for each Federal GSL Program loan that is guaranteed, except that no insurance premium is charged on a Federal...

  2. 12 CFR 1410.5 - Delinquent premium payments and premium overpayments. (United States)


    ... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Delinquent premium payments and premium overpayments. 1410.5 Section 1410.5 Banks and Banking FARM CREDIT SYSTEM INSURANCE CORPORATION PREMIUMS § 1410.5 Delinquent premium payments and premium overpayments. (a) Delinquent payments. Each insured bank...

  3. Disability in long-term care residents explained by prevalent geriatric syndromes, not long-term care home characteristics: a cross-sectional study. (United States)

    Lane, Natasha E; Wodchis, Walter P; Boyd, Cynthia M; Stukel, Thérèse A


    Self-care disability is dependence on others to conduct activities of daily living, such as bathing, eating and dressing. Among long-term care residents, self-care disability lowers quality of life and increases health care costs. Understanding the correlates of self-care disability in this population is critical to guide clinical care and ongoing research in Geriatrics. This study examines which resident geriatric syndromes and chronic conditions are associated with residents' self-care disability and whether these relationships vary across strata of age, sex and cognitive status. It also describes the proportion of variance in residents' self-care disability that is explained by residents' geriatric syndromes versus long-term care home characteristics. We conducted a cross-sectional study using a health administrative cohort of 77,165 long-term care home residents residing in 614 Ontario long-term care homes. Eligible residents had their self-care disability assessed using the RAI-MDS 2.0 activities of daily living long-form score (range: 0-28) within 90 days of April 1st, 2011. Hierarchical multivariable regression models with random effects for long-term care homes were used to estimate the association between self-care disability and resident geriatric syndromes, chronic conditions and long-term care home characteristics. Differences in findings across strata of sex, age and cognitive status (cognitively intact versus cognitively impaired) were examined. Geriatric syndromes were much more strongly associated with self-care disability than chronic conditions in multivariable models. The direction and size of some of these effects were different for cognitively impaired versus cognitively intact residents. Residents' geriatric syndromes explained 50% of the variation in their self-care disability scores, while characteristics of long-term care homes explained an additional 2% of variation. Differences in long-term care residents' self-care disability are

  4. Reforming long-term care financing through insurance (United States)

    Meiners, Mark R.


    Until recently, insurance for long-term care was not viewed as feasible. This perception has changed dramatically in the past few years. Several models of long-term care insurance have begun to be tested. Although the application of insurance principles to long-term care is still new, the emergence of private market interest in developing long-term care insurance has been a catalyst to renewed public-policy support for reforming the way we pay for long-term care. States, in particular, have become interested in developing public-private partnerships to support the emergence of long-term care insurance that could help relieve the mounting pressure on Medicaid budgets. PMID:10312962

  5. Considering extraction constraints in long-term oil price modelling

    Energy Technology Data Exchange (ETDEWEB)

    Rehrl, Tobias; Friedrich, Rainer; Voss, Alfred


    Apart from divergence about the remaining global oil resources, the peak oil discussion can be reduced to a dispute about the time rate at which these resources can be supplied. On the one hand it is problematic to project oil supply trends without taking both - prices as well as supply costs - explicitly into account. On the other hand are supply cost estimates however itself heavily dependent on the underlying extraction rates and are actually only valid within a certain business-as-usual extraction rate scenario (which itself is the task to determine). In fact, even after having applied enhanced recovery technologies, the rate at which an oil field can be exploited is quite restricted. Above a certain level an additional extraction rate increase can only be costly achieved at risks of losses in the overall recoverable amounts of the oil reservoir and causes much higher marginal cost. This inflexibility in extraction can be overcome in principle by the access to new oil fields. This indicates why the discovery trend may roughly form the long-term oil production curve, at least for price-taking suppliers. The long term oil discovery trend itself can be described as a logistic process with the two opposed effects of learning and depletion. This leads to the well-known Hubbert curve. Several attempts have been made to incorporate economic variables econometrically into the Hubbert model. With this work we follow a somewhat inverse approach and integrate Hubbert curves in our Long-term Oil Price and EXtraction model LOPEX. In LOPEX we assume that non-OPEC oil production - as long as the oil can be profitably discovered and extracted - is restricted to follow self-regulative discovery trends described by Hubbert curves. Non-OPEC production in LOPEX therefore consists of those Hubbert cycles that are profitable, depending on supply cost and price. Endogenous and exogenous technical progress is extra integrated in different ways. LOPEX determines extraction and price

  6. Long Term Consequences: Effects on Normal Development Profile after Concussion (United States)

    Daneshvar, Daniel H.; Riley, David O.; Nowinski, Christopher J.; McKee, Ann C.; Stern, Robert A.; Cantu, Robert C.


    Each year in the United States, approximately 1.7 million people are diagnosed with a traumatic brain injury (TBI); an estimated 75% of these injuries are classified as mild TBIs (mTBI) or concussions. The symptoms of such injuries include a variety of somatic, cognitive, and behavioral deficits. While these symptoms typically resolve in a matter of weeks, both children and adults may suffer from Post-Concussion Syndrome (PCS) for months or longer. Suffering from PCS-related symptoms for an extended time may delay an individual’s return to work, adversely affect one’s quality of life, and result in additional social and economic costs. Though a consensus has not been reached on the cause of long-term PCS, it is likely that biological, physiological, psychological, and social elements all play a role in symptom persistence. Additionally, persistent PCS may adversely affect one’s developmental trajectory. The enduring effects of head trauma are not limited to PCS-related effects, however. A progressive tauopathy, chronic traumatic encephalopathy (CTE) is believed to stem from repeated brain trauma. While CTE was originally associated with boxing, it has recently been found in other cases of repetitive head injury including former football and hockey players, and professional wrestlers. In addition to this observed pathology, repetitive brain trauma is also associated with Alzheimer’s-like dementia, Parkinsonism, and motor neuron disease including Amyotrophic Lateral Sclerosis (ALS). With these significant long-term effects of head injuries, there is a clear need to develop effective diagnoses, treatments, and education plans to reduce future burden and incidence. PMID:22050943

  7. Enhanced Polyhydroxybutyrate Production for Long-Term Spaceflight Applications (United States)

    Putman, Ryan J.; Rahman, Asif; Miller, Charles D.; Hadi, Masood Z.


    Synthetic biology holds the promise of advancing long term space fight by the production of medicine, food, materials, and energy. One such application of synthetic biology is the production of biomaterials, specifically polyhydroxyalkanoates (PHAs), using purposed organisms such as Escherichia coli. PHAs are a group of biodegradable bioplastics that are produced by a wide variety of naturally occurring microorganisms, mainly as an energy storage intermediate. PHAs have similar melting point to polypropylene and a Youngs modulus close to polystyrene. Due to limited resources and cost of transportation, large-scale extraction of biologically produced products in situ is extremely cumbersome during space flight. To that end, we are developing a secretion systems for exporting PHA from the cell in order to reduce unit operations. PHAs granules deposited inside bacteria are typically associated with proteins bound to the granule surface. Phasin, a granule bound protein, was targeted for type I secretion by fusion with HlyA signal peptide for indirect secretion of PHAs. In order to validate our secretion strategy, a green fluorescent protein (GFP) was tagged to the PHA polymerase enzyme (phaC), this three part gene cassette consists of phaA and phaB and are required for PHA production. Producing PHAs in situ during space flight or planet colonization will enable mission success by providing a valuable source of biomaterials that can have many potential applications thereby reducing resupply requirements. Biologically produced PHAs can be used in additive manufacturing such as three dimensional (3D) printing to create products that can be made on demand during space flight. After exceeding their lifetime, the PHAs could be melted and recycled back to 3D print other products. We will discuss some of our long term goals of this approach.

  8. Long-Term Monitoring of Permeable Reactive Barriers - Progress Report

    Energy Technology Data Exchange (ETDEWEB)

    Liang, L.


    The purpose of this project is to conduct collaborative research to evaluate and maximize the effectiveness of permeable reactive barriers (PRBs) with a broad-based working group including representatives from the U.S. Department of Energy (DOE), U.S. Department of Defense (DoD), and the U.S. Environmental Protection Agency (EPA). The Naval Facilities Engineering Service Center (NFESC) and its project partner, Battelle, are leading the DoD effort with funding from DoD's Environmental Security Technology Certification Program (ESTCP) and Strategic Environmental Research and Development Program (SERDP). Oak Ridge National Laboratory (ORNL) is coordinating the DOE effort with support from Subsurface Contaminant Focus Area (SCFA), a research program under DOEs Office of Science and Technology. The National Risk Management Research Laboratory's Subsurface Protection and Remediation Division is leading EPA's effort. The combined effort of these three agencies allows the evaluation of a large number of sites. Documents generated by this joint project will be reviewed by the participating agencies' principal investigators, the Permeable Barriers Group of the Remediation Technologies Development Forum (RTDF), and the Interstate Technology and Regulatory Cooperation (ITRC). The technical objectives of this project are to collect and review existing field data at selected PRB sites, identify data gaps, conduct additional measurements, and provide recommendations to DOE users on suitable long-term monitoring strategies. The specific objectives are to (1) evaluate geochemical and hydraulic performance of PRBs, (2) develop guidelines for hydraulic and geochemical characterization/monitoring, and (3) devise and implement long-term monitoring strategies through the use of hydrological and geochemical models. Accomplishing these objectives will provide valuable information regarding the optimum configuration and lifetime of barriers at specific sites. It will

  9. Long-Term Mean Wind Profiles Based on Similarity Theory

    DEFF Research Database (Denmark)

    Kelly, Mark C.; Gryning, Sven-Erik


    in turn facilitates the derivation of a long-term mean wind profile based on Monin–Obukhov similarity theory. The modelled stability distributions exhibit good agreement with measurements from sites having different local conditions. The long-term wind profile formulation is further extended to include...... the influence of the depth of the atmospheric boundary layer (h), which becomes relevant for heights above h/3, and the resultant long-term ‘tall’ profile form also matches observations....

  10. Long term behaviour of singularly perturbed parabolic degenerated equation


    Faye, Ibrahima; Frenod, Emmanuel; Seck, Diaraf


    In this paper we consider models for short-term, mean-term and long-term morphodynamics of dunes and megariples. We give an existence and uniqueness result for long term dynamics of dunes. This result is based on a time-space periodic solution existence result for degenerated parabolic equation that we set out. Finally the mean-term and long-term models are homogenized.


    Directory of Open Access Journals (Sweden)

    Daniela-Emanuela Dănăcică


    Full Text Available The aim of this paper is to analyze characteristics of long-term unemployment spells in Romania and to estimate the effect of factors influencing long-term unemployment spells. The study period is in between January 1st 2008 and December 31st 2010. 468159 long-term spells registered in the specified period at the National Agency of Employment are analyzed.

  12. Long term profitable technique: in situ combustion

    Energy Technology Data Exchange (ETDEWEB)

    Naudin, Y.


    Onsite combustion, used for heavy petroleum, should permit the rate of recuperation of certain oil fields to be increased to 45% before the end of the century. This procedure, which has not yet been perfected and is, to large extent, still in the laboratory stage, is the object of extensive experiments in the oil fields of Suplacu and Balaria in Rumania. The IFP, which has been associated with these projects since 1969, is continuing its exhaustive laboratory tests. From an economic point of view, onsite combustion necessitates heavy investments, and the technical cost of production ranges from $5 to $15/bbl.

  13. Handbook on Long Term Defence Planning (Manuel sur la planification de defense a long terme) (United States)


    ses mécanismes. On aborde également, dans le cadre de ce processus, le contexte de la planification et la traduction des plans en mesures exécutives...La planification à long terme est essentielle pour les organisations confrontées à un double impact : incertitude quant à l’avenir et très peu...d’apprendre, de prévoir et de réagir de façon plus appropriée aux événements au fur et à mesure qu’ils se produisent, en temps réel, notamment

  14. Stature and long-term labor market outcomes: Evidence using Mendelian randomization. (United States)

    Böckerman, Petri; Viinikainen, Jutta; Vainiomäki, Jari; Hintsanen, Mirka; Pitkänen, Niina; Lehtimäki, Terho; Pehkonen, Jaakko; Rovio, Suvi; Raitakari, Olli


    We use the Young Finns Study (N=∼2000) on the measured height linked to register-based long-term labor market outcomes. The data contain six age cohorts (ages 3, 6, 9, 12, 15 and 18, in 1980) with the average age of 31.7, in 2001, and with the female share of 54.7. We find that taller people earn higher earnings according to the ordinary least squares (OLS) estimation. The OLS models show that 10cm of extra height is associated with 13% higher earnings. We use Mendelian randomization, with the genetic score as an instrumental variable (IV) for height to account for potential confounders that are related to socioeconomic background, early life conditions and parental investments, which are otherwise very difficult to fully account for when using covariates in observational studies. The IV point estimate is much lower and not statistically significant, suggesting that the OLS estimation provides an upward biased estimate for the height premium. Our results show the potential value of using genetic information to gain new insights into the determinants of long-term labor market success. Copyright © 2016 Elsevier B.V. All rights reserved.

  15. Long-term follow-up of obstetric studies

    NARCIS (Netherlands)

    Teune, M.J.


    This thesis focuses on long-term child follow-up after obstetric studies. Obstetric randomized controlled clinical trials (RCTs) are performed to evaluate the effectiveness of perinatal interventions. However, most often only short-term outcomes are reported, while long-term outcomes are just as

  16. Albumin: Creatinine Ratio during long term Diabetes Mellitus in the ...

    African Journals Online (AJOL)

    Albumin: Creatinine Ratio during long term Diabetes Mellitus in the Assessment of early Nephropathy in Sudanese Population. ... Further studies with 24 hour urine sample are recommended for assessment of Microalbuminuria in long term Diabetic patients, provided that the patients are on a normal diet with regular ...

  17. Immunostimulatory and Other Haematological Effects of Long Term ...

    African Journals Online (AJOL)

    Carica papaya Linn. (Caricaceae)is used traditionally to treat malaria, hypertension, sickle cell anemia and diabetes. Its long-term hypoglycaemic and anti-obesity effects in normal rabbits are documented. This study assessed the long term immunostimulatory and other haematological effects of aqueous C. papaya leaf ...

  18. Long-term forest ecosystem research: a programmatic view (United States)

    Wayne Swank; James Vose


    Long-term research provides the building blocks of knowledge needed to address natural resource and environmental issues. "Long-term" has frequently been considered to span decades with a time frame that usually encompasses at least one generation of scientists and frequently two or more generations. In the rich history of forest science, the origin of long-...

  19. Long-term aged care: expenditure trends and projections


    Alan Madge


    Discusses the factors that influence long-term aged care demand and provides projections of future expenditure. Long-term aged care in this context comprises mainly residential care (nursing homes and hostels) and community care services for the infirm aged.

  20. Detecting long-term growth trends using tree rings

    NARCIS (Netherlands)

    Peters, R.L.; Groenendijk, Peter; Vlam, Mart; Zuidema, P.A.


    Tree-ring analysis is often used to assess long-term trends in tree growth. A variety of growth-trend detection methods (GDMs) exist to disentangle age/size trends in growth from long-term growth changes. However, these detrending methods strongly differ in approach, with possible implications

  1. Long-term hearing preservation in vestibular schwannoma

    DEFF Research Database (Denmark)

    Stangerup, Sven-Eric; Thomsen, Jens; Tos, Mirko


    The aim of the present study was to evaluate the long-term hearing during "wait and scan" management of vestibular schwannomas.......The aim of the present study was to evaluate the long-term hearing during "wait and scan" management of vestibular schwannomas....

  2. Long-term effects of a preoperative smoking cessation programme

    DEFF Research Database (Denmark)

    Villebro, Nete Munk; Pedersen, Tom; Møller, Ann M


    Preoperative smoking intervention programmes reduce post-operative complications in smokers. Little is known about the long-term effect upon smoking cessation.......Preoperative smoking intervention programmes reduce post-operative complications in smokers. Little is known about the long-term effect upon smoking cessation....

  3. How Does Long-Term Finance Affect Economic Volatility?

    NARCIS (Netherlands)

    Demirgüç-Kunt, A.; Horváth, Bálint; Huizinga, Harry


    In an approach analogous to Rajan and Zingales (1998), we examine how the ability to access long-term debt affects firm-level growth volatility. We find that firms in industries with stronger preference to use long-term finance relative to short-term finance experience lower growth volatility in

  4. Long-Term Orientation and Educational Performance. Working Paper 174 (United States)

    Figlio, David; Giuliano, Paola; Özek, Umut; Sapienza, Paola


    We use remarkable population-level administrative education and birth records from Florida to study the role of Long-Term Orientation on the educational attainment of immigrant students living in the US. Controlling for the quality of schools and individual characteristics, students from countries with long-term oriented attitudes perform better…

  5. Quantification of long term emission potential from landfills

    NARCIS (Netherlands)

    Heimovaara, T.J.


    Novel approaches for the after-care of Municipal Solid Waste (MSW) landfills are based on technological measures to reduce the long term emission potential in a short time period. Biological degradation in landfills is a means to significantly reduce the long term emission potential. Leachate

  6. Esophageal atresia: long-term morbidities in adolescence and adulthood.

    NARCIS (Netherlands)

    Ijsselstijn, H.; Beelen, N.W. van; Wijnen, R.M.H.


    Survival rates in esophageal atresia (EA) patients have reached 90%. In long-term follow-up studies the focus has shifted from purely surgical or gastrointestinal evaluation to a multidisciplinary approach. We evaluated the long-term morbidity in adolescent and adult EA patients and discussed mainly

  7. Long-Term Follow Up of Superficial Bladder Tumors | Shelbaia ...

    African Journals Online (AJOL)

    Conclusion: The treatment of superficial TCC may be done by relatively minor endoscopic procedures, but the disease itself is a serious condition that merits close long-term follow-up. Key words: bladder tumors, transitional cell carcinoma (TCC), ND: YAG lasers, transurethral resection (TURT) Suivi à long terme des ...

  8. Long-Term Mortality of Emergency Medical Services Patients

    DEFF Research Database (Denmark)

    Bøtker, Morten T; Terkelsen, Christian J; Sørensen, Jan Nørtved


    STUDY OBJECTIVE: Emergency medical services (EMS) provides out-of-hospital care to patients with life-threatening conditions, but the long-term outcomes of EMS patients are unknown. We seek to determine the long-term mortality of EMS patients in Denmark. METHODS: We analyzed linked EMS, hospital...

  9. Developmental Dyslexia and Explicit Long-Term Memory (United States)

    Menghini, Deny; Carlesimo, Giovanni Augusto; Marotta, Luigi; Finzi, Alessandra; Vicari, Stefano


    The reduced verbal long-term memory capacities often reported in dyslexics are generally interpreted as a consequence of their deficit in phonological coding. The present study was aimed at evaluating whether the learning deficit exhibited by dyslexics was restricted only to the verbal component of the long-term memory abilities or also involved…

  10. [Treatment methods for discontinuation of long-term benzodiazepine use

    NARCIS (Netherlands)

    Oude Voshaar, R.C.; Gorgels, W.J.M.J.; Mol, A.J.J.; Couvée, J.E.; Balkom, A.J.L.M. van; Zitman, F.G.


    Treatment strategies for discontinuing long-term benzodiazepine usage can be divided into minimal interventions and gradual discontinuation programs. Minimal interventions invite patients to quit their long-term benzodiazepine usage on their own by making them aware of the adverse effects. This type

  11. [Long-term clinical effects of antidepressive agents]. (United States)

    Sechter, D


    According to long term studies with antidepressants versus placebo, the therapeutic efficacy is prolonged: a long term treatment in full dosage seems to reduce from almost half the risk of relapse and recurrence till five years, during recurrent major affective disorders. We should therefore be cautious and we should not have a systematic prescription for all types of depressions; antidepressants are efficacious but have side effects and we do not know well their abilities in long term use. During bipolar disorders the prescription of long term antidepressants, even in association with normothymics, does not give benefits and can induce rapid cycles. In dysthymias and depressions with personality disorders, a psychotherapy is indicated, and it is difficult to evaluate the efficacy of a long term antidepressant treatment. Tricyclics antidepressants, MAOI's and SSRI's have classical side effects, and they can also induce: modifications of the symptomatology, of cognitive functions, of sleep, eating and sexual behaviours; modifications of the course of depressive illness, induction of manic switches, and may be sometimes an exacerbation of suicidal ideation ... pharmacogenetic modifications with their action on hepatic metabolism, neuroendocrine alterations and long term effects on monoamines. We have also to take into account the long term treatment consequences on quality of life, on self esteem with the importance of psychodynamic and relationships modifications. The use of a long term antidepressant treatment should be adapted to each individual, being cautious of its potential benefits and risks.

  12. Can Risk Adjustment prevent Risk Selection in a Competitive Long-Term Care Insurance Market?

    NARCIS (Netherlands)

    P.L.H. Bakx (Pieter); F.T. Schut (Erik); E.K.A. van Doorslaer (Eddy)


    textabstractWhen public long-term care (LTC) insurance is provided by insurers, they typically lack incentives for purchasing cost-effective LTC. Providing insurers with appropriate incentives for efficiency without jeopardizing access for high-risk individuals requires, among other things, an

  13. Factors related to the high fall rate in long-term care residents with dementia

    NARCIS (Netherlands)

    Kosse, Nienke M.; de Groot, Maartje H.; Vuillerme, Nicolas; Hortobagyi, Tibor; Lamoth, Claudine J. C.

    Background: Falls in long-term care residents with dementia represent a costly but unresolved safety issue. The aim of the present study was to (1) determine the incidence of falls, fall-related injuries and fall circumstances, and (2) identify the relationship between patient characteristics and

  14. Building Care Bridges between Acute and Long-Term Care with Nursing Diagnosis. (United States)

    Taylor, Carol A.

    The increasing age of the American population and the current emphasis on cost containment in health care make the 1980s an ideal time for building bridges to span the health care needs of elderly persons in acute care and long-term care. While hospitals often discharge patients to nursing homes as an intermediate step between hospitalization and…

  15. Long Term Expected Revenue of Wind Farms Considering the Bidding Admission Uncertainty

    DEFF Research Database (Denmark)

    Bashi, Mazaher Haji; Yousefi, G.R.; Bak, Claus Leth


    As a long term bidding behavior, bid shading is exhibited by wind farms participating in real Uniform Price (UP) markets. This signifies that the wind farm owners bid far below their true long run marginal cost. In this paper, a method is proposed to consider the uncertainty of bidding admission ...

  16. A Framework for Organizing a Long-Term Planetary Science Program (United States)

    Elvis, M.


    Rapid cost growth has cut the number of planetary missions to rates that are too small to sustain a vigorous program. Planning needs well-chosen principles to change this state of affairs, and commercial space offers a long-term solution.

  17. Can universal access and competition in long-term care insurance be combined?

    NARCIS (Netherlands)

    P.L.H. Bakx (Pieter); F.T. Schut (Erik); E.K.A. van Doorslaer (Eddy)


    markdownabstract__Abstract__ In countries with a public long-term care (LTC) insurance scheme administered by multiple non-competing insurers, these insurers typically lack incentives for purchasing cost-effective LTC because they are not at risk for LTC expenses. Plans to introduce these

  18. A Long-Term View on Perovskite Optoelectronics. (United States)

    Docampo, Pablo; Bein, Thomas


    Recently, metal halide perovskite materials have become an exciting topic of research for scientists of a wide variety of backgrounds. Perovskites have found application in many fields, starting from photovoltaics and now also making an impact in light-emitting applications. This new class of materials has proven so interesting since it can be easily solution processed while exhibiting materials properties approaching the best inorganic optoelectronic materials such as GaAs and Si. In photovoltaics, in only 3 years, efficiencies have rapidly increased from an initial value of 3.8% to over 20% in recent reports for the commonly employed methylammonium lead iodide (MAPI) perovskite. The first light emitting diodes and light-emitting electrochemical cells have been developed already exhibiting internal quantum efficiencies exceeding 15% for the former and tunable light emission spectra. Despite their processing advantages, perovskite optoelectronic materials suffer from several drawbacks that need to be overcome before the technology becomes industrially relevant and hence achieve long-term application. Chief among these are the sensitivity of the structure toward moisture and crystal phase transitions in the device operation regime, unreliable device performance dictated by the operation history of the device, that is, hysteresis, the inherent toxicity of the structure, and the high cost of the employed charge selective contacts. In this Account, we highlight recent advances toward the long-term viability of perovskite photovoltaics. We identify material decomposition routes and suggest strategies to prevent damage to the structure. In particular, we focus on the effect of moisture upon the structure and stabilization of the material to avoid phase transitions in the solar cell operating range. Furthermore, we show strategies to achieve low-cost chemistries for the development of hole transporters for perovskite solar cells, necessary to be able to compete with other

  19. Long-term monitoring of marine gas leakage (United States)

    Spickenbom, Kai; Faber, Eckhard; Poggenburg, Jürgen; Seeger, Christian; Furche, Markus


    The sequestration of CO2 in sub-seabed geological formations is one of the Carbon Capture and Storage (CCS) strategies currently under study. Although offshore operations are significantly more expensive than comparable onshore operations, the growing public resistance against onshore CCS projects makes sub-seabed storage a promising option. Even after a thorough review of the geological setting, there is always the possibility of leakage from the reservoir. As part of the EU-financed project CO2ReMoVe (Research, Monitoring, Verification), which aims to develop innovative research and technologies for monitoring and verification of carbon dioxide geological storage, we are working on the development of submarine long-term gas flow monitoring systems. The basic design of the monitoring system builds on our experience in volcano monitoring. Early prototypes were composed of a raft floating on the surface of a mud volcano, carrying sensors for CO2 flux and concentration, data storage and transmission, and power supply by battery-buffered solar panels. The system was modified for installation in open sea by using a buoy instead of a raft and a funnel on the seafloor to collect the gas, connected by a flexible tube. This setup provides a cost-effective solution for shallow waters. However, a buoy interferes with ship traffic, and it is also difficult to adapt this design to greater water depths. These requirements can best be complied by a completely submersed system. A system for unattended long-term monitoring in a marine environment has to be extremely durable. Therefore, we focussed on developing a mechanically and electrically as simple setup as possible, which has the additional advantage of low cost. The system consists of a funnel-shaped gas collector, a sensor head and pressure housings for electronics and power supply. Since this setup is inexpensive, it can be deployed in numbers to cover larger areas. By addition of multi-channel data loggers, data

  20. Environmental Management Long-Term Stewardship Transition Guidance

    Energy Technology Data Exchange (ETDEWEB)

    Kristofferson, Keith


    Long-term stewardship consists of those actions necessary to maintain and demonstrate continued protection of human health and the environment after the completion of facility cleanup. Long-term stewardship is administered and overseen by the U.S. Department of Energy Environmental Management Office of Science and Technology. This report describes the background of long-term stewardship and gives general guidance about considerations when ownership and/or responsibility of a site should be transferred to a long-term stewardship program. This guidance document will assist the U.S. Department of Energy in: (a) ensuring that the long-term stewardship program leads transition planning with respect to facility and site areas, and (b) describing the classes and types of criteria and data required to initiate transition for areas and sites where the facility mission has ended and cleanup is complete.

  1. Long-Term Memory Performance in Adult ADHD. (United States)

    Skodzik, Timo; Holling, Heinz; Pedersen, Anya


    Memory problems are a frequently reported symptom in adult ADHD, and it is well-documented that adults with ADHD perform poorly on long-term memory tests. However, the cause of this effect is still controversial. The present meta-analysis examined underlying mechanisms that may lead to long-term memory impairments in adult ADHD. We performed separate meta-analyses of measures of memory acquisition and long-term memory using both verbal and visual memory tests. In addition, the influence of potential moderator variables was examined. Adults with ADHD performed significantly worse than controls on verbal but not on visual long-term memory and memory acquisition subtests. The long-term memory deficit was strongly statistically related to the memory acquisition deficit. In contrast, no retrieval problems were observable. Our results suggest that memory deficits in adult ADHD reflect a learning deficit induced at the stage of encoding. Implications for clinical and research settings are presented.

  2. The essential value of long-term experimental data for hydrology and water management (United States)

    Tetzlaff, Doerthe; Carey, Sean K.; McNamara, James P.; Laudon, Hjalmar; Soulsby, Chris


    Observations and data from long-term experimental watersheds are the foundation of hydrology as a geoscience. They allow us to benchmark process understanding, observe trends and natural cycles, and are prerequisites for testing predictive models. Long-term experimental watersheds also are places where new measurement technologies are developed. These studies offer a crucial evidence base for understanding and managing the provision of clean water supplies, predicting and mitigating the effects of floods, and protecting ecosystem services provided by rivers and wetlands. They also show how to manage land and water in an integrated, sustainable way that reduces environmental and economic costs.

  3. A branch-and-price algorithm for the long-term home care scheduling problem

    DEFF Research Database (Denmark)

    Gamst, Mette; Jensen, Thomas Sejr


    In several countries, home care is provided for certain citizens living at home. The long-term home care scheduling problem is to generate work plans such that a high quality of service is maintained, the work hours of the employees are respected, and the overall cost is kept as low as possible. We...... propose a branchand-price algorithm for the long-term home care scheduling problem. The pricing problem generates a one-day plan for an employee, and the master problem merges the plans with respect to regularity constraints. The method is capable of generating plans with up to 44 visits during one week....

  4. Long-term Outcomes of Bariatric Surgery: A National Institutes of Health Symposium (United States)

    Courcoulas, Anita P.; Yanovski, Susan Z.; Bonds, Denise; Eggerman, Thomas L.; Horlick, Mary; Staten, Myrlene A.; Arterburn, David E.


    Importance The clinical evidence base demonstrating bariatric surgery’s health benefits is much larger than it was when the NIH last held a Consensus Panel in 1991. Still, it remains unclear whether ongoing studies will address critical questions about long-term complication rates and the sustainability of weight loss and comorbidity control. Objective The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the National Heart, Lung, and Blood Institute (NHLBI) convened a multidisciplinary workshop in May 2013 to summarize the current state of knowledge of bariatric surgery, review research findings on the long-term outcomes of bariatric surgery, and establish priorities for future research directions. Evidence Review The evidence presented at the workshop was selected by the planning committee for both its quality and duration of follow up. The data review emphasized RCTs and large observational studies with long-term follow up, with or without a control group. Findings Several small RCTs showed greater weight loss and T2DM remission compared to non-surgical treatments within the first 2 years of follow-up after bariatric surgery. Large, long-term observational studies show durable (>5 years) weight loss, diabetes and lipid improvements with bariatric surgery. Still unclear are predictors of outcomes, long-term complications, long-term survival, micro- and macro-vascular events, mental health outcomes, and costs. The studies needed to address these knowledge gaps would be expensive and logistically difficult to perform. Conclusions and Relevance High-quality evidence shows that bariatric surgical procedures result in greater weight loss than non-surgical treatments and are more effective at inducing initial T2DM remission in obese patients. More information is needed about the long term durability of comorbidity control and complications after bariatric procedures and this evidence will most likely come from carefully designed

  5. Abstracts 1987. New Horizons in Long Term Care: A Report on the Long Term Care Research and Demonstration Projects. (United States)

    Illinois State Dept. of Public Aid, Springfield.

    This booklet provides a description of 14 projects which were awarded funds during fiscal year 1987 for collaborative research in long-term care to find new ways to treat long-term care patients in Illinois nursing homes. It includes the organization or institution receiving the award, an abstract of the research proposal, and the name of the…

  6. [Calcium pros and cons: long term use of bisphosphonates. Bisphosphonates should be used for postmenopausal osteoporosis for a long term]. (United States)

    Soen, Satoshi


    Only bisphosphonates have evidence that show to reduce the risk of vertebral, nonvertebral, and hip fractures in postmenopausal osteoporosis. From the viewpoint of risk benefit, it may be said that a utility is far superior to problems of the long-term use. Long-term use of bisphosphonates is necessary for the patients at elevated risk for the hip fracture.

  7. 24 CFR 221.254 - Mortgage insurance premiums. (United States)


    ... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Mortgage insurance premiums. 221... HOUSING AND URBAN DEVELOPMENT MORTGAGE AND LOAN INSURANCE PROGRAMS UNDER NATIONAL HOUSING ACT AND OTHER AUTHORITIES LOW COST AND MODERATE INCOME MORTGAGE INSURANCE-SAVINGS CLAUSE Contract Rights and Obligations-Low...

  8. Beyond post-marketing research and MedWatch: Long-term studies of drug risks. (United States)

    Resnik, David B


    Critics of the drug safety system have discussed many different potential reforms, ranging from mandatory registration of clinical trials to increasing the power of regulatory agencies, but few have discussed one of the most important ways of enhancing safety: increasing the number of long-term studies of medications. Long-term studies of the risks and benefits of drugs can provide useful information for regulators, healthcare professionals, and patients. Government funding agencies should lead the effort to conduct long-term studies of drugs, but private companies should also be required to lend financial support. Because cost-effectiveness is likely to be an important consideration in conducting this research, funding agencies should focus, at first, on drugs that are used to treat common, chronic conditions.

  9. Long Term Expected Revenue of Wind Farms Considering the Bidding Admission Uncertainty

    DEFF Research Database (Denmark)

    Bashi, Mazaher Haji; Yousefi, G.R.; Bak, Claus Leth


    . The optimal behavior of the wind farm is then obtained by establishing a multi objective optimization problem and subsequently solved using genetic algorithm. The method is applied to the analysis of long term bidding behavior of a wind farm participating in a Pay-as-Bid (PAB) auction such as Iran Electricity......As a long term bidding behavior, bid shading is exhibited by wind farms participating in real Uniform Price (UP) markets. This signifies that the wind farm owners bid far below their true long run marginal cost. In this paper, a method is proposed to consider the uncertainty of bidding admission...... in the long term expected revenue of wind farms. We show that this consideration could perfectly explain the observed bid shading behavior of wind farm owners. We use a novel market price model with a stochastic model of a wind farm to derive indices describing the uncertainty of bidding admission...

  10. Price premium of organic salmon in Danish retail sale

    DEFF Research Database (Denmark)

    Ankamah Yeboah, Isaac; Nielsen, Max; Nielsen, Rasmus


    for organic salmon in Danish retail sale using consumer panel scanner data from households by applying a random effect hedonic price model that permits unobserved household heterogeneity. A price premium of 20% was identified for organic salmon. The magnitude of this premium is comparable to organic labeled......The year 2016 will be pivotal for organic aquaculture producers in EU, because it represents the deadline for implementing the complete organic life cycle in aquaculture production. Depending on the sturdiness of farms already producing, such a shift in the industry may affect production costs...

  11. Modulation of working memory updating: Does long-term memory lexical association matter? (United States)

    Artuso, Caterina; Palladino, Paola


    The aim of the present study was to investigate how working memory updating for verbal material is modulated by enduring properties of long-term memory. Two coexisting perspectives that account for the relation between long-term representation and short-term performance were addressed. First, evidence suggests that performance is more closely linked to lexical properties, that is, co-occurrences within the language. Conversely, other evidence suggests that performance is linked more to long-term representations which do not entail lexical/linguistic representations. Our aim was to investigate how these two kinds of long-term memory associations (i.e., lexical or nonlexical) modulate ongoing working memory activity. Therefore, we manipulated (between participants) the strength of the association in letters based on either frequency of co-occurrences (lexical) or contiguity along the sequence of the alphabet (nonlexical). Results showed a cost in working memory updating for strongly lexically associated stimuli only. Our findings advance knowledge of how lexical long-term memory associations between consonants affect working memory updating and, in turn, contribute to the study of factors which impact the updating process across memory systems.

  12. A Novel Unsupervised Adaptive Learning Method for Long-Term Electromyography (EMG) Pattern Recognition. (United States)

    Huang, Qi; Yang, Dapeng; Jiang, Li; Zhang, Huajie; Liu, Hong; Kotani, Kiyoshi


    Performance degradation will be caused by a variety of interfering factors for pattern recognition-based myoelectric control methods in the long term. This paper proposes an adaptive learning method with low computational cost to mitigate the effect in unsupervised adaptive learning scenarios. We presents a particle adaptive classifier (PAC), by constructing a particle adaptive learning strategy and universal incremental least square support vector classifier (LS-SVC). We compared PAC performance with incremental support vector classifier (ISVC) and non-adapting SVC (NSVC) in a long-term pattern recognition task in both unsupervised and supervised adaptive learning scenarios. Retraining time cost and recognition accuracy were compared by validating the classification performance on both simulated and realistic long-term EMG data. The classification results of realistic long-term EMG data showed that the PAC significantly decreased the performance degradation in unsupervised adaptive learning scenarios compared with NSVC (9.03% ± 2.23%, p < 0.05) and ISVC (13.38% ± 2.62%, p = 0.001), and reduced the retraining time cost compared with ISVC (2 ms per updating cycle vs. 50 ms per updating cycle).

  13. Long-term memory of individual identity in ant queens. (United States)

    Dreier, Stephanie; van Zweden, Jelle S; D'Ettorre, Patrizia


    Remembering individual identities is part of our own everyday social life. Surprisingly, this ability has recently been shown in two social insects. While paper wasps recognize each other individually through their facial markings, the ant, Pachycondyla villosa, uses chemical cues. In both species, individual recognition is adaptive since it facilitates the maintenance of stable dominance hierarchies among individuals, and thus reduces the cost of conflict within these small societies. Here, we investigated individual recognition in Pachycondyla ants by quantifying the level of aggression between pairs of familiar or unfamiliar queens over time. We show that unrelated founding queens of P. villosa and Pachycondyla inversa store information on the individual identity of other queens and can retrieve it from memory after 24h of separation. Thus, we have documented for the first time that long-term memory of individual identity is present and functional in ants. This novel finding represents an advance in our understanding of the mechanism determining the evolution of cooperation among unrelated individuals.

  14. Long-Term Stewardship Baseline Report and Transition Guidance

    Energy Technology Data Exchange (ETDEWEB)

    Kristofferson, Keith


    Long-term stewardship consists of those actions necessary to maintain and demonstrate continued protection of human health and the environment after facility cleanup is complete. As the Department of Energy’s (DOE) lead laboratory for environmental management programs, the Idaho National Engineering and Environmental Laboratory (INEEL) administers DOE’s long-term stewardship science and technology efforts. The INEEL provides DOE with technical, and scientific expertise needed to oversee its long-term environmental management obligations complexwide. Long-term stewardship is administered and overseen by the Environmental Management Office of Science and Technology. The INEEL Long-Term Stewardship Program is currently developing the management structures and plans to complete INEEL-specific, long-term stewardship obligations. This guidance document (1) assists in ensuring that the program leads transition planning for the INEEL with respect to facility and site areas and (2) describes the classes and types of criteria and data required to initiate transition for areas and sites where the facility mission has ended and cleanup is complete. Additionally, this document summarizes current information on INEEL facilities, structures, and release sites likely to enter long-term stewardship at the completion of DOE’s cleanup mission. This document is not intended to function as a discrete checklist or local procedure to determine readiness to transition. It is an overarching document meant as guidance in implementing specific transition procedures. Several documents formed the foundation upon which this guidance was developed. Principal among these documents was the Long-Term Stewardship Draft Technical Baseline; A Report to Congress on Long-Term Stewardship, Volumes I and II; Infrastructure Long-Range Plan; Comprehensive Facility Land Use Plan; INEEL End-State Plan; and INEEL Institutional Plan.

  15. The clinical effectiveness and cost-effectiveness of point-of-care tests (CoaguChek system, INRatio2 PT/INR monitor and ProTime Microcoagulation system) for the self-monitoring of the coagulation status of people receiving long-term vitamin K antagonist therapy, compared with standard UK practice: systematic review and economic evaluation. (United States)

    Sharma, Pawana; Scotland, Graham; Cruickshank, Moira; Tassie, Emma; Fraser, Cynthia; Burton, Chris; Croal, Bernard; Ramsay, Craig R; Brazzelli, Miriam


    Self-monitoring (self-testing and self-management) could be a valid option for oral anticoagulation therapy monitoring in the NHS, but current evidence on its clinical effectiveness or cost-effectiveness is limited. We investigated the clinical effectiveness and cost-effectiveness of point-of-care coagulometers for the self-monitoring of coagulation status in people receiving long-term vitamin K antagonist therapy, compared with standard clinic monitoring. We searched major electronic databases (e.g. MEDLINE, MEDLINE In Process & Other Non-Indexed Citations, EMBASE, Bioscience Information Service, Science Citation Index and Cochrane Central Register of Controlled Trials) from 2007 to May 2013. Reports published before 2007 were identified from the existing Cochrane review (major databases searched from inception to 2007). The economic model parameters were derived from the clinical effectiveness review, other relevant reviews, routine sources of cost data and clinical experts' advice. We assessed randomised controlled trials (RCTs) evaluating self-monitoring in people with atrial fibrillation or heart valve disease requiring long-term anticoagulation therapy. CoaguChek(®) XS and S models (Roche Diagnostics, Basel, Switzerland), INRatio2(®) PT/INR monitor (Alere Inc., San Diego, CA USA), and ProTime Microcoagulation system(®) (International Technidyne Corporation, Nexus Dx, Edison, NJ, USA) coagulometers were compared with standard monitoring. Where possible, we combined data from included trials using standard inverse variance methods. Risk of bias assessment was performed using the Cochrane risk of bias tool. A de novo economic model was developed to assess the cost-effectiveness over a 10-year period. We identified 26 RCTs (published in 45 papers) with a total of 8763 participants. CoaguChek was used in 85% of the trials. Primary analyses were based on data from 21 out of 26 trials. Only four trials were at low risk of bias. Major clinical events: self

  16. Medical malpractice reform and employer-sponsored health insurance premiums. (United States)

    Morrisey, Michael A; Kilgore, Meredith L; Nelson, Leonard Jack


    Tort reform may affect health insurance premiums both by reducing medical malpractice premiums and by reducing the extent of defensive medicine. The objective of this study is to estimate the effects of noneconomic damage caps on the premiums for employer-sponsored health insurance. Employer premium data and plan/establishment characteristics were obtained from the 1999 through 2004 Kaiser/HRET Employer Health Insurance Surveys. Damage caps were obtained and dated based on state annotated codes, statutes, and judicial decisions. Fixed effects regression models were run to estimate the effects of the size of inflation-adjusted damage caps on the weighted average single premiums. State tort reform laws were identified using Westlaw, LEXIS, and statutory compilations. Legislative repeal and amendment of statutes and court decisions resulting in the overturning or repealing state statutes were also identified using LEXIS. Using a variety of empirical specifications, there was no statistically significant evidence that noneconomic damage caps exerted any meaningful influence on the cost of employer-sponsored health insurance. The findings suggest that tort reforms have not translated into insurance savings.

  17. Long-term correlations in the surface behavior of dolphins (United States)

    Cancho, R. Ferrer i.; Lusseau, D.


    Here we study the sequences of surface behavioral patterns of dolphins (Tursiops sp.) and find long-term correlations. We show that the long-term correlations are not of a trivial nature, i.e. they cannot be explained by the repetition of the same surface behavior many times in a row. Our findings suggest that dolphins have a long collective memory extending back at least to the 7-th past behavior. As far as we know, this is the first evidence of long-term correlations in the behavior of a non-human species.

  18. Rural-urban differences in the long-term care of the disabled elderly in China.

    Directory of Open Access Journals (Sweden)

    Mei Li

    Full Text Available BACKGROUND: In China, the rapid rate of population aging and changes in the prevalence of disability among elderly people could have significant effects on the demand for long-term care. This study aims to describe the urban-rural differences in use and cost of long-term care of the disabled elderly and to explore potential influencing factors. METHODS: This study uses data from a cross-sectional survey and a qualitative investigation conducted in Zhejiang province in 2012. The participants were 826 individuals over 60 years of age, who had been bedridden or suffered from dementia for more than 6 months. A generalized linear model and two-part regression model were applied to estimate costs, with adjustment of covariates. RESULTS: Pensions provide the main source of income for urban elderly, while the principal income source for rural elderly is their family. Urban residents spend more on all services than do rural residents. Those who are married spend less on daily supplies and formal care than the unmarried do. Age, incapacitation time, comorbidity number, level of income, and bedridden status influence spending on medical care (β=-0.0316, -0.0206, 0.1882, 0.3444, and -0.4281, respectively, but the cost does not increase as the elderly grow older. Urban residents, the married, and those with a higher income level tend to spend more on medical equipment. Urban residence and living status are the two significant factors that affect spending on personal hygiene products. CONCLUSIONS: The use of long-term care services varies by living area. Long-term care of the disabled elderly imposes a substantial burden on families. Our study revealed that informal care involves huge opportunity costs to the caregivers. Chinese policy makers need to promote community care and long-term care insurance to relieve the burden of families of disabled elderly, and particular attention should be given to the rural elderly.

  19. Zambia : long-term generation expansion study - executive summary.

    Energy Technology Data Exchange (ETDEWEB)

    Conzelmann, G.; Koritarov, V.; Buehring, W.; Veselka, T.; Decision and Information Sciences


    The objective of this study is to analyze possible long-term development options of the Zambian electric power system in the period up to 2015. The analysis involved the hydro operations studies of the Zambezi river basin and the systems planning studies for the least-cost generation expansion planning. Two well-known and widely accepted computer models were used in the analysis: PC-VALORAGUA model for the hydro operations and optimization studies and the WASP-III Plus model for the optimization of long-term system development. The WASP-III Plus model is a part of the Argonne National Laboratory's Energy and Power Evaluation Model (ENPEP). The analysis was conducted in close collaboration with the Zambia Electricity Supply Corporation (ZESCO). On the initiative from The World Bank, the sponsor of the study, ZESCO formed a team of experts that participated in the analysis and were trained in the use of computer models. Both models were transferred to ZESCO free of charge and installed on several computers in the ZESCO corporate offices in Lusaka. In September-October 1995, two members of the ZESCO National Team participated in a 4-week training course at Argonne National Laboratory near Chicago, U.S.A., focusing on the long-term system expansion planning using the WASP and VALORAGUA models. The hydropower operations studies were performed for the whole Zambezi river basin, including the full installation of the Kariba power station, and the Cahora Bassa hydro power station in Mozambique. The analysis also included possible future projects such as Itezhi-Tezhi, Kafue Gorge Lower, and Batoka Gorge power stations. As hydropower operations studies served to determine the operational characteristics of the existing and future hydro power plants, it was necessary to simulate the whole Zambezi river basin in order to take into account all interactions and mutual influences between the hydro power plants. In addition, it allowed for the optimization of reservoir

  20. Long-term intrathecal administration of midazolam and clonidine

    NARCIS (Netherlands)

    Borg, PAJ; Krijnen, HJ

    Objective: To determine the clinical usefulness of the long-term intrathecal administration of midazolam and clonidine in patients with refractory neurogenic and musculoskeletal pain. Setting: Pain Centre, Academic Hospital Groningen, Groningen, The Netherlands. Patients: Four patients with chronic

  1. Long Term 1 Enhanced Surface Water Treatment Rule Documents (United States)

    The Long Term 1 Enhanced Surface Water Treatment Rule (LT1ESWTR) builds on the requirements of the Surface Water Treatment Rule and specifies treatment requirements to address Cryptosporidium m and other microbial contaminants in public water systems.

  2. Long-term outcome after mastectomy with immediate breast reconstruction

    DEFF Research Database (Denmark)

    Stralman, K.; Mollerup, C.L.; Kristoffersen, U.S.


    INTRODUCTION: The purpose of this study was to investigate long term outcome for women who had undergone mastectomy and immediate breast reconstruction. MATERIAL AND METHODS: Patient files of 167 immediately reconstructed breast cancer patients were reviewed for late surgical complications...

  3. Surgery for ACL Tear Often Successful Over Long Term (United States)

    ... fullstory_167352.html Surgery for ACL Tear Often Successful Over Long Term Even 10 years after procedure, ... were scheduled for presentation Friday at the annual meeting of the AOSSM in Toronto. Findings presented at ...

  4. Advancing an ethical framework for long-term care. (United States)

    Carter, Mary Whelan


    This article represents an effort to formulate an ethical framework for long-term care with the explicit purpose of providing a catalyst to promote further discourse and expand consideration of what an ethic of long-term care might entail. Grounding the discussion, an introduction to traditional ethical philosophy is presented, focusing mainly on the fundamentals of deontological and teleological ethical theories. Attention then shifts to a review of the more frequently cited principles found in the long-term care ethics literature, followed by a critique of the current reliance upon principlism to resolve ethical dilemmas in long-term care. In response to this criticism, an agent-driven ethical framework stressing dignity and respect for personhood, drawn from the philosophy of Immanuel Kant, is advanced.

  5. Institutional repositories as infrastructures for long-term preservation

    National Research Council Canada - National Science Library

    Francke, Helena; Gamalielsson, Jonas; Lundell, Björn


    Introduction. The study describes the conditions for long-term preservation of the content of the institutional repositories of Swedish higher education institutions based on an investigation of how deposited...

  6. Long-term patient survival in ANCA-associated vasculitis

    NARCIS (Netherlands)

    Flossmann, Oliver; Berden, Annelies; de Groot, Kirsten; Hagen, Chris; Harper, Lorraine; Heijl, Caroline; Hoglund, Peter; Jayne, David; Luqmani, Raashid; Mahr, Alfred; Mukhtyar, Chetan; Pusey, Charles; Rasmussen, Niels; Stegeman, Coen; Walsh, Michael; Westman, Kerstin

    Background Wegener's granulomatosis and microscopic polyangiitis are antineutrophil cytoplasm antibodies (ANCA)-associated vasculitides with significant morbidity and mortality. The long-term survival of patients with ANCA associated vasculitis treated with current regimens is uncertain. Objective

  7. Political connections, media monitoring and long-term loans

    National Research Council Canada - National Science Library

    Deming Yang Zhengfei Lu Danglun Luo


    We analyze data on Chinese non-state-listed firms and find that it is easier for firms with political connections to obtain long-term loans with extended debt maturities than it is for firms without...

  8. Physiological characteristics of long-term Bikram yoga practitioners

    National Research Council Canada - National Science Library

    Abel, Allison N; Lloyd, Lisa K; Williams, James S; Miller, Brian K


    .... The primary purpose of this cross-sectional study was to describe the resting heart rate, blood pressure, lung function and aerobic fitness characteristics of long-term Bikram yoga practitioners...

  9. Long-term outcome of Tunisian children with primary ciliary ...

    African Journals Online (AJOL)

    Long-term outcome of Tunisian children with primary ciliary dyskinesia confirmed by transmission electron microscopy. Hamouda Samia, Boussetta Khadija, Hamzaoui Agnes, Khalsi Fatma, Trabelsi Ines, Jaafoura Hafedh, Tinsa Faten ...

  10. Monitoring land degradation with long-term satellite data

    CSIR Research Space (South Africa)

    Wessels, Konrad J


    Full Text Available need for a standardised, quantitative and spatially-explicit measures of ecosystem functions to map and monitor land degradation, especially in the light of land redistribution and restitution. The authors investigated the long-term vegetation...

  11. Long-Term Complications of Diabetes (For Parents) (United States)

    ... Is Too High Keeping Track of Your Blood Sugar Diabetes Control: Why It's Important Diabetes Center Diabetes: What's ... False? Diabetes Center Keeping Track of Your Blood Sugar Diabetes Control: Why It's Important Long-Term Complications of ...

  12. Long term combination treatment for severe idiopathic pulmonary arterial hypertension (United States)

    Affuso, Flora; Cirillo, Plinio; Ruvolo, Antonio; Carlomagno, Guido; Fazio, Serafino


    We report the long-term follow-up of 3 cases of severe idiopathic pulmonary arterial hypertension, in whom tadalafil plus sitaxentan combination therapy improved the clinical condition and exercise performance without any relevant adverse event. PMID:21160759

  13. Long-term Periodicities of Cataclysmic Variables with Synoptic Surveys (United States)

    Yang, Michael Ting-Chang; Chou, Yi; Ngeow, Chow-Choong; Hu, Chin-Ping; Su, Yi-Hao; Prince, Thomas A.; Kulkarni, Shrinivas R.; Levitan, David; Laher, Russ; Surace, Jason; Drake, Andrew J.; Djorgovski, Stanislav G.; Mahabal, Ashish A.; Graham, Matthew J.; Donalek, Ciro


    A systematic study on the long-term periodicities of known Galactic cataclysmic variables (CVs) was conducted. Among 1580 known CVs, 344 sources were matched and extracted from the Palomar Transient Factory (PTF) data repository. The PTF light curves were combined with the Catalina Real-Time Transient Survey (CRTS) light curves and analyzed. Ten targets were found to exhibit long-term periodic variability, which is not frequently observed in the CV systems. These long-term variations are possibly caused by various mechanisms, such as the precession of the accretion disk, hierarchical triple star system, magnetic field change of the companion star, and other possible mechanisms. We discuss the possible mechanisms in this study. If the long-term period is less than several tens of days, the disk precession period scenario is favored. However, the hierarchical triple star system or the variations in magnetic field strengths are most likely the predominant mechanisms for longer periods.

  14. Examining Long-Term Global Climate Change on the Web. (United States)

    Huntoon, Jacqueline E.; Ridky, Robert K.


    Describes a web-based, inquiry-oriented activity that enables students to examine long-term global climate change. Supports instruction in other topics such as population growth. (Contains 34 references.) (DDR)

  15. Long-term memory, sleep, and the spacing effect. (United States)

    Bell, Matthew C; Kawadri, Nader; Simone, Patricia M; Wiseheart, Melody


    Many studies have shown that memory is enhanced when study sessions are spaced apart rather than massed. This spacing effect has been shown to have a lasting benefit to long-term memory when the study phase session follows the encoding session by 24 hours. Using a spacing paradigm we examined the impact of sleep and spacing gaps on long-term declarative memory for Swahili-English word pairs by including four spacing delay gaps (massed, 12 hours same-day, 12 hours overnight, and 24 hours). Results showed that a 12-hour spacing gap that includes sleep promotes long-term memory retention similar to the 24-hour gap. The findings support the importance of sleep to the long-term benefit of the spacing effect.

  16. The Long-Term Retention of Knowledge and Skills

    National Research Council Canada - National Science Library

    Healy, Alice


    .... The second class of guidelines concerned ways to optimize the strategies used. We found that in tasks that require deliberate retrieval from memory, training that promotes efficient encoding strategies maximizes long-term retention...

  17. Long-Term Ecological Monitoring Field Sampling Plan for 2007

    Energy Technology Data Exchange (ETDEWEB)

    T. Haney


    This field sampling plan describes the field investigations planned for the Long-Term Ecological Monitoring Project at the Idaho National Laboratory Site in 2007. This plan and the Quality Assurance Project Plan for Waste Area Groups 1, 2, 3, 4, 5, 6, 7, 10, and Removal Actions constitute the sampling and analysis plan supporting long-term ecological monitoring sampling in 2007. The data collected under this plan will become part of the long-term ecological monitoring data set that is being collected annually. The data will be used t determine the requirements for the subsequent long-term ecological monitoring. This plan guides the 2007 investigations, including sampling, quality assurance, quality control, analytical procedures, and data management. As such, this plan will help to ensure that the resulting monitoring data will be scientifically valid, defensible, and of known and acceptable quality.


    National Research Council Canada - National Science Library

    P Selvam; N Punitavati


      A Fundamental study on Capital Budgeting has been viewed with the intention of providing fundamental knowledge to investors whose inclination is making a profit by investing in long term securities...

  19. Long-term consequences of pregnancy-related venous thrombosis


    Wik, Hilde Skuterud


    Background: Venous thrombosis (VT) is among the leading causes of maternal mortality in countries with high standards of perinatal care; however the long-term outcomes of pregnancy-related VT are unknown. Aims: To assess the long-term prevalence of post-thrombotic syndrome (PTS), a frequently occurring chronic complication after deep vein thrombosis (DVT), to identify possible predictors for PTS, and to evaluate disease specific quality of life (QOL) after pregnancy-related DVT as compare...

  20. Preclinical rodent toxicity studies for long term use of ceftriaxone

    Directory of Open Access Journals (Sweden)

    Elena Ratti


    Ceftriaxone showed rapid absorption with half-life values ranging between 1 and 1.5 h. Additionally, there was no evidence of accumulation and a virtually complete elimination by 16 h after the last dose. Overall there were no toxicologically meaningful drug-related animal findings associated with the long-term administration (6 months of ceftriaxone. These results support safety of long-term use of ceftriaxone in human clinical trials.

  1. Long-term patient survival in ANCA-associated vasculitis

    DEFF Research Database (Denmark)

    Flossmann, Oliver; Berden, Annelies; de Groot, Kirsten


    Wegener's granulomatosis and microscopic polyangiitis are antineutrophil cytoplasm antibodies (ANCA)-associated vasculitides with significant morbidity and mortality. The long-term survival of patients with ANCA associated vasculitis treated with current regimens is uncertain.......Wegener's granulomatosis and microscopic polyangiitis are antineutrophil cytoplasm antibodies (ANCA)-associated vasculitides with significant morbidity and mortality. The long-term survival of patients with ANCA associated vasculitis treated with current regimens is uncertain....

  2. Alzheimer's disease: our biggest long-term health challenge. (United States)

    Hassan, Fred


    As we grapple with reforming health care in America, the discussion often seems to gravitate to short-term issues while ignoring growing long-term threats. There is a health care tsunami approaching. It is Alzheimer's Disease. How we deal with this crisis will tell us a lot about how we are doing on health policies and actions for the long term--and about how we are doing as a society.

  3. Adverse event reporting in Czech long-term care facilities. (United States)

    Hěib, Zdenřk; Vychytil, Pavel; Marx, David


    To describe adverse event reporting processes in long-term care facilities in the Czech Republic. Prospective cohort study involving a written questionnaire followed by in-person structured interviews with selected respondents. Long-term care facilities located in the Czech Republic. Staff of 111 long-term care facilities (87% of long-term care facilities in the Czech Republic). None. Sixty-three percent of long-term health-care facilities in the Czech Republic have adverse event-reporting processes already established, but these were frequently very immature programs sometimes consisting only of paper recording of incidents. Compared to questionnaire responses, in-person interview responses only partially tended to confirm the results of the written survey. Twenty-one facilities (33%) had at most 1 unconfirmed response, 31 facilities (49%) had 2 or 3 unconfirmed responses and the remaining 11 facilities (17%) had 4 or more unconfirmed responses. In-person interviews suggest that use of a written questionnaire to assess the adverse event-reporting process may have limited validity. Staff of the facilities we studied expressed an understanding of the importance of adverse event reporting and prevention, but interviews also suggested a lack of knowledge necessary for establishing a good institutional reporting system in long-term care.

  4. The Effect of Massachusetts' Health Reform on Employer-Sponsored Insurance Premiums. (United States)

    Cogan, John F; Hubbard, R Glenn; Kessler, Daniel


    In this paper, we use publicly available data from the Medical Expenditure Panel Survey - Insurance Component (MEPS-IC) to investigate the effect of Massachusetts' health reform plan on employer-sponsored insurance premiums. We tabulate premium growth for private-sector employers in Massachusetts and the United States as a whole for 2004 - 2008. We estimate the effect of the plan as the difference in premium growth between Massachusetts and the United States between 2006 and 2008-that is, before versus after the plan-over and above the difference in premium growth for 2004 to 2006. We find that health reform in Massachusetts increased single-coverage employer-sponsored insurance premiums by about 6 percent, or $262. Although our research design has important limitations, it does suggest that policy makers should be concerned about the consequences of health reform for the cost of private insurance.

  5. Innovative Strategy For Long Term Monitoring Of Metal And Radionuclide Plumes

    Energy Technology Data Exchange (ETDEWEB)

    Eddy-Dilek, Carol; Millings, Margaret R.; Looney, Brian B.; Denham, Miles E.


    Many government and private industry sites that were once contaminated with radioactive and chemical wastes cannot be cleaned up enough to permit unrestricted human access. The sites will require long term management, in some cases indefinitely, leaving site owners with the challenge of protecting human health and environmental quality at these "legacy" sites. Long-term monitoring of groundwater contamination is one of the largest projected costs in the life cycle of environmental management at the Savannah River Site, the larger DOE complex, and many large federal and private sites. There is a need to optimize the performance and manage the cost of long term surveillance and monitoring at their sites. Currently, SRNL is initiating a pilot field test using alternative protocols for long term monitoring of metals and radionuclides. A key component of the approach is that monitoring efforts are focused on measurement of low cost metrics related to hydrologic and chemical conditions that control contaminant migration. The strategy combines careful monitoring of hydrologic boundary conditions with measurement of master variables such as chemical surrogates along with a smaller number of standard well analyses. In plumes contaminated with metals, master variables control the chemistry of the groundwater system, and include redox variables (ORP, DO, chemicals), pH, specific conductivity, biological community (breakdown/decay products), and temperature. Significant changes in these variables will result in conditions whereby the plume may not be stable and therefore can be used to predict possible plume migration. Conversely, concentration measurements for all types of contaminants in groundwater are a lagging indicator plume movement - major changes contaminant concentrations indicate that contamination has migrated. An approach based on measurement of master variables and explicit monitoring of hydrologic boundary conditions combined with traditional metrics should lead

  6. A review on strontium ranelate long-term antifracture efficacy in the treatment of postmenopausal osteoporosis (United States)

    Cianferotti, Luisella; D’Asta, Federica


    Osteoporotic fractures are one of the major causes of increased morbidity and mortality in postmenopausal women and the overall aging population. One of the major issues in the management of postmenopausal osteoporosis is to find a safe and effective treatment in the long term (>3 years) to achieve and maintain a reduction in the risk of fracture. Strontium ranelate (PROTELOS®) is a relatively novel drug, currently approved in Europe for the treatment of postmenopausal osteoporosis. Strontium ranelate is the first agent of a new therapeutic class in osteoporosis, capable of both promoting bone formation and, to a lesser extent, inhibiting bone resorption. This uncoupling in bone turnover results in a net gain in bone mineral density (BMD), bone quality improvement and reduction in risk of vertebral and nonvertebral fractures, as initially demonstrated in the preplanned long-term registrative trials SOTI (Spinal Osteoporosis Therapeutic Intervention) and TROPOS (Treatment of Peripheral Osteoporosis) at 5 years. Recently, open-label extensions of the SOTI and TROPOS trials up to 8 and, recently, 10 years have confirmed the sustained efficacy of strontium ranelate in increasing BMD, the long-term safety profile and the high compliance to treatment, independently from baseline BMD or other risk factors for osteoporotic fractures. Recent economic impact analyses have proved that long-term treatment with strontium ranelate is highly cost effective, especially in women older than 70 years of age. Histomorphometric analyses in animals and humans participating in the phase III trials have proved that the quality of mineralization is preserved in the long term and bone microarchitecture is ameliorated, with increased bone strength. Thus, strontium ranelate has been confirmed to be an effective compound for the long-term, chronic treatment of postmenopausal osteoporosis. PMID:23858336

  7. Long-term flow monitoring of submarine gas emanations (United States)

    Spickenbom, K.; Faber, E.; Poggenburg, J.; Seeger, C.


    One of the Carbon Capture and Storage (CCS) strategies currently under study is the sequestration of CO2 in sub-seabed geological formations. Even after a thorough review of the geological setting, there is the possibility of leaks from the reservoirs. As part of the EU-financed project CO2ReMoVe (Research, Monitoring, Verification), which aims to develop innovative research and technologies for monitoring and verification of carbon dioxide geological storage, we are working on the development of submarine long-term gas flow monitoring systems. Technically, however, these systems are not limited to CO2 but can be used for monitoring of any free gas emission (bubbles) on the seafloor. The basic design of the gas flow sensor system was derived from former prototypes developed for monitoring CO2 and CH4 on mud volcanoes in Azerbaijan. This design was composed of a raft floating on the surface above the gas vent to collect the bubbles. Sensors for CO2 flux and concentration and electronics for data storage and transmission were mounted on the raft, together with battery-buffered solar panels for power supply. The system was modified for installation in open sea by using a buoy instead of a raft and a funnel on the seafloor to collect the gas, which is then guided above water level through a flexible tube. Besides some technical problems (condensed water in the tube, movement of the buoys due to waves leading to biased measurement of flow rates), this setup provides a cost-effective solution for shallow waters. However, a buoy interferes with ship traffic, and it is also difficult to adapt this design to greater water depths. These requirements can best be complied by a completely submersed system. To allow unattended long-term monitoring in a submarine environment, such a system has to be extremely durable. Therefore, we focussed on developing a mechanically and electrically as simple setup as possible, which has the additional advantage of low cost. The system

  8. Socioeconomics of long-term glaucoma therapy in India

    Directory of Open Access Journals (Sweden)

    Bhagabat Nayak


    Full Text Available Purpose: To determine the socioeconomic impact of long-term glaucoma therapy. Materials and Methods: One hundred and fifty consecutive glaucoma patients on medical therapy, following up at our glaucoma service for at least 6 months were recruited. A questionnaire regarding monthly income, cost of glaucoma medications prescribed, availability of medications, travel time, time spent in review clinics, compliance, education status, medical insurance and systemic or local side-effects was administered. Results: The patients seen at the tertiary government hospital had an average monthly income of Rs. 10,912/- (range: Rs. 500/- to Rs. 50,000/- with approximately 56% of the patients having an income of less than Rs. 5000/month. The expenditure on anti-glaucoma medications ranged from 0.3% in high income group to 123% of their monthly gross income in low income group (P < 0.0001. The total expenditure including travel, stay, and loss of wages of patients and accompanying persons ranged from 1.6% in high income group to 137% of the monthly income in low income group (P < 0.0001. Mean time required for a glaucoma clinic visit was 15.66 h, (range: 6-96 h/month. About 2.7% experienced systemic side-effects and 21.3% had complaints of ocular adverse effects. About 90% of the patients were compliant. 92% were not covered by any insurance plan/government reimbursement for their treatment. Conclusions: Medical therapy for glaucoma is an economic burden to many patients and should be individualized, according to the socioeconomic status, availability of drugs and the required distance to travel to reach the specialist clinics.

  9. Mesozoic long-term eustatic cycles and their uncertain hierarchy

    Directory of Open Access Journals (Sweden)

    Dmitry A. Ruban


    Full Text Available Global sea-level has changed in a cyclic manner through geologic history, but the regularities of these changes are yet to be fully understood. Despite certain (and sometimes significant differences, the available Mesozoic eustatic curves permit the outlining of long-term eustatic cycles, which are provisionally defined as cycles recognizable at the stage level and higher. Interpretation of the Triassic eustatic curves indicates two orders of long-term cycles and a 1st-order sea-level rise throughout the entire period. The Jurassic eustatic curves imply cyclicity of one or two orders, and a 1st-order eustatic rise during the entire period is also evident. Most challenges are interpretations for the Cretaceous; two to four orders of long-term eustatic cycles can be established for this period. Generally, the hierarchy of the long-term eustatic cycles might have changed through the Mesozoic. If so, and if one considers differences of cycles of the same order between the periods of this era, it is difficult to apply “standard” hierarchical classifications to the documented cycles. The hypothetical uncertainty of the hierarchy of the Mesozoic long-term eustatic cycles is an important challenge for modern researchers.

  10. Long-Term Retardation of Uranium in the KURT Environment

    Energy Technology Data Exchange (ETDEWEB)

    Baik, Min Hoon [KAERI, Daejeon (Korea, Republic of); Shin, Joo Do [KARA, Seoul (Korea, Republic of); Park, Tae Jin [KAERI, Daejeon (Korea, Republic of)


    One of possibilities resolving this issue is to study the migration and retardation processes of radionuclides in the subsurface environments by using naturally occurring radionuclides as analogues of radioactive waste. To date, however, the long-term behavior of radionuclides in a granitic groundwater system is not yet fully understood. The ubiquitous presence of uranium (U) in rocks makes it an ideal natural analogue for studying the behaviors of radionuclides in a deep geological repository for the final disposal of HLW. In this study, long-term retardation behavior of natural uranium was investigated using granite rock samples taken from the KURT (KAERI Underground Research Tunnel), located in Daejeon city. The distribution of uranium and its binding mechanism in granite samples were investigated using the sequential chemical extraction (SCE) technique combined with X-ray diffraction (XRD) and ICP-MS methods. In this study, the long-term retardation of uranium in the KURT environment was investigated using SCE and EPMA techniques combined with ICP-MS and XRD. Results showed that long-term interaction of rock with groundwater can change U species and mineralize dissolved U, which can consequently contribute to the retardation of U in the fractured granitic rock environment. This study will help us to understand the long-term behavior of radionuclides migrating through the fractured granite rock and then enhance the reliability of the safety assessment for a HLW repository.

  11. Long-Term Stewardship Program Science and Technology Requirements

    Energy Technology Data Exchange (ETDEWEB)

    Joan McDonald


    Many of the United States’ hazardous and radioactively contaminated waste sites will not be sufficiently remediated to allow unrestricted land use because funding and technology limitations preclude cleanup to pristine conditions. This means that after cleanup is completed, the Department of Energy will have long-term stewardship responsibilities to monitor and safeguard more than 100 sites that still contain residual contamination. Long-term stewardship encompasses all physical and institutional controls, institutions, information, and other mechanisms required to protect human health and the environment from the hazards remaining. The Department of Energy Long-Term Stewardship National Program is in the early stages of development, so considerable planning is still required to identify all the specific roles and responsibilities, policies, and activities needed over the next few years to support the program’s mission. The Idaho National Engineering and Environmental Laboratory was tasked with leading the development of Science and Technology within the Long-Term Stewardship National Program. As part of that role, a task was undertaken to identify the existing science and technology related requirements, identify gaps and conflicts that exist, and make recommendations to the Department of Energy for future requirements related to science and technology requirements for long-term stewardship. This work is summarized in this document.

  12. Long-term psychosocial consequences of surgical congenital malformations. (United States)

    Diseth, Trond H; Emblem, Ragnhild


    Surgical congenital malformations often represent years of treatment, large number of hospital stays, treatment procedures, and long-term functional sequels affecting patients' psychosocial functioning. Both functional defects and psychosocial difficulties that occur commonly in childhood may pass through adolescence on to adulthood. This overview presents reports published over the past 3 decades to elucidate the long-term psychosocial consequences of surgical congenital malformations. Literature searches conducted on PubMed database revealed that less than 1% of all the records of surgical congenital malformations described long-term psychosocial consequences, but with diverse findings. This inconsistency may be due to methodological differences or deficiencies; especially in study design, patient sampling, and methods. Most of the studies revealed that the functional deficits may have great impact on patients' mental health, psychosocial functioning, and QoL; both short- and long-term negative consequences. Factors other than functional problems, e.g., repeated anesthesia, multiple hospitalization, traumatic treatment procedures, and parental dysfunctioning, may also predict long-term mental health and psychosocial functioning. Through multidisciplinary approach, pediatric surgeons should also be aware of deficits in emotional and psychosocial functioning. To achieve overall optimal psychosocial functioning, the challenge is to find a compromise between physically optimal treatment procedures and procedures that are not psychologically detrimental. Copyright © 2017. Published by Elsevier Inc.

  13. Method for Water Management Considering Long-term Probabilistic Forecasts (United States)

    Hwang, J.; Kang, J.; Suh, A. S.


    This research is aimed at predicting the monthly inflow of the Andong-dam basin in South Korea using long-term probabilistic forecasts to apply long-term forecasts to water management. Forecasted Cumulative Distribution Functions (CDFs) of monthly precipitation are plotted by combining the range of monthly precipitation based on proper Probability Density Function (PDF) in past data with probabilistic forecasts in each category. Ensembles of inflow are estimated by entering generated ensembles of precipitation based on the CDFs into the 'abcd' water budget model. The bias and RMSE between averages in past data and observed inflow are compared to them in forecasted ensembles. In our results, the bias and RMSE of average precipitation in the forecasted ensemble are bigger than in past data, whereas the average inflow in the forecasted ensemble is smaller than in past data. This result could be used for reference data to apply long-term forecasts to water management, because of the limit in the number of forecasted data for verification and differences between the Andong-dam basin and the forecasted regions. This research has significance by suggesting a method of applying probabilistic information in climate variables from long-term forecasts to water management in Korea. Original data of a climate model, which produces long-term probabilistic forecasts should be verified directly as input data of a water budget model in the future, so that a more scientific response in water management against uncertainty of climate change could be reached.

  14. Confronting the challenges of long-term health care crisis in the United States. (United States)

    Hussain, Aftab; Rivers, Patrick A


    This article examines the factors that comprise long-term health care and the impact that the aging population will have in dramatically increasing the costs of long-term health care in the United States if current health policies are not amended. It further analyzes the reasons that will cause the health care expenditures to expand. It also discusses the economic challenges and the impact that absent reform can have on state and federal budgets, ultimately affecting the national economy. Aside from that, this article presents numerous options that communities across the nation can embark on to reduce health care costs and it briefly glances at the proposed legislation called America's Affordable Health Choices Act of 2009 that was submitted by the House Committee on Ways and Means and in summary discusses the key features of the bill.

  15. El coste de los cuidados de larga duración en la población española: análisis comparativo entre los años 1999 y 2008 || The Cost of Long-Term Care in the Spanish Population Comparative Analysis between 1999 and 2008


    Alcañiz Zanón, Manuela; Alemany Leira, Ramón; Bolancé Losilla, Catalina; Guillén Estany, Montserrat


    Este trabajo analiza los costes de los cuidados de larga duración (CLD) ligados a los individuos en situación de dependencia. El coste económico unitario de los servicios de cuidados de larga duración está relacionado con el tiempo esperado de necesidad de la atención y la intensidad de los servicios requeridos. Se ha estimado el coste individual esperado en CLD, desde el momento en que se inicia la dependencia, para la población española mayor de 65 años y separadamente para los hombres y la...

  16. Job burnout and job wornout as risk factors for long-term sickness absence. (United States)

    Hallsten, Lennart; Voss, Margaretha; Stark, Stefan; Josephson, Malin


    Contingent self-esteem has been assumed to be a risk for burnout-related disorders, and a contingent self-worth notion of job burnout was applied to study the prospective relationship between job burnout and registered episodes of sickness absence of ≥ 60 consecutive days. Job burnout was defined as being in the high quartiles on the Maslach Burnout Inventory - General Survey (MBI-GS) scales of exhaustion and cynicism and, in addition, as being above the median on a scale for performance-based self-esteem. Another high exhaustion-cynicism group, a "job wornout" group, was defined as being high on the same MBI-GS scales but having performance-based self-esteem scores below the median. Data were analyzed by a multivariate, logistic regression approach. 4,109 public employees in Sweden. The job burnout group showed an over-risk of long-term sickness absence incidence, both compared with a low exhaustion-cynicism reference group and with the job wornout group after adjustment for several potential confounders. No association with incidence of long-term sickness absence was found for the job wornout group. The differential vulnerability to long-term sickness absence among high exhaustion-cynicism groups suggests that a self-worth perspective of job burnout can be advantageous for prevention of the costly long-term sickness absences.

  17. Patent Citations and Financial Analysts’ Long-Term Growth Forecasts

    Directory of Open Access Journals (Sweden)

    Jincheol Bae


    Full Text Available This paper examines the influence of patent citations, a proxy for the quality of firms’ innovation outputs, on financial analysts’ long-term growth forecasts for firms. We find that financial analysts are more likely to issue long-term forecasts for firms with higher patent citations. In addition, we find that financial analysts’ long-term forecasts are more positive for firms with high patent citations. These results imply that patent citations increase financial analysts’ coverage, and result in more positive forecasts for firms with impactful patents. Considering that financial analysts play important roles in allocating financial resources in capital markets, our findings suggest that patents are valuable assets for firms in securing capital from capital markets, and are thus essential for the sustainable growth of firms.

  18. Stirling engine - Approach for long-term durability assessment (United States)

    Tong, Michael T.; Bartolotta, Paul A.; Halford, Gary R.; Freed, Alan D.


    The approach employed by NASA Lewis for the long-term durability assessment of the Stirling engine hot-section components is summarized. The approach consists of: preliminary structural assessment; development of a viscoplastic constitutive model to accurately determine material behavior under high-temperature thermomechanical loads; an experimental program to characterize material constants for the viscoplastic constitutive model; finite-element thermal analysis and structural analysis using a viscoplastic constitutive model to obtain stress/strain/temperature at the critical location of the hot-section components for life assessment; and development of a life prediction model applicable for long-term durability assessment at high temperatures. The approach should aid in the provision of long-term structural durability and reliability of Stirling engines.

  19. Long-term Internship through Cooperative Education with Regional Industries (United States)

    Takahashi, Kenzo; Hase, Hiroyuki

    The long term internship is one of special educational programs for graduate students of Graduate School of Engineering in University of Fukui. This is a collaborative program between university and industries where selected post-graduate students are dispatched to companies for a long term and educated in real business environments. It is the final goal of the program to develop sophisticated specialists who would be able to catch the business strategy in industries and solve any problems by themselves. The program is managed in a semester (6 months) and contains 1.5 month prior education of preliminary special knowledge, ethics and secrecy, about 3 month dispatch with long-term internship, and 1.5 month post-education for complementary education and presentation. This paper presents the effect of this program which has been evolving since 2005.

  20. Winning market positioning strategies for long term care facilities. (United States)

    Higgins, L F; Weinstein, K; Arndt, K


    The decision to develop an aggressive marketing strategy for its long term care facility has become a priority for the management of a one-hundred bed facility in the Rocky Mountain West. Financial success and lasting competitiveness require that the facility in question (Deer Haven) establish itself as the preferred provider of long term care for its target market. By performing a marketing communications audit, Deer Haven evaluated its present market position and created a strategy for solidifying and dramatizing this position. After an overview of present conditions in the industry, we offer a seven step process that provides practical guidance for positioning a long term care facility. We conclude by providing an example application.

  1. Are long-term bisphosphonate users a reality?

    DEFF Research Database (Denmark)

    Abrahamsen, B


    The prevalence of long-term bisphosphonate use may be low due to low refill compliance and gaps in treatment. An analysis of the prescription history of 58,674 bisphosphonate users in Denmark found that only 2.8 % had received ten dose years of treatment or above. INTRODUCTION: This study aims...... to describe the demographics of present bisphosphonate (BP) users, to determine the prevalence of long-term BP use, and to establish if long-term use (a 10-year history of osteoporosis treatment) translated to ten dose years of bisphosphonate prescriptions filled, given the propensity for treatment gaps...... and low refill compliance with bisphosphonates. METHODS: The study population was all persons aged 35 and above, who had filled at least one prescription for an oral bisphosphonate in the year 2008. Past use of osteoporosis medications (bisphosphonates, raloxifene, strontium ranelate, or PTH analogs...

  2. How to improve long-term outcome after liver transplantation? (United States)

    Durand, François


    The outcome of liver transplantation has markedly improved in the last 3 decades. Although early post-transplantation outcomes have improved over time, this is not true of the long-term outcome. The majority of late deaths are not related to graft dysfunction, and with the advent of new antiviral agents, recurrence of hepatitis B and hepatitis C after transplantation may no longer represent a source of graft loss and patient's death in the long term. The complications of metabolic syndrome may represent an increasing source of morbidity and mortality after transplantation. This study discusses these modifiable factors associated with late mortality to improve the long-term results of transplantation. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  3. Long-term intravenous treatment of Pompe disease with recombinant human alpha-glucosidase from milk


    Hout, Johanna; Sibbles, Barbara; Brakenhoff, Just; Cromme-Dijkhuis, Adri; Weisglas-Kuperus, Nynke; Reuser, Arnold; Boer, Marijke; Smeitink, Jan; Diggelen, Otto; Voort, Edwin; Corven, Emiel; Hirtum, Hans; Kamphoven, Joep; Ploeg, Ans; Hove, Johan


    OBJECTIVE: Recent reports warn that the worldwide cell culture capacity is insufficient to fulfill the increasing demand for human protein drugs. Production in milk of transgenic animals is an attractive alternative. Kilogram quantities of product per year can be obtained at relatively low costs, even in small animals such as rabbits. We tested the long-term safety and efficacy of recombinant human -glucosidase (rhAGLU) from rabbit milk for the treatment of the lysosomal storage disorder Pomp...

  4. Long term fuel price elasticity: Effect of price changes on mobility tool ownership


    Erath, Alexander; Axhausen, Kay W.


    The study analyzes how mobility tool usage and ownership as well as residence location choice are affected by rising fuel costs. Based on econometric models, long-term fuel price elasticities are derived. Based on data collected in stated choice and stated adaptation experiments that were conducted as computer-based face-to-face surveys, a structural equation model was estimated. The resulting fuel price elasticities are primarily dependent on fuel type and fuel price level, but sociodemograp...

  5. The Forecasting Procedure for Long-Term Wind Speed in the Zhangye Area


    Guo, Zhenhai; Dong, Yao; Wang, Jianzhou; Lu, Haiyan


    Energy crisis has made it urgent to find alternative energy sources for sustainable energy supply; wind energy is one of the attractive alternatives. Within a wind energy system, the wind speed is one key parameter; accurately forecasting of wind speed can minimize the scheduling errors and in turn increase the reliability of the electric power grid and reduce the power market ancillary service costs. This paper proposes a new hybrid model for long-term wind speed forecasting based on the fir...

  6. 42 CFR 412.536 - Special payment provisions for long-term care hospitals and satellites of long-term care... (United States)


    ... Federal rate in effect at the time of the long-term care hospital discharge. (2) Operating inpatient... hospitals and satellites of long-term care hospitals that discharged Medicare patients admitted from a... payment provisions for long-term care hospitals and satellites of long-term care hospitals that discharged...


    Directory of Open Access Journals (Sweden)

    Manju Khanna


    Full Text Available With present stress, being laid on green energy worldwide, harnessing solar energy for commercial use has importance in sizing and long-term prediction of solar radiation. However, with continuous changing environment parameters, it is quite difficult for long-term prediction of solar radiation. In the past research scholars, have carried out solar prediction only for a few days, which is insufficient to exploit the radiation for sizing and harnessing the solar energy for commercial use. To overcome this gap, present work utilizes application of lifting wavelet transform along with ANFIS to predict the radiation for long duration.

  8. Long-Term Effects of School Size on Students' Outcomes

    DEFF Research Database (Denmark)

    Humlum, Maria Knoth; Smith, Nina

    We estimate the effect of school size on students' long-term outcomes such as high school completion, being out of the labor market, and earnings at the age of 30. We use rich register data on the entire population of Danish children attending grade 9 in the period 1986-2004. This allows us...... school size and alternative measures of long-term success in the educational system and the labor market. The positive impact of school size seems mainly to be driven by boys, students from families with a low educational level and students attending schools in urban areas....

  9. Long-term recurrence and death rates after acute pancreatitis

    DEFF Research Database (Denmark)

    Lund, Helle; Tønnesen, Hanne; Tønnesen, Maja Hanne


    The aim of this study was to compare long-term recurrence and death rates after a first episode of acute pancreatitis in patients with and without gallstones. Additionally, it was of interest to find out if there were factors predictive of readmission or death.......The aim of this study was to compare long-term recurrence and death rates after a first episode of acute pancreatitis in patients with and without gallstones. Additionally, it was of interest to find out if there were factors predictive of readmission or death....

  10. Factors associated with long-term mortality in acute pancreatitis

    DEFF Research Database (Denmark)

    Nøjgaard, Camilla; Matzen, Peter; Bendtsen, Flemming


    Abstract Background and aims. Knowledge of the long-term prognosis of acute pancreatitis (AP) is limited. The aims were to investigate: (1) prognostic factors associated with long-term mortality in patients with AP; (2) whether or not the level of serum (S-)amylase at admission had an impact...... on the prognosis; (3) causes of death in these patients. Methods. During 1977-1982, patients who were admitted to the five main hospitals in Copenhagen with a diagnosis of AP or chronic pancreatitis (CP) were included in a prospective cohort, the Copenhagen Pancreatitis Study (CPS); in 2008, they were followed up...

  11. Long-term treatment of chronic hepatitis B

    Directory of Open Access Journals (Sweden)

    Experts attending the discussion on long-treatment of chronic hepatitis B


    Full Text Available Nucleos(tide analogs (NAs have been successfully used for treatment of chronic hepatitis B. Hepatitis B virus (HBV replication is now recognized as the key driver of liver injury and disease progression, so the primary aim of treatment for chronic HBV infection is to maximize sustained suppression of HBV replication to undetectable levels. The long-term treatment has also been shown to achieve substantial histological improvement and regression of liver fibrosis or cirrhosis, and reduction of hepatocellular carcinoma. This paper has reviewed the necessity, clinical benefits, and the management of long-term treatment for chronic hepatitis B.

  12. Mapping long-term wetland response to climate (United States)

    Zhou, Q.; Gallant, A.; Rover, J.


    Wetlands provide unique feeding and breeding habitat for numerous waterfowl species. The distribution of wetlands has been considerably changed due to agricultural land conversion and hydrologic modification. Climate change may further impact wetlands through altered moisture regimes. This study characterized long-term variation in wetland conditions by using dense time series from all available Landsat data from 1985 to 2014. We extracted harmonic frequencies from 30 years to two years to delineate the long-term variation in all seven Landsat bands. A cluster analysis and unsupervised classification then enabled us to map different classes of wetland response. We demonstrated the method in the Prairie Pothole Region in North Dakota.

  13. Long-term stability scintillation tiles for LHCb detector

    CERN Document Server

    Grinyov, B V; Khlapova, N P; Lebedev, V N; Melnychuk, S V; Senchyshyn, V G


    Accelerated thermal aging tests of materials-UPS-923A, UPS-96G, UPS-96GM and their analogues, SCSN-81 (Kuraray) and BC-408 (Bicron)- were made. A forecast of tile lifetime was made for normal conditions of usage (20% reduction of light output and 50% reduction of the bulk attenuation length (BAL) and technical attenuation length (TAL). Scintillator UPS-96GM has the most long-term stability of parameters- more than 11 yr. BC-408 samples have the minimum lifetime ~7 yr. The long-term stability, calculated by light yield reduction, of UPS-96G, UPS-923A and SCSN-81 is 10, 9 and 8 yr, respectively.

  14. Long-term skeletal findings in Menkes disease

    Energy Technology Data Exchange (ETDEWEB)

    Amador, Eva [Son Dureta Children' s Hospital, Department of Paediatric Radiology, Palma de Mallorca (Spain); Domene, Ruth; Fuentes, Cristian; Carreno, Juan-Carlos; Enriquez, Goya [Vall d' Hebron Children' s Hospital, Department of Paediatric Radiology, Barcelona (Spain)


    Skeletal findings in infants with Menkes disease, the most characteristic of which are metaphyseal spurs, long-bone fractures and wormian bones, have been widely reported. However, the changes in skeletal features over time are not well known. The long-term findings differ completely from those initially observed and consist of undertubulation and metaphyseal flaring, similar to the findings seen in some types of bone dysplasia. The initial and long-term radiological features in an 8-year-old boy with Menkes disease are illustrated. (orig.)

  15. A discrete event modelling framework for simulation of long-term outcomes of sequential treatment strategies for ankylosing spondylitis

    NARCIS (Netherlands)

    Tran-Duy, A.; Boonen, A.; Laar, M.A.F.J.; Franke, A.C.; Severens, J.L.


    Objective To develop a modelling framework which can simulate long-term quality of life, societal costs and cost-effectiveness as affected by sequential drug treatment strategies for ankylosing spondylitis (AS). Methods Discrete event simulation paradigm was selected for model development. Drug

  16. Long-term results after repair of ruptured and non-ruptured abdominal aortic aneurysm

    Directory of Open Access Journals (Sweden)

    Kuzmanović Ilija B.


    Full Text Available INTRODUCTION Abdominal aortic aneurysm can be repaired by elective procedure while asymptomatic, or immediately when it is complicated - mostly due to rupture. Treating abdominal aneurysm electively, before it becomes urgent, has medical and economical reason. Today, the first month mortality after elective operations of the abdominal aorta aneurysm is less than 3%; on the other hand, significant mortality (25%-70% has been recorded in patients operated immediately because of rupture of the abdominal aneurysm. In addition, the costs of elective surgical treatment are significantly lower. OBJECTIVE The objective of this study is to compare long-term survival of patients that underwent elective or immediate repair of abdominal aortic aneurysm (due to rupture, and to find out the factors influencing the long-term survival of these patients. MATERIAL AND METHODS Through retrospective review of prospectively collected data of the Institute for Cardiovascular Diseases of Clinical Center of Serbia, Belgrade, 56 patients that had elective surgery and 35 patients that underwent urgent operation due to rupture of abdominal aneurysm were followed up. Only the patients that survived 30 postoperative days were included in this review, and were followed up (ranging from 2 to 126 months. Electively operated patients were followed during 58.82 months on the average (range 7 to 122, and urgently operated were followed over 52.26 months (range 2 to 126. There was no significant difference of the length of postoperative follow-up between these two groups. RESULTS During this period, out of electively operated and immediately operated patients, 27 and 22 cases died, respectively. There was no significant difference (p>0,05a of long-term survival between these two groups. Obesity and early postoperative complications significantly decreased long-term survival of both electively and immediately operated patients. Graft infection, ventral hernia, aneurysm of

  17. Intermittent catheterisation for long-term bladder management. (United States)

    Prieto, Jacqui; Murphy, Catherine L; Moore, Katherine N; Fader, Mandy


    , mean differences and 95% confidence intervals were calculated for each outcome. Because of trial heterogeneity, it was not always possible to combine data to give an overall estimate of treatment effect. Thirty-one trials met the inclusion criteria, including 13 RCTs and 18 cross-over trials. Most were small (less than 60 participants completed), although five trials had more than 100 participants. There was considerable variation in length of follow-up and definitions of UTI. Participant dropout was a problem for several trials, particularly where there was long-term follow-up to measure incidence of UTI. Fifteen trials were more than 10 years old and focused mainly on comparing different catheterisation techniques (e.g. single versus multiple-use) on clinical outcomes whereas, several more recent trials have focused on comparing different types of catheter designs or materials, especially coatings, and user preference. It was not possible to combine data from some trials owing to variations in the catheters tested and in particular the catheter coatings. Where there were data, confidence intervals around estimates were wide and hence clinically important differences in UTI and other outcomes could neither be identified nor reliably ruled out. No study assessed cost-effectiveness. Despite a total of 31 trials, there is still no convincing evidence that the incidence of UTI is affected by use of aseptic or clean technique, coated or uncoated catheters, single (sterile) or multiple-use (clean) catheters, self-catheterisation or catheterisation by others, or by any other strategy. Results from user-reported outcomes varied. The current research evidence is weak and design issues are significant. More well-designed trials are strongly recommended. Such trials should include analysis of cost-effectiveness because there are likely to be substantial differences associated with the use of different catheter designs, catheterisation techniques and strategies.

  18. WITHDRAWN: Intermittent catheterisation for long-term bladder management. (United States)

    Prieto, Jacqui; Murphy, Catherine L; Moore, Katherine N; Fader, Mandy


    , mean differences and 95% confidence intervals were calculated for each outcome. Because of trial heterogeneity, it was not always possible to combine data to give an overall estimate of treatment effect. Thirty-one trials met the inclusion criteria, including 13 RCTs and 18 cross-over trials. Most were small (less than 60 participants completed), although five trials had more than 100 participants. There was considerable variation in length of follow-up and definitions of UTI. Participant dropout was a problem for several trials, particularly where there was long-term follow-up to measure incidence of UTI. Fifteen trials were more than 10 years old and focused mainly on comparing different catheterisation techniques (e.g. single versus multiple-use) on clinical outcomes whereas, several more recent trials have focused on comparing different types of catheter designs or materials, especially coatings, and user preference. It was not possible to combine data from some trials owing to variations in the catheters tested and in particular the catheter coatings. Where there were data, confidence intervals around estimates were wide and hence clinically important differences in UTI and other outcomes could neither be identified nor reliably ruled out. No study assessed cost-effectiveness. Despite a total of 31 trials, there is still no convincing evidence that the incidence of UTI is affected by use of aseptic or clean technique, coated or uncoated catheters, single (sterile) or multiple-use (clean) catheters, self-catheterisation or catheterisation by others, or by any other strategy. Results from user-reported outcomes varied. The current research evidence is weak and design issues are significant. More well-designed trials are strongly recommended. Such trials should include analysis of cost-effectiveness because there are likely to be substantial differences associated with the use of different catheter designs, catheterisation techniques and strategies.

  19. Hippocampal Focal Knockout of CBP Affects Specific Histone Modifications, Long-Term Potentiation, and Long-Term Memory (United States)

    Barrett, Ruth M; Malvaez, Melissa; Kramar, Eniko; Matheos, Dina P; Arrizon, Abraham; Cabrera, Sara M; Lynch, Gary; Greene, Robert W; Wood, Marcelo A


    To identify the role of the histone acetyltransferase (HAT) CREB-binding protein (CBP) in neurons of the CA1 region of the hippocampus during memory formation, we examine the effects of a focal homozygous knockout of CBP on histone modifications, gene expression, synaptic plasticity, and long-term memory. We show that CBP is critical for the in vivo acetylation of lysines on histones H2B, H3, and H4. CBP's homolog p300 was unable to compensate for the loss of CBP. Neurons lacking CBP maintained phosphorylation of the transcription factor CREB, yet failed to activate CREB:CBP-mediated gene expression. Loss of CBP in dorsal CA1 of the hippocampus resulted in selective impairments to long-term potentiation and long-term memory for contextual fear and object recognition. Together, these results suggest a necessary role for specific chromatin modifications, selectively mediated by CBP in the consolidation of memories. PMID:21508930

  20. An Investigation of Factors Influencing High Usage of Medical and Long-Term Care Services in an Aging Society in Japan. (United States)

    Kazawa, Kana; Rahman, Md Moshiur; Moriyama, Michiko


    Medical and long-term care costs are increasing all over the world. In this study, we investigated the characteristics of groups with high cost of medical and long-term care to define targets for curbing social security costs. As a result, for the population covered by the National Health Insurance, a large portion of medical costs were incurred for mental disorders, malignant neoplasms, and lifestyle-related diseases. For those covered by the Late Elderly Health Insurance System, most medical costs were incurred for lifestyle-related diseases, femoral fractures, neurological diseases, mental disorders, pneumonia, malignant neoplasms, and Alzheimer's disease. From multiple regression analysis, the hospitalization days, use of advanced medical treatment, outpatient days, and high long-term care level influenced the increased costs. On the other hand, disease characteristics had only a very low effect. These findings suggest that the target population has complex medical and long-term care needs because they have multiple diseases.

  1. Behind the scenes of GS: a long-term urban planning vision

    CERN Multimedia

    Corinne Pralavorio


    The GS Department is working on a long-term plan for the urban planning of the CERN sites, ensuring that their development takes place using a coherent approach and keeping in mind the need for harmonious integration in the surrounding area.   Visitors are often bemused by CERN’s buildings, with their 1950s style and a layout that seems to defy all logic. Up until the 90s, buildings were erected as accelerators were built, with no apparent concern for harmony. But now, with a much larger number of users and installations, space is at a premium, getting around the site is difficult and urban planners are needed more than ever. "Over 9,000 people enter the CERN sites every day and we have 7,500 workstations," says Frédéric Magnin, Civil Engineering and Buildings Section Leader in the GS Department. For this reason, specialists in the department have been working on the development of the sites for five years. It is especially important that the...

  2. Valuation of Long-Term Investments in Energy Assets under Uncertainty

    Directory of Open Access Journals (Sweden)

    Luis M. Abadie


    Full Text Available This paper aims to contribute to the development of valuation models for long-term investments while keeping an eye on market prices. The adopted methodology is rooted on the existence of markets for futures and options on commodities related to energy investments. These markets are getting ever-increasingly liquid with ever-longer maturities while trading contracts. We discuss the advantages of this approach relative to other alternatives such as the Net Present Value (NPV or the Internal Rate of Return (IRR, despite a limited increase in the complexity of the models involved. More specifically, using the valuation methods well-known to energy-finance academics, the paper shows how to: break down an investment into its constituent parts, apply to each of them the corresponding risk premium, value annuities on assets with a deterministic or stochastic behavior, and value the options that are available to its owner, in order to get an overall value of the investment project. It also includes an application to improvement in coal consumption, where futures markets are used to get a numerical estimate of the parameters that are required for valuation. The results are then compared with those from traditional methodologies. Conclusions for this type of investments under uncertainty are derived.

  3. Coding of the long-term value of multiple future rewards in the primate striatum. (United States)

    Yamada, Hiroshi; Inokawa, Hitoshi; Matsumoto, Naoyuki; Ueda, Yasumasa; Enomoto, Kazuki; Kimura, Minoru


    Decisions maximizing benefits involve a tradeoff between the quantity of a reward and the cost of elapsed time until an animal receives it. The estimation of long-term reward values is critical to attain the most desirable outcomes over a certain period of time. Reinforcement learning theories have established algorithms to estimate the long-term reward values of multiple future rewards in which the values of future rewards are discounted as a function of how many steps of choices are necessary to achieve them. Here, we report that presumed striatal projection neurons represent the long-term values of multiple future rewards estimated by a standard reinforcement learning model while monkeys are engaged in a series of trial-and-error choices and adaptive decisions for multiple rewards. We found that the magnitude of activity of a subset of neurons was positively correlated with the long-term reward values, and that of another subset of neurons was negatively correlated throughout the entire decision-making process in individual trials: from the start of the task trial, estimation of the values and their comparison among alternatives, choice execution, and evaluation of the received rewards. An idiosyncratic finding was that neurons showing negative correlations represented reward values in the near future (high discounting), while neurons showing positive correlations represented reward values not only in the near future, but also in the far future (low discounting). These findings provide a new insight that long-term value signals are embedded in two subsets of striatal neurons as high and low discounting of multiple future rewards.

  4. Plastic mulching in agriculture. Trading short-term agronomic benefits for long-term soil degradation? (United States)

    Steinmetz, Zacharias; Wollmann, Claudia; Schaefer, Miriam; Buchmann, Christian; David, Jan; Tröger, Josephine; Muñoz, Katherine; Frör, Oliver; Schaumann, Gabriele Ellen


    Plastic mulching has become a globally applied agricultural practice for its instant economic benefits such as higher yields, earlier harvests, improved fruit quality and increased water-use efficiency. However, knowledge of the sustainability of plastic mulching remains vague in terms of both an environmental and agronomic perspective. This review critically discusses the current understanding of the environmental impact of plastic mulch use by linking knowledge of agricultural benefits and research on the life cycle of plastic mulches with direct and indirect implications for long-term soil quality and ecosystem services. Adverse effects may arise from plastic additives, enhanced pesticide runoff and plastic residues likely to fragment into microplastics but remaining chemically intact and accumulating in soil where they can successively sorb agrochemicals. The quantification of microplastics in soil remains challenging due to the lack of appropriate analytical techniques. The cost and effort of recovering and recycling used mulching films may offset the aforementioned benefits in the long term. However, comparative and long-term agronomic assessments have not yet been conducted. Furthermore, plastic mulches have the potential to alter soil quality by shifting the edaphic biocoenosis (e.g. towards mycotoxigenic fungi), accelerate C/N metabolism eventually depleting soil organic matter stocks, increase soil water repellency and favour the release of greenhouse gases. A substantial process understanding of the interactions between the soil microclimate, water supply and biological activity under plastic mulches is still lacking but required to estimate potential risks for long-term soil quality. Currently, farmers mostly base their decision to apply plastic mulches rather on expected short-term benefits than on the consideration of long-term consequences. Future interdisciplinary research should therefore gain a deeper understanding of the incentives for farmers

  5. Mixing induces long-term hyperthermia in growing pigs

    NARCIS (Netherlands)

    de Jong, IC; Lambooij, E; Korte, SM; Blokhuis, HJ; Koolhaas, JM


    The purpose of this experiment was to determine whether body temperature is a sensitive parameter to measure long-term effects of stress in pigs. Mixing of unacquainted pigs is a severe stressor that has detrimental effects on health, production and welfare. We measured deep body temperature after

  6. Long term water integration in interconnected ramets of ...

    African Journals Online (AJOL)

    Buffalograss (Buchloë dactyloides) is known for its drought resistant character. Natural resources are patchily distributed and resource sharing between interconnected ramets can enhance the performance of the whole genet. In order to examine whether there exists long term water integration between interconnected ...

  7. Suicidal Behavior in Long-Term Care Facilities. (United States)

    Osgood, Nancy J.; Brant, Barbara A.


    Surveyed administrators of 463 long-term care facilities concerning overt suicides and intentional life-threatening behaviors. Data revealed that White males were highest risk group. Refusal to eat, drink, or take medications were most common suicidal behaviors. Depression, loneliness, feelings of family rejection, and loss were significant…

  8. Modelling the Long-term Periglacial Imprint on Mountain Landscapes

    DEFF Research Database (Denmark)

    Andersen, Jane Lund; Egholm, David Lundbek; Knudsen, Mads Faurschou

    Studies of periglacial processes usually focus on small-scale, isolated phenomena, leaving less explored questions of how such processes shape vast areas of Earth’s surface. Here we use numerical surface process modelling to better understand how periglacial processes drive large-scale, long-term...

  9. Long-term outcome in patients with juvenile dermatomyositis

    DEFF Research Database (Denmark)

    Mathiesen, P; Hegaard, H; Herlin, Troels


    To evaluate a group of 53 patients with juvenile dermatomyositis (JDM), on average 13.9 years after disease onset, in order to describe the long-term disease outcome and to identify disease-related parameters associated with poor disease outcome....

  10. Long-Term Outcomes of an Urban Farming Internship Program (United States)

    Sonti, Nancy Falxa; Campbell, Lindsay K.; Johnson, Michelle L.; Daftary-Steel, Sarita


    Long-term impacts of an urban farming youth internship were evaluated in Brooklyn, New York. Alumni surveyed 1 to 9 years after program completion were enrolled in college or graduate school at higher rates than their peers and reported connections to the environment and healthy eating. Participants reported learning job skills through the…

  11. Long-term salt stress responsive growth, carbohydrate metabolism ...

    African Journals Online (AJOL)

    We investigated the long-term responses of tobacco tissues to salt stress, with a particular interest for growth parameters, proline (Pro) accumulation, and carbohydrate metabolism. Exposure of 17-day-old tobacco plants to 0.2 M NaCl was followed by a higher decrease in dry matter in roots than shoots with a decrease of ...

  12. Domestic resource mobilization and long term economic growth in ...

    African Journals Online (AJOL)

    The objective of this paper is to examine the long term effects of domestic resource mobilization (DRM) on economic growth. This study used macroeconomic data for a period of 20 years spanning 1996 to 2015. By estimating the Autoregressive distributed lag (ARDL) model, Error Correction Model (ECM) and Impulse ...

  13. Recent warming reverses long-term arctic cooling

    DEFF Research Database (Denmark)

    kaufman, D.S.; Vinther, Bo Møllesøe


    continued through the Middle Ages and into the Little Ice Age. A 2000-year transient climate simulation with the Community Climate System Model shows the same temperature sensitivity to changes in insolation as does our proxy reconstruction, supporting the inference that this long-term trend was caused...

  14. Long-Term Growth and Fiscal Development Policies: The Ghanaian ...

    African Journals Online (AJOL)

    The article aims at clarifying the relationship between long-term growth and fiscal policy variables. Growth equations are derived from a structural macroeconomic model. The model developed here postulates that the steady-growth rate of output becomes endogenous and is influenced by government policies.

  15. Long term stability of cannabis resin and cannabis extracts

    DEFF Research Database (Denmark)

    Lindholst, Christian


      The aim of the present study was to investigate the stability of cannabinoids in cannabis resin slabs and cannabis extracts upon long-term storage. The levels of tetrahydrocannabinol (THC), cannabinol (CBN), cannabidiol (CBD) and cannabigerol (CBG) on both neutral and acidic form were measured...

  16. Endothelial damage in long-term survivors of childhood cancer

    NARCIS (Netherlands)

    Brouwer, Cornelia A J; Postma, Aleida; Hooimeijer, H Louise H; Smit, Andries J; Vonk, Judith M; van Roon, A. M.; van den Berg, Maarten P; Dolsma, W.; Lefrandt, Johan; Bink - Boelkens, Margaretha; Zwart, Nynke; de Vries, Elisabeth G. E.; Tissing, Wim J E; Gietema, Jourik A


    PURPOSE: To evaluate the presence of vascular damage in long-term childhood cancer survivors (CCS) and sibling controls, and to evaluate the association between vascular damage parameters and cancer treatment and influence of cardiovascular risk factors. PATIENTS AND METHODS: Vascular assessment was

  17. Long term neurological complications of bacterial meningitis in ...

    African Journals Online (AJOL)


    Long term neurological complications of bacterial meningitis in Nigerian children. Accepted: 11th March 2013. Frank-Briggs AI ... illnesses, a person's memory, mo- tor and cognitive abilities, con- centration, speech, and physique ... follow up prospective study of children with meningitis at the. Paediatric neurology unit of the.

  18. Long-term neurodevelopmental outcome after fetal arrhythmia

    NARCIS (Netherlands)

    Lopriore, Enrico; Aziz, Muhammed I.; Nagel, Helene T.; Blom, Nico A.; Rozendaal, Lieke; Kanhai, Humphrey H. H.; Vandenbussche, Frank P. H. A.


    OBJECTIVE: The purpose of this study was to determine the long-term neurodevelopmental outcome in fetuses with severe tachy- or bradyarrhythmia. STUDY DESIGN: This was a follow-up study to assess the neurologic, mental, and psychomotor development in cases with fetal cardiac arrhythmia. RESULTS: A

  19. Autonomy and Acceptance of Long-Term Care (United States)

    Hsu, Hui-Chuan; Ting, Yu-Shan; Jiang, Ting-Wen; Chien, Ming-Chih; Chien, Chih-Hsin


    This study explored the relationship between four types of autonomy (health autonomy, informational autonomy, living autonomy, and financial autonomy) and the acceptance of five types of long-term care (adult day care, respite care, assisted living, unit care, and group home) for the elderly in Taiwan. Data were collected from 167 middle-aged and…

  20. Neural correlates of long-term intense romantic love (United States)

    Aron, Arthur; Fisher, Helen E.; Brown, Lucy L.


    The present study examined the neural correlates of long-term intense romantic love using functional magnetic resonance imaging (fMRI). Ten women and 7 men married an average of 21.4 years underwent fMRI while viewing facial images of their partner. Control images included a highly familiar acquaintance; a close, long-term friend; and a low-familiar person. Effects specific to the intensely loved, long-term partner were found in: (i) areas of the dopamine-rich reward and basal ganglia system, such as the ventral tegmental area (VTA) and dorsal striatum, consistent with results from early-stage romantic love studies; and (ii) several regions implicated in maternal attachment, such as the globus pallidus (GP), substantia nigra, Raphe nucleus, thalamus, insular cortex, anterior cingulate and posterior cingulate. Correlations of neural activity in regions of interest with widely used questionnaires showed: (i) VTA and caudate responses correlated with romantic love scores and inclusion of other in the self; (ii) GP responses correlated with friendship-based love scores; (iii) hypothalamus and posterior hippocampus responses correlated with sexual frequency; and (iv) caudate, septum/fornix, posterior cingulate and posterior hippocampus responses correlated with obsession. Overall, results suggest that for some individuals the reward-value associated with a long-term partner may be sustained, similar to new love, but also involves brain systems implicated in attachment and pair-bonding. PMID:21208991

  1. Long-Term English Learners Writing Their Stories (United States)

    Jacobs, C. Lynn


    High school teacher C. Lynn Jacobs noted that the long-term English language learners in her class had improved in reading comprehension but still lacked writing skills. Inspired by a state humanities project, she worked with the students to publish a collection of stories and poems. Writing about their lives provided the motivation, and writing…

  2. Long-term followup of hypospadias: functional and cosmetic results

    NARCIS (Netherlands)

    Rynja, Sybren P.; Wouters, Gerlof A.; van Schaijk, Maaike; Kok, Esther T.; de Jong, Tom P.; de Kort, Laetitia M.


    We assessed long-term results after hypospadias surgery with respect to urinary and sexual function, cosmetic appearance and intimate relationships. We contacted 116 patients who are now adults and who underwent surgery between 1987 and 1992. Participation included mailed questionnaires containing

  3. long-term hepatotoxicity and hypoglycaemic study of aqueous ...

    African Journals Online (AJOL)


    The use of Carica papaya extracts as an anti-diabetic remedy in Nigeria is well documented. Since these extracts are usually taken for long periods of time, it is important to assess their long term biochemical effects so as to ascertain their safety. In this study, the effects of aqueous extracts of C. papaya leaves, orally ...

  4. Long-term hepatotoxicity and hypoglycaemic study of Aqueous ...

    African Journals Online (AJOL)

    The use of Carica papaya extracts as an anti-diabetic remedy in Nigeria is well documented. Since these extracts are usually taken for long periods of time, it is important to assess their long term biochemical effects so as to ascertain their safety. In this study, the effects of aqueous extracts of C. papaya leaves, orally ...

  5. North American long-term soil productivity research program (United States)

    Allan E. Tiarks; Marilyn A. Buford; Robert F. Powers; Jerry F. Ragus; Deborah S. Page-Dumroese; Felix Ponder; Douglas M. Stone


    The National Long-term Soil Productivity research program was chartered to address National Forest Management Act concerns over possible losses n soil productivity on national forest lands. The program supports validation of soil quality monitoring standards and process-level productivity research. Summarized results are supplied to forests as collected. National...

  6. Long-term brain slice culturing in a microfluidic platform

    DEFF Research Database (Denmark)

    Vedarethinam, Indumathi; Avaliani, N.; Tønnesen, J.


    In this work, we present the development of a transparent poly(methyl methacrylate) (PMMA) based microfluidic culture system for handling long-term brain slice cultures independent of an incubator. The different stages of system development have been validated by culturing GFP producing brain...... brain slice culturing for 16 days....

  7. Long term evolution of coastal morphology and global change

    NARCIS (Netherlands)

    Capobianco, M.; De Vriend, H.J.; Nicholls, R.J.; Stive, M.J.F.


    Long-term prediction of sediment transport and of morphological behaviour in the coastal zone, in response to human interference or to change in environmental conditions (collectively global change) is an increasingly important issue in coastal zone management, especially in relation to the needs

  8. Article Title: Appraisal of Long Term Groundwater Quality of ...

    Indian Academy of Sciences (India)


    Article Title: Appraisal of Long Term Groundwater Quality of Peninsular India using Water Quality Index and. Fractal Dimension. Authors Names: 1. Dr(Er.). Kishan Singh Rawat#. Centre for Remote Sensing and Geo-Informatics,. Sthyabama University. Chennai-600119, India. E-mail: 2. Dr. Sudhir ...

  9. Long-term protection of hepatitis B vaccination among Egyptian ...

    African Journals Online (AJOL)

    Background: Hepatitis B Vaccination is the most effective way to prevent transmission of hepatitis B virus (HBV). Objective: to detect the long-term immunogenicity of the vaccine in Egyptian children after five and ten years of vaccination. Methods: Two hundreds healthy children were recruited. They were divided into two ...

  10. Long-term survival in small-cell lung cancer

    DEFF Research Database (Denmark)

    Lassen, U; Osterlind, K; Hansen, M


    PURPOSE: To describe in patients with small-cell lung cancer (SCLC) the characteristics of those who survive for > or = 5 years, to identify long-term prognostic factors, to analyze survival data of 5-year survivors, and to study 10-year survival in patients entered before 1981. PATIENTS......, especially tobacco-related cancers and other tobacco-related diseases....

  11. [The behavior of bioelements during long-term parenteral feeding]. (United States)

    Herold, G; Stephan, B; Menzel, T


    26 adult patients were investigated for 26--35 postoperative days while being fed parenterally. Serum levels and urine excretion of zinc, magnesium, calcium and phosphate were measured. From the results it can be assumed that only phosphate substitution is necessary during parenteral long-term nutrition.

  12. A cross cultural comparison of long-term supply relationships

    NARCIS (Netherlands)

    Jong, Gjalt de; Nooteboom, Bart


    This paper challenges the received view that long-term supply relationships are a typically Japanese feature, embedded and developed in a typically Japanese society characterized by high levels of trust and cooperation, and for that reason cannot be established in the typically a-cooperative,

  13. Temporary and long-term consequences of bereavement on happiness

    NARCIS (Netherlands)

    Moor, J.A.; de Graaf, P.M.

    In this article, we examine the temporary and long-term consequences of the death of a parent or child on happiness. According to set-point theory external conditions are expected to only have a short-term or limited influence on happiness. This directly contradicts the basic assumption of affective

  14. Long Term Toxicity of Cancer Treatment in Older Patients (United States)

    Shahrokni, Armin; Wu, Abraham; Carter, Jeanne; Lichtman, Stuart M.


    Synopsis With earlier cancer diagnosis among older cancer patients, the possibility of curing cancer increases. However, cancer treatment may have long lasting impact on older cancer survivors. It is vital to screen, diagnose and properly manage the long term toxicities of cancer treatment, in order to maintain quality of life of older cancer survivors PMID:26614861

  15. Long-Term Parental Illness and Children: Perils and Promises. (United States)

    Johnston, Mona; And Others


    Discusses effects of long-term parental illness, focusing on effects on children. Describes effects on family homeostasis and family coping mechanisms. Discusses school counselor's role in bringing about a more balanced viewpoint of power and sharing within the family. Recommends establishing a strong therapeutic bond, assessing what the child is…

  16. [Disappointing long-term experiences of patients with penile prosthesis

    NARCIS (Netherlands)

    Meuleman, E.J.H.; Deunk, L.; Schreuders-Bais, C.; Rabsztyn, P.


    OBJECTIVE: To describe the long-term experience with the implantation of a penile prosthesis as a last resort treatment for erectile dysfunction. DESIGN: Retrospective and descriptive. METHOD: During the period 1986-1996, 124 men received a penile prosthesis. Basic information was obtained from

  17. Long-Term Effects of Neurofeedback Treatment in Autism (United States)

    Kouijzer, Mirjam E. J.; de Moor, Jan M. H.; Gerrits, Berrie J. L.; Buitelaar, Jan K.; van Schie, Hein T.


    Previously we demonstrated significant improvement of executive functions and social behavior in children with autism spectrum disorders (ASD) treated with 40 sessions of EEG neurofeedback in a nonrandomized waiting list control group design. In this paper we extend these findings by reporting the long-term results of neurofeedback treatment in…

  18. Long-Term Effects of Adderall XR in ADHD

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap


    Full Text Available The long-term tolerability and effectiveness of extended release mixed amphetamine salts (Adderall XR in children with attention deficit hyperactivity disorder (ADHD were evaluated in a 24-month, multicenter, open-label extension of 2 placebo-controlled studies at UCLA, Massachusetts General Hospital, UC-Irvine, Maitland, FL, and Shire Pharmaceutical, Wayne, PA.

  19. Long-term Ecological Monitoring in Schools and Colleges. (United States)

    Doberski, Julian; Brodie, Iain D. S.


    The value and difficulties of long-term ecological monitoring studies undertaken in schools and colleges are reviewed. Rookeries, stream ecology, sand dune succession, fish population, and seed production and survival are presented as examples of successful studies. This is followed by a discussion of points to consider when setting up a long-term…

  20. Current Perspectives on Long-term Obesity Pharmacotherapy. (United States)

    Wharton, Sean


    Approximately 1 in 4 adult Canadians are obese and, thus, are at an elevated risk for developing type 2 diabetes, cardiovascular disease and other conditions. Current treatment guidelines recommend that obese individuals lose 5% to 10% of their starting weights to minimize the risk factors for cardiovascular disease and reduce the risk for developing type 2 diabetes or hypertension. All obesity-management strategies involve lifestyle management, but few patients will lose a significant amount of weight and manage to keep it off over the long term using just this strategy. Bariatric surgery is associated with significant long-term weight loss but is restricted to subjects with very high body mass indices, who often wait many years to undergo the procedure. Recent breakthroughs in understanding the mechanisms underlying the development and maintenance of elevated body fat have led to the arrival of new obesity pharmacotherapies. These novel antiobesity therapies, which work by reducing energy intake or through increasing satiety, decreasing hunger, or reducing absorption of calories, may be used indefinitely once patients have demonstrated significant responses (usually defined as ≥5% weight loss) over the first 12 weeks of treatment. To date, 2 long-term obesity pharmacotherapies have been approved and are available in Canada: liraglutide and orlistat. Here, I summarize the mechanisms and clinical features of medications for long-term obesity management that are available in Canada, as well as those available in other jurisdictions or are currently in development. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

  1. Outcome of Long-Term Mechanical Ventilation Support in Children

    Directory of Open Access Journals (Sweden)

    Shao-Hsuan Hsia


    Conclusions: There are now more children on long-term MV support in Taiwan and most are in respiratory care wards in local hospitals. The shift in underlying diagnoses from pulmonary disease to neurogenic respiratory insufficiency affects hospitalization. The main cause of respiratory insufficiency is neurologic insult.

  2. Areas of Marital Dissatisfaction among Long-Term Couples (United States)

    Duba, Jill D.; Hughey, Aaron W.; Lara, Tracy; Burke, Monica G.


    To better understand relational dissatisfaction and duration of long-term married couples, this study surveyed 30 couples married at least 40 years with the Marital Satisfaction Inventory. Findings suggest various areas of dissatisfaction (e.g., affective communication, conflict over child rearing) and relationship among and link to other areas of…

  3. Long term ocular and neurological involvement in severe congenital toxoplasmosis

    NARCIS (Netherlands)

    Meenken, C.; Assies, J.; van Nieuwenhuizen, O.; Holwerda-van der Maat, W. G.; van Schooneveld, M. J.; Delleman, W. J.; Kinds, G.; Rothova, A.


    This study was set up to determine the long term ocular and systemic sequelae in patients with severe congenital toxoplasmosis. Cross sectional and retrospective study of 17 patients with severe congenital toxoplasmosis. In addition to chorioretinitis (100%), the most common abnormal ocular features

  4. Effects of Long-Term Kerosene Spillage on Heterotrophic ...

    African Journals Online (AJOL)

    Michael Horsfall

    This revealed that long-term kerosene slippage had a selecting effect on soil bacteria as opposed to soil ... The oil industry is the main stay of Nigerian economy ... using auger borer. Preparation and incubation of soil samples: The soil samples obtained for analysis were bulked, air dried and passed through a 2mm sieve to ...

  5. Long-term outcomes after upper limb arterial injuries

    NARCIS (Netherlands)

    vanderSluis, CK; Kucey, DS; Brenneman, FD; Hunter, GA; Maggisano, R; tenDuis, HJ

    OBJECTIVE: To assess long-term outcomes in multisystem trauma victims who have arterial injuries to upper limbs. DESIGN: A retrospective case series. SETTING: Tertiary care regional trauma centre in a university hospital. PATIENTS: All consecutive severely injured patients (Injury Severity Score

  6. Institutional Repositories as Infrastructures for Long-Term Preservation (United States)

    Francke, Helena; Gamalielsson, Jonas; Lundell, Björn


    Introduction: The study describes the conditions for long-term preservation of the content of the institutional repositories of Swedish higher education institutions based on an investigation of how deposited files are managed with regards to file format and how representatives of the repositories describe the functions of the repositories.…

  7. Long-term human-robot interaction with young users

    NARCIS (Netherlands)

    Baxter, P.; Belpaeme, T.; Canamero, L.; Cosi, P.; Demiris, Y.; Enescu, V.; Et al.


    Artificial companion agents have the potential to combine novel means for effective health communication with young patients support and entertainment. However, the theory and practice of long-term child-robot interaction is currently an underdeveloped area of research. This paper introduces an

  8. Species richness inside and outside long-term exclosures (United States)

    W. A. Laycock; D. L. Bartos; K. D. Klement


    Recent environmental literature contains claims that livestock grazing has caused reduction in species diversity on Western rangelands. Data of species richness (number of species) is presented from inside and outside 24 long-term exclosures in Montana, Utah, and Wyoming. For the average of all exclosures there was no difference between species richness inside and...

  9. Long-Term Outcome in Pyridoxine-Dependent Epilepsy (United States)

    Bok, Levinus A.; Halbertsma, Feico J..; Houterman, Saskia; Wevers, Ron A.; Vreeswijk, Charlotte; Jakobs, Cornelis; Struys, Eduard; van der Hoeven, Johan H.; Sival, Deborah A.; Willemsen, Michel A.


    Aim: The long-term outcome of the Dutch pyridoxine-dependent epilepsy cohort and correlations between patient characteristics and follow-up data were retrospectively studied. Method: Fourteen patients recruited from a national reference laboratory were included (four males, 10 females, from 11 families; median age at assessment 6y; range 2y…

  10. Structural composite panel performance under long-term load (United States)

    Theodore L. Laufenberg


    Information on the performance of wood-based structural composite panels under long-term load is currently needed to permit their use in engineered assemblies and systems. A broad assessment of the time-dependent properties of panels is critical for creating databases and models of the creep-rupture phenomenon that lead to reliability-based design procedures. This...

  11. Modeling Wettability Variation during Long-Term Water Flooding

    Directory of Open Access Journals (Sweden)

    Renyi Cao


    Full Text Available Surface property of rock affects oil recovery during water flooding. Oil-wet polar substances adsorbed on the surface of the rock will gradually be desorbed during water flooding, and original reservoir wettability will change towards water-wet, and the change will reduce the residual oil saturation and improve the oil displacement efficiency. However there is a lack of an accurate description of wettability alternation model during long-term water flooding and it will lead to difficulties in history match and unreliable forecasts using reservoir simulators. This paper summarizes the mechanism of wettability variation and characterizes the adsorption of polar substance during long-term water flooding from injecting water or aquifer and relates the residual oil saturation and relative permeability to the polar substance adsorbed on clay and pore volumes of flooding water. A mathematical model is presented to simulate the long-term water flooding and the model is validated with experimental results. The simulation results of long-term water flooding are also discussed.

  12. Long-term priming of the meanings of ambiguous words (United States)

    Rodd, Jennifer M.; Lopez Cutrin, Belen; Kirsch, Hannah; Millar, Allesandra; Davis, Matthew H.


    Comprehension of semantically ambiguous words (e.g., "bark") is strongly influenced by the relative frequencies of their meanings, such that listeners are biased towards retrieving the most frequent meaning. These biases are often assumed to reflect a highly stable property of an individual's long-term lexical-semantic representations. We present…

  13. The long-term financial consequences of breast cancer

    DEFF Research Database (Denmark)

    Jensen, Laura Schärfe; Overgaard, Charlotte; Bøggild, Henrik


    BACKGROUND: A breast cancer diagnosis affects an individual's affiliation to labour market, but the long-term consequences of breast cancer on income in a Danish setting have not been examined. The present study investigated whether breast cancer affected future income among Danish women that par...

  14. Long-term results of lower energy transurethral microwave thermotherapy

    NARCIS (Netherlands)

    Keijzers, G. B.; Francisca, E. A.; D'Ancona, F. C.; Kiemeney, L. A.; Debruyne, F. M.; de la Rosette, J. J.


    We evaluate long-term results of lower energy transurethral microwave thermotherapy (Prostasoft 2.0*) and identify pretreatment characteristics that predict a favorable outcome. Between December 1990 and December 1992, 231 patients with lower urinary tract symptoms were treated with lower energy

  15. Long-Term Impact of Service Learning in Environmental Studies (United States)

    MacFall, Janet


    Long-term impacts from a senior course in Environmental Studies were evaluated by a survey of program graduates (36 respondents, 50% response rate) who had participated in the course over an 8-year permiod. Each year, the Senior Seminar used a service-learning pedagogy with a different environmentally focused project ranging from web resource…

  16. Nurses struggle to help pupils with long-term conditions. (United States)

    Longhurst, Chris


    Most school nurses are not confident they can give essential support to pupils with long-term health conditions. Research by the National Children's Bureau found that, due to heavy workloads and the need to work across several schools, nine out of ten school nurses were less confident they can help children with conditions such as diabetes and asthma.

  17. Archiving primary data : Solutions for long-term studies

    NARCIS (Netherlands)

    Mills, James A.; Teplitsky, Celine; Arroyo, Beatriz; Charmantier, Anne; Becker, Peter. H.; Birkhead, Tim R.; Bize, Pierre; Blumstein, Daniel T.; Bonenfant, Christophe; Boutin, Stan; Bushuev, Andrey; Cam, Emmanuelle; Cockburn, Andrew; Cote, Steeve D.; Coulson, John C.; Daunt, Francis; Dingemanse, Niels J.; Doligez, Blandine; Drummond, Hugh; Espie, Richard H. M.; Festa-Bianchet, Marco; Frentiu, Francesca; Fitzpatrick, John W.; Furness, Robert W.; Garant, Dany; Gauthier, Gilles; Grant, Peter R.; Griesser, Michael; Gustafsson, Lars; Hansson, Bengt; Harris, Michael P.; Jiguet, Frederic; Kjellander, Petter; Korpimaki, Erkki; Krebs, Charles J.; Lens, Luc; Linne, John D. C.; Low, Matthew; McAdam, Andrew; Margalida, Antoni; Merila, Juha; Moller, Anders P.; Nakagawa, Shinichi; Nilsson, Jan-Ake; Nisbet, Ian C. T.; van Noordwijk, Arie J.; Oro, Daniel; Part, Tomas; Pelletier, Fanie; Potti, Jaime; Pujol, Benoit; Reale, Denis; Rockwel, Robert F.; Ropert-Coudert, Yan; Roulin, Alexandre; Sedinger, James S.; Swenson, Jon E.; Thebaud, Christophe; Visser, Marcel E.; Wanless, Sarah; Westneat, David F.; Wilson, Alastair J.; Zedrosser, Andreas


    The recent trend for journals to require open access to primary data included in publications has been embraced by many biologists, but has caused apprehension amongst researchers engaged in long-term ecological and evolutionary studies. A worldwide survey of 73 principal investigators (PIs) with

  18. Histological effects of long term administration of piliostigma ...

    African Journals Online (AJOL)

    Histological effects of long term administration of piliostigma thonningii stem bark on the liver of adult Wistar rats. ... Anatomy Journal of Africa ... by cervical dislocation on the twenty nine day of the experiment and the liver was carefully dissected out and quickly fixed in 10% formal saline for further routine histological study.

  19. Uterine artery embolization: Long term follow-up and implementation

    NARCIS (Netherlands)

    van der Kooij, S.M.


    This thesis aims to determine the position of uterine artery embolization (UAE) in the spectrum of treatments for symptomatic uterine fibroids and to stimulate its implementation into daily practice. To do this, firstly the following aspects of UAE were investigated: the long-term clinical results

  20. The efficacy of long-term psychotherapy: Methodological research issues

    NARCIS (Netherlands)

    Maat, S.M.; Dekker, J.J.M.; Schoevers, R.A.; Jonghe, de F.


    In evidence-based medicine (EBM) hierarchy, randomized controlled trials (RCTs) are ranked higher than cohort studies. However, cohort intervention studies are frequently, and RCTs rarely, used to investigate long-term psychotherapy (LTP). The authors compare the two methods and provide critical

  1. Lake restoration: successes, failures and long-term effects

    NARCIS (Netherlands)

    Sondergaard, M.; Jeppesen, E.; Lauridsen, T.L.; Skov, C.; Nes, van E.H.; Roijackers, R.M.M.; Lammens, E.; Portielje, R.


    1. Eutrophication constitutes a serious threat to many European lakes and many approaches have been used during the past 20–30 years to improve lake water quality. Results from the various lake restoration initiatives are diverse and the long-term effects are not well described. 2. In this study we

  2. Microfinance and rural development: a long-term perspective

    NARCIS (Netherlands)

    Moll, H.A.J.


    The long-term perspective on microfinance starts with a discussion of three central issues: first, views and policies, with two opposing views: "credit for target group" and "pushing the financial frontier"; second, the performance of microfinance institutions measured via two objectives: outreach

  3. Long-term Periodicity Analysis of Polarization Variation for Radio ...

    Indian Academy of Sciences (India)

    Abstract. We use the database of University of Michigan Radio As- tronomy Observatory (UMRAO) at three radio bands (4.8, 8 and 14.5. GHz) to analyse the long-term polarization variation in search of the pos- sible periodicity. Using the power spectral analysis method (PSA), the. Jurkevich method and the discrete ...

  4. Subintimal angioplasty: predictors of long-term success.

    LENUS (Irish Health Repository)

    Keeling, Aoife N


    To determine the clinical outcomes and success rates after percutaneous subintimal angioplasty (SIA) in patients with lower-limb occlusive lesions causing intermittent claudication (IC) or critical limb ischemia (CLI) at midterm to long-term follow-up. The secondary aim was to elicit factors predictive of a successful outcome.

  5. Long-term smoking results in haemostatic dysfunction in chronic ...

    African Journals Online (AJOL)

    Background: Smoking has been known to cause endothelial dysfunction and bronchial carcinoma and duration of smoking has been implicated in the effects of smoking on regular smokers. This study evaluated the effects of long-term smoking on some coagulation markers in chronic smokers. Materials and Methods: A ...

  6. Long-Term Sequelae after Cerebellar Astrocytoma Surgery

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap


    Full Text Available The long-term effects on neurologic, neuropsychological, and behavioral functioning in a consecutive series of 23 children treated surgically for cerebellar pilocytic astrocytoma without additional radio- and chemotherapy are determined in a study at Sophia Children’s Hospital, Rotterdam, The Netherlands, and other medical centers.

  7. Semi-automatic long-term acoustic surveying

    DEFF Research Database (Denmark)

    Andreassen, Tórur; Surlykke, Annemarie; Hallam, John


    Increasing concern about decline in biodiversity has created a demand for population surveys. Acoustic monitoring is an efficient non-invasive method, which may be deployed for surveys of animals as diverse as insects, birds, and bats. Long-term unmanned automatic monitoring may provide unique...... to determine bat behavior and correct for the bias toward loud bats inherent in acoustic surveying....

  8. Mathematics Learning Development: The Role of Long-Term Retrieval (United States)

    Calderón-Tena, Carlos O.; Caterino, Linda C.


    This study assessed the relation between long-term memory retrieval and mathematics calculation and mathematics problem solving achievement among elementary, middle, and high school students in nationally representative sample of US students, when controlling for fluid and crystallized intelligence, short-term memory, and processing speed. As…

  9. The Effect of Overlearning on Long-Term Retention (United States)

    Rohrer, Doug; Taylor, Kelli; Pashler, Harold; Wixted, John T.; Cepeda, Nicholas J.


    Once material has been learned to a criterion of one perfect trial, further study within the same session constitutes overlearning. Although overlearning is a popular learning strategy, its effect on long-term retention is unclear. In two experiments presented here, 218 college students learned geography facts (Experiment 1) or word definitions…

  10. 40 CFR 52.29 - Visibility long-term strategies. (United States)


    ... of this part. (b) Definitions. For the purposes of this section, all terms shall have the meaning as ascribed to them in the Clean Air Act, or in the protection of visibility program (40 CFR 51.301). (c) Long... retrofit technology (BART) and meeting other schedules set forth in the long-term strategy; (vi) The impact...

  11. Long-term RNA persistence in postmortem contexts

    DEFF Research Database (Denmark)

    Fordyce, Sarah Louise; Kampmann, Marie-Louise; van Doorn, Nienke L.


    Ribonucleic acids (RNA) are generally considered fragile molecules that are readily degraded. However, there is growing documentation of long-term (from days to centuries) RNA persistence in a variety of contexts and tissue types, and as such a number of academic disciplines are beginning...

  12. Concept Formation Skills in Long-Term Cochlear Implant Users (United States)

    Castellanos, Irina; Kronenberger, William G.; Beer, Jessica; Colson, Bethany G.; Henning, Shirley C.; Ditmars, Allison; Pisoni, David B.


    This study investigated if a period of auditory sensory deprivation followed by degraded auditory input and related language delays affects visual concept formation skills in long-term prelingually deaf cochlear implant (CI) users. We also examined if concept formation skills are mediated or moderated by other neurocognitive domains (i.e.,…

  13. Drug taper during long-term video-EEG monitoring

    DEFF Research Database (Denmark)

    Guld, Asger Toke; Sabers, A; Kjaer, T W


    OBJECTIVES: Anti-epileptic drugs (AED) are often tapered to reduce the time needed to record a sufficient number of seizure during long-term video-EEG monitoring (LTM). Fast AED reduction is considered less safe, but few studies have examined this. Our goal is to examine whether the rate of AED r...

  14. Long-term efficacy of the pubovaginal Mersilene mesh sling. (United States)

    Young, Stephen B; Howard, Allison E; Illanes, Diego S; Weber LeBrun, Emily E; Hardy, Janet R; Kambiss, Scott M; O'Dell, Katharine K; Zhang, Yan


    The objective of the study was to determine the efficacy of the pubovaginal Mersilene mesh sling (PVMMS) for complicated urodynamic stress incontinence (USI). Between 1990 and 2008, patients with USI plus an at-risk diagnosis underwent a PVMMS by a single surgeon. They were followed up with urodynamics (UDE) and Pelvic Floor Distress Inventory-short form 20 (PFDI-20). Stratification was in an at-risk hierarchy: intrinsic sphincter deficiency (ISD) greater than recurrent USI (RUSI) greater than USI with chronically increased intraabdominal pressure (CI-IAP). A cough stress test determined objective cure. PFDI question 17 assessed subjective cure. Three hundred six patients with ISD (43.5%), RUSI (26.8%), and CI-IAP (29.7%) had objective cure rates of 89.2% in the short term, 86.7% in the intermediate term, and 91.2% in the long term. A group of 48 patients with both short- and long-term UDEs showed cures of 100% and 91.7%. Long-term objective cure rates were: ISD, 90.5% (n = 21); RUSI, 84.2%, (n = 19); CI-IAP, 100% (n = 17). The mean score of postoperative PFDI question 17 was 0.57 (n = 119). Mean symptom improvement was -2.98 (n = 52; P < .0001). We demonstrated PVMMS to be subjectively and objectively effective in long-term treatment of complicated forms of USI.

  15. Carpal Tunnel Syndrome in Patient on long Term Hemodialysis - a ...

    African Journals Online (AJOL)

    Pain in hands is a common complaint in patients of end-stage renal disease on long term hemodialysis. This pain can arise from various different etiological factors. We present one such case of 56 years old lady who suffered from pain in the hand due to carpal tunnel syndrome on the side with angioaccess. Carpal tunnel ...

  16. Long-Term Outcome in Guillain-Barre Syndrome

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap


    Full Text Available The long-term sequelae and early predictors of sequelae were determined in a chart review of 47 children with Guillain-Barre syndrome (GBS of whom 30 had been treated with intravenous gammaglobulin (IVIG at The Hospital for Sick Children, Toronto, Canada.

  17. Gender-Based Violence in India: Long-Term Trends (United States)

    Simister, John; Mehta, Parnika S.


    This article examines long-term trends in Indian society regarding domestic violence between husband and wife, and attitudes to such violence. This article analyzes crime data and uses data from several Indian household surveys: "Work Attitudes and Spending" surveys (1992 to 2007); "World Values Survey" (1990, 1995, 2001, and…

  18. Gap filling strategies for long term energy flux data sets

    NARCIS (Netherlands)

    Falge, E.; Baldocchi, D.; Olson, R.; Anthoni, P.; Aubinet, M.; Bernhofer, C.; Burba, G.; Ceulemans, R.; Clement, R.; Dolman, H.; Granier, A.; Gross, P.; Grünwald, T.; Hollinger, D.; Jensen, N.O.; Katul, G.; Keronen, P.; Kowalski, A.; Lai, C.T.; Law, B.E.; Meyers, T.; Moncrieff, J.; Moors, E.J.; Munger, J.W.; Pilegaard, K.; Rebmann, C.; Suyker, A.; Tenhunen, J.; Tu, K.


    At present a network of over 100 field sites are measuring carbon dioxide, water vapor and sensible heat fluxes between the biosphere and atmosphere, on a nearly continuous basis. Gaps in the long term measurements of evaporation and sensible heat flux must be filled before these data can be used

  19. Evidence of long term benefit of morbidity reduction due to ...

    African Journals Online (AJOL)

    Evidence of long term benefit of morbidity reduction due to praziquantel treatment against Schistosoma mansoni in Kigungu fishing village in Entebbe, Uganda. ... a yearly administration of praziquantel to the community could be a regiment for mass drug administration (MAD) for this community to control schistosomiasis ...

  20. Factors influencing long-term and seasonal waterbird abundance ...

    African Journals Online (AJOL)

    The spatial and temporal structures of waterbird communities are dynamic and complex with many driving factors. We used long-term waterbird census data at two lakes in Zimbabwe to explore the ecological and anthropogenic drivers of waterbird community composition and abundance. Ecological drivers predicted to ...

  1. Recognition of ships for long-term tracking

    NARCIS (Netherlands)

    Broek, S.P. van den; Bouma, H.; Veerman, H.E.T.; Benoist, K.W.; Hollander, R.J.M. den; Schwering, P.B.W.


    Long-term tracking is important for maritime situational awareness to identify currently observed ships as earlier encounters. In cases of, for example, piracy and smuggling, past location and behavior analysis are useful to determine whether a ship is of interest. Furthermore, it is beneficial to

  2. The Long-Term Effects of the Couple Communication Program. (United States)

    Joanning, Harvey


    Assessed the immediate and long-term impact of the Couple Communication Program. Married couples (N=17) were assigned to training groups. Change was assessed using self-report measures of marital adjustment and communication quality along with behavioral ratings of couple verbal interaction. Couples increased significantly on all measures at…

  3. Nutrition in children with long-term health conditions | Westwood ...

    African Journals Online (AJOL)

    Long-term health conditions (LTHCs) in children may affect nutrition and growth by means of multiple mechanisms. Both undernutrition and overweight/obesity are risk factors. Direct effects of the condition that may cause undernutrition include increased resting energy expenditure, excess losses through malabsorption, ...

  4. Antimicrobial use in long-term-care facilities

    NARCIS (Netherlands)

    Nicolle, LE; Bentley, DW; Garibaldi, R; Neuhaus, EG; Smith, PW

    There is intense antimicrobial use in long-term-care facilities (LTCFs), and studies repeatedly document that much of this use is inappropriate. The current crisis in antimicrobial resistance, which encompasses the LTCF, heightens concerns of antimicrobial use. Attempts to improve antimicrobial use

  5. Appraisal of long term groundwater quality of peninsular India using ...

    Indian Academy of Sciences (India)

    Kishan Singh Rawat


    Dec 8, 2017 ... A review has been made to understand the hydrogeochemical behaviour of groundwater through statistical analysis of long term water quality data (year 2005–2013). Water Quality Index (WQI), descriptive statistics, Hurst exponent, fractal dimension and predictability index were estimated for each.

  6. Acute mastoiditis in children: presentation and long term consequences.

    LENUS (Irish Health Repository)

    Glynn, F


    Acute mastoiditis, a destructive bacterial infection of the mastoid bone and air cell system, is relatively uncommon today but remains a potentially serious condition. There is a lack of information in the literature regarding the long term otological problems that children may face following an episode of this condition.

  7. Long-term outcomes of an urban farming internship program (United States)

    Nancy Falxa Sonti; Lindsay Campbell; Michelle Johnson; S. Daftary-Steel


    Long-term impacts of an urban farming youth internship were evaluated in Brooklyn, New York. Alumni surveyed 1 to 9 years after program completion were enrolled in college or graduate school at higher rates than their peers and reported connections to the environment and healthy eating. Participants reported learning job skills through the internship, including farming...

  8. Long-term prevention of diabetic nephropathy: an audit

    DEFF Research Database (Denmark)

    Schjoedt, K.J.; Hansen, H.P.; Tarnow, L.


    AIMS/HYPOTHESIS: In type 1 diabetic patients with microalbuminuria not receiving antihypertensive treatment, an increase in urinary AER (UAER) of 6-14%/year and a risk of developing diabetic nephropathy (DN) of 3-30%/year have been reported. We audited the long-term effect of blocking the renin...

  9. Long-term theranostic hydrogel system for solid tumors. (United States)

    Kim, Jang Il; Lee, Beom Suk; Chun, Changju; Cho, Jung-Kyo; Kim, Sang-Yoon; Song, Soo-Chang


    The long-term theranostic hydrogel system for solid tumors was prepared via simple physical mixing, which consisted of three major parts: the thermosensitive/biodegradable poly(organophosphazene) hydrogel, PEGylated cobalt ferrite nanoparticles, and paclitaxel (PTX). The PEGylated cobalt ferrite nanoparticles showed extremely low cytotoxicity due to the surface modification using PEG chains. The long-term theranostic hydrogel system showed adequate properties to be used for long-term MR theragnosis. In particular, the theranostic hydrogel gradually degraded over 28 days, and the PTX was sustainedly released out from the theranostic hydrogel over the same period in vitro. Furthermore, the in vivo efficacy of long-term MR theragnosis using the theranostic hydrogel system was estimated successfully over 3 weeks by using high field (4.7 T) animal MRI and solid tumor-bearing mice. Based on our results, we expect that this system can supply multiple data regarding a) the progress of therapy and b) the treatment processes via one- or two-time i.t. administration for cases in which surgical approaches are difficult to apply. Meanwhile, cancer patients can be free from the pain of multiple surgical treatments and have the advantage of therapy through a simple i.t. administration. Copyright © 2011 Elsevier Ltd. All rights reserved.

  10. Long-term outcome in pyridoxine-dependent epilepsy

    NARCIS (Netherlands)

    Bok, Levinus A.; Halbertsma, Feico J.; Houterman, Saskia; Wevers, Ron A.; Vreeswijk, Charlotte; Jakobs, Cornelis; Struys, Eduard; Van der Hoeven, Johan H.; Sival, Deborah A.; Willemsen, Michel A.

    AIM: The long-term outcome of the Dutch pyridoxine-dependent epilepsy cohort and correlations between patient characteristics and follow-up data were retrospectively studied. METHOD: Fourteen patients recruited from a national reference laboratory were included (four males, 10 females, from 11

  11. Long-term outcome in pyridoxine-dependent epilepsy.

    NARCIS (Netherlands)

    Bok, L.A.; Halbertsma, F.J.; Houterman, S.; Wevers, R.A.; Vreeswijk, C.; Jakobs, C.; Struys, E.; Hoeven, J.H. van; Sival, D.A.; Willemsen, M.A.A.P.


    Aim The long-term outcome of the Dutch pyridoxine-dependent epilepsy cohort and correlations between patient characteristics and follow-up data were retrospectively studied. Method Fourteen patients recruited from a national reference laboratory were included (four males, 10 females, from 11

  12. Predicting the long-term citation impact of recent publications

    NARCIS (Netherlands)

    Stegehuis, Clara; Litvak, Nelli; Waltman, Ludo


    A fundamental problem in citation analysis is the prediction of the long-term citation impact of recent publications. We propose a model to predict a probability distribution for the future number of citations of a publication. Two predictors are used: The impact factor of the journal in which a

  13. Predicting the long-term citation impact of recent publications

    NARCIS (Netherlands)

    Stegehuis, Clara; Litvak, Nelli; Waltman, Ludo

    A fundamental problem in citation analysis is the prediction of the long-term citation impact of recent publications. We propose a model to predict a probability distribution for the future number of citations of a publication. Two predictors are used: the impact factor of the journal in which a

  14. Incidental Biasing of Attention from Visual Long-Term Memory (United States)

    Fan, Judith E.; Turk-Browne, Nicholas B.


    Holding recently experienced information in mind can help us achieve our current goals. However, such immediate and direct forms of guidance from working memory are less helpful over extended delays or when other related information in long-term memory is useful for reaching these goals. Here we show that information that was encoded in the past…

  15. Long-Term Memory Biases Auditory Spatial Attention (United States)

    Zimmermann, Jacqueline F.; Moscovitch, Morris; Alain, Claude


    Long-term memory (LTM) has been shown to bias attention to a previously learned visual target location. Here, we examined whether memory-predicted spatial location can facilitate the detection of a faint pure tone target embedded in real world audio clips (e.g., soundtrack of a restaurant). During an initial familiarization task, participants…

  16. Effects of Acute Exercise on Long-Term Memory (United States)

    Labban, Jeffrey D.; Etnier, Jennifer L.


    In this study, we tested the effect of acute exercise on long-term memory, specifically the timing of exercise relative to the memory challenge. We assessed memory via paragraph recall, in which participants listened to two paragraphs (exposure) and recounted them following a 35-min delay. Participants (n = 48) were randomly assigned to one of…

  17. Long term results of Intramedullary Nailing in childhood femur ...

    African Journals Online (AJOL)

    Six patients had lengthening; 4 had atrophy of the thigh and 7 patients had coxa valga of operated limb. All patients with coxa valga had undergone the intervention before the age of 12 years. Conclusion: intramedullary nailing using Küntschter nails to treat femoral fractures in children may have some long terms sequelae.

  18. Dying with Dementia in Long-Term Care (United States)

    Sloane, Philip D.; Zimmerman, Sheryl; Williams, Christianna S.; Hanson, Laura C.


    Purpose: To better understand the experiences and potential unmet need of persons who die in long-term care. Design and Methods: We conducted after-death interviews with staff who had cared for 422 decedents with dementia and 159 who were cognitively intact and received terminal care in U.S. nursing homes (NHs) or residential care-assisted living…

  19. Long-term cerebral imaging after pre-eclampsia

    NARCIS (Netherlands)

    Aukes, A. M.; De Groot, J. C.; Wiegman, M. J.; Aarnoudse, J. G.; Sanwikarja, G. S.; Zeeman, G. G.

    Please cite this paper as: Aukes A, De Groot J, Wiegman M, Aarnoudse J, Sanwikarja G, Zeeman G. Long-term cerebral imaging after pre-eclampsia. BJOG 2012;119:11171122. Objective Formerly eclamptic women demonstrate cerebral white matter lesions (WMLs) several years following the index pregnancy. The

  20. Long-term psychological sequelae of augmentation mammoplasty ...

    African Journals Online (AJOL)

    A request for elective surgery for augmentation mammoplasty (AM) is often associated with underlying psychopathology and high expectations of a positive psychological outcome. This study was designed to ascertain the long-term psychological sequelae of AM in a group of patients who were reassessed 3 years or more ...