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Sample records for cost-effectiveness indirect chest

  1. Cost-effectiveness and radiological risk associated with mass chest screening

    International Nuclear Information System (INIS)

    Stieve, F.E.

    1987-01-01

    This report presents in summary the cost effectiveness and radiological risks associated with mass chest tuberculosis screening in major European countries. The state of tuberculosis in west Europe, the cost effectiveness of mass screening, international standards regarding radiation doses as well as the need for quality control are addressed

  2. The cost-effectiveness of carbon-fibre cassettes in mobile chest radiography

    International Nuclear Information System (INIS)

    Brennan, P.C.; Hourihan, S.P.

    1998-01-01

    Employment of carbon fibre materials is an effective method of reducing radiation dose, yet the increased associated costs have led to a reluctance in implementation. This study investigates the level of dose reduction achievable, while maintaining image quality, in mobile chest radiography using carbon-fibre cassettes, compared with plastic cassettes, and balances this against increased expense of the cassettes. Dose measurements using thermoluminescent dosimeters were carried out on intensive therapy unit (ITU) patients undergoing an anteroposterior chest X-ray examination. Resultant image quality was assessed using objective Commission of European Communities (CEC) criteria. A retrospective audit recorded number of ITU patients currently having chest X-rays to determine total dose savings over the life of the cassettes. The results show significant reductions (p < 0.0001) of 32 % for entrance surface and effective dose with carbon-fibre cassettes. No deterioration in total image quality was noted. The added expense of ≤ 2260 per personSievert (calculated from the effective dose reduction) for employing carbon-fibre cassettes is minimal compared with the estimated cost of manSievert exposures reported by other workers. (orig.)

  3. Cost-effectiveness of chiropractic care versus self-management in patients with musculoskeletal chest pain

    DEFF Research Database (Denmark)

    Stochkendahl, Mette Jensen; Sørensen, Jan; Vach, Werner

    2016-01-01

    suggested that chiropractic care was cost-effective with a probability of 97%, given a threshold value of €30 000 per QALY gained. In both groups, there was an increase in the health-related quality of life, and the mean increases were similar over the 12-month evaluation period. The mean differences......AIMS: To assess whether primary sector healthcare in the form of chiropractic care is cost-effective compared with self-management in patients with musculoskeletal chest pain, that is, a subgroup of patients with non-specific chest pain. METHODS AND RESULTS: 115 adults aged 18-75 years with acute......-dimension questionnaire (EQ-5D) and Short Form 36-item Health Survey (SF-36)) were compared in cost-effectiveness analyses over 12 months from baseline. Mean costs were €2183 lower for the group with chiropractic care, but not statistically significant (95% CI -4410.5 to 43.0). The incremental cost-effectiveness ratio...

  4. Clinical outcomes and cost effectiveness of accelerated diagnostic protocol in a chest pain center compared with routine care of patients with chest pain.

    Science.gov (United States)

    Asher, Elad; Reuveni, Haim; Shlomo, Nir; Gerber, Yariv; Beigel, Roy; Narodetski, Michael; Eldar, Michael; Or, Jacob; Hod, Hanoch; Shamiss, Arie; Matetzky, Shlomi

    2015-01-01

    The aim of this study was to compare in patients presenting with acute chest pain the clinical outcomes and cost-effectiveness of an accelerated diagnostic protocol utilizing contemporary technology in a chest pain unit versus routine care in an internal medicine department. Hospital and 90-day course were prospectively studied in 585 consecutive low-moderate risk acute chest pain patients, of whom 304 were investigated in a designated chest pain center using a pre-specified accelerated diagnostic protocol, while 281 underwent routine care in an internal medicine ward. Hospitalization was longer in the routine care compared with the accelerated diagnostic protocol group (pdiagnostic protocol patients (98%) vs. 57 (20%) routine care patients underwent non-invasive testing, (pdiagnostic imaging testing was performed in 125 (44%) and 26 (9%) patients in the routine care and accelerated diagnostic protocol patients, respectively (pdiagnostic protocol patients compared with those receiving routine care was associated with a lower incidence of readmissions for chest pain [8 (3%) vs. 24 (9%), pdiagnostic protocol remained a predictor of lower acute coronary syndromes and readmissions after propensity score analysis [OR = 0.28 (CI 95% 0.14-0.59)]. Cost per patient was similar in both groups [($2510 vs. $2703 for the accelerated diagnostic protocol and routine care group, respectively, (p = 0.9)]. An accelerated diagnostic protocol is clinically superior and as cost effective as routine in acute chest pain patients, and may save time and resources.

  5. Decision tree sensitivity analysis for cost-effectiveness of chest FDG-PET in patients with a pulmonary tumor (non-small cell carcinoma)

    International Nuclear Information System (INIS)

    Kosuda, Shigeru; Watanabe, Masumi; Kobayashi, Hideo; Kusano, Shoichi; Ichihara, Kiyoshi

    1998-01-01

    Decision tree analysis was used to assess cost-effectiveness of chest FDG-PET in patients with a pulmonary tumor (non-small cell carcinoma, ≤Stage IIIB), based on the data of the current decision tree. Decision tree models were constructed with two competing strategies (CT alone and CT plus chest FDG-PET) in 1,000 patient population with 71.4% prevalence. Baselines of FDG-PET sensitivity and specificity on detection of lung cancer and lymph node metastasis, and mortality and life expectancy were available from references. Chest CT plus chest FDG-PET strategy increased a total cost by 10.5% when a chest FDG-PET study costs 0.1 million yen, since it increased the number of mediastinoscopy and curative thoracotomy despite reducing the number of bronchofiberscopy to half. However, the strategy resulted in a remarkable increase by 115 patients with curable thoracotomy and decrease by 51 patients with non-curable thoracotomy. In addition, an average life expectancy increased by 0.607 year/patient, which means increase in medical cost is approximately 218,080 yen/year/patient when a chest FDG-PET study costs 0.1 million yen. In conclusion, chest CT plus chest FDG-PET strategy might not be cost-effective in Japan, but we are convinced that the strategy is useful in cost-benefit analysis. (author)

  6. Ward-based, nurse-led, outpatient chest tube management: analysis of impact, cost-effectiveness and patient safety.

    Science.gov (United States)

    Tcherveniakov, Peter; De Siqueira, Jonathan; Milton, Richard; Papagiannopoulos, Kostas

    2012-06-01

    Prolonged drainage and air leaks are recognized complications of elective and acute thoracic surgery and carry significant burden on inpatient stay and outpatient resources. Since 2007, we have run a ward-based, nurse-led clinic for patients discharged with a chest drain in situ. The aim of this study is to assess its cost-effectiveness and safety. We present a retrospective review of the activity of the clinic for a period of 12 months (November 2009-10). An analysis of the gathered data is performed, focusing specifically on the duration of chest tube indwelling, the indications, complications and cost efficiency. The nurse-led clinic was housed in the thoracic ward with no additional fixed costs. Seventy-four patients were reviewed (53 males, 21 females, mean age of 59) and subsequently discharged from the clinic in this time period, accounting for 149 care episodes. Thirty-three (45%) of the patients underwent a video-assisted thoracoscopic surgery procedure, 35 (47%) of them a thoracotomy and 7 (9%) had a bedside chest tube insertion. Following hospital discharge, the chest tubes were removed after a median of 14 days (range 1-82 days). Fifty-eight percent of the patients were reviewed because of a prolonged air leak, 26% for persistent fluid drainage and 16% due to prolonged drainage following evacuation of empyemas. For the care episodes analysed, we estimate that the clinic has generated an income of €24,899 for the department. Hourly staffing costs for the service are significantly lower compared with those of the traditional outpatient clinic: €15 vs. €114. Our results show that a dedicated chest tube monitoring clinic is a safe and efficient alternative to formal outpatient clinic review. It can lead to shorter hospital stays and is cost effective.

  7. Mass chest radiography in Greece

    International Nuclear Information System (INIS)

    Papavasiliou, C.

    1987-01-01

    In Greece mass chest radiography has been performed regularly on various population groups as a measure to control tuberculosis. Routine chest radiography is performed in most Greek hospitals on admission. In this report available data-admittedly inadequate-directly or indirectly addressing the problem of benefit versus the risk or cost associated with this examination is presented

  8. TRIAGE OF PATIENTS TO ANGIOGRAPHY FOR DETECTION OF AORTIC RUPTURE AFTER BLUNT CHEST TRAUMA - COST-EFFECTIVENESS ANALYSIS OF USING CT

    NARCIS (Netherlands)

    HUNINK, MGM; BOS, JJ

    OBJECTIVE. The purpose of this study was to evaluate the cost-effectiveness of dynamic chest CT, compared with plain chest radiography and immediate angiography, in deciding when angiography should be performed in hemodynamically stable patients with suspected aortic rupture after blunt chest

  9. Methodology for cost analysis of film-based and filmless portable chest systems

    Science.gov (United States)

    Melson, David L.; Gauvain, Karen M.; Beardslee, Brian M.; Kraitsik, Michael J.; Burton, Larry; Blaine, G. James; Brink, Gary S.

    1996-05-01

    Many studies analyzing the costs of film-based and filmless radiology have focused on multi- modality, hospital-wide solutions. Yet due to the enormous cost of converting an entire large radiology department or hospital to a filmless environment all at once, institutions often choose to eliminate film one area at a time. Narrowing the focus of cost-analysis may be useful in making such decisions. This presentation will outline a methodology for analyzing the cost per exam of film-based and filmless solutions for providing portable chest exams to Intensive Care Units (ICUs). The methodology, unlike most in the literature, is based on parallel data collection from existing filmless and film-based ICUs, and is currently being utilized at our institution. Direct costs, taken from the perspective of the hospital, for portable computed radiography chest exams in one filmless and two film-based ICUs are identified. The major cost components are labor, equipment, materials, and storage. Methods for gathering and analyzing each of the cost components are discussed, including FTE-based and time-based labor analysis, incorporation of equipment depreciation, lease, and maintenance costs, and estimation of materials costs. Extrapolation of data from three ICUs to model hypothetical, hospital-wide film-based and filmless ICU imaging systems is described. Performance of sensitivity analysis on the filmless model to assess the impact of anticipated reductions in specific labor, equipment, and archiving costs is detailed. A number of indirect costs, which are not explicitly included in the analysis, are identified and discussed.

  10. Indirect Cost Reimbursement: An Industrial View.

    Science.gov (United States)

    Bolton, Robert

    1987-01-01

    The meaning of indirect costs in an industrial environment is discussed. Other factors considered are corporate policies; nature of work being supported; the uniqueness of the work; who is doing the negotiating for industry; and indirect rates. Suggestions are offered for approaches to indirect cost reimbursement. (Author/MLW)

  11. Management of End-Stage Ankle Arthritis: Cost-Utility Analysis Using Direct and Indirect Costs.

    Science.gov (United States)

    Nwachukwu, Benedict U; McLawhorn, Alexander S; Simon, Matthew S; Hamid, Kamran S; Demetracopoulos, Constantine A; Deland, Jonathan T; Ellis, Scott J

    2015-07-15

    Total ankle replacement and ankle fusion are costly but clinically effective treatments for ankle arthritis. Prior cost-effectiveness analyses for the management of ankle arthritis have been limited by a lack of consideration of indirect costs and nonoperative management. The purpose of this study was to compare the cost-effectiveness of operative and nonoperative treatments for ankle arthritis with inclusion of direct and indirect costs in the analysis. Markov model analysis was conducted from a health-systems perspective with use of direct costs and from a societal perspective with use of direct and indirect costs. Costs were derived from the 2012 Nationwide Inpatient Sample (NIS) and expressed in 2013 U.S. dollars; effectiveness was expressed in quality-adjusted life years (QALYs). Model transition probabilities were derived from the available literature. The principal outcome measure was the incremental cost-effectiveness ratio (ICER). In the direct-cost analysis for the base case, total ankle replacement was associated with an ICER of $14,500/QALY compared with nonoperative management. When indirect costs were included, total ankle replacement was both more effective and resulted in $5900 and $800 in lifetime cost savings compared with the lifetime costs following nonoperative management and ankle fusion, respectively. At a $100,000/QALY threshold, surgical management of ankle arthritis was preferred for patients younger than ninety-six years and total ankle replacement was increasingly more cost-effective in younger patients. Total ankle replacement, ankle fusion, and nonoperative management were the preferred strategy in 83%, 12%, and 5% of the analyses, respectively; however, our model was sensitive to patient age, the direct costs of total ankle replacement, the failure rate of total ankle replacement, and the probability of arthritis after ankle fusion. Compared with nonoperative treatment for the management of end-stage ankle arthritis, total ankle

  12. Indirect costs of rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    Filip Raciborski

    2015-12-01

    Full Text Available It is estimated that in Poland about 400,000 persons in general suffer from inflammatory joint diseases, including rheumatoid arthritis (RA. Epidemiological surveys documenting the frequency and disturbance of musculoskeletal disorders in the Polish population are few in number. Most of the estimations are based on epidemiological data from other countries (prevalence of 0.5–1%. According to the data of the National Health Fund in Poland 135,000–157,000 persons in total are treated because of rheumatoid arthritis per year [ICD10 (International Statistical Classification of Diseases and Related Health Problems: M05, M06]. In the case of this group of diseases indirect costs significantly outweigh the direct costs. Indirect costs increase together with activity level of the disease. The cost analysis of productivity loss of RA patients indicates that sickness absenteeism and informal care are the most burdensome. At the national level it amounts in total from 1.2 billion to 2.8 billion PLN per year, depending on the method of analysis. These costs could be significantly reduced through early diagnosis and introduction of effective treatment.

  13. Determination of chest x-ray cost using activity based costing ...

    African Journals Online (AJOL)

    Background: Activity based costing (ABC) is an approach to get insight of true costs and to solve accounting problems. It provides more accurate information on product cost than conventional accounting system. The purpose of this study was to identify detailed resource consumption for chest x-ray procedure. Methods: ...

  14. INDIRECT LABOR COSTS AND IMPLICATIONS FOR OVERHEAD ALLOCATION

    OpenAIRE

    Bea Chiang

    2013-01-01

    Cost accounting typically allocates indirect labor cost to cost object based on direct labor hours. The allocation process implicitly assumes that indirect labor costs vary proportionally with direct labor hours. The assumption of a linear relationship between indirect and direct labor is particularly suspicious at low production volume levels because there tends to be a fixed component in indirect labor. The linearity assumption is also challenged by recent increasing complexity of indirect ...

  15. Determination of chest x-ray cost using activity based costing approach at Penang General Hospital, Malaysia.

    Science.gov (United States)

    Atif, Muhammad; Sulaiman, Syed Azhar Syed; Shafie, Asrul Akmal; Saleem, Fahad; Ahmad, Nafees

    2012-01-01

    Activity based costing (ABC) is an approach to get insight of true costs and to solve accounting problems. It provides more accurate information on product cost than conventional accounting system. The purpose of this study was to identify detailed resource consumption for chest x-ray procedure. Human resource cost was calculated by multiplying the mean time spent by employees doing specific activity to their per-minute salaries. The costs of consumables and clinical equipments were obtained from the procurement section of the Radiology Department. The cost of the building was calculated by multiplying the area of space used by the chest X-ray facility with the unit cost of public building department. Moreover, straight-line deprecation with a discount rate of 3% was assumed for calculation of equivalent annual costs for building and machines. Cost of electricity was calculated by multiplying number of kilo watts used by electrical appliance in the year 2010 with electricity tariff for Malaysian commercial consumers (MYR 0.31 per kWh). Five activities were identified which were required to develop one chest X-ray film. Human resource, capital, consumable and electricity cost was MYR 1.48, MYR 1.98, MYR 2.15 and MYR 0.04, respectively. Total cost of single chest X-ray was MYR 5.65 (USD 1.75). By applying ABC approach, we can have more detailed and precise estimate of cost for specific activity or service. Choice of repeating a chest X-ray can be based on our findings, when cost is a limiting factor.

  16. Chest Computed Tomographic Image Screening for Cystic Lung Diseases in Patients with Spontaneous Pneumothorax Is Cost Effective.

    Science.gov (United States)

    Gupta, Nishant; Langenderfer, Dale; McCormack, Francis X; Schauer, Daniel P; Eckman, Mark H

    2017-01-01

    Patients without a known history of lung disease presenting with a spontaneous pneumothorax are generally diagnosed as having primary spontaneous pneumothorax. However, occult diffuse cystic lung diseases such as Birt-Hogg-Dubé syndrome (BHD), lymphangioleiomyomatosis (LAM), and pulmonary Langerhans cell histiocytosis (PLCH) can also first present with a spontaneous pneumothorax, and their early identification by high-resolution computed tomographic (HRCT) chest imaging has implications for subsequent management. The objective of our study was to evaluate the cost-effectiveness of HRCT chest imaging to facilitate early diagnosis of LAM, BHD, and PLCH. We constructed a Markov state-transition model to assess the cost-effectiveness of screening HRCT to facilitate early diagnosis of diffuse cystic lung diseases in patients presenting with an apparent primary spontaneous pneumothorax. Baseline data for prevalence of BHD, LAM, and PLCH and rates of recurrent pneumothoraces in each of these diseases were derived from the literature. Costs were extracted from 2014 Medicare data. We compared a strategy of HRCT screening followed by pleurodesis in patients with LAM, BHD, or PLCH versus conventional management with no HRCT screening. In our base case analysis, screening for the presence of BHD, LAM, or PLCH in patients presenting with a spontaneous pneumothorax was cost effective, with a marginal cost-effectiveness ratio of $1,427 per quality-adjusted life-year gained. Sensitivity analysis showed that screening HRCT remained cost effective for diffuse cystic lung diseases prevalence as low as 0.01%. HRCT image screening for BHD, LAM, and PLCH in patients with apparent primary spontaneous pneumothorax is cost effective. Clinicians should consider performing a screening HRCT in patients presenting with apparent primary spontaneous pneumothorax.

  17. Smoking Cessation Is Associated With Lower Indirect Costs.

    Science.gov (United States)

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

    2018-06-01

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

  18. 10 CFR 602.15 - Indirect cost limitations.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Indirect cost limitations. 602.15 Section 602.15 Energy DEPARTMENT OF ENERGY (CONTINUED) ASSISTANCE REGULATIONS EPIDEMIOLOGY AND OTHER HEALTH STUDIES FINANCIAL ASSISTANCE PROGRAM § 602.15 Indirect cost limitations. Awards issued under this part for conferences and...

  19. 10 CFR 605.16 - Indirect cost limitations.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Indirect cost limitations. 605.16 Section 605.16 Energy DEPARTMENT OF ENERGY (CONTINUED) ASSISTANCE REGULATIONS THE OFFICE OF ENERGY RESEARCH FINANCIAL ASSISTANCE PROGRAM § 605.16 Indirect cost limitations. Awards issued under this part for conferences and scientific...

  20. Life-Cycle Costing of Food Waste Management in Denmark: Importance of Indirect Effects

    DEFF Research Database (Denmark)

    Martinez Sanchez, Veronica; Tonini, Davide; Møller, Flemming

    2016-01-01

    assessment combined with life-cycle assessment, to evaluate food waste management. Both life-cycle costing assessments included direct and indirect effects. The latter are related to income effects, accounting for the marginal consumption induced when alternative scenarios lead to different household......Prevention has been suggested as the preferred food waste management solution compared to alternatives such as conversion to animal fodder or to energy. In this study we used societal life-cycle costing, as a welfare economic assessment, and environmental life-cycle costing, as a financial...... be included whenever alternative scenarios incur different financial costs. Furthermore, it highlights that food prevention measures should not only demote the purchase of unconsumed food but also promote a low-impact use of the savings generated....

  1. Estimating direct and indirect costs of premenstrual syndrome.

    Science.gov (United States)

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

    2005-01-01

    To quantify the economic impact of premenstrual syndrome (PMS) on the employer. Data were collected from 374 women aged 18-45 with regular menses. Direct costs were quantified using administrative claims of these patients and the Medicare Fee Schedule. Indirect costs were quantified by both self-reported days of work missed and lost productivity at work. Regression analyses were used to develop a model to project PMS-related direct and indirect costs. A total of 29.6% (n = 111) of the participants were diagnosed with PMS. A PMS diagnosis was associated with an average annual increase of $59 in direct costs (P increase in direct medical costs and a large increase in indirect costs.

  2. The Indirect cost of illness in Africa

    Directory of Open Access Journals (Sweden)

    Joses Muthuri Kirigia

    2018-06-01

    Full Text Available Background: The current study estimated (a the indirect costs associated with non-fatal disability and premature death across a wide range of diseases and health conditions in Africa in 2015 and (b the potential savings that could be accrued if countries were to meet the 3 health targets of the substainable development goal (SDG compared to the costs under the status quo. Methods: This study used the lost output or human capital approach to quantify the gross domestic product (GDP losses associated with the disability-adjusted-life-years (DALYs lost due to all causes by age group as well as by country economic classification (Group 1: 10 high/upper-middle income countries; Group 2: 17 lower-middle income countries; and Group 3: 27 low income countries. Results: The expected indirect cost of the 704,765,879 DALYs lost in Africa in 2015 was Int$ 2,983,187,560,197. Of this amount, 25.17%, 57.84% and 16.99% were incurred by the economies of the countries comprising Group 1, Group 2 and Group 3, respectively. Of the total continental indirect cost, 36.9%, 10.5%, 13.7%, 17.0%, 7.6%, 6.8% and 7.5% were associated with people aged 0-4, 5-14, 15-29, 30-49, 50-59, 60-69 and 70 years or older, respectively. Most of the total indirect cost (56.61% was attributable to maternal conditions, AIDS, tuberculosis (TB, malaria, neglected tropicald diseases (NTDs, non-communicable diseases and traffic injuries. Approximately half (47% of this cost could be avoided (or saved every year if the 3 (health targets of the SDG were fully met. Conclusion: The study estimated the total indirect cost of illness due to all causes by age group and country economic classification. The annual indirect cost is substantial. The findings contained in this paper suggest that health system strengthening should focus on both rich and poor countries, people of all ages and specific disease categories.

  3. The Indirect Costs of Financial Distress in Indonesia

    Directory of Open Access Journals (Sweden)

    Wijantini Wijantini

    2007-06-01

    Full Text Available This paper presents quantitative estimates of the indirect cost of financial distress and its determinants. In order to measure the cost, this study estimates the annualized changes in industry-adjusted operation profit and sales from a year before the onset of distress to the resolution year. Using those approaches, the median of indirect financial distress cost is estimated between three and 11 percent annually. To the extent that the direct cost of financial distress reduces reported operating income, the estimated costs are overstated. The simple regressions analysis suggest that the indirect cost of financial distress significantly increases with size, leverage, number of creditors, and poor industry performance, but is not related to degree of bank loan reliance. The findings provide a weak support for the financial distress theory which suggests that conflicts of interest render the costs of financial distress.

  4. Indirect reciprocity provides a narrow margin of efficiency for costly punishment

    Science.gov (United States)

    Iwasa, Yoh; Nowak, Martin A.

    2008-01-01

    Indirect reciprocity1-5 is a key mechanism for the evolution of human cooperation. Our behavior toward other people depends not only on what they have done to us, but also on what they have done to others. Indirect reciprocity works via reputation5-17. The standard model of indirect reciprocity offers a binary choice: people can either cooperate or defect. Cooperation implies a cost for the donor and a benefit for the recipient. Defection has no cost and yields no benefit. Currently there is considerable interest in studying the effect of costly (or altruistic) punishment on human behavior18-25. Punishment implies a cost for the punished person. Costly punishment means that the punisher also pays a cost. It has been suggested that costly punishment between individuals can promote cooperation. Here we study the role of costly punishment in an explicit model of indirect reciprocity. We analyze all social norms, which depend on the action of the donor and the reputation of the recipient. We allow errors in assigning reputation and study gossip as a mechanism for establishing coherence. We characterize all strategies that allow the evolutionary stability of cooperation. Some of those strategies use costly punishment, while others do not. We find that punishment strategies typically reduce the average payoff of the population. Consequently, there is only a small parameter region where costly punishment leads to an efficient equilibrium. In most cases, the population does better by not using costly punishment. The efficient strategy for indirect reciprocity is to withhold help for defectors rather than punish them. PMID:19122640

  5. The Indirect Costs of Financial Distress in Indonesia

    OpenAIRE

    Wijantini, Wijantini

    2007-01-01

    This paper presents quantitative estimates of the indirect cost of financial distress and its determinants. In order to measure the cost, this study estimates the annualized changes in industry-adjusted operation profit and sales from a year before the onset of distress to the resolution year. Using those approaches, the median of indirect financial distress cost is estimated between three and 11 percent annually. To the extent that the direct cost of financial distress reduces reported opera...

  6. Incorporating indirect costs into a cost-benefit analysis of laparoscopic adjustable gastric banding.

    Science.gov (United States)

    Finkelstein, Eric A; Allaire, Benjamin T; Dibonaventura, Marco Dacosta; Burgess, Somali M

    2012-01-01

    The objective of this study was to estimate the time to breakeven and 5-year net costs of laparoscopic adjustable gastric banding (LAGB) taking both direct and indirect costs and cost savings into account. Estimates of direct cost savings from LAGB were available from the literature. Although longitudinal data on indirect cost savings were not available, these estimates were generated by quantifying the relationship between medical expenditures and absenteeism and between medical expenditures and presenteeism (reduced on-the-job productivity) and combining these elasticity estimates with estimates of the direct cost savings to generate total savings. These savings were then combined with the direct and indirect costs of the procedure to quantify net savings. By including indirect costs, the time to breakeven was reduced by half a year, from 16 to 14 quarters. After 5 years, net savings in medical expenditures from a gastric banding procedure were estimated to be $4970 (±$3090). Including absenteeism increased savings to $6180 (±$3550). Savings were further increased to $10,960 (±$5864) when both absenteeism and presenteeism estimates were included. This study presented a novel approach for including absenteeism and presenteeism estimates in cost-benefit analyses. Application of the approach to gastric banding among surgery-eligible obese employees revealed that the inclusion of indirect costs and cost savings improves the business case for the procedure. This approach can easily be extended to other populations and treatments. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  7. 48 CFR 31.203 - Indirect costs.

    Science.gov (United States)

    2010-10-01

    ... fiscal year used for financial reporting purposes in accordance with generally accepted accounting... contract or other work, indirect costs are those remaining to be allocated to intermediate or two or more... basis of the benefits accruing to intermediate and final cost objectives. When substantially the same...

  8. Chest X-ray : a cost-diagnostic benefit analysis

    International Nuclear Information System (INIS)

    Winter, L.H.L.

    1991-01-01

    Although plain chest radiography is one of the most useful diagnostic tools available to the physician, this procedure has not evolved into a consistent method. Two Large Field of View Image Intensifiers (LFOV-II) became available; the large imaging area makes them suitable for chest imaging. Both modalities supply 100 mm images to the radiologist. In this thesis the 'diagnostic benefits and 'costs' of these modalities are evaluated and related to the 'gold' standard (conventional full-size). The emphasis is on diagnostic image quality using phantoms for observer performance qualities. (author). 170 refs.; 21 figs.; 47 tabs

  9. Cost and Morbidity Analysis of Chest Port Insertion: Interventional Radiology Suite Versus Operating Room.

    Science.gov (United States)

    LaRoy, Jennifer R; White, Sarah B; Jayakrishnan, Thejus; Dybul, Stephanie; Ungerer, Dirk; Turaga, Kiran; Patel, Parag J

    2015-06-01

    To compare complications and cost, from a hospital perspective, of chest port insertions performed in an interventional radiology (IR) suite versus in surgery in an operating room (OR). This study was approved by an institutional review board and is HIPAA compliant. Medical records were retrospectively searched on consecutive chest port placement procedures, in the IR suite and the OR, between October 22, 2010 and February 26, 2013, to determine patients' demographic information and chest port-related complications and/or infections. A total of 478 charts were reviewed (age range: 21-85 years; 309 women, 169 men). Univariate and bivariate analyses were performed to identify risk factors associated with an increased complication rate. Cost data on 149 consecutive Medicare outpatients (100 treated in the IR suite; 49 treated in the OR) who had isolated chest port insertions between March 2012 and February 2013 were obtained for both the operative services and pharmacy. Nonparametric tests for heterogeneity were performed using the Kruskal-Wallis method. Early complications occurred in 9.2% (22 of 239) of the IR patients versus 13.4% (32 of 239) of the OR patients. Of the 478 implanted chest ports, 9 placed in IR and 18 placed in surgery required early removal. Infections from the ports placed in IR versus the OR were 0.25 versus 0.18 infections per 1000 catheters, respectively. Overall mean costs for chest port insertion were significantly higher in the OR, for both room and pharmacy costs (P chest ports in an OR setting was almost twice that of placement in the IR suite. Hospital costs to place a chest port were significantly lower in the IR suite than in the OR, whereas radiology and surgery patients did not show a significantly different rate of complications and/or infections. Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  10. The indirect costs and benefits of greenhouse gas mitigation

    International Nuclear Information System (INIS)

    Markandya, A.

    1998-01-01

    The indirect costs of GHG projects are very important in the evaluation of such projects. In many cases they are more important than the direct costs. This paper has shown what such costs consist of and how they may be estimated. As countries prepare their mitigation strategies, it is very important that they develop tools for the assessment of these indirect costs and use these tools in the appropriate manner. Hopefully, this paper will point them in the right direction. (au) 11 refs

  11. Productivity loss due to overweight and obesity: a systematic review of indirect costs.

    Science.gov (United States)

    Goettler, Andrea; Grosse, Anna; Sonntag, Diana

    2017-10-05

    The increasingly high levels of overweight and obesity among the workforce are accompanied by a hidden cost burden due to losses in productivity. This study reviews the extent of indirect cost of overweight and obesity. A systematic search was conducted in eight electronic databases (PubMed, Cochrane Library, Web of Science Core Collection, PsychInfo, Cinahl, EconLit and ClinicalTrial.gov). Additional studies were added from reference lists of original studies and reviews. Studies were eligible if they were published between January 2000 and June 2017 and included monetary estimates of indirect costs of overweight and obesity. The authors reviewed studies independently and assessed their quality. Of the 3626 search results, 50 studies met the inclusion criteria. A narrative synthesis of the reviewed studies revealed substantial costs due to lost productivity among workers with obesity. Especially absenteeism and presenteeism contribute to high indirect costs. However, the methodologies and results vary greatly, especially regarding the cost of overweight, which was even associated with lower indirect costs than normal weight in three studies. The evidence predominantly confirms substantial short-term and long-term indirect costs of overweight and obesity in the absence of effective customised prevention programmes and thus demonstrates the extent of the burden of obesity beyond the healthcare sector. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  12. Life-Cycle Costing of Food Waste Management in Denmark: Importance of Indirect Effects.

    Science.gov (United States)

    Martinez-Sanchez, Veronica; Tonini, Davide; Møller, Flemming; Astrup, Thomas Fruergaard

    2016-04-19

    Prevention has been suggested as the preferred food waste management solution compared to alternatives such as conversion to animal fodder or to energy. In this study we used societal life-cycle costing, as a welfare economic assessment, and environmental life-cycle costing, as a financial assessment combined with life-cycle assessment, to evaluate food waste management. Both life-cycle costing assessments included direct and indirect effects. The latter are related to income effects, accounting for the marginal consumption induced when alternative scenarios lead to different household expenses, and the land-use-changes effect, associated with food production. The results highlighted that prevention, while providing the highest welfare gains as more services/goods could be consumed with the same income, could also incur the highest environmental impacts if the monetary savings from unpurchased food commodities were spent on goods/services with a more environmentally damaging production than that of the (prevented) food. This was not the case when savings were used, e.g., for health care, education, and insurances. This study demonstrates that income effects, although uncertain, should be included whenever alternative scenarios incur different financial costs. Furthermore, it highlights that food prevention measures should not only demote the purchase of unconsumed food but also promote a low-impact use of the savings generated.

  13. The hidden costs: Identification of indirect costs associated with acute gastrointestinal illness in an Inuit community

    Science.gov (United States)

    Vriezen, Rachael; Edge, Victoria L.; Ford, James; Wood, Michele; Harper, Sherilee

    2018-01-01

    Background Acute gastrointestinal illness (AGI) incidence and per-capita healthcare expenditures are higher in some Inuit communities as compared to elsewhere in Canada. Consequently, there is a demand for strategies that will reduce the individual-level costs of AGI; this will require a comprehensive understanding of the economic costs of AGI. However, given Inuit communities’ unique cultural, economic, and geographic contexts, there is a knowledge gap regarding the context-specific indirect costs of AGI borne by Inuit community members. This study aimed to identify the major indirect costs of AGI, and explore factors associated with these indirect costs, in the Inuit community of Rigolet, Canada, in order to develop a case-based context-specific study framework that can be used to evaluate these costs. Methods A mixed methods study design and community-based methods were used. Qualitative in-depth, group, and case interviews were analyzed using thematic analysis to identify and describe indirect costs of AGI specific to Rigolet. Data from two quantitative cross-sectional retrospective surveys were analyzed using univariable regression models to examine potential associations between predictor variables and the indirect costs. Results/Significance The most notable indirect costs of AGI that should be incorporated into cost-of-illness evaluations were the tangible costs related to missing paid employment and subsistence activities, as well as the intangible costs associated with missing community and cultural events. Seasonal cost variations should also be considered. This study was intended to inform cost-of-illness studies conducted in Rigolet and other similar research settings. These results contribute to a better understanding of the economic impacts of AGI on Rigolet residents, which could be used to help identify priority areas and resource allocation for public health policies and programs. PMID:29768456

  14. [Methodologies for estimating the indirect costs of traffic accidents].

    Science.gov (United States)

    Carozzi, Soledad; Elorza, María Eugenia; Moscoso, Nebel Silvana; Ripari, Nadia Vanina

    2017-01-01

    Traffic accidents generate multiple costs to society, including those associated with the loss of productivity. However, there is no consensus about the most appropriate methodology for estimating those costs. The aim of this study was to review methods for estimating indirect costs applied in crash cost studies. A thematic review of the literature was carried out between 1995 and 2012 in PubMed with the terms cost of illness, indirect cost, road traffic injuries, productivity loss. For the assessment of costs we used the the human capital method, on the basis of the wage-income lost during the time of treatment and recovery of patients and caregivers. In the case of premature death or total disability, the discount rate was applied to obtain the present value of lost future earnings. The computed years arose by subtracting to life expectancy at birth the average age of those affected who are not incorporated into the economically active life. The interest in minimizing the problem is reflected in the evolution of the implemented methodologies. We expect that this review is useful to estimate efficiently the real indirect costs of traffic accidents.

  15. Indirect costs of teaching in Canadian hospitals.

    Science.gov (United States)

    MacKenzie, T A; Willan, A R; Cox, M A; Green, A

    1991-01-01

    We sought to determine whether there are indirect costs of teaching in Canadian hospitals. To examine cost differences between teaching and nonteaching hospitals we estimated two cost functions: cost per case and cost per patient-day (dependent variables). The independent variables were number of beds, occupancy rate, teaching ratio (number of residents and interns per 100 beds), province, urbanicity (the population density of the county in which the hospital was situated) and wage index. Within each hospital we categorized a random sample of patient discharges according to case mix and severity of illness using age and standard diagnosis and procedure codes. Teaching ratio and case severity were each highly correlated positively with the dependent variables. The other variables that led to higher costs in teaching hospitals were wage rates and number of beds. Our regression model could serve as the basis of a reimbursement system, adjusted for severity and teaching status, particularly in provinces moving toward introducing case-weighting mechanisms into their payment model. Even if teaching hospitals were paid more than nonteaching hospitals because of the difference in the severity of illness there should be an additional allowance to cover the indirect costs of teaching. PMID:1898870

  16. The direct and indirect costs of Dravet Syndrome.

    Science.gov (United States)

    Whittington, Melanie D; Knupp, Kelly G; Vanderveen, Gina; Kim, Chong; Gammaitoni, Arnold; Campbell, Jonathan D

    2018-03-01

    The objective of this study was to estimate the annual direct and indirect costs associated with Dravet Syndrome (DS). A survey was electronically administered to the caregivers of patients with DS treated at Children's Hospital Colorado. Survey domains included healthcare utilization of the patient with DS and DS caregiver work productivity and activity impairment. Patient healthcare utilization was measured using modified questions from the National Health Interview Survey; caregiver work productivity and activity impairment were measured using modified questions from the Work Productivity and Activity Impairment questionnaire. Direct costs were calculated by multiplying the caregiver-reported healthcare utilization rates by the mean unit cost for each healthcare utilization category. Indirect costs included lost productivity, income loss, and lost leisure time. The indirect costs were a function of caregiver-reported hours spent caregiving and an hourly unit cost. The survey was emailed to 60 DS caregivers, of which 34 (57% response rate) responded. Direct costs on average were $27,276 (95% interval: $15,757, $41,904) per patient with DS. Hospitalizations ($11,565 a year) and in-home medical care visits ($9894 a year) were substantial cost drivers. Additionally, caregivers reported extensive time spent providing care to an individual with DS. This caregiver time resulted in average annual indirect costs of $81,582 (95% interval: $57,253, $110,151), resulting in an average total annual financial burden of $106,378 (95% interval: $78,894, $137,906). Dravet Syndrome results in substantial healthcare utilization, financial burden, and time commitment. Establishing evidence on the financial burden of DS is essential to understanding the overall impact of DS, identifying potential areas for support needs, and assessing the impact of novel treatments as they become available. Based on the study findings, in-home visits, hospitalizations, and lost productivity and

  17. Lifestyle factors, direct and indirect costs for a Brazilian airline company

    Science.gov (United States)

    Rabacow, Fabiana Maluf; Luiz, Olinda do Carmo; Malik, Ana Maria; Burdorf, Alex

    2014-01-01

    OBJECTIVE To analyze lifestyle risk factors related to direct healthcare costs and the indirect costs due to sick leave among workers of an airline company in Brazil. METHODS In this longitudinal 12-month study of 2,201 employees of a Brazilian airline company, the costs of sick leave and healthcare were the primary outcomes of interest. Information on the independent variables, such as gender, age, educational level, type of work, stress, and lifestyle-related factors (body mass index, physical activity, and smoking), was collected using a questionnaire on enrolment in the study. Data on sick leave days were available from the company register, and data on healthcare costs were obtained from insurance records. Multivariate linear regression analysis was used to investigate the association between direct and indirect healthcare costs with sociodemographic, work, and lifestyle-related factors. RESULTS Over the 12-month study period, the average direct healthcare expenditure per worker was US$505.00 and the average indirect cost because of sick leave was US$249.00 per worker. Direct costs were more than twice the indirect costs and both were higher in women. Body mass index was a determinant of direct costs and smoking was a determinant of indirect costs. CONCLUSIONS Obesity and smoking among workers in a Brazilian airline company were associated with increased health costs. Therefore, promoting a healthy diet, physical activity, and anti-tobacco campaigns are important targets for health promotion in this study population. PMID:26039398

  18. Lifestyle factors, direct and indirect costs for a Brazilian airline company.

    Science.gov (United States)

    Rabacow, Fabiana Maluf; Luiz, Olinda do Carmo; Malik, Ana Maria; Burdorf, Alex

    2014-12-01

    OBJECTIVE To analyze lifestyle risk factors related to direct healthcare costs and the indirect costs due to sick leave among workers of an airline company in Brazil. METHODS In this longitudinal 12-month study of 2,201 employees of a Brazilian airline company, the costs of sick leave and healthcare were the primary outcomes of interest. Information on the independent variables, such as gender, age, educational level, type of work, stress, and lifestyle-related factors (body mass index, physical activity, and smoking), was collected using a questionnaire on enrolment in the study. Data on sick leave days were available from the company register, and data on healthcare costs were obtained from insurance records. Multivariate linear regression analysis was used to investigate the association between direct and indirect healthcare costs with sociodemographic, work, and lifestyle-related factors. RESULTS Over the 12-month study period, the average direct healthcare expenditure per worker was US$505.00 and the average indirect cost because of sick leave was US$249.00 per worker. Direct costs were more than twice the indirect costs and both were higher in women. Body mass index was a determinant of direct costs and smoking was a determinant of indirect costs. CONCLUSIONS Obesity and smoking among workers in a Brazilian airline company were associated with increased health costs. Therefore, promoting a healthy diet, physical activity, and anti-tobacco campaigns are important targets for health promotion in this study population.

  19. Lifestyle factors, direct and indirect costs for a Brazilian airline company

    Directory of Open Access Journals (Sweden)

    Fabiana Maluf Rabacow

    2014-12-01

    Full Text Available OBJECTIVE To analyze lifestyle risk factors related to direct healthcare costs and the indirect costs due to sick leave among workers of an airline company in Brazil. METHODS In this longitudinal 12-month study of 2,201 employees of a Brazilian airline company, the costs of sick leave and healthcare were the primary outcomes of interest. Information on the independent variables, such as gender, age, educational level, type of work, stress, and lifestyle-related factors (body mass index, physical activity, and smoking, was collected using a questionnaire on enrolment in the study. Data on sick leave days were available from the company register, and data on healthcare costs were obtained from insurance records. Multivariate linear regression analysis was used to investigate the association between direct and indirect healthcare costs with sociodemographic, work, and lifestyle-related factors. RESULTS Over the 12-month study period, the average direct healthcare expenditure per worker was US$505.00 and the average indirect cost because of sick leave was US$249.00 per worker. Direct costs were more than twice the indirect costs and both were higher in women. Body mass index was a determinant of direct costs and smoking was a determinant of indirect costs. CONCLUSIONS Obesity and smoking among workers in a Brazilian airline company were associated with increased health costs. Therefore, promoting a healthy diet, physical activity, and anti-tobacco campaigns are important targets for health promotion in this study population.

  20. Cost-effectiveness of exercise 201Tl myocardial SPECT in patients with chest pain assessed by decision-tree analysis

    International Nuclear Information System (INIS)

    Kosuda, Shigeru; Momiyama, Yukihiko; Ohsuzu, Fumitaka; Kusano, Shoichi; Ichihara, Kiyoshi

    1999-01-01

    To evaluate the potential cost-effectiveness of exercise 201 Tl myocardial SPECT in outpatients with angina-like chest pain, we developed a decision-tree model which comprises three 1000-patients groups, i.e., a coronary arteriography (CAG) group, a follow-up group, and a SPECT group, and total cost and cardiac events, including cardiac deaths, were calculated. Variables used for the decision-tree analysis were obtained from references and the data available at out hospital. The sensitivity and specificity of 201 Tl SPECT for diagnosing angina pectoris, and its prevalence were assumed to be 95%, 85%, and 33%, respectively. The mean costs were 84.9 x 10 4 yen/patient in the CAG group, 30.2 x 10 4 yen/patient in the follow-up group, and 71.0 x 10 4 yen/patient in the SPECT group. The numbers of cardiac events and cardiac deaths were 56 and 15, respectively in the CAG group, 264 and 81 in the follow-up group, and 65 and 17 in the SPECT group. SPECT increases cardiac events and cardiac deaths by 0.9% and 0.2%, but it reduces the number of CAG studies by 50.3%, and saves 13.8 x 10 4 yen/patient, as compared to the CAG group. In conclusion, the exercise 201 Tl myocardial SPECT strategy for patients with chest pain has the potential to reduce health care costs in Japan. (author)

  1. The indirect costs of ankylosing spondylitis: a systematic review and meta-analysis.

    Science.gov (United States)

    Malinowski, Krzysztof Piotr; Kawalec, Paweł

    2015-04-01

    The aim of this systematic review was to collect and summarize all current data on the indirect costs related to absenteeism and presenteeism associated with ankylosing spondylitis. The search was conducted using Medline, Embase and Centre for Reviews and Dissemination databases. All collected costs were recalculated to average annual cost per patient, expressed in 2013 prices USD using the consumer price index and purchasing power parity. Identified studies were then analyzed to assess their possible inclusion in the meta-analysis. We identified 32 records. The average annual indirect cost per patient varies among all the identified results from US$660.95 to 45,953.87. The mean annual indirect per patient equals US$6454.76. This systematic review summarizes current data related to indirect costs generated by ankylosing spondylitis; it revealed the great economic burden of the disease for society. We observed a great variety of the considered components of indirect costs and their definitions.

  2. Indirect reciprocity can overcome free-rider problems on costly moral assessment.

    Science.gov (United States)

    Sasaki, Tatsuya; Okada, Isamu; Nakai, Yutaka

    2016-07-01

    Indirect reciprocity is one of the major mechanisms of the evolution of cooperation. Because constant monitoring and accurate evaluation in moral assessments tend to be costly, indirect reciprocity can be exploited by cost evaders. A recent study crucially showed that a cooperative state achieved by indirect reciprocators is easily destabilized by cost evaders in the case with no supportive mechanism. Here, we present a simple and widely applicable solution that considers pre-assessment of cost evaders. In the pre-assessment, those who fail to pay for costly assessment systems are assigned a nasty image that leads to them being rejected by discriminators. We demonstrate that considering the pre-assessment can crucially stabilize reciprocal cooperation for a broad range of indirect reciprocity models. In particular for the most leading social norms, we analyse the conditions under which a prosocial state becomes locally stable. © 2016 The Authors.

  3. 48 CFR 52.216-15 - Predetermined Indirect Cost Rates.

    Science.gov (United States)

    2010-10-01

    .... (c) Allowability of costs and acceptability of cost allocation methods shall be determined in...) the period for which the rates apply, and (4) the specific items treated as direct costs or any changes in the items previously agreed to be direct costs. The indirect cost rate agreement shall not...

  4. 23 CFR 140.907 - Overhead and indirect construction costs.

    Science.gov (United States)

    2010-04-01

    ... accounting principles; (2) The costs included in the distribution are limited to costs actually incurred by...), part 31, Contract Cost Principles and Procedures, relating to contracts with commercial organizations... 23 Highways 1 2010-04-01 2010-04-01 false Overhead and indirect construction costs. 140.907...

  5. Estimating two indirect logging costs caused by accelerated erosion.

    Science.gov (United States)

    Glen O. Klock

    1976-01-01

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

  6. 48 CFR 49.303-4 - Adjustment of indirect costs.

    Science.gov (United States)

    2010-10-01

    ... costs. 49.303-4 Section 49.303-4 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION CONTRACT MANAGEMENT TERMINATION OF CONTRACTS Additional Principles for Cost-Reimbursement Contracts... compute indirect costs for other contracts performed during the applicable accounting period. [48 FR 42447...

  7. The indirect costs of multiple sclerosis: systematic review and meta-analysis.

    Science.gov (United States)

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

    2015-01-01

    The aim of this systematic review is to collect and summarize all current data on the indirect costs related to absenteeism and presenteeism associated with multiple sclerosis. Searches were conducted using Medline, Embase and Centre for Reviews and Dissemination databases. All collected costs were recalculated to average annual cost per patient, expressed in 2014 prices US$ using the consumer price index and purchasing power parity (scenario 1) and expressed as proportion of specific gross domestic product in current local currency unit to adjust for country's development (scenario 2). Identified studies were then analyzed in order to assess their possible inclusion in the meta-analysis. The authors identified 63 records, of which 23 were eligible for meta-analysis. Overall indirect cost per patient calculated in scenario 1 was as high as US$20,167 with US$22,197 in Europe, US$17,382 in North America and US$153 in Asia. Overall indirect cost per patient calculated in scenario 2 was equal to US$16,939, with US$19,612 in Europe, US$11,592 in North America and US$899 in Asia. Overall indirect costs varied from US$3726 for patients with EDSS score less than 3 to US$19,264 for patients with Expanded Disability Status Scale score grater that 7. This review revealed the great economic burden of multiple sclerosis on society. The authors observed a great variety of the considered components of indirect costs and their definitions. Costs were higher for Europe than for other continents and were also higher for patients with a higher Expanded Disability Status Scale score.

  8. How to Prepare an Indirect Cost Rate Proposal for a Non-profit Organization

    Science.gov (United States)

    The indirect cost rate proposal is the documentation prepared by a grantee organization, in accordance with applicable federal cost principles, to substantiate its claim for the reimbursement of indirect costs.

  9. Digitizing pediatric chest radiographs: comparison of low-cost, commercial off-the-shelf technologies

    International Nuclear Information System (INIS)

    Ruess, L.; Shiels, K.C.; Cho, K.H.; O'Connor, S.C.; Uyehara, C.F.T.; Person, D.A.; Whitton, R.K.

    2001-01-01

    Objective: To compare low-cost, off-the-shelf technology for digitizing pediatric chest radiographs. Materials and methods: Forty pediatric chest radiographs (hard copy), each with a single abnormality, were digitized using a commercial film digitizer and two low-cost methods: a digital camera and a flatbed scanner. A stratified, randomized, block design was used where 20 readers evaluated 40 different images to determine the ability to accurately detect the abnormality. Readers then rated all 160 images (40 images x 4 methods) for conspicuity of the abnormality and overall image quality. Results: Abnormalities were correctly identified on 82.3 % of hard copy images, 82.9 % of flatbed scanner images, 74.3 % of film digitizer images, and 69.7 % of digital camera images (p flatbed scanner > film digitizer > digital camera images. Conclusion: A low-cost flatbed scanner yielded digital pediatric chest images which were significantly superior to digital camera images While flatbed scanner images were interpreted with the equivalent diagnostic accuracy of hard copy images, they were rated lower for image quality and lesion conspicuity. (orig.)

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

    Science.gov (United States)

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

    2011-01-01

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

  11. Assessing the indirect effects due to natural hazards on a mesoscale

    Science.gov (United States)

    Pfurtscheller, C.; Schwarze, R.

    2009-04-01

    Measuring indirect economic costs and other effects from natural hazards, especially floods in alpine and other mountainous regions, are a necessary part of a comprehensive economic assessment. Their omission seriously affects the relative economic benefits of structural or non structural measures of flood defence. Surpassing controversial, IO-model-based economic estimates, analysing indirect economic effects lead to the key question of identifying and evaluating the drivers of indirect economic effects and resilience to system effects in the regional economy, i.e. at the meso-level. This investigation takes place for the catastrophic floods in summer 2005 in the provinces of Tyrol and Vorarlberg, Austria, which caused an estimated € 670 Mio direct loss on private and public assets and severe interruptions in lifeline services. The paper starts out with differentiating the concept of indirect economic costs from direct costs, examing different temporal (short vs. long-term) and spatial (macro-, meso- vs. microeconomic) system boundaries. It surveys common theories of economic resilience and vulnerability at the regional economy level. Indirect effects at the regional economy level can be defined as interferences of the economic exchange of goods and services triggered by breakdowns of transport lines and critical production inputs. The extent and persistence of indirect effects of natural hazards is not only by parameters of the extreme event, such as duration and amplitude of the flood, but much more by resilience parameters of the regional economy such as size of enterprises, the network structure (linkages) of the regional economy, availability of insurance and relief funds, and the stock of inventory. These effects can only be dissected by means of expert judgement and event studies. This paper presents the results of a survey conducted among business practioneers, members of chamber of commerce, civil protection agencies to identify and scale the drivers of

  12. [Prevalence and indirect costs of headache in a Brazilian Company].

    Science.gov (United States)

    Vincent, M; Rodrigues, A de J; De Oliveira, G V; De Souza, K F; Doi, L M; Rocha, M B; Saporta, M A; Orleans, R B; Kotecki, R; Estrela, V V; De Medeiros, V A; Borges, W I

    1998-12-01

    Employees from a Brazilian oil company research centre (n = 993) were interviewed on the occurrence of headache during a 30 days period. Headache prevalence was 49.8%, with a mean frequency of 4.3 +/- 7.0 attacks per month, lasting 12.2 +/- 21.4 hours each. According to the International Headache Society diagnostic criteria, migraine (5.5%), episodic tension-type headache (26.4%), chronic tension-type headache (1.7%) and headaches not fulfilling the criteria for such disorders (16.2%) were observed. Women suffered comparatively more headache and specifically migraine than men. The pain interfered with work productivity in 10% of the subjects, corresponding to 538.75 hours off. According to an indirect costs estimation for each headache, the company may loose up to US$125.98 per employee annually. Since among headaches migraine has the highest indirect cost, migraine prevention and treatment is particularly important at the working environment. Migraine frequency may be prevented to a large extent, resulting on positive effects in both the quality of life and productivity. The cost-benefit ratio clearly favours therapeutic and preventive programs against chronic headaches.

  13. Utility loss and indirect costs after stroke in Sweden.

    Science.gov (United States)

    Lindgren, Peter; Glader, Eva-Lotta; Jönsson, Bengt

    2008-04-01

    Currently little data exist on the development of quality of life over time in patients suffering from stroke, in particular using instruments that can be adapted in economic studies. The purpose of the study was to assess the utility loss and indirect costs following a stroke in Sweden. A cross-sectional mail survey. In collaboration with the National Stroke registry (RIKS-STROKE), a questionnaire consisting of the EuroQol-5D and questions regarding the present working status and the status prior to the stroke was mailed to patients below 76 years of age at six participating centres. The questionnaire was mailed to 393 patients in total, divided into groups with 3, 6, 9 or 12 months having passed since the stroke. The EuroQol-5D scores were converted to utility scores using the UK social tariff. Indirect costs were valued according to the average salary+employer contributions. A total of 275 questionnaires (70%) were returned. Utility scores were similar over time: 0.65, 0.75, 0.63, and 0.67 at 3, 6, 9 and 12 months, respectively. Regression analyses revealed a tendency for lower utility scores among women, but no significant differences overall. Among patients in the working ages, a stroke caused 18.5 work weeks lost, corresponding to an indirect cost of 120,000 Swedish Kronor (SEK) (13,200euro, 95% confidence interval 82,541-160,050 SEK, 9080-17 605euro). Stroke causes a significant reduction in utility and causes high indirect costs. A substantial improvement was not noted over time, which is important to consider in economic models.

  14. Indirect Costs: Daily Bread, Cake, or Cracker.

    Science.gov (United States)

    Lucas, Robert A.

    1988-01-01

    The tradition of negotiating indirect costs in grants should be abandoned, and research administrators should instead offer different levels of service depending on what the sponsor wants to spend. Three levels of overhead rate are suggested (super, regular, and economy) and their corresponding levels of service are defined. (MSE)

  15. Suspected acute pulmonary emboli: cost-effectiveness of chest helical computed tomography versus a standard diagnostic algorithm incorporating ventilation-perfusion scintigraphy

    International Nuclear Information System (INIS)

    Larcos, G.; Chi, K.K.G.; Berry, G.; Westmead Hospital, Sydney, NSW; Shiell, A.

    2000-01-01

    There is a controversy regarding the investigation of patients with suspected acute pulmonary embolism (PE). To compare the cost-effectiveness of alternative methods of diagnosing acute PE, chest helical computed tomography (CT) alone and in combination with venous ultrasound (US) of legs and pulmonary angiography (PA) were compared to a conventional algorithm using ventilation-perfusion (V/Q) scintigraphy supplemented in selected cases by US and PA. A decision-analytical model was constructed to model the costs and effects of the three diagnostic strategies in a hypothetical cohort of 1000 patients each. Transition probabilities were based on published data. Life years gained by each strategy were estimated from published mortality rates. Schedule fees were used to estimate costs. The V/Q protocol is both more expensive and more effective than CT alone resulting in 20.1 additional lives saved at a (discounted) cost of $940 per life year gained. An additional 2.5 lives can be saved if CT replaces V/Q scintigraphy in the diagnostic algorithm but at a cost of $23,905 per life year saved. It resulted that the more effective diagnostic strategies are also more expensive. In patients with suspected PE, the incremental cost-effectiveness of the V/Q based strategy over CT alone is reasonable in comparison with other health interventions. The cost-effectiveness of the supplemented CT strategy is more questionable. Copyright (2000) The Australasian College of Physicians

  16. Indirect costs of inflammatory bowel diseases: Crohn's disease and ulcerative colitis. A systematic review.

    Science.gov (United States)

    Kawalec, Paweł

    2016-04-01

    Crohn's disease and ulcerative colitis are lifelong illnesses which have a significant impact on quality of life and personal burden through a reduction in the ability to work, sick leave and restrictions of leisure time. The aim of this study was to conduct a systematic review of the indirect costs of Crohn's disease and ulcerative colitis. The search was carried out in Medline, EMBASE, the Centre for Reviews and Dissemination, and reference lists of identified articles and reference lists of identified articles were also handsearched. All costs were adjusted to 2013 USD values by using the consumer price index and purchasing power parity. Identified studies were then analysed in order to assess their heterogeneity and possibility of inclusion in the meta-analysis. Eleven of the identified publications presented indirect costs of Crohn's disease or ulcerative colitis. The range of estimated yearly indirect costs per patient was large, from $1 159.09 for loss of earnings to $14 135.64 for lost productivity and sick leave for Crohn's disease. The values for ulcerative colitis ranged from $926.49 to $6 583.17. Because of the imprecise definition of methods of indirect cost calculations as well as heterogeneity of indirect cost components, a meta-analysis was not performed. The indirect costs of ulcerative colitis seem to be slightly lower than in the case of Crohn's disease. A small number of studies referring to indirect costs of Crohn's disease and ulcerative colitis were identified, which indicates the need to conduct further investigations on this problem.

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

    Science.gov (United States)

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

    2011-11-01

    To estimate direct and indirect economic costs among private-sector employees with osteoarthritis (OA). Using a large US employer benefits database, we identified all employees with evidence of OA during calendar year 2007, and compared their costs of health care and work loss to age-and-sex-matched employees without evidence of OA in that year. Private-sector employees with OA (n = 2399) averaged 62.9 days of absenteeism versus 36.7 days among matched comparators (n = 2399) (P Private-sector employees with OA have higher direct and indirect costs than those without this condition.

  18. Issues connected with indirect cost quantification: a focus on the transportation system

    Science.gov (United States)

    Křivánková, Zuzana; Bíl, Michal; Kubeček, Jan; Vodák, Rostislav

    2017-04-01

    Transportation and communication networks in general are vital parts of modern society. The economy relies heavily on transportation system performance. A number of people commutes to work regularly. Stockpiles in many companies are being reduced as the just-in-time production process is able to supply resources via the transportation network on time. Natural hazards have the potential to disturb transportation systems. Earthquakes, flooding or landsliding are examples of high-energetic processes which are capable of causing direct losses (i.e. physical damage to the infrastructure). We have focused on quantification of the indirect cost of natural hazards which are not easy to estimate. Indirect losses can also emerge as a result of meteorological hazards with low energy which only seldom cause direct losses, e.g. glaze, snowfall. Whereas evidence of repair work and general direct costs usually exist or can be estimated, indirect costs are much more difficult to identify particularly when they are not covered by insurance agencies. Delimitations of alternative routes (detours) are the most frequent responses to blocked road links. Indirect costs can then be related to increased fuel consumption and additional operating costs. Detours usually result in prolonged travel times. Indirect costs quantification has to therefore cover the value of the time. The costs from the delay are a nonlinear function of travel time, however. The existence of an alternative transportation pattern may also result in an increased number of traffic crashes. This topic has not been studied in depth but an increase in traffic crashes has been reported when people suddenly changed their traffic modes, e.g. when air traffic was not possible. The lost user benefit from those trips that were cancelled or suppressed is also difficult to quantify. Several approaches, based on post-event questioner surveys, have been applied to communities and companies affected by transportation accessibility

  19. 78 FR 53425 - Indirect Cost Rates for the Damage Assessment, Remediation, and Restoration Program for Fiscal...

    Science.gov (United States)

    2013-08-29

    ... method continues to be the Direct Labor Cost Base for all three DARRP component organizations. The Direct... allocation method for the development of the FY 2012 indirect cost rates. The DARRP's Indirect Cost Rates and... accounting system and allocation practices; recommend the appropriate indirect cost allocation methodology...

  20. Acute hospital, community, and indirect costs of stroke associated with atrial fibrillation: population-based study.

    LENUS (Irish Health Repository)

    Hannon, Niamh

    2014-10-30

    No economic data from population-based studies exist on acute or late hospital, community, and indirect costs of stroke associated with atrial fibrillation (AF-stroke). Such data are essential for policy development, service planning, and cost-effectiveness analysis of new therapeutic agents.

  1. Cost-effectiveness of interferon-γ release assay versus chest X-ray for tuberculosis screening of employees.

    Science.gov (United States)

    Kowada, Akiko

    2011-12-01

    Currently, an annual chest X-ray examination (CXR) for detection of active tuberculosis (TB) in employees aged ≥40 years is recommended in the guidelines of the Japan Industrial Safety and Health Law. Interferon-γ release assays are new alternatives to the tuberculin skin test for detecting Mycobacterium tuberculosis infection, with higher specificity than the tuberculin skin test and without cross-reactivity with the Bacille Calmette-Guérin vaccine. This study aimed to assess the cost-effectiveness of employee TB screening using QuantiFERON-TB Gold In-Tube (QFT) versus CXR. Markov models were constructed. The target population was a hypothetical cohort of immunocompetent 40-year-old individuals, using a societal perspective and a lifetime horizon. All costs and clinical benefits were discounted at a fixed annual rate of 3%. In a base-case analysis, the QFT strategy was the most cost-effective ($US 262.84; 22.87049 quality-adjusted life-years [QALYs]) compared with no screening ($448.38; 22.85452 QALYs) and CXR ($543.50; 22.85453 QALYs) [year 2009 values]. The QFT strategy is currently robust for screening Bacille Calmette-Guérin- vaccinated employees in Japan. There appears to be little role for CXR. These findings may be applicable to other countries in terms of choosing optimal TB screening for employees. Copyright © 2011 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

  2. Development of subcontractor indirect cost and other direct cost at the DOE Fernald Site

    International Nuclear Information System (INIS)

    Cossman, R.L.

    1994-01-01

    The Fernald Environmental Restoration Management Corporation (FERMCO) took great strides in the development of cost estimates at Fernald. There have been many opportunities to improve on how the policies and procedures pertaining to cost estimates were to be implemented. As FERMCO took over the existing Fernald facility, the Project Controls Division began to format the estimating procedures and tools to do business at Fernald. The Estimating Department looked at the problems that pre-existed at the site. One of the key problems that FERMCO encountered was how to summarized the direct and indirect accounts of each subcontracted estimate. Direct costs were broken down by prime and sub-prime accounts. This presented a level of detail that had not been experienced at the site before; it also created many issues concerning accounts and definitions to be applied to ''all other accounts associated with a project.'' Existing subcontract indirect cost accounts were reviewed from existing historical estimates. It was found that some were very detailed and some were not. The Estimating Department was given the task of standardizing the accounts and percentages for each of the subcontractor indirect costs. Then, as the project progressed, the percentages could be revised with actual estimates, subcontract comparisons, or with level of effort (LOE) accounts, which would represent qualified people assigned a task for the completion of each project. The approach is to assign particular employees to perform a specific task within a project from start to finish, and then to reassign the individual(s) to a new project (if it was available) integrating the expertise available with the skills required by the other operable units

  3. Lifestyle factors, direct and indirect costs for a Brazilian airline company

    NARCIS (Netherlands)

    F.M. Rabacow (Fabiana Maluf); O. Do Carmo Luiz (Olinda); A.M. Malik (Ana Maria); A. Burdorf (Alex)

    2014-01-01

    textabstractObjective: To analyze lifestyle risk factors related to direct healthcare costs and the indirect costs due to sick leave among workers of an airline company in Brazil. Methods: In this longitudinal 12-month study of 2,201 employees of a Brazilian airline company, the costs of sick leave

  4. Direct, indirect and intangible costs of acute hand and wrist injuries: A systematic review.

    Science.gov (United States)

    Robinson, Luke Steven; Sarkies, Mitchell; Brown, Ted; O'Brien, Lisa

    2016-12-01

    Injuries sustained to the hand and wrist are common, accounting for 20% of all emergency presentations. The economic burden of these injuries, comprised of direct (medical expenses incurred), indirect (value of lost productivity) and intangible costs, can be extensive and rise sharply with the increase of severity. This paper systematically reviews cost-of-illness studies and health economic evaluations of acute hand and wrist injuries with a particular focus on direct, indirect and intangible costs. It aims to provide economic cost estimates of burden and discuss the cost components used in international literature. A search of cost-of-illness studies and health economic evaluations of acute hand and wrist injuries in various databases was conducted. Data extracted for each included study were: design, population, intervention, and estimates and measurement methodologies of direct, indirect and intangible costs. Reported costs were converted into US-dollars using historical exchange rates and then adjusted into 2015 US-dollars using an inflation calculator RESULTS: The search yielded 764 studies, of which 21 met the inclusion criteria. Twelve studies were cost-of-illness studies, and seven were health economic evaluations. The methodology used to derive direct, indirect and intangible costs differed markedly across all studies. Indirect costs represented a large portion of total cost in both cost-of-illness studies [64.5% (IQR 50.75-88.25)] and health economic evaluations [68% (IQR 49.25-73.5)]. The median total cost per case of all injury types was US$6951 (IQR $3357-$22,274) for cost-of-illness studies and US$8297 (IQR $3858-$33,939) for health economic evaluations. Few studies reported intangible cost data associated with acute hand and wrist injuries. Several studies have attempted to estimate the direct, indirect and intangible costs associated with acute hand and wrist injuries in various countries using heterogeneous methodologies. Estimates of the economic

  5. 77 FR 63804 - Federal Acquisition Regulation; Information Collection; Indirect Cost Rates

    Science.gov (United States)

    2012-10-17

    ... cost accounting information normally prepared by organizations under sound management and accounting...; Information Collection; Indirect Cost Rates AGENCY: Department of Defense (DOD), General Services... Paperwork Reduction Act, the Regulatory Secretariat will be submitting to the Office of Management and...

  6. Direct and indirect healthcare costs of rheumatoid arthritis patients in Turkey.

    Science.gov (United States)

    Hamuryudan, Vedat; Direskeneli, Haner; Ertenli, Ihsan; Inanc, Murat; Karaaslan, Yasar; Oksel, Fahrettin; Ozbek, Suleyman; Pay, Salih; Terzioglu, Ender; Balkan Tezer, Dilara; Hacibedel, Basak; Akkoc, Nurullah

    2016-01-01

    To estimate the annual cost of rheumatoid arthritis (RA) in Turkey by obtaining real-world data directly from patients. In this cross-sectional study, RA patients from the rheumatology outpatient clinics of 10 university hospitals were interviewed with a standardised questionnaire on RA-related healthcare care costs. The study included 689 RA patients (565 females) with a mean age of 51.2±13.2 years and mean disease duration of 9.4±7.8 years. The mean scores of the Routine Assessment of Patient Index Data 3 and the Health Assessment Questionnaire-Disability Index (5.08±2.34 and 1.08±0.68, respectively) indicated moderate disease activity and severity for the whole group. One-third of the patients were on biologic agents and 12% had co-morbid conditions. The mean number of annual outpatient visits was 11.7±9.6 per patient. Of the patients, 15% required hospitalisation and 4% underwent surgery. The mean annual direct cost was € 4,954 (median, € 1,805), whereas the mean annual indirect cost was € 2,802 (median, € 608). Pharmacy costs accounted for the highest expenditure (mean, € 2,777; median, € 791), followed by the RA-related consultations and expenses (mean, € 1,600; median, € 696). RA has a substantial economic burden in Turkey, direct costs being higher than indirect costs. Although both direct and indirect costs are lower in Turkey than in Europe with respect to nominal Euro terms, they are higher from the perspectives of purchasing power parity and gross domestic product. Early diagnosis and treatment of RA may positively affect the national economy considering the positive correlation between health care utilisations and increased cost with disease severity.

  7. Determinants of Mortality in Chest Trauma Patients

    African Journals Online (AJOL)

    10% of trauma admissions.[1,2] In the United States it is estimated at 12 out of 1 million population per day.[3] Furthermore chest injury is still directly responsible for about 25% of trauma‑related deaths and contribute to death in another 25% of trauma‑related deaths.[1,2,4] Therefore, chest injury directly and indirectly ...

  8. The direct and indirect costs of managing chronic obstructive pulmonary disease in Greece.

    Science.gov (United States)

    Souliotis, Kyriakos; Kousoulakou, Hara; Hillas, Georgios; Tzanakis, Nikos; Toumbis, Michalis; Vassilakopoulos, Theodoros

    2017-01-01

    COPD is associated with significant economic burden. The objective of this study was to explore the direct and indirect costs associated with COPD and identify the key cost drivers of disease management in Greece. A Delphi panel of Greek pulmonologists was conducted, which aimed at eliciting local COPD treatment patterns and resource use. Resource use was translated into costs using official health insurance tariffs and Diagnosis-Related Groups (DRGs). In addition, absenteeism and caregiver's costs were recorded in order to quantify indirect COPD costs. The total costs of managing COPD per patient per year were estimated at €4,730, with direct (medical and nonmedical) and indirect costs accounting for 62.5% and 37.5%, respectively. COPD exacerbations were responsible for 32% of total costs (€1,512). Key exacerbation-related cost drivers were hospitalization (€830) and intensive care unit (ICU) admission costs (€454), jointly accounting for 85% of total exacerbation costs. Annual maintenance phase costs were estimated at €835, with pharmaceutical treatment accounting for 77% (€639.9). Patient time costs were estimated at €146 per year. The average number of sick days per year was estimated at 16.9, resulting in productivity losses of €968. Caregiver's costs were estimated at €806 per year. The management of COPD in Greece is associated with intensive resource use and significant economic burden. Exacerbations and productivity losses are the key cost drivers. Cost containment policies should focus on prioritizing treatments that increase patient compliance as these can lead to reduction of exacerbations, longer maintenance phases, and thus lower costs.

  9. [Direct and indirect costs of fractures due to osteoporosis in Austria].

    Science.gov (United States)

    Dimai, H-P; Redlich, K; Schneider, H; Siebert, U; Viernstein, H; Mahlich, J

    2012-10-01

    We examined the financial burden of osteoporosis in Austria. We took both direct and indirect costs into consideration. Direct costs encompass medical costs such as expenses for pharmaceuticals, inpatient and outpatient medical care costs, as well as other medical services (e.g., occupational therapies). Non-medical direct costs include transportation costs and medical devices (e.g., wheel chairs or crutches). Indirect costs refer to costs of productivity losses due to absence of work. Moreover, we included costs for early retirement and opportunity costs of informal care provided by family members. While there exist similar studies for other countries, this is the first comprehensive study for Austria. For our analysis, we combined data of official statistics, expert estimates as well as unique patient surveys that are currently conducted in the course of an international osteoporotic fracture study in Austria. Our estimation of the total annual costs in the year 2008 imposed by osteoporosis in Austria is 707.4 million €. The largest fraction of this amount is incurred by acute hospital treatment. Another significant figure, accounting for 29% of total costs, is the opportunity cost of informal care. The financial burden of osteoporosis in Austria is substantial. Economic evaluations of preventive and therapeutic interventions for the specific context of Austria are needed to inform health policy decision makers. © Georg Thieme Verlag KG Stuttgart · New York.

  10. Indirect, out-of-pocket and medical costs from influenza-related illness in young children.

    Science.gov (United States)

    Ortega-Sanchez, Ismael R; Molinari, Noelle-Angelique M; Fairbrother, Gerry; Szilagyi, Peter G; Edwards, Kathryn M; Griffin, Marie R; Cassedy, Amy; Poehling, Katherine A; Bridges, Carolyn; Staat, Mary Allen

    2012-06-13

    Studies have documented direct medical costs of influenza-related illness in young children, however little is known about the out-of-pocket and indirect costs (e.g., missed work time) incurred by caregivers of children with medically attended influenza. To determine the indirect, out-of-pocket (OOP), and direct medical costs of laboratory-confirmed medically attended influenza illness among young children. Using a population-based surveillance network, we evaluated a representative group of children aged accounting databases, and follow-up interviews with caregivers. Outcome measures included work time missed, OOP expenses (e.g., over-the-counter medicines, travel expenses), and direct medical costs. Costs were estimated (in 2009 US Dollars) and comparisons were made among children with and without high risk conditions for influenza-related complications. Data were obtained from 67 inpatients, 121 ED patients and 92 outpatients with laboratory-confirmed influenza. Caregivers of hospitalized children missed an average of 73 work hours (estimated cost $1456); caregivers of children seen in the ED and outpatient clinics missed 19 ($383) and 11 work hours ($222), respectively. Average OOP expenses were $178, $125 and $52 for inpatients, ED-patients and outpatients, respectively. OOP and indirect costs were similar between those with and without high risk conditions (p>0.10). Medical costs totaled $3990 for inpatients and $730 for ED-patients. Out-of-pocket and indirect costs of laboratory-confirmed and medically attended influenza in young children are substantial and support the benefits of vaccination. Published by Elsevier Ltd.

  11. Direct and indirect costs of Multiple Sclerosis in Baix Llobregat (Catalonia, Spain, according to disability

    Directory of Open Access Journals (Sweden)

    Gubieras Laura

    2006-11-01

    Full Text Available Abstract Background Multiple sclerosis (MS is an incurable chronic disease that predominantly affects young adults. It has a high socio-economic impact which increases as disability progresses. An assessment of the real costs of MS may contribute to our knowledge of the disease and to treat it more efficiently. Our objective is to assess the direct and indirect costs of MS from a societal perspective, in patients monitored in our MS Unit (Baix Llobregat, Catalonia and grouped according to their disability (EDSS. Methods We analysed data from 200 MS patients, who answered a questionnaire on resource consumption, employment and economical status. Mean age was 41.6 years, mean EDSS 2.7, 65.5% of patients were female, 79.5% had a relapsing-remitting course, and 67.5% of them were receiving immunomodulatory treatment (IT. Patients were grouped into five EDSS stages. Data from the questionnaires, hospital charts, Catalan Health Service tariffs, and figures from Catalan Institute of Statistics were used to calculate the direct and indirect costs. The cost-of-illness method, and the human capital approach for indirect costs, were applied. Sensitivity analyses were performed to strengthen results. Results The mean total annual cost of MS per patient results 24272 euros. This cost varied according to EDSS: 14327 euros (EDSS = 0, 18837 euros (EDSS = 1–3, 27870 euros (EDSS = 3.5–5.5, 41198 euros (EDSS = 6–7 and 52841 euros (EDSS>7.5. When the mean total annual costs was adjusted by the mean % of patients on IT in our Unit (31% the result was 19589 euros. The key-drivers for direct costs were IT in low EDSS stages, and caregiver costs in high stages. Indirect costs were assessed in terms of the loss of productivity when patients stop working. Direct costs accounted for around 60% of total costs in all EDSS groups. IT accounts from 78% to 11% of direct costs, and decreased as disability progressed. Conclusion The total mean social costs of MS in a

  12. Indirect costs and workplace productivity loss associated with non-Hodgkin lymphoma.

    Science.gov (United States)

    Yu, Justin S; Hansen, Ryan N; Valderrama, Adriana; Carlson, Josh J

    2016-11-01

    The objective of this study was to examine indirect costs and workplace productivity loss (defined as an aggregate measure of absenteeism, short-term disability, and long-term disability days) associated with non-Hodgkin lymphoma (NHL) from a societal perspective in a commercially insured working-age United States population. The MarketScan(®) Commercial Claims and Encounters and Health and Productivity Management Databases (2007-2013) were used in this study, with controls matched 3:1 to NHL patients. In comparison to controls, NHL patients incurred significantly more workplace productivity loss (31.99 days; 95% CI: 25.24 days, 38.73 days; p workplace productivity and higher associated indirect costs.

  13. The indirect costs of cancer-related absenteeism in the workplace in Poland.

    Science.gov (United States)

    Macioch, Tomasz; Hermanowski, Tomasz

    2011-12-01

    The aim of this study was to evaluate cancer-related absenteeism costs in Poland. Data on sickness absences and disability were retrieved from the Department of Statistics of the Social Insurance Institution. The cost of lost productivity owing to premature death was estimated from data retrieved from the Polish National Cancer Registry. Absenteeism costs were estimated on the basis of the measure of gross value added per employee. The costs of lost productivity owing to sick leave, disability, and premature death were estimated to be 1.572 billion EUR, 0.504 billion EUR, and 0.535 billion EUR, respectively, in 2009. The indirect costs of lost productivity owing to cancer-related sick leave, disability, and premature death have a substantial effect on the Polish economy. In 2009, they accounted for more than 0.8% of GDP.

  14. 76 FR 65182 - Indirect Cost Rates for the Damage Assessment, Remediation, and Restoration Program for Fiscal...

    Science.gov (United States)

    2011-10-20

    ... determined that the most appropriate indirect allocation method continues to be the Direct Labor Cost Base... Cost Base is the most appropriate indirect allocation method for the development of the FY 2009 and FY... the Direct Labor Cost Base allocation methodology. The FY 2009 rates will be applied to all damage...

  15. Risk-benefit analysis and cost-effectiveness analysis of lung cancer screening by spiral CT

    International Nuclear Information System (INIS)

    Iinuma, Takeshi

    1999-01-01

    Mass screening of lung cancer has been widely performed using indirect chest X-ray method in Japan. However reduction of the mortality for lung cancer is questioned. We have proposed that recently developed spiral CT should be adopted for the screening of lung cancer, since CT has an excellent detectability for small nodule. Lung Cancer Screening CT (LSCT) has been developed by author's group using spiral CT with low dose and light weight in order to make a mobile unit. In this paper risk-benefit analysis and cost-effectiveness analysis are described for the LSCT screening of lung cancer. As a risk, radiation carcinogenesis due to exposure from LSCT are compared with gain of life-expectancy by screening and men of 40 years or more and women of 45 years or more are justified. The cost per person-year is estimated for LSCT screening which is better than that of present method, although total cost is higher. The LSCT screening could be recommended if total cost is affordable. (author)

  16. A HALF-WAY RIGHT: FREE EDUCATION, INDIRECT COSTS, AND EDUCATIONAL POLICY

    Directory of Open Access Journals (Sweden)

    Mariano Fernández Enguita

    2014-12-01

    Full Text Available This paper examines those indirect costs of education associated to state funded schooling that come to be privately financed by families, specially those linked to mandatory or mandated provision schooling. Discussion is more detailed about textbooks, school meals and academic support activities. Then we study the consequences of this private spending for gratuity and its effects related to educational and social equality or inequality. Finally, we analyze the implications related to sectional interests at stake and educational policies.

  17. A half-way right: free education, indirect costs, and educational policy

    Directory of Open Access Journals (Sweden)

    Mariano Fernández Enguita

    2014-12-01

    Full Text Available This paper examines those indirect costs of education associated to state funded schooling that come to be privately financed by families, specially those linked to mandatory or mandated provision schooling. Discussion is more detailed about textbooks, school meals and academic support activities. Then we study the consequences of this private spending for gratuity and its effects related to educational and social equality or inequality. Finally, we analyze the implications related to sectional interests at stake and educational policies.

  18. Indirect health costs in ulcerative colitis and Crohn's disease: a systematic review and meta-analysis.

    Science.gov (United States)

    Kawalec, Paweł; Malinowski, Krzysztof Piotr

    2015-04-01

    The aim of this systematic review was to collect all current data on indirect costs related to inflammatory bowel disease as well as assessing homogeneity and comparability, and conducting a meta-analysis. Costs were collected using databases from Medline, Embase and Centre for Reviews and Dissemination databases, then average annual cost per patient was calculated and expressed in 2013-rate USD using the consumer price index and purchasing power parity (scenario 1) and then adjusted to specific gross domestic product (scenario 2) to make them comparable. The studies were then included in quantitative synthesis using the meta-analysis and bootstrap methods. This systematic review was carried out and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. From 18 publications, overall annual indirect costs per patient as a result of the quantitative synthesis among all studies eligible for meta-analysis ranged from US$2425.01-US$9622.15 depending on the scenario and model used for analysis. The cost of presenteeism was assessed in only two studies. Considering heterogeneity among all identified studies random-effect model presented the most accurate results of meta-analysis equal to US$7189.27 and US$9622.15 per patient per year for scenario 1 and scenario 2, respectively. This systematic review revealed the existence of a relatively small number of studies that reported on the great economic burden of the disease upon society. A great variety of methodologies and cost components resulted in a very large discrepancy in indirect costs and made meta-analysis difficult to perform, so two scenarios were considered and meta-analysis conducted in subgroups to make data more comparable.

  19. A study on the digital image transfer application mass chest X-ray system up-grade

    International Nuclear Information System (INIS)

    Kim, Sun Chil; Park, Jong Sam; Lee, Jon Il

    2003-01-01

    By converting movable indirect mass chest X-ray devices for vehicles into digital systems and upgrading it to share information with the hospital's medical image information system, excellencies have been confirmed as a result of installing and running this type of system and are listed hereinafter. Upgrading analog systems, such as indirect mass chest X-ray devices dependent on printed film, to digital systems allows them to be run and managed much more efficiently, contributing to the increase in the stability and the efficiency of the system. Unlike existing images, communication based on DICOM standards allow images to be compatible with the hospital's outer and inner network PACS systems, extending the scope of the radiation departments information system. Assuming chest-exclusive indirect mass chest X-rays, a linked development of CAD (Computer Aided Diagnosis, Detector) becomes possible. By applying wireless Internet, Web-PACS for movable indirect mass chest X-ray devices for vehicles will become possible. Research in these fields must continue and if the superior image quality and convenience of digital systems are confirmed, I believe that the conversion of systems still dependent on analog images to modernized digital systems is a must

  20. Indirect costs of diabetes and its impact on the public finance: the case of Poland.

    Science.gov (United States)

    Torój, Andrzej; Mela, Aneta

    2018-02-01

    Growing public and private expenditure on healthcare results i.a. from the spreading of chronic diseases. Diabetes belongs to the most frequent ones, beyond neoplasms and cardiological diseases, and hence generates a significant burden for the public finance in terms of the direct costs. However, the economy suffers also from the indirect cost of diabetes that manifests itself in the loss in Gross Domestic Product (GDP) and general government revenues. This paper aims to measure this indirect cost, both in terms of GDP drop (social perspective) and public revenue drop (public finance perspective), in the case of Poland in 2012-2014. We use a modified human capital approach and unique dataset provided by the Social Security institution in Poland and the Polish Central Statistical Office. Diabetes is a substantial and growing burden for the Polish economy. In the years 2012, 2013 and 2014 the indirect cost (output loss) amounted to 1.85 bn USD, 1.94 bn USD and 2.00 bn USD respectively. Estimated indirect cost of diabetes can be a useful input for health technology analyses of drugs or economic impact assessments of public health programmes.

  1. Prospective evaluation of indirect costs due to acute rotavirus gastroenteritis in Spain: the ROTACOST study

    Directory of Open Access Journals (Sweden)

    Sánchez-Lastres Juan

    2011-09-01

    Full Text Available Abstract Background The effect of rotavirus in developed countries is mainly economic. This study aimed to assess the indirect costs induced by rotavirus acute gastroenteritis (RVAGE in Spain. Methods A prospective observational study was conducted from October 2008 to June 2009. It included 682 children up to 5 years of age with acute gastroenteritis (AGE who attended primary care (n = 18 and emergency room/hospital settings (n = 10, covering the regions of Galicia and Asturias (North-west Spain. All non-medical expenses incurred throughout the episode were recorded in detail using personal interviews and telephone contact. Results Among the 682 enrolled children, 207 (30.4% were rotavirus positive and 170 (25% had received at least one dose of rotavirus vaccine. The mean (standard deviation indirect cost caused by an episode of AGE was estimated at 135.17 (182.70 Euros. Costs were 1.74-fold higher when AGE was caused by rotavirus compared with other etiologies: 192.7 (219.8 Euros vs. 111.6 (163.5 Euros (p Conclusions Rotavirus generates a significant indirect economic burden. Our data should be considered in the decision-making process of the eventual inclusion of rotavirus vaccine in the national immunization schedule of well developed countries.

  2. 78 FR 25443 - Federal Acquisition Regulation; Submission for OMB Review; Indirect Cost Rates

    Science.gov (United States)

    2013-05-01

    ... supporting cost data are the cost accounting information normally prepared by organizations under sound management and accounting practices. The proposal and supporting data is used by the contracting official and...; Submission for OMB Review; Indirect Cost Rates AGENCY: Department of Defense (DOD), General Services...

  3. Relationship between patient dependence and direct medical-, social-, indirect-, and informal-care costs in Spain

    Directory of Open Access Journals (Sweden)

    Darbà J

    2015-07-01

    Full Text Available Josep Darbà,1 Lisette Kaskens2 1Department of Economics, University of Barcelona, 2BCN Health Economics and Outcomes Research SL, Barcelona, Spain Objective: The objectives of this analysis were to examine how patients' dependence on others relates to costs of care and explore the incremental effects of patient dependence measured by the Dependence Scale on costs for patients with Alzheimer's disease (AD in Spain. Methods: The Co-Dependence in Alzheimer's Disease study is an 18 multicenter, cross-sectional, observational study among patients with AD according to the clinical dementia rating score and their caregivers in Spain. This study also gathered data on resource utilization for medical care, social care, caregiver productivity losses, and informal caregiver time reported in the Resource Utilization in Dementia Lite instrument and a complementary questionnaire. The data of 343 patients and their caregivers were collected through the completion of a clinical report form during one visit/assessment at an outpatient center or hospital, where all instruments were administered. The data collected (in addition to clinical measures also included sociodemographic data concerning the patients and their caregivers. Cost analysis was based on resource use for medical care, social care, caregiver productivity losses, and informal caregiver time reported in the Resource Utilization in Dementia Lite instrument and a complementary questionnaire. Resource unit costs were applied to value direct medical-, social-, and indirect-care costs. A replacement cost method was used to value informal care. Patient dependence on others was measured using the Dependence Scale, and the Cumulative Index Rating Scale was administered to the patient to assess multi-morbidity. Multivariate regression analysis was used to model the effects of dependence and other sociodemographic and clinical variables on cost of care. Results: The mean (standard deviation costs per patient

  4. STEM Faculty and Indirect Costs: What Administrators Need to Know

    Science.gov (United States)

    Gossman, Susan

    2016-01-01

    The focus of this single site, qualitative case study was on public research university STEM (science, technology, engineering and mathematics) faculty and their perspectives on, and behavior towards, indirect cost recovery. The explanatory scheme was derived from anthropological theory and incorporated organizational culture, resource dependency…

  5. Assessment of indirect losses and costs of emergency for project planning of alpine hazard mitigation

    Science.gov (United States)

    Amenda, Lisa; Pfurtscheller, Clemens

    2013-04-01

    By virtue of augmented settling in hazardous areas and increased asset values, natural disasters such as floods, landslides and rockfalls cause high economic losses in Alpine lateral valleys. Especially in small municipalities, indirect losses, mainly stemming from a breakdown of transport networks, and costs of emergency can reach critical levels. A quantification of these losses is necessary to estimate the worthiness of mitigation measures, to determine the appropriate level of disaster assistance and to improve risk management strategies. There are comprehensive approaches available for assessing direct losses. However, indirect losses and costs of emergency are widely not assessed and the empirical basis for estimating these costs is weak. To address the resulting uncertainties of project appraisals, a standardized methodology has been developed dealing with issues of local economic effects and emergency efforts needed. In our approach, the cost-benefit-analysis for technical mitigation of the Austrian Torrent and Avalanche Control (TAC) will be optimized and extended using the 2005-debris flow as a design event, which struggled a small town in the upper Inn valley in southwest Tyrol (Austria). Thereby, 84 buildings were affected, 430 people were evacuated and due to this, the TAC implemented protection measures for 3.75 million Euros. Upgrading the method of the TAC and analyzing to what extent the cost-benefit-ratio is about to change, is one of the main objectives of this study. For estimating short-run indirect effects and costs of emergency on the local level, data was collected via questionnaires, field mapping, guided interviews, as well as intense literature research. According to this, up-to-date calculation methods were evolved and the cost-benefit-analysis of TAC was recalculated with these new-implemented results. The cost-benefit-ratio will be more precise and specific and hence, the decision, which mitigation alternative will be carried out

  6. Indirect cost of maternal deaths in the WHO African Region in 2010.

    Science.gov (United States)

    Kirigia, Joses Muthuri; Mwabu, Germano Mwige; Orem, Juliet Nabyonga; Muthuri, Rosenabi Deborah Karimi

    2014-08-31

    An estimated 147,741 maternal deaths occurred in 2010 in 45 of the 47 countries in the African Region of the World Health Organization (WHO). The objective of this study was to estimate the indirect cost of maternal deaths in the Region to provide data for use in advocacy for increased domestic and external investment in multisectoral policy interventions to curb maternal mortality. This study used the cost-of-illness method to estimate the indirect cost of maternal mortality, i.e. the loss in non-health gross domestic product (GDP) attributable to maternal deaths. Estimates on maternal mortality for 2010 from Trends in maternal mortality: 1990 to 2010 published by WHO, UNICEF, UNFPA and the World Bank were used in these calculations. Values for future non-health GDP lost were converted into their present values by applying a 3% discount rate. One-way sensitivity analysis at 5% and 10% discount rates assessed the impact on non-health GDP loss. Indirect cost analysis was undertaken for the countries, categorized under three income groups. Group 1 consisted of nine high and upper middle income countries, Group 2 of 12 lower middle income countries, and Group 3 of 26 low income countries. Estimates for Seychelles in Group 1 and South Sudan in Group 3 were not provided in the source used. The 147,741 maternal deaths that occurred in 45 countries in the African Region in 2010 resulted in a total non-health GDP loss of Int$ 4.5 billion (PPP). About 24.5% of the loss was in Group 1 countries, 44.9% in Group 2 countries and 30.6% in Group 3 countries. This translated into losses in non-health GDP of Int$ 139,219, Int$ 35,440 and Int$ 16,397 per maternal death, respectively, for the three groups. Using discount rates of 5% and 10% reduced the total non-health GDP loss by 19.1% and 47.7%, respectively. Maternal mortality is responsible for a noteworthy level of non-health GDP loss among the countries in the African Region. There is urgent need, therefore, to increase

  7. Evaluation of chest tomosynthesis for the detection of pulmonary nodules: effect of clinical experience and comparison with chest radiography

    Science.gov (United States)

    Zachrisson, Sara; Vikgren, Jenny; Svalkvist, Angelica; Johnsson, Åse A.; Boijsen, Marianne; Flinck, Agneta; Månsson, Lars Gunnar; Kheddache, Susanne; Båth, Magnus

    2009-02-01

    Chest tomosynthesis refers to the technique of collecting low-dose projections of the chest at different angles and using these projections to reconstruct section images of the chest. In this study, a comparison of chest tomosynthesis and chest radiography in the detection of pulmonary nodules was performed and the effect of clinical experience of chest tomosynthesis was evaluated. Three senior thoracic radiologists, with more than ten years of experience of chest radiology and 6 months of clinical experience of chest tomosynthesis, acted as observers in a jackknife free-response receiver operating characteristics (JAFROC-1) study, performed on 42 patients with and 47 patients without pulmonary nodules examined with both chest tomosynthesis and chest radiography. MDCT was used as reference and the total number of nodules found using MDCT was 131. To investigate the effect of additional clinical experience of chest tomosynthesis, a second reading session of the tomosynthesis images was performed one year after the initial one. The JAFROC-1 figure of merit (FOM) was used as the principal measure of detectability. In comparison with chest radiography, chest tomosynthesis performed significantly better with regard to detectability. The observer-averaged JAFROC-1 FOM was 0.61 for tomosynthesis and 0.40 for radiography, giving a statistically significant difference between the techniques of 0.21 (p<0.0001). The observer-averaged JAFROC-1 FOM of the second reading of the tomosynthesis cases was not significantly higher than that of the first reading, indicating no improvement in detectability due to additional clinical experience of tomosynthesis.

  8. Direct and indirect costs for adverse drug events identified in medical records across care levels, and their distribution among payers.

    Science.gov (United States)

    Natanaelsson, Jennie; Hakkarainen, Katja M; Hägg, Staffan; Andersson Sundell, Karolina; Petzold, Max; Rehnberg, Clas; Jönsson, Anna K; Gyllensten, Hanna

    2017-11-01

    Adverse drug events (ADEs) cause considerable costs in hospitals. However, little is known about costs caused by ADEs outside hospitals, effects on productivity, and how the costs are distributed among payers. To describe the direct and indirect costs caused by ADEs, and their distribution among payers. Furthermore, to describe the distribution of patient out-of-pocket costs and lost productivity caused by ADEs according to socio-economic characteristics. In a random sample of 5025 adults in a Swedish county, prevalence-based costs for ADEs were calculated. Two different methods were used: 1) based on resource use judged to be caused by ADEs, and 2) as costs attributable to ADEs by comparing costs among individuals with ADEs to costs among matched controls. Payers of costs caused by ADEs were identified in medical records among those with ADEs (n = 596), and costs caused to individual patients were described by socio-economic characteristics. Costs for resource use caused by ADEs were €505 per patient with ADEs (95% confidence interval €345-665), of which 38% were indirect costs. Compared to matched controls, the costs attributable to ADEs were €1631, of which €410 were indirect costs. The local health authorities paid 58% of the costs caused by ADEs. Women had higher productivity loss than men (€426 vs. €109, p = 0.018). Out-of-pocket costs displaced a larger proportion of the disposable income among low-income earners than higher income earners (0.7% vs. 0.2%-0.3%). We used two methods to identify costs for ADEs, both identifying indirect costs as an important component of the overall costs for ADEs. Although the largest payers of costs caused by ADEs were the local health authorities responsible for direct costs, employers and patients costs for lost productivity contributed substantially. Our results indicate inequalities in costs caused by ADEs, by sex and income. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Cost and morbidity analysis of chest port insertion in adults: Outpatient clinic versus operating room placement.

    Science.gov (United States)

    Feo, Claudio F; Ginesu, Giorgio C; Bellini, Alessandro; Cherchi, Giuseppe; Scanu, Antonio M; Cossu, Maria Laura; Fancellu, Alessandro; Porcu, Alberto

    2017-09-01

    Totally implantable venous access devices (TIVADs) represent a convenient way for the administration of medications or nutrients. Traditionally, chest ports have been positioned by surgeons in the operating room, however there has been a transition over the years to port insertion by interventional radiologists in the radiology suite. The optimal method for chest port placement is still under debate. Data on all adult patients undergoing isolated chest port placement at our institution in a 12-year period were retrospectively reviewed. The aim of this cohort study was to compare cost and morbidity for chest port insertion in two different settings: outpatient clinic and operating room. Between 2003 and 2015 a total of 527 chest ports were placed in adult patients. Of them, 262 procedures were performed in the operating room and 265 procedures were undertaken in the outpatient clinic. Patient characteristics were similar and there was no significant difference in early (port was 1270 Euros in the operating room versus 620 Euros in the outpatient clinic. Our results suggest that chest ports can be safely placed in most patients under local anesthesia in the office setting without fluoroscopy or ultrasound guidance. Future randomized controlled studies may evaluate if surgeons or interventional radiologists should routinely perform these procedures in a dedicated office setting and reserve more sophisticated facilities only for patients at high risk of technical failure.

  10. Costs of endometriosis in Austria: a survey of direct and indirect costs.

    Science.gov (United States)

    Prast, Johanna; Oppelt, Peter; Shamiyeh, Andreas; Shebl, Omar; Brandes, Iris; Haas, Dietmar

    2013-09-01

    The literature includes a wealth of medical data on endometriosis, but the economic significance of the condition has so far been neglected. An analysis of hospital costs for endometriosis in Austria was, therefore, carried out for economic purposes. Seventy-three patients with endometriosis were included in the study. A bottom-up approach was used to collect data on the average hospital costs of an endometriosis patient over a time period of 1 year. In addition, a prevalence approach was used that allows subsequent estimation of the total costs of endometriosis for the health-care system in Austria for that period. Retrospective questionnaire survey was conducted. The average annual costs of one case of endometriosis are 7,712, with 5,605.55 attributable to direct costs and 2,106.34 to indirect costs. This indicates an overall economic burden of 328 million. In-patient care (45 %) and loss of productivity (27 %) were identified as the major cost factors. The patients themselves pay for 13 % of the costs (through out-of-pocket payments). This study impressively demonstrates the financial burden on the economy and on each individually affected patient caused by the disease of endometriosis. The massive consumption of resources represents a high level of usage of the medical services provided. The question arises as to whether more timely diagnosis, followed by better-targeted treatment, might have the potential to reduce these costs. The overall economic burden of endometriosis in Austria is currently comparable with that of Parkinson's disease.

  11. The indirect costs and benefits of greenhouse gas limitations: Hungary Case Study

    Energy Technology Data Exchange (ETDEWEB)

    Zilahy, G.; Zsoka, A.N.; Szeszler, A.; Urge-Vorsatz, D.; Markandya, A.; Hunt, A.

    2000-05-01

    A methodology has been developed which provides a framework for the assessment of the wider impacts arising from GHG limitation projects, and advice on how to incorporate them into the decision-making framework. The purpose of this report is to apply the methodology to a set of selected GHG limitation projects currently being considered for implementation in Hungary. In total, four GHG limitation projects were selected for application of the methodology. This second phase of the research in Hungary, concentrated on four mitigation options in the household sector: Specifically, the selected GHG limitation projects involve: 1. The installation of new, better insulated windows. 2. The installation of water saving devices on water taps. 3. The installation of active solar cells to prepare domestic hot water. 4. The replacement of traditional light bulbs by compact fluorescent bulbs. This study has shown the potential, as well as the current pratical limitations, of the methodology. The value of the employment created has been estimated by adding gains in income effects with health effects. The environmental effects that have been quantified suggest that the reduction of pollution and associated health effects would be significant. The options that have been investigated are too small-scale to generate distributional impacts or macro-economic effects but the estimated effects on sustainability are positive and significant. The principal policy conclusion that can be drawn from the analysis thus far is that it is imperative to consider indirect effects. It is possible that inclusion of indirect effects will make the net economic cost of an option negative thereby making it much more easy to 'sell' as a policy measure - though the assumptions will have to be made explicit and therefore defensible. It is important for policy makers to note that whilst there is a general pattern of lower economic costs derived from this analysis, the reductions are not uniform and

  12. The indirect costs and benefits of greenhouse gas limitations: Hungary Case Study

    Energy Technology Data Exchange (ETDEWEB)

    Zilahy, G; Zsoka, A N; Szeszler, A; Urge-Vorsatz, D; Markandya, A; Hunt, A

    2000-05-01

    A methodology has been developed which provides a framework for the assessment of the wider impacts arising from GHG limitation projects, and advice on how to incorporate them into the decision-making framework. The purpose of this report is to apply the methodology to a set of selected GHG limitation projects currently being considered for implementation in Hungary. In total, four GHG limitation projects were selected for application of the methodology. This second phase of the research in Hungary, concentrated on four mitigation options in the household sector: Specifically, the selected GHG limitation projects involve: 1. The installation of new, better insulated windows. 2. The installation of water saving devices on water taps. 3. The installation of active solar cells to prepare domestic hot water. 4. The replacement of traditional light bulbs by compact fluorescent bulbs. This study has shown the potential, as well as the current pratical limitations, of the methodology. The value of the employment created has been estimated by adding gains in income effects with health effects. The environmental effects that have been quantified suggest that the reduction of pollution and associated health effects would be significant. The options that have been investigated are too small-scale to generate distributional impacts or macro-economic effects but the estimated effects on sustainability are positive and significant. The principal policy conclusion that can be drawn from the analysis thus far is that it is imperative to consider indirect effects. It is possible that inclusion of indirect effects will make the net economic cost of an option negative thereby making it much more easy to 'sell' as a policy measure - though the assumptions will have to be made explicit and therefore defensible. It is important for policy makers to note that whilst there is a general pattern of lower economic costs derived from this analysis, the reductions are not uniform and

  13. Indications for chest CT. Retrospective study of cases with normal chest CT

    International Nuclear Information System (INIS)

    Obata, Shiro

    1995-01-01

    The usefulness of computed tomography (CT) in thoracic radiology is now well appreciated, and the number of chest CTs has greatly increased. There are, however, many chest CT cases that are completely or almost completely normal. Indications for chest CT should be re-evaluated considering the cost and radiation exposure associated with the examination. Reviewing the reports of 4930 chest CT examinations performed in three hospitals during the period of two years, the author found 620 (12.6%) negative CT examinations. In 312 of the 620, the CT was requested because of 'abnormal shadow' on chest radiograph. When the same chest radiographs were re-evaluated by two radiologists, no abnormality was noted in 257 cases (82.4%). CT examinations were considered justified in only 55 cases (17.6%). There was a significant difference in the frequency of normal chest CT examinations between the university hospital and two other hospitals. The causes of false positive interpretation of chest radiographs were analyzed, and it was felt that fundamental knowledge necessary to interpret chest radiographs was lacking. The importance of close cooperation between clinicians and radiologists should be emphasized. (author)

  14. Direct and indirect costs of tuberculosis among immigrant patients in the Netherlands.

    Science.gov (United States)

    Kik, Sandra V; Olthof, Sandra P J; de Vries, Jonie T N; Menzies, Dick; Kincler, Naomi; van Loenhout-Rooyakkers, Joke; Burdo, Conny; Verver, Suzanne

    2009-08-05

    In low tuberculosis (TB) incidence countries TB affects mostly immigrants in the productive age group. Little empirical information is available about direct and indirect TB-related costs that patients face in these high-income countries. We assessed the direct and indirect costs of immigrants with TB in the Netherlands. A cross-sectional survey at 14 municipal health services and 2 specialized TB hospitals was conducted. Interviews were administered to first or second generation immigrants, 18 years or older, with pulmonary or extrapulmonary TB, who were on treatment for 1-6 months. Out of pocket expenditures and time loss, related to TB, was assessed for different phases of the current TB illness. In total 60 patients were interviewed. Average direct costs spent by households with a TB patient amounted euro353. Most costs were spent when being hospitalized. Time loss (mean 81 days) was mainly due to hospitalization (19 days) and additional work days lost (60 days), and corresponded with a cost estimation of euro2603. Even in a country with a good health insurance system that covers medication and consultation costs, patients do have substantial extra expenditures. Furthermore, our patients lost on average 2.7 months of productive days. TB patients are economically vulnerable.

  15. Direct and indirect costs of tuberculosis among immigrant patients in the Netherlands

    Directory of Open Access Journals (Sweden)

    Kincler Naomi

    2009-08-01

    Full Text Available Abstract Background In low tuberculosis (TB incidence countries TB affects mostly immigrants in the productive age group. Little empirical information is available about direct and indirect TB-related costs that patients face in these high-income countries. We assessed the direct and indirect costs of immigrants with TB in the Netherlands. Methods A cross-sectional survey at 14 municipal health services and 2 specialized TB hospitals was conducted. Interviews were administered to first or second generation immigrants, 18 years or older, with pulmonary or extrapulmonary TB, who were on treatment for 1–6 months. Out of pocket expenditures and time loss, related to TB, was assessed for different phases of the current TB illness. Results In total 60 patients were interviewed. Average direct costs spent by households with a TB patient amounted €353. Most costs were spent when being hospitalized. Time loss (mean 81 days was mainly due to hospitalization (19 days and additional work days lost (60 days, and corresponded with a cost estimation of €2603. Conclusion Even in a country with a good health insurance system that covers medication and consultation costs, patients do have substantial extra expenditures. Furthermore, our patients lost on average 2.7 months of productive days. TB patients are economically vulnerable.

  16. 77 FR 8219 - Notice of Indirect Cost Rates for the Office of National Marine Sanctuaries for Fiscal Years 2008...

    Science.gov (United States)

    2012-02-14

    ... requirements. C&C also determined that the most appropriate indirect allocation method was the Direct Labor... most appropriate indirect allocation method for the development of the FY 2008 and 2009 indirect cost... October 1, 2008 and present, using the Direct Labor Cost base allocation methodology. For cases that have...

  17. Large and abundant flowers increase indirect costs of corollas: a study of coflowering sympatric Mediterranean species of contrasting flower size.

    Science.gov (United States)

    Teixido, Alberto L; Valladares, Fernando

    2013-09-01

    Large floral displays receive more pollinator visits but involve higher production and maintenance costs. This can result in indirect costs which may negatively affect functions like reproductive output. In this study, we explored the relationship between floral display and indirect costs in two pairs of coflowering sympatric Mediterranean Cistus of contrasting flower size. We hypothesized that: (1) corolla production entails direct costs in dry mass, N and P, (2) corollas entail significant indirect costs in terms of fruit set and seed production, (3) indirect costs increase with floral display, (4) indirect costs are greater in larger-flowered sympatric species, and (5) local climatic conditions influence indirect costs. We compared fruit set and seed production of petal-removed flowers and unmanipulated control flowers and evaluated the influence of mean flower number and mean flower size on relative fruit and seed gain of petal-removed and control flowers. Fruit set and seed production were significantly higher in petal-removed flowers in all the studied species. A positive relationship was found between relative fruit gain and mean individual flower size within species. In one pair of species, fruit gain was higher in the large-flowered species, as was the correlation between fruit gain and mean number of open flowers. In the other pair, the correlation between fruit gain and mean flower size was also higher in the large-flowered species. These results reveal that Mediterranean environments impose significant constraints on floral display, counteracting advantages of large flowers from the pollination point of view with increased indirect costs of such flowers.

  18. Cost of Care Among Patients With Pulmonary Tuberculosis in Lagos ...

    African Journals Online (AJOL)

    Tuberculosis (TB) is a global health challenge. Currently it is the 7th leading cause of death worldwide, and Nigeria ranks fourth amongst 22 high-burden countries for the disease. This study sought to appraise the direct and indirect costs borne by TB patients attending the Chest Clinics at the Lagos State University ...

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

    Science.gov (United States)

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

    2015-01-01

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

  20. Chest X ray effective doses estimation in computed radiography

    International Nuclear Information System (INIS)

    Abdalla, Esra Abdalrhman Dfaalla

    2013-06-01

    Conventional chest radiography is technically difficult because of wide in tissue attenuations in the chest and limitations of screen-film systems. Computed radiography (CR) offers a different approach utilizing a photostimulable phosphor. photostimulable phosphors overcome some image quality limitations of chest imaging. The objective of this study was to estimate the effective dose in computed radiography at three hospitals in Khartoum. This study has been conducted in radiography departments in three centres Advanced Diagnostic Center, Nilain Diagnostic Center, Modern Diagnostic Center. The entrance surface dose (ESD) measurement was conducted for quality control of x-ray machines and survey of operators experimental techniques. The ESDs were measured by UNFORS dosimeter and mathematical equations to estimate patient doses during chest X rays. A total of 120 patients were examined in three centres, among them 62 were males and 58 were females. The overall mean and range of patient dosed was 0.073±0.037 (0.014-0.16) mGy per procedure while the effective dose was 3.4±01.7 (0.6-7.0) mSv per procedure. This study compared radiation doses to patients radiographic examinations of chest using computed radiology. The radiation dose was measured in three centres in Khartoum- Sudan. The results of the measured effective dose showed that the dose in chest radiography was lower in computed radiography compared to previous studies.(Author)

  1. Marginal cost and congestion in the Italian electricity market: An indirect estimation approach

    International Nuclear Information System (INIS)

    Bigerna, Simona; Andrea Bollino, Carlo; Polinori, Paolo

    2015-01-01

    In this paper we construct an indirect measure of the supply marginal cost function for the main generators from the observed bid data in the Italian electricity market in the period 2004–2007. We compute the residual demand function for each generator, taking explicitly into account the issue of transmission line congestion. This procedure allows recovering correct zonal Lerner index and the implied measure of the marginal cost function. We find evidence of a stable U-shaped marginal cost function for three main Italian generators, but a flat function for ENEL, the former national monopolist. The policy relevance of our approach lies in the possibility to offer some empirical knowledge of the marginal cost function of each generator to the regulator to design appropriate policy measures geared to the promotion of competitive market conditions. We propose a new market surveillance mechanism, which is based on the principle of sanctioning excessive deviations from the estimated measure of the marginal cost function presented in this work. -- Highlights: •We construct an indirect measure of the supply marginal cost function. •We compute the residual demand function taking into account transmission line congestion. •We find a general evidence of a stable U-shaped marginal cost function for Italian generators. •We find flat marginal cost function for the former national monopolist. •We use excessive deviations from estimated marginal cost function as a new market surveillance mechanism

  2. The single chest tube versus double chest tube application after pulmonary lobectomy: A systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Xuefei Zhang

    2016-01-01

    Conclusion: Compared with the double chest tube, the single chest tube significantly decreases amount of drainage, duration of chest tube drainage, pain score, the number of patients who need thoracentesis, and cost. Although there is convincing evidence to confirm the results mentioned herein, they still need to be confirmed by large-sample, multicenter, randomized, controlled trials.

  3. Prospective evaluation of indirect costs due to acute rotavirus gastroenteritis in Spain: the ROTACOST study.

    Science.gov (United States)

    Bouzón-Alejandro, Marta; Redondo-Collazo, Lorenzo; Sánchez-Lastres, Juan Manuel; Martinón-Torres, Nazareth; Martinón-Sánchez, José María; Martinón-Torres, Federico

    2011-09-14

    The effect of rotavirus in developed countries is mainly economic. This study aimed to assess the indirect costs induced by rotavirus acute gastroenteritis (RVAGE) in Spain. A prospective observational study was conducted from October 2008 to June 2009. It included 682 children up to 5 years of age with acute gastroenteritis (AGE) who attended primary care (n = 18) and emergency room/hospital settings (n = 10), covering the regions of Galicia and Asturias (North-west Spain). All non-medical expenses incurred throughout the episode were recorded in detail using personal interviews and telephone contact. Among the 682 enrolled children, 207 (30.4%) were rotavirus positive and 170 (25%) had received at least one dose of rotavirus vaccine. The mean (standard deviation) indirect cost caused by an episode of AGE was estimated at 135.17 (182.70) Euros. Costs were 1.74-fold higher when AGE was caused by rotavirus compared with other etiologies: 192.7 (219.8) Euros vs. 111.6 (163.5) Euros (p purchase of material. Patients with RVAGE were admitted to hospital more frequently than those with other etiologies (47.8% vs 14%, p decision-making process of the eventual inclusion of rotavirus vaccine in the national immunization schedule of well developed countries.

  4. Cost-effectiveness analysis on the results of screening of lung cancer using helical CT conducted by the anti-lung cancer association (ALCA)

    International Nuclear Information System (INIS)

    Iinuma, Takeshi; Kaneko, Masahiro; Moriyama, Noriyuki; Misawa, Jun

    1999-01-01

    To compare Yen/person saved in lung cancer screening using helical CT with Yen/person in the screening using conventional direct chest X-rays conducted under the Anti-lung cancer association program of the Tokyo Health Service Association. A mathematical model for cancer screening was used to estimate net number of person relieved from lung cancer by the screening and net cost required for the screening. Finally cost-effectiveness ratios in terms of Yen/person saved were calculated and compared between the two programs. Several important variables employed in the model were as follows: 5 year survival rate in chest X-ray group was 50%, and the rate in helical CT group was 75%. Cost of screening in the chest X-ray group was 15,000 Yen, and that in the helical CT group was 25,000 Yen. Cost/person screened was 14,470 Yen for chest X-ray and 21,890 Yen for helical CT. Cost/person saved was 267 x 10 5 Yen in X-ray group and 112 x 10 5 Yen in CT group. Thus the cost was higher, but cost-effectiveness ratio was better in the CT screening group. Helical CT can be adopted for lung cancer screening in stead of chest X-ray if total cost is affordable. (author)

  5. The impact of chest compression rates on quality of chest compressions - a manikin study.

    Science.gov (United States)

    Field, Richard A; Soar, Jasmeet; Davies, Robin P; Akhtar, Naheed; Perkins, Gavin D

    2012-03-01

    Chest compressions are often performed at a variable rate during cardiopulmonary resuscitation (CPR). The effect of compression rate on other chest compression quality variables (compression depth, duty-cycle, leaning, performance decay over time) is unknown. This randomised controlled cross-over manikin study examined the effect of different compression rates on the other chest compression quality variables. Twenty healthcare professionals performed 2 min of continuous compressions on an instrumented manikin at rates of 80, 100, 120, 140 and 160 min(-1) in a random order. An electronic metronome was used to guide compression rate. Compression data were analysed by repeated measures ANOVA and are presented as mean (SD). Non-parametric data was analysed by Friedman test. At faster compression rates there were significant improvements in the number of compressions delivered (160(2) at 80 min(-1) vs. 312(13) compressions at 160 min(-1), P<0.001); and compression duty-cycle (43(6)% at 80 min(-1) vs. 50(7)% at 160 min(-1), P<0.001). This was at the cost of a significant reduction in compression depth (39.5(10)mm at 80 min(-1) vs. 34.5(11)mm at 160 min(-1), P<0.001); and earlier decay in compression quality (median decay point 120 s at 80 min(-1) vs. 40s at 160 min(-1), P<0.001). Additionally not all participants achieved the target rate (100% at 80 min(-1) vs. 70% at 160 min(-1)). Rates above 120 min(-1) had the greatest impact on reducing chest compression quality. For Guidelines 2005 trained rescuers, a chest compression rate of 100-120 min(-1) for 2 min is feasible whilst maintaining adequate chest compression quality in terms of depth, duty-cycle, leaning, and decay in compression performance. Further studies are needed to assess the impact of the Guidelines 2010 recommendation for deeper and faster chest compressions. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  6. Cost-effective and low-technology options for simulation and training in neonatology.

    Science.gov (United States)

    Bruno, Christie J; Glass, Kristen M

    2016-11-01

    The purpose of this review is to explore low-cost options for simulation and training in neonatology. Numerous cost-effective options exist for simulation and training in neonatology. Lower cost options are available for teaching clinical skills and procedural training in neonatal intubation, chest tube insertion, and pericardiocentesis, among others. Cost-effective, low-cost options for simulation-based education can be developed and shared in order to optimize the neonatal simulation training experience. Copyright © 2016 Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

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

    2014-01-01

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

  8. Turning lights into flights: Estimating direct and indirect rebound effects for UK households

    International Nuclear Information System (INIS)

    Chitnis, Mona; Sorrell, Steve; Druckman, Angela; Firth, Steven K.; Jackson, Tim

    2013-01-01

    Energy efficiency improvements by households lead to rebound effects that offset the potential energy and emissions savings. Direct rebound effects result from increased demand for cheaper energy services, while indirect rebound effects result from increased demand for other goods and services that also require energy to provide. Research to date has focused upon the former, but both are important for climate change. This study estimates the combined direct and indirect rebound effects from seven measures that improve the energy efficiency of UK dwellings. The methodology is based upon estimates of the income elasticity and greenhouse gas (GHG) intensity of 16 categories of household goods and services, and allows for the embodied emissions of the energy efficiency measures themselves, as well as the capital cost of the measures. Rebound effects are measured in GHG terms and relate to the adoption of these measures by an average UK household. The study finds that the rebound effects from these measures are typically in the range 5–15% and arise mostly from indirect effects. This is largely because expenditure on gas and electricity is more GHG-intensive than expenditure on other goods and services. However, the anticipated shift towards a low carbon electricity system in the UK may lead to much larger rebound effects. - Highlights: ► We estimate the direct and indirect rebound effects from energy efficiency improvements by UK households. ► We allow for the capital cost of the improvement, together with the emissions embodied in the relevant equipment. ► We find rebound effects to be relatively modest, in the range 5–15%. ► The anticipated shift towards a low carbon electricity system will lead to larger rebound effects

  9. Direct and indirect patient costs of dermatology clinic visits and their impact on access to care and provider preference.

    Science.gov (United States)

    Rothstein, Brooke E; Gonzalez, Jessica; Cunningham, Kiera; Saraiya, Ami; Dornelles, Adriana C; Nguyen, Bichchau M

    2017-12-01

    The direct and indirect costs of dermatology clinic visits are infrequently quantified. Indirect costs, such as the time spent traveling to and from appointments and the value of lost earnings from time away from work, are substantial costs that often are not included in economic analyses but may pose barriers to receiving care. Due to the national shortage of dermatologists, patients may have to wait longer for appointments or travel further to see dermatologists outside of their local community, resulting in high time and travel costs for patients. Patients' lost time and earnings comprise the opportunity cost of obtaining care. A monetary value for this opportunity cost can be calculated by multiplying a patient's hourly wage by the number of hours that the patient dedicated to attending the dermatology appointment. Using a single institution survey, this study quantified the direct and indirect patient costs, including opportunity costs and time burden, associated with dermatology clinic visits to better appreciate the impact of these factors on health care access and dermatologic provider preference.

  10. Diagnostic imaging costs before and after digital tomosynthesis implementation in patient management after detection of suspected thoracic lesions on chest radiography.

    Science.gov (United States)

    Quaia, Emilio; Grisi, Guido; Baratella, Elisa; Cuttin, Roberto; Poillucci, Gabriele; Kus, Sara; Cova, Maria Assunta

    2014-02-01

    To evaluate diagnostic imaging costs before and after DTS implementation in patients with suspected thoracic lesions on CXR. Four hundred sixty-five patients (263 male, 202 female; age, 72.47 ± 11.33 years) with suspected thoracic lesion(s) after CXR underwent DTS. Each patient underwent CT when a pulmonary non-calcified lesion was identified by DTS while CT was not performed when a benign pulmonary or extrapulmonary lesion or pseudolesion was identified. The average per-patient imaging cost was calculated by normalising the costs before and after DTS implementation. In 229/465 patients who underwent DTS after suspicious CXR, DTS showed 193 pulmonary lesions and 36 pleural lesions, while in the remaining 236/465 patients, lesions were ruled out as pseudolesions of CXR. Chest CT examination was performed in 127/465 (27 %) patients while in the remaining 338/465 patients (73 %) CXR doubtful findings were resolved by DTS. The average per-patient costs of CXR, DTS and CT were 15.15, 41.55 and 113.66. DTS allowed an annual cost saving of 8,090.2 considering unenhanced CT and 19,298.12 considering contrast-enhanced CT. Considering a DTS reimbursement rate of 62.7 the break even point corresponds to 479 DTS examinations. Per-patient diagnostic imaging costs decreased after DTS implementation in patients with suspected thoracic lesions. • Digital tomosynthesis improves the diagnostic accuracy and confidence in chest radiography • Digital tomosynthesis reduces the need for CT for a suspected pulmonary lesion • Digital tomosynthesis requires a dose level equivalent to that of around two chest radiographies • Digital tomosynthesis produces a significant per-patient saving in diagnostic imaging costs.

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

    Directory of Open Access Journals (Sweden)

    Patel JG

    2014-03-01

    Full Text Available Jeetvan G Patel,1,2 Saurabh P Nagar,2 Anand A Dalal2 1Pharmacy Administration and Public Health, University of Houston, Houston, TX, 2US Health Outcomes, GlaxoSmithKline, Durham, NC, USA Objective: To review and summarize existing literature on the indirect burden of chronic obstructive pulmonary disease (COPD in the US. Methods: Medline, Scopus, and OvidSP databases were searched using defined search terms to identify relevant studies. Eligible studies were published in English between January 2000 and April 2012 and calculated the indirect burden of COPD in a US population in terms of prevalence, incidence or costs of productivity loss, disability, morbidity, or mortality. Results: Of 53 studies identified, eleven met eligibility criteria, with data years spanning 1987–2009. Estimates of workforce participation range from 56% to 69% among individuals with COPD and from 65% to 77% among individuals without COPD. Approximately 13%–18% of those with COPD are limited in the amount or type of work they can do and one-third or more experience general activity limitation. Estimates of restricted activity days range from 27–63 days per year. Estimates of mean annual sick leave and/or disability days among employed individuals with COPD range from 1.3–19.4 days. Estimates of bed confinement range from 13–32 days per year. Estimated mean annual indirect costs were $893–$2,234/person (US dollars with COPD ($1,521–$3,348 in 2010 [US dollars] and varied with the population studied, specific cost outcomes, and economic inputs. In studies that assessed total (direct and indirect costs, indirect costs accounted for 27%–61% of total costs, depending on the population studied. Conclusions: COPD is associated with substantial indirect costs. The disease places a burden on employers in terms of lost productivity and associated costs and on individuals in terms of lost income related to absenteeism, activity limitation, and disability

  12. Cost-Effectiveness of Rotavirus Vaccination in France-Accounting for Indirect Protection.

    Science.gov (United States)

    Yamin, Dan; Atkins, Katherine E; Remy, Vanessa; Galvani, Alison P

    Vaccination against rotavirus has shown great potential for reducing the primary cause of severe childhood gastroenteritis. Previous economic evaluations of rotavirus vaccination in France have not modeled the potential impact of vaccines on disease burden via reduced transmission. To determine the cost-effectiveness of the introduction of pentavalent rotavirus vaccination into the French infant vaccination schedule. We developed an age-structured model of rotavirus transmission calibrated to 6 years of French gastroenteritis incidence and vaccine clinical trial data. We evaluated the cost-effectiveness of pentavalent rotavirus vaccination considering that 75% of infants would receive the three-dose vaccine course. Our model predicts that rotavirus vaccination will decrease rotavirus gastroenteritis incidence and associated clinical outcomes in vaccinated and unvaccinated individuals, delay the seasonal peak of infection, and increase the age of infection. From the societal perspective, our base-case scenario predicts that vaccination coverage would be cost-effective at €115 or €135 per vaccine course at €28,500 and €39,500/quality-adjusted life-year (QALY) gained, respectively, and suggests that almost 95% of the financial benefits will be recouped within the first 5 years following vaccination implementation. From the third-party payer perspective, incremental cost-effectiveness ratios ranged from €12,500 to €20,000/QALY, respectively. Our uncertainty analysis suggests that findings were sensitive to various assumptions including the number of hospitalizations, outpatient visits, and the extent of QALY losses per rotavirus episode. Introducing pentavalent rotavirus vaccination into the French infant vaccination schedule would significantly reduce the burden of rotavirus disease in children, and could be cost-effective under plausible conditions. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by

  13. Direct and indirect costs of surgically treated pelvic fractures.

    Science.gov (United States)

    Aprato, Alessandro; Joeris, Alexander; Tosto, Ferdinando; Kalampoki, Vasiliki; Stucchi, Alessandro; Massè, Alessandro

    2016-03-01

    Pelvic fractures requiring surgical fixation are rare injuries but present a great societal impact in terms of disability, as well as economic resources. In the literature, there is no description of these costs. Main aim of this study is to describe the direct and indirect costs of these fractures. Secondary aims were to test if the type of fracture (pelvic ring injury or acetabular fracture) influences these costs (hospitalization, consultation, medication, physiotherapy sessions, job absenteeism). We performed a retrospective study on patients with surgically treated acetabular fractures or pelvic ring injuries. Medical records were reviewed in terms of demographic data, follow-up, diagnosis (according to Letournel and Tile classifications for acetabular and pelvic fractures, respectively) and type of surgical treatment. Patients were interviewed about hospitalization length, consultations after discharge, medications, physiotherapy sessions and absenteeism. The study comprised 203 patients, with a mean age of 49.1 ± 15.6 years, who had undergone surgery for an acetabular fracture or pelvic ring injury. The median treatment costs were 29.425 Euros per patient. Sixty percent of the total costs were attributed to health-related work absence. Median costs (in Euros) were 2.767 for hospitalization from trauma to definitive surgery, 4.530 for surgery, 3.018 for hospitalization in the surgical unit, 1.693 for hospitalization in the rehabilitation unit, 1.920 for physiotherapy after discharge and 402 for consultations after discharge. Total costs for treating pelvic ring injuries were higher than for acetabular fractures, mainly due to the significant higher costs of pelvic injuries regarding hospitalization from trauma to definitive surgery (p fractures are associated with both high direct costs and substantial productivity loss.

  14. 76 FR 61089 - Indirect Cost Rates for the Damage Assessment, Remediation, and Restoration Program for Fiscal...

    Science.gov (United States)

    2011-10-03

    ... method continues to be the Direct Labor Cost Base for all three DARRP component organizations. The Direct....gov . Cotton reaffirmed that the Direct Labor Cost Base is the most appropriate indirect allocation... Natural Resources (GCNR).... 83.93 49.49 These rates are based on the Direct Labor Cost Base allocation...

  15. Chest X-Ray (Chest Radiography)

    Science.gov (United States)

    ... Resources Professions Site Index A-Z X-ray (Radiography) - Chest Chest x-ray uses a very small dose ... Radiography? What is a Chest X-ray (Chest Radiography)? The chest x-ray is the most commonly performed diagnostic ...

  16. U.S. Department of Education Indirect Cost Determination Guidance for State and Local Government Agencies.

    Science.gov (United States)

    Department of Education, Washington, DC. Office of the Chief Financial and Chief Information Officer.

    This guide provides new direction in financial management and oversight practices for accounting and charging administrative costs as they relate to programs administered by the U.S. Department of Education. The document is divided into six sections. Section 1, which presents general information, offers details on definitions; indirect-cost rates;…

  17. Implementation and Effectiveness of Early Chest Tube Removal during an Enhanced Recovery Programme after Oesophago-gastrectomy

    Directory of Open Access Journals (Sweden)

    Rajeev Bhandari

    2015-03-01

    Full Text Available Introduction: Oesophageal resection were notoriously complicated and produces a cohort of patients prone to postoperative complications and here we would like to focus on the implementation and effectiveness of early chest tube removal in ERAS after oesophago-gastrectomy considering the various aspect like pleural effusion and reducing the length of hospital stay which ultimately lead to reducing the economic burden on patient. Methods: An ERAS programme was devised and implemented with the support of a dedicated in-hospital task-force. The patients underwent esophago-gastrectomy were randomly divided into two groups: the ERAS group and the control group (non-ERAS. The ERAS group was treated with early removal of the chest tube after surgery, and the control group was treated with traditional way and outcomes were compared between them. Results: The length of hospital stay and the cost of hospitalization in the ERAS group were significantly lower than those in the control group(p<0.05. However, there was no statistical significant difference in the incidences of pleural effusion between the two groups(p>0.05. Conclusions: The introduction of early chest tube removal as an ERAS programme after oesophago-gastrectomy would not increase the risk of pleural effusion and would not increase the total length of stay and cost of hospitalisation without jeopardising patient safety or clinical outcomes.

  18. [Assessing the economic impact of cancer in Chile: a direct and indirect cost measurement based on 2009 registries].

    Science.gov (United States)

    Cid, Camilo; Herrera, Cristian; Rodríguez, Rodrigo; Bastías, Gabriel; Jiménez, Jorge

    2016-08-02

    This paper aims to determine the economic impact that cancer represents to Chile, exploring the share of costs for the most important cancers and the differences between the public and private sector. We used the cost of illness methodology, through the assessment of the direct and indirect costs associated with cancer treatment. Data was obtained from 2009 registries of the Chilean Ministry of Health and the Superintendence of Health. Indirect costs were calculated by days of job absenteeism and potential years of life lost. Over US$ 2.1 billion were spent on cancer in 2009, which represents almost 1% of Chile’s Gross Domestic Product. The direct per capita cost was US$ 47. Indirect costs were 1.92 times more than direct costs. The three types of cancer that embody the highest share of costs were gastric cancer (17.6%), breast cancer (7%) and prostate cancer (4.2%) in the public sector, and breast cancer (14%), lung cancer (7.5%) and prostate cancer (4.1%) in the private sector. On average men spent 30.33% more than women. There are few studies of this kind in Chile and the region. The country can be classified as having a cancer economic impact below the average of those in European Union countries. We expect that this information can be used to develop access policies and resource allocation decision making, and as a first step into further cancer-costing studies in Chile and the Latin American and Caribbean region.

  19. Secukinumab Significantly Reduces Psoriasis-Related Work Impairment and Indirect Costs Compared With Ustekinumab and Etanercept in the United Kingdom.

    Science.gov (United States)

    Warren, R B; Halliday, A; Graham, C N; Gilloteau, I; Miles, L; McBride, D

    2018-05-30

    Psoriasis causes work productivity impairment that increases with disease severity. Whether differential treatment efficacy translates into differential indirect cost savings is unknown. To assess work hours lost and indirect costs associated with secukinumab versus ustekinumab and etanercept in the United Kingdom (UK). This was a post hoc analysis of work impairment data collected in the CLEAR study (secukinumab vs. ustekinumab) and applied to the FIXTURE study (secukinumab vs. etanercept). Weighted weekly and annual average indirect costs per patient per treatment were calculated from (1) overall work impairment derived from Work Productivity and Activity Impairment data collected in CLEAR at 16 and 52 weeks by Psoriasis Area and Severity Index (PASI) response level; (2) weekly/annual work productivity loss by PASI response level; (3) weekly and annual indirect costs by PASI response level, based on hours of work productivity loss; and (4) weighted average indirect costs for each treatment. In the primary analysis, work impairment data for employed patients in CLEAR at Week 16 were used to compare secukinumab and ustekinumab. Secondary analyses were conducted at different timepoints and with patient cohorts, including FIXTURE. In CLEAR, 452 patients (67%) were employed at baseline. At Week 16, percentages of weekly work impairment/mean hours lost decreased with higher PASI: PASI hours; PASI 50-74: 13.3%/4.45 hours; PASI 75-89: 6.4%/2.14 hours; PASI ≥90: 4.9%/1.65 hours. Weighted mean weekly/annual work hours lost were significantly lower for secukinumab than ustekinumab (1.96/102.51 vs. 2.40/125.12; P=0.0006). Results were consistent for secukinumab versus etanercept (2.29/119.67 vs. 3.59/187.17; Ρreduced work impairment and associated indirect costs of psoriasis compared with ustekinumab and etanercept at Week 16 through 52 in the UK. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  20. Dynamic Modeling of Cost-effectiveness of Rotavirus Vaccination, Kazakhstan

    Science.gov (United States)

    Flem, Elmira; Latipov, Renat; Kuatbaeva, Ajnagul; Kristiansen, Ivar Sønbø

    2014-01-01

    The government of Kazakhstan, a middle-income country in Central Asia, is considering the introduction of rotavirus vaccination into its national immunization program. We performed a cost-effectiveness analysis of rotavirus vaccination spanning 20 years by using a synthesis of dynamic transmission models accounting for herd protection. We found that a vaccination program with 90% coverage would prevent ≈880 rotavirus deaths and save an average of 54,784 life-years for children <5 years of age. Indirect protection accounted for 40% and 60% reduction in severe and mild rotavirus gastroenteritis, respectively. Cost per life year gained was US $18,044 from a societal perspective and US $23,892 from a health care perspective. Comparing the 2 key parameters of cost-effectiveness, mortality rates and vaccine cost at costs would be entirely offset. To further evaluate efficacy of a vaccine program, benefits of indirect protection conferred by vaccination warrant further study. PMID:24378188

  1. The indirect costs of agency nurses in South Africa: a case study in two public sector hospitals

    Directory of Open Access Journals (Sweden)

    Laetitia C. Rispel

    2015-05-01

    Full Text Available Background: Globally, flexible work arrangements – through the use of temporary nursing staff – are an important strategy for dealing with nursing shortages in hospitals. Objective: The objective of the study was to determine the direct and indirect costs of agency nurses, as well as the advantages and the problems associated with agency nurse utilisation in two public sector hospitals in South Africa. Methods: Following ethical approval, two South African public sector hospitals were selected purposively. Direct costs were determined through an analysis of hospital expenditure information for a 5-year period from 2005 until 2010, obtained from the national transversal Basic Accounting System database. At each hospital, semi-structured interviews were conducted with the chief executive officer, executive nursing services manager, the maternity or critical care unit nursing manager, the human resource manager, and the finance manager. Indirect costs measured were the time spent on pre-employment checks, and nurse recruitment, orientation, and supervision. All expenditure is expressed in South African Rands (R: 1 USD=R7, 2010 prices. Results: In the 2009/10 financial year, Hospital 1 spent R38.86 million (US$5.55 million on nursing agencies, whereas Hospital 2 spent R10.40 million (US$1.49 million. The total estimated time spent per week on indirect cost activities at Hospital 1 was 51.5 hours, and 60 hours at Hospital 2. The estimated monetary value of this time at Hospital 1 was R962,267 (US$137,467 and at Hospital 2 the value was R300,121 (US$42,874, thus exceeding the weekly direct costs of nursing agencies. Agency nurses assisted the selected hospitals in dealing with problems of nurse recruitment, absenteeism, shortages, and skills gaps in specialised clinical areas. The problems experienced with agency nurses included their perceived lack of commitment, unreliability, and providing sub-optimal quality of patient care. Conclusion

  2. The indirect costs of agency nurses in South Africa: a case study in two public sector hospitals.

    Science.gov (United States)

    Rispel, Laetitia C; Moorman, Julia

    2015-01-01

    Globally, flexible work arrangements - through the use of temporary nursing staff - are an important strategy for dealing with nursing shortages in hospitals. The objective of the study was to determine the direct and indirect costs of agency nurses, as well as the advantages and the problems associated with agency nurse utilisation in two public sector hospitals in South Africa. Following ethical approval, two South African public sector hospitals were selected purposively. Direct costs were determined through an analysis of hospital expenditure information for a 5-year period from 2005 until 2010, obtained from the national transversal Basic Accounting System database. At each hospital, semi-structured interviews were conducted with the chief executive officer, executive nursing services manager, the maternity or critical care unit nursing manager, the human resource manager, and the finance manager. Indirect costs measured were the time spent on pre-employment checks, and nurse recruitment, orientation, and supervision. All expenditure is expressed in South African Rands (R: 1 USD=R7, 2010 prices). In the 2009/10 financial year, Hospital 1 spent R38.86 million (US$5.55 million) on nursing agencies, whereas Hospital 2 spent R10.40 million (US$1.49 million). The total estimated time spent per week on indirect cost activities at Hospital 1 was 51.5 hours, and 60 hours at Hospital 2. The estimated monetary value of this time at Hospital 1 was R962,267 (US$137,467) and at Hospital 2 the value was R300,121 (US$42,874), thus exceeding the weekly direct costs of nursing agencies. Agency nurses assisted the selected hospitals in dealing with problems of nurse recruitment, absenteeism, shortages, and skills gaps in specialised clinical areas. The problems experienced with agency nurses included their perceived lack of commitment, unreliability, and providing sub-optimal quality of patient care. Hospital managers and policy-makers need to address the effective

  3. Manifestation of Aerosol Indirect Effects in Arctic Clouds

    Science.gov (United States)

    Lubin, D.; Vogelmann, A. M.

    2009-12-01

    The first aerosol indirect effect has traditionally been conceived as an enhancement of shortwave cloud reflectance in response to decreased effective droplet size at fixed liquid water path, as cloud nucleating aerosol becomes entrained in the cloud. The high Arctic, with its pervasive low-level stratiform cloud cover and frequent episodes of anthropogenic aerosol (Artic "haze"), has in recent years served as a natural laboratory for research on actual manifestations of aerosol indirect effects. This paper will review the surprising set of developments: (1) the detection of the indirect effect as a source of surface warming, rather than cooling, throughout early spring, (2) a transition to a cooling effect in late spring, corresponding to the beginning of the sea ice melt season, and (3) detection of an indirect effect during summer, outside of the "Arctic haze" season. This paper will also discuss measurements of spectral shortwave irradiance (350-2200 nm) made at Barrow, Alaska, during the U.S. Department of Energy's Indirect and Semi-Direct Aerosol Campaign (ISDAC), which reveal complications in our conception of the indirect effect related to the ice phase in Arctic stratiform clouds.

  4. Indirect Genetic Effects for group-housed animals

    DEFF Research Database (Denmark)

    Alemu, Setegn Worku

    This thesis investigated social interactions in group-housed animals. The main findings of this thesis: 1) Statistical methods to estimate indirect genetic effects when interactions differ between kin vs. non-kin were developed. 2) Indirect genetic effects contribute a substantial amount...... of heritable variation for bite mark traits in group-housed min. 3) Indirect genetic effects estimation needs to take into account systematic interactions due to sex or kin for bite mark trait in group-housed min. 4) Genomic selection can be used to increase the response to selection for survival time in Brown...

  5. MRI of the Chest

    Medline Plus

    Full Text Available ... etc.). top of page What are some common uses of the procedure? MR imaging of the chest ... community, you can search the ACR-accredited facilities database . This website does not provide cost information. The ...

  6. MRI of the Chest

    Medline Plus

    Full Text Available ... to a CD or uploaded to a digital cloud server. MRI of the chest gives detailed pictures ... community, you can search the ACR-accredited facilities database . This website does not provide cost information. The ...

  7. System markets: Indirect network effects in action, or inaction?

    NARCIS (Netherlands)

    J.L.G. Binken (Jeroen)

    2010-01-01

    textabstractIn this dissertation, I empirically examine system markets up close. More specifically I examine indirect network effects, both demand-side and supply-side indirect network effects. Indirect network effects are the source of positive feedback in system markets, or so network effect

  8. Health-related quality of life, work productivity, and indirect costs among patients with irritable bowel syndrome with diarrhea.

    Science.gov (United States)

    Buono, Jessica L; Carson, Robyn T; Flores, Natalia M

    2017-02-14

    Irritable bowel syndrome (IBS) affects 10-15% of adults in the US, and is associated with significant impairment in health-related quality of life (HRQoL); however, information specific to the diarrhea subtype (IBS-D) is lacking. We assessed the impact of IBS-D on HRQoL, work productivity, and daily activities, and the associated indirect costs, among a sample of the US population. Respondents (≥18 years) from the 2012 US National Health and Wellness Survey who reported an IBS-D diagnosis by a physician or symptoms consistent with Rome II criteria for IBS-D were identified as having IBS-D. Controls included respondents without IBS-D or inflammatory bowel disease. HRQoL was assessed via the Short Form 36 Health Survey version 2 questionnaire and summarized into Mental and Physical Component Summary (MCS; PCS) scores and a Short Form-6 dimension (SF-6D) utility score. Work and activity impairment were assessed via the Work Productivity and Activity Impairment Questionnaire: General Health version (WPAI:GH), which measures absenteeism, presenteeism, overall work productivity loss, and daily activity impairment. Indirect costs were calculated using unit cost data from the Bureau of Labor Statistics and variables from the WPAI:GH. Generalized linear models were used to examine differences in health outcomes between respondents with IBS-D and controls, controlling for demographic and health characteristics. In total, 66,491 respondents (1102 IBS-D; 65,389 controls) were analyzed. Mean age was 48.7 years; 50% were female. Compared with controls, the IBS-D cohort reported significantly lower HRQoL (mean MCS: 45.16 vs. 49.48; p work productivity loss (20.7% vs. 13.2%; p work and daily activities, and higher indirect costs, imposing a substantial burden on patients and employers. These findings suggest a significant unmet need exists for effective IBS-D treatments.

  9. The indirect costs of psoriatic arthritis: systematic review and meta-analysis.

    Science.gov (United States)

    Kawalec, Paweł; Malinowski, Krzysztof Piotr

    2015-02-01

    The aim of this systematic review is to collect all current data on the indirect costs (IC) related to psoriatic arthritis (PsA). The search was conducted using MEDLINE (via PubMed), Embase and Centre for Reviews and Dissemination databases. We considered original studies, systematic reviews, economic evaluations, conference abstracts and posters. All collected data were recalculated to average annual cost per patient, expressed using the consumer price index for 2013 and converted to US dollars using purchasing power parity. Eight of the identified publications presented IC of PsA. Average annual IC per patient calculated using the friction cost approach range from US$1693.83 to $12,318.45, while using the human capital approach they range from US$1750.68 to $50,270.52. Result of the meta-analysis was a basis for calculating cost of work disability equaled US$10,754.04 per patient per year in 2013 prices. This systematic review revealed a great economic burden of the disease to the society. A small number of studies on IC in PsA justify further investigations.

  10. Regional economic activity and absenteeism: a new approach to estimating the indirect costs of employee productivity loss.

    Science.gov (United States)

    Bankert, Brian; Coberley, Carter; Pope, James E; Wells, Aaron

    2015-02-01

    This paper presents a new approach to estimating the indirect costs of health-related absenteeism. Productivity losses related to employee absenteeism have negative business implications for employers and these losses effectively deprive the business of an expected level of employee labor. The approach herein quantifies absenteeism cost using an output per labor hour-based method and extends employer-level results to the region. This new approach was applied to the employed population of 3 health insurance carriers. The economic cost of absenteeism was estimated to be $6.8 million, $0.8 million, and $0.7 million on average for the 3 employers; regional losses were roughly twice the magnitude of employer-specific losses. The new approach suggests that costs related to absenteeism for high output per labor hour industries exceed similar estimates derived from application of the human capital approach. The materially higher costs under the new approach emphasize the importance of accurately estimating productivity losses.

  11. The approach to patients with possible cardiac chest pain.

    Science.gov (United States)

    Parsonage, William A; Cullen, Louise; Younger, John F

    2013-07-08

    Chest pain is a common reason for presentation in hospital emergency departments and general practice. Some patients presenting with chest pain to emergency departments and, to a lesser extent, general practice will be found to have a life-threatening cause, but most will not. The challenge is to identify those who do in a safe, timely and cost-effective manner. An acute coronary syndrome cannot be excluded on clinical grounds alone. In patients with ongoing symptoms of chest pain, without an obvious other cause, ST-segment-elevation myocardial infarction should be excluded with a 12-lead electrocardiogram at the first available opportunity. Significant recent advances in the clinical approach to patients with acute chest pain, including better understanding of risk stratification, increasingly sensitive cardiac biomarkers and new non-invasive tests for coronary disease, can help clinicians minimise the risk of unexpected short-term adverse cardiac events. An approach that integrates these advances is needed to deliver the best outcomes for patients with chest pain. All hospital emergency departments should adopt such a strategic approach, and general practitioners should be aware of when and how to access these facilities.

  12. Chest sonography. 2. ed.

    Energy Technology Data Exchange (ETDEWEB)

    Mathis, Gebhard (ed.)

    2008-07-01

    Chest sonography is an established procedure in the stepwise imaging diagnosis of pulmonary and pleural disease. It is the method of choice to distinguish between solid and liquid lesions and allows the investigator to make an unequivocal diagnosis without exposing the patient to costly and stressful procedures. This book presents the state of the art in chest investigation by means of ultrasonography. A number of excellent illustrations and the compact text provide concise and easy-to-assimilate information about the diagnostic procedure. Basic elements such as indications, investigation techniques and image artifacts are detailed in separate chapters. (orig.)

  13. Chest sonography. 2. ed.

    International Nuclear Information System (INIS)

    Mathis, Gebhard

    2008-01-01

    Chest sonography is an established procedure in the stepwise imaging diagnosis of pulmonary and pleural disease. It is the method of choice to distinguish between solid and liquid lesions and allows the investigator to make an unequivocal diagnosis without exposing the patient to costly and stressful procedures. This book presents the state of the art in chest investigation by means of ultrasonography. A number of excellent illustrations and the compact text provide concise and easy-to-assimilate information about the diagnostic procedure. Basic elements such as indications, investigation techniques and image artifacts are detailed in separate chapters. (orig.)

  14. Direct benefits of choosing a high-fitness mate can offset the indirect costs associated with intralocus sexual conflict.

    Science.gov (United States)

    Pischedda, Alison; Chippindale, Adam K

    2017-06-01

    Intralocus sexual conflict generates a cost to mate choice: high-fitness partners transmit genetic variation that confers lower fitness to offspring of the opposite sex. Our earlier work in the fruit fly, Drosophila melanogaster, revealed that these indirect genetic costs were sufficient to reverse potential "good genes" benefits of sexual selection. However, mate choice can also confer direct fitness benefits by inducing larger numbers of progeny. Here, we consider whether direct benefits through enhanced fertility could offset the costs associated with intralocus sexual conflict in D. melanogaster. Using hemiclonal analysis, we found that females mated to high-fitness males produced 11% more offspring compared to those mated to low-fitness males, and high-fitness females produced 34% more offspring than low-fitness females. These direct benefits more than offset the reduction in offspring fitness caused by intralocus sexual conflict, creating a net fitness benefit for each sex to pairing with a high-fitness partner. Our findings highlight the need to consider both direct and indirect effects when investigating the fitness impacts of mate choice. Direct fitness benefits may shelter sexually antagonistic alleles from selection, suggesting a novel mechanism for the maintenance of fitness variation. © 2017 The Author(s). Evolution © 2017 The Society for the Study of Evolution.

  15. Diagnostic Evaluation of Nontraumatic Chest Pain in Athletes.

    Science.gov (United States)

    Moran, Byron; Bryan, Sean; Farrar, Ted; Salud, Chris; Visser, Gary; Decuba, Raymond; Renelus, Deborah; Buckley, Tyler; Dressing, Michael; Peterkin, Nicholas; Coris, Eric

    This article is a clinically relevant review of the existing medical literature relating to the assessment and diagnostic evaluation for athletes complaining of nontraumatic chest pain. The literature was searched using the following databases for the years 1975 forward: Cochrane Database of Systematic Reviews; CINAHL; PubMed (MEDLINE); and SportDiscus. The general search used the keywords chest pain and athletes. The search was revised to include subject headings and subheadings, including chest pain and prevalence and athletes. Cross-referencing published articles from the databases searched discovered additional articles. No dissertations, theses, or meeting proceedings were reviewed. The authors discuss the scope of this complex problem and the diagnostic dilemma chest pain in athletes can provide. Next, the authors delve into the vast differential and attempt to simplify this process for the sports medicine physician by dividing potential etiologies into cardiac and noncardiac conditions. Life-threatening causes of chest pain in athletes may be cardiac or noncardiac in origin, which highlights the need for the sports medicine physician to consider pathology in multiple organ systems simultaneously. This article emphasizes the importance of ruling out immediately life threatening diagnoses, while acknowledging the most common causes of noncardiac chest pain in young athletes are benign. The authors propose a practical algorithm the sports medicine physician can use as a guide for the assessment and diagnostic work-up of the athlete with chest pain designed to help the physician arrive at the correct diagnosis in a clinically efficient and cost-effective manner.

  16. The cost-effectiveness of rotavirus vaccination in Armenia.

    Science.gov (United States)

    Jit, Mark; Yuzbashyan, Ruzanna; Sahakyan, Gayane; Avagyan, Tigran; Mosina, Liudmila

    2011-11-08

    The cost-effectiveness of introducing infant rotavirus vaccination in Armenia in 2012 using Rotarix(R) was evaluated using a multiple birth cohort model. The model considered the cost and health implications of hospitalisations, primary health care consultations and episodes not leading to medical care in children under five years old. Rotavirus vaccination is expected to cost the Ministry of Health $220,000 in 2012, rising to $830,000 in 2016 following termination of GAVI co-financing, then declining to $260,000 in 2025 due to vaccine price maturity. It may reduce health care costs by $34,000 in the first year, rising to $180,000 by 2019. By 2025, vaccination may be close to cost saving to the Ministry of Health if the vaccine purchase price declines as expected. Once coverage has reached high levels, vaccination may prevent 25,000 cases, 3000 primary care consultations, 1000 hospitalisations and 8 deaths per birth cohort vaccinated. The cost per disability-adjusted life year (DALY) saved is estimated to be about $650 from the perspective of the Ministry of Health, $850 including costs accrued to both the Ministry and to GAVI, $820 from a societal perspective excluding indirect costs and $44 from a societal perspective including indirect costs. Since the gross domestic product per capita of Armenia in 2008 was $3800, rotavirus vaccination is likely to be regarded as "very cost-effective" from a WHO standpoint. Vaccination may still be "very cost-effective" if less favourable assumptions are used regarding vaccine price and disease incidence, as long as DALYs are not age-weighted. Copyright © 2011 Elsevier Ltd. All rights reserved.

  17. The economic impact of chronic fatigue syndrome in Georgia: direct and indirect costs

    Directory of Open Access Journals (Sweden)

    Brimmer Dana J

    2011-01-01

    Full Text Available Abstract Background Chronic fatigue syndrome (CFS is a debilitating chronic illness affecting at least 4 million people in the United States. Understanding its cost improves decisions regarding resource allocation that may be directed towards treatment and cure, and guides the evaluation of clinical and community interventions designed to reduce the burden of disease. Methods This research estimated direct and indirect costs of CFS and the impact on educational attainment using a population-based, case-control study between September 2004 and July 2005, Georgia, USA. Participants completed a clinical evaluation to confirm CFS, identify other illnesses, and report on socioeconomic factors. We estimated the effect of CFS on direct medical costs (inpatient hospitalizations, provider visits, prescription medication spending, other medical supplies and services and loss in productivity (employment and earnings with a stratified sample (n = 500 from metropolitan, urban, and rural Georgia. We adjusted medical costs and earnings for confounders (age, sex, race/ethnicity, education, and geographic strata using econometric models and weighted estimates to reflect response-rate adjusted sampling rates. Results Individuals with CFS had mean annual direct medical costs of $5,683. After adjusting for confounding factors, CFS accounted for $3,286 of these costs (p Conclusions Study results indicate that chronic fatigue syndrome may lead to substantial increases in healthcare costs and decreases in individual earnings. Studies have estimated up to 2.5% of non-elderly adults may suffer from CFS. In Georgia, a state with roughly 5.5 million people age 18-59, illness could account for $452 million in total healthcare expenditures and $1.2 billion of lost productivity.

  18. Modeling the cost-effectiveness of infant vaccination with pneumococcal conjugate vaccines in Germany.

    Science.gov (United States)

    Kuhlmann, Alexander; von der Schulenburg, J-Matthias Graf

    2017-04-01

    In 2009, the European Medicines Agency granted approval for two higher-valent pneumococcal conjugate vaccines. This study aims to evaluate the cost-effectiveness of universal infant (historical vaccination scheme in infants as well as indirect herd effects and replacement disease. We used German epidemiological data to calculate episodes of IPD, PNE, and AOM, as well as direct and indirect effects of the vaccination. Parameter uncertainty was tested in univariate and probabilistic sensitivity analyses. In the base-case analysis, the ICER of PCV13 versus PCV10 infant vaccination was EUR 9826 per quality-adjusted life-year (QALY) gained or EUR 5490 per life-year (LY) gained from the societal perspective and EUR 3368 per QALY gained or EUR 1882 per LY gained from the perspective of the German statutory health insurance. The results were particularly sensitive to the magnitude of indirect effects of both vaccines. Universal infant vaccination with PCV13 is likely to be a cost-effective intervention compared with PCV10 within the German health care system, if additional net indirect effects of PCV13 vaccination are significant.

  19. Chest radiography after minor chest trauma

    Energy Technology Data Exchange (ETDEWEB)

    Rossen, B.; Laursen, N.O.; Just, S.

    The results of chest radiography in 581 patients with blunt minor thoracic trauma were reviewed. Frontal and lateral views of the chest indicated pathology in 72 patients (12.4%). Pneumothorax was present in 16 patients; 4 had hemothorax. The physical examination and the results of chest radiography were not in accordance because in 6(30%) of the 20 patients with hemo/-pneumothorax the physical examination was normal. Consequently there is wide indication for chest radiography after minor blunt chest trauma.

  20. Chest radiography after minor chest trauma

    International Nuclear Information System (INIS)

    Rossen, B.; Laursen, N.O.; Just, S.

    1987-01-01

    The results of chest radiography in 581 patients with blunt minor thoracic trauma were reviewed. Frontal and lateral views of the chest indicated pathology in 72 patients (12.4%). Pneumothorax was present in 16 patients; 4 had hemothorax. The physical examination and the results of chest radiography were not in accordance because in 6(30%) of the 20 patients with hemo/-pneumothorax the physical examination was normal. Consequently there is wide indication for chest radiography after minor blunt chest trauma. (orig.)

  1. A Monte Carlo estimation of effective dose in chest tomosynthesis

    International Nuclear Information System (INIS)

    Sabol, John M.

    2009-01-01

    Purpose: The recent introduction of digital tomosynthesis imaging into routine clinical use has enabled the acquisition of volumetric patient data within a standard radiographic examination. Tomosynthesis requires the acquisition of multiple projection views, requiring additional dose compared to a standard projection examination. Knowledge of the effective dose is needed to make an appropriate decision between standard projection, tomosynthesis, and CT for thoracic x-ray examinations. In this article, the effective dose to the patient of chest tomosynthesis is calculated and compared to a standard radiographic examination and to values published for thoracic CT. Methods: Radiographic technique data for posterior-anterior (PA) and left lateral (LAT) radiographic chest examinations of medium-sized adults was obtained from clinical sites. From these data, the average incident air kerma for the standard views was determined. A commercially available tomosynthesis system was used to define the acquisition technique and geometry for each projection view. Using Monte Carlo techniques, the effective dose of the PA, LAT, and each tomosynthesis projection view was calculated. The effective dose for all projections of the tomosynthesis sweep was summed and compared to the calculated PA and LAT values and to the published values for thoracic CT. Results: The average incident air kerma for the PA and left lateral clinical radiographic examinations were found to be 0.10 and 0.40 mGy, respectively. The effective dose for the PA view of a patient of the size of an average adult male was determined to be 0.017 mSv (ICRP 60) [0.018 mSv (ICRP 103)]. For the left lateral view of the same sized patient, the effective dose was determined to be 0.039 mSv (ICRP 60) [0.050 mSv (ICRP 103)]. The cumulative mA s for a tomosynthesis examination is recommended to be ten times the mA s of the PA image. With this technique, the effective dose for an average tomosynthesis examination was

  2. Health-Related Quality of Life Impairment and Indirect Cost of Crohn’s Disease: A Self-Report Study in Poland

    Science.gov (United States)

    Kawalec, Paweł; Mossakowska, Małgorzata; Pilc, Andrzej

    2016-01-01

    Background and Aims Evidence on indirect cost of Crohn’s disease (CD) is available but typically provides information on the loss of productivity at paid work of patients. In the present study, the quality of life and indirect costs of CD patients were assessed (overall and by disease severity). Methods A self-report questionnaire-based study among adult Polish patients with CD was performed. We collected data on patients’ characteristics, quality of life, loss of productivity, consumption of medical resources, and out-of-pocket expenses. The disease severity was determined using the patient’s version of the Harvey-Bradshaw index. Productivity costs were assessed from the social perspective, using a human capital approach. The cost of absenteeism, presenteeism and permanent work disability was valuated using the gross domestic product per worker. The patients’ productivity loss at unpaid work was measured by time inputs of others to assist patients. The productivity loss among informal caregivers and patients’ productivity loss at unpaid work were valuated with the average wage in Poland. The results were adjusted for confounders. Results The responses from 200 patients (47% in remission) were analysed. The mean utility index was 0.839 (SD 0.171). The total indirect cost was estimated at €462.47 per patient per month (24.0%, absenteeism; 35.0%, work disability; 30.4%, presenteeism; 0.4%, productivity loss at unpaid work; and 10.4%, informal care). A significant correlation of the quality of life and productivity losses with disease severity was observed. Compared with active disease, the remission subgroup had a higher utility index by 16% (pabsenteeism, 41% (p = 0.030) for presenteeism, 76% (pproductivity loss at unpaid work, and 75% (p<0.001) for informal care. Conclusions Our study revealed the social burden of CD and high dependency of indirect costs and quality of life on the severity of CD in Poland. PMID:27992531

  3. Indirect effects in dual radiation action

    International Nuclear Information System (INIS)

    Zaider, M.; Rossi, H.H.

    1988-01-01

    The basic aim in this paper is to establish the link between indirect effects of radiation action and the spatial distribution of radicals at the time of energy deposition as well as throughout subsequent diffusion and interaction. The fact that radicals diffuse for a finite distance before damaging a biomolecule has dramatic effects on their subsequent probability to result in lesions. Thus at very low DMSO concentrations, where p = 0.5, one expects - all other things being equal - some 75% of the lesions to result from indirect or semidirect lesions. The number calculated here is lower (15%), a direct result of the fact that such lesions involve proximity functions modulated by diffusion. At higher DMSO concentrations this percentage becomes progressively smaller, as expected. It appears thus that for low-LET radiation, the relative amount of indirect damage in single tracks (also termed intratrack or single events) action is very small. By contrast, intertrack (or two-event) contributions will have the ratio between direct and (indirect + semidirect) contributions given by p 2 /(1-p 2 ). The reason for this is that sublesions from different tracks are uniformly distributed throughout the cell nucleus; their probability of interaction should not depend on any previous diffusional processes. For the example given above (p = 0.5) they do expect 65% of intertrack (two-hit) lesions to have resulted from indirect or semidirect mechanisms. This contrast between the almost exclusively direct character of intratrack lesions and the dominant role of indirect action in intertrack lesions produced by low-LET radiation is an important conclusion of this study

  4. Global indirect aerosol effects: a review

    Directory of Open Access Journals (Sweden)

    U. Lohmann

    2005-01-01

    Full Text Available Aerosols affect the climate system by changing cloud characteristics in many ways. They act as cloud condensation and ice nuclei, they may inhibit freezing and they could have an influence on the hydrological cycle. While the cloud albedo enhancement (Twomey effect of warm clouds received most attention so far and traditionally is the only indirect aerosol forcing considered in transient climate simulations, here we discuss the multitude of effects. Different approaches how the climatic implications of these aerosol effects can be estimated globally as well as improvements that are needed in global climate models in order to better represent indirect aerosol effects are discussed in this paper.

  5. The impact of chest compression rates on quality of chest compressions : a manikin study

    OpenAIRE

    Field, Richard A.; Soar, Jasmeet; Davies, Robin P.; Akhtar, Naheed; Perkins, Gavin D.

    2012-01-01

    Purpose\\ud Chest compressions are often performed at a variable rate during cardiopulmonary resuscitation (CPR). The effect of compression rate on other chest compression quality variables (compression depth, duty-cycle, leaning, performance decay over time) is unknown. This randomised controlled cross-over manikin study examined the effect of different compression rates on the other chest compression quality variables.\\ud Methods\\ud Twenty healthcare professionals performed two minutes of co...

  6. System markets: Indirect network effects in action, or inaction?

    OpenAIRE

    Binken, Jeroen

    2010-01-01

    textabstractIn this dissertation, I empirically examine system markets up close. More specifically I examine indirect network effects, both demand-side and supply-side indirect network effects. Indirect network effects are the source of positive feedback in system markets, or so network effect theory tells us. Systems are composed of complementary and interdependent products, such as hardware and software. For instance, a video game system is composed of the video game console, on the one han...

  7. Effectiveness of chest physiotherapy in the management of bronchiectasis

    International Nuclear Information System (INIS)

    Arif, M.; Bashir, M.S.

    2014-01-01

    Bronchiectasis is a chronic disease in which clearance of sputum is disturbed because bronchi dilated permanently. So for the clearance of sputum we have to use physiotherapy techniques such as postural drainage percussion and vibration (PDPY), active cycle of breathing technique (ACBT), autogenic drainage, positive expiratory pressure, high frequency chest wall oscillation. Objective: To determine the role of Chest Physical therapy intervention in the management of Bronchi ectasis. To compare the prognosis of bronchiectasis with and without chest physiotherapy. Methodology: Data was collected from Gulab Devi Chest Hospital, Lahore. A Randomized Control Trial (RCT) study method was used and 60 patients are studied. In this study, they were divided into 03 groups 1- Antibiotics Therapy 2-Chest Physical therapy 3-Antibiotics and Chest Physical therapy. Each group consistant. (author)

  8. Tuberculosis patients in the Dominican Republic face severe direct and indirect costs and need social protection

    NARCIS (Netherlands)

    Mauch, V.M.C.; Melgen, R.; Marcelino, B.; Acosta, I.; Klinkenberg, E.; Suarez, P.

    2013-01-01

    OBJECTIVE: To examine direct and indirect costs incurred by new, retreatment, and multidrug-resistant (MDR) tuberculosis (TB) patients in the Dominican Republic before and during diagnosis, and during treatment, to generate an evidence base and formulate recommendations. METHODS: The "Tool to

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

    Science.gov (United States)

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

    2017-03-01

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

  10. Tipping and Concentration in Markets with Indirect Network Effects

    OpenAIRE

    Jean-Pierre H. Dubé; Günter J. Hitsch; Pradeep K. Chintagunta

    2010-01-01

    This paper develops a framework for measuring “tipping”—the increase in a firm's market share dominance caused by indirect network effects. Our measure compares the expected concentration in a market to the hypothetical expected concentration that would arise in the absence of indirect network effects. In practice, this measure requires a model that can predict the counterfactual market concentration under different parameter values capturing the strength of indirect network effects. We build...

  11. Cost and resource utilization associated with use of computed tomography to evaluate chest pain in the emergency department: the Rule Out Myocardial Infarction using Computer Assisted Tomography (ROMICAT) study.

    Science.gov (United States)

    Hulten, Edward; Goehler, Alexander; Bittencourt, Marcio Sommer; Bamberg, Fabian; Schlett, Christopher L; Truong, Quynh A; Nichols, John; Nasir, Khurram; Rogers, Ian S; Gazelle, Scott G; Nagurney, John T; Hoffmann, Udo; Blankstein, Ron

    2013-09-01

    Coronary computed tomographic angiography (cCTA) allows rapid, noninvasive exclusion of obstructive coronary artery disease (CAD). However, concern exists whether implementation of cCTA in the assessment of patients presenting to the emergency department with acute chest pain will lead to increased downstream testing and costs compared with alternative strategies. Our aim was to compare observed actual costs of usual care (UC) with projected costs of a strategy including early cCTA in the evaluation of patients with acute chest pain in the Rule Out Myocardial Infarction Using Computer Assisted Tomography I (ROMICAT I) study. We compared cost and hospital length of stay of UC observed among 368 patients enrolled in the ROMICAT I study with projected costs of management based on cCTA. Costs of UC were determined by an electronic cost accounting system. Notably, UC was not influenced by cCTA results because patients and caregivers were blinded to the cCTA results. Costs after early implementation of cCTA were estimated assuming changes in management based on cCTA findings of the presence and severity of CAD. Sensitivity analysis was used to test the influence of key variables on both outcomes and costs. We determined that in comparison with UC, cCTA-guided triage, whereby patients with no CAD are discharged, could reduce total hospital costs by 23% (Pcost increases such that when the prevalence of ≥ 50% stenosis is >28% to 33%, the use of cCTA becomes more costly than UC. cCTA may be a cost-saving tool in acute chest pain populations that have a prevalence of potentially obstructive CAD cost would be anticipated in populations with higher prevalence of disease.

  12. Digital vs conventional radiography: cost and revenue analysis

    International Nuclear Information System (INIS)

    Dalla Palma, L.; Cuttin, R.; Rimondini, A.; Grisi, G.

    1999-01-01

    The objective of this study was to analyse and compare the operating and investment costs of two radiographic systems, a conventional and a digital one, and to evaluate the cost/revenue ratio of the two systems. The radiological activity over 1 year for chest and skeletal exams was evaluated: 13,401 chest and 7,124 skeletal exams were considered. The following parameters of variable costs were evaluated: the difference between variable proportional costs of the two technologies, the effective variable cost of any size film, including the chemicals, and for different sizes of digital film, variable costs of chest plus skeletal exams performed with the two techniques. Afterwards the economical effect was considered taking into account depreciation during a time of utilization ranging between 8 and 4 years. In the second part of the analysis the total cost and the revenues of the two technologies were determined. The comparison between the digital and conventional systems has shown the following aspects: 1. Digital radiography system has a much higher investment cost in comparison with the conventional one. 2. Operating costs of digital equipment are higher or lower depending on the film size used. Evaluating chest X-ray we reach a breakeven point after 1 year and 10,000 exams only if displayed over 8 x 10-in. film and after 30,000 if displayed over a 11 x 14-in. film. 3. The total cost (variable cost, technology cost, labour cost) of digital technology is lower than that of the conventional system by 20 % on average using 8 x 10-in. film size. 4. Digital technology also allows lesser film waste and lesser film per exam (orig.)

  13. Treatment of refractory chest angina with spinal electrical stimulator: literature review

    International Nuclear Information System (INIS)

    Gomezese, Omar F; Paola, Aranda; Echeverria, Luis E; Saibi, Jose F; Calderon, Jaime; Barrera, Juan G

    2008-01-01

    There is a group of patients with chronic refractory chest angina, who are not ideal candidates for surgical or percutaneous revascularization and who although having a good medical handling continues to experience severe episodes of angina. The spinal electrical stimulator is a neuromodulators used as an alternative to treat these patients. The objective is to realize a review of scientific literature regarding the spinal electric stimulation in the treatment of chest angina, its mechanism of action, benefits and its cost effectiveness. Materials and methods: using the Cochrane methodology, a search of articles published from January 1980 to January 2007 in Medline using the terms spinal cord stimulation, was realized. The papers considered most pertinent were selected. Conclusions: the anti-ischemic effect of the electrical spinal stimulator reduces the episodes of chest angina, improves the quality of life and the tolerance to exercise, diminishes the hospital stay and delays the appearance of ischemic signs

  14. Indirect Transportation Cost in the border crossing process: The United States–Mexico trade

    Directory of Open Access Journals (Sweden)

    Carlos Obed Figueroa Ortiz

    2015-12-01

    Full Text Available Using a Social Accounting Matrix as database, a Computable General Equilibrium model is implemented in order to estimate the Indirect Transportations Costs (ITC present in the border crossing for the U.S.–Mexico bilateral trade. Here, an “iceberg–type” transportation function is assumed to determine the amount of loss that must be faced as a result of border crossing process through the ports of entry existing between the two countries. The study period covers annual data from 1995 to 2009 allowing the analysis of the trend of these costs considering the trade liberalisation that is experienced. Results show that the ITC have experienced a decrease of 12% during the period.Test

  15. Direct and Indirect Healthcare Resource Utilization and Costs Among Migraine Patients in the United States.

    Science.gov (United States)

    Bonafede, Machaon; Sapra, Sandhya; Shah, Neel; Tepper, Stewart; Cappell, Katherine; Desai, Pooja

    2018-05-01

    The goal of this analysis was to provide a contemporary estimate of the burden of migraine, incorporating both direct and indirect costs, by comparing the costs of migraine patients to a matched group of patients without migraine in a large, nationally representative sample of commercially insured patients in the United States. Previous studies have shown that the economic burden of migraine in the United States is substantial for payers, patients, and employers. Despite the availability of multiple acute and preventive pharmacological treatment options and a relatively stable migraine prevalence in the United States, there has been a documented increase in migraine-related healthcare resource and pharmacy use. Given the frequently disabling nature of migraine and its high prevalence, especially during peak productive years, and the lack of recent estimates of the burden of migraine, there is a need to update the existing literature with more current data. This retrospective, observational cohort study identified migraine patients in the Truven Health Market Scan Research Databases between January 2008 and June 2013. Adult patients had 12 months of continuous enrollment before (baseline period) and after (follow-up period) the day they received migraine diagnoses and/or medications (index) and no diagnosis of HIV or malignancy during the study period. The patients with migraine were matched 1:1 to a group of patients without migraine on demographic variables and index date. Direct healthcare utilization and costs and indirect (absenteeism, short-term disability, and long-term disability) costs were assessed during the 12-month follow-up period and differences between patients with vs without migraine were assessed. Two additional multivariable logistic regression analyses were conducted. First, an analysis was conducted comparing the odds of having a short-term disability claim between patients with and without migraine after controlling for patient demographic and

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

    Science.gov (United States)

    Strauss, S Y

    1991-07-01

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

  17. Trimethoprim-sulfamethoxazole in children with chronic otitis media: a randomized comparison of costs and effects.

    NARCIS (Netherlands)

    Boonacker, C.W.; Veen, E.L. van der; Wilt, G.J. van der; Schilder, A.G.M.; Rovers, M.M.

    2008-01-01

    OBJECTIVE: To study the cost-effectiveness of a 6- to 12-week course of high-dose oral trimethoprim-sulfamethoxazole in children with chronic active otitis media (COM). STUDY DESIGN: Cost-effectiveness study including both direct and indirect costs alongside a randomized placebo-controlled trial.

  18. Diagnostic value of chest ultrasound after cardiac surgery: a comparison with chest X-ray and auscultation.

    Science.gov (United States)

    Vezzani, Antonella; Manca, Tullio; Brusasco, Claudia; Santori, Gregorio; Valentino, Massimo; Nicolini, Francesco; Molardi, Alberto; Gherli, Tiziano; Corradi, Francesco

    2014-12-01

    Chest auscultation and chest x-ray commonly are used to detect postoperative abnormalities and complications in patients admitted to intensive care after cardiac surgery. The aim of the study was to evaluate whether chest ultrasound represents an effective alternative to bedside chest x-ray to identify early postoperative abnormalities. Diagnostic accuracy of chest auscultation and chest ultrasound were compared in identifying individual abnormalities detected by chest x-ray, considered the reference method. Cardiac surgery intensive care unit. One hundred fifty-one consecutive adult patients undergoing cardiac surgery. All patients included were studied by chest auscultation, ultrasound, and x-ray upon admission to intensive care after cardiac surgery. Six lung pathologic changes and endotracheal tube malposition were found. There was a highly significant correlation between abnormalities detected by chest ultrasound and x-ray (k = 0.90), but a poor correlation between chest auscultation and x-ray abnormalities (k = 0.15). Chest auscultation may help identify endotracheal tube misplacement and tension pneumothorax but it may miss most major abnormalities. Chest ultrasound represents a valid alternative to chest x-ray to detect most postoperative abnormalities and misplacements. Copyright © 2014 Elsevier Inc. All rights reserved.

  19. Lung involvement quantification in chest radiographs

    International Nuclear Information System (INIS)

    Giacomini, Guilherme; Alvarez, Matheus; Oliveira, Marcela de; Miranda, Jose Ricardo A.; Pina, Diana R.; Pereira, Paulo C.M.; Ribeiro, Sergio M.

    2014-01-01

    Tuberculosis (TB) caused by Mycobacterium tuberculosis, is an infectious disease which remains a global health problem. The chest radiography is the commonly method employed to assess the TB's evolution. The methods for quantification of abnormalities of chest are usually performed on CT scans (CT). This quantification is important to assess the TB evolution and treatment and comparing different treatments. However, precise quantification is not feasible for the amount of CT scans required. The purpose of this work is to develop a methodology for quantification of lung damage caused by TB through chest radiographs. It was developed an algorithm for computational processing of exams in Matlab, which creates a lungs' 3D representation, with compromised dilated regions inside. The quantification of lung lesions was also made for the same patients through CT scans. The measurements from the two methods were compared and resulting in strong correlation. Applying statistical Bland and Altman, all samples were within the limits of agreement, with a confidence interval of 95%. The results showed an average variation of around 13% between the two quantification methods. The results suggest the effectiveness and applicability of the method developed, providing better risk-benefit to the patient and cost-benefit ratio for the institution. (author)

  20. 42 CFR 412.105 - Special treatment: Hospitals that incur indirect costs for graduate medical education programs.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Special treatment: Hospitals that incur indirect costs for graduate medical education programs. 412.105 Section 412.105 Public Health CENTERS FOR... SYSTEMS FOR INPATIENT HOSPITAL SERVICES Special Treatment of Certain Facilities Under the Prospective...

  1. Effect of Corrective Exercises on Chest Expansion in Kyphotic Females

    Directory of Open Access Journals (Sweden)

    Yahya Sokhangouei

    2008-04-01

    Full Text Available Objective: The aim of this study was to investigate the effect of corrective exercises on chest expansion in kyphotic girls, aged 11-15. Materials & Methods: This quasi experirnental research was applied as a clinical trial and had done on 50 girls with postural hyperkyphosis those were selected by convenient sampling and assigned to control (n=25 and experimental (n=25 group by simple randomized method. The experimental group received corrective exercises for 15 days and the control group was given no intervention. Chest expansion was measured before and after 15 days in all subjects. Data were analyzed by use of Chi-square, Paired T and Independent T tests. Results: There was statistically significant difference in chest expansion of experimental group between before and after intervention (P<0/001, but in control group there was no significant difference (P=0/746. Also, there was significant difference between two groups after intervention (P=0/02. Conclusion: This study demonstrates that corrective exercises can lead to improvement of chest expansion in kyphotic girls. Further study with larger sample size is needed to support the findings of this study.

  2. Should the lateral chest radiograph be routinely performed?

    International Nuclear Information System (INIS)

    Osman, Fatuma; Williams, Imelda

    2014-01-01

    Background: The chest x-ray is one of the most common plain film radiographic examinations performed. Inclusion of the lateral chest radiograph varies internationally and nationally across radiology departments and states in Australia. Search strategy: A search strategy of the databases Cochrane Library, Ovid Medline/Medline, PubMed, Scopus and Science Direct was conducted. The results were restricted to those published between 1985 and 2013 and those published in English. The following search terms were used: ‘lateral chest’, ‘radiograph’, ‘digital radiography’, ‘chest x-ray’, ‘plain film radiography’, ‘ionising radiation’. The results were restricted to publications with these terms in the title, abstract and/or keywords. Main findings: There are few national or international guidelines pertaining to the inclusion of the lateral chest x-ray as routine. Primary concerns are the increased radiation dose associated with the additional chest view and reduction of medical imaging services cost. Modern digital imaging systems result in a lower radiation dose. The diagnostic yield of the lateral chest x-ray is highly dependent on the clinical indications of the patient. Further research into the routine inclusion of the lateral chest x-ray is recommended. Conclusion: Review of the literature suggests that the lateral chest radiograph should not be performed routinely unless clinically indicated

  3. The logic of indirect speech

    Science.gov (United States)

    Pinker, Steven; Nowak, Martin A.; Lee, James J.

    2008-01-01

    When people speak, they often insinuate their intent indirectly rather than stating it as a bald proposition. Examples include sexual come-ons, veiled threats, polite requests, and concealed bribes. We propose a three-part theory of indirect speech, based on the idea that human communication involves a mixture of cooperation and conflict. First, indirect requests allow for plausible deniability, in which a cooperative listener can accept the request, but an uncooperative one cannot react adversarially to it. This intuition is supported by a game-theoretic model that predicts the costs and benefits to a speaker of direct and indirect requests. Second, language has two functions: to convey information and to negotiate the type of relationship holding between speaker and hearer (in particular, dominance, communality, or reciprocity). The emotional costs of a mismatch in the assumed relationship type can create a need for plausible deniability and, thereby, select for indirectness even when there are no tangible costs. Third, people perceive language as a digital medium, which allows a sentence to generate common knowledge, to propagate a message with high fidelity, and to serve as a reference point in coordination games. This feature makes an indirect request qualitatively different from a direct one even when the speaker and listener can infer each other's intentions with high confidence. PMID:18199841

  4. The effect of hydraulic bed movement on the quality of chest compressions.

    Science.gov (United States)

    Park, Maeng Real; Lee, Dae Sup; In Kim, Yong; Ryu, Ji Ho; Cho, Young Mo; Kim, Hyung Bin; Yeom, Seok Ran; Min, Mun Ki

    2017-08-01

    The hydraulic height control systems of hospital beds provide convenience and shock absorption. However, movements in a hydraulic bed may reduce the effectiveness of chest compressions. This study investigated the effects of hydraulic bed movement on chest compressions. Twenty-eight participants were recruited for this study. All participants performed chest compressions for 2min on a manikin and three surfaces: the floor (Day 1), a firm plywood bed (Day 2), and a hydraulic bed (Day 3). We considered 28 participants of Day 1 as control and each 28 participants of Day 2 and Day 3 as study subjects. The compression rates, depths, and good compression ratios (>5-cm compressions/all compressions) were compared between the three surfaces. When we compared the three surfaces, we did not detect a significant difference in the speed of chest compressions (p=0.582). However, significantly lower values were observed on the hydraulic bed in terms of compression depth (p=0.001) and the good compression ratio (p=0.003) compared to floor compressions. When we compared the plywood and hydraulic beds, we did not detect significant differences in compression depth (p=0.351) and the good compression ratio (p=0.391). These results indicate that the movements in our hydraulic bed were associated with a non-statistically significant trend towards lower-quality chest compressions. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Investigation of the dosimetry of chest tomosynthesis

    Science.gov (United States)

    Svalkvist, Angelica; Zachrisson, Sara; Månsson, Lars Gunnar; Båth, Magnus

    2009-02-01

    Chest tomosynthesis has recently been introduced to healthcare as a low-dose alternative to CT or as a tool for improved diagnostics in chest radiography with only a modest increase in radiation dose to the patient. However, no detailed description of the dosimetry for this type of examination has been presented. The aim of this work was therefore to investigate the dosimetry of chest tomosynthesis. The chest tomosynthesis examination was assumed to be performed using a stationary detector and a vertically moving x-ray tube, exposing the patient from different angles. The Monte Carlo based computer software PCXMC was used to determine the effective dose delivered to a standard-sized patient from various angles using different assumptions of the distribution of the effective dose over the different projections. The obtained conversion factors between input dose measures and effective dose for chest tomosynthesis for different angular intervals were then compared with the horizontal projection. The results indicate that the error introduced by using conversion factors for the PA projection in chest radiography for estimating the effective dose of chest tomosynthesis is small for normally sized patients, especially if a conversion factor between KAP and effective dose is used.

  6. Effects of worksite health interventions involving reduced work hours and physical exercise on sickness absence costs.

    Science.gov (United States)

    von Thiele Schwarz, Ulrica; Hasson, Henna

    2012-05-01

    To investigate the effects of physical exercise during work hours (PE) and reduced work hours (RWH) on direct and indirect costs associated with sickness absence (SA). Sickness absence and related costs at six workplaces, matched and randomized to three conditions (PE, RWH, and referents), were retrieved from company records and/or estimated using salary conversion methods or value-added equations on the basis of interview data. Although SA days decreased in all conditions (PE, 11.4%; RWH, 4.9%; referents, 15.9%), costs were reduced in the PE (22.2%) and RWH (4.9%) conditions but not among referents (10.2% increase). Worksite health interventions may generate savings in SA costs. Costs may not be linear to changes in SA days. Combing the friction method with indirect cost estimates on the basis of value-added productivity may help illuminate both direct and indirect SA costs.

  7. Cost-benefit analysis of a green electricity system in Japan considering the indirect economic impacts of tropical cyclones

    International Nuclear Information System (INIS)

    Esteban, Miguel; Zhang, Qi; Longarte-Galnares, Gorka

    2012-01-01

    Global warming is likely to profoundly influence future weather patterns, and one consequence of this is the likelihood of an increase in tropical cyclone intensity. The present paper presents a cost-benefit analysis of introducing significant amounts of green energy in the electricity system in Japan in the light of the economic damage that an increase in tropical cyclone intensity could have on GDP growth between 2010 and 2085. Essentially the passage of a tropical cyclone will result not only in physical damage but also on a decrease in economic productivity due to precautionary cessation of the economic activity, which has an effect on GDP growth. By comparing the economic performance of different electricity system scenarios with the indirect economic damage of tropical cyclones from 2010 to 2085, based on the yearly economic data of green electricity, fossil fuel, GDP and population, it can be seen that the green scenarios are generally a cost-effective way of mitigating the effects of these weather systems, despite the large amount of initial investments necessary. - Highlights: ► Climate change is likely to increase the future strength of tropical cyclones. ► An increase in tropical cyclone strength would reduce GDP growth in Japan. ► Reducing green-house gas emissions is a cost-effective mitigation strategy.

  8. 77 FR 57074 - Indirect Cost Rates for the Damage Assessment, Remediation, and Restoration Program for Fiscal...

    Science.gov (United States)

    2012-09-17

    ... information on these rates and the DARRP policy can be found at the DARRP web site at: http://www.darrp.noaa.gov/library/12_b.html FOR FURTHER INFORMATION CONTACT: For further information, contact LaTonya... develop indirect cost rates for its component organizations and formulate policies on the recovery of...

  9. Diagnosis and Treatment of Chest Injury and Emergency Diseases of Chest Organs

    Directory of Open Access Journals (Sweden)

    A. M. Khadjibaev

    2016-01-01

    Full Text Available Goal of research: to evaluate efficiency of videothoracoscopy in diagnosis and treatment of patients with injuries and emergency diseases ща chest organs.Material and methods: Study wasbased on treatment results analysis of 2111 patients with injuries and chest organs emergency diseases, who were treated at Republican Research Centre of Emergency Medicine in 2001-2014. Chest trauma made up 1396 (66,1% victims. There were 477 (22,6% patients with spontaneous pneumothorax. At the stages of initial diagnosis, the radiologic evaluations, CT investigations and videothoracoscopies were performed. In chest trauma patients the videothoracoscopy underwent in 844 cases, in spontaneous pneu#mothorax this method was employed in 290 patients. Complicated forms of lung echinococcosis were observed in 238 (11,3% patients and complicated forms of lung echinococcosis were evident in 72 patients.Results. Videothoracoscopy and video-assisted interventions allowed to eliminate lungs and pleura pathology in 1206 (57,1% patients, whereas the traditional methods were effective only in 905 cases (42,9%.Conclusions. Investigation methods such as multiplanar radioscopy, radiography, chest CT and videothora-coscopy must be included into algorithm of diagnosis and surgical treatment of chest injuries and emergency diseases of chest organs. At chest trauma the videothoracoscopy allows to avoid broad thoracotomy from 9,4% to 4,7% of cases, to reduce the frequency of repeated interventions from 17,4% to 0,5% and diminish a number of early postsurgery complications from 25,4% to 10,9%. Videothoracoscopy of chest traumas allows to reduce frequency of repeated interventions from 19,8 to 1,7%.

  10. Costs of diarrheal disease and the cost-effectiveness of a rotavirus vaccination program in kyrgyzstan.

    Science.gov (United States)

    Flem, Elmira T; Latipov, Renat; Nurmatov, Zuridin S; Xue, Yiting; Kasymbekova, Kaliya T; Rheingans, Richard D

    2009-11-01

    We examined the cost-effectiveness of a rotavirus immunization program in Kyrgyzstan, a country eligible for vaccine funding from the GAVI Alliance. We estimated the burden of rotavirus disease and its economic consequences by using national and international data. A cost-effectiveness analysis was conducted from government and societal perspectives, along with a range of 1-way sensitivity analyses. Rotavirus-related hospitalizations and outpatient visits cost US$580,864 annually, of which $421,658 (73%) is direct medical costs and $159,206 (27%) is nonmedical and indirect costs. With 95% coverage, vaccination could prevent 75% of rotavirus-related hospitalizations and deaths and 56% of outpatient visits and could avert $386,193 (66%) in total costs annually. The medical break-even price at which averted direct medical costs equal vaccination costs is $0.65/dose; the societal break-even price is $1.14/dose for a 2-dose regimen. At the current GAVI Alliance-subsidized vaccine price of $0.60/course, rotavirus vaccination is cost-saving for the government. Vaccination is cost-effective at a vaccine price $9.41/dose, according to the cost-effectiveness standard set by the 2002 World Health Report. Addition of rotavirus vaccines to childhood immunization in Kyrgyzstan could substantially reduce disease burden and associated costs. Vaccination would be cost-effective from the national perspective at a vaccine price $9.41 per dose.

  11. Gonad protective effect of radiation protective apron in chest radiography

    International Nuclear Information System (INIS)

    Hashimoto, Masatoshi; Kato, Hideyuki; Fujibuchi, Toshiou; Ochi, Shigehiro; Morita, Fuminori

    2004-01-01

    Depending on the facility, a radiation protective apron (protector) is used to protect the gonad from radiation exposure in chest radiography. To determine the necessity of using a protector during chest radiography, we measured the effect of the protector on the gonad in this study. First, using a human body phantom, we measured the absorbed dose of the female gonad with and without the protector, using a thermoluminescence dosimeter (TLD), and confirmed its protective effect. Using the protector, the absorbed dose was reduced to 28±2% and 39±4% for field sizes of 14 x 17 inch and 14 x 14 inch, respectively. Next, we used Monte Carlo simulation and confirmed, not only the validity of the actual measurement values, but also the fact that the influence of radiation on the absorbed dose of the gonad was mostly from scattered radiation from inside the body for the 14 x 17 inch field size, and also from the X-ray tube for the 14 x 14 inch field size. Although a certain protective effect is achieved by using the protector, the radiation dose to the gonad is only a few μGy even without a protector. Thus, the risk of a genetic effect would be as small as 10 -8 . Given that acceptable risk is below 10 -6 , we conclude the use of a radiation protective apron is not necessary for diagnostic chest radiography. (author)

  12. [Gonad protective effect of radiation protective apron in chest radiography].

    Science.gov (United States)

    Hashimoto, Masatoshi; Kato, Hideyuki; Fujibuchi, Toshiou; Ochi, Shigehiro; Morita, Fuminori

    2004-12-01

    Depending on the facility, a radiation protective apron (protector) is used to protect the gonad from radiation exposure in chest radiography. To determine the necessity of using a protector during chest radiography, we measured the effect of the protector on the gonad in this study. First, using a human body phantom, we measured the absorbed dose of the female gonad with and without the protector, using a thermoluminescence dosimeter (TLD), and confirmed its protective effect. Using the protector, the absorbed dose was reduced to 28+/-2% and 39+/-4% for field sizes of 14 x 17 inch and 14 x 14 inch, respectively. Next, we used Monte Carlo simulation and confirmed, not only the validity of the actual measurement values, but also the fact that the influence of radiation on the absorbed dose of the gonad was mostly from scattered radiation from inside the body for the 14 x 17 inch field size, and also from the X-ray tube for the 14 x 14 inch field size. Although a certain protective effect is achieved by using the protector, the radiation dose to the gonad is only a few microGy even without a protector. Thus, the risk of a genetic effect would be as small as 10(-8). Given that acceptable risk is below 10(-6), we conclude the use of a radiation protective apron is not necessary for diagnostic chest radiography.

  13. Costo-efectividad de la radiografía de tórax en lactantes con sospecha clínica de bronquiolitis viral en Colombia Cost-effectiveness of chest x-rays in infants with clinically suspected viral bronchiolitis in Colombia

    Directory of Open Access Journals (Sweden)

    Carlos E. Rodríguez Martínez

    2011-03-01

    pacientes que tengan predictores de anormalidades radiológicas.OBJECTIVE: Estimate the cost-effectiveness of not taking chest x-rays of any infant with clinically suspected viral bronchiolitis versus routinely taking them of all such patients, the most common practice today in Colombia. METHODS: A cost-effectiveness study was conducted, comparing strategies of taking chest x-rays of all infants with clinically suspected viral bronchiolitis and not x-raying any of these infants. The principal outcome was the proportion of correct diagnoses. The time horizon was the clinical course of the bronchiolitis. The perspective was that of the third-party payer, and the costs were obtained from the rates in effect in a clinic in Bogotá. Deterministic and probabilistic sensitivity analyses were performed. RESULTS: The strategy of not taking a chest x-ray of any patient prevailed over that of routinely taking one in all cases, with an average cost of US$ 111.00 and a correct diagnosis rate of 0.8020, versus the respective values of US$ 129.00 and 0.7873 for the strategy of routinely x-raying all of these patients. The most influential variable was pneumonia-related hospital costs. In the probabilistic sensitivity analysis, the strategy of not x-raying any infant prevailed in 61.1% of the simulations. CONCLUSIONS: The results suggest that not taking routine chest x-rays of infants with clinically suspected viral bronchiolitis is a cost-effective strategy compared with the common practice of taking them in all cases, since the former yields a greater proportion of correct diagnoses at a lower average cost per patient. Nevertheless, new studies will be needed that have more representative samples from all of the health facilities and include the strategy of taking chest x-rays only of patients with predictors of radiologic abnormalities.

  14. Indirect genetic effects and kin recognition

    DEFF Research Database (Denmark)

    Alemu, Setegn Worku; Berg, Peer; Janss, Luc

    2014-01-01

    Social interactions among individuals are widespread, both in natural and domestic populations. As a result, trait values of individuals may be affected by genes in other individuals, a phenomenon known as indirect genetic effects (IGEs). IGEs can be estimated using linear mixed models. The tradi......Social interactions among individuals are widespread, both in natural and domestic populations. As a result, trait values of individuals may be affected by genes in other individuals, a phenomenon known as indirect genetic effects (IGEs). IGEs can be estimated using linear mixed models...... present a reduced model that yields estimates of the total heritable effects on kin, on non-kin and on all social partners of an individual, as well as the total heritable variance for response to selection. Finally we discuss the consequences of analysing data in which IGEs depend on relatedness using...

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

    Science.gov (United States)

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

    2016-05-01

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

  16. Indirect and direct costs of acute coronary syndromes with comorbid atrial fibrillation, heart failure, or both.

    Science.gov (United States)

    Ghushchyan, Vahram; Nair, Kavita V; Page, Robert L

    2015-01-01

    The objective of this study was to determine the direct and indirect costs of acute coronary syndromes (ACS) alone and with common cardiovascular comorbidities. A retrospective analysis was conducted using the Medical Expenditure Panel Survey from 1998 to 2009. Four mutually exclusive cohorts were evaluated: ACS only, ACS with atrial fibrillation (AF), ACS with heart failure (HF), and ACS with both conditions. Direct costs were calculated for all-cause and cardiovascular-related health care resource utilization. Indirect costs were determined from productivity losses from missed days of work. Regression analysis was developed for each outcome controlling for age, US census region, insurance coverage, sex, race, ethnicity, education attainment, family income, and comorbidity burden. A negative binomial regression model was used for health care utilization variables. A Tobit model was utilized for health care costs and productivity loss variables. Total health care costs were greatest for those with ACS and both AF and HF ($38,484±5,191) followed by ACS with HF ($32,871±2,853), ACS with AF ($25,192±2,253), and ACS only ($17,954±563). Compared with the ACS only cohort, the mean all-cause adjusted health care costs associated with ACS with AF, ACS with HF, and ACS with AF and HF were $5,073 (95% confidence interval [CI] 719-9,427), $11,297 (95% CI 5,610-16,985), and $15,761 (95% CI 4,784-26,738) higher, respectively. Average wage losses associated with ACS with and without AF and/or HF amounted to $5,266 (95% CI -7,765, -2,767), when compared with patients without these conditions. ACS imposes a significant economic burden at both the individual and society level, particularly when with comorbid AF and HF.

  17. Radiological diagnosis of chest wall tuberculosis: CT versus chest radiograph

    International Nuclear Information System (INIS)

    Liu Fugeng; Pan Jishu; Chen Qihang; Zhou Cheng; Yu Jingying; Tang Dairong

    2006-01-01

    Objective: To evaluate the role of CT or Chest radiograph in diagnosis of chest wall tuberculosis. Methods: The study population included 21 patients with chest wall tuberculosis confirmed by operation or biopsy. Chest radiograph and plain CT were performed in all eases, while enhanced CT in 9 cases, and all images were reviewed by 2 radiologists. Results: Single soft tissue mass of the chest wall was detected in all cases on CT, but not on chest radiograph(χ 2 =42.000, P 2 =4.421, P<0.05). Conclusion: CT, especially enhanced CT scan is the first choice in the diagnosis of chest wall tuberculosis. (authors)

  18. Cost-effectiveness of 13-valent pneumococcal conjugate vaccination in Mongolia.

    Science.gov (United States)

    Sundaram, Neisha; Chen, Cynthia; Yoong, Joanne; Luvsan, Munkh-Erdene; Fox, Kimberley; Sarankhuu, Amarzaya; La Vincente, Sophie; Jit, Mark

    2017-02-15

    The Ministry of Health (MOH), Mongolia, is considering introducing 13-valent pneumococcal conjugate vaccine (PCV13) in its national immunization programme to prevent the burden of disease caused by Streptococcus pneumoniae. This study evaluates the cost-effectiveness and budget impact of introducing PCV13 compared to no PCV vaccination in Mongolia. The incremental cost-effectiveness ratio (ICER) of introducing PCV13 compared to no PCV vaccination was assessed using an age-stratified static multiple cohort model. The risk of various clinical presentations of pneumococcal disease (meningitis, pneumonia, non-meningitis non-pneumonia invasive pneumococcal disease and acute otitis media) at all ages for thirty birth cohorts was assessed. The analysis considered both health system and societal perspectives. A 3+0 vaccine schedule and price of US$3.30 per dose was assumed for the baseline scenario based on Gavi, the Vaccine Alliance's advance market commitment tail price. The ICER of PCV13 introduction is estimated at US$52 per disability-adjusted life year (DALY) averted (health system perspective), and cost-saving (societal perspective). Although indirect effects of PCV have been well-documented, a conservative scenario that does not consider indirect effects estimated PCV13 introduction to cost US$79 per DALY averted (health system perspective), and US$19 per DALY averted (societal perspective). Vaccination with PCV13 is expected to cost around US$920,000 in 2016, and thereafter US$820,000 every year. The programme is likely to reduce direct disease-related costs to MOH by US$440,000 in the first year, increasing to US$510,000 by 2025. Introducing PCV13 as part of Mongolia's national programme appears to be highly cost-effective when compared to no vaccination and cost-saving from a societal perspective at vaccine purchase prices offered through Gavi. Notwithstanding uncertainties around some parameters, cost-effectiveness of PCV introduction for Mongolia remains

  19. Cost-Effectiveness Analysis of Regorafenib for Gastrointestinal Stromal Tumour (GIST) in Germany.

    Science.gov (United States)

    Tamoschus, David; Draexler, Katja; Chang, Jane; Ngai, Christopher; Madin-Warburton, Matthew; Pitcher, Ashley

    2017-06-01

    No study has compared the cost-effectiveness of active treatment options for unresectable or metastatic gastrointestinal stromal tumours in patients who progressed on or are intolerant to prior treatment with imatinib and sunitinib. The aim of this study was to estimate the cost-effectiveness of regorafenib compared to imatinib rechallenge in this setting in Germany. Hazard ratios for progression-free (PFS) and overall survival (OS) with regorafenib versus imatinib rechallenge were estimated by indirect comparison. A state distribution model was used to simulate progression, mortality and treatment costs over a lifetime horizon. Drug acquisition costs and utilities were derived from clinical trial data and published literature; non-drug costs were not included. The outcomes measured were treatment costs, life-years (LYs) and quality-adjusted life-years (QALYs). The indirect comparison suggested that median PFS and OS were longer with regorafenib compared to imatinib but results were not statistically significant. Regorafenib versus imatinib rechallenge was estimated to have hazard ratios of 0.58 (95% CI 0.31-1.11) for PFS and 0.77 (95% CI 0.34-1.77) for OS, with substantial uncertainty due to the rarity of the disease and small number of patients within the trials. Regorafenib treatment per patient over a lifetime horizon provided an additional 0.61 LYs and 0.42 QALYs over imatinib rechallenge, with additional direct drug costs of €8,773. The incremental cost-effectiveness ratio was €21,127 per QALY gained. At a cost-effectiveness threshold of €50,000 per QALY, regorafenib had a 67% probability of being cost-effective. Based on the currently available clinical data, this analysis suggests that regorafenib is cost-effective compared with imatinib rechallenge in Germany.

  20. Chest X-Ray

    Medline Plus

    Full Text Available ... about chest radiography also known as chest x-rays. Chest x-rays are the most commonly performed x-ray exams and use a very small dose of ... of the inside of the chest. A chest x-ray is used to evaluate the lungs, heart and ...

  1. Understanding the direct and indirect costs of patients with schizophrenia [v2; ref status: indexed, http://f1000r.es/5ow

    Directory of Open Access Journals (Sweden)

    Kazuhiro Tajima-Pozo

    2015-08-01

    Full Text Available Background: Schizophrenia is a disabling mental disorder with high prevalence and that usually  requires long-term follow-up and expensive lifelong treatment. The cost of schizophrenia treatment consumes a significant amount of the health services' budget in western countries. Objective: The aim of the study was to find out about the costs related to schizophrenia across different european countries and compare them. Results: Schizophrenia treatment costs an estimated 18 billion euros annually worldwide. The direct costs associated with medical help are only part of the total expenditure. The indirect costs are an equally (or even moreimportant part of the total cost. These expenses are related to the lack of productivity of schizophrenic patients and the cost that relatives have to bear as a result of taking care of their affected relatives. Conclusions: Although data on the cost of schizophrenia may vary slightly between different european countries, the general conclusion that can be drawn is that schizophrenia is a very costly disorder. Not only because of direct costs related to medical procedures, but also due to the non-medical (indirect costs. Together this suggests the need to investigate cost-efficient strategies that could provide a better outcome for schizophrenic patients, as well as the people who care for them.

  2. Novel model of direct and indirect cost-benefit analysis of mechanical embolectomy over IV tPA for large vessel occlusions: a real-world dollar analysis based on improvements in mRS.

    Science.gov (United States)

    Mangla, Sundeep; O'Connell, Keara; Kumari, Divya; Shahrzad, Maryam

    2016-01-20

    Ischemic strokes result in significant healthcare expenditures (direct costs) and loss of quality-adjusted life years (QALYs) (indirect costs). Interventional therapy has demonstrated improved functional outcomes in patients with large vessel occlusions (LVOs), which are likely to reduce the economic burden of strokes. To develop a novel real-world dollar model to assess the direct and indirect cost-benefit of mechanical embolectomy compared with medical treatment with intravenous tissue plasminogen activator (IV tPA) based on shifts in modified Rankin scores (mRS). A cost model was developed including multiple parameters to account for both direct and indirect stroke costs. These were adjusted based upon functional outcome (mRS). The model compared IV tPA with mechanical embolectomy to assess the costs and benefits of both therapies. Direct stroke-related costs included hospitalization, inpatient and outpatient rehabilitation, home care, skilled nursing facilities, and long-term care facility costs. Indirect costs included years of life expectancy lost and lost QALYs. Values for the model cost parameters were derived from numerous resources and functional outcomes were derived from the MR CLEAN study as a reflective sample of LVOs. Direct and indirect costs and benefits for the two treatments were assessed using Microsoft Excel 2013. This cost-benefit model found a cost-benefit of mechanical embolectomy over IV tPA of $163 624.27 per patient and the cost benefit for 50 000 patients on an annual basis is $8 181 213 653.77. If applied widely within the USA, mechanical embolectomy will significantly reduce the direct and indirect financial burden of stroke ($8 billion/50 000 patients). Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  3. Economic analysis of three interventions of different intensity in improving school implementation of a government healthy canteen policy in Australia: costs, incremental and relative cost effectiveness.

    Science.gov (United States)

    Reilly, Kathryn L; Reeves, Penny; Deeming, Simon; Yoong, Sze Lin; Wolfenden, Luke; Nathan, Nicole; Wiggers, John

    2018-03-20

    No evaluations of the cost or cost effectiveness of interventions to increase school implementation of food availability policies have been reported. Government and non-government agency decisions regarding the extent of investment required to enhance school implementation of such policies are unsupported by such evidence. This study sought to i) Determine cost and cost-effectiveness of three interventions in improving school implementation of an Australian government healthy canteen policy and; ii) Determine the relative cost-effectiveness of the interventions in improving school implementation of such a policy. An analysis of the cost and cost-effectiveness of three implementation interventions of varying support intensity, relative to usual implementation support conducted during 2013-2015 was undertaken. Secondly, an indirect comparison of the trials was undertaken to determine the most cost-effective of the three strategies. The economic analysis was based on the cost of delivering the interventions by health service delivery staff to increase the proportion of schools 'adherent' with the policy. The total costs per school were $166,971, $70,926 and $75,682 for the high, medium and low intensity interventions respectively. Compared to usual support, the cost effectiveness ratios for each of the three interventions were: A$2982 (high intensity), A$2627 (medium intensity) and A$4730 (low intensity) per percent increase in proportion of schools reporting 'adherence'). Indirect comparison between the 'high' and 'medium intensity' interventions showed no statistically significant difference in cost-effectiveness. The results indicate that while the cost profiles of the interventions varied substantially, the cost-effectiveness did not. This result is valuable to policy makers seeking cost-effective solutions that can be delivered within budget.

  4. Volume Threshold for Chest Tube Removal: A Randomized ‎Controlled Trial

    Directory of Open Access Journals (Sweden)

    Sajad Hatami

    2009-07-01

    Full Text Available Background: Despite importance of chest tube insertion in chest trauma, there is no ‎general agreement on the level of daily volume drainage from chest tube. This study ‎was conducted to compare the effectiveness and safety of chest tube removal at the ‎levels of 150 ml/day and 2oo ml/day. Methods: Eligible patients (138 who needed replacement of chest tube (because of ‎trauma or malignancy were randomized into two groups; control (removal of chest tube ‎when drainage reached to 150 ml/day and trial (removal of chest tube at the level of ‎‎200 ml/day. All patients received standard care during hospital admission and a follow-‎up visit after 7days of discharge from hospital. Patients were then compared in terms of ‎major clinical outcomes using chi-squared and t-test. Results: From the total of 138 patients, 70 and 68 patients were randomized to control ‎‎(G150 and trial (G200 group, respectively. Baseline characteristics were comparable ‎between the two groups. Although the trial group had a shorter mean for length of ‎hospital stay (LOS (4.1 compared to 4.8, p=0.04, their differences in drainage time ‎did not reach to the level of statistical significance (p=0.1. Analysis of data showed no ‎statistically significant differences between the rate of radiological reaccumulation, ‎thoracentesis and decrease in pulmonary sounds (auscultatory, one week after ‎discharge from hospital.‎‏ ‏Conclusions: Compared to a daily volume drainage of 150 ml, removal of chest tube ‎when there is 200 ml/day is safe and will even result in a shorter hospital stay. This in ‎turn leads to a lower cost.‎

  5. School leadership effects revisited: a review of empirical studies guided by indirect-effect models

    NARCIS (Netherlands)

    Hendriks, Maria A.; Scheerens, Jaap

    2013-01-01

    Fourteen leadership effect studies that used indirect-effect models were quantitatively analysed to explore the most promising mediating variables. The results indicate that total effect sizes based on indirect-effect studies appear to be low, quite comparable to the results of some meta-analyses of

  6. Environmental effects of indirect subsidies

    International Nuclear Information System (INIS)

    Van Beers, C.P.; De Moor, A.P.G.; Van den Bergh, J.C.J.M.; Oosterhuis, F.H.

    2003-01-01

    The aim of the study on the title subject is to develop a transparent integrated method to determine and analyze the environmental impacts of indirect subsidies, applied in the sectors agriculture, energy, mobility, and tourism. From the results it appears that the hazardous effects of subsidies are big. Examples are milk, the regulating energy levy, and kerosene [nl

  7. Dynamic modeling of cost-effectiveness of rotavirus vaccination, Kazakhstan.

    Science.gov (United States)

    Freiesleben de Blasio, Birgitte; Flem, Elmira; Latipov, Renat; Kuatbaeva, Ajnagul; Kristiansen, Ivar Sønbø

    2014-01-01

    The government of Kazakhstan, a middle-income country in Central Asia, is considering the introduction of rotavirus vaccination into its national immunization program. We performed a cost-effectiveness analysis of rotavirus vaccination spanning 20 years by using a synthesis of dynamic transmission models accounting for herd protection. We found that a vaccination program with 90% coverage would prevent ≈880 rotavirus deaths and save an average of 54,784 life-years for children vaccine cost at vaccination program costs would be entirely offset. To further evaluate efficacy of a vaccine program, benefits of indirect protection conferred by vaccination warrant further study.

  8. Ultrasonic measurements of chest wall thickness and realistic chest phantom for calibration of Pu lung counting facilities

    International Nuclear Information System (INIS)

    Shirotani, Takashi

    1990-01-01

    There are four important problems for the measurements of chest wall thickness using ultrasonic device: (1) selection of optimum position of transducer and the number of measured points on the chest covered with detector, (2) estimation of adipose-to-muscle ratio in the chest wall, especially for dispersed adipose like 'marbled beef', (3) determination of regression equations for the prediction of chest wall thickness, derived from groups of different body shape, i.e. corpulent and lean, and (4) estimation of effective chest wall thickness involved self-absorption layer of lung tissue, which changes with distribution of activity in the lungs. This quantity can not be measured with ultrasonic device. Realistic chest phantom was developed. The phantom contains removable model organs (lungs, liver, kidneys and heart), model trachea and artificial rib cage, and also includes chest plates that can be placed over the chest to simulate wide range adipose-to-muscle ratio in the chest wall. Various soft tissue substitutes were made of polyurethane with different concentrations of additive, and the rib cage were made of epoxy resin with calcium carbonate. The experimental data have shown that the phantom can be used as a standard phantom for the calibration. (author)

  9. An improved recommendation algorithm via weakening indirect linkage effect

    International Nuclear Information System (INIS)

    Chen Guang; Qiu Tian; Shen Xiao-Quan

    2015-01-01

    We propose an indirect-link-weakened mass diffusion method (IMD), by considering the indirect linkage and the source object heterogeneity effect in the mass diffusion (MD) recommendation method. Experimental results on the MovieLens, Netflix, and RYM datasets show that, the IMD method greatly improves both the recommendation accuracy and diversity, compared with a heterogeneity-weakened MD method (HMD), which only considers the source object heterogeneity. Moreover, the recommendation accuracy of the cold objects is also better elevated in the IMD than the HMD method. It suggests that eliminating the redundancy induced by the indirect linkages could have a prominent effect on the recommendation efficiency in the MD method. (paper)

  10. Chest X-Ray

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    Full Text Available ... talk with you about chest radiography also known as chest x-rays. Chest x-rays are the ... treatment for a variety of lung conditions such as pneumonia, emphysema and cancer. A chest x-ray ...

  11. Derivation and validation of two decision instruments for selective chest CT in blunt trauma: a multicenter prospective observational study (NEXUS Chest CT).

    Science.gov (United States)

    Rodriguez, Robert M; Langdorf, Mark I; Nishijima, Daniel; Baumann, Brigitte M; Hendey, Gregory W; Medak, Anthony J; Raja, Ali S; Allen, Isabel E; Mower, William R

    2015-10-01

    Unnecessary diagnostic imaging leads to higher costs, longer emergency department stays, and increased patient exposure to ionizing radiation. We sought to prospectively derive and validate two decision instruments (DIs) for selective chest computed tomography (CT) in adult blunt trauma patients. From September 2011 to May 2014, we prospectively enrolled blunt trauma patients over 14 y of age presenting to eight US, urban level 1 trauma centers in this observational study. During the derivation phase, physicians recorded the presence or absence of 14 clinical criteria before viewing chest imaging results. We determined injury outcomes by CT radiology readings and categorized injuries as major or minor according to an expert-panel-derived clinical classification scheme. We then employed recursive partitioning to derive two DIs: Chest CT-All maximized sensitivity for all injuries, and Chest CT-Major maximized sensitivity for only major thoracic injuries (while increasing specificity). In the validation phase, we employed similar methodology to prospectively test the performance of both DIs. We enrolled 11,477 patients-6,002 patients in the derivation phase and 5,475 patients in the validation phase. The derived Chest CT-All DI consisted of (1) abnormal chest X-ray, (2) rapid deceleration mechanism, (3) distracting injury, (4) chest wall tenderness, (5) sternal tenderness, (6) thoracic spine tenderness, and (7) scapular tenderness. The Chest CT-Major DI had the same criteria without rapid deceleration mechanism. In the validation phase, Chest CT-All had a sensitivity of 99.2% (95% CI 95.4%-100%), a specificity of 20.8% (95% CI 19.2%-22.4%), and a negative predictive value (NPV) of 99.8% (95% CI 98.9%-100%) for major injury, and a sensitivity of 95.4% (95% CI 93.6%-96.9%), a specificity of 25.5% (95% CI 23.5%-27.5%), and a NPV of 93.9% (95% CI 91.5%-95.8%) for either major or minor injury. Chest CT-Major had a sensitivity of 99.2% (95% CI 95.4%-100%), a specificity of

  12. Chest X-Ray

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    Full Text Available ... by Image/Video Gallery Your Radiologist Explains Chest X-ray Transcript Welcome to Radiology Info dot org! Hello, ... d like to talk with you about chest radiography also known as chest x-rays. Chest x- ...

  13. FLAIL CHEST

    Directory of Open Access Journals (Sweden)

    Anton Crnjac

    2003-12-01

    Full Text Available Background. Major thoracic trauma is consistent with high mortality rate because of associated injuries of vital thoracic organs and dangerous complications. The flail chest occurs after disruption of the skeletal continuity of chest wall and demands because of its pathophysiological complexity rapid and accurate diagnosis and treatment.Conclusions. Basic pathophysiological mechanism of the flail chest is respiratory distress, which is provoked by pulmonary contusions and paradoxical chest wall motion. The treatment should be pointed to improvement and support of respiratory functions and include aggressive pain control, pulmonary physiotherapy and selective mechanical ventilation. Views about operative fixation of the flail chest are still controversial. Neither mortality rate neither long-term disability are improved after operative fixation.

  14. NICE recommendations for the assessment of stable chest pain: assessing the early economic and service impact in the rapid-access chest pain service.

    Science.gov (United States)

    Ashrafi, Reza; Raga, Santosh; Abdool, Ali; Disney, Andrew; Wong, Peter; Davis, Gershan K

    2013-05-01

    In 2010, guidelines published by the National Institute for Clinical Excellence (NICE) suggested a change in the way patients with stable chest pain of suspected cardiac origin were investigated. These guidelines removed exercise treadmill testing from routine use and introduced cardiac CT to regular use. To investigate whether these guidelines had improved our service provision by reducing the number of further investigations required to make a diagnosis, and to see if our costs had increased now that the less expensive exercise treadmill tests were not recommended. Clinic letters were used to assess patients pretest likelihood of coronary artery disease for two six-month cohorts of consecutive patients seen in the rapid access chest pain clinic (January-June 2010 and July-December 2011) using NICE published methodology, and to ascertain which investigations patients had. Using NICE modelled costs, we generated comparative hypothetical costs for each cohort and an average cost per patient. In the January-June 2010 cohort, 435 patients with chest pain were seen, and in July-December 2011, 334 patients were seen. In the pre-NICE guidelines cohort, 23% of patients required two investigations as compared with 11.4% in the post-NICE guidelines cohort, with no patient requiring three investigations as compared with 3% in the original cohort. There was no significant increase in costs per patient in the post-NICE guidance group. Implementing NICE guidance reduced the number of investigations needed per patient, and did not prove more expensive for our department in the short term.

  15. Chest X-Ray

    Medline Plus

    Full Text Available ... by Image/Video Gallery Your Radiologist Explains Chest X-ray Transcript Welcome to Radiology Info dot org! Hello, ... you about chest radiography also known as chest x-rays. Chest x-rays are the most commonly performed ...

  16. Ultrasonography of chest wall lesion

    Energy Technology Data Exchange (ETDEWEB)

    Park, Cheol Min; Kim, C. H.; Cha, I. H.; Chung, K. B.; Ser, W. H.; Choi, Y. H. [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1989-12-15

    Thirty-one patients with chest wall diseases were studied with ultrasound to evaluate its role in chest wall lesions. There were eight infectious conditions, 9 benign tumors, 11 malignant lesions and 3 miscellaneous cases. Diffuse chest wall thickening with heterogeneous echogenicity and obliteration of subcutaneous fat layer are findings of acute infection. In cases of tuberculous smpyema necessitates, pleural abnormality extended to the chest wall through intercostal space. Benign tumors were well demarcated, except in 4 cases of lipoma/lipomatosis. Malignant lesions showed irregular soft tissue masses, bone destruction, pleural effusion and subcutaneous invasion. Multiple enlarged lymph nodes were also shown. Ultrasound can demonstrate te internal structure, extent, depth and associated findings such as pleural effusion, bone destruction and peripheral lung involvement. Ultrasound is not only safe, non-invasive and an effective diagnostic imaging modality for chest wall disease, but can also guide aspiration or biopsy for pathologic diagnosis

  17. Ultrasonography of chest wall lesion

    International Nuclear Information System (INIS)

    Park, Cheol Min; Kim, C. H.; Cha, I. H.; Chung, K. B.; Ser, W. H.; Choi, Y. H.

    1989-01-01

    Thirty-one patients with chest wall diseases were studied with ultrasound to evaluate its role in chest wall lesions. There were eight infectious conditions, 9 benign tumors, 11 malignant lesions and 3 miscellaneous cases. Diffuse chest wall thickening with heterogeneous echogenicity and obliteration of subcutaneous fat layer are findings of acute infection. In cases of tuberculous smpyema necessitates, pleural abnormality extended to the chest wall through intercostal space. Benign tumors were well demarcated, except in 4 cases of lipoma/lipomatosis. Malignant lesions showed irregular soft tissue masses, bone destruction, pleural effusion and subcutaneous invasion. Multiple enlarged lymph nodes were also shown. Ultrasound can demonstrate te internal structure, extent, depth and associated findings such as pleural effusion, bone destruction and peripheral lung involvement. Ultrasound is not only safe, non-invasive and an effective diagnostic imaging modality for chest wall disease, but can also guide aspiration or biopsy for pathologic diagnosis

  18. Digital tomosynthesis of the chest: A literature review

    International Nuclear Information System (INIS)

    Molk, N.; Seeram, E.

    2015-01-01

    Digital tomosynthesis is a relatively novel imaging modality using limited angle tomography to provide 3D imaging. The purpose of this review is to compare the sensitivity of digital tomosynthesis of the chest and plain film chest imaging in accurately identifying pulmonary nodules and to compare the effective dose between standard chest examinations using digital tomosynthesis and CT. A review of current literature has shown that small scale studies found digital tomosynthesis to be three times more effective in identifying pulmonary nodules compared to conventional radiography and at lower doses compared with routine chest CT examinations. This indicates that tomosynthesis could potentially be a beneficial imaging modality and could be used in a number of ways to detect and monitor pulmonary nodules for cancer. However with limited research, large-scale studies would need to be performed to confirm its benefits and identify where it is best used in the clinical setting. - Highlights: • The detection of pulmonary nodules is compared between tomosynthesis and plain film. • The effective dose of digital chest tomosynthesis and chest CT are compared. • The place of digital tomosynthesis of the chest in the clinical setting is explored. • Three times more pulmonary nodules are seen with tomosynthesis. • The effective dose of tomosynthesis is significantly lower than CT

  19. The Short-Term Effect of Chest Physiotherapy on Spirometric Indices in Chemical Warfare Victims Exposed to Mustard Gas

    Directory of Open Access Journals (Sweden)

    A Abedi

    2008-12-01

    Full Text Available ABCTRACT Introduction & Objective: Chronic respiratory diseases are the most prevalent late sequels of sulfur mustard gas injury among Iranian chemical warfare victims. Chest physiotherapy is one of the useful methods in care, cure and infection prevention of these patients. The aim of this study was to determine the short-term effect of chest physiotherapy on spirometric indices in chemical warfare victims exposed to sulfur mustard gas. Materials & Methods: In this study, 27 of the chemical warfare victims with respiratory diseases were selected. Chest physiotherapy including postural drainage percussion and vibration were used in four positions for all patients. Pulmonary function test (PFT was obtained before (baseline, immediately and 20 minute after the chest physiotherapy. The SPSS software was used for the data analysis of the collected data. Results: Results of this study showed the significant effect (p<0.01 of chest physiotherapy upon forced expiratory volume in first second (FEV1 (baseline mean, 44.19 immediately after intervention mean 47.3 and 20 minute after intervention mean 48.3 and forced vital capacity (FVC (baseline mean, 69.37 immediately after intervention mean, 73.67 20 minute after intervention 75.74. Chest physiotherapy had significant effect (p<0.01 in asthmatic bronchitis group and also had significant effect (p<0.05 in both severe and moderate groups. Conclusion: Chest physiotherapy was able to improve pulmonary function test indices in chemical warfare victims suffering from respiratory problems. The effect on asthmatic bronchitis group, as well as both severe and moderate groups, was significant.

  20. Chest X-Ray

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    Full Text Available ... I’d like to talk with you about chest radiography also known as chest x-rays. Chest x-rays are the most ... far outweighs any risk. For more information about chest x-rays, visit Radiology Info dot org. Thank you for your time! ...

  1. Disease activity, quality of life and indirect costs of reduced productivity at work, generated by Polish patients with ankylosing spondylitis

    Directory of Open Access Journals (Sweden)

    Paweł Kawalec

    2016-02-01

    Full Text Available Objectives: The aim of the study was to investigate the association between activity of ankylosing spondylitis (AS and decrease in quality of life as well as productivity loss of affected patients in a specified group of patients in the Polish setting. Material and methods : An questionnaire survey was conducted using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI to assess disease activity, as well as the Work Productivity and Activity Impairment Questionnaires to assess productivity loss; quality of life was presented as utility calculated using the EuroQol 5 questionnaire and also measured on a visual analogue scale (VAS. Indirect costs were assessed with the human capital approach implying gross domestic product per capita or gross value added per worker in Poland in 2014 and were expressed in Polish zlotys (PLN as well as in euros. Correlation was presented using Spearman’s rank correlation coefficient. Results : We performed our analysis based on 78 full questionnaires collected. A mean BASDAI score of 5.91 in the analysed group of patients was detected and mean utility of 0.5135 was observed. Average quality of life measured on the visual analogue scale was 46.55. Mean number of days off work was 45.26 days per year and mean on-the-job productivity loss was 49.29%. Average annual indirect costs per patient were €4241 (17 686 PLN calculated using gross domestic product and €10 172 (42 417 PLN estimated using gross value added. Total productivity loss was significantly correlated with disease activity (strong correlation of 0.6005 and utility (moderate correlation of –0.3698. Conclusions : Ankylosing spondylitis causes a great decrease in quality of life as well as patients’ productivity loss associated with both absenteeism and presenteeism. The greater the disease activity is, the lower is the utility, the lower is the quality of life measured on the VAS, and the greater are the total annual indirect costs. Total

  2. Comparative Effects of Biomass Pre-Treatments for Direct and Indirect Transesterification to Enhance Microalgal Lipid Recovery

    International Nuclear Information System (INIS)

    Ghasemi Naghdi, Forough; Thomas-Hall, Skye R.; Durairatnam, Reuben; Pratt, Steven; Schenk, Peer M.

    2014-01-01

    Microalgal lipid recovery for biodiesel production is currently considered suboptimal, but pre-treatment of algal biomass, the use of solvent mixtures and the positioning of transesterification can lead to increased yields. Here, the effect of various reportedly successful pre-treatments and solvent mixtures were directly compared to each other and combined with direct and indirect transesterification methods using the oleaginous microalga Tetraselmis sp. M8. Microwave and thermal pre-treatments were applied and the total lipid and fatty acid methyl ester (FAME) recoveries were investigated. The application of pre-treatments increased FAME recovery through indirect transesterification when a Soxhlet system was used but they had no significant effect for direct transesterification. Gravimetric analyses of total lipids revealed that lipid recovery was highest when utilizing the chloroform-based Bligh and Dyer extraction method; however, FAME yield was the highest when applying a Soxhlet system utilizing a solvent mixture of hexane–ethanol (3:1). Total lipid recovery did not necessarily correlate with the recovery of FAMEs. The highest FAME recovery was achieved from thermal or microwave pre-treated biomass followed by indirect transesterification through Soxhlet extraction. FAME recovery could be more than doubled (increase of up to 171%) under these conditions. We conclude that a simple thermal pre-treatment (80°C for 10 min) in combination with solvent mixture extraction through indirect transesterification may present a cost-effective and scalable option for large-scale lipid extraction from microalgae.

  3. Comparative effects of biomass pre-treatments for direct and indirect transesterification to enhance microalgal lipid recovery

    Directory of Open Access Journals (Sweden)

    Forough eGhasemi Naghdi

    2014-12-01

    Full Text Available Microalgal lipid recovery for biodiesel production is currently considered suboptimal, but pre-treatment of algal biomass, the use of solvent mixtures and the positioning of transesterification can lead to increased yields. Here, the effect of various reportedly successful pre-treatments and solvent mixtures were directly compared to each other and combined with direct and indirect transesterification methods using the oleaginous microalga Tetraselmis sp. M8. Microwave and thermal pre-treatments were applied and the total lipid and fatty acid methyl ester (FAME recoveries were investigated. The application of pre-treatments increased FAME recovery through indirect transesterification when a Soxhlet system was used but they had no significant effect for direct transesterification. Gravimetric analyses of total lipids revealed that lipid recovery was highest when utilizing the chloroform-based Bligh and Dyer extraction method; however FAME yield was the highest when applying a Soxhlet system utilizing a solvent mixture of hexane-ethanol (3:1. Total lipid recovery did not necessarily correlate with the recovery of FAMEs. The highest FAME recovery was achieved from thermal or microwave pre-treated biomass followed by indirect transesterification through Soxhlet extraction. FAME recovery could be more than doubled (increase of up to 171% under these conditions. We conclude that a simple thermal pre-treatment (80°C for 10 min in combination with solvent mixture extraction through indirect transesterification may present a cost-effective and scalable option for large-scale lipid extraction from microalgae.

  4. Comparative Effects of Biomass Pre-Treatments for Direct and Indirect Transesterification to Enhance Microalgal Lipid Recovery

    Energy Technology Data Exchange (ETDEWEB)

    Ghasemi Naghdi, Forough; Thomas-Hall, Skye R.; Durairatnam, Reuben [Algae Biotechnology Laboratory, School of Agriculture and Food Sciences, The University of Queensland, Brisbane, QLD (Australia); Pratt, Steven [School of Chemical Engineering, The University of Queensland, Brisbane, QLD (Australia); Schenk, Peer M., E-mail: p.schenk@uq.edu.au [Algae Biotechnology Laboratory, School of Agriculture and Food Sciences, The University of Queensland, Brisbane, QLD (Australia)

    2014-12-04

    Microalgal lipid recovery for biodiesel production is currently considered suboptimal, but pre-treatment of algal biomass, the use of solvent mixtures and the positioning of transesterification can lead to increased yields. Here, the effect of various reportedly successful pre-treatments and solvent mixtures were directly compared to each other and combined with direct and indirect transesterification methods using the oleaginous microalga Tetraselmis sp. M8. Microwave and thermal pre-treatments were applied and the total lipid and fatty acid methyl ester (FAME) recoveries were investigated. The application of pre-treatments increased FAME recovery through indirect transesterification when a Soxhlet system was used but they had no significant effect for direct transesterification. Gravimetric analyses of total lipids revealed that lipid recovery was highest when utilizing the chloroform-based Bligh and Dyer extraction method; however, FAME yield was the highest when applying a Soxhlet system utilizing a solvent mixture of hexane–ethanol (3:1). Total lipid recovery did not necessarily correlate with the recovery of FAMEs. The highest FAME recovery was achieved from thermal or microwave pre-treated biomass followed by indirect transesterification through Soxhlet extraction. FAME recovery could be more than doubled (increase of up to 171%) under these conditions. We conclude that a simple thermal pre-treatment (80°C for 10 min) in combination with solvent mixture extraction through indirect transesterification may present a cost-effective and scalable option for large-scale lipid extraction from microalgae.

  5. Chemistry of cost effective water treatment programme in HWP (Manuguru)

    International Nuclear Information System (INIS)

    Mohapatra, C.; Laxmana Prasad, K.

    2008-01-01

    In order to develop a water treatment programme following points must be kept in mind: Effectiveness to achieve desired water quality objectives; Compliance with regulatory requirements; Cost minimization; Safety; Easy operation and protection to equipments. Heavy Water Plant (Manuguru) laboratory has developed treatment programs to treat raw water and cooling water which satisfy the above requirements and has been in use for last several years successfully without any problem. These treatment programs have been given to other plants in Heavy Water Board for implementation. This paper describes the chemistry of the treatment program and cost minimization achieved. Further these treatments have helped the plant in achieving ΦZero Discharge and indirectly reduced the production cost. The chemistry parameters are monitored regularly to ascertain the effectiveness of these treatments. The areas where significant benefits derived are raw water treatment using polyelectrolyte instead of inorganic coagulant (alum), change over of regenerant of cation exchangers from hydrochloric acid to sulfuric acid and development of in-house cooling water treatment formulation. The advantages and cost effectiveness of these treatments are discussed in detail. Further these treatments helped the plant in achieving Zero discharge and indirectly reduced production cost of heavy water. The dosage of 3 ppm of polyelectrolyte can replace 90 ppm alum at turbidity level of 300 NTU of raw water which has resulted in cost saving of Rs. 15 - 20 Lakhs in a year besides other advantages. The changeover of regenerant from HCl to H 2 SO 4 will result in cost saving of at least Rs. 1.4 Crore a year along with other advantages. The change over of proprietary formulation to in-house formulation in cooling water treatment has resulted a saving about Rs. 11 Lakhs a year. To achieve the above objectives in a sustainable way the performance results are being monitored (author)

  6. Economic Cost of Breast Cancer in Ghana: The Komfo Anokye ...

    African Journals Online (AJOL)

    The aim is to assist in the efficient and effective allocation of scarce health ... Again, the study found the direct annual cost per patient to be GH¢2,070.83 and the indirect ... Cost, Breast Cancer, Direct Cost, Indirect Cost, Human Capital Method ...

  7. Pulmonary effects of synthetic marijuana: chest radiography and CT findings.

    Science.gov (United States)

    Berkowitz, Eugene A; Henry, Travis S; Veeraraghavan, Srihari; Staton, Gerald W; Gal, Anthony A

    2015-04-01

    The purpose of this article is to present the first chest radiographic and CT descriptions of organizing pneumonia in response to smoking synthetic marijuana. Chest radiographs showed a diffuse miliary-micronodular pattern. Chest CT images showed diffuse centrilobular nodules and tree-in-bud pattern and a histopathologic pattern of organizing pneumonia with or without patchy acute alveolar damage. This distinct imaging pattern should alert radiologists to include synthetic marijuana abuse in the differential diagnosis.

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

    Science.gov (United States)

    Wang, Jian; Shete, Sanjay

    2017-01-01

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

  9. Chest Reconstruction and Chest Dysphoria in Transmasculine Minors and Young Adults: Comparisons of Nonsurgical and Postsurgical Cohorts.

    Science.gov (United States)

    Olson-Kennedy, Johanna; Warus, Jonathan; Okonta, Vivian; Belzer, Marvin; Clark, Leslie F

    2018-05-01

    Transmasculine youth, who are assigned female at birth but have a gender identity along the masculine spectrum, often report considerable distress after breast development (chest dysphoria). Professional guidelines lack clarity regarding referring minors (defined as people younger than 18 years) for chest surgery because there are no data documenting the effect of chest surgery on minors. To examine the amount of chest dysphoria in transmasculine youth who had had chest reconstruction surgery compared with those who had not undergone this surgery. Using a novel measure of chest dysphoria, this cohort study at a large, urban, hospital-affiliated ambulatory clinic specializing in transgender youth care collected survey data about testosterone use and chest distress among transmasculine youth and young adults. Additional information about regret and adverse effects was collected from those who had undergone surgery. Eligible youth were 13 to 25 years old, had been assigned female at birth, and had an identified gender as something other than female. Recruitment occurred during clinical visits and via telephone between June 2016 and December 2016. Surveys were collected from participants who had undergone chest surgery at the time of survey collection and an equal number of youth who had not undergone surgery. Outcomes were chest dysphoria composite score (range 0-51, with higher scores indicating greater distress) in all participants; desire for chest surgery in patients who had not had surgery; and regret about surgery and complications of surgery in patients who were postsurgical. Of 136 completed surveys, 68 (50.0%) were from postsurgical participants, and 68 (50.0%) were from nonsurgical participants. At the time of the survey, the mean (SD) age was 19 (2.5) years for postsurgical participants and 17 (2.5) years for nonsurgical participants. Chest dysphoria composite score mean (SD) was 29.6 (10.0) for participants who had not undergone chest reconstruction, which

  10. Cardiorespiratory effects of inelastic chest wall restriction.

    Science.gov (United States)

    Miller, Jordan D; Beck, Kenneth C; Joyner, Michael J; Brice, A Glenn; Johnson, Bruce D

    2002-06-01

    We examined the effects of chest wall restriction (CWR) on cardiorespiratory function at rest and during exercise in healthy subjects in an attempt to approximate the cardiorespiratory interactions observed in clinical conditions that result in restrictive lung and/or chest wall changes and a reduced intrathoracic space. Canvas straps were applied around the thorax and abdomen so that vital capacity was reduced by >35%. Data were acquired at rest and during cycle ergometry at 25 and 45% of peak workloads. CWR elicited significant increases in the flow-resistive work performed on the lung (160%) and the gastric pressure-time integral (>400%) at the higher workload, but it resulted in a decrease in the elastic work performed on the lung (56%) compared with control conditions. With CWR, heart rate increased and stroke volume (SV) fell, resulting in >10% fall in cardiac output at rest and during exercise at matched workloads (P < 0.05). Blood pressure and catecholamines were significantly elevated during CWR exercise conditions (P < 0.05). We conclude that CWR significantly impairs SV during exercise and that a compensatory increase in heart rate does not prevent a significant reduction in cardiac output. O(2) consumption appears to be maintained via increased extraction and a redistribution of blood flow via sympathetic activation.

  11. Management of chest drainage tubes after lung surgery.

    Science.gov (United States)

    Satoh, Yukitoshi

    2016-06-01

    Since chest tubes have been routinely used to drain the pleural space, particularly after lung surgery, the management of chest tubes is considered to be essential for the thoracic surgeon. The pleural drainage system requires effective drainage, suction, and water-sealing. Another key point of chest tube management is that a water seal is considered to be superior to suction for most air leaks. Nowadays, the most common pleural drainage device attached to the chest tube is the three-bottle system. An electronic chest drainage system has been developed that is effective in standardizing the postoperative management of chest tubes. More liberal use of digital drainage devices in the postoperative management of the pleural space is warranted. The removal of chest tubes is a common procedure occurring almost daily in hospitals throughout the world. Extraction of the tube is usually done at the end of full inspiration or at the end of full expiration. The tube removal technique is not as important as how it is done and the preparation for the procedure. The management of chest tubes must be based on careful observation, the patient's characteristics, and the operative procedures that had been performed.

  12. New Federal Cost Accounting Regulations

    Science.gov (United States)

    Wolff, George J.; Handzo, Joseph J.

    1973-01-01

    Discusses a new set of indirect cost accounting procedures which must be followed by school districts wishing to recover any indirect costs of administering federal grants and contracts. Also discusses the amount of indirect costs that may be recovered, computing indirect costs, classifying project costs, and restricted grants. (Author/DN)

  13. Economic impact of indirects effects of tourism on the South Bohemian production

    OpenAIRE

    Michaela Antoušková

    2010-01-01

    Tourism is characterized as a sector of economy with high multiplier effect; tourism significantly influences other sectors of national economy. Through the multiplier the indirect effect of tourism might be measured. The value of tourist multiplier is a strongly discussed topic, especially in the Czech Republic. The indirect effects of tourism are commonly measured by multiplier in other countries. The article aims to quantify the indirect effects of tourism in the Southern Bohemia. To quant...

  14. Color indirect effects on melatonin regulation

    Science.gov (United States)

    Mian, Tian; Liu, Timon C.; Li, Yan

    2002-04-01

    Color indirect effect (CIE) is referred to as the physiological and psychological effects of color resulting from color vision. In previous papers, we have studied CIE from the viewpoints of the integrated western and Chinese traditional medicine, put forward the color-autonomic- nervous-subsystem model (CAM), and provided its time-theory foundation. In this paper, we applied it to study light effects on melatonin regulation in humans, and suggested that it is CIE that mediates light effects on melatonin suppression.

  15. Nodule detection in digital chest radiography: Summary of the radius chest trial

    International Nuclear Information System (INIS)

    Haakansson, M.; Baath, M.; Boerjesson, S.; Kheddache, S.; Grahn, A.; Ruschin, M.; Tingberg, A.; Mattson, S.; Maansson, L. G.

    2005-01-01

    As a part of the Europe-wide research project 'Unification of physical and clinical requirements for medical X-ray imaging' - governed by the Radiological Imaging Unification Strategies (RADIUS) Group - a major image quality trial was conducted by members of the group. The RADIUS chest trial aimed at thoroughly examining various aspects of nodule detection in digital chest radiography, such as the effects of nodule location, system noise, anatomical noise, and anatomical background. The main findings of the RADIUS chest trial concerning the detection of a lung nodule with a size in the order of 10 mm can be summarised as: (1) the detectability of the nodule is largely dependent on its location in the chest, (2) the system noise has a minor impact on the detectability at the dose levels used today, (3) the disturbance of the anatomical noise is larger than that of the system noise but smaller than that of the anatomical background and (4) the anatomical background acts as noise to a large extent and is the major image component affecting the detectability of the nodule. (authors)

  16. Productivity loss and resource utilization, and associated indirect and direct costs in individuals providing care for adults with schizophrenia in the EU5

    Directory of Open Access Journals (Sweden)

    Gupta S

    2015-11-01

    Full Text Available Shaloo Gupta,1 Gina Isherwood,2 Kevin Jones,3 Kristel Van Impe4 1Kantar Health, Princeton, NJ, USA; 2Kantar Health, Epsom, Surrey, UK; 3European Federation of Associations of Families of People with Mental Illness, Diestsevest, Leuven, Belgium; 4Janssen-Cilag GmbH, Neuss, Germany Objective: This study aimed to understand the impact of providing care for adults with schizophrenia on productivity, resource utilization, and costs in the EU5 (France, Germany, Italy, Spain, and UK. Methods: Data from the 2010, 2011, and 2013 EU5 National Health and Wellness Survey, an online questionnaire of a nationwide sample of adults, were analyzed. Schizophrenia caregivers (n=398 were matched to noncaregivers (n=158,989 and other caregivers (n=14,341 via propensity scores. Outcome measures included health care utilization, Work Productivity and Activity Impairment questionnaire-based scores, and associated direct and indirect costs (estimated from the literature. Significant differences between schizophrenia caregivers vs noncaregivers and other caregivers (eg, cancer and Alzheimer's disease were examined. Results: After matching, schizophrenia caregivers reported greater activity impairment (38.4% vs 26.1%, provider visits (8.0 vs 5.7, emergency room visits (0.9 vs 0.2, hospitalizations (0.8 vs 0.1, and direct costs (€2,258 vs €617 than noncaregivers, all P<0.001. Employed schizophrenia caregivers reported greater absenteeism, presenteeism, overall work impairment (35.0% vs 20.7%, and indirect costs (€6,667 vs €3,795 than noncaregivers, all P<0.001. Schizophrenia caregivers (vs other caregivers reported greater activity impairment (38.4% vs 32.3% and provider visits (8.0 vs 6.6, P<0.05. A greater proportion of schizophrenia caregivers (vs other caregivers reported at least one emergency room visit (26.1% vs 20.2% and hospitalization (20.4% vs 14.3%, P<0.05. Employed schizophrenia caregivers incurred greater indirect costs than other caregivers (€6

  17. Cost Analysis of Direct versus Indirect and Individual versus Group Modes of Manual-Based Speech-and-Language Therapy for Primary School-Age Children with Primary Language Impairment

    Science.gov (United States)

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

    2009-01-01

    Background: The study is the first within trial cost analysis of direct versus indirect and individual versus group modes of speech-and-language therapy for children with primary language impairment. Aims: To compare the short-run resource consequences of the four interventions alongside the effects achieved measured by standardized scores on a…

  18. Indirect and direct costs of acute coronary syndromes with comorbid atrial fibrillation, heart failure, or both

    Directory of Open Access Journals (Sweden)

    Ghushchyan V

    2014-12-01

    Full Text Available Vahram Ghushchyan,1,2 Kavita V Nair,2 Robert L Page II2,3 1College of Business and Economics, American University of Armenia, Yerevan, Armenia; 2Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA; 3Department of Physical Medicine, School of Medicine, University of Colorado, Aurora, CO, USA Background: The objective of this study was to determine the direct and indirect costs of acute coronary syndromes (ACS alone and with common cardiovascular comorbidities. Methods: A retrospective analysis was conducted using the Medical Expenditure Panel Survey from 1998 to 2009. Four mutually exclusive cohorts were evaluated: ACS only, ACS with atrial fibrillation (AF, ACS with heart failure (HF, and ACS with both conditions. Direct costs were calculated for all-cause and cardiovascular-related health care resource utilization. Indirect costs were determined from productivity losses from missed days of work. Regression analysis was developed for each outcome controlling for age, US census region, insurance coverage, sex, race, ethnicity, education attainment, family income, and comorbidity burden. A negative binomial regression model was used for health care utilization variables. A Tobit model was utilized for health care costs and productivity loss variables. Results: Total health care costs were greatest for those with ACS and both AF and HF ($38,484±5,191 followed by ACS with HF ($32,871±2,853, ACS with AF ($25,192±2,253, and ACS only ($17,954±563. Compared with the ACS only cohort, the mean all-cause adjusted health care costs associated with ACS with AF, ACS with HF, and ACS with AF and HF were $5,073 (95% confidence interval [CI] 719–9,427, $11,297 (95% CI 5,610–16,985, and $15,761 (95% CI 4,784–26,738 higher, respectively. Average wage losses associated with ACS with and without AF and/or HF amounted to $5,266 (95% CI -7,765, -2,767, when compared with patients

  19. Chest Tomosynthesis: Technical Principles and Clinical Update

    Science.gov (United States)

    Dobbins, James T.; McAdams, H. Page

    2009-01-01

    Digital tomosynthesis is a radiographic technique that can produce an arbitrary number of section images of a patient from a single pass of the x-ray tube. It utilizes a conventional x-ray tube, a flat-panel detector, a computer-controlled tube mover, and special reconstruction algorithms to produce section images. While it does not have the depth resolution of computed tomography (CT), tomosynthesis provides some of the tomographic benefits of CT but at lower cost and radiation dose than CT. Compared to conventional chest radiography, chest tomosynthesis results in improved visibility of normal structures such as vessels, airway and spine. By reducing visual clutter from overlying normal anatomy, it also enhances detection of small lung nodules. This review article outlines the components of a tomosynthesis system, discusses results regarding improved lung nodule detection from the recent literature, and presents examples of nodule detection from a clinical trial in human subjects. Possible implementation strategies for use in clinical chest imaging are discussed. PMID:19616909

  20. Large pneumothorax in blunt chest trauma: Is a chest drain always necessary in stable patients? A case report.

    Science.gov (United States)

    Idris, Baig M; Hefny, Ashraf F

    2016-01-01

    Pneumothorax is the most common potentially life-threatening blunt chest injury. The management of pneumothorax depends upon the etiology, its size and hemodynamic stability of the patient. Most clinicians agree that chest drainage is essential for the management of traumatic large pneumothorax. Herein, we present a case of large pneumothorax in blunt chest trauma patient that resolved spontaneously without a chest drain. A 63- year- old man presented to the Emergency Department complaining of left lateral chest pain due to a fall on his chest at home. On examination, he was hemodynamically stable. An urgent chest X-ray showed evidence of left sided pneumothorax. CT scan of the chest showed pneumothorax of more than 30% of the left hemithorax (around 600ml of air) with multiple left ribs fracture. Patient refused tube thoracostomy and was admitted to surgical department for close observation. The patient was managed conservatively without chest tube insertion. A repeat CT scan of the chest has shown complete resolution of the pneumothorax. The clinical spectrum of pneumothorax varies from asymptomatic to life threatening tension pneumothorax. In stable patients, conservative management can be safe and effective for small pneumothorax. To the best of our knowledge, this is the second reported case in the English literature with large pneumothorax which resolved spontaneously without chest drain. Blunt traumatic large pneumothorax in a clinically stable patient can be managed conservatively. Current recommendations for tube placement may need to be reevaluated. This may reduce morbidity associated with chest tube thoracostomy. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  1. [Standard chest x-ray: from film to all digital!].

    Science.gov (United States)

    Ducou Le Pointe, H

    2000-04-01

    Conventional imaging will be totally replaced by digital imaging because of the lower exposure dosage and the clear advantages in terms of image processing, transfer and storage. Reports in the literature have demonstrated that a 2.5 pl/mm spatial resolution is satisfactory to detect a pneumothorax, a parenchymal nodule or a mediastinal mass. For most authors, this resolution is also sufficient to detect an interstitial syndrome. Digitalization by amplification or by particle detectors using wire chambers are not, for the time being, acceptable for interpretation of a simple chest image because of the low spatial resolution. The selenium cylinder is an adapted technology dedicated to chest imaging. Memory display screens can be used to digitalize the entire radiology unit. They are perfectly adapted for bedside imaging. Flat detectors are based on direct or indirect conversion of the X photons into an electrical signal during the clinical evaluation. The early results appear most promising.

  2. The role of CT in assessing chest pain

    International Nuclear Information System (INIS)

    Capsa, R.

    2012-01-01

    Full text: Objective: Thoracic pain represents the common feature of a wide range of diseases of different causes. Usually, chest pain requires a fast workup, in order to eliminate potentially hazardous underlying conditions. The objective of the paper consists of presenting the role of computerized tomography (CT) in assessing the different causes and conditions related to chest pain. Materials and methods: The educational presentation relies on current literature data and mostly on images obtained from patients admitted in the various clinics and departments of our hospital, suffering from chest pain as admittance condition or as a symptom appeared during the hospital stay. Results: There are various radiological and imaging options for assessing a patient with chest pain, with reference to the underlying condition, type of pain onset (acute or chronic), specific indications and contraindications. From all these, CT is considered one of the most useful imaging options, in terms of diagnosis accuracy, fast workup, cost and availability. This paper focuses on the role of CT, presenting the most important diseases and conditions related to potential occurrence of chest pain and the most specific CT signs and findings usually reported in this setting. Furthermore, the presentation separates acute and chronic conditions, presenting the actual imaging protocols employed in this circumstances. Finally, there are considerations regarding CT rule-out protocols used in patients with acute chest pain in emergency conditions. Conclusions: Fast and accurate diagnosis is crucial for patient outcome, often life-saving, but currently there is no single algorithm in the imaging assessment of chest pain, while choosing the best imaging option relies mainly on history, clinical and laboratory data. CT is one of the most important imaging options available in patients with both acute and chronic chest pain. CT rule-out techniques have still to establish their clear role in a

  3. 42 CFR 412.322 - Indirect medical education adjustment factor.

    Science.gov (United States)

    2010-10-01

    ... Payment System for Inpatient Hospital Capital Costs Basic Methodology for Determining the Federal Rate for Capital-Related Costs § 412.322 Indirect medical education adjustment factor. (a) Basic data. CMS.... The indirect teaching adjustment factor equals [e (raised to the power of .2822×the ratio of residents...

  4. Effect of rib-cage structure on acoustic chest impedance

    DEFF Research Database (Denmark)

    Zimmermann, Niels Henrik; Møller, Henrik; Hansen, John

    2011-01-01

    When a stethoscope is placed on the surface of the chest, the coupler picks up sound from heart and lungs transmitted through the tissues of the ribcage and from the surface of the skin. If the acoustic impedance of the chest surface is known, it is possible to optimize the coupler for picking up...

  5. Diagnostic modalities x-ray and CT chest differ in the management of thoracic injury

    Directory of Open Access Journals (Sweden)

    D Chapagain

    2015-06-01

    Full Text Available Objective: To observe difference in the management of blunt trauma to the chest on the basis of conventional xray and computerised tomography of the chest. Methods: This prospective study was conducted between December 2011 to October 2012 in COMS in Bharatpur,a tertiary referral centre in central Nepal . Clinically stable thoracic injury patients were first evaluated with chest x-ray and the management on this basis was recorded. The findings of the CT chest were assessed and the type of management on the basis of CT was also recorded. Outcome was assessed in terms of mortality, morbidity, hospital and ICU stay with respect to the management on the basis of chest x-ray and CT scan. Results: Of the 129 patients, 74.4% were male and 25.6% were female with the patients ranging in age from 7 to 87 years (mean = 40.41 years. The most common mechanism of trauma to the chest was as a result of a motor vehicle accident (69.8%, followed by fall injury (20.2%. X-ray chest diagnosed rib fracture in 62%, haemothorax in 37%, pneumothorax in 27%, lung contusion in 10% and haemopneumothorax in 21% patients. Similarly CT chest diagnosed rib fracture in 86%, haemothorax in 54%, pneumothorax in 36%, lung contusion in 30% and haemopneumothorax in 30% patients. Mean hospital stay was 9.5 days in the group of patients having management on the basis of x-ray chest relative to mean stay of 10.2 days in the CT- chest group. In the management on the basis of xray group, there was a mean ICU stay of 2.8days compared to mean stays of 3.2 days in CT chest group. Conclusion: Though CT scan of the chest is more informative and differs the management of the blunt chest trauma, one should not forget to advise the cost effective, easily available and initial guiding agent, xray chest for early management of the chest injury patient. DOI: http://dx.doi.org/10.3126/jcmsn.v10i1.12764 Journal of College of Medical Sciences-Nepal, 2014, Vol.10(1; 22-31

  6. Development of a simple, low cost, indirect ion beam fluence measurement system for ion implanters, accelerators

    Science.gov (United States)

    Suresh, K.; Balaji, S.; Saravanan, K.; Navas, J.; David, C.; Panigrahi, B. K.

    2018-02-01

    We developed a simple, low cost user-friendly automated indirect ion beam fluence measurement system for ion irradiation and analysis experiments requiring indirect beam fluence measurements unperturbed by sample conditions like low temperature, high temperature, sample biasing as well as in regular ion implantation experiments in the ion implanters and electrostatic accelerators with continuous beam. The system, which uses simple, low cost, off-the-shelf components/systems and two distinct layers of in-house built softwarenot only eliminates the need for costly data acquisition systems but also overcomes difficulties in using properietry software. The hardware of the system is centered around a personal computer, a PIC16F887 based embedded system, a Faraday cup drive cum monitor circuit, a pair of Faraday Cups and a beam current integrator and the in-house developed software include C based microcontroller firmware and LABVIEW based virtual instrument automation software. The automatic fluence measurement involves two important phases, a current sampling phase lasting over 20-30 seconds during which the ion beam current is continuously measured by intercepting the ion beam and the averaged beam current value is computed. A subsequent charge computation phase lasting 700-900 seconds is executed making the ion beam to irradiate the samples and the incremental fluence received by the sampleis estimated usingthe latest averaged beam current value from the ion beam current sampling phase. The cycle of current sampling-charge computation is repeated till the required fluence is reached. Besides simplicity and cost-effectiveness, other important advantages of the developed system include easy reconfiguration of the system to suit customisation of experiments, scalability, easy debug and maintenance of the hardware/software, ability to work as a standalone system. The system was tested with different set of samples and ion fluences and the results were verified using

  7. Resource reduction in pediatric chest pain: Standardized clinical assessment and management plan.

    Science.gov (United States)

    Saleeb, Susan F; McLaughlin, Sarah R; Graham, Dionne A; Friedman, Kevin G; Fulton, David R

    2018-01-01

    Using a Standardized Clinical Assessment and Management Plan (SCAMP) for pediatric patients presenting to clinic with chest pain, we evaluated the cost impact associated with implementation of the care algorithm. Prior to introduction of the SCAMP, we analyzed charges for 406 patients with chest pain, seen in 2009, and predicted 21% reduction of overall charges had the SCAMP methodology been used. The SCAMP recommended an echocardiogram for history, examination, or ECG findings suggestive of a cardiac etiology for chest pain. Resource utilization was reviewed for 1517 patients (7-21 years) enrolled in the SCAMP from July 2010 to April 2014. Compared to the 2009 historic cohort, patients evaluated by the SCAMP had higher rates of exertional chest pain (45% vs 37%) and positive family history (5% vs 1%). The SCAMP cohort had fewer abnormal physical examination findings (1% vs 6%) and abnormal electrocardiograms (3% vs 5%). Echocardiogram use increased in the SCAMP cohort compared to the 2009 historic cohort (45% vs 41%), whereas all other ancillary testing was reduced: exercise stress testing (4% SCAMP vs 28% historic), Holter (4% vs 7%), event monitors (3% vs 10%), and MRI (1% vs 2%). Total charges were reduced by 22% ($822 625) by use of the Chest Pain SCAMP, despite a higher percentage of patients for whom echocardiogram was recommended compared to the historic cohort. The Chest Pain SCAMP effectively streamlines cardiac testing and reduces resource utilization. Further reductions can be made by algorithm refinement regarding echocardiograms for exertional symptoms. © 2017 Wiley Periodicals, Inc.

  8. Satisfaction of Search in Chest Radiography 2015.

    Science.gov (United States)

    Berbaum, Kevin S; Krupinski, Elizabeth A; Schartz, Kevin M; Caldwell, Robert T; Madsen, Mark T; Hur, Seung; Laroia, Archana T; Thompson, Brad H; Mullan, Brian F; Franken, Edmund A

    2015-11-01

    Two decades have passed since the publication of laboratory studies of satisfaction of search (SOS) in chest radiography. Those studies were performed using film. The current investigation tests for SOS effects in computed radiography of the chest. Sixty-four chest computed radiographs half demonstrating various "test" abnormalities were read twice by 20 radiologists, once with and once without the addition of a simulated pulmonary nodule. Receiver-operating characteristic detection accuracy and decision thresholds were analyzed to study the effects of adding the nodule on detecting the test abnormalities. Results of previous studies were reanalyzed using similar modern techniques. In the present study, adding nodules did not influence detection accuracy for the other abnormalities (P = .93), but did induce a reluctance to report them (P chest radiography (P chest radiography has changed, but it is not clear why. SOS may be changing as a function of changes in radiology education and practice. Copyright © 2015 AUR. Published by Elsevier Inc. All rights reserved.

  9. Direct and indirect effects of body weight on adult wages.

    Science.gov (United States)

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

    2011-12-01

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

  10. Mechanical work as an indirect measure of subjective costs influencing human movement.

    Directory of Open Access Journals (Sweden)

    Karl E Zelik

    Full Text Available To descend a flight of stairs, would you rather walk or fall? Falling seems to have some obvious disadvantages such as the risk of pain or injury. But the preferred strategy of walking also entails a cost for the use of active muscles to perform negative work. The amount and distribution of work a person chooses to perform may, therefore, reflect a subjective valuation of the trade-offs between active muscle effort and other costs, such as pain. Here we use a simple jump landing experiment to quantify the work humans prefer to perform to dissipate the energy of landing. We found that healthy normal subjects (N = 8 preferred a strategy that involved performing 37% more negative work than minimally necessary (P<0.001 across a range of landing heights. This then required additional positive work to return to standing rest posture, highlighting the cost of this preference. Subjects were also able to modulate the amount of landing work, and its distribution between active and passive tissues. When instructed to land softly, they performed 76% more work than necessary (P<0.001, with a higher proportion from active muscles (89% vs. 84%, P<0.001. Stiff-legged landings, performed by one subject for demonstration, exhibited close to the minimum of work, with more of it performed passively through soft tissue deformations (at least 30% in stiff landings vs. 16% preferred. During jump landings, humans appear not to minimize muscle work, but instead choose to perform a consistent amount of extra work, presumably to avoid other subjective costs. The degree to which work is not minimized may indirectly quantify the relative valuation of costs that are otherwise difficult to measure.

  11. Effect of the rate of chest compression familiarised in previous training on the depth of chest compression during metronome-guided cardiopulmonary resuscitation: a randomised crossover trial

    OpenAIRE

    Bae, Jinkun; Chung, Tae Nyoung; Je, Sang Mo

    2016-01-01

    Objectives To assess how the quality of metronome-guided cardiopulmonary resuscitation (CPR) was affected by the chest compression rate familiarised by training before the performance and to determine a possible mechanism for any effect shown. Design Prospective crossover trial of a simulated, one-person, chest-compression-only CPR. Setting Participants were recruited from a medical school and two paramedic schools of South Korea. Participants 42 senior students of a medical school and two pa...

  12. Optical compensation device for chest film radiography

    Science.gov (United States)

    Gould, Robert G.; Hasegawa, Bruce H.; DeForest, Sherman E.; Schmidt, Gregory W.; Hier, Richard G.

    1990-07-01

    Although chest radiography is the most commonly performed radiographic examination and one of the most valuable and cost-effective studies in medicine it suffers from relatively high error rates in both missing pathology and false positive interpretations. Detectability of lung nodules and other structures in underpenetrated regions of the chest film can be improved by both exposure and optical compensation but current compensation systems require major capital cost or a significant change in normal clinical practice. A new optical compensation system called the " Intelligent X-Ray Illuminator" (IXI) automatically and virtually instantaneously generates a patient-specific optical unsharp mask that is projected directly on a radiograph. When a radiograph is placed on the IXI which looks much like a conventional viewbox it acquires a low-resolution electronic image of this film from which the film transmission is derived. The transmission information is inverted and blurred in an image processor to form an unsharp mask which is fed into a spatial light modulator (SLM) placed between a light source and the radiograph. The SLM tailors the viewbox luminance by decreasing illumination to underexposed (i. e. transmissive) areas of the radiograph presenting the observer with an optically unsharp-masked image. The IXI uses the original radiograph and will allow it to be viewed on demand with conventional (uniform illumination. Potentially the IXI could introduce the known beneficial aspects of optical unsharp masking into radiology at low capital

  13. Effectiveness of feedback with a smartwatch for high-quality chest compressions during adult cardiac arrest: A randomized controlled simulation study.

    Science.gov (United States)

    Ahn, Chiwon; Lee, Juncheol; Oh, Jaehoon; Song, Yeongtak; Chee, Youngjoon; Lim, Tae Ho; Kang, Hyunggoo; Shin, Hyungoo

    2017-01-01

    Previous studies have demonstrated the potential for using smartwatches with a built-in accelerometer as feedback devices for high-quality chest compression during cardiopulmonary resuscitation. However, to the best of our knowledge, no previous study has reported the effects of this feedback on chest compressions in action. A randomized, parallel controlled study of 40 senior medical students was conducted to examine the effect of chest compression feedback via a smartwatch during cardiopulmonary resuscitation of manikins. A feedback application was developed for the smartwatch, in which visual feedback was provided for chest compression depth and rate. Vibrations from smartwatch were used to indicate the chest compression rate. The participants were randomly allocated to the intervention and control groups, and they performed chest compressions on manikins for 2 min continuously with or without feedback, respectively. The proportion of accurate chest compression depth (≥5 cm and ≤6 cm) was assessed as the primary outcome, and the chest compression depth, chest compression rate, and the proportion of complete chest decompression (≤1 cm of residual leaning) were recorded as secondary outcomes. The proportion of accurate chest compression depth in the intervention group was significantly higher than that in the control group (64.6±7.8% versus 43.1±28.3%; p = 0.02). The mean compression depth and rate and the proportion of complete chest decompressions did not differ significantly between the two groups (all p>0.05). Cardiopulmonary resuscitation-related feedback via a smartwatch could provide assistance with respect to the ideal range of chest compression depth, and this can easily be applied to patients with out-of-hospital arrest by rescuers who wear smartwatches.

  14. Computed tomography of chest wall abscess

    International Nuclear Information System (INIS)

    Ikezoe, Junpei; Morimoto, Shizuo; Akira, Masanori

    1986-01-01

    Inflammatory lesions of the chest wall become less common because of the improvement of antibiotics and chemotherapeutic agents. Over a 5-year period, 7 patients with chest wall inflammatory diseases underwent chest computed tomography. These were 2 tuberculous pericostal abscesses, 2 empyema necessitatis, 1 spinal caries, and 2 bacterial chest wall abscesses (unknown organisms). Computed tomography (CT) helped in demonstrating the density, border, site, and extent of the lesions. CT images also demonstrated the accompaning abnormalities which included bone changes, pleural calcification, or old tuberculous changes of the lung. CT was very effective to demonstrate the communicating portions from the inside of the bony thorax to the outside of the bony thorax in 2 empyema necessitatis. (author)

  15. Chest tube placement in thorax trauma - comparison chest X-ray and computed tomography (CT)

    International Nuclear Information System (INIS)

    Heim, P.; Maas, R.; Buecheler, E.; Tesch, C.

    1998-01-01

    Estimation of chest tube placement in patients with thoracic trauma with regard to chest tube malposition in chest radiography in the supine position compared to additional computed tomography of the thorax. Material and methods: Apart from compulsory chest radiography after one or multiple chest tube insertions, 31 severely injured patients with thoracic trauma underwent a CT scan of the thorax. These 31 patients with 40 chest tubes constituted the basis for the present analysis. Results: In chest radiography in the supine position there were no chest tube malpositions (n=40); In the CT scans 25 correct positions, 7 pseudo-malpositions, 6 intrafissural and 2 intrapulmonary malpositions were identified. Moreover 16 sufficient, 18 insufficient and 6 indifferent functions of the chest tubes were seen. Conclusion: In case of lasting clinical problems and questionable function of the chest tube, chest radiography should be supplemented by a CT scan of the thorax in order to estimate the position of the chest tube. (orig.) [de

  16. Cost-effectiveness of clust X-ray follow-up of patients treated for seminoma of the testis

    Energy Technology Data Exchange (ETDEWEB)

    Ciatto, S; Cionini, L; Pacini, P

    1986-01-01

    The authors report on a consecutive series of 253 cases of seminoma of the testis followed with periodic chest X-ray examinations from a minimum of three to a maximum of 27 years. The detection rate of asymptomatic intrathoracic metastases (ITM) was considered together with the costs of the follow-up procedure. Chest X-ray follow-up is not advisable beyound one year from primary treatment, since most (14 of 18) ITM occur in the first year, the detection rate of ITM beyond this date is too low (0.11% patients/year), and the related costs are too high (over $ 130,000 per ITM detected). Chest X-ray follow-up is questionable even in the first year primary treatment for Stage I cases bacause of the low detection rate (1.38 % patients/year) and the high costs (over $ 14,000 per ITM detected), whwreas it appears to be opportune in Stage IIA and IIB.

  17. Cost effectiveness of open versus laparoscopic living-donor nephrectomy

    DEFF Research Database (Denmark)

    Hamidi, Vida; Andersen, Marit Helen; Oyen, Ole

    2009-01-01

    , and a consequent potential to increase the pool of kidney donors. However, the cost effectiveness of LLDN remains unknown. The aim of this study was to explore the health and cost consequences of replacing open-donor nephrectomy by LLDN. METHODS: Kidney donors were randomized to laparoscopic (n=63) or open surgery...... (n=59). We obtained data on operating time, personnel costs, length of stay, cost of analgesic, disposable instruments and complications, and indirect costs. Quality of life was captured before the operation and at 1, 6, and 12 months postdonation by means of short form-36. The scores were translated...... into utilities by means of Brazier's 6D algorithm. RESULTS: The cost per patient was U.S. $55,292 with laparoscopic and U.S. $29,886 with open surgery. The greatest cost difference was in costs attributed to complications (U.S. $33,162 vs. U.S. $4,573). The 1-year quality-adjusted life years (QALYs) were 0...

  18. Lateral topography for reducing effective dose in low-dose chest CT.

    Science.gov (United States)

    Bang, Dong-Ho; Lim, Daekeon; Hwang, Wi-Sub; Park, Seong-Hoon; Jeong, Ok-man; Kang, Kyung Wook; Kang, Hohyung

    2013-06-01

    The purposes of this study were to assess radiation exposure during low-dose chest CT by using lateral topography and to compare the lateral topographic findings with findings obtained with anteroposterior topography alone and anteroposterior and lateral topography combined. From November 2011 to February 2012, 210 male subjects were enrolled in the study. Age, weight, and height of the men were recorded. All subjects were placed into one of three subgroups based on the type of topographic image obtained: anteroposterior topography, lateral topography, and both anteroposterior and lateral topography. Imaging was performed with a 128-MDCT scanner. CT, except for topography, was the same for all subjects. A radiologist analyzed each image, recorded scan length, checked for any insufficiencies in the FOV, and calculated the effective radiation dose. One-way analysis of variance and multiple comparisons were used to compare the effective radiation exposure and scan length between groups. The mean scan length in the anteroposterior topography group was significantly greater than that of the lateral topography group and the combined anteroposterior and lateral topography group (p topography group (0.735 ± 0.033 mSv) was significantly lower than that for the anteroposterior topography group (0.763 ± 0.038 mSv) and the combined anteroposterior and lateral topography group (0.773 ± 0.038) (p < 0.001). Lateral topographic low-dose CT was associated with a lower effective radiation dose and scan length than either anteroposterior topographic low-dose chest CT or low-dose chest CT with both anteroposterior and lateral topograms.

  19. SPSS and SAS procedures for estimating indirect effects in simple mediation models.

    Science.gov (United States)

    Preacher, Kristopher J; Hayes, Andrew F

    2004-11-01

    Researchers often conduct mediation analysis in order to indirectly assess the effect of a proposed cause on some outcome through a proposed mediator. The utility of mediation analysis stems from its ability to go beyond the merely descriptive to a more functional understanding of the relationships among variables. A necessary component of mediation is a statistically and practically significant indirect effect. Although mediation hypotheses are frequently explored in psychological research, formal significance tests of indirect effects are rarely conducted. After a brief overview of mediation, we argue the importance of directly testing the significance of indirect effects and provide SPSS and SAS macros that facilitate estimation of the indirect effect with a normal theory approach and a bootstrap approach to obtaining confidence intervals, as well as the traditional approach advocated by Baron and Kenny (1986). We hope that this discussion and the macros will enhance the frequency of formal mediation tests in the psychology literature. Electronic copies of these macros may be downloaded from the Psychonomic Society's Web archive at www.psychonomic.org/archive/.

  20. An improved recommendation algorithm via weakening indirect linkage effect

    Science.gov (United States)

    Chen, Guang; Qiu, Tian; Shen, Xiao-Quan

    2015-07-01

    We propose an indirect-link-weakened mass diffusion method (IMD), by considering the indirect linkage and the source object heterogeneity effect in the mass diffusion (MD) recommendation method. Experimental results on the MovieLens, Netflix, and RYM datasets show that, the IMD method greatly improves both the recommendation accuracy and diversity, compared with a heterogeneity-weakened MD method (HMD), which only considers the source object heterogeneity. Moreover, the recommendation accuracy of the cold objects is also better elevated in the IMD than the HMD method. It suggests that eliminating the redundancy induced by the indirect linkages could have a prominent effect on the recommendation efficiency in the MD method. Project supported by the National Natural Science Foundation of China (Grant No. 11175079) and the Young Scientist Training Project of Jiangxi Province, China (Grant No. 20133BCB23017).

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

    Science.gov (United States)

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

    2016-01-01

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

  2. American College of Chest Physicians

    Science.gov (United States)

    ... Foundation Participate in the e-Community Get Social Career Connection Publications CHEST Journal CHEST SEEK Guidelines & Consensus Statements CHEST Physician CHEST NewsBrief Coding for Chest Medicine Tobacco Dependence Toolkit (3rd Ed.) Mobile Websites and Apps CHEST Journal ...

  3. A novel method for improving chest tube insertion skills among medical interns

    Science.gov (United States)

    Tatli, Ozgur; Turkmen, Suha; Imamoglu, Melih; Karaca, Yunus; Cicek, Mustafa; Yadigaroglu, Metin; Bayrak, Selen T.; Asik, Olgun; Topbas, Murat; Turedi, Suleyman

    2017-01-01

    Objectives: To develop a low-cost biomaterial-covered chest tube simulation model and assess its possible usefulness for developing the chest tube insertion skills among medical interns. Methods: This mannequin-based interventional study was performed in a University hospital setting. We included 63 physicians performing emergency medicine internship at the Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey, between January 2015 and March 2015. A dummy was prepared for training simulation using a display mannequin. Medical interns received instruction concerning pneumothorax and the chest tube procedure. A total of 63 medical interns participating in this interventional study were asked to insert a chest tube in a biomaterial-covered mannequin. A senior trainee scored their performance using a check list and the mean of the total scores was calculated (21 items; total score, 42). Results: The mean procedural score was 40.9 ± 1.3 of a possible 42. The maximum score of 42 was achieved by 39.7% of the medical interns, while another 33.3% achieved a score of 41. Of the participants, 85% succeeded in inserting the tube via an appropriate technique, achieving a score of 40 or more. Conclusion: Our results indicated that this model could be useful for effective training of medical interns for chest tube insertion, which is an important skill in emergency medicine. This biomaterial-covered model is inexpensive and its use can potentially be widened to improve training methods without significant financial demand. PMID:28917064

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

    Science.gov (United States)

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

    2016-05-01

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

  5. Cost-Effectiveness of a Nonpharmacological Intervention in Pediatric Burn Care.

    Science.gov (United States)

    Brown, Nadia J; David, Michael; Cuttle, Leila; Kimble, Roy M; Rodger, Sylvia; Higashi, Hideki

    2015-07-01

    To report the cost-effectiveness of a tailored handheld computerized procedural preparation and distraction intervention (Ditto) used during pediatric burn wound care in comparison to standard practice. An economic evaluation was performed alongside a randomized controlled trial of 75 children aged 4 to 13 years who presented with a burn to the Royal Children's Hospital, Brisbane, Australia. Participants were randomized to either the Ditto intervention (n = 35) or standard practice (n = 40) to measure the effect of the intervention on days taken for burns to re-epithelialize. Direct medical, direct nonmedical, and indirect cost data during burn re-epithelialization were extracted from the randomized controlled trial data and combined with scar management cost data obtained retrospectively from medical charts. Nonparametric bootstrapping was used to estimate statistical uncertainty in cost and effect differences and cost-effectiveness ratios. On average, the Ditto intervention reduced the time to re-epithelialize by 3 days at AU$194 less cost for each patient compared with standard practice. The incremental cost-effectiveness plane showed that 78% of the simulated results were within the more effective and less costly quadrant and 22% were in the more effective and more costly quadrant, suggesting a 78% probability that the Ditto intervention dominates standard practice (i.e., cost-saving). At a willingness-to-pay threshold of AU$120, there is a 95% probability that the Ditto intervention is cost-effective (or cost-saving) against standard care. This economic evaluation showed the Ditto intervention to be highly cost-effective against standard practice at a minimal cost for the significant benefits gained, supporting the implementation of the Ditto intervention during burn wound care. Copyright © 2015. Published by Elsevier Inc.

  6. Chest CT in children: anesthesia and atelectasis

    Energy Technology Data Exchange (ETDEWEB)

    Newman, Beverley; Gawande, Rakhee [Lucile Packard Children' s Hospital, Department of Radiology, Stanford, CA (United States); Krane, Elliot J. [Stanford University School of Medicine, Lucile Packard Children' s Hospital, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford, CA (United States); Holmes, Tyson H. [Stanford University School of Medicine, Lucile Packard Children' s Hospital, Department of Psychiatry and Behavioral Sciences, Stanford, CA (United States); Robinson, Terry E. [Stanford University School of Medicine, Lucile Packard Children' s Hospital, Department of Pulmonary Medicine and Cystic Fibrosis Center for Excellence in Pulmonary Biology, Stanford, CA (United States)

    2014-02-15

    There has been an increasing tendency for anesthesiologists to be responsible for providing sedation or anesthesia during chest CT imaging in young children. Anesthesia-related atelectasis noted on chest CT imaging has proven to be a common and troublesome problem, affecting image quality and diagnostic sensitivity. To evaluate the safety and effectiveness of a standardized anesthesia, lung recruitment, controlled-ventilation technique developed at our institution to prevent atelectasis for chest CT imaging in young children. Fifty-six chest CT scans were obtained in 42 children using a research-based intubation, lung recruitment and controlled-ventilation CT scanning protocol. These studies were compared with 70 non-protocolized chest CT scans under anesthesia taken from 18 of the same children, who were tested at different times, without the specific lung recruitment and controlled-ventilation technique. Two radiology readers scored all inspiratory chest CT scans for overall CT quality and atelectasis. Detailed cardiorespiratory parameters were evaluated at baseline, and during recruitment and inspiratory imaging on 21 controlled-ventilation cases and 8 control cases. Significant differences were noted between groups for both quality and atelectasis scores with optimal scoring demonstrated in the controlled-ventilation cases where 70% were rated very good to excellent quality scans compared with only 24% of non-protocol cases. There was no or minimal atelectasis in 48% of the controlled ventilation cases compared to 51% of non-protocol cases with segmental, multisegmental or lobar atelectasis present. No significant difference in cardiorespiratory parameters was found between controlled ventilation and other chest CT cases and no procedure-related adverse events occurred. Controlled-ventilation infant CT scanning under general anesthesia, utilizing intubation and recruitment maneuvers followed by chest CT scans, appears to be a safe and effective method to obtain

  7. Chest CT in children: anesthesia and atelectasis

    International Nuclear Information System (INIS)

    Newman, Beverley; Gawande, Rakhee; Krane, Elliot J.; Holmes, Tyson H.; Robinson, Terry E.

    2014-01-01

    There has been an increasing tendency for anesthesiologists to be responsible for providing sedation or anesthesia during chest CT imaging in young children. Anesthesia-related atelectasis noted on chest CT imaging has proven to be a common and troublesome problem, affecting image quality and diagnostic sensitivity. To evaluate the safety and effectiveness of a standardized anesthesia, lung recruitment, controlled-ventilation technique developed at our institution to prevent atelectasis for chest CT imaging in young children. Fifty-six chest CT scans were obtained in 42 children using a research-based intubation, lung recruitment and controlled-ventilation CT scanning protocol. These studies were compared with 70 non-protocolized chest CT scans under anesthesia taken from 18 of the same children, who were tested at different times, without the specific lung recruitment and controlled-ventilation technique. Two radiology readers scored all inspiratory chest CT scans for overall CT quality and atelectasis. Detailed cardiorespiratory parameters were evaluated at baseline, and during recruitment and inspiratory imaging on 21 controlled-ventilation cases and 8 control cases. Significant differences were noted between groups for both quality and atelectasis scores with optimal scoring demonstrated in the controlled-ventilation cases where 70% were rated very good to excellent quality scans compared with only 24% of non-protocol cases. There was no or minimal atelectasis in 48% of the controlled ventilation cases compared to 51% of non-protocol cases with segmental, multisegmental or lobar atelectasis present. No significant difference in cardiorespiratory parameters was found between controlled ventilation and other chest CT cases and no procedure-related adverse events occurred. Controlled-ventilation infant CT scanning under general anesthesia, utilizing intubation and recruitment maneuvers followed by chest CT scans, appears to be a safe and effective method to obtain

  8. Chest MRI

    Science.gov (United States)

    ... resonance imaging - chest; NMR - chest; MRI of the thorax; Thoracic MRI Patient Instructions ... Gotway MB, Panse PM, Gruden JF, Elicker BM. Thoracic radiology. In: Broaddus VC, Mason RJ, Ernst JD, et ...

  9. Effects of Air Stacking Maneuver on Cough Peak Flow and Chest Wall Compartmental Volumes of Subjects With Amyotrophic Lateral Sclerosis.

    Science.gov (United States)

    Sarmento, Antonio; Resqueti, Vanessa; Dourado-Júnior, Mario; Saturnino, Lailane; Aliverti, Andrea; Fregonezi, Guilherme; de Andrade, Armele Dornelas

    2017-11-01

    To assess the acute effects of air stacking on cough peak flow (CPF) and chest wall compartmental volumes of persons with amyotrophic lateral sclerosis (ALS) versus healthy subjects positioned at 45° body inclination. Cross-sectional study with a matched-pair design. University hospital. Persons (N=24) with ALS (n=12) and age-matched healthy subjects (n=12). CPF, chest wall compartmental inspiratory capacity, chest wall vital capacity, chest wall tidal volume and operational volumes, breathing pattern, and percentage of contribution of the compartments to the inspired volume were measured by optoelectronic plethysmography. Compared with healthy subjects, significantly lower CPF (P=.007), chest wall compartmental inspiratory capacity (Pprotocol in the healthy subjects, mainly because of end-inspiratory (P<.001) and abdominal volumes (P=.008). No significant differences were observed in percentage of contribution of the compartments to the inspired volume and end-expiratory volume of both groups. No significant differences were found in chest wall tidal volume, operational volume, and breathing pattern in persons with ALS. Air stacking is effective in increasing CPF, chest wall compartmental inspiratory capacity, and chest wall vital capacity of persons with ALS with no hyperinflation. Differences in compartmental volume contributions are probably because of lung and chest wall physiological changes. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  10. Effect of Clinical Experience of Chest Tomosynthesis on Detection of Pulmonary Nodules

    International Nuclear Information System (INIS)

    Zachrisson, S.; Svalkvist, A.; Maansson, L.G.; Baath, M.; Vikgren, J.; Johnsson, Aa.A.; Boijsen, M.; Flinck, A.; Kheddache, S.

    2009-01-01

    Background: The new technique chest tomosynthesis refers to the principle of collecting low-dose projections of the chest at different angles and using these projections to reconstruct section images of the chest at a radiation dose comparable to that of chest radiography. Purpose: To investigate if, for experienced thoracic radiologists, the detectability of pulmonary nodules obtained after only a short initial learning period of chest tomosynthesis improves with additional clinical experience of the new technique. Material and Methods: Two readings of the same clinical chest tomosynthesis cases, the first performed after 6 months of clinical experience and the second after an additional period of 1 year, were conducted. Three senior thoracic radiologists, with more than 20 years of experience of chest radiography, acted as observers, with the task of detecting pulmonary nodules in a jackknife free-response receiver operating characteristics (JAFROC1) study. The image material consisted of 42 patients with and 47 patients without pulmonary nodules examined with chest tomosynthesis. Multidetector computed tomography (MDCT) was used as a reference. The total number of nodules was 131. The JAFROC1 figure of merit (FOM) was used as the principal measure of detectability. Results: The difference in the observer-averaged JAFROC1 FOM of the two readings was 0.004 (95% confidence interval: -0.11, 0.12; F-statistic: 0.01 on 1 and 2.65 df; P=0.91). Thus, no significant improvement in detectability was found after the additional clinical experience of tomosynthesis. Conclusion: The study indicates that experienced thoracic radiologists already within the first months of clinical use of chest tomosynthesis are able to take advantage of the new technique in the task of detecting pulmonary nodules

  11. Chest Pain: First Aid

    Science.gov (United States)

    First aid Chest pain: First aid Chest pain: First aid By Mayo Clinic Staff Causes of chest pain can vary from minor problems, such as indigestion ... 26, 2018 Original article: http://www.mayoclinic.org/first-aid/first-aid-chest-pain/basics/ART-20056705 . Mayo ...

  12. DROUGHTS IN THE TIETÊ-PARANÁ WATERWAY: IMPACTS ON THE DIRECT, INDIRECT AND HIDDEN COSTS IN THE TRANSPORTATION OF SOYBEAN.

    Directory of Open Access Journals (Sweden)

    Rodrigo Carlo Toloi

    2016-05-01

    Full Text Available Brazil's agricultural economy is growing and increasing productivity. Therefore, it has required transportation systems with high load capacity and lower transportation costs. However, with the drought in the Southeast region of Brazil, the waterway Tietê-Paraná closed since May 2014 generating a loss of more than 30 million last year. Thus, this study investigates the impacts on direct, indirect and hidden costs resulting from this change of route for soy transport. The methodology consists of an exploratory, descriptive and bibliographic research that seeks to raise the main costs. The results show that failing to ensure the production of soybeans by the Tiete-Parana waterway and using the highway transportation costs for waterway users are increased by US$ 37,760,146.86.

  13. Effect of the rate of chest compression familiarised in previous training on the depth of chest compression during metronome-guided cardiopulmonary resuscitation: a randomised crossover trial.

    Science.gov (United States)

    Bae, Jinkun; Chung, Tae Nyoung; Je, Sang Mo

    2016-02-12

    To assess how the quality of metronome-guided cardiopulmonary resuscitation (CPR) was affected by the chest compression rate familiarised by training before the performance and to determine a possible mechanism for any effect shown. Prospective crossover trial of a simulated, one-person, chest-compression-only CPR. Participants were recruited from a medical school and two paramedic schools of South Korea. 42 senior students of a medical school and two paramedic schools were enrolled but five dropped out due to physical restraints. Senior medical and paramedic students performed 1 min of metronome-guided CPR with chest compressions only at a speed of 120 compressions/min after training for chest compression with three different rates (100, 120 and 140 compressions/min). Friedman's test was used to compare average compression depths based on the different rates used during training. Average compression depths were significantly different according to the rate used in training (ptraining at a speed of 100 compressions/min and those at speeds of 120 and 140 compressions/min (both pCPR is affected by the relative difference between the rate of metronome guidance and the chest compression rate practised in previous training. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  14. Strong impacts on aerosol indirect effects from historical oxidant changes

    Science.gov (United States)

    Hafsahl Karset, Inger Helene; Koren Berntsen, Terje; Storelvmo, Trude; Alterskjær, Kari; Grini, Alf; Olivié, Dirk; Kirkevåg, Alf; Seland, Øyvind; Iversen, Trond; Schulz, Michael

    2018-06-01

    Uncertainties in effective radiative forcings through aerosol-cloud interactions (ERFaci, also called aerosol indirect effects) contribute strongly to the uncertainty in the total preindustrial-to-present-day anthropogenic forcing. Some forcing estimates of the total aerosol indirect effect are so negative that they even offset the greenhouse gas forcing. This study highlights the role of oxidants in modeling of preindustrial-to-present-day aerosol indirect effects. We argue that the aerosol precursor gases should be exposed to oxidants of its era to get a more correct representation of secondary aerosol formation. Our model simulations show that the total aerosol indirect effect changes from -1.32 to -1.07 W m-2 when the precursor gases in the preindustrial simulation are exposed to preindustrial instead of present-day oxidants. This happens because of a brightening of the clouds in the preindustrial simulation, mainly due to large changes in the nitrate radical (NO3). The weaker oxidative power of the preindustrial atmosphere extends the lifetime of the precursor gases, enabling them to be transported higher up in the atmosphere and towards more remote areas where the susceptibility of the cloud albedo to aerosol changes is high. The oxidation changes also shift the importance of different chemical reactions and produce more condensate, thus increasing the size of the aerosols and making it easier for them to activate as cloud condensation nuclei.

  15. Indirect radiation effects related to the environmental structure of targets

    International Nuclear Information System (INIS)

    Frankenberg, D.

    1976-01-01

    It is supposed, that in biological systems there are direct as well as indirect radiation effects. Their contributions to lethal effects depend mainly on two different kinds of structures within irradiated systems: the microscopic energy deposition patterns of radiation and the environmental structures of targets. The approach to determine these contributions of the lethal action of ionizing radiation in yeast cells was, to use chemical compounds, which specifically change the radical spectrum of water radiolysis. The efficiency of such chemical compounds in scavenging specifically water radicals was tested in aqueous solutions of thymine molecules, in which indirect radiation effects occur exclusively. The main result is, that the OH'-radical is by far the most effective radical to destroy thymine molecules. The relative contributions of direct and indirect radiation effects to lethal actions of ionizing radiation was investigated in yeast cells. The radical spectrum of water radiolysis was changed by bubbling the cell suspensions with different gases. The main result is, that there are no lethal radiation effects du to the action of water radicals

  16. Direct and indirect effects for neighborhood-based clustered and longitudinal data

    OpenAIRE

    VanderWeele, T.J.

    2010-01-01

    Definitions of direct and indirect effects are given for settings in which individuals are clustered in groups or neighborhoods and in which treatments are administered at the group level. A particular intervention may affect individual outcomes both through its effect on the individual and by changing the group or neighborhood itself. Identification conditions are given for controlled direct effects and for natural direct and indirect effects. The interpretation of these identification condi...

  17. Comparative Cost-Effectiveness Analysis of Three Different Automated Medication Systems Implemented in a Danish Hospital Setting.

    Science.gov (United States)

    Risør, Bettina Wulff; Lisby, Marianne; Sørensen, Jan

    2018-02-01

    Automated medication systems have been found to reduce errors in the medication process, but little is known about the cost-effectiveness of such systems. The objective of this study was to perform a model-based indirect cost-effectiveness comparison of three different, real-world automated medication systems compared with current standard practice. The considered automated medication systems were a patient-specific automated medication system (psAMS), a non-patient-specific automated medication system (npsAMS), and a complex automated medication system (cAMS). The economic evaluation used original effect and cost data from prospective, controlled, before-and-after studies of medication systems implemented at a Danish hematological ward and an acute medical unit. Effectiveness was described as the proportion of clinical and procedural error opportunities that were associated with one or more errors. An error was defined as a deviation from the electronic prescription, from standard hospital policy, or from written procedures. The cost assessment was based on 6-month standardization of observed cost data. The model-based comparative cost-effectiveness analyses were conducted with system-specific assumptions of the effect size and costs in scenarios with consumptions of 15,000, 30,000, and 45,000 doses per 6-month period. With 30,000 doses the cost-effectiveness model showed that the cost-effectiveness ratio expressed as the cost per avoided clinical error was €24 for the psAMS, €26 for the npsAMS, and €386 for the cAMS. Comparison of the cost-effectiveness of the three systems in relation to different valuations of an avoided error showed that the psAMS was the most cost-effective system regardless of error type or valuation. The model-based indirect comparison against the conventional practice showed that psAMS and npsAMS were more cost-effective than the cAMS alternative, and that psAMS was more cost-effective than npsAMS.

  18. Quantifying Direct and Indirect Effects of Elevated CO2 on Ecosystem Response

    Science.gov (United States)

    Fatichi, S.; Leuzinger, S.; Paschalis, A.; Donnellan-Barraclough, A.; Hovenden, M. J.; Langley, J. A.

    2015-12-01

    Increasing concentrations of atmospheric carbon dioxide are expected to affect carbon assimilation, evapotranspiration (ET) and ultimately plant growth. Direct leaf biochemical effects have been widely investigated, while indirect effects, although documented, are very difficult to quantify in experiments. We hypothesize that the interaction of direct and indirect effects is a possible reason for conflicting results concerning the magnitude of CO2 fertilization effects across different climates and ecosystems. A mechanistic ecohydrological model (Tethys-Chloris) is used to investigate the relative contribution of direct (through plant physiology) and indirect (via stomatal closure and thus soil moisture, and changes in Leaf Area Index, LAI) effects of elevated CO2 across a number of ecosystems. We specifically ask in which ecosystems and climate indirect effects are expected to be largest. Data and boundary conditions from flux-towers and free air CO2 enrichment (FACE) experiments are used to force the model and evaluate its performance. Numerical results suggest that indirect effects of elevated CO2, through water savings and increased LAI, are very significant and sometimes larger than direct effects. Indirect effects tend to be considerably larger in water-limited ecosystems, while direct effects correlate positively with mean air temperature. Increasing CO2 from 375 to 550 ppm causes a total effect on Net Primary Production in the order of 15 to 40% and on ET from 0 to -8%, depending on climate and ecosystem type. The total CO2 effect has a significant negative correlation with the wetness index and positive correlation with vapor pressure deficit. These results provide a more general mechanistic understanding of relatively short-term (less than 20 years) implications of elevated CO2 on ecosystem response and suggest plausible magnitudes for the expected changes.

  19. Pediatric chest imaging. Chest imaging in infants and children. 2. rev. ed.

    Energy Technology Data Exchange (ETDEWEB)

    Lucaya, Javier [Vall d' Hebron Hospitals, Barcelona (Spain). Dept. of Pediatric Radiology and Inst. of Diagnostic Imaging; Hospital Quiron, Barcelona (Spain). Dept. of Radiology; Strife, Janet L. (eds.) [Cincinnati Univ. Coll. of Medicine, Cincinnati, OH (United States). Dept. of Radiology Cincinnati Children' s Hospital Medical Center

    2008-07-01

    Imaging of the pediatric chest continues to evolve rapidly. All chapters in this 2nd edition of Pediatric Chest Imaging have been extensively updated, with additional disease-specific information and numerous new illustrations. The book thus presents the state of the art in the diagnosis of pediatric chest disorders, highlighting the role played by advanced technology. As the conventional features of most of these disorders are extremely well known, special attention is devoted to the technical aspects of the modern imaging modalities, their indications, and the diagnostic information that they supply. Individual chapters focus on chest ultrasound, nuclear medicine imaging, high-resolution chest CT, helical CT, and pediatric cardiac CT and pediatric cardiacMRI. Others are directed towards specific disorders, including congenital malformations of the chest, chest tumors, pulmonary infection, trauma, the lung in systemic diseases, the pediatric airway, foreign bodies, the thymus, and the chest wall. Without exception, the authors of this book are internationally known specialists with great expertise in the field. This book will serve as a handy, superbly illustrated reference for all who routinely image children, as well as for those who need access to information on how best to image them. (orig.)

  20. Coexistence in a One-Predator, Two-Prey System with Indirect Effects

    Directory of Open Access Journals (Sweden)

    Renato Colucci

    2013-01-01

    Full Text Available We study the dynamics of a one-predator, two-prey system in which the predator has an indirect effect on the preys. We show that, in presence of the indirect effect term, the system admits coexistence of the three populations while, if we disregard it, at least one of the populations goes to extinction.

  1. Conceptus radiation dose and risk from chest screen-film radiography

    International Nuclear Information System (INIS)

    Damilakis, John; Perisinakis, Kostas; Dimovasili, Evangelia; Prassopoulos, Panos; Gourtsoyiannis, Nicholas; Varveris, Haralambos

    2003-01-01

    The objectives of the present study were to (a) estimate the conceptus radiation dose and risks for pregnant women undergoing posteroanterior and anteroposterior (AP) chest radiographs, (b) study the conceptus dose as a function of chest thickness of the patient undergoing chest radiograph, and (c) investigate the possibility of a conceptus to receive a dose of more than 10 mGy, the level above which specific measurements of conceptus doses may be necessary. Thermoluminescent dosimeters were used for dose measurements in anthropomorphic phantoms simulating pregnancy at the three trimesters of gestation. The effect of chest thickness on conceptus dose and risk was studied by adding slabs of lucite on the anterior and posterior surface of the phantom chest. The conceptus risk for radiation-induced childhood fatal cancer and hereditary effects was calculated based on appropriate risk factors. The average AP chest dimension (d a ) was estimated for 51 women of childbearing age from chest CT examinations. The value of d a was estimated to be 22.3 cm (17.4-27.2 cm). The calculated maximum conceptus dose was 107 x 10 -3 mGy for AP chest radiographs performed during the third trimester of pregnancy with maternal chest thickness of 27.2 cm. This calculation was based on dose data obtained from measurements in the phantoms and d a estimated from the patient group. The corresponding average excess of childhood cancer was 10.7 per million patients. The risk for hereditary effects was 1.1 per million births. Radiation dose for a conceptus increases exponentially as chest thickness increases. The conceptus dose at the third trimester is higher than that of the second and first trimesters. The results of the current study suggest that chest radiographs carried out in women at any time during gestation will result in a negligible increase in risk of radiation-induced harmful effects to the unborn child. After a properly performed maternal chest X-ray, there is no need for

  2. Conceptus radiation dose and risk from chest screen-film radiography.

    Science.gov (United States)

    Damilakis, John; Perisinakis, Kostas; Prassopoulos, Panos; Dimovasili, Evangelia; Varveris, Haralambos; Gourtsoyiannis, Nicholas

    2003-02-01

    The objectives of the present study were to (a) estimate the conceptus radiation dose and risks for pregnant women undergoing posteroanterior and anteroposterior (AP) chest radiographs, (b) study the conceptus dose as a function of chest thickness of the patient undergoing chest radiograph, and (c) investigate the possibility of a conceptus to receive a dose of more than 10 mGy, the level above which specific measurements of conceptus doses may be necessary. Thermoluminescent dosimeters were used for dose measurements in anthropomorphic phantoms simulating pregnancy at the three trimesters of gestation. The effect of chest thickness on conceptus dose and risk was studied by adding slabs of lucite on the anterior and posterior surface of the phantom chest. The conceptus risk for radiation-induced childhood fatal cancer and hereditary effects was calculated based on appropriate risk factors. The average AP chest dimension (d(a)) was estimated for 51 women of childbearing age from chest CT examinations. The value of d(a) was estimated to be 22.3 cm (17.4-27.2 cm). The calculated maximum conceptus dose was 107 x 10(-3) mGy for AP chest radiographs performed during the third trimester of pregnancy with maternal chest thickness of 27.2 cm. This calculation was based on dose data obtained from measurements in the phantoms and d(a) estimated from the patient group. The corresponding average excess of childhood cancer was 10.7 per million patients. The risk for hereditary effects was 1.1 per million births. Radiation dose for a conceptus increases exponentially as chest thickness increases. The conceptus dose at the third trimester is higher than that of the second and first trimesters. The results of the current study suggest that chest radiographs carried out in women at any time during gestation will result in a negligible increase in risk of radiation-induced harmful effects to the unborn child. After a properly performed maternal chest X-ray, there is no need for

  3. Conceptus radiation dose and risk from chest screen-film radiography

    Energy Technology Data Exchange (ETDEWEB)

    Damilakis, John; Perisinakis, Kostas; Dimovasili, Evangelia [Department of Medical Physics, University of Crete, Faculty of Medicine, P.O. Box 1393, 714 09 Iraklion, Crete (Greece); Prassopoulos, Panos; Gourtsoyiannis, Nicholas [Department of Radiology, University of Crete, Faculty of Medicine, P.O. Box 1393, 714 09 Iraklion, Crete (Greece); Varveris, Haralambos [Department of Radiotherapy, University of Crete, Faculty of Medicine, P.O. Box 1393, 714 09 Iraklion, Crete (Greece)

    2003-02-01

    The objectives of the present study were to (a) estimate the conceptus radiation dose and risks for pregnant women undergoing posteroanterior and anteroposterior (AP) chest radiographs, (b) study the conceptus dose as a function of chest thickness of the patient undergoing chest radiograph, and (c) investigate the possibility of a conceptus to receive a dose of more than 10 mGy, the level above which specific measurements of conceptus doses may be necessary. Thermoluminescent dosimeters were used for dose measurements in anthropomorphic phantoms simulating pregnancy at the three trimesters of gestation. The effect of chest thickness on conceptus dose and risk was studied by adding slabs of lucite on the anterior and posterior surface of the phantom chest. The conceptus risk for radiation-induced childhood fatal cancer and hereditary effects was calculated based on appropriate risk factors. The average AP chest dimension (d{sub a}) was estimated for 51 women of childbearing age from chest CT examinations. The value of d{sub a} was estimated to be 22.3 cm (17.4-27.2 cm). The calculated maximum conceptus dose was 107 x 10{sup -3} mGy for AP chest radiographs performed during the third trimester of pregnancy with maternal chest thickness of 27.2 cm. This calculation was based on dose data obtained from measurements in the phantoms and d{sub a} estimated from the patient group. The corresponding average excess of childhood cancer was 10.7 per million patients. The risk for hereditary effects was 1.1 per million births. Radiation dose for a conceptus increases exponentially as chest thickness increases. The conceptus dose at the third trimester is higher than that of the second and first trimesters. The results of the current study suggest that chest radiographs carried out in women at any time during gestation will result in a negligible increase in risk of radiation-induced harmful effects to the unborn child. After a properly performed maternal chest X-ray, there is

  4. Testing indirect effect of consumer attitudes toward a product

    DEFF Research Database (Denmark)

    Hrubá, Renata; Sudzina, Frantisek

    2016-01-01

    a questionnaire in 2010-2011. The model is estimated using probit analysis to predict relationship between producer and consumer in decision-making when buying a new type of cheese and to examine consumer attitudes toward food origins and nutrient food security. It can be concluded that the indirect effect (e...... and on the indirect and direct effects of the perception of information through information behavior and the use of the model ordered. It is proposed that consumer levels of product familiarity of attributes affects behavior. Consumer attitudes towards agri-food products and behaviour were analyzed through...

  5. Effect of display type and room illuminance in chest radiographs

    International Nuclear Information System (INIS)

    Liukkonen, Esa; Jartti, Airi; Haapea, Marianne; Oikarinen, Heljae; Ahvenjaervi, Lauri; Mattila, Seija; Nevala, Terhi; Palosaari, Kari; Perhomaa, Marja; Nieminen, Miika T.

    2016-01-01

    To compare diagnostic accuracy in the detection of subtle chest lesions on digital chest radiographs using medical-grade displays, consumer-grade displays, and tablet devices under bright and dim ambient light. Five experienced radiologists independently assessed 50 chest radiographs (32 with subtle pulmonary findings and 18 without apparent findings) under bright (510 lx) and dim (16 lx) ambient lighting. Computed tomography was used as the reference standard for interstitial and nodular lesions and follow-up chest radiograph for pneumothorax. Diagnostic accuracy and sensitivity were calculated for assessments carried out in all displays and compared using the McNemar test. The level of significance was set to p < 0.05. Significant differences in sensitivity between the assessments under bright and dim lighting were found among consumer-grade displays in interstitial opacities with, and in pneumothorax without, Digital Imaging and Communication in Medicine-Grayscale Standard Display Function (DICOM-GSDF) calibration. Compared to 6 megapixel (MP) display under bright lighting, sensitivity in pneumothorax was lower in the tablet device and the consumer-grade display. Sensitivity in interstitial opacities was lower in the DICOM-GSDF calibrated consumer-grade display. A consumer-grade display with or without DICOM-GSDF calibration or a tablet device is not suitable for reading digital chest radiographs in bright lighting. No significant differences were observed between five displays in dim light. (orig.)

  6. Incremental cost-effectiveness of percutaneous versus surgical closure of atrial septal defects in children under a public health system perspective in Brazil.

    Science.gov (United States)

    Costa, Rodrigo; Pedra, Carlos A C; Ribeiro, Marcelo; Pedra, Simone; Ferreira-Da-Silva, André Luis; Polanczyk, Carisi; Berwanger, Otávio; Biasi, Alexandre; Ribeiro, Rodrigo

    2014-11-01

    Cost-effectiveness (CE) studies of percutaneous (PC) versus surgical (SC) atrial septal defect closure are lacking. A systematic literature review in children and a CE analysis based on a model of long-term outcomes were performed. Direct costs of PC and SC were US$8700 (defined arbitrarily) and US$5700 (actually paid), respectively. Three-times the Brazilian GDI (US$28,700) per year of life saved (with a discount rate of 5%) was used as a limit for willingness-to-pay. PC had a high (US$104,500) incremental CE ratio despite lower complication rates, shorter hospital stay and better (nonsignificant) adjusted life expectancy. PC would be cost-effective if it cost US$6400 or SC had an 8% loss of utility or its indirect costs were US$2250. Costs of PC should be reduced to be cost-effective in the Brazilian public health system. Indirect costs and impact on quality of life should be further assessed.

  7. Adaptive evolution of body size subject to indirect effect in trophic cascade system.

    Science.gov (United States)

    Wang, Xin; Fan, Meng; Hao, Lina

    2017-09-01

    Trophic cascades represent a classic example of indirect effect and are wide-spread in nature. Their ecological impact are well established, but the evolutionary consequences have received even less theoretical attention. We theoretically and numerically investigate the trait (i.e., body size of consumer) evolution in response to indirect effect in a trophic cascade system. By applying the quantitative trait evolutionary theory and the adaptive dynamic theory, we formulate and explore two different types of eco-evolutionary resource-consumer-predator trophic cascade model. First, an eco-evolutionary model incorporating the rapid evolution is formulated to investigate the effect of rapid evolution of the consumer's body size, and to explore the impact of density-mediate indirect effect on the population dynamics and trait dynamics. Next, by employing the adaptive dynamic theory, a long-term evolutionary model of consumer body size is formulated to evaluate the effect of long-term evolution on the population dynamics and the effect of trait-mediate indirect effect. Those models admit rich dynamics that has not been observed yet in empirical studies. It is found that, both in the trait-mediated and density-mediated system, the body size of consumer in predator-consumer-resource interaction (indirect effect) evolves smaller than that in consumer-resource and predator-consumer interaction (direct effect). Moreover, in the density-mediated system, we found that the evolution of consumer body size contributes to avoiding consumer extinction (i.e., evolutionary rescue). The trait-mediate and density-mediate effects may produce opposite evolutionary response. This study suggests that the trophic cascade indirect effect affects consumer evolution, highlights a more comprehensive mechanistic understanding of the intricate interplay between ecological and evolutionary force. The modeling approaches provide avenue for study on indirect effects from an evolutionary perspective

  8. Simple X-ray versus ultrasonography examination in blunt chest trauma: effective tools of accurate diagnosis and considerations for rib fractures

    OpenAIRE

    Hwang, Eun Gu; Lee, Yunjung

    2016-01-01

    Simple radiography is the best diagnostic tool for rib fractures caused by chest trauma, but it has some limitations. Thus, other tools are also being used. The aims of this study were to investigate the effectiveness of ultrasonography (US) for identifying rib fractures and to identify influencing factors of its effectiveness. Between October 2003 and August 2007, 201 patients with blunt chest trauma were available to undergo chest radiographic and US examinations for diagnosis of rib fractu...

  9. Chest computed tomography

    DEFF Research Database (Denmark)

    Loeve, Martine; Krestin, Gabriel P.; Rosenfeld, Margaret

    2013-01-01

    are not suitable to study CF lung disease in young children. Chest computed tomography (CT) holds great promise for use as a sensitive surrogate endpoint in CF. A large body of evidence has been produced to validate the use of chest CT as primary endpoint to study CF lung disease. However, before chest CT can...

  10. CT findings of chest trauma

    International Nuclear Information System (INIS)

    Kim, Young Tong; Kim Young Il

    1998-01-01

    Trauma is the third leading cause of death, irrespective of age, and the leading cause of death in persons under 40 persons under 40 years of age. Most pleural, pulmonary, mediastinal, and diaphragmatic injuries are not seen on conventional chest radiographs, or are underestimated. In patients with chest trauma, CT scanning is an effective and sensitive method of detecting thoracic injuries and provides accurate information regarding their pattern and extent. (author). 5 refs., 17 figs

  11. Diagnostic Yield of Recommendations for Chest CT Examination Prompted by Outpatient Chest Radiographic Findings

    Science.gov (United States)

    Harvey, H. Benjamin; Gilman, Matthew D.; Wu, Carol C.; Cushing, Matthew S.; Halpern, Elkan F.; Zhao, Jing; Pandharipande, Pari V.; Shepard, Jo-Anne O.

    2015-01-01

    Purpose To evaluate the diagnostic yield of recommended chest computed tomography (CT) prompted by abnormalities detected on outpatient chest radiographic images. Materials and Methods This HIPAA-compliant study had institutional review board approval; informed consent was waived. Reports of all outpatient chest radiographic examinations performed at a large academic center during 2008 (n = 29 138) were queried to identify studies that included a recommendation for a chest CT imaging. The radiology information system was queried for these patients to determine if a chest CT examination was obtained within 1 year of the index radiographic examination that contained the recommendation. For chest CT examinations obtained within 1 year of the index chest radiographic examination and that met inclusion criteria, chest CT images were reviewed to determine if there was an abnormality that corresponded to the chest radiographic finding that prompted the recommendation. All corresponding abnormalities were categorized as clinically relevant or not clinically relevant, based on whether further work-up or treatment was warranted. Groups were compared by using t test and Fisher exact test with a Bonferroni correction applied for multiple comparisons. Results There were 4.5% (1316 of 29138 [95% confidence interval {CI}: 4.3%, 4.8%]) of outpatient chest radiographic examinations that contained a recommendation for chest CT examination, and increasing patient age (P recommendation for chest CT examination. Of patients within this subset who met inclusion criteria, 65.4% (691 of 1057 [95% CI: 62.4%, 68.2%) underwent a chest CT examination within the year after the index chest radiographic examination. Clinically relevant corresponding abnormalities were present on chest CT images in 41.4% (286 of 691 [95% CI: 37.7%, 45.2%]) of cases, nonclinically relevant corresponding abnormalities in 20.6% (142 of 691 [95% CI: 17.6%, 23.8%]) of cases, and no corresponding abnormalities in 38

  12. Strong impacts on aerosol indirect effects from historical oxidant changes

    Directory of Open Access Journals (Sweden)

    I. H. H. Karset

    2018-06-01

    Full Text Available Uncertainties in effective radiative forcings through aerosol–cloud interactions (ERFaci, also called aerosol indirect effects contribute strongly to the uncertainty in the total preindustrial-to-present-day anthropogenic forcing. Some forcing estimates of the total aerosol indirect effect are so negative that they even offset the greenhouse gas forcing. This study highlights the role of oxidants in modeling of preindustrial-to-present-day aerosol indirect effects. We argue that the aerosol precursor gases should be exposed to oxidants of its era to get a more correct representation of secondary aerosol formation. Our model simulations show that the total aerosol indirect effect changes from −1.32 to −1.07 W m−2 when the precursor gases in the preindustrial simulation are exposed to preindustrial instead of present-day oxidants. This happens because of a brightening of the clouds in the preindustrial simulation, mainly due to large changes in the nitrate radical (NO3. The weaker oxidative power of the preindustrial atmosphere extends the lifetime of the precursor gases, enabling them to be transported higher up in the atmosphere and towards more remote areas where the susceptibility of the cloud albedo to aerosol changes is high. The oxidation changes also shift the importance of different chemical reactions and produce more condensate, thus increasing the size of the aerosols and making it easier for them to activate as cloud condensation nuclei.

  13. Immediate effects of chest physiotherapy on hemodynamic, metabolic, and oxidative stress parameters in subjects with septic shock.

    Science.gov (United States)

    dos Santos, Rafael S; Donadio, Márcio V F; da Silva, Gabriela V; Blattner, Clarissa N; Melo, Denizar A S; Nunes, Fernanda B; Dias, Fernando S; Squizani, Eamim D; Pedrazza, Leonardo; Gadegast, Isabella; de Oliveira, Jarbas R

    2014-09-01

    Septic shock presents as a continuum of infectious events, generating tissue hypoxia and hypovolemia, and increased oxidative stress. Chest physiotherapy helps reduce secretion, improving dynamic and static compliance, as well as improving secretion clearance and preventing pulmonary complications. The purpose of this study was to evaluate the immediate effect of chest physiotherapy on hemodynamic, metabolic, inflammatory, and oxidative stress parameters in subjects in septic shock. We conducted a quasi-experimental study in 30 subjects in septic shock, who underwent chest physiotherapy, without associated heart diseases and with vasopressors stress were evaluated before and 15 min after physiotherapy. Thirty subjects with a mean age of 61.8 ± 15.9 y and Sequential Organ Failure Assessment of 8 (range 6-10) were included. Chest physiotherapy caused a normalization of pH (P = .046) and P(aCO2) (P = .008); reduction of lactate (P = .001); and an increase in P(aO2) (P = .03), arterial oxygen saturation (P = .02), and P(aO2)/F(IO2) (P = .034), 15 min after it was applied. The results indicate that chest physiotherapy has immediate effects, improving oxygenation and reducing lactate and oxidative damage in subjects in septic shock. However, it does not cause alterations in the inflammatory and hemodynamic parameters. Copyright © 2014 by Daedalus Enterprises.

  14. A cost-effectiveness analysis of fixed-combination therapies in patients with open-angle glaucoma: a European perspective.

    Science.gov (United States)

    Hommer, A; Wickstrøm, J; Friis, M M; Steeds, C; Thygesen, J; Ferreras, A; Gouws, P; Buchholz, P

    2008-04-01

    To compare the efficacy and cost implications of the use of the intraocular pressure-lowering prostaglandin analogues bimatoprost, travoprost, and latanoprost as fixed-combination therapies with timolol, a beta-adrenergic receptor antagonist. A decision analytic cost-effectiveness model was constructed. Since no head-to-head studies comparing the three treatment options exist, the analysis was based on an indirect comparison. Hence, the model was based on efficacy data from five randomized, controlled, clinical studies. The studies were comparable with respect to study design, time horizon, patient population and type of end point presented. The measure of effectiveness was the percentage reduction of the intraocular pressure level from baseline. The cost evaluated was the cost of medication and clinical visits to the ophthalmologist. All drug costs were market prices inclusive of value-added tax, and visit costs were priced using official physician fees. Cost-effectiveness analyses were carried out in five European countries: Spain, Italy, United Kingdom, Norway and Sweden. The time horizon for the analyses was 3 months. The analysis showed that fixed-combination bimatoprost/timolol was more effective and less costly than fixed-combination travoprost/timolol and fixed-combination latanoprost/timolol in three out of the five countries analyzed. In two countries, bimatoprost/timolol was less costly than latanoprost/timolol, and cost the same as travoprost/timolol. This cost-effectiveness analysis showed that the fixed combination of bimatoprost 0.03%/timolol 0.5% administered once daily was a cost-effective treatment option for patients with primary open-angle glaucoma. This study was limited by available clinical data: without a head-to-head trial, indirect comparisons were necessary. In the United Kingdom, Sweden, Norway, Italy, and Spain, from a health service viewpoint, bimatoprost/timolol was a slightly more effective as well as less costly treatment strategy

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

    Science.gov (United States)

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

    2010-01-01

    The most commonly used method to test an indirect effect is to divide the estimate of the indirect effect by its standard error and compare the resulting z statistic with a critical value from the standard normal distribution. Confidence limits for the indirect effect are also typically based on critical values from the standard normal distribution. This article uses a simulation study to demonstrate that confidence limits are imbalanced because the distribution of the indirect effect is normal only in special cases. Two alternatives for improving the performance of confidence limits for the indirect effect are evaluated: (a) a method based on the distribution of the product of two normal random variables, and (b) resampling methods. In Study 1, confidence limits based on the distribution of the product are more accurate than methods based on an assumed normal distribution but confidence limits are still imbalanced. Study 2 demonstrates that more accurate confidence limits are obtained using resampling methods, with the bias-corrected bootstrap the best method overall. PMID:20157642

  16. Distribution of the product confidence limits for the indirect effect: Program PRODCLIN

    Science.gov (United States)

    MacKinnon, David P.; Fritz, Matthew S.; Williams, Jason; Lockwood, Chondra M.

    2010-01-01

    This article describes a program, PRODCLIN (distribution of the PRODuct Confidence Limits for INdirect effects), written for SAS, SPSS, and R, that computes confidence limits for the product of two normal random variables. The program is important because it can be used to obtain more accurate confidence limits for the indirect effect, as demonstrated in several recent articles (MacKinnon, Lockwood, & Williams, 2004; Pituch, Whittaker, & Stapleton, 2005). Tests of the significance of and confidence limits for indirect effects based on the distribution of the product method have more accurate Type I error rates and more power than other, more commonly used tests. Values for the two paths involved in the indirect effect and their standard errors are entered in the PRODCLIN program, and distribution of the product confidence limits are computed. Several examples are used to illustrate the PRODCLIN program. The PRODCLIN programs in rich text format may be downloaded from www.psychonomic.org/archive. PMID:17958149

  17. Known unknowns: indirect energy effects of information and communication technology

    Science.gov (United States)

    Horner, Nathaniel C.; Shehabi, Arman; Azevedo, Inês L.

    2016-10-01

    Background. There has been sustained and growing interest in characterizing the net energy impact of information and communication technology (ICT), which results from indirect effects offsetting (or amplifying) the energy directly consumed by ICT equipment. These indirect effects may be either positive or negative, and there is considerable disagreement as to the direction of this sign as well as the effect magnitude. Literature in this area ranges from studies focused on a single service (such as e-commerce versus traditional retail) to macroeconomic studies attempting to characterize the overall impact of ICT. Methods. We review the literature on the indirect energy effect of ICT found via Google Scholar, our own research, and input from other researchers in the field. The various studies are linked to an effect taxonomy, which is synthesized from several different hierarchies present in the literature. References are further grouped according to ICT service (e.g., e-commerce, telework) and summarized by scope, method, and quantitative and qualitative findings. Review results. Uncertainty persists in understanding the net energy effects of ICT. Results of indirect energy effect studies are highly sensitive to scoping decisions and assumptions made by the analyst. Uncertainty increases as the impact scope broadens, due to complex and interconnected effects. However, there is general agreement that ICT has large energy savings potential, but that the realization of this potential is highly dependent on deployment details and user behavior. Discussion. While the overall net effect of ICT is likely to remain unknown, this review suggests several guidelines for improving research quality in this area, including increased data collection, enhancing traditional modeling studies with sensitivity analysis, greater care in scoping, less confidence in characterizing aggregate impacts, more effort on understanding user behavior, and more contextual integration across the

  18. Mechanical versus manual chest compressions for cardiac arrest.

    Science.gov (United States)

    Brooks, Steven C; Hassan, Nizar; Bigham, Blair L; Morrison, Laurie J

    2014-02-27

    This is the first update of the Cochrane review on mechanical chest compression devices published in 2011 (Brooks 2011). Mechanical chest compression devices have been proposed to improve the effectiveness of cardiopulmonary resuscitation (CPR). To assess the effectiveness of mechanical chest compressions versus standard manual chest compressions with respect to neurologically intact survival in patients who suffer cardiac arrest. We searched the Cochrane Central Register of Controlled Studies (CENTRAL; 2013, Issue 12), MEDLINE Ovid (1946 to 2013 January Week 1), EMBASE (1980 to 2013 January Week 2), Science Citation abstracts (1960 to 18 November 2009), Science Citation Index-Expanded (SCI-EXPANDED) (1970 to 11 January 2013) on Thomson Reuters Web of Science, biotechnology and bioengineering abstracts (1982 to 18 November 2009), conference proceedings Citation Index-Science (CPCI-S) (1990 to 11 January 2013) and clinicaltrials.gov (2 August 2013). We applied no language restrictions. Experts in the field of mechanical chest compression devices and manufacturers were contacted. We included randomised controlled trials (RCTs), cluster RCTs and quasi-randomised studies comparing mechanical chest compressions versus manual chest compressions during CPR for patients with atraumatic cardiac arrest. Two review authors abstracted data independently; disagreement between review authors was resolved by consensus and by a third review author if consensus could not be reached. The methodologies of selected studies were evaluated by a single author for risk of bias. The primary outcome was survival to hospital discharge with good neurological outcome. We planned to use RevMan 5 (Version 5.2. The Nordic Cochrane Centre) and the DerSimonian & Laird method (random-effects model) to provide a pooled estimate for risk ratio (RR) with 95% confidence intervals (95% CIs), if data allowed. Two new studies were included in this update. Six trials in total, including data from 1166

  19. Effective dose from direct and indirect digital panoramic units

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Gun Sun; Kim, Jin Soo; Seo, Yo Seob; Kim, Jae Duk [School of Dentistry, Oral Biology Research Institute, Chosun University, Gwangju (Korea, Republic of)

    2013-06-15

    This study aimed to provide comparative measurements of the effective dose from direct and indirect digital panoramic units according to phantoms and exposure parameters. Dose measurements were carried out using a head phantom representing an average man (175 cm tall, 73.5 kg male) and a limbless whole body phantom representing an average woman (155 cm tall, 50 kg female). Lithium fluoride thermoluminescent dosimeter (TLD) chips were used for the dosimeter. Two direct and 2 indirect digital panoramic units were evaluated in this study. Effective doses were derived using 2007 International Commission on Radiological Protection (ICRP) recommendations. The effective doses of the 4 digital panoramic units ranged between 8.9 {mu}Sv and 37.8 {mu}Sv. By using the head phantom, the effective doses from the direct digital panoramic units (37.8 {mu}Sv, 27.6 {mu}Sv) were higher than those from the indirect units (8.9 {mu}Sv, 15.9 {mu}Sv). The same panoramic unit showed the difference in effective doses according to the gender of the phantom, numbers and locations of TLDs, and kVp. To reasonably assess the radiation risk from various dental radiographic units, the effective doses should be obtained with the same numbers and locations of TLDs, and with standard hospital exposure. After that, it is necessary to survey the effective doses from various dental radiographic units according to the gender with the corresponding phantom.

  20. Indirect environmental effects of nuclear war affecting health

    International Nuclear Information System (INIS)

    Leaf, A.

    1984-01-01

    The indirect effects of a nuclear war that will affect the health of survivors are considered to include consequences to: (a) the economies of nations, (b) food and nutrition, (c) water supplies, (d) the climate and the ecosphere, and (e) sanitation and public health; and they include long-term radiation effects

  1. Cost of stroke

    DEFF Research Database (Denmark)

    Jennum, Poul; Iversen, Helle K; Ibsen, Rikke

    2015-01-01

    . The attributable cost of direct net health care costs after the stroke (general practitioner services, hospital services, and medication) and indirect costs (loss of labor market income) were €10,720, €8,205 and €7,377 for patients, and €989, €1,544 and €1.645 for their partners, over and above that of controls......BACKGROUND: To estimate the direct and indirect costs of stroke in patients and their partners. DESCRIPTION: Direct and indirect costs were calculated using records from the Danish National Patient Registry from 93,047 ischemic, 26,012 hemorrhagic and 128,824 unspecified stroke patients...

  2. Instructions to "push as hard as you can" improve average chest compression depth in dispatcher-assisted cardiopulmonary resuscitation.

    Science.gov (United States)

    Mirza, Muzna; Brown, Todd B; Saini, Devashish; Pepper, Tracy L; Nandigam, Hari Krishna; Kaza, Niroop; Cofield, Stacey S

    2008-10-01

    Cardiopulmonary resuscitation (CPR) with adequate chest compression depth appears to improve first shock success in cardiac arrest. We evaluate the effect of simplification of chest compression instructions on compression depth in dispatcher-assisted CPR protocol. Data from two randomized, double-blinded, controlled trials with identical methodology were combined to obtain 332 records for this analysis. Subjects were randomized to either modified Medical Priority Dispatch System (MPDS) v11.2 protocol or a new simplified protocol. The main difference between the protocols was the instruction to "push as hard as you can" in the simplified protocol, compared to "push down firmly 2in. (5cm)" in MPDS. Data were recorded via a Laerdal ResusciAnne SkillReporter manikin. Primary outcome measures included: chest compression depth, proportion of compressions without error, with adequate depth and with total release. Instructions to "push as hard as you can", compared to "push down firmly 2in. (5cm)", resulted in improved chest compression depth (36.4 mm vs. 29.7 mm, pCPR instructions by changing "push down firmly 2in. (5cm)" to "push as hard as you can" achieved improvement in chest compression depth at no cost to total release or average chest compression rate.

  3. Indirect Climatic Effects of Major Volcanic Eruptions

    Science.gov (United States)

    Hofmann, D. J.

    2007-05-01

    The direct effects on climate, related to atmospheric emissions to the atmosphere following major volcanic eruptions, are well-known although the sparseness of such eruptions make detailed study on the range of such variations difficult. In general terms, infrared absorption by volcanic emissions to the stratosphere result in local heating early in the event when gaseous sulfur compounds exist. This early period is followed by gas to particle conversion, on a time scale of 1-2 months, promoting the formation of sulfuric acid-water droplets. Coagulation and droplet growth result in the "volcanic stratospheric aerosol layer" which is related to the predominant direct climatic effect of large eruptions, the cooling of the troposphere by backscattering of solar visible radiation to space with a recovery time scale of 1-2 years. In this paper we will discuss some of the less-known "indirect" effects of the volcanic stratospheric aerosol on climate. We label them indirect as they act on climate through intermediary atmospheric constituents. The intermediaries in the volcanic indirect climatic effect are generally atmospheric greenhouse gases or other atmospheric gases and conditions which affect greenhouse gases. For example, cooling of the troposphere following major eruptions reduces the growth rate of atmospheric carbon dioxide related to respiration by the terrestrial biosphere. In addition, redirection of part of the direct solar beam into diffuse radiation by the volcanic stratospheric aerosol stimulates plant photosynthesis, further reducing the carbon dioxide growth rate. The growth rate of the second-most important atmospheric greenhouse gas, methane, is also affected by volcanic emissions. Volcanic stratospheric aerosol particles provide surface area which catalyzes heterogeneous chemical reactions thus stimulating removal of stratospheric ozone, also a greenhouse gas. Although major droughts usually related to ENSO events have opposite effects on carbon

  4. Coronary Computed Tomography Angiography in the Assessment of Acute Chest Pain in the Emergency Room

    Energy Technology Data Exchange (ETDEWEB)

    Prazeres, Carlos Eduardo Elias dos; Cury, Roberto Caldeira; Carneiro, Adriano Camargo de Castro [Hospital do Coração - HCor, Associação do Sanatório Sírio, São Paulo, SP (Brazil); Rochitte, Carlos Eduardo, E-mail: rochitte@cardiol.br [Hospital do Coração - HCor, Associação do Sanatório Sírio, São Paulo, SP (Brazil); Instituto do Coração - InCor - HCFMUSP, São Paulo, SP (Brazil)

    2013-12-15

    The coronary computed tomography angiography has recently emerged as an accurate diagnostic tool in the evaluation of coronary artery disease, providing diagnostic and prognostic data that correlate directly with the data provided by invasive coronary angiography. The association of recent technological developments has allowed improved temporal resolution and better spatial coverage of the cardiac volume with significant reduction in radiation dose, and with the crucial need for more effective protocols of risk stratification of patients with chest pain in the emergency room, recent evaluation of the computed tomography coronary angiography has been performed in the setting of acute chest pain, as about two thirds of invasive coronary angiographies show no significantly obstructive coronary artery disease. In daily practice, without the use of more efficient technologies, such as coronary angiography by computed tomography, safe and efficient stratification of patients with acute chest pain remains a challenge to the medical team in the emergency room. Recently, several studies, including three randomized trials, showed favorable results with the use of this technology in the emergency department for patients with low to intermediate likelihood of coronary artery disease. In this review, we show data resulting from coronary angiography by computed tomography in risk stratification of patients with chest pain in the emergency room, its diagnostic value, prognosis and cost-effectiveness and a critical analysis of recently published multicenter studies.

  5. Coronary Computed Tomography Angiography in the Assessment of Acute Chest Pain in the Emergency Room

    International Nuclear Information System (INIS)

    Prazeres, Carlos Eduardo Elias dos; Cury, Roberto Caldeira; Carneiro, Adriano Camargo de Castro; Rochitte, Carlos Eduardo

    2013-01-01

    The coronary computed tomography angiography has recently emerged as an accurate diagnostic tool in the evaluation of coronary artery disease, providing diagnostic and prognostic data that correlate directly with the data provided by invasive coronary angiography. The association of recent technological developments has allowed improved temporal resolution and better spatial coverage of the cardiac volume with significant reduction in radiation dose, and with the crucial need for more effective protocols of risk stratification of patients with chest pain in the emergency room, recent evaluation of the computed tomography coronary angiography has been performed in the setting of acute chest pain, as about two thirds of invasive coronary angiographies show no significantly obstructive coronary artery disease. In daily practice, without the use of more efficient technologies, such as coronary angiography by computed tomography, safe and efficient stratification of patients with acute chest pain remains a challenge to the medical team in the emergency room. Recently, several studies, including three randomized trials, showed favorable results with the use of this technology in the emergency department for patients with low to intermediate likelihood of coronary artery disease. In this review, we show data resulting from coronary angiography by computed tomography in risk stratification of patients with chest pain in the emergency room, its diagnostic value, prognosis and cost-effectiveness and a critical analysis of recently published multicenter studies

  6. Chest Seal Placement for Penetrating Chest Wounds by Prehospital Ground Forces in Afghanistan.

    Science.gov (United States)

    Schauer, Steven G; April, Michael D; Naylor, Jason F; Simon, Erica M; Fisher, Andrew D; Cunningham, Cord W; Morissette, Daniel M; Fernandez, Jessie Renee D; Ryan, Kathy L

    Thoracic trauma represents 5% of all battlefield injuries. Communicating pneumothoraces resulting in tension physiology remain an important etiology of prehospital mortality. In addressing penetrating chest trauma, current Tactical Combat Casualty Care (TCCC) guidelines advocate the immediate placement of a vented chest seal device. Although the Committee on TCCC (CoTCCC) has approved numerous chest seal devices for battlefield use, few data exist regarding their use in a combat zone setting. To evaluate adherence to TCCC guidelines for chest seal placement among personnel deployed to Afghanistan. We obtained data from the Prehospital Trauma Registry (PHTR). Joint Trauma System personnel linked patients to the Department of Defense Trauma Registry, when available, for outcome data upon reaching a fixed facility. In the PHTR, we identified 62 patients with documented gunshot wound (GSW) or puncture wound trauma to the chest. The majority (74.2%; n = 46) of these were due to GSW, with the remainder either explosive-based puncture wounds (22.6%; n = 14) or a combination of GSW and explosive (3.2%; n = 2). Of the 62 casualties with documented GSW or puncture wounds, 46 (74.2%) underwent chest seal placement. Higher proportions of patients with medical officers in their chain of care underwent chest seal placement than those that did not (63.0% versus 37.0%). The majority of chest seals placed were not vented. Of patients with a GSW or puncture wound to the chest, 74.2% underwent chest seal placement. Most of the chest seals placed were not vented in accordance with guidelines, despite the guideline update midway through the study period. These data suggest the need to improve predeployment training on TCCC guidelines and matching of the Army logistical supply chain to the devices recommended by the CoTCCC. 2017.

  7. MRI of the Chest

    Medline Plus

    Full Text Available ... gives detailed pictures of structures within the chest cavity, including the mediastinum , chest wall, pleura, heart and ... helpful to assess the vessels of the chest cavity (arteries and veins). MRA can also demonstrate an ...

  8. MRI of the Chest

    Medline Plus

    Full Text Available ... to produce detailed pictures of organs, soft tissues, bone and virtually all other internal body structures. MRI ... of the chest. assess disorders of the chest bones (vertebrae, ribs and sternum) and chest wall soft ...

  9. The clinician's guide to diagnostic imaging: Cost-effective pathways. Second edition

    International Nuclear Information System (INIS)

    Grossman, Z.D.; Chew, F.S.; Ellis, D.A.; Brigham, S.C.

    1987-01-01

    The authors developed a cost-effective approach to imaging studies, based on initial selection of an exam that best addresses the specific clinical problem and obviates the need for additional diagnostic tests. Tightly reasoned arguments compare available imaging options with respect to diagnostic yield, feasibility, risk, and cost. To aid the clinician in making cost comparisons, each paper of the Second Edition lists the dollar cost of relevant imaging studies. The Second Edition has been thoroughly revised to reflect the important advances in diagnostic imaging of the past three years, highlighting CT's expanding role in thoracic and abdominal problems, magnetic resonance imaging as a spectacular diagnostic tool for the central nervous system, and the clinical application of many newly-developed radiopharmaceuticals. New chapters cover breast cancer screening, acute spinal trauma, search for primary cancer of unknown origin, acute anuria, blunt chest trauma, new onset seizures, and spinal cord compression from metastases. Other papers have been rewritten for greater clarity and to incorporate new techniques, like dipyridamole stress testing. A glossary and an introduction define and explain the capabilities and limitations of current techniques

  10. [Chest trauma].

    Science.gov (United States)

    Freixinet Gilart, Jorge; Ramírez Gil, María Elena; Gallardo Valera, Gregorio; Moreno Casado, Paula

    2011-01-01

    Chest trauma is a frequent problem arising from lesions caused by domestic and occupational activities and especially road traffic accidents. These injuries can be analyzed from distinct points of view, ranging from consideration of the most severe injuries, especially in the context of multiple trauma, to the specific characteristics of blunt and open trauma. In the present article, these injuries are discussed according to the involvement of the various thoracic structures. Rib fractures are the most frequent chest injuries and their diagnosis and treatment is straightforward, although these injuries can be severe if more than three ribs are affected and when there is major associated morbidity. Lung contusion is the most common visceral lesion. These injuries are usually found in severe chest trauma and are often associated with other thoracic and intrathoracic lesions. Treatment is based on general support measures. Pleural complications, such as hemothorax and pneumothorax, are also frequent. Their diagnosis is also straightforward and treatment is based on pleural drainage. This article also analyzes other complex situations, notably airway trauma, which is usually very severe in blunt chest trauma and less severe and even suitable for conservative treatment in iatrogenic injury due to tracheal intubation. Rupture of the diaphragm usually causes a diaphragmatic hernia. Treatment is always surgical. Myocardial contusions should be suspected in anterior chest trauma and in sternal fractures. Treatment is conservative. Other chest injuries, such as those of the great thoracic and esophageal vessels, are less frequent but are especially severe. Copyright © 2011 Sociedad Española de Neumología y Cirugía Torácica. Published by Elsevier Espana. All rights reserved.

  11. Contaminants as viral cofactors: assessing indirect population effects

    Science.gov (United States)

    Springman, Katherine R.; Kurath, Gael; Anderson, James J.; Emlen, John M.

    2005-01-01

    Current toxicological methods often miss contaminant effects, particularly when immune suppression is involved. The failure to recognize and evaluate indirect and sublethal effects severely limits the applicability of those methods at the population level. In this study, the Vitality model is used to evaluate the population level effects of a contaminant exerting only indirect, sublethal effects at the individual level. Juvenile rainbow trout (Oncorhynchus mykiss) were injected with 2.5 or 10.0 mg/kg doses of the model CYP1A inducer, β-naphthoflavone (BNF) as a pre-stressor, then exposed to a challenge dose of 102 or 104 pfu/fish of infectious hematopoietic necrosis virus (IHNV), an important viral pathogen of salmonids in North America. At the end of the 28-d challenge, the mortality data were processed according to the Vitality model which indicated that the correlation between the average rate of vitality loss and the pre-stressor dose was strong:R2 = 0.9944. Average time to death and cumulative mortality were dependent on the BNF dose, while no significant difference between the two viral dosages was shown, implying that the history of the organism at the time of stressor exposure is an important factor in determining the virulence or toxicity of the stressor. The conceptual framework of this model permits a smoother transfer of results to a more complex stratum, namely the population level, which allows the immunosuppressive results generated by doses of a CYP1A inducer that more accurately represent the effects elicited by environmentally-relevant contaminant concentrations to be extrapolated to target populations. The indirect effects of other environmental contaminants with similar biotransformation pathways, such as polycyclic aromatic hydrocarbons (PAH), could be assessed and quantified with this model and the results applied to a more complex biological hierarchy.

  12. How to remove a chest drain.

    Science.gov (United States)

    Allibone, Elizabeth

    2015-10-07

    RATIONALE AND KEY POINTS: This article aims to help nurses to undertake the removal of a chest drain in a safe, effective and patient-centred manner. This procedure requires two practitioners. The chest drain will have been inserted aseptically to remove air, blood, fluid or pus from the pleural cavity. ▶ Chest drains may be small or wide bore depending on the underlying condition and clinical setting. They may be secured with a mattress suture and/or an anchor suture. ▶ Chest drains are usually removed under medical instructions when the patient's lung has inflated, the underlying condition has resolved, there is no evidence of respiratory compromise or failure, and their anticoagulation status has been assessed as satisfactory. ▶ Chest drains secured with a mattress suture should be removed by two practitioners. One practitioner is required to remove the tube and the other to tie the mattress suture (if present) and secure the site. REFLECTIVE ACTIVITY: Clinical skills articles can help update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: 1. How reading this article will change your practice. 2. How this article could be used to educate patients with chest drains. Subscribers can upload their reflective accounts at: rcni.com/portfolio .

  13. High-sensitivity troponin assays for the early rule-out or diagnosis of acute myocardial infarction in people eith acute chest pain: a systematic review and cost-effectiveness analysis

    NARCIS (Netherlands)

    M. Westwood (Marie); T. van Asselt (Thea); B. Ramaekers (Bram); P. Whiting (Penny); P. Tokala (Praveen); M.A. Joore (Manuela); N. Armstrong (Nigel); J. Ross (Janine); J.L. Severens (Hans); J. Kleijnen (Jos)

    2015-01-01

    textabstractBackground: Early diagnosis of acute myocardial infarction (AMI) can ensure quick and effective treatment but only 20% of adults with emergency admissions for chest pain have an AMI. High-sensitivity cardiac troponin (hs-cTn) assays may allow rapid rule-out of AMI and avoidance of

  14. High-sensitivity troponin assays for the early rule-out or diagnosis of acute myocardial infarction in people with acute chest pain : a systematic review and cost-effectiveness analysis

    NARCIS (Netherlands)

    Westwood, Marie; van Asselt, Thea; Ramaekers, Bram; Whiting, Penny; Thokala, Praveen; Joore, Manuela; Armstrong, Nigel; Ross, Janine; Severens, Johan; Kleijnen, Jos

    BACKGROUND: Early diagnosis of acute myocardial infarction (AMI) can ensure quick and effective treatment but only 20% of adults with emergency admissions for chest pain have an AMI. High-sensitivity cardiac troponin (hs-cTn) assays may allow rapid rule-out of AMI and avoidance of unnecessary

  15. Evaluating Cost-Effectiveness of Interventions that Affect Fertility and Childbearing: How Health Effects are Measured Matters

    Science.gov (United States)

    Goldhaber-Fiebert, Jeremy D.; Brandeau, Margaret L.

    2015-01-01

    Background Current guidelines for economic evaluations of health interventions define relevant outcomes as those accruing to individuals receiving interventions. Little consensus exists on counting health impacts on current and future fertility and childbearing. Objective To characterize current practices for counting such health outcomes. Design We developed a framework characterizing health interventions with direct and/or indirect effects on fertility and childbearing and how such outcomes are reported. We identified interventions spanning the framework and performed a targeted literature review for economic evaluations of these interventions. For each article, we characterized how the potential health outcomes from each intervention were considered, focusing on QALYs associated with fertility and childbearing. Results We reviewed 108 studies, identifying seven themes: 1) Studies were heterogeneous in reporting outcomes. 2) Studies often selected outcomes for inclusion that tend to bias toward finding the intervention to be cost-effective. 3) Studies often avoided the challenges of assigning QALYs for pregnancy and fertility by instead considering cost per intermediate outcome. 4) Even for the same intervention, studies took heterogeneous approaches to outcome evaluation. 5) Studies employed multiple, competing rationales for whether and how to include fertility-related QALYs and whose QALYs to include. 6) Studies examining interventions with indirect effects on fertility typically ignored such QALYs. 7) Even recent studies had these shortcomings. Limitations The review was targeted rather than systematic. Conclusions Economic evaluations inconsistently consider QALYs from current and future fertility and childbearing in ways that frequently appear biased towards the interventions considered. As the Panel on Cost-Effectiveness in Health and Medicine updates its guidelines, making the practice of cost-effectiveness analysis more consistent is a priority. Our

  16. Effect of radiation dose level on the detectability of pulmonary nodules in chest tomosynthesis.

    Science.gov (United States)

    Asplund, Sara A; Johnsson, Åse A; Vikgren, Jenny; Svalkvist, Angelica; Flinck, Agneta; Boijsen, Marianne; Fisichella, Valeria A; Månsson, Lars Gunnar; Båth, Magnus

    2014-07-01

    To investigate the detectability of pulmonary nodules in chest tomosynthesis at reduced radiation dose levels. Eighty-six patients were included in the study and were examined with tomosynthesis and computed tomography (CT). Artificial noise was added to simulate that the tomosynthesis images were acquired at dose levels corresponding to 12, 32, and 70% of the default setting effective dose (0.12 mSv). Three observers (with >20, >20 and three years of experience) read the tomosynthesis cases for presence of nodules in a free-response receiver operating characteristics (FROC) study. CT served as reference. Differences between dose levels were calculated using the jack-knife alternative FROC (JAFROC) figure of merit (FOM). The JAFROC FOM was 0.45, 0.54, 0.55, and 0.54 for the 12, 32, 70, and 100% dose levels, respectively. The differences in FOM between the 12% dose level and the 32, 70, and 100% dose levels were 0.087 (p = 0.006), 0.099 (p = 0.003), and 0.093 (p = 0.004), respectively. Between higher dose levels, no significant differences were found. A substantial reduction from the default setting dose in chest tomosynthesis may be possible. In the present study, no statistically significant difference in detectability of pulmonary nodules was found when reducing the radiation dose to 32%. • A substantial radiation dose reduction in chest tomosynthesis may be possible. • Pulmonary nodule detectability remained unchanged at 32% of the effective dose. • Tomosynthesis might be performed at the dose of a lateral chest radiograph.

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

    Science.gov (United States)

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

    2016-01-01

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

  18. Imaging of non-cardiac, non-traumatic causes of acute chest pain

    Energy Technology Data Exchange (ETDEWEB)

    Kienzl, Daniela, E-mail: daniela.kienzl@meduniwien.ac.at [Department of Radiology, Medical University of Vienna (Austria); Prosch, Helmut; Töpker, Michael; Herold, Christian [Department of Radiology, Medical University of Vienna (Austria)

    2012-12-15

    Non-traumatic chest pain is a common symptom in patients who present in the emergency department. From a clinical point of view, it is important to differentiate cardiac chest pain from non-cardiac chest pain (NCCP). Among the plethora of potential causes of NCCP, life-threatening diseases, such as aortic dissection, pulmonary embolism, tension pneumothorax, and esophageal rupture, must be differentiated from non-life threatening causes. The majority of NCCP, however, is reported to be benign in nature. The presentation of pain plays an important role in narrowing the differential diagnosis and initiating further diagnostic management and treatment. As the benign causes tend to recur, and may lead to patient anxiety and great costs, a meticulous evaluation of the patient is necessary to diagnose the underlying disorder or disease.

  19. Effect of Localizer Radiography Projection on Organ Dose at Chest CT with Automatic Tube Current Modulation.

    Science.gov (United States)

    Saltybaeva, Natalia; Krauss, Andreas; Alkadhi, Hatem

    2017-03-01

    Purpose To calculate the effect of localizer radiography projections to the total radiation dose, including both the dose from localizer radiography and that from subsequent chest computed tomography (CT) with tube current modulation (TCM). Materials and Methods An anthropomorphic phantom was scanned with 192-section CT without and with differently sized breast attachments. Chest CT with TCM was performed after one localizer radiographic examination with anteroposterior (AP) or posteroanterior (PA) projections. Dose distributions were obtained by means of Monte Carlo simulations based on acquired CT data. For Monte Carlo simulations of localizer radiography, the tube position was fixed at 0° and 180°; for chest CT, a spiral trajectory with TCM was used. The effect of tube start angles on dose distribution was investigated with Monte Carlo simulations by using TCM curves with fixed start angles (0°, 90°, and 180°). Total doses for lungs, heart, and breast were calculated as the sum of the dose from localizer radiography and CT. Image noise was defined as the standard deviation of attenuation measured in 14 circular regions of interest. The Wilcoxon signed rank test, paired t test, and Friedman analysis of variance were conducted to evaluate differences in noise, TCM curves, and organ doses, respectively. Results Organ doses from localizer radiography were lower when using a PA instead of an AP projection (P = .005). The use of a PA projection resulted in higher TCM values for chest CT (P chest CT. © RSNA, 2016 Online supplemental material is available for this article.

  20. The combined effects of cold therapy and music therapy on pain following chest tube removal among patients with cardiac bypass surgery.

    Science.gov (United States)

    Yarahmadi, Sajad; Mohammadi, Nooredin; Ardalan, Arash; Najafizadeh, Hassan; Gholami, Mohammad

    2018-05-01

    Chest tube removal is an extremely painful procedure and patients may not respond well to palliative therapies. This study aimed to examine the effect of cold and music therapy individually, as well as a combination of these interventions on reducing pain following chest tube removal. A factorial randomized-controlled clinical trial was performed on 180 patients who underwent cardiac surgery. Patients were randomized into four groups of 45. Group A used ice packs for 20 minutes prior to chest tube removal. Group B was assigned to listen to music for a total length of 30 minutes which started 15 minutes prior to chest tube removal. Group C received a combination of both interventions; and Group D received no interventions. Pain intensity was measured in each group every 15 minutes for a total of 3 readings. Analysis of variance, Tukey and Bonferroni post hoc tests, as well as repeated measures ANOVA were employed for data analysis. Cold therapy and combined method intervention effectively reduced the pain caused by chest tube removal (P < 0.001). Additionally, there were no statistically significant difference in pain intensity scores between groups at 15 minutes following chest tube removal (P = 0.07). Cold and music therapy can be used by nursing staff in clinical practice as a combined approach to provide effective pain control following chest tube removal. Copyright © 2018 Elsevier Ltd. All rights reserved.

  1. Indirect Effects of Global Change: From Physiological and Behavioral Mechanisms to Ecological Consequences.

    Science.gov (United States)

    Gunderson, Alex R; Tsukimura, Brian; Stillman, Jonathon H

    2017-07-01

    A major focus of current ecological research is to understand how global change makes species vulnerable to extirpation. To date, mechanistic ecophysiological analyses of global change vulnerability have focused primarily on the direct effects of changing abiotic conditions on whole-organism physiological traits, such as metabolic rate, locomotor performance, cardiac function, and critical thermal limits. However, species do not live in isolation within their physical environments, and direct effects of climate change are likely to be compounded by indirect effects that result from altered interactions with other species, such as competitors and predators. The Society for Integrative and Comparative Biology 2017 Symposium "Indirect Effects of Global Change: From Physiological and Behavioral Mechanisms to Ecological Consequences" was designed to synthesize multiple approaches to investigating the indirect effects of global change by bringing together researchers that study the indirect effects of global change from multiple perspectives across habitat, type of anthropogenic change, and level of biological organization. Our goal in bringing together researchers from different backgrounds was to foster cross-disciplinary insights into the mechanistic bases and higher-order ecological consequences of indirect effects of global change, and to promote collaboration among fields. © The Author 2017. Published by Oxford University Press on behalf of the Society for Integrative and Comparative Biology. All rights reserved. For permissions please email: journals.permissions@oup.com.

  2. Cost-effectiveness of anatomical and functional test strategies for stable chest pain: public health perspective from a middle-income country.

    Science.gov (United States)

    Bertoldi, Eduardo G; Stella, Steffen F; Rohde, Luis Eduardo P; Polanczyk, Carisi A

    2017-05-04

    The aim of this research is to evaluate the relative cost-effectiveness of functional and anatomical strategies for diagnosing stable coronary artery disease (CAD), using exercise (Ex)-ECG, stress echocardiogram (ECHO), single-photon emission CT (SPECT), coronary CT angiography (CTA) or stress cardiacmagnetic resonance (C-MRI). Decision-analytical model, comparing strategies of sequential tests for evaluating patients with possible stable angina in low, intermediate and high pretest probability of CAD, from the perspective of a developing nation's public healthcare system. Hypothetical cohort of patients with pretest probability of CAD between 20% and 70%. The primary outcome is cost per correct diagnosis of CAD. Proportion of false-positive or false-negative tests and number of unnecessary tests performed were also evaluated. Strategies using Ex-ECG as initial test were the least costly alternatives but generated more frequent false-positive initial tests and false-negative final diagnosis. Strategies based on CTA or ECHO as initial test were the most attractive and resulted in similar cost-effectiveness ratios (I$ 286 and I$ 305 per correct diagnosis, respectively). A strategy based on C-MRI was highly effective for diagnosing stable CAD, but its high cost resulted in unfavourable incremental cost-effectiveness (ICER) in moderate-risk and high-risk scenarios. Non-invasive strategies based on SPECT have been dominated. An anatomical diagnostic strategy based on CTA is a cost-effective option for CAD diagnosis. Functional strategies performed equally well when based on ECHO. C-MRI yielded acceptable ICER only at low pretest probability, and SPECT was not cost-effective in our analysis. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  3. Accuracy of chest radiography versus chest computed tomography in hemodynamically stable patients with blunt chest trauma

    Directory of Open Access Journals (Sweden)

    Chardoli Mojtaba

    2013-12-01

    Full Text Available 【Abstract】 Objective: Thoracic injuries are respon- sible for 25% of deaths of blunt traumas. Chest X-ray (CXR is the first diagnostic method in patients with blunt trauma. The aim of this study was to detect the accuracy of CXR versus chest computed tomograpgy (CT in hemodynami- cally stable patients with blunt chest trauma. Methods: Study was conducted at the emergency department of Sina Hospital from March 2011 to March 2012. Hemodynamically stable patients with at least 16 years of age who had blunt chest trauma were included. All patients underwent the same diagnostic protocol which consisted of physical examination, CXR and CT scan respectively. Results: Two hundreds patients (84% male and 16% female were included with a mean age of (37.9±13.7 years. Chin J Traumatol 2013;16(6:351-354 Rib fracture was the most common finding of CXR (12.5% and CT scan (25.5%. The sensitivity of CXR for hemothorax, thoracolumbar vertebra fractures and rib fractures were 20%, 49% and 49%, respectively. Pneumothorax, foreign body, emphysema, pulmonary contusion, liver hematoma and ster- num fracture were not diagnosed with CXR alone. Conclusion: Applying CT scan as the first-line diag- nostic modality in hemodynamically stable patients with blunt chest trauma can detect pathologies which may change management and outcome. Key words: Radiography; Thoracic injuries; Tomography, X-ray computed

  4. Interactive indirect illumination using adaptive multiresolution splatting.

    Science.gov (United States)

    Nichols, Greg; Wyman, Chris

    2010-01-01

    Global illumination provides a visual richness not achievable with the direct illumination models used by most interactive applications. To generate global effects, numerous approximations attempt to reduce global illumination costs to levels feasible in interactive contexts. One such approximation, reflective shadow maps, samples a shadow map to identify secondary light sources whose contributions are splatted into eye space. This splatting introduces significant overdraw that is usually reduced by artificially shrinking each splat's radius of influence. This paper introduces a new multiresolution approach for interactively splatting indirect illumination. Instead of reducing GPU fill rate by reducing splat size, we reduce fill rate by rendering splats into a multiresolution buffer. This takes advantage of the low-frequency nature of diffuse and glossy indirect lighting, allowing rendering of indirect contributions at low resolution where lighting changes slowly and at high-resolution near discontinuities. Because this multiresolution rendering occurs on a per-splat basis, we can significantly reduce fill rate without arbitrarily clipping splat contributions below a given threshold-those regions simply are rendered at a coarse resolution.

  5. Patient-specific dose estimation for pediatric chest CT

    Energy Technology Data Exchange (ETDEWEB)

    Li Xiang; Samei, Ehsan; Segars, W. Paul; Sturgeon, Gregory M.; Colsher, James G.; Frush, Donald P. [Medical Physics Graduate Program, Duke University, Durham, North Carolina 27705 and Department of Radiology, Duke Advanced Imaging Laboratories, Duke University Medical Center, Durham, North Carolina 27705 (United States); Medical Physics Graduate Program, Duke University, Durham, North Carolina 27705 (United States); Department of Radiology, Duke Advanced Imaging Laboratories, Duke University Medical Center, Durham, North Carolina 27705 (United States); Department of Physics, Duke University, Durham, North Carolina 27710 (United States); and Department of Biomedical Engineering, Duke University, Durham, North Carolina 27708 (United States); Medical Physics Graduate Program, Duke University, Durham, North Carolina 27705 and Department of Radiology, Duke Advanced Imaging Laboratories, Duke University Medical Center, Durham, North Carolina 27705 (United States); Department of Radiology, Duke Advanced Imaging Laboratories, Duke University Medical Center, Durham, North Carolina 27705 (United States); Medical Physics Graduate Program, Duke University, Durham, North Carolina 27705 and Global Applied Science Laboratory, GE Healthcare, Waukesha, Wisconsin 53188 (United States); Medical Physics Graduate Program, Duke University, Durham, North Carolina 27705 and Department of Radiology, Division of Pediatric Radiology, Duke University Medical Center, Durham North Carolina 27710 (United States)

    2008-12-15

    Current methods for organ and effective dose estimations in pediatric CT are largely patient generic. Physical phantoms and computer models have only been developed for standard/limited patient sizes at discrete ages (e.g., 0, 1, 5, 10, 15 years old) and do not reflect the variability of patient anatomy and body habitus within the same size/age group. In this investigation, full-body computer models of seven pediatric patients in the same size/protocol group (weight: 11.9-18.2 kg) were created based on the patients' actual multi-detector array CT (MDCT) data. Organs and structures in the scan coverage were individually segmented. Other organs and structures were created by morphing existing adult models (developed from visible human data) to match the framework defined by the segmented organs, referencing the organ volume and anthropometry data in ICRP Publication 89. Organ and effective dose of these patients from a chest MDCT scan protocol (64 slice LightSpeed VCT scanner, 120 kVp, 70 or 75 mA, 0.4 s gantry rotation period, pitch of 1.375, 20 mm beam collimation, and small body scan field-of-view) was calculated using a Monte Carlo program previously developed and validated to simulate radiation transport in the same CT system. The seven patients had normalized effective dose of 3.7-5.3 mSv/100 mAs (coefficient of variation: 10.8%). Normalized lung dose and heart dose were 10.4-12.6 mGy/100 mAs and 11.2-13.3 mGy/100 mAs, respectively. Organ dose variations across the patients were generally small for large organs in the scan coverage (<7%), but large for small organs in the scan coverage (9%-18%) and for partially or indirectly exposed organs (11%-77%). Normalized effective dose correlated weakly with body weight (correlation coefficient: r=-0.80). Normalized lung dose and heart dose correlated strongly with mid-chest equivalent diameter (lung: r=-0.99, heart: r=-0.93); these strong correlation relationships can be used to estimate patient-specific organ

  6. The effect of breast anthropometry on the Hybrid III 5th female chest response.

    Science.gov (United States)

    Tylko, Suzanne; Charlebois, Dominique; Bussières, Alain; Dalmotas, Dainius

    2006-11-01

    Two manufacturers, Denton ATD and FTSS, currently produce the Hybrid III 5th percentile female dummy. In response to concerns raised by industry that differences in the anthropometry of the molded breasts between the two manufacturers may influence chest responses, Transport Canada conducted a comparative testing program. Thorax biofidelity tests were conducted to compare force-deflection characteristics; full frontal rigid-barrier tests were conducted at 40, 48 and 56 km/h to compare chest responses, and out-of-position chest on module static airbag deployment tests were conducted to compare peak chest deflections of the Denton and FTSS dummy jackets and of a prototype jacket without breasts. Differences in force-deflection characteristics were observed during biofidelity pendulum impacts of the two dummies, with much of the differences attributed to the different chest jackets. Differences of up to 11 mm in the peak sternum deflection and of the order of 15 g for the 3-ms chest acceleration clips were noted in rigid-barrier vehicle tests. In the out-of-position airbag-deployment tests, differences in the magnitude of peak chest deflections were observed. The prototype chest jacket without breasts was found to improve repeatability in the belted crash tests and in out-of-position airbag testing. Though neither the Denton nor the FTSS chest jackets fully meet the original design intent of the Hybrid III 5th percentile dummy, the Denton dummy more closely met the drawing specifications and had less manufacturing variability. The results demonstrate the importance of detailed chest flesh assembly specifications, provide evidence that a fully molded jacket design would eliminate manufacturing variability and suggest that removal of the breasts may further improve test repeatability.

  7. Chest tube insertion

    Science.gov (United States)

    Chest drainage tube insertion; Insertion of tube into chest; Tube thoracostomy; Pericardial drain ... Be careful there are no kinks in your tube. The drainage system should always sit upright and be placed ...

  8. Direct and Indirect Effects of PM on the Cardiovascular System

    Science.gov (United States)

    Nelin, Timothy D.; Joseph, Allan M.; Gorr, Matthew W.; Wold, Loren E.

    2011-01-01

    Human exposure to particulate matter (PM) elicits a variety of responses on the cardiovascular system through both direct and indirect pathways. Indirect effects of PM on the cardiovascular system are mediated through the autonomic nervous system, which controls heart rate variability, and inflammatory responses, which augment acute cardiovascular events and atherosclerosis. Recent research demonstrates that PM also affects the cardiovascular system directly by entry into the systemic circulation. This process causes myocardial dysfunction through mechanisms of reactive oxygen species production, calcium ion interference, and vascular dysfunction. In this review, we will present key evidence in both the direct and indirect pathways, suggest clinical applications of the current literature, and recommend directions for future research. PMID:22119171

  9. CT of the chest in suspected child abuse using submillisievert radiation dose

    International Nuclear Information System (INIS)

    Sanchez, Thomas R.; Seibert, J.A.; Stein-Wexler, Rebecca; Lee, Justin S.; Coulter, Kevin P.

    2015-01-01

    The cornerstone of child abuse imaging is the skeletal survey, but initial imaging with radiographs may not demonstrate acute and non-displaced fractures, especially those involving the ribs. Given the high mortality of undiagnosed non-accidental trauma, timely diagnosis is crucial. CT is more sensitive in assessing rib fractures; however the effective radiation dose of a standard chest CT is high. We retrospectively identified four children (three boys, one girl; age range 1-4 months) admitted between January 2013 and February 2014 with high suspicion for non-accidental trauma from unexplained fractures of the long bones; these children all had CT of the chest when no rib fractures were evident on the skeletal survey. The absorbed radiation dose estimates for organs and tissue from the four-view chest radiographs and subsequent CT were determined using Monte Carlo photon transport software, and the effective dose was calculated using published tissue-weighting factors. In two children, CT showed multiple fractures of the ribs, scapula and vertebral body that were not evident on the initial skeletal survey. The average effective dose for a four-view chest radiograph across the four children was 0.29 mSv and the average effective dose for the chest CT was 0.56 mSv. Therefore the effective dose of a chest CT is on average less than twice that of a four-view chest radiograph. Our protocol thus shows that a reduced-dose chest CT may be useful in the evaluation of high specificity fractures of non-accidental trauma when the four-view chest radiographs are negative. (orig.)

  10. CT of the chest in suspected child abuse using submillisievert radiation dose

    Energy Technology Data Exchange (ETDEWEB)

    Sanchez, Thomas R.; Seibert, J.A.; Stein-Wexler, Rebecca [Medical Center Children' s Hospital, Division of Pediatric Radiology, University of California-Davis, Sacramento, CA (United States); Lee, Justin S. [University of California-Davis, Department of Radiology, Sacramento, CA (United States); Coulter, Kevin P. [Medical Center Children' s Hospital, Department of Pediatrics, University of California-Davis, Sacramento, CA (United States)

    2015-07-15

    The cornerstone of child abuse imaging is the skeletal survey, but initial imaging with radiographs may not demonstrate acute and non-displaced fractures, especially those involving the ribs. Given the high mortality of undiagnosed non-accidental trauma, timely diagnosis is crucial. CT is more sensitive in assessing rib fractures; however the effective radiation dose of a standard chest CT is high. We retrospectively identified four children (three boys, one girl; age range 1-4 months) admitted between January 2013 and February 2014 with high suspicion for non-accidental trauma from unexplained fractures of the long bones; these children all had CT of the chest when no rib fractures were evident on the skeletal survey. The absorbed radiation dose estimates for organs and tissue from the four-view chest radiographs and subsequent CT were determined using Monte Carlo photon transport software, and the effective dose was calculated using published tissue-weighting factors. In two children, CT showed multiple fractures of the ribs, scapula and vertebral body that were not evident on the initial skeletal survey. The average effective dose for a four-view chest radiograph across the four children was 0.29 mSv and the average effective dose for the chest CT was 0.56 mSv. Therefore the effective dose of a chest CT is on average less than twice that of a four-view chest radiograph. Our protocol thus shows that a reduced-dose chest CT may be useful in the evaluation of high specificity fractures of non-accidental trauma when the four-view chest radiographs are negative. (orig.)

  11. Closing the mental health treatment gap in South Africa: a review of costs and cost-effectiveness

    Science.gov (United States)

    Jack, Helen; Wagner, Ryan G.; Petersen, Inge; Thom, Rita; Newton, Charles R.; Stein, Alan; Kahn, Kathleen; Tollman, Stephen; Hofman, Karen J.

    2014-01-01

    Background Nearly one in three South Africans will suffer from a mental disorder in his or her lifetime, a higher prevalence than many low- and middle-income countries. Understanding the economic costs and consequences of prevention and packages of care is essential, particularly as South Africa considers scaling-up mental health services and works towards universal health coverage. Economic evaluations can inform how priorities are set in system or spending changes. Objective To identify and review research from South Africa and sub-Saharan Africa on the direct and indirect costs of mental, neurological, and substance use (MNS) disorders and the cost-effectiveness of treatment interventions. Design Narrative overview methodology. Results and conclusions Reviewed studies indicate that integrating mental health care into existing health systems may be the most effective and cost-efficient approach to increase access to mental health services in South Africa. Integration would also direct treatment, prevention, and screening to people with HIV and other chronic health conditions who are at high risk for mental disorders. We identify four major knowledge gaps: 1) accurate and thorough assessment of the health burdens of MNS disorders, 2) design and assessment of interventions that integrate mental health screening and treatment into existing health systems, 3) information on the use and costs of traditional medicines, and 4) cost-effectiveness evaluation of a range of specific interventions or packages of interventions that are tailored to the national context. PMID:24848654

  12. Closing the mental health treatment gap in South Africa: a review of costs and cost-effectiveness

    Directory of Open Access Journals (Sweden)

    Helen Jack

    2013-05-01

    Full Text Available Background: Nearly one in three South Africans will suffer from a mental disorder in his or her lifetime, a higher prevalence than many low- and middle-income countries. Understanding the economic costs and consequences of prevention and packages of care is essential, particularly as South Africa considers scaling-up mental health services and works towards universal health coverage. Economic evaluations can inform how priorities are set in system or spending changes. Objective: To identify and review research from South Africa and sub-Saharan Africa on the direct and indirect costs of mental, neurological, and substance use (MNS disorders and the cost-effectiveness of treatment interventions. Design: Narrative overview methodology. Results and conclusions: Reviewed studies indicate that integrating mental health care into existing health systems may be the most effective and cost-efficient approach to increase access to mental health services in South Africa. Integration would also direct treatment, prevention, and screening to people with HIV and other chronic health conditions who are at high risk for mental disorders. We identify four major knowledge gaps: 1 accurate and thorough assessment of the health burdens of MNS disorders, 2 design and assessment of interventions that integrate mental health screening and treatment into existing health systems, 3 information on the use and costs of traditional medicines, and 4 cost-effectiveness evaluation of a range of specific interventions or packages of interventions that are tailored to the national context.

  13. Cost-effectiveness Analysis Appraisal and Application: An Emergency Medicine Perspective.

    Science.gov (United States)

    April, Michael D; Murray, Brian P

    2017-06-01

    Cost-effectiveness is an important goal for emergency care delivery. The many diagnostic, treatment, and disposition decisions made in the emergency department (ED) have a significant impact upon healthcare resource utilization. Cost-effectiveness analysis (CEA) is an analytic tool to optimize these resource allocation decisions through the systematic comparison of costs and effects of alternative healthcare decisions. Yet few emergency medicine leaders and policymakers have any formal training in CEA methodology. This paper provides an introduction to the interpretation and use of CEA with a focus on application to emergency medicine problems and settings. It applies a previously published CEA to the hypothetical case of a patient presenting to the ED with chest pain who requires risk stratification. This paper uses a widely cited checklist to appraise the CEA. This checklist serves as a vehicle for presenting basic CEA terminology and concepts. General topics of focus include measurement of costs and outcomes, incremental analysis, and sensitivity analysis. Integrated throughout the paper are recommendations for good CEA practice with emphasis on the guidelines published by the U.S. Panel on Cost-Effectiveness in Health and Medicine. Unique challenges for emergency medicine CEAs discussed include the projection of long-term outcomes from emergent interventions, costing ED services, and applying study results to diverse patient populations across various ED settings. The discussion also includes an overview of the limitations inherent in applying CEA results to clinical practice to include the lack of incorporation of noncost considerations in CEA (e.g., ethics). After reading this article, emergency medicine leaders and researchers will have an enhanced understanding of the basics of CEA critical appraisal and application. The paper concludes with an overview of economic evaluation resources for readers interested in conducting ED-based economic evaluation

  14. Effectiveness of chest compression feedback during cardiopulmonary resuscitation in lateral tilted and semirecumbent positions: a randomised controlled simulation study.

    Science.gov (United States)

    Song, Y; Oh, J; Chee, Y; Cho, Y; Lee, S; Lim, T H

    2015-11-01

    Feedback devices have been shown to improve the quality of chest compression during cardiopulmonary resuscitation for patients in the supine position, but no studies have reported the effects of feedback devices on chest compression when the chest is tilted. Basic life support-trained providers were randomly assigned to administer chest compressions to a manikin in the supine, 30° left lateral tilt and 30° semirecumbent positions, with or without the aid of a feedback device incorporated into a smartphone. Thirty-six participants were studied. The feedback device did not affect the quality of chest compressions in the supine position, but improved aspects of performance in the tilted positions. In the lateral tilted position, the median (IQR [range]) chest compression rate was 99 (99-100 [96-117]) compressions.min(-1) with and 115 (95-128 [77-164]) compressions.min(-1) without feedback (p = 0.05), and the proportion of compressions of correct depth was 55 (0-96 [0-100])% with and 1 (0-30 [0-100])% without feedback (p = 0.03). In the semirecumbent position, the proportion of compressions of correct depth was 21 (0-87 [0-100])% with and 1 (0-26 [0-100])% without feedback (p = 0.05). Female participants applied chest compressions at a more accurate rate using the feedback device in the lateral tilted position but were unable to increase the chest compression depth, whereas male participants were able to increase the force of chest compression using the feedback device in the lateral tilted and semirecumbent positions. We conclude that a feedback device improves the application of chest compressions during simulated cardiopulmonary resuscitation when the chest is tilted. © 2015 The Association of Anaesthetists of Great Britain and Ireland.

  15. Blunt chest trauma.

    Science.gov (United States)

    Stewart, Daphne J

    2014-01-01

    Blunt chest trauma is associated with a wide range of injuries, many of which are life threatening. This article is a case study demonstrating a variety of traumatic chest injuries, including pathophysiology, diagnosis, and treatment. Literature on the diagnosis and treatment was reviewed, including both theoretical and research literature, from a variety of disciplines. The role of the advance practice nurse in trauma is also discussed as it relates to assessment, diagnosis, and treatment of patients with traumatic chest injuries.

  16. Clinical factors and comorbidities affecting the cost of hospital-treated COPD

    Directory of Open Access Journals (Sweden)

    Deniz S

    2016-12-01

    Full Text Available Sami Deniz,1 Aysun Şengül,2 Yusuf Aydemir,3 Jülide Çeldir Emre,4 Mustafa Hikmet Özhan5 1Clinics of Chest Diseases, Dr Suat Seren Chest Diseases and Thoracic Surgery Education and Research Hospital, İzmir, 2Clinics of Chest Diseases, Kocaeli Derince Research and Education Hospital, Kocaeli, 3Department of Chest Diseases, Sakarya University Faculty of Medicine, Sakarya, 4Clinics of Chest Diseases, Turgutlu State Hospital, Manisa, 5Department of Chest Diseases, Faculty of Medicine, Ege University İzmir, Turkey Purpose: We aimed to assess the effects of comorbidities on COPD costs and to investigate the relationship between comorbidities and clinical variables.Patients and methods: All patients hospitalized with a diagnosis of COPD exacerbation between January 1, 2014, and December 31, 2014, at all state hospitals of Aydin province, a city located in the western part of Turkey, were included in this study. The costs examined in the study pertained to medications, laboratory tests, hospital stays, and other treatment-related factors, such as consumption of materials, doctor visits, and consultation fees.Results: A total of 3,095 patients with 5,237 exacerbations (mean age, 71.9±10.5 years; 2,434 males and 661 females were evaluated. For 880 of the patients (28.9%, or 3,852 of the exacerbations (73.1%, at least one comorbid disease was recorded. The mean cost of each exacerbation was $808.5±1,586, including $325.1±879.9 (40.7% for hospital stays, $223.1±1,300.9 (27.6% for medications, $46.3±49.6 (0.9% for laboratory expenditures, and $214±1,068 (26.5% for other treatment-related factors, such as consumption of materials, doctor visits, and consultation fees. The cost of each exacerbation was $1,014.9 in patients with at least one comorbidity, whereas it was $233.6 in patients without comorbidity (P<0.001. Age >65 years, female gender, hospitalization in an intensive care unit, invasive or noninvasive mechanical ventilation, and a

  17. U.S. DOE indirect coal liquefaction program: An overview

    Energy Technology Data Exchange (ETDEWEB)

    Shen, J.; Schmetz, E.; Winslow, J.; Tischer, R. [Dept. of Energy, Germantown, MD (United States); Srivastava, R.

    1997-12-31

    Coal is the most abundant domestic energy resource in the United States. The Fossil Energy Organization within the US Department of Energy (DOE) has been supporting a coal liquefaction program to develop improved technologies to convert coal to clean and cost-effective liquid fuels to complement the dwindling supply of domestic petroleum crude. The goal of this program is to produce coal liquids that are competitive with crude at $20 to $25 per barrel. Indirect and direct liquefaction routes are the two technologies being pursued under the DOE coal liquefaction program. This paper will give an overview of the DOE indirect liquefaction program. More detailed discussions will be given to the F-T diesel and DME fuels which have shown great promises as clean burning alternative diesel fuels. The authors also will briefly discuss the economics of indirect liquefaction and the hurdles and opportunities for the early commercial deployment of these technologies. Discussions will be preceded by two brief reviews on the liquid versus gas phase reactors and the natural gas versus coal based indirect liquefaction.

  18. The analysis of cost-effectiveness of implant and conventional fixed dental prosthesis.

    Science.gov (United States)

    Chun, June Sang; Har, Alix; Lim, Hyun-Pil; Lim, Hoi-Jeong

    2016-02-01

    This study conducted an analysis of cost-effectiveness of the implant and conventional fixed dental prosthesis (CFDP) from a single treatment perspective. The Markov model for cost-effectiveness analysis of the implant and CFDP was carried out over maximum 50 years. The probabilistic sensitivity analysis was performed by the 10,000 Monte-Carlo simulations, and cost-effectiveness acceptability curves (CEAC) were also presented. The results from meta-analysis studies were used to determine the survival rates and complication rates of the implant and CFDP. Data regarding the cost of each treatment method were collected from University Dental Hospital and Statistics Korea for 2013. Using the results of the patient satisfaction survey study, quality-adjusted prosthesis year (QAPY) of the implant and CFDP strategy was evaluated with annual discount rate. When only the direct cost was considered, implants were more cost-effective when the willingness to pay (WTP) was more than 10,000 won at 10(th) year after the treatment, and more cost-effective regardless of the WTP from 20(th) year after the prosthodontic treatment. When the indirect cost was added to the direct cost, implants were more cost-effective only when the WTP was more than 75,000 won at the 10(th) year after the prosthodontic treatment, more than 35,000 won at the 20(th) year after prosthodontic treatment. The CFDP was more cost-effective unless the WTP was more than 75,000 won at the 10(th) year after prosthodontic treatment. But the cost-effectivenss tendency changed from CFDP to implant as time passed.

  19. Chest X-Ray

    Medline Plus

    Full Text Available ... some concerns about chest x-rays. However, it’s important to consider the likelihood of benefit to your health. While a chest x-ray use a ... posted: How to Obtain and Share ...

  20. Physiological effects of a single chest physiotherapy session in mechanically ventilated and extubated preterm neonates.

    Science.gov (United States)

    Mehta, Y; Shetye, J; Nanavati, R; Mehta, A

    2016-01-01

    to study the long term effects of chest physical therapy.

  1. Total, Direct, and Indirect Effects in Logit Models

    DEFF Research Database (Denmark)

    Karlson, Kristian Bernt; Holm, Anders; Breen, Richard

    It has long been believed that the decomposition of the total effect of one variable on another into direct and indirect effects, while feasible in linear models, is not possible in non-linear probability models such as the logit and probit. In this paper we present a new and simple method...... average partial effects, as defined by Wooldridge (2002). We present the method graphically and illustrate it using the National Educational Longitudinal Study of 1988...

  2. Thin chest wall is an independent risk factor for the development of pneumothorax after chest tube removal.

    Science.gov (United States)

    Anand, Rahul J; Whelan, James F; Ferrada, Paula; Duane, Therese M; Malhotra, Ajai K; Aboutanos, Michel B; Ivatury, Rao R

    2012-04-01

    The factors contributing to the development of pneumothorax after removal of chest tube thoracostomy are not fully understood. We hypothesized that development of post pull pneumothorax (PPP) after chest tube removal would be significantly lower in those patients with thicker chest walls, due to the "protective" layer of adipose tissue. All patients on our trauma service who underwent chest tube thoracostomy from July 2010 to February 2011 were retrospectively reviewed. Patient age, mechanism of trauma, and chest Abbreviated Injury Scale score were analyzed. Thoracic CTs were reviewed to ascertain chest wall thickness (CW). Thickness was measured at the level of the nipple at the midaxillary line, as perpendicular distance between skin and pleural cavity. Chest X-ray reports from immediately prior and after chest tube removal were reviewed for interval development of PPP. Data are presented as average ± standard deviation. Ninety-one chest tubes were inserted into 81 patients. Patients who died before chest tube removal (n = 11), or those without thoracic CT scans (n = 13) were excluded. PPP occurred in 29.9 per cent of chest tube removals (20/67). When PPP was encountered, repeat chest tube was necessary in 20 per cent of cases (4/20). After univariate analysis, younger age, penetrating mechanism, and thin chest wall were found to be significant risk factors for development of PPP. Chest Abbreviated Injury Scale score was similar in both groups. Logistic regression showed only chest wall thickness to be an independent risk factor for development of PPP.

  3. Impact of cloud-borne aerosol representation on aerosol direct and indirect effects

    Directory of Open Access Journals (Sweden)

    S. J. Ghan

    2006-01-01

    Full Text Available Aerosol particles attached to cloud droplets are much more likely to be removed from the atmosphere and are much less efficient at scattering sunlight than if unattached. Models used to estimate direct and indirect effects of aerosols employ a variety of representations of such cloud-borne particles. Here we use a global aerosol model with a relatively complete treatment of cloud-borne particles to estimate the sensitivity of simulated aerosol, cloud and radiation fields to various approximations to the representation of cloud-borne particles. We find that neglecting transport of cloud-borne particles introduces little error, but that diagnosing cloud-borne particles produces global mean biases of 20% and local errors of up to 40% for aerosol, droplet number, and direct and indirect radiative forcing. Aerosol number, aerosol optical depth and droplet number are significantly underestimated in regions and seasons where and when wet removal is primarily by stratiform rather than convective clouds (polar regions during winter, but direct and indirect effects are less biased because of the limited sunlight there and then. A treatment that predicts the total mass concentration of cloud-borne particles for each mode yields smaller errors and runs 20% faster than the complete treatment. The errors are much smaller than current estimates of uncertainty in direct and indirect effects of aerosols, which suggests that the treatment of cloud-borne aerosol is not a significant source of uncertainty in estimates of direct and indirect effects.

  4. Chest X-Ray

    Medline Plus

    Full Text Available ... and chest wall and may be used to help evaluate shortness of breath, persistent cough, fever, chest ... or injury. It may also be useful to help diagnose and monitor treatment for a variety of ...

  5. Direct and indirect effects of organizational justice on work ability.

    Science.gov (United States)

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

    2014-12-01

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

  6. Cardiac CT for the assessment of chest pain: Imaging techniques and clinical results

    International Nuclear Information System (INIS)

    Becker, Hans-Christoph; Johnson, Thorsten

    2012-01-01

    Immediate and efficient risk stratification and management of patients with acute chest pain in the emergency department is challenging. Traditional management of these patients includes serial ECG, laboratory tests and further on radionuclide perfusion imaging or ECG treadmill testing. Due to the advances of multi-detector CT technology, dedicated coronary CT angiography provides the potential to rapidly and reliably diagnose or exclude acute coronary artery disease. Life-threatening causes of chest pain, such as aortic dissection and pulmonary embolism can simultaneously be assessed with a single scan, sometimes referred to as “triple rule out” scan. With appropriate patient selection, cardiac CT can accurately diagnose heart disease or other sources of chest pain, markedly decrease health care costs, and reliably predict clinical outcomes. This article reviews imaging techniques and clinical results for CT been used to evaluate patients with chest pain entering the emergency department.

  7. Application of off-line image processing for optimization in chest computed radiography using a low cost system.

    Science.gov (United States)

    Muhogora, Wilbroad E; Msaki, Peter; Padovani, Renato

    2015-03-08

     The objective of this study was to improve the visibility of anatomical details by applying off-line postimage processing in chest computed radiography (CR). Four spatial domain-based external image processing techniques were developed by using MATLAB software version 7.0.0.19920 (R14) and image processing tools. The developed techniques were implemented to sample images and their visual appearances confirmed by two consultant radiologists to be clinically adequate. The techniques were then applied to 200 chest clinical images and randomized with other 100 images previously processed online. These 300 images were presented to three experienced radiologists for image quality assessment using standard quality criteria. The mean and ranges of the average scores for three radiologists were characterized for each of the developed technique and imaging system. The Mann-Whitney U-test was used to test the difference of details visibility between the images processed using each of the developed techniques and the corresponding images processed using default algorithms. The results show that the visibility of anatomical features improved significantly (0.005 ≤ p ≤ 0.02) with combinations of intensity values adjustment and/or spatial linear filtering techniques for images acquired using 60 ≤ kVp ≤ 70. However, there was no improvement for images acquired using 102 ≤ kVp ≤ 107 (0.127 ≤ p ≤ 0.48). In conclusion, the use of external image processing for optimization can be effective in chest CR, but should be implemented in consultations with the radiologists.

  8. Chest X-Ray

    Medline Plus

    Full Text Available ... breath, persistent cough, fever, chest pain or injury. It may also be useful to help diagnose and ... have some concerns about chest x-rays. However, it’s important to consider the likelihood of benefit to ...

  9. Low-Dose Chest Computed Tomography for Lung Cancer Screening Among Hodgkin Lymphoma Survivors: A Cost-Effectiveness Analysis

    International Nuclear Information System (INIS)

    Wattson, Daniel A.; Hunink, M.G. Myriam; DiPiro, Pamela J.; Das, Prajnan; Hodgson, David C.; Mauch, Peter M.; Ng, Andrea K.

    2014-01-01

    Purpose: Hodgkin lymphoma (HL) survivors face an increased risk of treatment-related lung cancer. Screening with low-dose computed tomography (LDCT) may allow detection of early stage, resectable cancers. We developed a Markov decision-analytic and cost-effectiveness model to estimate the merits of annual LDCT screening among HL survivors. Methods and Materials: Population databases and HL-specific literature informed key model parameters, including lung cancer rates and stage distribution, cause-specific survival estimates, and utilities. Relative risks accounted for radiation therapy (RT) technique, smoking status (>10 pack-years or current smokers vs not), age at HL diagnosis, time from HL treatment, and excess radiation from LDCTs. LDCT assumptions, including expected stage-shift, false-positive rates, and likely additional workup were derived from the National Lung Screening Trial and preliminary results from an internal phase 2 protocol that performed annual LDCTs in 53 HL survivors. We assumed a 3% discount rate and a willingness-to-pay (WTP) threshold of $50,000 per quality-adjusted life year (QALY). Results: Annual LDCT screening was cost effective for all smokers. A male smoker treated with mantle RT at age 25 achieved maximum QALYs by initiating screening 12 years post-HL, with a life expectancy benefit of 2.1 months and an incremental cost of $34,841/QALY. Among nonsmokers, annual screening produced a QALY benefit in some cases, but the incremental cost was not below the WTP threshold for any patient subsets. As age at HL diagnosis increased, earlier initiation of screening improved outcomes. Sensitivity analyses revealed that the model was most sensitive to the lung cancer incidence and mortality rates and expected stage-shift from screening. Conclusions: HL survivors are an important high-risk population that may benefit from screening, especially those treated in the past with large radiation fields including mantle or involved-field RT. Screening

  10. Low-Dose Chest Computed Tomography for Lung Cancer Screening Among Hodgkin Lymphoma Survivors: A Cost-Effectiveness Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Wattson, Daniel A., E-mail: dwattson@partners.org [Harvard Radiation Oncology Program, Boston, Massachusetts (United States); Hunink, M.G. Myriam [Departments of Radiology and Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands and Center for Health Decision Science, Harvard School of Public Health, Boston, Massachusetts (United States); DiPiro, Pamela J. [Department of Imaging, Dana-Farber Cancer Institute, Boston, Massachusetts (United States); Das, Prajnan [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Hodgson, David C. [Department of Radiation Oncology, University of Toronto, Toronto, Ontario (Canada); Mauch, Peter M.; Ng, Andrea K. [Department of Radiation Oncology, Brigham and Women' s Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts (United States)

    2014-10-01

    Purpose: Hodgkin lymphoma (HL) survivors face an increased risk of treatment-related lung cancer. Screening with low-dose computed tomography (LDCT) may allow detection of early stage, resectable cancers. We developed a Markov decision-analytic and cost-effectiveness model to estimate the merits of annual LDCT screening among HL survivors. Methods and Materials: Population databases and HL-specific literature informed key model parameters, including lung cancer rates and stage distribution, cause-specific survival estimates, and utilities. Relative risks accounted for radiation therapy (RT) technique, smoking status (>10 pack-years or current smokers vs not), age at HL diagnosis, time from HL treatment, and excess radiation from LDCTs. LDCT assumptions, including expected stage-shift, false-positive rates, and likely additional workup were derived from the National Lung Screening Trial and preliminary results from an internal phase 2 protocol that performed annual LDCTs in 53 HL survivors. We assumed a 3% discount rate and a willingness-to-pay (WTP) threshold of $50,000 per quality-adjusted life year (QALY). Results: Annual LDCT screening was cost effective for all smokers. A male smoker treated with mantle RT at age 25 achieved maximum QALYs by initiating screening 12 years post-HL, with a life expectancy benefit of 2.1 months and an incremental cost of $34,841/QALY. Among nonsmokers, annual screening produced a QALY benefit in some cases, but the incremental cost was not below the WTP threshold for any patient subsets. As age at HL diagnosis increased, earlier initiation of screening improved outcomes. Sensitivity analyses revealed that the model was most sensitive to the lung cancer incidence and mortality rates and expected stage-shift from screening. Conclusions: HL survivors are an important high-risk population that may benefit from screening, especially those treated in the past with large radiation fields including mantle or involved-field RT. Screening

  11. Low-dose chest computed tomography for lung cancer screening among Hodgkin lymphoma survivors: a cost-effectiveness analysis.

    Science.gov (United States)

    Wattson, Daniel A; Hunink, M G Myriam; DiPiro, Pamela J; Das, Prajnan; Hodgson, David C; Mauch, Peter M; Ng, Andrea K

    2014-10-01

    Hodgkin lymphoma (HL) survivors face an increased risk of treatment-related lung cancer. Screening with low-dose computed tomography (LDCT) may allow detection of early stage, resectable cancers. We developed a Markov decision-analytic and cost-effectiveness model to estimate the merits of annual LDCT screening among HL survivors. Population databases and HL-specific literature informed key model parameters, including lung cancer rates and stage distribution, cause-specific survival estimates, and utilities. Relative risks accounted for radiation therapy (RT) technique, smoking status (>10 pack-years or current smokers vs not), age at HL diagnosis, time from HL treatment, and excess radiation from LDCTs. LDCT assumptions, including expected stage-shift, false-positive rates, and likely additional workup were derived from the National Lung Screening Trial and preliminary results from an internal phase 2 protocol that performed annual LDCTs in 53 HL survivors. We assumed a 3% discount rate and a willingness-to-pay (WTP) threshold of $50,000 per quality-adjusted life year (QALY). Annual LDCT screening was cost effective for all smokers. A male smoker treated with mantle RT at age 25 achieved maximum QALYs by initiating screening 12 years post-HL, with a life expectancy benefit of 2.1 months and an incremental cost of $34,841/QALY. Among nonsmokers, annual screening produced a QALY benefit in some cases, but the incremental cost was not below the WTP threshold for any patient subsets. As age at HL diagnosis increased, earlier initiation of screening improved outcomes. Sensitivity analyses revealed that the model was most sensitive to the lung cancer incidence and mortality rates and expected stage-shift from screening. HL survivors are an important high-risk population that may benefit from screening, especially those treated in the past with large radiation fields including mantle or involved-field RT. Screening may be cost effective for all smokers but possibly not

  12. Mastitis therapy: Direct and indirect costs

    OpenAIRE

    Boboš, S.; Radinović, M.; Vidić, B.; Pajić, M.; Vidić, V.; Galfi, A.

    2013-01-01

    One of the most important problems in milk production, causing great economic loses is certainly mastitis. In order to minimize economic losses from mastitis dairy farms introduce different mastitis management programs. These programs include mastitis therapy and prevention. In mastitis control prevention is most important and when mastitis occurs cost of therapy and milk discharge is very important. In our study we examined cost of mastitis treatment and m...

  13. Effect of data compression on diagnostic accuracy in digital hand and chest radiography

    Science.gov (United States)

    Sayre, James W.; Aberle, Denise R.; Boechat, Maria I.; Hall, Theodore R.; Huang, H. K.; Ho, Bruce K. T.; Kashfian, Payam; Rahbar, Guita

    1992-05-01

    Image compression is essential to handle a large volume of digital images including CT, MR, CR, and digitized films in a digital radiology operation. The full-frame bit allocation using the cosine transform technique developed during the last few years has been proven to be an excellent irreversible image compression method. This paper describes the effect of using the hardware compression module on diagnostic accuracy in hand radiographs with subperiosteal resorption and chest radiographs with interstitial disease. Receiver operating characteristic analysis using 71 hand radiographs and 52 chest radiographs with five observers each demonstrates that there is no statistical significant difference in diagnostic accuracy between the original films and the compressed images with a compression ratio as high as 20:1.

  14. Forecasting of indirect consumables for a Job Shop

    Science.gov (United States)

    Shakeel, M.; Khan, S.; Khan, W. A.

    2016-08-01

    A job shop has an arrangement where similar machines (Direct consumables) are grouped together and use indirect consumables to produce a product. The indirect consumables include hack saw blades, emery paper, painting brush etc. The job shop is serving various orders at a particular time for the optimal operation of job shop. Forecasting is required to predict the demand of direct and indirect consumables in a job shop. Forecasting is also needed to manage lead time, optimize inventory cost and stock outs. The objective of this research is to obtain the forecast for indirect consumables. The paper shows how job shop can manage their indirect consumables more accurately by establishing a new technique of forecasting. This results in profitable use of job shop by multiple users.

  15. Development and validation of the Emergency Department Assessment of Chest pain Score and 2 h accelerated diagnostic protocol

    NARCIS (Netherlands)

    Than, Martin; Flaws, Dylan; Sanders, Sharon; Doust, Jenny; Glasziou, Paul; Kline, Jeffery; Aldous, Sally; Troughton, Richard; Reid, Christopher; Parsonage, William A.; Frampton, Christopher; Greenslade, Jaimi H.; Deely, Joanne M.; Hess, Erik; Sadiq, Amr Bin; Singleton, Rose; Shopland, Rosie; Vercoe, Laura; Woolhouse-Williams, Morgana; Ardagh, Michael; Bossuyt, Patrick; Bannister, Laura; Cullen, Louise

    2014-01-01

    Risk scores and accelerated diagnostic protocols can identify chest pain patients with low risk of major adverse cardiac event who could be discharged early from the ED, saving time and costs. We aimed to derive and validate a chest pain score and accelerated diagnostic protocol (ADP) that could

  16. MRI of the Chest

    Medline Plus

    Full Text Available ... transplant, it will be necessary to perform a blood test to determine whether the kidneys are functioning adequately. ... abnormalities where Chest CT is a preferred imaging test. MR imaging can assess blood flow without risking the side effects of conventional ( ...

  17. A finite and stable exponential growth-adjusted indirect cost of cancer associated with discounted years of life lost in Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Omar B. Da'ar

    2018-05-01

    Conclusion: Our findings reveal evidence of indirect cost associated with cancer premature deaths in Saudi Arabia. In order to develop cancer control actions, the results of this study can inform health system policymakers not only of the extent of the enormous economic burden but also drawing attention to epidemiological and economic factors that explain the variability of the burden.

  18. Chest tomosynthesis: technical and clinical perspectives.

    Science.gov (United States)

    Johnsson, Ase Allansdotter; Vikgren, Jenny; Bath, Magnus

    2014-02-01

    The recent implementation of chest tomosynthesis is built on the availability of large, dose-efficient, high-resolution flat panel detectors, which enable the acquisition of the necessary number of projection radiographs to allow reconstruction of section images of the chest within one breath hold. A chest tomosynthesis examination obtains the increased diagnostic information provided by volumetric imaging at a radiation dose comparable to that of conventional chest radiography. There is evidence that the sensitivity of chest tomosynthesis may be at least three times higher than for conventional chest radiography for detection of pulmonary nodules. The sensitivity increases with increasing nodule size and attenuation and decreases for nodules with subpleural location. Differentiation between pleural and subpleural lesions is a known pitfall due to the limited depth resolution in chest tomosynthesis. Studies on different types of pathology report increased detectability in favor of chest tomosynthesis in comparison to chest radiography. The technique provides improved diagnostic accuracy and confidence in the diagnosis of suspected pulmonary lesions on chest radiography and facilitates the exclusion of pulmonary lesions in a majority of patients, avoiding the need for computed tomography (CT). However, motion artifacts can be a cumbersome limitation and breathing during the tomosynthesis image acquisition may result in severe artifacts significantly affecting the detectability of pathology. In summary, chest tomosynthesis has been shown to be superior to chest conventional radiography for many tasks and to be able to replace CT in selected cases. In our experience chest tomosynthesis is an efficient problem solver in daily clinical work. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  19. Practical applications of digital tomosynthesis of the chest

    International Nuclear Information System (INIS)

    Galea, A.; Durran, A.; Adlan, T.; Gay, D.; Riordan, R.; Dubbins, P.; Williams, M.P.

    2014-01-01

    Digital tomosynthesis is a radiographic technique that generates a number of coronal raw images of a patient from a single pass of the x-ray tube. Tomosynthesis provides some of the tomographic benefits of computed tomography (CT), but at a much lower dose of radiation and cost when compared to CT. This review illustrates the range of practical applications of digital tomosynthesis of the chest

  20. Direct and indirect punishment among strangers in the field.

    Science.gov (United States)

    Balafoutas, Loukas; Nikiforakis, Nikos; Rockenbach, Bettina

    2014-11-11

    Many interactions in modern human societies are among strangers. Explaining cooperation in such interactions is challenging. The two most prominent explanations critically depend on individuals' willingness to punish defectors: In models of direct punishment, individuals punish antisocial behavior at a personal cost, whereas in models of indirect reciprocity, they punish indirectly by withholding rewards. We investigate these competing explanations in a field experiment with real-life interactions among strangers. We find clear evidence of both direct and indirect punishment. Direct punishment is not rewarded by strangers and, in line with models of indirect reciprocity, is crowded out by indirect punishment opportunities. The existence of direct and indirect punishment in daily life indicates the importance of both means for understanding the evolution of cooperation.

  1. Total, direct, and indirect effects of paan on oral cancer.

    Science.gov (United States)

    Merchant, Anwar T; Pitiphat, Waranuch

    2015-03-01

    Paan (betel leaf and betel nut quid) used with or without tobacco has been positively associated with oral cancer. Oral submucous fibrosis (OSMF), a precancerous condition caused by paan, lies on the causal pathway between paan use and oral cancer. The purpose of this analysis was to estimate the effect of paan consumption on oral cancer risk when it is mediated by OSMF. We used mediation methods proposed by VanderWeele, which are based on causal inference principles, to characterize the total, direct, and indirect effects of paan, consumed with and without tobacco, on oral cancer mediated by OSMF. We reanalyzed case-control data collected from three hospitals in Karachi, Pakistan, between July 1996 and March 1998. For paan without tobacco, the total effect on oral cancer was OR 7.39, 95 % CI 1.01, 38.11, the natural indirect effect (due to OSMF among paan users) was OR 2.48, 95 % CI 0.99, 10.44, and the natural direct effect (due to paan with OSMF absent) was OR 3.32, 95 % CI 0.68, 10.07. For paan with tobacco, the total direct effect was OR 15.68, 95 % CI 3.00, 54.90, the natural indirect effect was OR 2.18, 95 % CI 0.82, 5.52, and the natural direct effect was OR 7.27, 95 % CI 2.15, 20.43. Paan, whether or not it contained tobacco, raised oral cancer risk irrespective of OSMF. Oral cancer risk was higher among those who used paan with tobacco.

  2. Allocation base of general production costs as optimization of prime costs

    Directory of Open Access Journals (Sweden)

    Levytska I.O.

    2017-03-01

    Full Text Available Qualified management aimed at optimizing financial results is the key factor in today's society. Effective management decisions depend on the necessary information about the costs of production process in all its aspects – their structure, types, accounting policies of reflecting costs. General production costs, the so-called indirect costs that are not directly related to the production process, but provide its functioning in terms of supporting structural divisions and create the necessary conditions of production, play a significant role in calculating prime costs of goods (works, services. However, the accurate estimate of prime costs of goods (works, services should be determined with the value of indirect costs (in other words, general production costs, and properly determined with the base of their allocation. The choice of allocation base of general production costs is the significant moment, depending on the nature of business, which must guarantee fair distribution regarding to the largest share of direct expenses in the total structure of production costs. The study finds the essence of general production costs based on the analysis of key definitions of leading Ukrainian economists. The optimal allocation approach of general production costs is to calculate these costs as direct production costs within each subsidiary division (department separately without selecting a base as the main one to the their total amount.

  3. CT of chest trauma

    International Nuclear Information System (INIS)

    Goodman, P.C.

    1986-01-01

    There appears to be a limited role for computed tomography in the evaluation of chest trauma. The literature contains few papers specifically addressing the use of CT in the setting of chest trauma. Another series of articles relates anecdotal experiences in this regard. This paucity of reports attests to the remarkable amount of information present on conventional chest radiographs as well as the lack of clear indications for CT in the setting of chest trauma. In this chapter traumatic lesions of various areas of the thorax are discussed. The conventional radiographic findings are briefly described and the potential or proven application of CT is addressed

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

    Science.gov (United States)

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

    1996-01-01

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

  5. Treatment of funnel chest in children

    Directory of Open Access Journals (Sweden)

    Viktor N. Stalmakhovich

    2017-10-01

    Full Text Available Background. Funnel chest has a relatively high prevalence in the Russian population. Given the high percentage of the unsatisfactory results of thoracoplasty, further research for the development of new treatment methods is needed. Aim. To improve the treatment results for funnel chest in children. Materials and methods. We analyzed the treatment results of 230 children with funnel chest after thoracoplasty. We used 2 surgical techniques: classic thoracoplasty by Nuss (114 children and its modified version by the authors (116 children. The modified technique included two-sided thoracoscopy, partial resection of the deformed rib cartilages, and endoscopic longitudinal transection of the sternal cortical plate, resulting in subcutaneous emphysema along the sternum. Results. The comparison of the 2 surgical techniques showed no significant difference in terms of duration and invasiveness of the procedure. Recurrent episodes of funnel chest were observed in children who had undergone thoracoplasty before 7 years of age, regardless of the technique used. Conclusion. This study revealed that the author’s modified thoracoplasty method was more effective in children > 14 years of age with rigid funnel chest because it allowed the surgeon to decrease the thoracic pressure on the plate and the plate itself on the ribs, facilitating the repositioning of the sternum and preventing the deformation and development of pressure sores on the ribs.

  6. Identification of Indirect Effects in a Cognitive Patient Education (COPE) Intervention for Low Back Pain.

    Science.gov (United States)

    Mansell, Gemma; Storheim, Kjersti; Løchting, Ida; Werner, Erik L; Grotle, Margreth

    2017-12-01

    Many interventions for the treatment of low back pain exist, but the mechanisms through which such treatments work are not always clear. This situation is especially true for biopsychosocial interventions that incorporate several different components and methods of delivery. The study objective was to examine the indirect effects of the Cognitive Patient Education (COPE) intervention via illness perceptions, back pain myths, and pain catastrophizing on disability outcome. This study was a secondary analysis of the COPE randomized controlled trial. Mediation analysis techniques were employed to examine the indirect effects of the COPE intervention via residualized change (baseline - posttreatment) in the 3 variables hypothesized to be targeted by the COPE intervention on posttreatment disability outcome. Pain intensity at baseline, pain duration, clinician type, and a treatment-mediator interaction term were controlled for in the analysis. Preliminary analyses confirmed that changes in pain catastrophizing and illness perceptions (not back pain myths) were related to both allocation to the intervention arm and posttreatment disability score. The treatment exerted statistically significant indirect effects via changes in illness perceptions and pain catastrophizing on posttreatment disability score (illness perceptions standardized indirect effect = 0.09 [95% CI = 0.03 to 0.16]; pain catastrophizing standardized indirect effect = 0.05 [95% CI = 0.01 to 0.12]). However, the inclusion of an interaction term led to the indirect effects being significantly reduced, with the effects no longer being statistically significant. This study presents a secondary analysis of variables not identified a priori as being potentially important treatment targets; other, unmeasured factors could also be important in explaining treatment effects. The finding that small indirect effects of the COPE intervention via changes in illness perceptions and pain catastrophizing on posttreatment

  7. Comparative Effectiveness of Emergency Resuscitative Thoracotomy versus Closed Chest Compressions among Patients with Critical Blunt Trauma: A Nationwide Cohort Study in Japan.

    Science.gov (United States)

    Suzuki, Kodai; Inoue, Shigeaki; Morita, Seiji; Watanabe, Nobuo; Shintani, Ayumi; Inokuchi, Sadaki; Ogura, Shinji

    2016-01-01

    Although emergency resuscitative thoracotomy is performed as a salvage maneuver for critical blunt trauma patients, evidence supporting superior effectiveness of emergency resuscitative thoracotomy compared to conventional closed-chest compressions remains insufficient. The objective of this study was to investigate whether emergency resuscitative thoracotomy at the emergency department or in the operating room was associated with favourable outcomes after blunt trauma and to compare its effectiveness with that of closed-chest compressions. This was a retrospective nationwide cohort study. Data were obtained from the Japan Trauma Data Bank for the period between 2004 and 2012. The primary and secondary outcomes were patient survival rates 24 h and 28 d after emergency department arrival. Statistical analyses were performed using multivariable generalized mixed-effects regression analysis. We adjusted for the effects of different hospitals by introducing random intercepts in regression analysis to account for the differential quality of emergency resuscitative thoracotomy at hospitals where patients in cardiac arrest were treated. Sensitivity analyses were performed using propensity score matching. In total, 1,377 consecutive, critical blunt trauma patients who received cardiopulmonary resuscitation in the emergency department or operating room were included in the study. Of these patients, 484 (35.1%) underwent emergency resuscitative thoracotomy and 893 (64.9%) received closed-chest compressions. Compared to closed-chest compressions, emergency resuscitative thoracotomy was associated with lower survival rate 24 h after emergency department arrival (4.5% vs. 17.5%, respectively, P chest compressions (P chest compressions.

  8. Enterogastroesophageal reflux detected on 99m-technetium sestamibi cardiac imaging as a cause of chest pain

    International Nuclear Information System (INIS)

    Erdogan, Zeynep; Silov, Güler; Özdal, Aysegül; Turhal, Özgül

    2013-01-01

    Myocardial perfusion imaging (MPI) with technetium-99m sestamibi ( 99m Tc MIBI) is considered a diagnostic technique that is widely used for the investigation of suspected coronary artery disease. Incidental inspection of an extracardiac activity is indirect, but important marker, which can identify a potentially treatable non-coronary cause for chest pain that may mimic cardiac symptoms. Here, we present an illustrative case in which significant enterogastroesophageal reflux of 99m Tc MIBI occurred during the cardiac imaging following prompt hepatobiliary clearance. Because, there was normal myocardial perfusion on MPI, presence of gastroesophageal reflux (GER) on GER scintigraphy and detection of mild inflammation with pathologically confirmed hyperplastic polyp by endoscopy, in view of the above findings we concluded that the probable cause of chest pain was reflux. (author)

  9. Learning chest imaging

    Energy Technology Data Exchange (ETDEWEB)

    Pedrozo Pupo, John C. (ed.) [Magdalena Univ., Santa Maria (Colombia). Respire - Inst. for Respiratory Care

    2013-03-01

    Useful learning tool for practitioners and students. Overview of the imaging techniques used in chest radiology. Aid to the correct interpretation of chest X-ray images. Radiology of the thorax forms an indispensable element of the basic diagnostic process for many conditions and is of key importance in a variety of medical disciplines. This user-friendly book provides an overview of the imaging techniques used in chest radiology and presents numerous instructive case-based images with accompanying explanatory text. A wide range of clinical conditions and circumstances are covered with the aim of enabling the reader to confidently interpret chest images by correctly identifying structures of interest and the causes of abnormalities. This book, which will be an invaluable learning tool, forms part of the Learning Imaging series for medical students, residents, less experienced radiologists, and other medical staff. Learning Imaging is a unique case-based series for those in professional education in general and for physicians in prarticular.

  10. Chest radiology

    International Nuclear Information System (INIS)

    Reed, J.C.

    1990-01-01

    This book is a reference in plain chest film diagnosis provides a thorough background in the differential diagnosis of 22 of the most common radiologic patterns of chest disease. Each chapter is introduced with problem cases and a set of questions, followed by a tabular listing of the appropriate differential considerations. The book emphasizes plain films, CT and some MR scans are integrated to demonstrate how these modalities enhance the work of a case

  11. Predonation Direct and Indirect Costs Incurred by Adults Who Donated a Kidney: Findings From the KDOC Study.

    Science.gov (United States)

    Rodrigue, J R; Schold, J D; Morrissey, P; Whiting, J; Vella, J; Kayler, L K; Katz, D; Jones, J; Kaplan, B; Fleishman, A; Pavlakis, M; Mandelbrot, D A

    2015-09-01

    Limited information exists on the predonation costs incurred by eventual living kidney donors (LKDs). Expenses related to completion of the donation evaluation were collected from 194 LKDs participating in the multi-center, prospective Kidney Donor Outcomes Cohort (KDOC) Study. Most LKDs (n = 187, 96%) reported one or more direct costs, including ground transportation (80%), healthcare (24%), lodging (17%) and air transportation (14%), totaling $101 484 (USD; mean = $523 ± 942). Excluding paid vacation or sick leave, donor and companion lost wages totaled $35 918 (mean = $187 ± 556) and $14 378 (mean = $76 ± 311), respectively. One-third of LKDs used paid vacation or sick leave to avoid incurring lost wages. Few LKDs reported receiving financial support from the transplant candidate (6%), transplant candidate's family (3%), a nonprofit organization (3%), the National Living Donor Assistance Center (7%), or transplant center (3%). Higher total costs were significantly associated with longer distance traveled to the transplant center (p costs were not associated with age, sex, race/ethnicity, household income, marital status, insurance status, or transplant center. Moderate predonation direct and indirect costs are common for adults who complete the donation evaluation. Potential LKDs should be advised of these possible costs, and the transplant community should examine additional strategies to reimburse donors for them. © Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.

  12. Effect of Body Mass Index on Postoperative Transfusions and 24-Hour Chest-Tube Output

    Science.gov (United States)

    Nolan, Heather R.; Ramaiah, Chandrashekhar

    2011-01-01

    An increasing obese population in the United States focuses attention on the effect of obesity on surgical outcomes. Our objective was to see if obesity, determined by body mass index (BMI), contributed to bleeding in coronary artery bypass graft (CABG) surgery as measured by intraoperative and postoperative packed red blood cell transfusion frequency and amount and 24-hour chest-tube output. A retrospective chart review examined 150 subjects undergoing single-surgeon off-pump or on-pump CABG surgery between September 2006 and April 2009. BMI groups included normal-weight (BMI trend based on BMI group (p = 0.054). The percentage of subjects receiving transfusions in the combined intraoperative or 72-hour postoperative period showed a decreasing linear trend based on BMI group (p = 0.054). The transfusion amount during the 72-hour postoperative period varied significantly between BMI groups (p = 0.021), and the test for a linear decrease across groups was significant (p = 0.020). Twenty-four hour chest-tube output showed variation across all three BMI categories (p = 0.018) with chest-tube output decreasing with increasing obesity in a linear fashion (p = 0.006). Transfusion rate and amount indicate total blood loss is decreased in the obese, and chest-tube output findings give a direct measurable indicator of blood loss from the surgical site indicating increasing BMI is linearly correlated with decreasing postoperative bleeding. PMID:22654469

  13. Cost-effectiveness in the contemporary management of critical limb ischemia with tissue loss.

    Science.gov (United States)

    Barshes, Neal R; Chambers, James D; Cohen, Joshua; Belkin, Michael

    2012-10-01

    The care of patients with critical limb ischemia (CLI) and tissue loss is notoriously challenging and expensive. We evaluated the cost-effectiveness of various management strategies to identify those that would optimize value to patients. A probabilistic Markov model was used to create a detailed simulation of patient-oriented outcomes, including clinical events, wound healing, functional outcomes, and quality-adjusted life-years (QALYs) after various management strategies in a CLI patient cohort during a 10-year period. Direct and indirect cost estimates for these strategies were obtained using transition cost-accounting methodology. Incremental cost-effectiveness ratios (ICERs), in 2009 U.S. dollars per QALYs, were calculated compared with the most conservative management strategy of local wound care with amputation as needed. With an ICER of $47,735/QALY, an initial surgical bypass with subsequent endovascular revision(s) as needed was the most cost-effective alternative to local wound care alone. Endovascular-first management strategies achieved comparable clinical outcomes but at higher cost (ICERs ≥$101,702/QALY); however, endovascular management did become cost-effective when the initial foot wound closure rate was >37% or when procedural costs were decreased by >42%. Primary amputation was dominated (less effectiveness and more costly than wound care alone). Contemporary clinical effectiveness and cost estimates show an initial surgical bypass is the most cost-effective alternative to local wound care alone for CLI with tissue loss and can be supported even in a cost-averse health care environment. Copyright © 2012. Published by Mosby, Inc.

  14. Anteroposterior chest radiograph vs. chest CT scan in early detection of pneumothorax in trauma patients

    Directory of Open Access Journals (Sweden)

    Omar Hesham R

    2011-09-01

    Full Text Available Abstract Pneumothorax is a common complication following blunt chest wall trauma. In these patients, because of the restrictions regarding immobilization of the cervical spine, Anteroposterior (AP chest radiograph is usually the most feasible initial study which is not as sensitive as the erect chest X-ray or CT chest for detection of a pneumothorax. We will present 3 case reports which serve for better understanding of the entity of occult pneumothorax. The first case is an example of a true occult pneumothorax where an initial AP chest X-ray revealed no evidence of pneumothorax and a CT chest immediately performed revealed evidence of pneumothorax. The second case represents an example of a missed rather than a truly occult pneumothorax where the initial chest radiograph revealed clues suggesting the presence of pneumothorax which were missed by the reading radiologist. The third case emphasizes the fact that "occult pneumothorax is predictable". The presence of subcutaneous emphesema and pulmonary contusion should call for further imaging with CT chest to rule out pneumothorax. Thoracic CT scan is therefore the "gold standard" for early detection of a pneumothorax in trauma patients. This report aims to sensitize readers to the entity of occult pneumothorax and create awareness among intensivists and ER physicians regarding the proper diagnosis and management.

  15. Anteroposterior chest radiograph vs. chest CT scan in early detection of pneumothorax in trauma patients.

    Science.gov (United States)

    Omar, Hesham R; Mangar, Devanand; Khetarpal, Suneel; Shapiro, David H; Kolla, Jaya; Rashad, Rania; Helal, Engy; Camporesi, Enrico M

    2011-09-27

    Pneumothorax is a common complication following blunt chest wall trauma. In these patients, because of the restrictions regarding immobilization of the cervical spine, Anteroposterior (AP) chest radiograph is usually the most feasible initial study which is not as sensitive as the erect chest X-ray or CT chest for detection of a pneumothorax. We will present 3 case reports which serve for better understanding of the entity of occult pneumothorax. The first case is an example of a true occult pneumothorax where an initial AP chest X-ray revealed no evidence of pneumothorax and a CT chest immediately performed revealed evidence of pneumothorax. The second case represents an example of a missed rather than a truly occult pneumothorax where the initial chest radiograph revealed clues suggesting the presence of pneumothorax which were missed by the reading radiologist. The third case emphasizes the fact that "occult pneumothorax is predictable". The presence of subcutaneous emphesema and pulmonary contusion should call for further imaging with CT chest to rule out pneumothorax. Thoracic CT scan is therefore the "gold standard" for early detection of a pneumothorax in trauma patients. This report aims to sensitize readers to the entity of occult pneumothorax and create awareness among intensivists and ER physicians regarding the proper diagnosis and management.

  16. Effects of the steam chest on steamhammer analysis for nuclear piping systems

    International Nuclear Information System (INIS)

    Luk, C.

    1975-01-01

    When applying the method of characteristics for the steamhammer analysis of a nuclear piping system, if the dynamic fluid behavior in the steam chest is not considered, the boundary condition thus formulated to describe the time-dependent fluid behavior of the steam chest would lead to numerical unstable solution. To overcome this difficulty, the dynamic fluid behavior in the steam chest can be described by a single degree mechanical system. The corresponding flow conditions there are then determined by the time-step amplification method. This dynamic boundary condition reduces the calculated steamhammer loads and helps avoid numerical instability problems in the computing procedure. 4 refs

  17. The health-related social costs of alcohol in Belgium.

    Science.gov (United States)

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

    2017-12-16

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

  18. A novel method for improving chest tube insertion skills among medical interns. Using biomaterial-covered mannequin

    Directory of Open Access Journals (Sweden)

    Ozgur Tatli

    2017-10-01

    Full Text Available Objectives: To develop a low-cost biomaterial-covered chest tube simulation model and assess its possible usefulness for developing the chest tube insertion skills among medical interns. Methods: This mannequin-based interventional study was performed in a University hospital setting. We included 63 physicians performing emergency medicine internship at the Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey, between January 2015 and March 2015. A dummy was prepared for training simulation using a display mannequin. Medical interns received instruction concerning pneumothorax and the chest tube procedure. A total of 63 medical interns participating in this interventional study were asked to insert a chest tube in a biomaterial-covered mannequin. A senior trainee scored their performance using a check list and the mean of the total scores was calculated (21 items; total score, 42. Results: The mean procedural score was 40.9 ± 1.3 of a possible 42. The maximum score of 42 was achieved by 39.7% of the medical interns, while another 33.3% achieved a score of 41. Of the participants, 85% succeeded in inserting the tube via an appropriate technique, achieving a score of 40 or more. Conclusion: Our results indicated that this model could be useful for effective training of medical interns for chest tube insertion, which is an important skill in emergency medicine. This biomaterial-covered model is inexpensive and its use can potentially be widened to improve training methods without significant financial demand.

  19. A novel method for improving chest tube insertion skills among medical interns. Using biomaterial-covered mannequin.

    Science.gov (United States)

    Tatli, Ozgur; Turkmen, Suha; Imamoglu, Melih; Karaca, Yunus; Cicek, Mustafa; Yadigaroglu, Metin; Bayrak, Selen T; Asik, Olgun; Topbas, Murat; Turedi, Suleyman

    2017-10-01

    To develop a low-cost biomaterial-covered chest tube simulation model and assess its possible usefulness for developing the chest tube insertion skills among medical interns. Methods: This mannequin-based interventional study was performed in a University hospital setting. We included 63 physicians performing emergency medicine internship at the Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey, between January 2015 and March 2015. A dummy was prepared for training simulation using a display mannequin. Medical interns received instruction concerning pneumothorax and the chest tube procedure. A total of 63 medical interns participating in this interventional study were asked to insert a chest tube in a biomaterial-covered mannequin. A senior trainee scored their performance using a check list and the mean of the total scores was calculated (21 items; total score, 42). Results: The mean procedural score was 40.9 ± 1.3 of a possible 42. The maximum score of 42 was achieved by 39.7% of the medical interns, while another 33.3% achieved a score of 41. Of the participants, 85% succeeded in inserting the tube via an appropriate technique, achieving a score of 40 or more. Conclusion: Our results indicated that this model could be useful for effective training of medical interns for chest tube insertion, which is an important skill in emergency medicine. This biomaterial-covered model is inexpensive and its use can potentially be widened to improve training methods without significant financial demand.

  20. Effects of indirect bandgap top cells in a monolithic cascade cell structure

    Science.gov (United States)

    Curtis, H. B.; Godlewski, M. P.

    1982-01-01

    The effect of having a slightly indirect top cell in a three junction cascade monolithic stack is calculated. The minority carrier continuity equations are utilized to calculate individual junction performance. Absorption coefficient curves for general III-V compounds are calculated for a variety of direct and indirect gap materials. The results indicate that for a small excursion into the indirect region, (about 0.1 eV), the loss of efficiency is acceptably small (less than 2.5 percent) and considerably less than attempting to make the top junction a smaller direct bandgap.

  1. Digital chest radiography

    DEFF Research Database (Denmark)

    Debess, Jeanne Elisabeth; Johnsen, Karen Kirstine; Thomsen, Henrik

    on collimation and dose reduction in digital chest radiography Methods and Materials A retrospective study of digital chest radiography is performed to evaluate the primary x-ray tube collimation of the PA and lateral radiographs. Data from one hundred fifty self-reliant female patients between 15 and 55 years...

  2. Patient-specific radiation dose and cancer risk for pediatric chest CT.

    Science.gov (United States)

    Li, Xiang; Samei, Ehsan; Segars, W Paul; Sturgeon, Gregory M; Colsher, James G; Frush, Donald P

    2011-06-01

    To estimate patient-specific radiation dose and cancer risk for pediatric chest computed tomography (CT) and to evaluate factors affecting dose and risk, including patient size, patient age, and scanning parameters. The institutional review board approved this study and waived informed consent. This study was HIPAA compliant. The study included 30 patients (0-16 years old), for whom full-body computer models were recently created from clinical CT data. A validated Monte Carlo program was used to estimate organ dose from eight chest protocols, representing clinically relevant combinations of bow tie filter, collimation, pitch, and tube potential. Organ dose was used to calculate effective dose and risk index (an index of total cancer incidence risk). The dose and risk estimates before and after normalization by volume-weighted CT dose index (CTDI(vol)) or dose-length product (DLP) were correlated with patient size and age. The effect of each scanning parameter was studied. Organ dose normalized by tube current-time product or CTDI(vol) decreased exponentially with increasing average chest diameter. Effective dose normalized by tube current-time product or DLP decreased exponentially with increasing chest diameter. Chest diameter was a stronger predictor of dose than weight and total scan length. Risk index normalized by tube current-time product or DLP decreased exponentially with both chest diameter and age. When normalized by DLP, effective dose and risk index were independent of collimation, pitch, and tube potential (chest CT protocols. http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11101900/-/DC1. RSNA, 2011

  3. Indirection and computer security.

    Energy Technology Data Exchange (ETDEWEB)

    Berg, Michael J.

    2011-09-01

    The discipline of computer science is built on indirection. David Wheeler famously said, 'All problems in computer science can be solved by another layer of indirection. But that usually will create another problem'. We propose that every computer security vulnerability is yet another problem created by the indirections in system designs and that focusing on the indirections involved is a better way to design, evaluate, and compare security solutions. We are not proposing that indirection be avoided when solving problems, but that understanding the relationships between indirections and vulnerabilities is key to securing computer systems. Using this perspective, we analyze common vulnerabilities that plague our computer systems, consider the effectiveness of currently available security solutions, and propose several new security solutions.

  4. Does the quality of chest compressions deteriorate when the chest compression rate is above 120/min?

    Science.gov (United States)

    Lee, Soo Hoon; Kim, Kyuseok; Lee, Jae Hyuk; Kim, Taeyun; Kang, Changwoo; Park, Chanjong; Kim, Joonghee; Jo, You Hwan; Rhee, Joong Eui; Kim, Dong Hoon

    2014-08-01

    The quality of chest compressions along with defibrillation is the cornerstone of cardiopulmonary resuscitation (CPR), which is known to improve the outcome of cardiac arrest. We aimed to investigate the relationship between the compression rate and other CPR quality parameters including compression depth and recoil. A conventional CPR training for lay rescuers was performed 2 weeks before the 'CPR contest'. CPR anytime training kits were distributed to respective participants for self-training on their own in their own time. The participants were tested for two-person CPR in pairs. The quantitative and qualitative data regarding the quality of CPR were collected from a standardised check list and SkillReporter, and compared by the compression rate. A total of 161 teams consisting of 322 students, which includes 116 men and 206 women, participated in the CPR contest. The mean depth and rate for chest compression were 49.0±8.2 mm and 110.2±10.2/min. Significantly deeper chest compression depths were noted at rates over 120/min than those at any other rates (47.0±7.4, 48.8±8.4, 52.3±6.7, p=0.008). Chest compression depth was proportional to chest compression rate (r=0.206, pcompression including chest compression depth and chest recoil by chest compression rate. Further evaluation regarding the upper limit of the chest compression rate is needed to ensure complete full chest wall recoil while maintaining an adequate chest compression depth. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  5. Cost effectiveness analysis of immunotherapy in patients with grass pollen allergic rhinoconjunctivitis in Germany.

    Science.gov (United States)

    Westerhout, K Y; Verheggen, B G; Schreder, C H; Augustin, M

    2012-01-01

    An economic evaluation was conducted to assess the outcomes and costs as well as cost-effectiveness of the following grass-pollen immunotherapies: OA (Oralair; Stallergenes S.A., Antony, France) vs GRZ (Grazax; ALK-Abelló, Hørsholm, Denmark), and ALD (Alk Depot SQ; ALK-Abelló) (immunotherapy agents alongside symptomatic medication) and symptomatic treatment alone for grass pollen allergic rhinoconjunctivitis. The costs and outcomes of 3-year treatment were assessed for a period of 9 years using a Markov model. Treatment efficacy was estimated using an indirect comparison of available clinical trials with placebo as a common comparator. Estimates for immunotherapy discontinuation, occurrence of asthma, health state utilities, drug costs, resource use, and healthcare costs were derived from published sources. The analysis was conducted from the insurant's perspective including public and private health insurance payments and co-payments by insurants. Outcomes were reported as quality-adjusted life years (QALYs) and symptom-free days. The uncertainty around incremental model results was tested by means of extensive deterministic univariate and probabilistic multivariate sensitivity analyses. In the base case analysis the model predicted a cost-utility ratio of OA vs symptomatic treatment of €14,728 per QALY; incremental costs were €1356 (95%CI: €1230; €1484) and incremental QALYs 0.092 (95%CI: 0.052; 0.140). OA was the dominant strategy compared to GRZ and ALD, with estimated incremental costs of -€1142 (95%CI: -€1255; -€1038) and -€54 (95%CI: -€188; €85) and incremental QALYs of 0.015 (95%CI: -0.025; 0.056) and 0.027 (95%CI: -0.022; 0.075), respectively. At a willingness-to-pay threshold of €20,000, the probability of OA being the most cost-effective treatment was predicted to be 79%. Univariate sensitivity analyses show that incremental outcomes were moderately sensitive to changes in efficacy estimates. The main study limitation was the

  6. The effect of time-of-day and chest physiotherapy on multiple breath washout measures in children with clinically stable cystic fibrosis.

    Science.gov (United States)

    Voldby, Christian; Green, Kent; Rosthøj, Susanne; Kongstad, Thomas; Philipsen, Lue; Buchvald, Frederik; Skov, Marianne; Pressler, Tania; Gustafsson, Per; Nielsen, Kim G

    2018-01-01

    In this pilot study we investigated daytime variation of multiple breath nitrogen washout (N2MBW) measures in children with clinically stable cystic fibrosis. To our knowledge the effect of time-of-day on multiple breath washout measures in patients with cystic fibrosis has not previously been reported. Furthermore, we assessed the influence of chest physiotherapy on N2MBW measures. Ten school children with cystic fibrosis performed N2MBW followed by spirometry and plethysmography in the morning and afternoon at three visits that were one month apart. Chest physiotherapy was performed immediately before the afternoon measurements at visit 2 and immediately before morning and afternoon measurements at visit 3. The influence of time-of-day and chest physiotherapy on the measures was evaluated using linear mixed models. There were adequate quality data from 8 children with median age (range) 9.6 (6.0; 15.1) years. Baseline lung clearance index (LCI) (range) was 9.0 (7.1; 13.0) and baseline FEV1% predicted was 97.5 (78.5; 117.9). No N2MBW measures were significantly influenced by time-of-day or chest physiotherapy. LCI (95% confidence interval) decreased non-significantly 0.05 (-0.32; 0.22) during the day and increased non-significantly 0.08 (-0.26; 0.42) after chest physiotherapy. All spirometric measures were unaffected by time-of-day and chest physiotherapy. For plethysmographic measures FRCpleth decreased significantly (pphysiotherapy performed immediately prior to N2MBW had no consistent or significant influence on N2MBW measures. However, we emphasize that further studies of the effect of both daytime variation and the effect of chest physiotherapy on multiple breath washout measures are warranted.

  7. Cost-effectiveness of SHINE: A Telephone Translation of the Diabetes Prevention Program

    Directory of Open Access Journals (Sweden)

    Christopher S. Hollenbeak

    2016-01-01

    Full Text Available Background The Support, Health Information, Nutrition, and Exercise (SHINE trial recently showed that a telephone adaptation of the Diabetes Prevention Program (DPP lifestyle intervention was effective in reducing weight among patients with metabolic syndrome. The aim of this study is to determine whether a conference call (CC adaptation was cost effective relative to an individual call (IC adaptation of the DPP lifestyle intervention in the primary care setting. Methods We performed a stochastic cost-effectiveness analysis alongside a clinical trial comparing two telephone adaptations of the DPP lifestyle intervention. The primary outcomes were incremental cost-effectiveness ratios estimated for weight loss, body mass index (BMI, waist circumference, and quality-adjusted life years (QALYs. Costs were estimated from the perspective of society and included direct medical costs, indirect costs, and intervention costs. Results After one year, participants receiving the CC intervention accumulated fewer costs ($2,831 vs. $2,933 than the IC group, lost more weight (6.2 kg vs. 5.1 kg, had greater reduction in BMI (2.1 vs. 1.9, and had greater reduction in waist circumference (6.5 cm vs. 5.9 cm. However, participants in the CC group had fewer QALYs than those in the IC group (0.635 vs. 0.646. The incremental cost-effectiveness ratio for CC vs. IC was $9,250/QALY, with a 48% probability of being cost-effective at a willingness-to-pay of $100,000/QALY. Conclusions CC delivery of the DPP was cost effective relative to IC delivery in the first year in terms of cost per clinical measure (weight lost, BMI, and waist circumference but not in terms of cost per QALY, most likely because of the short time horizon.

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

    Science.gov (United States)

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

    2004-07-01

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

  9. Safety and efficacy of 2,790-nm laser resurfacing for chest photoaging.

    Science.gov (United States)

    Grunebaum, Lisa D; Murdock, Jennifer; Cofnas, Paul; Kaufman, Joely

    2015-01-01

    Chest photodamage is a common cosmetic complaint. Laser treatment of the chest may be higher risk than other areas. The objective of this study was to assess the safety and efficacy of 2,790-nm chest resurfacing for photodamage. Twelve patients with Fitzpatrick skin types I-III were enrolled in this university IRB-approved study. Photo documentation was obtained at baseline and each visit. A test spot with the 2,790-nm resurfacing laser was performed on the chest. Patients who did not have adverse effects from the test spot went on to have a full chest resurfacing procedure. Patients were instructed on standardized aftercare, including sunscreen. A 5-point healing and photodamage improvement scale was used to rate improvement by both investigators and the patients and was obtained at 2 weeks, 1 month, 2 months, and 3 months. One pass chest treatment with the 2,790-nm resurfacing laser at fluences greater than or equal to 3.0 mJ with 10% overlap leads to unacceptable rates of hyperpigmentation. Double pass chest treatment at fluences less than or equal to 2.5 mJ with 10% overlap leads to mild improvement in chest photodamage parameters without significant or persistent adverse effects. Laser treatment of aging/photodamaged chest skin remains a challenge due to the delicacy of chest skin. Mild improvement may be obtained with double pass resurfacing with the 2,790-nm wavelength.

  10. Effect of automatic exposure control marker with chest radiography in radiation reduction

    International Nuclear Information System (INIS)

    Jung, Ji Sang; Choi, Byoung Wook; Shim, Ji Na; Ahn, Ho Sik; Jin, Duk Eun; Liml, Jae Sik; Kang, Sung Ho; Kim, Sung Ho; Kim, Young Mo

    2014-01-01

    This study focused on effects of patient exposure dose reduction with AEC (Auto Exposure Control) marker that is designed for showing location of AEC in X-ray Chest radiography. It included 880 adults who have to use Chest X-ray Digital Radiography system (DRS, LISTEM, Korea). AEC (Ion chambers are posited in top of both sides) are used to every adult and set X-ray system as Field size 17 x 17 inch, 120 kVp, FFD 180 cm. 440 people of control group are posited on detector to include both sides of lung field and the other 440 people of experimental group are set to contact their lung directly to Ion chamber (making marker to shows location). Then, measured every DAP and, estimated patient effective dose by using PCXMC 2.0. The average age of control group (M:F=245:195) is 53.9 and the average BMI is 23.4. BMI ranges from under weight: 35, normal range: 279, over weight: 106 to obese: 20 and average DAP is 223.56 mGycm2, Mean effective dose is 0.045 mSv. The average age of experimental group (M:F=197:243) is 53.7 and the average BMI is 22.7. BMI ranges from under weight: 34, normal range: 315, over weight: 85 to obese: 6 and average DAP is 207.36 mGycm2, Mean effective dose is 0.041 mSv. Experimental group shows less Mean effective dose as 0.004mSv (9.7%) than control group. Also, patient numbers who got over exposure more than 0.056 mSv (limit point to know efficiency of AEC marker) is 65 in control group(14.7%), 19 in experimental group (4.3%) and take statistics with t-Test. The statistical difference between two groups is 0.006. In order to use proper amount of X-ray in auto exposure controlled chest X-ray system, matching location between ion chamber and body part is needed, and using AEC marker (designed for showing location of ion chamber) is a way to reduce unnecessary patient exposure dose

  11. Effect of automatic exposure control marker with chest radiography in radiation reduction

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Ji Sang; Choi, Byoung Wook; Shim, Ji Na; Ahn, Ho Sik; Jin, Duk Eun; Liml, Jae Sik; Kang, Sung Ho [Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Kim, Sung Ho [LISTEM, Woonju (Korea, Republic of); Kim, Young Mo [Dept. of Biomedical Engineering, Konyang University, Nonsan (Korea, Republic of)

    2014-09-15

    This study focused on effects of patient exposure dose reduction with AEC (Auto Exposure Control) marker that is designed for showing location of AEC in X-ray Chest radiography. It included 880 adults who have to use Chest X-ray Digital Radiography system (DRS, LISTEM, Korea). AEC (Ion chambers are posited in top of both sides) are used to every adult and set X-ray system as Field size 17 x 17 inch, 120 kVp, FFD 180 cm. 440 people of control group are posited on detector to include both sides of lung field and the other 440 people of experimental group are set to contact their lung directly to Ion chamber (making marker to shows location). Then, measured every DAP and, estimated patient effective dose by using PCXMC 2.0. The average age of control group (M:F=245:195) is 53.9 and the average BMI is 23.4. BMI ranges from under weight: 35, normal range: 279, over weight: 106 to obese: 20 and average DAP is 223.56 mGycm2, Mean effective dose is 0.045 mSv. The average age of experimental group (M:F=197:243) is 53.7 and the average BMI is 22.7. BMI ranges from under weight: 34, normal range: 315, over weight: 85 to obese: 6 and average DAP is 207.36 mGycm2, Mean effective dose is 0.041 mSv. Experimental group shows less Mean effective dose as 0.004mSv (9.7%) than control group. Also, patient numbers who got over exposure more than 0.056 mSv (limit point to know efficiency of AEC marker) is 65 in control group(14.7%), 19 in experimental group (4.3%) and take statistics with t-Test. The statistical difference between two groups is 0.006. In order to use proper amount of X-ray in auto exposure controlled chest X-ray system, matching location between ion chamber and body part is needed, and using AEC marker (designed for showing location of ion chamber) is a way to reduce unnecessary patient exposure dose.

  12. Imaging of blunt chest trauma

    International Nuclear Information System (INIS)

    Prosch, H.; Negrin, L.

    2014-01-01

    Blunt chest trauma is associated with high morbidity and mortality. Consequently, all patients should be evaluated radiologically after blunt chest trauma to allow timely and appropriate treatment. Conventional chest radiographs and computed tomography (CT) are proven modalities with which to evaluate patients after blunt chest trauma. Over the last several years extended focused assessment with sonography for trauma (eFAST) has gained increasing importance for the initial assessment of seriously injured patients. In the acute phase of severely injured patients eFAST examinations are helpful to exclude pneumothorax, hemothorax and hemopericardium. Chest radiographs may also be used to diagnose a pneumothorax or hemothorax; however, the sensitivity is limited and CT is the diagnostic modality of choice to evaluate severely injured patients. (orig.) [de

  13. Anteroposterior chest radiograph vs. chest CT scan in early detection of pneumothorax in trauma patients

    OpenAIRE

    Omar, Hesham R; Mangar, Devanand; Khetarpal, Suneel; Shapiro, David H; Kolla, Jaya; Rashad, Rania; Helal, Engy; Camporesi, Enrico M

    2011-01-01

    Abstract Pneumothorax is a common complication following blunt chest wall trauma. In these patients, because of the restrictions regarding immobilization of the cervical spine, Anteroposterior (AP) chest radiograph is usually the most feasible initial study which is not as sensitive as the erect chest X-ray or CT chest for detection of a pneumothorax. We will present 3 case reports which serve for better understanding of the entity of occult pneumothorax. The first case is an example of a tru...

  14. Assessing the aerosol direct and first indirect effects using ACM/GCM simulation results

    Science.gov (United States)

    Huang, H.; Gu, Y.; Xue, Y.; Lu, C. H.

    2016-12-01

    Atmospheric aerosols have been found to play an important role in global climate change but there are still large uncertainty in evaluating its role in the climate system. The aerosols generally affect global and regional climate through the scattering and the absorption of solar radiation (direct effect) and through their influences on cloud particle, number and sizes (first indirect effect). The indirect effect will further affects cloud water content, cloud top albedo and surface precipitations. In this study, we investigate the global climatic effect of aerosols using a coupled NCEP Global Forecast System (GFS) and a land surface model (SSiB2) The OPAC (Optical Properties of Aerosols and Clouds) database is used for aerosol effect. The OPAC data provides the optical properties (i.e., the extinction, scattering and absorption coefficient, single-scattering albedo, asymmetry factor and phase function) of ten types of aerosols under various relative humidity conditions for investigating the global direct and first indirect effects of dust aerosols. For indirect forcings due to liquid water, we follow the approach presented by Jiang et al (2011), in which a parameterization of cloud effective radius was calculated to describe its variance with convective strength and aerosol concentration. Since the oceans also play an important role on aerosol climatic effect, we also design a set of simulations using a coupled atmosphere/ocean model (CFS) to evaluate the sensitivity of aerosol effect with two-way atmosphere-ocean interactions.

  15. Effect of timing and duration of a single chest compression pause on short-term survival following prolonged ventricular fibrillation.

    Science.gov (United States)

    Walcott, Gregory P; Melnick, Sharon B; Walker, Robert G; Banville, Isabelle; Chapman, Fred W; Killingsworth, Cheryl R; Ideker, Raymond E

    2009-04-01

    Pauses during chest compressions are thought to have a detrimental effect on resuscitation outcome. The Guidelines 2005 have recently eliminated the post-defibrillation pause. Previous animal studies have shown that multiple pauses of increasing duration decrease resuscitation success. We investigated the effect of varying the characteristics of a single pause near defibrillation on resuscitation outcome. Part A: 48 swine were anesthetized, fibrillated for 7min and randomized. Chest compressions were initiated for 90s followed by defibrillation and then resumption of chest compressions. Four groups were studied-G2000: 40s pause beginning 20s before, and ending 20s after defibrillation, A1: a 20s pause just before defibrillation, A2: a 20s pause ending 30s prior to defibrillation, and group A3: a 10s pause ending 30s prior to defibrillation. Part B: 12 swine (Group B) were studied with a protocol identical to Part A but with no pause in chest compressions. Primary endpoint was survival to 4h. The survival rate was significantly higher for groups A1, A2, A3, and B (5/12, 7/12, 5/12, and 5/12 survived) than for the G2000 group (0/12, p<0.05). Survival did not differ significantly among groups A1, A2, A3, and B. These results suggest that the Guidelines 2005 recommendation to omit the post-shock pulse check and immediately resume chest compressions may be an important resuscitation protocol change. However, these results also suggest that clinical maneuvers further altering a single pre-shock chest compression pause provide no additional benefit.

  16. Effect of timing and duration of a single chest compression pause on short-term survival following prolonged ventricular fibrillation☆

    Science.gov (United States)

    Walcott, Gregory P.; Melnick, Sharon B.; Walker, Robert G.; Banville, Isabelle; Chapman, Fred W.; Killingsworth, Cheryl R.; Ideker, Raymond E.

    2014-01-01

    Background Pauses during chest compressions are thought to have a detrimental effect on resuscitation outcome. The Guidelines 2005 have recently eliminated the post-defibrillation pause. Previous animal studies have shown that multiple pauses of increasing duration decrease resuscitation success. We investigated the effect of varying the characteristics of a single pause near defibrillation on resuscitation outcome. Methods Part A: 48 swine were anesthetized, fibrillated for 7 min and randomized. Chest compressions were initiated for 90 s followed by defibrillation and then resumption of chest compressions. Four groups were studied—G2000: 40 s pause beginning 20 s before, and ending 20 s after defibrillation, A1: a 20 s pause just before defibrillation, A2: a 20 s pause ending 30 s prior to defibrillation, and group A3: a 10 s pause ending 30 s prior to defibrillation. Part B: 12 swine (Group B) were studied with a protocol identical to Part A but with no pause in chest compressions. Primary endpoint was survival to 4 h. Results The survival rate was significantly higher for groups A1, A2, A3, and B (5/12, 7/12, 5/12, and 5/12 survived) than for the G2000 group (0/12, p < 0.05). Survival did not differ significantly among groups A1, A2, A3, and B. Conclusions These results suggest that the Guidelines 2005 recommendation to omit the post-shock pulse check and immediately resume chest compressions may be an important resuscitation protocol change. However, these results also suggest that clinical maneuvers further altering a single pre-shock chest compression pause provide no additional benefit. PMID:19185411

  17. Objective quantification of pulmonary effects in X-ray chest images

    International Nuclear Information System (INIS)

    Oliveira, Marcela de; Giacomini, Guilherme; Alvarez, Matheus; Pereira, Paulo M.C.; Ribeiro, Sergio M.; Pina, Diana R. de

    2016-01-01

    Tuberculosis (TB) is an infectious lung disease of great concern worldwide. Even after treatment, TB leaves pulmonary sequelae that compromise the quality of life of patients. The exam of diagnostic imaging done more frequently is the X-ray chest. The evaluation of pulmonary involvement of these patients is performed visually by the radiologist. The detection and quantification aided by computer systems are of great importance for the more accurate assessment of pulmonary involvement. The objective of this study was to evaluate computationally the reduction of lung damage in X-ray of chest in patients treated with two different medication regimens. (author)

  18. Cost-of-illness studies.

    Science.gov (United States)

    Oderda, Gary M

    2003-01-01

    Cost-of-illness studies measure the overall economic impact of a disease on society. Such studies are important in setting public health priorities and for economic evaluation of new treatments. These studies should take the societal perspective and include both direct and indirect costs. Often indirect costs exceed direct costs. Comparison of cost-of-illness studies from different countries is difficult because of differences in population, currency, the way health care is provided, and other social and political factors.

  19. Odour-based context reinstatement effects with indirect measures of memory: the curious case of rosemary.

    Science.gov (United States)

    Ball, Linden J; Shoker, Jaswinder; Miles, Jeremy N V

    2010-11-01

    Previous studies examining environmental context-dependent memory (ECDM) effects using indirect measures of memory have produced inconsistent findings. We report three experiments that examined ECDM in an indirect memory paradigm (word-fragment completion) using ambient odours as environmental contexts. Expt 1 manipulated the odour present at learning and testing (rosemary or lemon) to produce reinstated-context or switched-context conditions. Reinstating rosemary led to a striking ECDM effect, indicating that indirect memory testing can be sensitive to ECDM manipulations. Odour ratings also indicated that rosemary induced a more unpleasant mood in participants than lemon. Expt 2 assessed the influence on indirect retrieval of odour-based mood induction as well as odour distinctiveness, and indicated that rosemary's capacity to promote ECDM effects appears to arise from an additive combination of its unpleasantness-inducing properties and its distinctiveness. Expt 3 partially supported these proposals. Overall, our findings indicate that some odours are capable of producing ECDM effects using indirect testing procedures. Moreover, it appears that it is the inherent proprieties of odours on dimensions such as unpleasantness and distinctiveness that mediate the emergence of ECDM effects, thereby explaining the particular potency of rosemary's mnemonic influence when it is reinstated.

  20. The effect of Tc99m Sestamibi scans during acute chest pain on clinical management

    International Nuclear Information System (INIS)

    Baldey, A.; Cameron, P.; Grigg, L.; Knott, J.; Better, N.

    1998-01-01

    Full text: The aim of this study is to assess whether the increased sensitivity and specificity of Tc99m sestamibi scans, during acute chest pain, will lead to alteration in clinical management and potential cost saving in an Australian population. Consecutive patients who presented with acute chest pain were injected 800 MBq of Tc99m sestamibi during pain (Hot MlBI) and SPECT imaging performed 1-6 hours later. The population was those only with a 'intermediate risk' of myocardial ischaemia The patients included in patients, those in the Emergency Department, and those with a previous history of cardiac disease. 25% of patients required a second, pain free study the following day to differentiate acute ischaemia from prior infarction. A question sheet was filled out by the requesting physician prior to the study indicating the likelihood of cardiac disease and the proposed management if no 'Hot MIBI' scan was available. The treatment that the patient subsequently received was ascertained from the patient's medical record. Of the 28 patients, a prediction whether to or not to proceed to coronary angiography was made in 13 patients prior to the MIBI study being performed. Of the 13, 5 would have had coronary angiography performed. and in all 5, the decision to proceed to coronary angiography was averted by the 'Hot MIBI'. Of note, 3 patients were admitted purely because of an abnormal 'Hot MIBI'. The 'Hot MIBI' was able to reduce coronary care admissions by 83% reduce all admissions by 17%, and avert coronary angiography in 38% of patients. In this intermediate risk category patient, this translates to not only admissions saved but potential cost saving

  1. Non-Invasive Mechanic Ventilation Using in Flail Chest, Caused By Blunt Chest Trauma

    Directory of Open Access Journals (Sweden)

    Serdar Onat

    2008-01-01

    Full Text Available A 75-year-old woman admitted our faculty emergency room with shortness of breath, and chest pain after traffic accident’s second hour. She was diagnosed as bilateral multipl rib fractures, left clavicula fracture, and left flail chest by phsical and radiological examinations. She was transfered to Chest Surgery Depatment’s intensive care unit. The patient was undergone non-invasive mask mechanic ventilation support, because of the decreasing of blood oxygen saturation and increasing of arteriel blood partial carbondioxide pressure. The treatment of non-invasive mechanic ventilation was succesfull for ventilation support. With this report, we would like to attentioned that non-invasive mechanic ventilation for blunt chest trauma patients could be used succesfully and could be used instead of endotracheal invasive mechanic ventilation.

  2. Computer-Aided Detection of Malignant Lung Nodules on Chest Radiographs: Effect on Observers' Performance

    International Nuclear Information System (INIS)

    Lee, Kyung Hee; Goo, Jin Mo; Park, Chang Min; Lee, Hyun Ju; Jin, Kwang Nam

    2012-01-01

    To evaluate the effect of computer-aided detection (CAD) system on observer performance in the detection of malignant lung nodules on chest radiograph. Two hundred chest radiographs (100 normal and 100 abnormal with malignant solitary lung nodules) were evaluated. With CT and histological confirmation serving as a reference, the mean nodule size was 15.4 mm (range, 7-20 mm). Five chest radiologists and five radiology residents independently interpreted both the original radiographs and CAD output images using the sequential testing method. The performances of the observers for the detection of malignant nodules with and without CAD were compared using the jackknife free-response receiver operating characteristic analysis. Fifty-nine nodules were detected by the CAD system with a false positive rate of 1.9 nodules per case. The detection of malignant lung nodules significantly increased from 0.90 to 0.92 for a group of observers, excluding one first-year resident (p = 0.04). When lowering the confidence score was not allowed, the average figure of merit also increased from 0.90 to 0.91 (p = 0.04) for all observers after a CAD review. On average, the sensitivities with and without CAD were 87% and 84%, respectively; the false positive rates per case with and without CAD were 0.19 and 0.17, respectively. The number of additional malignancies detected following true positive CAD marks ranged from zero to seven for the various observers. The CAD system may help improve observer performance in detecting malignant lung nodules on chest radiographs and contribute to a decrease in missed lung cancer.

  3. Utility of routine postoperative chest radiography in pediatric tracheostomy.

    Science.gov (United States)

    Genther, Dane J; Thorne, Marc C

    2010-12-01

    Routine chest radiography following pediatric tracheostomy is commonly performed in order to evaluate for air-tracking complications. Routine chest radiography affords disadvantages of radiation exposure and cost. The primary objective of this study was to determine the utility of routine postoperative chest radiography following tracheostomy in pediatric patients. Secondary objectives were to compare the rates of postoperative complications by various patient and surgeon characteristics. All infants and children 18 years of age or less (n=421) who underwent tracheostomy at a single tertiary-care medical center from January 2000 to April 2009 were included in the study. A combination of data obtained from billing and administrative systems and review of electronic medical records were recorded and compiled in a database for statistical analysis. Three air-tracking complications (2 pneumothoraces and 1 pneumomediastinum) were identified in our population of 421 pediatric patients, for an incidence of 0.71% (95% CI: 0.1-2.0%). No significant relationships were found between the incidence of air-tracking complication and surgical specialty, patient age, or type of procedure (elective, urgent/emergent). Our study identified a low rate of pneumothorax and pneumomediastinum following pediatric tracheostomy. In all three cases, the pneumothorax was suspected clinically. This finding suggests that postoperative chest radiography should be reserved for cases where there is suspicion of a complication on the basis of intraoperative findings or clinical parameters. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  4. Is aggressive treatment of traumatic brain injury cost-effective?

    Science.gov (United States)

    Whitmore, Robert G; Thawani, Jayesh P; Grady, M Sean; Levine, Joshua M; Sanborn, Matthew R; Stein, Sherman C

    2012-05-01

    The object of this study was to determine whether aggressive treatment of severe traumatic brain injury (TBI), including invasive intracranial monitoring and decompressive craniectomy, is cost-effective. A decision-analytical model was created to compare costs, outcomes, and cost-effectiveness of 3 strategies for treating a patient with severe TBI. The aggressive-care approach is compared with "routine care," in which Brain Trauma Foundation guidelines are not followed. A "comfort care" category, in which a single day in the ICU is followed by routine floor care, is included for comparison only. Probabilities of each treatment resulting in various Glasgow Outcome Scale (GOS) scores were obtained from the literature. The GOS scores were converted to quality-adjusted life years (QALYs), based on expected longevity and calculated quality of life associated with each GOS category. Estimated direct (acute and long-term medical care) and indirect (loss of productivity) costs were calculated from the perspective of society. Sensitivity analyses employed a 2D Monte Carlo simulation of 1000 trials, each with 1000 patients. The model was also used to estimate these values for patients 40, 60, and 80 years of age. For the average 20-year-old, aggressive care yields 11.7 (± 1.6 [SD]) QALYs, compared with routine care (10.0 ± 1.5 QALYs). This difference is highly significant (p care remains significantly better at all ages. When all costs are considered, aggressive care is also significantly less costly than routine care ($1,264,000 ± $118,000 vs $1,361,000 ± $107,000) for the average 20-year-old. Aggressive care remains significantly less costly until age 80, at which age it costs more than routine care. However, even in the 80-year-old, aggressive care is likely the more cost-effective approach. Comfort care is associated with poorer outcomes at all ages and with higher costs for all groups except 80-year-olds. When all the costs of severe TBI are considered, aggressive

  5. Controlling Healthcare Costs: Just Cost Effectiveness or "Just" Cost Effectiveness?

    Science.gov (United States)

    Fleck, Leonard M

    2018-04-01

    Meeting healthcare needs is a matter of social justice. Healthcare needs are virtually limitless; however, resources, such as money, for meeting those needs, are limited. How then should we (just and caring citizens and policymakers in such a society) decide which needs must be met as a matter of justice with those limited resources? One reasonable response would be that we should use cost effectiveness as our primary criterion for making those choices. This article argues instead that cost-effectiveness considerations must be constrained by considerations of healthcare justice. The goal of this article will be to provide a preliminary account of how we might distinguish just from unjust or insufficiently just applications of cost-effectiveness analysis to some healthcare rationing problems; specifically, problems related to extraordinarily expensive targeted cancer therapies. Unconstrained compassionate appeals for resources for the medically least well-off cancer patients will be neither just nor cost effective.

  6. Cost-effectiveness of intensified versus conventional multifactorial intervention in type 2 diabetes: results and projections from the Steno-2 study

    DEFF Research Database (Denmark)

    Gaede, Peter; Valentine, William J; Palmer, Andrew J

    2008-01-01

    and account Danish-specific costs to project life expectancy, quality-adjusted life expectancy (QALE), and lifetime direct medical costs expressed in year 2005 Euros. Clinical and cost outcomes were projected over patient lifetimes and discounted at 3% annually. Sensitivity analyses were performed. RESULTS...... gained. This is considered a conservative estimate because accounting prescription of generic drugs and capturing indirect costs would further favor intensified therapy. CONCLUSIONS: From a health care payer perspective in Denmark, intensive therapy was more cost-effective than conventional treatment...

  7. Effectiveness comparison of inferior alveolar nerve block anesthesia using direct and indirect technique

    Directory of Open Access Journals (Sweden)

    Rehatta Yongki

    2016-12-01

    Full Text Available Local anesthesia is important to do prior to tooth extraction procedure to control the patient's pain. Local anesthetic technique in dentistry consists of topical, infiltration, and anesthetic blocks. For molar tooth extraction, mandibular block technique is used either direct or indirect. This study aimed to see if there are differences in effectiveness of inferior alveolar nerve block anesthesia techniques between direct and indirect. This clinical experimental design study used 20 patients as samples during February-April. 10 patients were taken as a group that carried out direct technique while 10 others group conducted indirect techniques. The sample selection using purposive sampling method. Pain level were measured using objective assessments (pain experienced by the patient after a given stimulus and subjective evaluation (thick taste perceived by the patient. The average time of onset in direct and indirect techniques in each sample was 16.88 ± 5.30 and 102.00 ± 19.56 seconds (subjectively and 22.50 ± 8.02 and 159.00 ± 25.10 (objectively. These results indicated direct techniques onset faster than indirect techniques. The average duration of direct and indirect techniques respectively was 121.63 ± 8.80 and 87.80 ± 9.96 minutes (subjectively and 91.88 ± 8.37 and 60.20 ± 10.40 minutes (objectively. These results indicated the duration of direct technique is longer than indirect technique. There was no significant difference when viewed from anesthesia depth and aspiration level. This study indicated that direct technique had better effect than indirect technique in terms of onset and duration, while in terms of anesthesia depth and aspiration level was relatively equal. Insignificant differences were obtained when assessing anesthetic technique successful rate based on gender, age and extracted tooth.

  8. Costs and cost-effectiveness of periviable care.

    Science.gov (United States)

    Caughey, Aaron B; Burchfield, David J

    2014-02-01

    With increasing concerns regarding rapidly expanding healthcare costs, cost-effectiveness analysis allows assessment of whether marginal gains from new technology are worth the increased costs. Particular methodologic issues related to cost and cost-effectiveness analysis in the area of neonatal and periviable care include how costs are estimated, such as the use of charges and whether long-term costs are included; the challenges of measuring utilities; and whether to use a maternal, neonatal, or dual perspective in such analyses. A number of studies over the past three decades have examined the costs and the cost-effectiveness of neonatal and periviable care. Broadly, while neonatal care is costly, it is also cost effective as it produces both life-years and quality-adjusted life-years (QALYs). However, as the gestational age of the neonate decreases, the costs increase and the cost-effectiveness threshold is harder to achieve. In the periviable range of gestational age (22-24 weeks of gestation), whether the care is cost effective is questionable and is dependent on the perspective. Understanding the methodology and salient issues of cost-effectiveness analysis is critical for researchers, editors, and clinicians to accurately interpret results of the growing body of cost-effectiveness studies related to the care of periviable pregnancies and neonates. Copyright © 2014 Elsevier Inc. All rights reserved.

  9. Evaluating aerosol indirect effect through marine stratocumulus clouds

    Energy Technology Data Exchange (ETDEWEB)

    Kogan, Z.N.; Kogan, Y.L.; Lilly, D.K. [Univ. of Oklahoma, Norman, OK (United States)

    1996-04-01

    During the last decade much attention has been focused on anthropogenic aerosols and their radiative influence on the global climate. Charlson et al. and Penner et al. have demonstrated that tropospheric aerosols and particularly anthropogenic sulfate aerosols may significantly contribute to the radiative forcing exerting a cooling influence on climate (-1 to -2 W/m{sup 2}) which is comparable in magnitude to greenhouse forcing, but opposite in sign. Aerosol particles affect the earth`s radiative budget either directly by scattering and absorption of solar radiation by themselves or indirectly by altering the cloud radiative properties through changes in cloud microstructure. Marine stratocumulus cloud layers and their possible cooling influence on the atmosphere as a result of pollution are of special interest because of their high reflectivity, durability, and large global cover. We present an estimate of thet aerosol indirect effect, or, forcing due to anthropogenic sulfate aerosols.

  10. Abstract: Inference and Interval Estimation for Indirect Effects With Latent Variable Models.

    Science.gov (United States)

    Falk, Carl F; Biesanz, Jeremy C

    2011-11-30

    Models specifying indirect effects (or mediation) and structural equation modeling are both popular in the social sciences. Yet relatively little research has compared methods that test for indirect effects among latent variables and provided precise estimates of the effectiveness of different methods. This simulation study provides an extensive comparison of methods for constructing confidence intervals and for making inferences about indirect effects with latent variables. We compared the percentile (PC) bootstrap, bias-corrected (BC) bootstrap, bias-corrected accelerated (BC a ) bootstrap, likelihood-based confidence intervals (Neale & Miller, 1997), partial posterior predictive (Biesanz, Falk, and Savalei, 2010), and joint significance tests based on Wald tests or likelihood ratio tests. All models included three reflective latent variables representing the independent, dependent, and mediating variables. The design included the following fully crossed conditions: (a) sample size: 100, 200, and 500; (b) number of indicators per latent variable: 3 versus 5; (c) reliability per set of indicators: .7 versus .9; (d) and 16 different path combinations for the indirect effect (α = 0, .14, .39, or .59; and β = 0, .14, .39, or .59). Simulations were performed using a WestGrid cluster of 1680 3.06GHz Intel Xeon processors running R and OpenMx. Results based on 1,000 replications per cell and 2,000 resamples per bootstrap method indicated that the BC and BC a bootstrap methods have inflated Type I error rates. Likelihood-based confidence intervals and the PC bootstrap emerged as methods that adequately control Type I error and have good coverage rates.

  11. Two cases of Chest Heating Sensation treated by Hwangryunhaedok-tang Herbal-Acupuncture

    Directory of Open Access Journals (Sweden)

    Gwon-Il Cho

    2003-06-01

    Full Text Available The purpose of this study is to evaluate the clinical effect of Hwangryunhaedok-tang Herbal-Acupuncture. Hwangryunhaedok-tang is used in all heating diseases. Chest Heating Sensation is a unique concept in Oriental Medicine. So we applied Hwangryunhaedok-tang Herbal-Acupuncture to treat the Chest Heating Sensation. We used DITI(Digital Infrared Thermographic Imaging to estimate the temperatures of chest surface for the outcome assessment. We came to know that the chest surface temperatures were all reduced in both cases after Herbal-Acupuncture treatment. The reduced average temperature was 1.5℃ in case 1 and 0.9℃ in case 2. The above result indicates that Hwangryunhaedok-tang Herbal-Acupuncture treatment has an effect on Chest Heating Sensation, thus continuous Hwangryunhaedok-tang Herbal-Acupuncture study will be needed for more clinical applications.

  12. MRI of the Chest

    Medline Plus

    Full Text Available ... are the limitations of MRI of the Chest? What is MRI of the Chest? Magnetic resonance imaging ( ... heart, valves, great vessels, etc.). top of page What are some common uses of the procedure? MR ...

  13. MRI of the Chest

    Medline Plus

    Full Text Available ... to assess the anatomy and function of the heart and its blood flow. Tell your doctor about ... chest cavity, including the mediastinum , chest wall, pleura, heart and vessels, from almost any angle. MRI also ...

  14. Dose and perceived image quality in chest radiography

    International Nuclear Information System (INIS)

    Veldkamp, Wouter J.H.; Kroft, Lucia J.M.; Geleijns, Jacob

    2009-01-01

    Chest radiography is the most commonly performed diagnostic X-ray examination. The radiation dose to the patient for this examination is relatively low but because of its frequent use, the contribution to the collective dose is considerable. Consequently, optimization of dose and image quality offers a challenging area of research. In this article studies on dose reduction, different detector technologies, optimization of image acquisition and new technical developments in image acquisition and post processing will be reviewed. Studies indicate that dose reduction in PA chest images to at least 50% of commonly applied dose levels does not affect diagnosis in the lung fields; however, dose reduction in the mediastinum, upper abdomen and retrocardiac areas appears to directly deteriorate diagnosis. In addition to patient dose, also the design of the various digital detectors seems to have an effect on image quality. With respect to image acquisition, studies showed that using a lower tube voltage improves visibility of anatomical structures and lesions in digital chest radiographs but also increases the disturbing appearance of ribs. New techniques that are currently being evaluated are dual energy, tomosynthesis, temporal subtraction and rib suppression. These technologies may improve diagnostic chest X-ray further. They may for example reduce the negative influence of over projection of ribs, referred to as anatomic noise. In chest X-ray this type of noise may be the dominating factor in the detection of nodules. In conclusion, optimization and new developments will enlarge the value of chest X-ray as a mainstay in the diagnosis of chest diseases.

  15. Effects of Direct and Indirect Instructional Strategies on Students ...

    African Journals Online (AJOL)

    This is a quasi experimental research designed to determine the effects of Direct and Indirect instructional strategies on Mathematics achievement among junior secondary school students. The population consisted of students in a Public Secondary School in Owerri, Imo State. A sample of 102 students from two (2) intact ...

  16. Impact and Cost-Effectiveness of Point-Of-Care CD4 Testing on the HIV Epidemic in South Africa.

    Directory of Open Access Journals (Sweden)

    Alastair Heffernan

    Full Text Available Rapid diagnostic tools have been shown to improve linkage of patients to care. In the context of infectious diseases, assessing the impact and cost-effectiveness of such tools at the population level, accounting for both direct and indirect effects, is key to informing adoption of these tools. Point-of-care (POC CD4 testing has been shown to be highly effective in increasing the proportion of HIV positive patients who initiate ART. We assess the impact and cost-effectiveness of introducing POC CD4 testing at the population level in South Africa in a range of care contexts, using a dynamic compartmental model of HIV transmission, calibrated to the South African HIV epidemic. We performed a meta-analysis to quantify the differences between POC and laboratory CD4 testing on the proportion linking to care following CD4 testing. Cumulative infections averted and incremental cost-effectiveness ratios (ICERs were estimated over one and three years. We estimated that POC CD4 testing introduced in the current South African care context can prevent 1.7% (95% CI: 0.4% - 4.3% of new HIV infections over 1 year. In that context, POC CD4 testing was cost-effective 99.8% of the time after 1 year with a median estimated ICER of US$4,468/DALY averted. In healthcare contexts with expanded HIV testing and improved retention in care, POC CD4 testing only became cost-effective after 3 years. The results were similar when, in addition, ART was offered irrespective of CD4 count, and CD4 testing was used for clinical assessment. Our findings suggest that even if ART is expanded to all HIV positive individuals and HIV testing efforts are increased in the near future, POC CD4 testing is a cost-effective tool, even within a short time horizon. Our study also illustrates the importance of evaluating the potential impact of such diagnostic technologies at the population level, so that indirect benefits and costs can be incorporated into estimations of cost-effectiveness.

  17. Clinical Utility of Chest Computed Tomography in Patients with Rib Fractures CT Chest and Rib Fractures.

    Science.gov (United States)

    Chapman, Brandon C; Overbey, Douglas M; Tesfalidet, Feven; Schramm, Kristofer; Stovall, Robert T; French, Andrew; Johnson, Jeffrey L; Burlew, Clay C; Barnett, Carlton; Moore, Ernest E; Pieracci, Fredric M

    2016-12-01

    Chest CT is more sensitive than a chest X-ray (CXR) in diagnosing rib fractures; however, the clinical significance of these fractures remains unclear. The purpose of this study was to determine the added diagnostic use of chest CT performed after CXR in patients with either known or suspected rib fractures secondary to blunt trauma. Retrospective cohort study of blunt trauma patients with rib fractures at a level I trauma center that had both a CXR and a CT chest. The CT finding of ≥ 3 additional fractures in patients with ≤ 3 rib fractures on CXR was considered clinically meaningful. Student's t-test and chi-square analysis were used for comparison. We identified 499 patients with rib fractures: 93 (18.6%) had CXR only, 7 (1.4%) had chest CT only, and 399 (79.9%) had both CXR and chest CT. Among these 399 patients, a total of 1,969 rib fractures were identified: 1,467 (74.5%) were missed by CXR. The median number of additional fractures identified by CT was 3 (range, 4 - 15). Of 212 (53.1%) patients with a clinically meaningful increase in the number of fractures, 68 patients underwent one or more clinical interventions: 36 SICU admissions, 20 pain catheter placements, 23 epidural placements, and 3 SSRF. Additionally, 70 patients had a chest tube placed for retained hemothorax or occult pneumothorax. Overall, 138 patients (34.5%) had a change in clinical management based upon CT chest. The chest X-ray missed ~75% of rib fractures seen on chest CT. Although patients with a clinical meaningful increase in the number of rib fractures were more likely to be admitted to the intensive care unit, there was no associated improvement in pulmonary outcomes.

  18. The Cost-Effectiveness of Dual Mobility Implants for Primary Total Hip Arthroplasty: A Computer-Based Cost-Utility Model.

    Science.gov (United States)

    Barlow, Brian T; McLawhorn, Alexander S; Westrich, Geoffrey H

    2017-05-03

    Dislocation remains a clinically important problem following primary total hip arthroplasty, and it is a common reason for revision total hip arthroplasty. Dual mobility (DM) implants decrease the risk of dislocation but can be more expensive than conventional implants and have idiosyncratic failure mechanisms. The purpose of this study was to investigate the cost-effectiveness of DM implants compared with conventional bearings for primary total hip arthroplasty. Markov model analysis was conducted from the societal perspective with use of direct and indirect costs. Costs, expressed in 2013 U.S. dollars, were derived from the literature, the National Inpatient Sample, and the Centers for Medicare & Medicaid Services. Effectiveness was expressed in quality-adjusted life years (QALYs). The model was populated with health state utilities and state transition probabilities derived from previously published literature. The analysis was performed for a patient's lifetime, and costs and effectiveness were discounted at 3% annually. The principal outcome was the incremental cost-effectiveness ratio (ICER), with a willingness-to-pay threshold of $100,000/QALY. Sensitivity analyses were performed to explore relevant uncertainty. In the base case, DM total hip arthroplasty showed absolute dominance over conventional total hip arthroplasty, with lower accrued costs ($39,008 versus $40,031 U.S. dollars) and higher accrued utility (13.18 versus 13.13 QALYs) indicating cost-savings. DM total hip arthroplasty ceased being cost-saving when its implant costs exceeded those of conventional total hip arthroplasty by $1,023, and the cost-effectiveness threshold for DM implants was $5,287 greater than that for conventional implants. DM was not cost-effective when the annualized incremental probability of revision from any unforeseen failure mechanism or mechanisms exceeded 0.29%. The probability of intraprosthetic dislocation exerted the most influence on model results. This model

  19. Endobronchial Tuberculosis and Chest Radiography

    Directory of Open Access Journals (Sweden)

    Mohammad Reza Sasani

    2016-03-01

    Full Text Available Endobronchial tuberculosis and chest radiography I read, with interest, the article entitled “Clinical and Para-clinical Presentations of Endobronchial Tuberculosis” by Ahmadi Hoseini H. S. et al. (1 published in this journal. I would like to focus on some details about the chest X-ray of patients as elaborated by the authors in the results section. Accordingly, the findings of chest radiography in the available patients were as follows: pulmonary consolidation (75%, reduced pulmonary volume (20%, and hilar adenopathy (10%. This is an incomplete statement because the authors did not explain whether there was any normal chest radiography in the study population. In addition, it is not clear whether the X-ray examinations of the patients were normal, how many abnormal plain films yielded the presented data. On the other hand, the fact that the studied patients had no normal chest radiography is  controversial since in the literature, 10-20% of the patients with endobronchial tuberculosis are reported to have normal chest X-ray (2, 3. In fact, this is one of the problems in the diagnosis of the disease, as well as a potential cause of delayed diagnosis and treatment of the patients. Therefore, the absence of normal chest radiographs is in contrast to the available literature, and if not an error, it could be a subject of further investigation.

  20. Single-energy pediatric chest computed tomography with spectral filtration at 100 kVp: effects on radiation parameters and image quality

    Energy Technology Data Exchange (ETDEWEB)

    Bodelle, Boris; Fischbach, Constanze; Booz, Christian; Yel, Ibrahim; Frellesen, Claudia; Kaup, Moritz; Beeres, Martin; Vogl, Thomas J.; Scholtz, Jan-Erik [Goethe University of Frankfurt, Department of Diagnostic and Interventional Radiology, Frankfurt (Germany)

    2017-06-15

    Most of the applied radiation dose at CT is in the lower photon energy range, which is of limited diagnostic importance. To investigate image quality and effects on radiation parameters of 100-kVp spectral filtration single-energy chest CT using a tin-filter at third-generation dual-source CT in comparison to standard 100-kVp chest CT. Thirty-three children referred for a non-contrast chest CT performed on a third-generation dual-source CT scanner were examined at 100 kVp with a dedicated tin filter with a tube current-time product resulting in standard protocol dose. We compared resulting images with images from children examined using standard single-source chest CT at 100 kVp. We assessed objective and subjective image quality and compared radiation dose parameters. Radiation dose was comparable for children 5 years old and younger, and it was moderately decreased for older children when using spectral filtration (P=0.006). Effective tube current increased significantly (P=0.0001) with spectral filtration, up to a factor of 10. Signal-to-noise ratio and image noise were similar for both examination techniques (P≥0.06). Subjective image quality showed no significant differences (P≥0.2). Using 100-kVp spectral filtration chest CT in children by means of a tube-based tin-filter on a third-generation dual-source CT scanner increases effective tube current up to a factor of 10 to provide similar image quality at equivalent dose compared to standard single-source CT without spectral filtration. (orig.)

  1. Single-energy pediatric chest computed tomography with spectral filtration at 100 kVp: effects on radiation parameters and image quality

    International Nuclear Information System (INIS)

    Bodelle, Boris; Fischbach, Constanze; Booz, Christian; Yel, Ibrahim; Frellesen, Claudia; Kaup, Moritz; Beeres, Martin; Vogl, Thomas J.; Scholtz, Jan-Erik

    2017-01-01

    Most of the applied radiation dose at CT is in the lower photon energy range, which is of limited diagnostic importance. To investigate image quality and effects on radiation parameters of 100-kVp spectral filtration single-energy chest CT using a tin-filter at third-generation dual-source CT in comparison to standard 100-kVp chest CT. Thirty-three children referred for a non-contrast chest CT performed on a third-generation dual-source CT scanner were examined at 100 kVp with a dedicated tin filter with a tube current-time product resulting in standard protocol dose. We compared resulting images with images from children examined using standard single-source chest CT at 100 kVp. We assessed objective and subjective image quality and compared radiation dose parameters. Radiation dose was comparable for children 5 years old and younger, and it was moderately decreased for older children when using spectral filtration (P=0.006). Effective tube current increased significantly (P=0.0001) with spectral filtration, up to a factor of 10. Signal-to-noise ratio and image noise were similar for both examination techniques (P≥0.06). Subjective image quality showed no significant differences (P≥0.2). Using 100-kVp spectral filtration chest CT in children by means of a tube-based tin-filter on a third-generation dual-source CT scanner increases effective tube current up to a factor of 10 to provide similar image quality at equivalent dose compared to standard single-source CT without spectral filtration. (orig.)

  2. X-ray chest mass screening for pulmonary tuberculosis in Friuli Venezia Giulia region, Italy

    International Nuclear Information System (INIS)

    Barbina, V.; Contento, G.; Padovani, R.; Pitzalis, G.; Nigris, C.

    1987-01-01

    Since 1980, the law which instituted the National Health Service (NHS) in Italy, attributing both the organization and the administration of all public health services to local government bodies referred to as 'Regioni', is being gradually enforced. One result is that the mass screening services are now set up on local basis, involving important practice and regulatory changes. These in particular concern chest X-ray mass screening centers, which were formerly organized as Provincial Antituberculosis Services, supervised by the Ministry of Health and dealing almost exclusively with pulmonary tuberculosis (PTB). Today, chest X-ray mass screening is carried on the 'Centri Sociali di Pneumologia', which in some case inherited the staff and diagnostic facilities of Provincial Antituberculosis Services, but are directed by the Councillorship of Health of the 'Regioni' and, in most cases, deal with the diagnosis and care of general pulmonary diseases. Therefore, regulations and practices of mass screening are eventually different in most Italian 'Regioni', depending on different economic and social situations. In this connection, this paper reports up-to-date information and data on frequency, effectiveness, cost and radiation risks of chest X-ray screening in the 'Regione Autonoma Friuli Venezia Giulia' (FVG), North-East Italy, population 1,300,000

  3. Lung involvement quantification in chest radiographs; Quantificacao de comprometimento pulmonar em radiografias de torax

    Energy Technology Data Exchange (ETDEWEB)

    Giacomini, Guilherme; Alvarez, Matheus; Oliveira, Marcela de; Miranda, Jose Ricardo A. [Universidade Estadual Paulista Julio de Mesquita Filho (UNESP), Botucatu, SP (Brazil). Instituto de Biociencias. Departamento de Fisica e Biofisica; Pina, Diana R.; Pereira, Paulo C.M.; Ribeiro, Sergio M., E-mail: giacomini@ibb.unesp.br [Universidade Estadual Paulista Julio de Mesquita Filho (UNESP), Botucatu, SP (Brazil). Faculdade de Medicina. Departamento de Doencas Tropicais e Diagnostico por Imagem

    2014-12-15

    Tuberculosis (TB) caused by Mycobacterium tuberculosis, is an infectious disease which remains a global health problem. The chest radiography is the commonly method employed to assess the TB's evolution. The methods for quantification of abnormalities of chest are usually performed on CT scans (CT). This quantification is important to assess the TB evolution and treatment and comparing different treatments. However, precise quantification is not feasible for the amount of CT scans required. The purpose of this work is to develop a methodology for quantification of lung damage caused by TB through chest radiographs. It was developed an algorithm for computational processing of exams in Matlab, which creates a lungs' 3D representation, with compromised dilated regions inside. The quantification of lung lesions was also made for the same patients through CT scans. The measurements from the two methods were compared and resulting in strong correlation. Applying statistical Bland and Altman, all samples were within the limits of agreement, with a confidence interval of 95%. The results showed an average variation of around 13% between the two quantification methods. The results suggest the effectiveness and applicability of the method developed, providing better risk-benefit to the patient and cost-benefit ratio for the institution. (author)

  4. Managing a chest tube and drainage system.

    Science.gov (United States)

    Durai, Rajaraman; Hoque, Happy; Davies, Tony W

    2010-02-01

    Intercostal drainage tubes (ie, chest tubes) are inserted to drain the pleural cavity of air, blood, pus, or lymph. The water-seal container connected to the chest tube allows one-way movement of air and liquid from the pleural cavity. The container should not be changed unless it is full, and the chest tube should not be clamped unnecessarily. After a chest tube is inserted, a nurse trained in chest-tube management is responsible for managing the chest tube and drainage system. This entails monitoring the chest-tube position, controlling fluid evacuation, identifying when to change or empty the containers, and caring for the tube and drainage system during patient transport. This article provides an overview of indications, insertion techniques, and management of chest tubes. Copyright 2010 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  5. Effectiveness of dispatcher training in increasing bystander chest compression for out-of-hospital cardiac arrest patients in Japan.

    Science.gov (United States)

    Tsunoyama, Taichiro; Nakahara, Shinji; Yoshida, Masafumi; Kitamura, Maki; Sakamoto, Tetsuya

    2017-10-01

    The Japanese government has developed a standardized training program for emergency call dispatchers to improve their skills in providing oral guidance on chest compression to bystanders who have witnessed out-of-hospital cardiac arrests (OHCAs). This study evaluated the effects of such a training program for emergency call dispatchers in Japan. The analysis included all consecutive non-traumatic OHCA patients transported to hospital by eight emergency medical services, where the program was implemented as a pilot project. We compared the provision of oral guidance and the incidence of chest compression applications by bystanders in the 1-month period before and after the program. Data collection was undertaken from October 2014 to March 2015. The 532 non-traumatic OHCA cases were used for analysis: these included 249 cases before and 283 after the guidance intervention. Most patients were over 75 years old and were men. After the program, provision of oral guidance to callers slightly increased from 63% of cases to 69% ( P = 0.13) and implementation of chest compression on patients by bystanders significantly increased from 40% to 52% ( P = 0.01). Appropriate chest compression also increased from 34% to 47% ( P = 0.01). In analysis stratified by the provision of oral guidance, increased chest compressions were observed only under oral guidance. We found increased provision of oral guidance by dispatchers and increased appropriate chest compressions by bystanders after the training program for dispatchers had been rolled out. Long-term observation and further data analysis, including patient outcomes, are needed.

  6. External costs of atmospheric lead emissions from a waste-to-energy plant: a follow-up assessment of indirect neurotoxic impacts via topsoil ingestion

    DEFF Research Database (Denmark)

    Pizzol, Massimo; Møller, Flemming; Thomsen, Marianne

    2013-01-01

    The link between anthropogenic emissions and the monetary value of their impacts, so-called external cost, can be determined via the impact pathway approach. This method is used in the present study to calculate the indirect costs, via topsoil ingestion, of lead emitted into atmosphere from a waste......-to-energy facility in Denmark. The Operational Meteorological air-quality model, the Simplified Fate and Speciation Model, and the Age Dependent Biokinetic Model are used to determine the metals’ atmospheric transport, its deposition and accumulation in topsoil, and its bio-accumulation in the human body...

  7. Selective chest imaging for blunt trauma patients: The national emergency X-ray utilization studies (NEXUS-chest algorithm).

    Science.gov (United States)

    Rodriguez, Robert M; Hendey, Gregory W; Mower, William R

    2017-01-01

    Chest imaging plays a prominent role in blunt trauma patient evaluation, but indiscriminate imaging is expensive, may delay care, and unnecessarily exposes patients to potentially harmful ionizing radiation. To improve diagnostic chest imaging utilization, we conducted 3 prospective multicenter studies over 12years to derive and validate decision instruments (DIs) to guide the use of chest x-ray (CXR) and chest computed tomography (CT). The first DI, NEXUS Chest x-ray, consists of seven criteria (Age >60years; rapid deceleration mechanism; chest pain; intoxication; altered mental status; distracting painful injury; and chest wall tenderness) and exhibits a sensitivity of 99.0% (95% confidence interval [CI] 98.2-99.4%) and a specificity of 13.3% (95% CI, 12.6%-14.0%) for detecting clinically significant injuries. We developed two NEXUS Chest CT DIs, which are both highly reliable in detecting clinically major injuries (sensitivity of 99.2%; 95% CI 95.4-100%). Designed primarily to focus on detecting major injuries, the NEXUS Chest CT-Major DI consists of six criteria (abnormal CXR; distracting injury; chest wall tenderness; sternal tenderness; thoracic spine tenderness; and scapular tenderness) and exhibits higher specificity (37.9%; 95% CI 35.8-40.1%). Designed to reliability detect both major and minor injuries (sensitivity 95.4%; 95% CI 93.6-96.9%) with resulting lower specificity (25.5%; 95% CI 23.5-27.5%), the NEXUS CT-All rule consists of seven elements (the six NEXUS CT-Major criteria plus rapid deceleration mechanism). The purpose of this review is to synthesize the three DIs into a novel, cohesive summary algorithm with practical implementation recommendations to guide selective chest imaging in adult blunt trauma patients. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Comparison of chest compression quality between the modified chest compression method with the use of smartphone application and the standardized traditional chest compression method during CPR.

    Science.gov (United States)

    Park, Sang-Sub

    2014-01-01

    The purpose of this study is to grasp difference in quality of chest compression accuracy between the modified chest compression method with the use of smartphone application and the standardized traditional chest compression method. Participants were progressed 64 people except 6 absentees among 70 people who agreed to participation with completing the CPR curriculum. In the classification of group in participants, the modified chest compression method was called as smartphone group (33 people). The standardized chest compression method was called as traditional group (31 people). The common equipments in both groups were used Manikin for practice and Manikin for evaluation. In the meantime, the smartphone group for application was utilized Android and iOS Operating System (OS) of 2 smartphone products (G, i). The measurement period was conducted from September 25th to 26th, 2012. Data analysis was used SPSS WIN 12.0 program. As a result of research, the proper compression depth (mm) was shown the proper compression depth (p< 0.01) in traditional group (53.77 mm) compared to smartphone group (48.35 mm). Even the proper chest compression (%) was formed suitably (p< 0.05) in traditional group (73.96%) more than smartphone group (60.51%). As for the awareness of chest compression accuracy, the traditional group (3.83 points) had the higher awareness of chest compression accuracy (p< 0.001) than the smartphone group (2.32 points). In the questionnaire that was additionally carried out 1 question only in smartphone group, the modified chest compression method with the use of smartphone had the high negative reason in rescuer for occurrence of hand back pain (48.5%) and unstable posture (21.2%).

  9. Religiousness and hazardous alcohol use: a conditional indirect effects model.

    Science.gov (United States)

    Jankowski, Peter J; Hardy, Sam A; Zamboanga, Byron L; Ham, Lindsay S

    2013-08-01

    The current study examined a conditional indirect effects model of the association between religiousness and adolescents' hazardous alcohol use. In doing so, we responded to the need to include both mediators and moderators, and the need for theoretically informed models when examining religiousness and adolescents' alcohol use. The sample consisted of 383 adolescents, aged 15-18, who completed an online questionnaire. Results of structural equation modeling supported the proposed model. Religiousness was indirectly associated with hazardous alcohol use through both positive alcohol expectancy outcomes and negative alcohol expectancy valuations. Significant moderating effects for alcohol expectancy valuations on the association between alcohol expectancies and alcohol use were also found. The effects for alcohol expectancy valuations confirm valuations as a distinct construct to that of alcohol expectancy outcomes, and offer support for the protective role of internalized religiousness on adolescents' hazardous alcohol use as a function of expectancy valuations. Copyright © 2013 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

  10. Single chest tube drainage is superior to double chest tube drainage after lobectomy: a meta-analysis.

    Science.gov (United States)

    Zhou, Dong; Deng, Xu-Feng; Liu, Quan-Xing; Chen, Qian; Min, Jia-Xin; Dai, Ji-Gang

    2016-05-27

    In this meta-analysis, we conducted a pooled analysis of clinical studies comparing the efficacy of single chest tube versus double chest tube after a lobectomy. According to the recommendations of the Cochrane Collaboration, we established a rigorous study protocol. We performed a systematic electronic search of the PubMed, Embase, Cochrane Library and Web of Science databases to identify articles to include in our meta-analysis. A literature search was performed using relevant keywords. A meta-analysis was performed using RevMan© software. Five studies, published between 2003 and 2014, including 630 patients (314 patients with a single chest tube and 316 patients with a double chest tube), met the selection criteria. From the available data, the patients using a single tube demonstrated significantly decreased postoperative pain [weighted mean difference [WMD] -0.60; 95 % confidence intervals [CIs] -0.68-- 0.52; P tube after a pulmonary lobectomy. However, there were no significant differences in postoperative complications [OR 0.91; 95 % CIs 0.57-1.44; P = 0.67] and re-drainage rates [OR 0.81; 95 % CIs 0.42-1.58; P = 0.54]. Our results showed that a single-drain method is effective, reducing postoperative pain, hospitalization times and duration of drainage in patients who undergo a lobectomy. Moreover, the single-drain method does not increase the occurrence of postoperative complications and re-drainage rates.

  11. Advanced-stage Hodgkin lymphoma: US/chest radiography for detection of relapse in patients in first complete remission--a randomized trial of routine surveillance imaging procedures.

    Science.gov (United States)

    Picardi, Marco; Pugliese, Novella; Cirillo, Michele; Zeppa, Pio; Cozzolino, Imma; Ciancia, Giuseppe; Pettinato, Guido; Salvatore, Claudia; Quintarelli, Concetta; Pane, Fabrizio

    2014-07-01

    chest radiography are diagnostic tools that enable effective, safe, and low-cost routine surveillance imaging for patients at high risk of Hodgkin lymphoma relapse. © RSNA, 2014.

  12. The 'indirect costs' of underfunding foreign partners in global health research: A case study.

    Science.gov (United States)

    Crane, Johanna T; Andia Biraro, Irene; Fouad, Tamer M; Boum, Yap; R Bangsberg, David

    2017-09-16

    This study of a global health research partnership assesses how U.S. fiscal administrative policies impact capacity building at foreign partner institutions. We conducted a case study of a research collaboration between Mbarara University of Science and Technology (MUST) in Mbarara, Uganda, and originally the University of California San Francisco (UCSF), but now Massachusetts General Hospital (MGH). Our case study is based on three of the authors' experiences directing and working with this partnership from its inception in 2003 through 2015. The collaboration established an independent Ugandan non-profit to act as a local fiscal agent and grants administrator and to assure compliance with the Ugandan labour and tax law. This structure, combined with low indirect cost reimbursements from U.S. federal grants, failed to strengthen institutional capacity at MUST. In response to problems with this model, the collaboration established a contracts and grants office at MUST. This office has built administrative capacity at MUST but has also generated new risks and expenses for MGH. We argue that U.S. fiscal administrative practices may drain rather than build capacity at African universities by underfunding the administrative costs of global health research, circumventing host country institutions, and externalising legal and financial risks associated with international work. MGH: Massachusetts General Hospital; MUST: Mbarara University of Science and Technology; NIH: National Institutes of Health; UCSF: University of California San Francisco; URI: Uganda Research Institute.

  13. Cost-Effectiveness of Increasing Influenza Vaccination Coverage in Adults with Type 2 Diabetes in Turkey.

    Science.gov (United States)

    Akın, Levent; Macabéo, Bérengère; Caliskan, Zafer; Altinel, Serdar; Satman, Ilhan

    2016-01-01

    In Turkey, the prevalence of diabetes is high but the influenza vaccination coverage rate (VCR) is low (9.1% in 2014), despite vaccination being recommended and reimbursed. This study evaluated the cost-effectiveness of increasing the influenza VCR of adults with type 2 diabetes in Turkey to 20%. A decision-analytic model was adapted to Turkey using data derived from published sources. Direct medical costs and indirect costs due to productivity loss were included in the societal perspective. The time horizon was set at 1 year to reflect the seasonality of influenza. Increasing the VCR for adults with type 2 diabetes to 20% is predicted to avert an additional 19,777 influenza cases, 2376 hospitalizations, and 236 deaths. Associated influenza costs avoided were estimated at more than 8.3 million Turkish Lira (TRY), while the cost of vaccination would be more than TRY 8.4 million. The incremental cost-effectiveness ratio was estimated at TRY 64/quality-adjusted life years, which is below the per capita gross domestic product of TRY 21,511 and therefore very cost-effective according to World Health Organization guidelines. Factors most influencing the incremental cost-effectiveness ratio were the excess hospitalization rate, inpatient cost, vaccine effectiveness against hospitalization, and influenza attack rate. Increasing the VCR to >20% was also estimated to be very cost-effective. Increasing the VCR for adults with type 2 diabetes in Turkey to ≥20% would be very cost-effective.

  14. Direct versus indirect effects of tropospheric humidity changes on the hydrologic cycle

    International Nuclear Information System (INIS)

    Sherwood, S C

    2010-01-01

    Abundant evidence indicates that tropospheric specific humidity increases in a warmer atmosphere, at rates roughly comparable to those at constant relative humidity. While the implications for the planetary energy budget and global warming are well recognized, it is the net atmospheric cooling (or surface heating) that controls the hydrologic cycle. Relative humidity influences this directly through gas-phase radiative transfer, and indirectly by affecting cloud cover (and its radiative effects) and convective heating. Simple calculations show that the two indirect impacts are larger than the direct impact by roughly one and two orders of magnitude respectively. Global or regional relative humidity changes could therefore have significant indirect impacts on energy and water cycles, especially by altering deep convection, even if they are too small to significantly affect global temperature. Studies of climate change should place greater emphasis on these indirect links, which may not be adequately represented in models.

  15. Patients' costs and cost-effectiveness of tuberculosis treatment in DOTS and non-DOTS facilities in Rio de Janeiro, Brazil.

    Directory of Open Access Journals (Sweden)

    Ricardo Steffen

    2010-11-01

    Full Text Available Costs of tuberculosis diagnosis and treatment may represent a significant burden for the poor and for the health system in resource-poor countries.The aim of this study was to analyze patients' costs of tuberculosis care and to estimate the incremental cost-effectiveness ratio (ICER of the directly observed treatment (DOT strategy per completed treatment in Rio de Janeiro, Brazil.We interviewed 218 adult patients with bacteriologically confirmed pulmonary tuberculosis. Information on direct (out-of-pocket expenses and indirect (hours lost costs, loss in income and costs with extra help were gathered through a questionnaire. Healthcare system additional costs due to supervision of pill-intake were calculated considering staff salaries. Effectiveness was measured by treatment completion rate. The ICER of DOT compared to self-administered therapy (SAT was calculated.DOT increased costs during the treatment phase, while SAT increased costs in the pre-diagnostic phase, for both the patient and the health system. Treatment completion rates were 71% in SAT facilities and 79% in DOT facilities. Costs per completed treatment were US$ 194 for patients and U$ 189 for the health system in SAT facilities, compared to US$ 336 and US$ 726 in DOT facilities. The ICER was US$ 6,616 per completed DOT treatment compared to SAT.Costs incurred by TB patients are high in Rio de Janeiro, especially for those under DOT. The DOT strategy doubles patients' costs and increases by fourfold the health system costs per completed treatment. The additional costs for DOT may be one of the contributing factors to the completion rates below the targeted 85% recommended by WHO.

  16. Cost-effectiveness of alternative management strategies for patients with solitary pulmonary nodules.

    Science.gov (United States)

    Gould, Michael K; Sanders, Gillian D; Barnett, Paul G; Rydzak, Chara E; Maclean, Courtney C; McClellan, Mark B; Owens, Douglas K

    2003-05-06

    Positron emission tomography (PET) with 18-fluorodeoxyglucose (FDG) is a potentially useful but expensive test to diagnose solitary pulmonary nodules. To evaluate the cost-effectiveness of strategies for pulmonary nodule diagnosis and to specifically compare strategies that did and did not include FDG-PET. Decision model. Accuracy and complications of diagnostic tests were estimated by using meta-analysis and literature review. Modeled survival was based on data from a large tumor registry. Cost estimates were derived from Medicare reimbursement and other sources. All adult patients with a new, noncalcified pulmonary nodule seen on chest radiograph. Patient lifetime. Societal. 40 clinically plausible combinations of 5 diagnostic interventions, including computed tomography, FDG-PET, transthoracic needle biopsy, surgery, and watchful waiting. Costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios. The cost-effectiveness of strategies depended critically on the pretest probability of malignancy. For patients with low pretest probability (26%), strategies that used FDG-PET selectively when computed tomography results were possibly malignant cost as little as 20 000 dollars per QALY gained. For patients with high pretest probability (79%), strategies that used FDG-PET selectively when computed tomography results were benign cost as little as 16 000 dollars per QALY gained. For patients with intermediate pretest probability (55%), FDG-PET strategies cost more than 220 000 dollars per QALY gained because they were more costly but only marginally more effective than computed tomography-based strategies. The choice of strategy also depended on the risk for surgical complications, the probability of nondiagnostic needle biopsy, the sensitivity of computed tomography, and patient preferences for time spent in watchful waiting. In probabilistic sensitivity analysis, FDG-PET strategies were cost saving or cost less than 100 000 dollars per QALY

  17. An experimental test for indirect benefits in Drosophila melanogaster

    Directory of Open Access Journals (Sweden)

    Ödeen Anders

    2007-03-01

    Full Text Available Abstract Background Despite much empirical attention, tests for indirect benefits of mate choice have rarely considered the major components of sexual and nonsexual offspring fitness relevant to a population. Here we use a novel experimental design to test for the existence of any indirect benefits in a laboratory adapted population of D. melanogaster. Our experiment compared the fitness (mating success, longevity, and productivity of individuals possessing genomes that derived two generations previously from males that were either entirely successful (studs or wholly unsuccessful (duds at achieving mates in three subsequent rounds of mating trials. Results Males from the stud treatment were 30% more successful on average at securing mates than males from the dud treatment. In contrast, we found no difference between treatments in measures of productivity or of longevity when measured in a mixed-sex environment. In the absence of females, however, males in the stud treatment outlived males in the dud treatment. Conclusion Our results suggest that mating with successful males in this population provides an indirect benefit to females and that, at least in this environment, the benefit arises primarily through the production of more attractive male offspring. However, it is unclear whether this represents solely a traditional sexy sons benefit or whether there is an additional good genes component (with male offspring simply allocating their surplus condition to traits that enhance their mating success. The lack of any detectable differences in female fitness between the two treatments suggests the former, although the longevity advantage of males in the stud treatment when females were absent is consistent with the latter. Determining the effect of this indirect benefit on the evolution of female mate preferences (or resistance will require comparable data on the direct costs of mating with various males, and an understanding of how these costs

  18. The effectiveness and cost-effectiveness of screening for active tuberculosis among migrants in the EU/EEA

    DEFF Research Database (Denmark)

    Greenaway, Christina; Pareek, Manish; Abou Chakra, Claire-Nour

    2018-01-01

    BACKGROUND: The foreign-born population make up an increasing and large proportion of tuberculosis (TB) cases in European Union/European Economic Area (EU/EEA) low-incidence countries and challenge TB elimination efforts. Methods: We conducted a systematic review to determine effectiveness (yield...... and performance of chest radiography (CXR) to detect active TB, treatment outcomes and acceptance of screening) and a second systematic review on cost-effectiveness of screening for active TB among migrants living in the EU/EEA. Results: We identified six systematic reviews, one report and three individual...... studies that addressed our aims. CXR was highly sensitive (98%) but only moderately specific (75%). The yield of detecting active TB with CXR screening among migrants was 350 per 100,000 population overall but ranged widely by host country (110-2,340), migrant type (170-1,192), TB incidence in source...

  19. Computer-aided Detection Fidelity of Pulmonary Nodules in Chest Radiograph

    Directory of Open Access Journals (Sweden)

    Nikolaos Dellios

    2017-01-01

    Full Text Available Aim: The most ubiquitous chest diagnostic method is the chest radiograph. A common radiographic finding, quite often incidental, is the nodular pulmonary lesion. The detection of small lesions out of complex parenchymal structure is a daily clinical challenge. In this study, we investigate the efficacy of the computer-aided detection (CAD software package SoftView™ 2.4A for bone suppression and OnGuard™ 5.2 (Riverain Technologies, Miamisburg, OH, USA for automated detection of pulmonary nodules in chest radiographs. Subjects and Methods: We retrospectively evaluated a dataset of 100 posteroanterior chest radiographs with pulmonary nodular lesions ranging from 5 to 85 mm. All nodules were confirmed with a consecutive computed tomography scan and histologically classified as 75% malignant. The number of detected lesions by observation in unprocessed images was compared to the number and dignity of CAD-detected lesions in bone-suppressed images (BSIs. Results: SoftView™ BSI does not affect the objective lesion-to-background contrast. OnGuard™ has a stand-alone sensitivity of 62% and specificity of 58% for nodular lesion detection in chest radiographs. The false positive rate is 0.88/image and the false negative (FN rate is 0.35/image. From the true positive lesions, 20% were proven benign and 80% were malignant. FN lesions were 47% benign and 53% malignant. Conclusion: We conclude that CAD does not qualify for a stand-alone standard of diagnosis. The use of CAD accompanied with a critical radiological assessment of the software suggested pattern appears more realistic. Accordingly, it is essential to focus on studies assessing the quality-time-cost profile of real-time (as opposed to retrospective CAD implementation in clinical diagnostics.

  20. Can we infer external effects from a study of the Irish indirect tax system?

    OpenAIRE

    Madden, David (David Patrick)

    1992-01-01

    This paper estimates implied external effects for the Irish indirect tax system for the year 1987. The study uses the inverse optimum technique of Christiansen and Jansen (1978) which estimates implied external effects, given the assumption that the economy is at an optimum with regard to the indirect tax system. External effects are estimated for three goods: tobacco, alcohol and petrol and in all cases the estimated external effects are of the expected sign. The paper also estimates the imp...

  1. Prehospital chest tube thoracostomy: effective treatment or additional trauma?

    NARCIS (Netherlands)

    Spanjersberg, W.R.; Bergs, B.; Krijen, P.; Schipper, I.; Ringburg, A.; Steyerberg, E.W.; Edwards, M.J.R.; Schipper, I.B.; Vugt, A.B. van

    2005-01-01

    BACKGROUND: The use of prehospital chest tube thoracostomy (TT) remains controversial because of presumed increased complication risks. This study analyzed infectious complication rates for physician-performed prehospital and emergency department (ED) TT. METHODS: Over a 40-month period, all

  2. The cost of tuberculosis in Denmark

    DEFF Research Database (Denmark)

    Fløe, Andreas; Hilberg, Ole; Wejse, Christian

    Hypothesis: Tuberculosis (TB) patients carry higher direct health-related and indirect costs than the general population. Objective: To calculate the economic burden of TB in Denmark, including the health-related costs of treatment and the indirect costs for society in a national retrospective case...

  3. Tuberculosis screening of travelers to higher-incidence countries: A cost-effectiveness analysis

    Directory of Open Access Journals (Sweden)

    Menzies Dick

    2008-06-01

    Full Text Available Abstract Background Travelers to countries with high tuberculosis incidence can acquire infection during travel. We sought to compare four screening interventions for travelers from low-incidence countries, who visit countries with varying tuberculosis incidence. Methods Decision analysis model: We considered hypothetical cohorts of 1,000 travelers, 21 years old, visiting Mexico, the Dominican Republic, or Haiti for three months. Travelers departed from and returned to the United States or Canada; they were born in the United States, Canada, or the destination countries. The time horizon was 20 years, with 3% annual discounting of future costs and outcomes. The analysis was conducted from the health care system perspective. Screening involved tuberculin skin testing (post-travel in three strategies, with baseline pre-travel tests in two, or chest radiography post-travel (one strategy. Returning travelers with tuberculin conversion (one strategy or other evidence of latent tuberculosis (three strategies were offered treatment. The main outcome was cost (in 2005 US dollars per tuberculosis case prevented. Results For all travelers, a single post-trip tuberculin test was most cost-effective. The associated cost estimate per case prevented ranged from $21,406 for Haitian-born travelers to Haiti, to $161,196 for US-born travelers to Mexico. In all sensitivity analyses, the single post-trip tuberculin test remained most cost-effective. For US-born travelers to Haiti, this strategy was associated with cost savings for trips over 22 months. Screening was more cost-effective with increasing trip duration and infection risk, and less so with poorer treatment adherence. Conclusion A single post-trip tuberculin skin test was the most cost-effective strategy considered, for travelers from the United States or Canada. The analysis did not evaluate the use of interferon-gamma release assays, which would be most relevant for travelers who received BCG

  4. Clinical assessment compared with chest X-Ray after removal of chest tube to diagnose pneumothorax

    International Nuclear Information System (INIS)

    Majeed, F. A.; Noor, Q. U. H.; Mehmood, U.; Imtiaz, T.; Zafar, U.

    2017-01-01

    Objective: To evaluate clinical judgment in ruling out pneumothorax during the removal of the chest tube by auscultating the chest before removal and after the extubation of the chest tube in comparison to x ray radiological results. Study Design: Descriptive cross sectional study. Place and Duration of Study: Combined Military Hospital (CMH) Lahore Pakistan, from August 2015 to March 2016. Material and Methods: A sample size of 100 was calculated. Patients were selected via non probability purposive sampling. Children under 14 years were not included. The patients with mal-positioned chest tube, surgical site infection, air leak and the patients with more than one chest tube on one side were excluded. A proforma was made and filled by one person. Chest tubes were removed by two trained senior registrars according to a protocol devised. It was ensured that there was no air leak present before removal clinically and radiologically. Another chest x-ray was done within 24 hours of extubation to detect any pathology that might have occurred during the process. Any complication in the patient clinically was observed till the x-ray film became available. Two sets of readings were obtained. Set A included auscultation findings and set B included x ray results. Results: Out of 100 patients, 60 (60 percent) were males and 40 (40 percent) females. The ages of the patients ranged between 17-77 years. Mean age of the patient was 43.27 ± 17.05 years. In set A out of 100 (100 percent) no pneumothorax developed clinically. In set B out of 100 patients 99 (99 percent) showed no pneumothorax on chest x ray, only 1 (1 percent) showed pneumothorax which was not significant (less than 15 percent on X ray). However, the patient remained asymptomatic clinically and there was no need of reinsertion of the chest tube. Conclusion: Auscultatory findings in diagnosing a significant pneumothorax are justified. Hence, if the chest tube is removed according to the protocol, clinically by

  5. Age- and sex-based resource utilisation and costs in patients with acute chest pain undergoing cardiac CT angiography. Pooled evidence from ROMICAT II and ACRIN-PA trials

    Energy Technology Data Exchange (ETDEWEB)

    Bamberg, Fabian; Hoffmann, Udo [Harvard Medical School, Cardiac MR PET CT Program, Massachusetts General Hospital, Boston, MA (United States); University of Tuebingen, Department of Diagnostic and Interventional Radiology, Tuebingen (Germany); Mayrhofer, Thomas [Harvard Medical School, Cardiac MR PET CT Program, Massachusetts General Hospital, Boston, MA (United States); Harvard Medical School, Department of Radiology, Massachusetts General Hospital, Boston, MA (United States); Stralsund University of Applied Science, School of Business Studies, Stralsund (Germany); Ferencik, Maros [Harvard Medical School, Cardiac MR PET CT Program, Massachusetts General Hospital, Boston, MA (United States); Oregon Health and Science University, Knight Cardiovascular Institute, Portland, OR (United States); Bittner, Daniel O. [Harvard Medical School, Cardiac MR PET CT Program, Massachusetts General Hospital, Boston, MA (United States); Harvard Medical School, Department of Radiology, Massachusetts General Hospital, Boston, MA (United States); Friedrich-Alexander University Erlangen-Nuernberg (FAU), University Hospital Erlangen, Department of Medicine 2 - Cardiology, Erlangen (Germany); Hallett, Travis R.; Janjua, Sumbal [Harvard Medical School, Cardiac MR PET CT Program, Massachusetts General Hospital, Boston, MA (United States); Harvard Medical School, Department of Radiology, Massachusetts General Hospital, Boston, MA (United States); Schlett, Christopher L. [Harvard Medical School, Cardiac MR PET CT Program, Massachusetts General Hospital, Boston, MA (United States); Nagurney, John T. [Harvard Medical School, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA (United States); Udelson, James E. [Tufts Medical Center, Division of Cardiology and the Cardio-Vascular Center, Boston, MA (United States); Truong, Quynh A. [Weill Cornell Medical College, New York, NY (United States); Woodard, Pamela K. [Washington University School of Medicine, Mallinckrodt Institute of Radiology, St. Louis, MO (United States); Hollander, Judd E. [Sidney Kimmel Medical College of Thomas Jefferson University, Department of Emergency Medicine, Philadelphia, PA (United States); Litt, Harold [Perelman School of Medicine at the University of Pennsylvania, Department of Radiology and Division of Cardiovascular Medicine, Philadelphia, PA (United States)

    2018-02-15

    To determine resource utilisation according to age and gender-specific subgroups in two large randomized diagnostic trials. We pooled patient-specific data from ACRIN-PA 4005 and ROMICAT II that enrolled subjects with acute chest pain at 14 US sites. Subjects were randomized between a standard work-up and a pathway utilizing cardiac computed tomography angiography (CCTA) and followed for the occurrence of acute coronary syndrome (ACS) and resource utilisation during index hospitalisation and 1-month follow-up. Study endpoints included diagnostic accuracy of CCTA for the detection of ACS as well as resource utilisation. Among 1240 patients who underwent CCTA, negative predictive value of CCTA to rule out ACS remained very high (≥99.4%). The proportion of patients undergoing additional diagnostic testing and cost increased with age for both sexes (p < 0.001), and was higher in men as compared to women older than 60 years (43.1% vs. 23.4% and $4559 ± 3382 vs. $3179 ± 2562, p < 0.01; respectively). Cost to rule out ACS was higher in men (p < 0.001) and significantly higher for patients older than 60 years ($2860-5935 in men, p < 0.001). CCTA strategy in patients with acute chest pain results in varying resource utilisation according to age and gender-specific subgroups, mandating improved selection for advanced imaging. (orig.)

  6. Age- and sex-based resource utilisation and costs in patients with acute chest pain undergoing cardiac CT angiography. Pooled evidence from ROMICAT II and ACRIN-PA trials

    International Nuclear Information System (INIS)

    Bamberg, Fabian; Hoffmann, Udo; Mayrhofer, Thomas; Ferencik, Maros; Bittner, Daniel O.; Hallett, Travis R.; Janjua, Sumbal; Schlett, Christopher L.; Nagurney, John T.; Udelson, James E.; Truong, Quynh A.; Woodard, Pamela K.; Hollander, Judd E.; Litt, Harold

    2018-01-01

    To determine resource utilisation according to age and gender-specific subgroups in two large randomized diagnostic trials. We pooled patient-specific data from ACRIN-PA 4005 and ROMICAT II that enrolled subjects with acute chest pain at 14 US sites. Subjects were randomized between a standard work-up and a pathway utilizing cardiac computed tomography angiography (CCTA) and followed for the occurrence of acute coronary syndrome (ACS) and resource utilisation during index hospitalisation and 1-month follow-up. Study endpoints included diagnostic accuracy of CCTA for the detection of ACS as well as resource utilisation. Among 1240 patients who underwent CCTA, negative predictive value of CCTA to rule out ACS remained very high (≥99.4%). The proportion of patients undergoing additional diagnostic testing and cost increased with age for both sexes (p < 0.001), and was higher in men as compared to women older than 60 years (43.1% vs. 23.4% and $4559 ± 3382 vs. $3179 ± 2562, p < 0.01; respectively). Cost to rule out ACS was higher in men (p < 0.001) and significantly higher for patients older than 60 years ($2860-5935 in men, p < 0.001). CCTA strategy in patients with acute chest pain results in varying resource utilisation according to age and gender-specific subgroups, mandating improved selection for advanced imaging. (orig.)

  7. Evaluation of radiation doses delivered in different chest CT protocols

    International Nuclear Information System (INIS)

    Gorycki, Tomasz; Lasek, Iwona; Kamiński, Kamil; Studniarek, Michał

    2014-01-01

    There are differences in the reference diagnostic levels for the computed tomography (CT) of the chest as cited in different literature sources. The doses are expressed either in weighted CT dose index (CTDI VOL ) used to express the dose per slice, dose-length product (DLP), and effective dose (E). The purpose of this study was to assess the radiation dose used in Low Dose Computer Tomography (LDCT) of the chest in comparison with routine chest CT examinations as well as to compare doses delivered in low dose chest CT with chest X-ray doses. CTDI VOL and DLP doses were taken to analysis from routine CT chest examinations (64 MDCT TK LIGHT SPEED GE Medical System) performed in 202 adult patients with FBP reconstruction: 51 low dose, 106 helical, 20 angio CT, and 25 high resolution CT protocols, as well as 19 helical protocols with iterative ASIR reconstruction. The analysis of chest X-ray doses was made on the basis of reports from 44 examinations. Mean values of CTDI VOL and DLP were, respectively: 2.1 mGy and 85.1 mGy·cm, for low dose, 9.7 mGy and 392.3 mGy·cm for helical, 18.2 mGy and 813.9 mGy·cm for angio CT, 2.3 mGy and 64.4 mGy·cm for high resolution CT, 8.9 mGy. and 317.6 mGy·cm for helical ASIR protocols. Significantly lower CTDI VOL and DLP values were observed for low dose and high resolution CT versus the remaining CT protocols; doses delivered in CT ASIR protocols were also lower (80–81%). The ratio between medial doses in low dose CT and chest X-ray was 11.56. Radiation dose in extended chest LDCT with parameters allowing for identification of mediastinal structures and adrenal glands is still much lower than that in standard CT protocols. Effective doses predicted for LDCT may exceed those used in chest X-ray examinations by a factor of 4 to 12, depending on LDCT scan parameters. Our results, as well as results from other authors, suggest a possibility of reducing the dose by means of iterative reconstruction. Efforts towards further dose

  8. Meta-Analysis of the Effect of Chest Shielding on Preventing Patent Ductus Arteriosus in Premature Infants.

    Science.gov (United States)

    Mannan, Javed; Amin, Sanjiv B

    2017-03-01

    Objective  This study aims to perform a meta-analysis of randomized studies to evaluate if chest shielding during phototherapy is associated with decreased incidence of patent ductus arteriosus (PDA) in premature infants. Design/Methods  We used published guidelines for the meta-analysis of clinical trials. The search strategy included electronic searches of CINAHL, CENTRAL Cochrane Library, MEDLINE, PubMed, and abstracts presented at the Pediatric Academic Societies. Inclusion criteria were randomized controlled trials (RCTs), quasi-RCTs or cluster RCTs published in English and involving chest shielding during phototherapy in premature infants with PDA as an outcome. Exclusion criteria involved case reports, case series, and multiple publications from the same author. Heterogeneity testing using Q statistics was performed to evaluate the variance between studies. Results  Two RCTs met study criteria. There was heterogeneity (I 2 : 55.4%) between the two trials. Meta-analysis of RCTs using the random effect model demonstrated that chest shielding during phototherapy was associated with decreased incidence of PDA (odds ratio: 0.47, 95% confidence interval: 0.23-0.96). There was no publication bias on Eggers test. Heterogeneity was seen in gestational age, gender, prophylactic use of postnatal indomethacin, duration of phototherapy, and assessment of PDA. Conclusion  Chest shielding during phototherapy may be associated with decreased incidence of PDA among premature infants. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  9. 48 CFR 1631.203 - Indirect costs.

    Science.gov (United States)

    2010-10-01

    ... Section 1631.203 Federal Acquisition Regulations System OFFICE OF PERSONNEL MANAGEMENT FEDERAL EMPLOYEES HEALTH BENEFITS ACQUISITION REGULATION GENERAL CONTRACTING REQUIREMENTS CONTRACT COST PRINCIPLES AND... general practice in the insurance industry. [70 FR 31391, June 1, 2005] ...

  10. Cost-effectiveness of Bariatric Surgery: Increasing the Economic Viability of the Most Effective Treatment for Type II Diabetes Mellitus.

    Science.gov (United States)

    Warren, Jeremy A; Ewing, Joseph A; Hale, Allyson L; Blackhurst, Dawn W; Bour, Eric S; Scott, John D

    2015-08-01

    There has been considerable debate on the cost-effectiveness of bariatric surgery within larger population groups. Despite the recognition that morbid obesity and its comorbidities are best treated surgically, insurance coverage is not universally available. One of the more costly comorbidities of obesity is Type II diabetes mellitus (T2DM). We propose a model that demonstrates the cost-effectiveness of increasing the number of bariatric surgical operations performed on patients with T2DM in the United States. We applied published population cost estimates (2012) for medical care of T2DM to a retrospective cohort of morbidly obese patients in South Carolina. We compared differences in 10-year medical costs between those having bariatric surgery and controls. Resolution of T2DM in the bariatric cohort was assumed to be 40 per cent. Considering only the direct medical costs of T2DM, the 10-year aggregate cost savings compared with a control group is $2.7 million/1000 patients; the total (direct and indirect) cost savings is $5.4 million/1000 patients. When considering resolution of T2DM alone, increasing the number of bariatric operations for a given population leads to a substantial cost savings over a 10-year period. This study adds to the growing body of evidence suggesting that bariatric surgery is a cost-effective means of caring for the obese patient.

  11. Estimating direct and indirect rebound effects by supply-driven input-output model: A case study of Taiwan's industry

    International Nuclear Information System (INIS)

    Wu, Kuei-Yen; Wu, Jung-Hua; Huang, Yun-Hsun; Fu, Szu-Chi; Chen, Chia-Yon

    2016-01-01

    Most existing literature focuses on the direct rebound effect on the demand side for consumers. This study analyses direct and indirect rebound effects in Taiwan's industry from the perspective of producers. However, most studies on the producers' viewpoint may overlook inter-industry linkages. This study applies a supply-driven input-output model to quantify the magnitude of rebound effects by explicitly considering inter-industry linkages. Empirical results showed that total rebound effects for most Taiwan's sectors were less than 10% in 2011. A comparison among the sectors yields that sectors with lower energy efficiency had higher direct rebound effects, while sectors with higher forward linkages generated higher indirect rebound effects. Taking the Mining sector (S3) as an example, which is an upstream supplier and has high forward linkages; it showed high indirect rebound effects that are derived from the accumulation of additional energy consumption by its downstream producers. The findings also showed that in almost all sectors, indirect rebound effects were higher than direct rebound effects. In other words, if indirect rebound effects are neglected, the total rebound effects will be underestimated. Hence, the energy-saving potential may be overestimated. - Highlights: • This study quantifies rebound effects by a supply-driven input-output model. • For most Taiwan's sectors, total rebound magnitudes were less than 10% in 2011. • Direct rebound effects and energy efficiency were inverse correlation. • Indirect rebound effects and industrial forward linkages were positive correlation. • Indirect rebound effects were generally higher than direct rebound effects.

  12. Theoretical research on color indirect effects

    Science.gov (United States)

    Liu, T. C.; Liao, Changjun; Liu, Songhao

    1995-05-01

    Color indirect effects (CIE) means the physiological and psychological effects of color resulting from color vision. In this paper, we study CIE from the viewpoints of the integrated western and Chinese traditional medicine and the time quantum theory established by C. Y. Liu et al., respectively, and then put forward the color-automatic-nervous-subsystem model that could color excites parasympathetic subsystem and hot color excites sympathetic subsystem. Our theory is in agreement with modern color vision theory, and moreover, it leads to the resolution of the conflict between the color code theory and the time code theory oncolor vision. For the latitude phenomena on athlete stars number and the average lifespan, we also discuss the possibility of UV vision. The applications of our theory lead to our succeeding in explaining a number of physiological and psychological effects of color, in explaining the effects of age on color vision, and in explaining the Chinese chromophototherapy. We also discuss its application to neuroimmunology. This research provides the foundation of the clinical applications of chromophototherapy.

  13. Can a Costly Intervention Be Cost-effective?

    Science.gov (United States)

    Foster, E. Michael; Jones, Damon

    2009-01-01

    Objectives To examine the cost-effectiveness of the Fast Track intervention, a multi-year, multi-component intervention designed to reduce violence among at-risk children. A previous report documented the favorable effect of intervention on the highest-risk group of ninth-graders diagnosed with conduct disorder, as well as self-reported delinquency. The current report addressed the cost-effectiveness of the intervention for these measures of program impact. Design Costs of the intervention were estimated using program budgets. Incremental cost-effectiveness ratios were computed to determine the cost per unit of improvement in the 3 outcomes measured in the 10th year of the study. Results Examination of the total sample showed that the intervention was not cost-effective at likely levels of policymakers' willingness to pay for the key outcomes. Subsequent analysis of those most at risk, however, showed that the intervention likely was cost-effective given specified willingness-to-pay criteria. Conclusions Results indicate that the intervention is cost-effective for the children at highest risk. From a policy standpoint, this finding is encouraging because such children are likely to generate higher costs for society over their lifetimes. However, substantial barriers to cost-effectiveness remain, such as the ability to effectively identify and recruit such higher-risk children in future implementations. PMID:17088509

  14. Digital chest radiography

    DEFF Research Database (Denmark)

    Debess, Jeanne Elisabeth; Vejle-Sørensen, Jens Kristian; Thomsen, Henrik

    ,3 mAs and SID SID of 180 centimetres using a phantom and lithium fluoride thermo luminescence dosimeter (TLD). Dose to risk organs mamma, thyroid and colon are measured at different collimations with one-centimetre steps. TLD results are used to estimate dose reduction for different collimations...... at the conference. Conclusion: Collimation improvement in basic chest radiography can reduce the radiation to female patients at chest x-ray examinations....

  15. Nurses’ Knowledge Levels of Chest Drain Management: A Descriptive Study

    Directory of Open Access Journals (Sweden)

    Merve Tarhan

    2016-12-01

    Full Text Available Objective: The physician is responsible for inserting one or more chest tubes into the pleural space or the mediastinal space and connecting them to an appropriate drainage system. When the general principles about care of patients with chest drains were implemented correctly and effectively by nurses, nurse will contribute to accelerate the healing process of patients. In this context, the aim of this study was to determine the nurses’ level of knowledge regarding the care of patients with chest drains. Methods: The study was conducted with 153 nurses who worked in a chest diseases and thoracic surgery hospital in July 2014. Questionnaire form of 35 questions prepared by investigators was used to collect data. For the analysis of results, frequency tests, independent sample t-test and oneway ANOVA test were used. Results: 69.3% of nurses stated that they had obtained information from colleguages. 35.3% considered their knowledge about chest drain management to be inadequate. 55.6% scored 13 points and above from knowledge questionnaire about chest drain management. There were statistically significant difference between knowledge level and educational background, clinic work type, working unit, years of professional experience and institutional experience, frequency of contact patients with chest drain and perception of knowledge level (p<0.05. Conclusion: Results of this study indicate that lack of evidence-based nursing care and insufficient training has resulted in uncertainty and knowledge deficit in important aspects of chest drain care. It can be concluded that nurses receive training needs and training protocols are about chest drain management.

  16. Indirect reciprocity with optional interactions.

    Science.gov (United States)

    Ghang, Whan; Nowak, Martin A

    2015-01-21

    Indirect reciprocity is a mechanism for the evolution of cooperation that is relevant for prosocial behavior among humans. Indirect reciprocity means that my behavior towards you also depends on what you have done to others. Indirect reciprocity is associated with the evolution of social intelligence and human language. Most approaches to indirect reciprocity assume obligatory interactions, but here we explore optional interactions. In any one round a game between two players is offered. A cooperator accepts a game unless the reputation of the other player indicates a defector. For a game to take place, both players must accept. In a game between a cooperator and a defector, the reputation of the defector is revealed to all players with probability Q. After a sufficiently large number of rounds the identity of all defectors is known and cooperators are no longer exploited. The crucial condition for evolution of cooperation can be written as hQB>1, where h is the average number of rounds per person and B=(b/c)-1 specifies the benefit-to-cost ratio. We analyze both stochastic and deterministic evolutionary game dynamics. We study two extensions that deal with uncertainty: hesitation and malicious gossip. Copyright © 2014 Elsevier Ltd. All rights reserved.

  17. Cost-effectiveness of computed tomography colonography in colorectal cancer screening: a systematic review.

    Science.gov (United States)

    Hanly, Paul; Skally, Mairead; Fenlon, Helen; Sharp, Linda

    2012-10-01

    The European Code Against Cancer recommends individuals aged ≥ 50 should participate in colorectal cancer screening. CT-colonography (CTC) is one of several screening tests available. We systematically reviewed evidence on, and identified key factors influencing, cost-effectiveness of CTC screening. PubMed, Medline, and the Cochrane library were searched for cost-effectiveness or cost-utility analyses of CTC-based screening, published in English, January 1999 to July 2010. Data was abstracted on setting, model type and horizon, screening scenario(s), comparator(s), participants, uptake, CTC performance and cost, effectiveness, ICERs, and whether extra-colonic findings and medical complications were considered. Sixteen studies were identified from the United States (n = 11), Canada (n = 2), and France, Italy, and the United Kingdom (1 each). Markov state-transition (n = 14) or microsimulation (n = 2) models were used. Eleven considered direct medical costs only; five included indirect costs. Fourteen compared CTC with no screening; fourteen compared CTC with colonoscopy-based screening; fewer compared CTC with sigmoidoscopy (8) or fecal tests (4). Outcomes assessed were life-years gained/saved (13), QALYs (2), or both (1). Three considered extra-colonic findings; seven considered complications. CTC appeared cost-effective versus no screening and, in general, flexible sigmoidoscopy and fecal occult blood testing. Results were mixed comparing CTC to colonoscopy. Parameters most influencing cost-effectiveness included: CTC costs, screening uptake, threshold for polyp referral, and extra-colonic findings. Evidence on cost-effectiveness of CTC screening is heterogeneous, due largely to between-study differences in comparators and parameter values. Future studies should: compare CTC with currently favored tests, especially fecal immunochemical tests; consider extra-colonic findings; and conduct comprehensive sensitivity analyses.

  18. Cost-Effectiveness Model for Chemoimmunotherapy Options in Patients with Previously Untreated Chronic Lymphocytic Leukemia Unsuitable for Full-Dose Fludarabine-Based Therapy.

    Science.gov (United States)

    Becker, Ursula; Briggs, Andrew H; Moreno, Santiago G; Ray, Joshua A; Ngo, Phuong; Samanta, Kunal

    2016-06-01

    To evaluate the cost-effectiveness of treatment with anti-CD20 monoclonal antibody obinutuzumab plus chlorambucil (GClb) in untreated patients with chronic lymphocytic leukemia unsuitable for full-dose fludarabine-based therapy. A Markov model was used to assess the cost-effectiveness of GClb versus other chemoimmunotherapy options. The model comprised three mutually exclusive health states: "progression-free survival (with/without therapy)", "progression (refractory/relapsed lines)", and "death". Each state was assigned a health utility value representing patients' quality of life and a specific cost value. Comparisons between GClb and rituximab plus chlorambucil or only chlorambucil were performed using patient-level clinical trial data; other comparisons were performed via a network meta-analysis using information gathered in a systematic literature review. To support the model, a utility elicitation study was conducted from the perspective of the UK National Health Service. There was good agreement between the model-predicted progression-free and overall survival and that from the CLL11 trial. On incorporating data from the indirect treatment comparisons, it was found that GClb was cost-effective with a range of incremental cost-effectiveness ratios below a threshold of £30,000 per quality-adjusted life-year gained, and remained so during deterministic and probabilistic sensitivity analyses under various scenarios. GClb was estimated to increase both quality-adjusted life expectancy and treatment costs compared with several commonly used therapies, with incremental cost-effectiveness ratios below commonly referenced UK thresholds. This article offers a real example of how to combine direct and indirect evidence in a cost-effectiveness analysis of oncology drugs. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  19. 46 CFR 169.743 - Portable magazine chests.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 7 2010-10-01 2010-10-01 false Portable magazine chests. 169.743 Section 169.743... Vessel Control, Miscellaneous Systems, and Equipment Markings § 169.743 Portable magazine chests. Portable magazine chests must be marked in letters at least 3 inches high: “PORTABLE MAGAZINE CHEST...

  20. Satellite remote sensing of dust aerosol indirect effects on ice cloud formation.

    Science.gov (United States)

    Ou, Steve Szu-Cheng; Liou, Kuo-Nan; Wang, Xingjuan; Hansell, Richard; Lefevre, Randy; Cocks, Stephen

    2009-01-20

    We undertook a new approach to investigate the aerosol indirect effect of the first kind on ice cloud formation by using available data products from the Moderate-Resolution Imaging Spectrometer (MODIS) and obtained physical understanding about the interaction between aerosols and ice clouds. Our analysis focused on the examination of the variability in the correlation between ice cloud parameters (optical depth, effective particle size, cloud water path, and cloud particle number concentration) and aerosol optical depth and number concentration that were inferred from available satellite cloud and aerosol data products. Correlation results for a number of selected scenes containing dust and ice clouds are presented, and dust aerosol indirect effects on ice clouds are directly demonstrated from satellite observations.

  1. Caregiver burden, productivity loss, and indirect costs associated with caring for patients with poststroke spasticity

    Science.gov (United States)

    Ganapathy, Vaidyanathan; Graham, Glenn D; DiBonaventura, Marco D; Gillard, Patrick J; Goren, Amir; Zorowitz, Richard D

    2015-01-01

    Objective Many stroke survivors experience poststroke spasticity and the related inability to perform basic activities, which necessitates patient management and treatment, and exerts a considerable burden on the informal caregiver. The current study aims to estimate burden, productivity loss, and indirect costs for caregivers of stroke survivors with spasticity. Methods Internet survey data were collected from 153 caregivers of stroke survivors with spasticity including caregiving time and difficulty (Oberst Caregiver Burden Scale), Work Productivity and Activity Impairment measures, and caregiver and patient characteristics. Fractional logit models examined predictors of work-related restriction, and work losses were monetized (2012 median US wages). Results Mean Oberst Caregiver Burden Scale time and difficulty scores were 46.1 and 32.4, respectively. Employed caregivers (n=71) had overall work restriction (32%), absenteeism (9%), and presenteeism (27%). Caregiver characteristics, lack of nursing home coverage, and stroke survivors’ disability predicted all work restriction outcomes. The mean total lost-productivity cost per employed caregiver was US$835 per month (>$10,000 per year; 72% attributable to presenteeism). Conclusion These findings demonstrate the substantial burden of caring for stroke survivors with spasticity illustrating the societal and economic impact of stroke that extends beyond the stroke survivor. PMID:26609225

  2. MRI of the Chest

    Medline Plus

    Full Text Available ... chest is performed to: assess abnormal masses, including cancer of the lungs or other tissues, which either cannot be assessed ... in diagnosing a broad range of conditions, including cancer, heart and ... tissues, except for lung abnormalities where Chest CT is a preferred imaging ...

  3. Effective high voltage at X-ray tube in hard X-ray chest imaging

    International Nuclear Information System (INIS)

    Klein, J.

    1987-01-01

    The FRG standard TGL 36 661 (March 1980) for synoptical chest pictures of large size in adults specifies the 120 kV voltage at the X-ray tube together with maximal, 100% use of the capacity of the tube (hard picture, short exposure time). By means of circular recording and by measuring the high voltage at the X-ray tube it was quantitatively shown that the effective voltage during exposure is (according to the exposure time and the attenuation phase of the generator) always lower than the set-up voltage of 120 kV. This phenomenon is the more marked the shorter the actual exposure time in comparison with the attenuation phase of the generator. The typical characteristic of a hard X-ray chest picture is thus not given only by the setting-up of voltage. The impact of the reduction in voltage is thus quantitatively shown also from the aspect of the radiation burden for the patient. (author). 7 figs., 8 refs

  4. DEVELOPMENT OF A CHEST FREEZER – OPTIMUM DESIGN OF AN EVAPORATOR COIL

    Directory of Open Access Journals (Sweden)

    K. Kalyani Radha

    2012-06-01

    Full Text Available In a country such as India, food grains, fruit, vegetables, meat, poultry and fish, are very susceptible to microbial contamination and spoilage and require stringent preservation methods. One such method is by the use of a chest freezer for the storage of frozen food. This investigation considers different loads and design parameters for the development of a chest freezer using R134a as the working fluid. Experimental designs of an evaporator coil, condenser coil and capillary tube are investigated through the development of storage periods in terms of steady state and cyclic performance, by optimising the quantity of refrigerant charge, with strict adherence to the standards and requirement for maintaining an internal temperature of -23 °C at 43 °C ambient. Cyclic load performance tests optimise the performance of individual components selected for the design of a chest freezer. The system selection has a highly balanced performance with R134a and showed 118 kJ/kg cooling capacity with 8.42 coefficient of performance (COP. By the replacement of R134a, temperatures of -23 °C are maintained inside the freezer cabinet with low power consumption and an increase in the net refrigerating effect, which in turn increases the COP. The system design has optimum efficiency with moderate costs by optimising the length and diameter of the evaporator coil, i.e., 34.15 m and 7.94 mm, respectively.

  5. THE DIRECT AND INDIRECT EFFECTS OF CUSTOMER FOCUS ON PERFORMANCE IN PUBLIC FIRMS

    Directory of Open Access Journals (Sweden)

    Zulnaidi Yaacob

    2014-06-01

    Full Text Available It has been demonstrated within the literature that the practice of customer focus is significantly associated with customer satisfaction. However, the possibility that the construct of customer focus may affect other relevant measures remains underexplored. As such, this paper discusses the effect that customer focus has on organizational performance, operating upon the premise that customer satisfaction is an end result of other relevant performance measures such as employee satisfaction, innovation, and cost benefits. Data were collected from 205 managers within the public service sector, all of whom were directly involved with the process of customer focus. The results of this study revealed that customer focus is a significant predictor of employee satisfaction, innovation, and customer satisfaction. The structural model developed also indicated that there is an indirect relationship between customer focus and customer satisfaction, as determined by employee satisfaction. In addition, the effect of customer focus on innovation is mediated by employee satisfaction. Therefore, this model implies that the practice of customer focus may enable public firms to increase their levels of performance.

  6. Clinical aspects of plain film radiography of the chest

    International Nuclear Information System (INIS)

    Ravin, C.E.

    1988-01-01

    In spite of the introduction of a number of intriguing new imaging modalities including Computed Tomography and Magnetic Resonance Imaging, the plain film of the chest remains the mainstay of thoracic imaging. It is estimated that more than fifty million chest radiographs are performed each year in the United States. In the attempt to compare newer imaging modalities with the standard plain film of the chest, investigators have been forced to adopt specific structures and or disease processes to be analyzed. To some extent identification of normally appearing structures in the mediastinum and lung parenchyma serves as a clue as to the ability of a newer technology to compete with or be compared with the plain film. However, as most authors would acknowledge, the ability to portray normal underlying anatomy is only the first step in analysis in intrathoracic disease. Experimental design becomes somewhat more complicated when one wishes to move beyond normal anatomy to analysis of disease processes. The challenge of digital radiography in whatever form it may take will be to equal or exceed the standard established by conventional plain film radiography and deliver such service at reasonable cost in a manner which allows for appropriate patient throughput

  7. Good research practices for measuring drug costs in cost-effectiveness analyses: a societal perspective: the ISPOR Drug Cost Task Force report--Part II.

    Science.gov (United States)

    Garrison, Louis P; Mansley, Edward C; Abbott, Thomas A; Bresnahan, Brian W; Hay, Joel W; Smeeding, James

    2010-01-01

    Major guidelines regarding the application of cost-effectiveness analysis (CEA) have recommended the common and widespread use of the "societal perspective" for purposes of consistency and comparability. The objective of this Task Force subgroup report (one of six reports from the International Society for Pharmacoeconomics and Outcomes Research [ISPOR] Task Force on Good Research Practices-Use of Drug Costs for Cost Effectiveness Analysis [Drug Cost Task Force (DCTF)]) was to review the definition of this perspective, assess its specific application in measuring drug costs, identify any limitations in theory or practice, and make recommendations regarding potential improvements. Key articles, books, and reports in the methodological literature were reviewed, summarized, and integrated into a draft review and report. This draft report was posted for review and comment by ISPOR membership. Numerous comments and suggestions were received, and the report was revised in response to them. The societal perspective can be defined by three conditions: 1) the inclusion of time costs, 2) the use of opportunity costs, and 3) the use of community preferences. In practice, very few, if any, published CEAs have met all of these conditions, though many claim to have taken a societal perspective. Branded drug costs have typically used actual acquisition cost rather than the much lower social opportunity costs that would reflect only short-run manufacturing and distribution costs. This practice is understandable, pragmatic, and useful to current decision-makers. Nevertheless, this use of CEA focuses on static rather than dynamic efficacy and overlooks the related incentives for innovation. Our key recommendation is that current CEA practice acknowledge and embrace this limitation by adopting a new standard for the reference case as one of a "limited societal" or "health systems" perspective, using acquisition drug prices while including indirect costs and community preferences. The

  8. Regional variance of visually lossless threshold in compressed chest CT images: Lung versus mediastinum and chest wall

    International Nuclear Information System (INIS)

    Kim, Tae Jung; Lee, Kyoung Ho; Kim, Bohyoung; Kim, Kil Joong; Chun, Eun Ju; Bajpai, Vasundhara; Kim, Young Hoon; Hahn, Seokyung; Lee, Kyung Won

    2009-01-01

    Objective: To estimate the visually lossless threshold (VLT) for the Joint Photographic Experts Group (JPEG) 2000 compression of chest CT images and to demonstrate the variance of the VLT between the lung and mediastinum/chest wall. Subjects and methods: Eighty images were compressed reversibly (as negative control) and irreversibly to 5:1, 10:1, 15:1 and 20:1. Five radiologists determined if the compressed images were distinguishable from their originals in the lung and mediastinum/chest wall. Exact tests for paired proportions were used to compare the readers' responses between the reversible and irreversible compressions and between the lung and mediastinum/chest wall. Results: At reversible, 5:1, 10:1, 15:1, and 20:1 compressions, 0%, 0%, 3-49% (p < .004, for three readers), 69-99% (p < .001, for all readers), and 100% of the 80 image pairs were distinguishable in the lung, respectively; and 0%, 0%, 74-100% (p < .001, for all readers), 100%, and 100% were distinguishable in the mediastinum/chest wall, respectively. The image pairs were less frequently distinguishable in the lung than in the mediastinum/chest wall at 10:1 (p < .001, for all readers) and 15:1 (p < .001, for two readers). In 321 image comparisons, the image pairs were indistinguishable in the lung but distinguishable in the mediastinum/chest wall, whereas there was no instance of the opposite. Conclusion: For JPEG2000 compression of chest CT images, the VLT is between 5:1 and 10:1. The lung is more tolerant to the compression than the mediastinum/chest wall.

  9. Regional variance of visually lossless threshold in compressed chest CT images: Lung versus mediastinum and chest wall

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Tae Jung [Department of Radiology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707 (Korea, Republic of); Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center (Korea, Republic of); Lee, Kyoung Ho [Department of Radiology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707 (Korea, Republic of); Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center (Korea, Republic of)], E-mail: kholee@snubhrad.snu.ac.kr; Kim, Bohyoung; Kim, Kil Joong; Chun, Eun Ju; Bajpai, Vasundhara; Kim, Young Hoon [Department of Radiology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707 (Korea, Republic of); Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center (Korea, Republic of); Hahn, Seokyung [Medical Research Collaborating Center, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul 110-744 (Korea, Republic of); Seoul National University College of Medicine (Korea, Republic of); Lee, Kyung Won [Department of Radiology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707 (Korea, Republic of); Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center (Korea, Republic of)

    2009-03-15

    Objective: To estimate the visually lossless threshold (VLT) for the Joint Photographic Experts Group (JPEG) 2000 compression of chest CT images and to demonstrate the variance of the VLT between the lung and mediastinum/chest wall. Subjects and methods: Eighty images were compressed reversibly (as negative control) and irreversibly to 5:1, 10:1, 15:1 and 20:1. Five radiologists determined if the compressed images were distinguishable from their originals in the lung and mediastinum/chest wall. Exact tests for paired proportions were used to compare the readers' responses between the reversible and irreversible compressions and between the lung and mediastinum/chest wall. Results: At reversible, 5:1, 10:1, 15:1, and 20:1 compressions, 0%, 0%, 3-49% (p < .004, for three readers), 69-99% (p < .001, for all readers), and 100% of the 80 image pairs were distinguishable in the lung, respectively; and 0%, 0%, 74-100% (p < .001, for all readers), 100%, and 100% were distinguishable in the mediastinum/chest wall, respectively. The image pairs were less frequently distinguishable in the lung than in the mediastinum/chest wall at 10:1 (p < .001, for all readers) and 15:1 (p < .001, for two readers). In 321 image comparisons, the image pairs were indistinguishable in the lung but distinguishable in the mediastinum/chest wall, whereas there was no instance of the opposite. Conclusion: For JPEG2000 compression of chest CT images, the VLT is between 5:1 and 10:1. The lung is more tolerant to the compression than the mediastinum/chest wall.

  10. Aerosol indirect effects on the nighttime Arctic Ocean surface from thin, predominantly liquid clouds

    Directory of Open Access Journals (Sweden)

    L. M. Zamora

    2017-06-01

    Full Text Available Aerosol indirect effects have potentially large impacts on the Arctic Ocean surface energy budget, but model estimates of regional-scale aerosol indirect effects are highly uncertain and poorly validated by observations. Here we demonstrate a new way to quantitatively estimate aerosol indirect effects on a regional scale from remote sensing observations. In this study, we focus on nighttime, optically thin, predominantly liquid clouds. The method is based on differences in cloud physical and microphysical characteristics in carefully selected clean, average, and aerosol-impacted conditions. The cloud subset of focus covers just ∼ 5 % of cloudy Arctic Ocean regions, warming the Arctic Ocean surface by ∼ 1–1.4 W m−2 regionally during polar night. However, within this cloud subset, aerosol and cloud conditions can be determined with high confidence using CALIPSO and CloudSat data and model output. This cloud subset is generally susceptible to aerosols, with a polar nighttime estimated maximum regionally integrated indirect cooling effect of ∼ −0.11 W m−2 at the Arctic sea ice surface (∼ 8 % of the clean background cloud effect, excluding cloud fraction changes. Aerosol presence is related to reduced precipitation, cloud thickness, and radar reflectivity, and in some cases, an increased likelihood of cloud presence in the liquid phase. These observations are inconsistent with a glaciation indirect effect and are consistent with either a deactivation effect or less-efficient secondary ice formation related to smaller liquid cloud droplets. However, this cloud subset shows large differences in surface and meteorological forcing in shallow and higher-altitude clouds and between sea ice and open-ocean regions. For example, optically thin, predominantly liquid clouds are much more likely to overlay another cloud over the open ocean, which may reduce aerosol indirect effects on the surface. Also, shallow clouds over

  11. Biological effects of direct and indirect manipulation of the fascial system. Narrative review.

    Science.gov (United States)

    Parravicini, Giovanni; Bergna, Andrea

    2017-04-01

    Osteopathic Manipulative Treatment (OMT) is effective in improving function, movement and restoring pain conditions. Despite clinical results, the mechanisms of how OMT achieves its' effects remain unclear. The fascial system is described as a tensional network that envelops the human body. Direct or indirect manipulations of the fascial system are a distinctive part of OMT. This review describes the biological effects of direct and indirect manipulation of the fascial system. Literature search was performed in February 2016 in the electronic databases: Cochrane, Medline, Scopus, Ostmed, Pedro and authors' publications relative to Fascia Research Congress Website. Manipulation of the fascial system seems to interfere with some cellular processes providing various pro-inflammatory and anti-inflammatory cells and molecules. Despite growing research in the osteopathic field, biological effects of direct or indirect manipulation of the fascial system are not conclusive. To elevate manual medicine as a primary intervention in clinical settings, it's necessary to clarify how OMT modalities work in order to underpin their clinical efficacies. Copyright © 2017 Elsevier Ltd. All rights reserved.

  12. Practical applications of digital tomosynthesis of the chest.

    Science.gov (United States)

    Galea, A; Durran, A; Adlan, T; Gay, D; Riordan, R; Dubbins, P; Williams, M P

    2014-04-01

    Digital tomosynthesis is a radiographic technique that generates a number of coronal raw images of a patient from a single pass of the x-ray tube. Tomosynthesis provides some of the tomographic benefits of computed tomography (CT), but at a much lower dose of radiation and cost when compared to CT. This review illustrates the range of practical applications of digital tomosynthesis of the chest. Copyright © 2013 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  13. Comparative Effectiveness of Emergency Resuscitative Thoracotomy versus Closed Chest Compressions among Patients with Critical Blunt Trauma: A Nationwide Cohort Study in Japan.

    Directory of Open Access Journals (Sweden)

    Kodai Suzuki

    Full Text Available Although emergency resuscitative thoracotomy is performed as a salvage maneuver for critical blunt trauma patients, evidence supporting superior effectiveness of emergency resuscitative thoracotomy compared to conventional closed-chest compressions remains insufficient. The objective of this study was to investigate whether emergency resuscitative thoracotomy at the emergency department or in the operating room was associated with favourable outcomes after blunt trauma and to compare its effectiveness with that of closed-chest compressions.This was a retrospective nationwide cohort study. Data were obtained from the Japan Trauma Data Bank for the period between 2004 and 2012. The primary and secondary outcomes were patient survival rates 24 h and 28 d after emergency department arrival. Statistical analyses were performed using multivariable generalized mixed-effects regression analysis. We adjusted for the effects of different hospitals by introducing random intercepts in regression analysis to account for the differential quality of emergency resuscitative thoracotomy at hospitals where patients in cardiac arrest were treated. Sensitivity analyses were performed using propensity score matching.In total, 1,377 consecutive, critical blunt trauma patients who received cardiopulmonary resuscitation in the emergency department or operating room were included in the study. Of these patients, 484 (35.1% underwent emergency resuscitative thoracotomy and 893 (64.9% received closed-chest compressions. Compared to closed-chest compressions, emergency resuscitative thoracotomy was associated with lower survival rate 24 h after emergency department arrival (4.5% vs. 17.5%, respectively, P < 0.001 and 28 d after arrival (1.2% vs. 6.0%, respectively, P < 0.001. Multivariable generalized mixed-effects regression analysis with and without a propensity score-matched dataset revealed that the odds ratio for an unfavorable survival rate after 24 h was lower for

  14. The health economics of ankle and foot sprains and fractures: A systematic review of English-language published papers. Part 2: The direct and indirect costs of injury.

    Science.gov (United States)

    Bielska, Iwona A; Wang, Xiang; Lee, Raymond; Johnson, Ana P

    2017-07-20

    Ankle and foot sprains and fractures are prevalent injuries, which may result in substantial physical and economic consequences for the patient and place a financial burden on the health care system. Therefore, the objectives of this paper are to examine the direct and indirect costs of treating ankle and foot injuries (sprains, dislocations, fractures), as well as to provide an overview of the outcomes of full economic analyses of different treatment strategies. A systematic review was carried out among seven databases to identify English language publications on the health economics of ankle and foot injury treatment published between 1980 and 2014. The direct and indirect costs were abstracted by two independent reviewers. All costs were adjusted for inflation and reported in 2016 US dollars (USD). Among 2047 identified studies, 32 were selected for analysis. The direct costs of ankle sprain management ranged from $292 to $2268 per patient (2016 USD), depending on the injury severity and treatment strategy. The direct costs of managing ankle fractures were higher ($1908-$19,555). Foot fracture treatment had similar direct costs ranging from $998 to $21,801. The economic evaluations were conducted from the societal or payer's perspectives. The costs of treating ankle and foot sprains and fractures varied among the studies, mostly due to differences in injury type and study characteristics, which impacted the ability of directly comparing the financial burden of treatment. Nonetheless, the review showed that the costs experienced by the patient and the health care system increased with injury complexity. Copyright © 2017 Elsevier Ltd. All rights reserved.

  15. FY 2011 4th Quarter Metric: Estimate of Future Aerosol Direct and Indirect Effects

    Energy Technology Data Exchange (ETDEWEB)

    Koch, D

    2011-09-21

    The global and annual mean aerosol direct and indirect effects, relative to 1850 conditions, estimated from CESM simulations are 0.02 W m-2 and -0.39 W m-2, respectively, for emissions in year 2100 under the IPCC RCP8.5 scenario. The indirect effect is much smaller than that for 2000 emissions because of much smaller SO2 emissions in 2100; the direct effects are small due to compensation between warming by black carbon and cooling by sulfate.

  16. Digital and conventional radiology techniques: comparison of dosage and costs

    International Nuclear Information System (INIS)

    Arranza, L.; Albornoz, C. de

    1996-01-01

    To compare the radiation dosage and costs in conventional and digital technologies. The study dealt with transverse sections. The dosage applied with conventional technology was measured in 254 patients who intertwined 402 explorations of 6 anatomic regions in 4 Radiodiagnostic Services. The dosage applied with digital technology was measured in 57 patients who underwent 95 explorations of the same anatomic region in one Radiodiagnostic Service. The costs of the 6 types of conventional and digital explorations performed were calculated for two Radiodiagnostic Service. The doses administered (mGy) using convectional/digital technology were as follows: chest PA 0.2/0.1; chest LAT 0.7/0.3; breast CC 7.0/8.4; breast LAT 7.0/7.8; breast OB 7.0/10.5; cervical spine AP 9.6/9.0; cervical spine LAT 21.9/29.6; pelvis AP 7.3/7.1; plain abdominal 6.5/2.2. The costs incurred (1992 pesetas) with the convectional/digital technologies: chest AP and LAT 1,393/2,973; portable chest 2,027/3,714; mammography 2,357/3,486; phlebography 12,718/14,023; hysterosalpingography 4,876/6,701; bone scientigraphy 1,633/2,839. Compared with conventional technology, digital imaging reduces the radiation doses received by the patients, except in the case of mammography. The costs associated with the use of digital technology are greater than those incurred with conventional technology, mainly due to the costs of amortization. the use of digital technology is more justified when: 1) it is very necessary to reduce the dosage; 2) studies of chest and abdomen predominant; 3) the volume of utilization is high; 4) staff management is flexible , and 5) the cost of purchasing the equipment is lower. (Author) 10 refs

  17. Primary Chest Wall Abscess Mimicking a Breast Tumor That Occurred after Blunt Chest Trauma: A Case Report

    Science.gov (United States)

    Masuda, Norikazu; Yasojima, Hiroyuki; Mizutani, Makiko; Nakamori, Shoji; Kanazawa, Toru; Kuriyama, Keiko; Mano, Masayuki; Sekimoto, Mitsugu

    2014-01-01

    Primary chest wall abscess occurring after blunt chest trauma is rare. We present the case of a 50-year-old woman who presented with a swelling in her left breast. The patient had experienced blunt chest trauma 2 months back. Needle aspiration revealed pus formation in the patient's chest. Computed tomography revealed a mass in the lower region of the left mammary gland, with thickening of the parietal pleura and skin and fracture of the fifth rib under the abscess. Following antibiotic administration and irrigation of the affected region, surgical debridement was performed. During surgery, we found that the pectoralis major muscle at the level of the fifth rib was markedly damaged, although the necrotic tissue did not contact the mammary gland. We diagnosed the lesion as a chest wall abscess that occurred in response to blunt chest trauma. Her postoperative course was uneventful. There has been no recurrence for six months after surgery. PMID:24660001

  18. Primary Chest Wall Abscess Mimicking a Breast Tumor That Occurred after Blunt Chest Trauma: A Case Report

    Directory of Open Access Journals (Sweden)

    Yusuke Yamaoka

    2014-01-01

    Full Text Available Primary chest wall abscess occurring after blunt chest trauma is rare. We present the case of a 50-year-old woman who presented with a swelling in her left breast. The patient had experienced blunt chest trauma 2 months back. Needle aspiration revealed pus formation in the patient’s chest. Computed tomography revealed a mass in the lower region of the left mammary gland, with thickening of the parietal pleura and skin and fracture of the fifth rib under the abscess. Following antibiotic administration and irrigation of the affected region, surgical debridement was performed. During surgery, we found that the pectoralis major muscle at the level of the fifth rib was markedly damaged, although the necrotic tissue did not contact the mammary gland. We diagnosed the lesion as a chest wall abscess that occurred in response to blunt chest trauma. Her postoperative course was uneventful. There has been no recurrence for six months after surgery.

  19. Improved drainage with active chest tube clearance.

    Science.gov (United States)

    Shiose, Akira; Takaseya, Tohru; Fumoto, Hideyuki; Arakawa, Yoko; Horai, Tetsuya; Boyle, Edward M; Gillinov, A Marc; Fukamachi, Kiyotaka

    2010-05-01

    This study was performed to evaluate the efficacy of a novel chest drainage system. This system employs guide wire-based active chest tube clearance to improve drainage and maintain patency. A 32 Fr chest tube was inserted into pleural cavities of five pigs. On the left, a tube was connected to the chest canister, and on the right, the new system was inserted between the chest tube and chest canister. Acute bleeding was mimicked by periodic infusion of blood. The amount of blood drained from each chest cavity was recorded every 15 min for 2 h. After completion of the procedure, all residual blood and clots in each chest cavity were assessed. The new system remained widely patent, and the amount of drainage achieved with this system (670+/-105 ml) was significantly (P=0.01) higher than that with the standard tube (239+/-131 ml). The amount of retained pleural blood and clots with this system (150+/-107 ml) was significantly (P=0.04) lower than that with the standard tube (571+/-248 ml). In conclusion, a novel chest drainage system with active tube clearance significantly improved drainage without tube manipulations. 2010 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.

  20. Surgical treatment of chest instability

    International Nuclear Information System (INIS)

    Kitka, M.; Masek, M.

    2015-01-01

    Fractures of the ribs is the most common thoracic injury after blunt trauma. Chest wall instability (flail chest) is a common occurrence in the presence of multiple ribs fracture. Unilateral or bilateral fractures more ribs anteriorly or posteriorly will produce enough instability that paradoxical respiratory motion results in hypoventilation of an unacceptable degree. Open approach and surgical stabilisation of the chest preserved pulmonary function, improved pain control, minimized posttraumatic deformities and shorter back to work time. (author)

  1. Direct and indirect effects of copper-contaminated sediments on the functions of model freshwater ecosystems.

    Science.gov (United States)

    Gardham, Stephanie; Chariton, Anthony A; Hose, Grant C

    2015-01-01

    Copper is acutely toxic to, and directly affects, primary producers and decomposers, which are key players in essential processes such as the nutrient cycle in freshwater ecosystems. Even though the indirect effects of metals (for example effects due to changes in species interactions) may be more common than direct effects, little is known about the indirect effects of copper on primary producers and decomposers. The effects of copper on phytoplankton, macrophytes, periphyton and organic matter decomposition in an outdoor lentic mesocosm facility were assessed, and links between the responses examined. Copper directly decreased macrophyte growth, subsurface organic matter decomposition, and the potential for high phytoplankton Chlorophyll a concentrations. However, periphyton cover and organic matter decomposition on the surface of the sediment were stimulated by the presence of copper. These latter responses were attributed to indirect effects, due to a reduction in grazing pressure from snails, particularly Physa acuta, in the higher copper-contaminated mesocosms. This permitted the growth of periphyton and other heterotrophs, ultimately increasing decomposition at the sediment surface. The present study demonstrates the pronounced influence indirect effects may have on ecological function, findings that may not be observed in traditional laboratory studies (which utilize single species or simplistic communities).

  2. Clinical Utility of Chest Computed Tomography in Patients with Rib Fractures CT Chest and Rib Fractures

    OpenAIRE

    Chapman, Brandon C.; Overbey, Douglas M.; Tesfalidet, Feven; Schramm, Kristofer; Stovall, Robert T.; French, Andrew; Johnson, Jeffrey L.; Burlew, Clay C.; Barnett, Carlton; Moore, Ernest E.; Pieracci, Fredric M.

    2016-01-01

    Background Chest CT is more sensitive than a chest X-ray (CXR) in diagnosing rib fractures; however, the clinical significance of these fractures remains unclear. Objectives The purpose of this study was to determine the added diagnostic use of chest CT performed after CXR in patients with either known or suspected rib fractures secondary to blunt trauma. Methods Retrospective coho...

  3. Chest pain

    International Nuclear Information System (INIS)

    Martinez A, Juan Carlos; Saenz M, Oscar; Martinez M, Camilo; Gonzales A Francisco; Nicolas R, Jose; Vergara V, Erika P; Pereira G, Alberto M

    2010-01-01

    In emergency departments, chest pain is one of the leading motives of consultation. We thus consider it important to review aspects such as its classification, causes, and clinical profiles. Initial assessment should include a full clinical history comprising thorough anamnesis and physical examination. Adequate interpretation of auxiliary tests, ordered in accordance with suspected clinical conditions, should lead to accurate diagnosis. We highlight certain symptoms and clinical signs, ECG and X-ray findings, cardiac bio markers, arterial blood gases, and CT-scanning. Scores of severity and prognosis such as TIMI are assessed. Optimal treatment of the clinical conditions leading to chest pain depends on adequate initial approach and assessment.

  4. Imaging of blunt chest trauma

    International Nuclear Information System (INIS)

    Wicky, S.; Wintermark, M.; Schnyder, P.; Capasso, P.; Denys, A.

    2000-01-01

    In western European countries most blunt chest traumas are associated with motor vehicle and sport-related accidents. In Switzerland, 39 of 10,000 inhabitants were involved and severely injured in road accidents in 1998. Fifty two percent of them suffered from blunt chest trauma. According to the Swiss Federal Office of Statistics, traumas represented in men the fourth major cause of death (4 %) after cardiovascular disease (38 %), cancer (28 %), and respiratory disease (7 %) in 1998. The outcome of chest trauma patients is determined mainly by the severity of the lesions, the prompt appropriate treatment delivered on the scene of the accident, the time needed to transport the patient to a trauma center, and the immediate recognition of the lesions by a trained emergency team. Other determining factors include age as well as coexisting cardiac, pulmonary, and renal diseases. Our purpose was to review the wide spectrum of pathologies related to blunt chest trauma involving the chest wall, pleura, lungs, trachea and bronchi, aorta, aortic arch vessels, and diaphragm. A particular focus on the diagnostic impact of CT is demonstrated. (orig.)

  5. Correlations between quality indexes of chest compression.

    Science.gov (United States)

    Zhang, Feng-Ling; Yan, Li; Huang, Su-Fang; Bai, Xiang-Jun

    2013-01-01

    Cardiopulmonary resuscitation (CPR) is a kind of emergency treatment for cardiopulmonary arrest, and chest compression is the most important and necessary part of CPR. The American Heart Association published the new Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care in 2010 and demanded for better performance of chest compression practice, especially in compression depth and rate. The current study was to explore the relationship of quality indexes of chest compression and to identify the key points in chest compression training and practice. Totally 219 healthcare workers accepted chest compression training by using Laerdal ACLS advanced life support resuscitation model. The quality indexes of chest compression, including compression hands placement, compression rate, compression depth, and chest wall recoil as well as self-reported fatigue time were monitored by the Laerdal Computer Skills and Reporting System. The quality of chest compression was related to the gender of the compressor. The indexes in males, including self-reported fatigue time, the accuracy of compression depth and the compression rate, the accuracy of compression rate, were higher than those in females. However, the accuracy of chest recoil was higher in females than in males. The quality indexes of chest compression were correlated with each other. The self-reported fatigue time was related to all the indexes except the compression rate. It is necessary to offer CPR training courses regularly. In clinical practice, it might be better to change the practitioner before fatigue, especially for females or weak practitioners. In training projects, more attention should be paid to the control of compression rate, in order to delay the fatigue, guarantee enough compression depth and improve the quality of chest compression.

  6. Cost-effectiveness of 2 + 1 dosing of 13-valent and 10-valent pneumococcal conjugate vaccines in Canada

    Directory of Open Access Journals (Sweden)

    Earnshaw Stephanie R

    2012-04-01

    Full Text Available Abstract Background Thirteen-valent pneumococcal conjugate vaccine (PCV13 and 10-valent pneumococcal conjugate vaccine (PCV10 are two recently approved vaccines for the active immunization against Streptococcus pneumoniae causing invasive pneumococcal disease in infants and children. PCV13 offers broader protection against Streptococcus pneumoniae; however, PCV10 offers potential protection against non-typeable Haemophilus influenza (NTHi. We examined public health and economic impacts of a PCV10 and PCV13 pediatric national immunization programs (NIPs in Canada. Methods A decision-analytic model was developed to examine the costs and outcomes associated with PCV10 and PCV13 pediatric NIPs. The model followed individuals over the remainder of their lifetime. Recent disease incidence, serotype coverage, population data, percent vaccinated, costs, and utilities were obtained from the published literature. Direct and indirect effects were derived from 7-valent pneumococcal vaccine. Additional direct effect of 4% was attributed to PCV10 for moderate to severe acute otitis media to account for potential NTHi benefit. Annual number of disease cases and costs (2010 Canadian dollars were presented. Results In Canada, PCV13 was estimated to prevent more cases of disease (49,340 when considering both direct and indirect effects and 7,466 when considering direct effects only than PCV10. This translated to population gains of 258 to 13,828 more quality-adjusted life-years when vaccinating with PCV13 versus PCV10. Annual direct medical costs (including the cost of vaccination were estimated to be reduced by $5.7 million to $132.8 million when vaccinating with PCV13. Thus, PCV13 dominated PCV10, and sensitivity analyses showed PCV13 to always be dominant or cost-effective versus PCV10. Conclusions Considering the epidemiology of pneumococcal disease in Canada, PCV13 is shown to be a cost-saving immunization program because it provides substantial public

  7. The indirect effects of cheatgrass invasion: Grasshopper herbivory on native grasses determined by neighboring cheatgrass abundance

    Science.gov (United States)

    Julie Beckstead; Susan E. Meyer; Carol K. Augsperger

    2008-01-01

    Invasion biology has focused on the direct effects of plant invasion and has generally overlooked indirect interactions. Here we link theories of invasion biology and herbivory to explore an indirect effect of one invading species on associational herbivory (the effect of neighboring plants on herbivory) of native species. We studied a Great Basin shadscale (...

  8. Segmentation of ribs in digital chest radiographs

    Science.gov (United States)

    Cong, Lin; Guo, Wei; Li, Qiang

    2016-03-01

    Ribs and clavicles in posterior-anterior (PA) digital chest radiographs often overlap with lung abnormalities such as nodules, and cause missing of these abnormalities, it is therefore necessary to remove or reduce the ribs in chest radiographs. The purpose of this study was to develop a fully automated algorithm to segment ribs within lung area in digital radiography (DR) for removal of the ribs. The rib segmentation algorithm consists of three steps. Firstly, a radiograph was pre-processed for contrast adjustment and noise removal; second, generalized Hough transform was employed to localize the lower boundary of the ribs. In the third step, a novel bilateral dynamic programming algorithm was used to accurately segment the upper and lower boundaries of ribs simultaneously. The width of the ribs and the smoothness of the rib boundaries were incorporated in the cost function of the bilateral dynamic programming for obtaining consistent results for the upper and lower boundaries. Our database consisted of 93 DR images, including, respectively, 23 and 70 images acquired with a DR system from Shanghai United-Imaging Healthcare Co. and from GE Healthcare Co. The rib localization algorithm achieved a sensitivity of 98.2% with 0.1 false positives per image. The accuracy of the detected ribs was further evaluated subjectively in 3 levels: "1", good; "2", acceptable; "3", poor. The percentages of good, acceptable, and poor segmentation results were 91.1%, 7.2%, and 1.7%, respectively. Our algorithm can obtain good segmentation results for ribs in chest radiography and would be useful for rib reduction in our future study.

  9. Nodule detection in digital chest radiography: Effect of anatomical noise

    International Nuclear Information System (INIS)

    Baath, M.; Haakansson, M.; Boerjesson, S.; Hoeschen, C.; Tischenko, O.; Kheddache, S.; Vikgren, J.; Maansson, L. G.

    2005-01-01

    The image background resulting from imaged anatomy can be divided into those components that are meaningful to the observers, in the sense that they are recognised as separate structures, and those that are not. These latter components (referred to as anatomical noise) can be removed using a method developed within the RADIUS group. The aim of the present study was to investigate whether the removal of the anatomical noise results in images where lung nodules with lower contrast can be detected. A receiver operating characteristic (ROC) study was therefore conducted using two types of images: clinical chest images and chest images in which the anatomical noise had been removed. Simulated designer nodules with a full-width-at-fifth-maximum of 10 mm but with varying contrast were added to the images. The contrast needed to obtain an area under the ROC curve of 0.80, C0.8, was used as a measure of detectability (a low value of C0.8 represents a high delectability). Five regions of the chest X ray were investigated and it was found that in all regions the removal of anatomical noise led to images with lower C0.8 than the original images. On average, C0.8 was 20% higher in the original images, ranging from 7% (the lateral pulmonary regions) to 41% (the upper mediastinal regions). (authors)

  10. Estimating adipose tissue in the chest wall using ultrasonic and alternate 40K and biometric measurements

    International Nuclear Information System (INIS)

    Anderson, A.L.; Campbell, G.W.; Singh, M.S.

    1982-01-01

    The percentage of adipose (fat) tissue in the chest wall must be known to accurately measure Pu in the human lung. Correction factors of 100% or more in X-ray detection efficiency are common in a normal population of individuals of differing body composition and have been determined in the past by means of elaborate and costly ultrasonic measurements of the subject's chest. Methods using simple 40 K and biometric measurement techniques have been investigated to determine the adipose content in the human chest wall. These methods compare favorably with ultrasonic measurements and allow laboratories not possessing ultrasonic equipment to make appropriate corrections for x-ray detection efficiency. These methods predict adipose content to within 15% of the absolute ultrasonic value. (author)

  11. The forgotten view: Chest X-ray - Lateral view

    Directory of Open Access Journals (Sweden)

    Abraham M. Ittyachen

    2017-01-01

    Full Text Available With CT (computed tomography chest gaining more importance as a diagnostic tool, chest X-ray especially the lateral view is taken less commonly nowadays. Besides CT chest is also proven to be superior to chest X-ray in patients with major blunt trauma. We are presenting a 68-year old male who was partially treated from outside for a left sided pneumonia. He came to our hospital because of persisting chest pain. Chest X-ray, frontal view (postero-anterior was almost normal except for a mild opacity in the left lower zone. CT scan of the chest revealed a fluid collection posteriorly enclosed within enhancing pleura. Chest X-ray, left lateral view showed a corresponding posterior pleural based opacity. We are presenting this case to highlight the importance of the lateral view of the chest X-ray. In selected cases there is still a role for the lateral view. With the three dimensional visualization provided by the CT, the lateral view of the chest may be easier to understand. Consequent to the initial diagnosis by CT further follow up can be done with the chest X-ray. In a limited way this mitigates unnecessary expenditure and more importantly prevents the patient from exposure to harmful radiation in the form of repeated CT.

  12. Large pneumothorax in blunt chest trauma: Is a chest drain always necessary in stable patients? A case report

    OpenAIRE

    Idris, Baig M.; Hefny, Ashraf F.

    2016-01-01

    Introduction: Pneumothorax is the most common potentially life-threatening blunt chest injury. The management of pneumothorax depends upon the etiology, its size and hemodynamic stability of the patient. Most clinicians agree that chest drainage is essential for the management of traumatic large pneumothorax. Herein, we present a case of large pneumothorax in blunt chest trauma patient that resolved spontaneously without a chest drain. Presentation of case: A 63- year- old man presented...

  13. Development of a Practical Costing Method for Hospitals

    OpenAIRE

    Cao, Pengyu; Toyabe, Shin-ichi; Akazawa, Kouhei

    2006-01-01

    To realize an effective cost control, a practical and accurate cost accounting system is indispensable in hospitals. In traditional cost accounting systems, the volume-based costing (VBC) is the most popular cost accounting method. In this method, the indirect costs are allocated to each cost object (services or units of a hospital) using a single indicator named a cost driver (e.g., Labor hours, revenues or the number of patients). However, this method often results in rough and inaccurate r...

  14. Anatomical decomposition in dual energy chest digital tomosynthesis

    Science.gov (United States)

    Lee, Donghoon; Kim, Ye-seul; Choi, Sunghoon; Lee, Haenghwa; Choi, Seungyeon; Kim, Hee-Joung

    2016-03-01

    Lung cancer is the leading cause of cancer death worldwide and the early diagnosis of lung cancer has recently become more important. For early screening lung cancer, computed tomography (CT) has been used as a gold standard for early diagnosis of lung cancer [1]. The major advantage of CT is that it is not susceptible to the problem of misdiagnosis caused by anatomical overlapping while CT has extremely high radiation dose and cost compared to chest radiography. Chest digital tomosynthesis (CDT) is a recently introduced new modality for lung cancer screening with relatively low radiation dose compared to CT [2] and also showing high sensitivity and specificity to prevent anatomical overlapping occurred in chest radiography. Dual energy material decomposition method has been proposed for better detection of pulmonary nodules as means of reducing the anatomical noise [3]. In this study, possibility of material decomposition in CDT was tested by simulation study and actual experiment using prototype CDT. Furthermore organ absorbed dose and effective dose were compared with single energy CDT. The Gate v6 (Geant4 application for tomographic emission), and TASMIP (Tungsten anode spectral model using the interpolating polynomial) code were used for simulation study and simulated cylinder shape phantom consisted of 4 inner beads which were filled with spine, rib, muscle and lung equivalent materials. The patient dose was estimated by PCXMC 1.5 Monte Carlo simulation tool [4]. The tomosynthesis scan was performed with a linear movement and 21 projection images were obtained over 30 degree of angular range with 1.5° degree of angular interval. The proto type CDT system has same geometry with simulation study and composed of E7869X (Toshiba, Japan) x-ray tube and FDX3543RPW (Toshiba, Japan) detector. The result images showed that reconstructed with dual energy clearly visualize lung filed by removing unnecessary bony structure. Furthermore, dual energy CDT could enhance

  15. Efficacy of the addition of positive airway pressure to conventional chest physiotherapy in resolution of pleural effusion after drainage: protocol for a randomised controlled trial.

    Science.gov (United States)

    da Conceição Dos Santos, Elinaldo; Lunardi, Adriana Claudia

    2015-04-01

    Chest drainage for pleural effusion can cause pain and changes in respiratory function. It can also increase the risk of pulmonary complications and impair functional ability, which may increase length of hospital stay and the associated costs. For these reasons, surgical and clinical strategies have been adopted to reduce the duration of chest drainage. To evaluate the efficacy of the addition of intermittent positive airway pressure applied by the Muller reanimator via a rubber facial mask versus conventional physiotherapy on the duration of chest drainage (primary objective), and its effect on the recovery of respiratory function, length of hospital stay and incidence of pulmonary complications (secondary objectives). Randomised, controlled trial. Inpatients with pleural effusion, aged over 18 years, who have had chest drainage in situ for drain will be a transudate output ≤ 200ml over 24hours and full lung expansion on chest radiography, as assessed by a blinded physician. Duration of chest drainage, length of hospital stay, and any pulmonary complications diagnosed during hospitalisation will be recorded. Intention to treat using: survival analysis for duration of chest drainage, and length of hospital stay; analysis of variance for chest-tube output, lung function and peripheral oxygen saturation; and chi-square tests for comparing the incidence of pulmonary complications between groups. Conventional chest physiotherapy and intermittent positive airway pressure breathing are widely indicated for people with pleural effusion and chest drains; however, no studies have evaluated the real benefit of this type of treatment. Our hypothesis is that optimised lung expansion achieved through the application of intermittent positive airway pressure will accelerate the reabsorption of pleural effusion, decrease the duration of chest drainage and respiratory system impairment, reduce the length of hospital stay, and reduce the incidence of pulmonary complications

  16. Atmospheric ions and probable indirect biological effect of low-level radiation

    International Nuclear Information System (INIS)

    Spurny, Z.

    1984-01-01

    The problem is discussed of the health consequences of low radiation doses (of less than 0.01 Gy). Owing to natural radioactivity and cosmic radiation, ions are formed in the atmosphere which may thus indirectly mediate the effects of ionizing radiation on the organism. The rate of ion formation is approximately 6.1 ion pairs/cm 3 .s and their number will not exceed 10 3 ions/cm 3 . In an environment where artificial radioactive sources are used, the ion concentration may reach up to 10 5 ions/cm 3 . The effect of ions on man may be divided into several types: 1. effect on mental state (behaviour, fatigue, headaches); 2. effect on the cardiovascular system; 3. effect on the bronchial system;and 4. effect on physiological processes, e.g., secretion by endocrine glands. It is not yet known whether the biological effect of small (fast) ions is a function of their electric charge only or of their kinetic energy as well. The view is discussed that low radiation doses through indirect effects have favourable and beneficial influence on the human organism. (M.D.)

  17. Integrating Efficiency of Industry Processes and Practices Alongside Technology Effectiveness in Space Transportation Cost Modeling and Analysis

    Science.gov (United States)

    Zapata, Edgar

    2012-01-01

    This paper presents past and current work in dealing with indirect industry and NASA costs when providing cost estimation or analysis for NASA projects and programs. Indirect costs, when defined as those costs in a project removed from the actual hardware or software hands-on labor; makes up most of the costs of today's complex large scale NASA space/industry projects. This appears to be the case across phases from research into development into production and into the operation of the system. Space transportation is the case of interest here. Modeling and cost estimation as a process rather than a product will be emphasized. Analysis as a series of belief systems in play among decision makers and decision factors will also be emphasized to provide context.

  18. Algorithm for optimisation of paediatric chest radiography

    International Nuclear Information System (INIS)

    Kostova-Lefterova, D.

    2016-01-01

    The purpose of this work is to assess the current practice and patient doses in paediatric chest radiography in a large university hospital. The X-ray unit is used in the paediatric department for respiratory diseases. Another purpose was to recommend and apply optimized protocols to reduce patient dose while maintaining diagnostic image quality for the x-ray images. The practice of two different radiographers was studied. The results were compared with the existing practice in paediatric chest radiography and the opportunities for optimization were identified in order to reduce patient doses. A methodology was developed for optimization of the x-ray examinations by grouping children in age groups or according to other appropriate indication and creating an algorithm for proper selection of the exposure parameters for each group. The algorithm for the optimisation of paediatric chest radiography reduced patient doses (PKA, organ dose, effective dose) between 1.5 and 6 times for the different age groups, the average glandular dose up to 10 times and the dose for the lung between 2 and 5 times. The resulting X-ray images were of good diagnostic quality. The subjectivity in the choice of exposure parameters was reduced and standardization has been achieved in the work of the radiographers. The role of the radiologist, the medical physicist and radiographer in the process of optimization was shown. It was proven the effect of teamwork in reducing patient doses at keeping adequate image quality. Key words: Chest Radiography. Paediatric Radiography. Optimization. Radiation Exposure. Radiation Protection

  19. Implementation of a guideline for low back pain management in primary care: a cost-effectiveness analysis.

    Science.gov (United States)

    Becker, Annette; Held, Heiko; Redaelli, Marcus; Chenot, Jean F; Leonhardt, Corinna; Keller, Stefan; Baum, Erika; Pfingsten, Michael; Hildebrandt, Jan; Basler, Heinz-Dieter; Kochen, Michael M; Donner-Banzhoff, Norbert; Strauch, Konstantin

    2012-04-15

    Cost-effectiveness analysis alongside a cluster randomized controlled trial. To study the cost-effectiveness of 2 low back pain guideline implementation (GI) strategies. Several evidence-based guidelines on management of low back pain have been published. However, there is still no consensus on the effective implementation strategy. Especially studies on the economic impact of different implementation strategies are lacking. This analysis was performed alongside a cluster randomized controlled trial on the effectiveness of 2 GI strategies (physician education alone [GI] or physician education in combination with motivational counseling [MC] by practice nurses)--both compared with the postal dissemination of the guideline (control group, C). Sociodemographic data, pain characteristics, and cost data were collected by interview at baseline and after 6 and 12 months. low back pain-related health care costs were valued for 2004 from the societal perspective. For the cost analysis, 1322 patients from 126 general practices were included. Both interventions showed lower direct and indirect costs as well as better patient outcomes during follow-up compared with controls. In addition, both intervention arms showed superiority of cost-effectiveness to C. The effects attenuated when adjusting for differences of health care utilization prior to patient recruitment and for clustering of data. Trends in cost-effectiveness are visible but need to be confirmed in future studies. Researchers performing cost-evaluation studies should test for baseline imbalances of health care utilization data instead of judging on the randomization success by reviewing non-cost parameters like clinical data alone.

  20. Noncardiac chest pain: diagnosis and management.

    Science.gov (United States)

    Yamasaki, Takahisa; Fass, Ronnie

    2017-07-01

    Noncardiac chest pain (NCCP) has been defined as recurrent chest pain that is indistinguishable from ischemic heart pain after excluding a cardiac cause. NCCP is a common and highly challenging clinical problem in Gastrointestinal practice that requires targeted diagnostic assessment to identify the underlying cause of the symptoms. Treatment is tailored according to the cause of NCCP: gastroesophageal reflux disease (GERD), esophageal dysmotility or functional chest pain. The purpose of this review is to discuss the current diagnosis and treatment of NCCP. Utilization of new diagnostic techniques such as pH-impedance and high-resolution esophageal manometry, and the introduction of a new definition for functional chest pain have helped to better diagnose the underlying mechanisms of NCCP. A better therapeutic approach toward GERD-related NCCP, the introduction of new interventions for symptoms due to esophageal spastic motor disorders and the expansion of the neuromodulator armamentarium for functional chest pain have changed the treatment landscape of NCCP. GERD is the most common esophageal cause of NCCP, followed by functional chest pain and esophageal dysmotility. The proton pump inhibitor test, upper endoscopy, wireless pH capsule and pH-impedance are used to identify GERD-induced NCCP. High-resolution esophageal manometry is the main tool to identify esophageal motor disorder in non-GERD-related NCCP. Negative diagnostic assessment suggests functional chest pain. Potent antireflux treatment is offered to patients with GERD-related NCCP; medical, endoscopic or surgical interventions are considered in esophageal dysmotility; and neuromodulators are prescribed for functional chest pain. Assessment and treatment of psychological comorbidity should be considered in all NCCP patients.

  1. The costs of hepatitis A infections in South Korea

    Directory of Open Access Journals (Sweden)

    Kyohyun Kim

    2014-08-01

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

  2. Cost-effectiveness of CBT, SSRI, and CBT+SSRI in the treatment for panic disorder.

    Science.gov (United States)

    van Apeldoorn, F J; Stant, A D; van Hout, W J P J; Mersch, P P A; den Boer, J A

    2014-04-01

    The objective of this study was to assess the cost-effectiveness of three empirically supported treatments for panic disorder with or without agoraphobia: cognitive behavioral therapy (CBT), pharmacotherapy using a selective serotonin reuptake inhibitor (SSRI), or the combination of both (CBT+SSRI). Cost-effectiveness was examined based on the data from a multicenter randomized controlled trial. The Hamilton Anxiety Rating Scale was selected as a primary health outcome measure. Data on costs from a societal perspective (i.e., direct medical, direct non-medical, and indirect non-medical costs) were collected in the study sample (N=150) throughout a 24-month period in which patients received active treatment during the first twelve months and were seen twice for follow-up in the next twelve months. Total costs were largely influenced by costs of the interventions and productivity losses. The mean total societal costs were lower for CBT as compared to SSRI and CBT+SSRI. Costs of medication use were substantial for both SSRI and CBT+SSRI. When examining the balance between costs and health outcomes, both CBT and CBT+SSRI led to more positive outcomes than SSRI. Cognitive behavioral therapy is associated with the lowest societal costs. Cognitive behavioral therapy and CBT+SSRI are more cost-effective treatments for panic disorder with or without agoraphobia as compared to SSRI only. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  3. Coronary artery dissection following chest trauma

    Directory of Open Access Journals (Sweden)

    Manoj K Agarwala

    2016-01-01

    Full Text Available Chest trauma has a high rate of mortality. Coronary dissection causing myocardial infarction (MI following blunt chest trauma is rare. We describe the case of an anterior MI following blunt chest trauma. A 39-year-old male was received in our hospital following a motorcycle accident. The patient was asymptomatic before the accident. The patient underwent craniotomy for evacuation of hematoma. He developed severe chest pain and an electrocardiogram (ECG revealed anterior ST segment elevation following surgery. Acute coronary event was medically managed; subsequently, coronary angiogram was performed that showed dissection in the left anterior coronary artery, which was stented.

  4. A Systematic Review of the Cost-Effectiveness of Biologics for the Treatment of Inflammatory Bowel Diseases.

    Directory of Open Access Journals (Sweden)

    Saara Huoponen

    Full Text Available Biologics are used for the treatment of inflammatory bowel diseases, Crohn´s disease and ulcerative colitis refractory to conventional treatment. In order to allocate healthcare spending efficiently, costly biologics for inflammatory bowel diseases are an important target for cost-effectiveness analyses. The aim of this study was to systemically review all published literature on the cost-effectiveness of biologics for inflammatory bowel diseases and to evaluate the methodological quality of cost-effectiveness analyses.A literature search was performed using Medline (Ovid, Cochrane Library, and SCOPUS. All cost-utility analyses comparing biologics with conventional medical treatment, another biologic treatment, placebo, or surgery for the treatment of inflammatory bowel diseases in adults were included in this review. All costs were converted to the 2014 euro. The methodological quality of the included studies was assessed by Drummond's, Philips', and the Consolidated Health Economic Evaluation Reporting Standards checklist.Altogether, 25 studies were included in the review. Among the patients refractory to conventional medical treatment, the incremental cost-effectiveness ratio ranged from dominance to 549,335 €/Quality-Adjusted Life Year compared to the incremental cost-effectiveness ratio associated with conventional medical treatment. When comparing biologics with another biologic treatment, the incremental cost-effectiveness ratio ranged from dominance to 24,012,483 €/Quality-Adjusted Life Year. A study including both direct and indirect costs produced more favorable incremental cost-effectiveness ratios than those produced by studies including only direct costs.With a threshold of 35,000 €/Quality-Adjusted Life Year, biologics seem to be cost-effective for the induction treatment of active and severe inflammatory bowel disease. Between biologics, the cost-effectiveness remains unclear.

  5. An update of “Cost-effectiveness of rotavirus vaccination in the Netherlands: the results of a Consensus Rotavirus Vaccine model”

    Directory of Open Access Journals (Sweden)

    Tu Hong Anh T

    2013-01-01

    Full Text Available Abstract Background To update a cost-effectiveness analysis of rotavirus vaccination in the Netherlands previously published in 2011. Methods The rotavirus burden of disease and the indirect protection of older children and young adults (herd protection were updated. Results When updated data was used, routine infant rotavirus vaccination in the Netherlands would potentially become an even more cost-effective strategy than previously estimated with the incremental cost per QALY at only €3,000-4,000. Break-even total vaccination costs were indicated at €92–122, depending on the applied threshold. Conclusions We concluded that the results on potentially favourable cost-effectiveness in the previous study remained valid, however, the new data suggested that previous results might represent an underestimation of the economic attractiveness of rotavirus vaccination.

  6. Early appearance of SARS on chest CT scan

    International Nuclear Information System (INIS)

    Cheng Xiaoguang; Feng Suchen; Xia Guoguang; Zhao Tao; Gu Xiang; Qu Hui

    2003-01-01

    Objective: To evaluate the early appearance of SARS on chest CT scan and its role in the early diagnosis. Methods: Forty cases of SARS in keeping with the criteria of the Ministry of Health had chest CT scans within 7 days of onset of symptoms, and CR chest X-ray films were available as well. These chest X-rays and CT images were retrospectively reviewed to determine if there were any abnormalities on the images. The lesions on the chest CT images were then further analyzed in terms of the number, location, size, and density. Results: Positive abnormalities on chest CT scans were revealed in all 40 SARS cases. Positive findings on CR chest films were showed in only 25 cases, equivocal in 6, and normal in 9 cases. The main abnormalities seen on CT and X-rays were pulmonary infiltrations varied markedly in severity. 70 % cases had 1 or 2 lesions on chest CT scan, 30 % cases had 3 or more lesions. The lesions seen on chest CT scan tended to be ground-glass opacification, sometimes with consolidation which was very faint and inhomogeneous, easily missed on chest X-rays. Typically the lesions were located in the periphery of the lung, or both central and peripheral lung, but very rare in a pure central location. They were commonly in the shape of patch or ball. Conclusions: Chest CT scan is much more sensitive in detecting the lesions of the lung in SARS. The early appearance of SARS on chest CT scan is characteristic but non-specific, indicating that chest CT scan plays a very important role in the early diagnosis and differential diagnosis of SARS

  7. Comprehensive cardiovascular ECG-gated MDCT as a standard diagnostic tool in patients with acute chest pain

    Energy Technology Data Exchange (ETDEWEB)

    Runza, G. [Department of Radiology, University of Palermo (Italy)], E-mail: grunza@sirm.org; La Grutta, L.; Alaimo, V. [Department of Radiology, University of Palermo (Italy); Evola, S. [Department of Cardiology, University of Palermo (Italy); Lo Re, F.; Bartolotta, T.V. [Department of Radiology, University of Palermo (Italy); Cademartiri, F. [Department of Radiology and Cardiology, Erasmus Medical Center, Rotterdam (Netherlands); Department of Radiology and Cardiology, Cardiovascular CT Unit, University Hospital, Parma (Italy); Midiri, M. [Department of Radiology, University of Palermo (Italy)

    2007-10-15

    Acute myocardial infarction, pulmonary embolism, and aortic dissection are diseases associated with acute chest pain and may lead to severe morbidity and mortality. These diseases may not be trivial to diagnose in the settings of emergency room. ECG-gated multi-detector computed tomography (MDCT), already established for the assessment of pulmonary embolism and aortic dissection, provides reliable information regarding the triage of patients with acute coronary syndrome in the emergency room. MDCT recently appeared to be logistically feasible and a promising comprehensive method for the evaluation of cardiac and non-cardiac chest pain in emergency department patients. The possibility to scan the entire thorax visualizing the thoracic aorta, the pulmonary arteries, and the coronary arteries could provide a new approach to the triage of acute chest pain. The inherent advantage of MDCT with cardiac state-of-the-art capabilities is the rapid investigation of the main sources of acute chest pain with a high negative predictive value. Recent studies also reports an advantage in terms of costs. With current evidence, the selection of patients with acute chest pain candidates to MDCT should remain restricted to avoid unjustified risk of ionizing radiation.

  8. Comprehensive cardiovascular ECG-gated MDCT as a standard diagnostic tool in patients with acute chest pain

    International Nuclear Information System (INIS)

    Runza, G.; La Grutta, L.; Alaimo, V.; Evola, S.; Lo Re, F.; Bartolotta, T.V.; Cademartiri, F.; Midiri, M.

    2007-01-01

    Acute myocardial infarction, pulmonary embolism, and aortic dissection are diseases associated with acute chest pain and may lead to severe morbidity and mortality. These diseases may not be trivial to diagnose in the settings of emergency room. ECG-gated multi-detector computed tomography (MDCT), already established for the assessment of pulmonary embolism and aortic dissection, provides reliable information regarding the triage of patients with acute coronary syndrome in the emergency room. MDCT recently appeared to be logistically feasible and a promising comprehensive method for the evaluation of cardiac and non-cardiac chest pain in emergency department patients. The possibility to scan the entire thorax visualizing the thoracic aorta, the pulmonary arteries, and the coronary arteries could provide a new approach to the triage of acute chest pain. The inherent advantage of MDCT with cardiac state-of-the-art capabilities is the rapid investigation of the main sources of acute chest pain with a high negative predictive value. Recent studies also reports an advantage in terms of costs. With current evidence, the selection of patients with acute chest pain candidates to MDCT should remain restricted to avoid unjustified risk of ionizing radiation

  9. Estimated cost of overactive bladder in Thailand.

    Science.gov (United States)

    Prasopsanti, Kriangsak; Santi-Ngamkun, Apirak; Pornprasit, Kanokwan

    2007-11-01

    To estimate the annual direct and indirect costs of overactive bladder (OAB) in indigenous Thai people aged 18 years and over in the year 2005. Economically based models using diagnostic and treatment algorithms from clinical practice guidelines and current disease prevalence data were used to estimate direct and indirect costs of OAB. Prevalence and event probability estimates were obtained from the literature, national data sets, and expert opinion. Costs were estimated from a small survey using a cost questionnaire and from unit costs of King Chulalongkorn Memorial Hospital. The annual cost of OAB in Thailand is estimated as 1.9 billion USD. It is estimated to consume 1.14% of national GDP The cost includes 0.33 billion USD for direct medical costs, 1.3 billion USD for direct, nonmedical costs and 0.29 billion USD for indirect costs of lost productivity. The largest costs category was direct treatment costs of comorbidities associated with OAB. Costs of OAB medication accountedfor 14% of the total costs ofOAB.

  10. Assessing Mediational Models: Testing and Interval Estimation for Indirect Effects.

    Science.gov (United States)

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

    2010-08-06

    Theoretical models specifying indirect or mediated effects are common in the social sciences. An indirect effect exists when an independent variable's influence on the dependent variable is mediated through an intervening variable. Classic approaches to assessing such mediational hypotheses ( Baron & Kenny, 1986 ; Sobel, 1982 ) have in recent years been supplemented by computationally intensive methods such as bootstrapping, the distribution of the product methods, and hierarchical Bayesian Markov chain Monte Carlo (MCMC) methods. These different approaches for assessing mediation are illustrated using data from Dunn, Biesanz, Human, and Finn (2007). However, little is known about how these methods perform relative to each other, particularly in more challenging situations, such as with data that are incomplete and/or nonnormal. This article presents an extensive Monte Carlo simulation evaluating a host of approaches for assessing mediation. We examine Type I error rates, power, and coverage. We study normal and nonnormal data as well as complete and incomplete data. In addition, we adapt a method, recently proposed in statistical literature, that does not rely on confidence intervals (CIs) to test the null hypothesis of no indirect effect. The results suggest that the new inferential method-the partial posterior p value-slightly outperforms existing ones in terms of maintaining Type I error rates while maximizing power, especially with incomplete data. Among confidence interval approaches, the bias-corrected accelerated (BC a ) bootstrapping approach often has inflated Type I error rates and inconsistent coverage and is not recommended; In contrast, the bootstrapped percentile confidence interval and the hierarchical Bayesian MCMC method perform best overall, maintaining Type I error rates, exhibiting reasonable power, and producing stable and accurate coverage rates.

  11. Cost-effectiveness of pneumococcal conjugate vaccination in Croatia.

    Science.gov (United States)

    Vučina, V Višekruna; Filipović, S Kurečić; Kožnjak, N; Stamenić, V; Clark, A D; Mounaud, B; Blau, J; Hoestlandt, C; Kaić, B

    2015-05-07

    were borderline cost-effective (US$ per DALY averted less than 3×GDP per capita of approximately US$ 40,000). The first was a scenario based primarily on the WHO 2008 pneumococcal disease burden estimates for Croatia. The second was a scenario that assumed a fairly dramatic drop in the price of the vaccine over the period. Both vaccines would need to be priced at approximately US$ 20 per dose or less to be considered cost-effective under base-case assumptions. PCV10 would be more cost-effective than PCV13 with base-case assumptions, but this is sensitive to the price of each vaccine. Based on estimated health and economic benefits in children alone, PCV is unlikely to be cost-effective in Croatia. Both vaccines would need to be priced at less than US$ 20 per dose to be considered cost-effective for children. Further analyses should be conducted to estimate the health and economic burden of pneumococcal disease in older age groups, and to assess the influence on cost-effectiveness results when short-term and long-term indirect effects are included for older individuals. While there are important uncertainties around the price and effectiveness of both vaccines, our analysis suggests there is insufficient evidence to warrant a significant difference in the price of the two vaccines. Copyright © 2014 Elsevier Ltd. All rights reserved.

  12. Cost-Effectiveness Analysis of Omalizumab for the Treatment of Severe Persistent Asthma in Real Clinical Practice in Spain.

    Science.gov (United States)

    Vennera, María Del Carmen; Valero, Antonio; Uría, Estefany; Forné, Carles; Picado, César

    2016-07-01

    Omalizumab is a humanized monoclonal antibody that targets circulating immunoglobulin E molecules to treat severe uncontrolled asthma. The aim of this study was to determine the cost effectiveness of omalizumab compared with standard treatment for the control of severe persistent asthma according to data from patients treated in a specialized asthma unit. This was an observational, retrospective, single-center study in the setting of the Pulmonology and Respiratory Allergy Service, Thorax Institute, Hospital Clínic de Barcelona, Barcelona, Spain. Data were collected by review of medical records of 86 uncontrolled severe persistent asthma patients treated with omalizumab from January 2005 to April 2014. Effectiveness was assessed by the reduction in asthma exacerbations and 3-point increases in the Asthma Control Test (ACT) score. The economic evaluation was performed from the societal perspective, including direct health costs (resource use and drug treatments) and indirect costs (disease impact on labor productivity) in 2016 Euros. The time horizon was 12 months before and after the initiation of treatment with omalizumab. Results were expressed using the incremental cost-effectiveness ratio (ICER). Taking into account only direct costs, the ICERs were €1487.46 (95 % confidence interval [CI] 1241.21-1778.34) per exacerbation avoided and €5425.13 (95 % CI 4539.30-6551.03) per 3-point increase in the ACT. When indirect costs were included, the ICERs were €1130.93 (95 % CI 909.08-1392.86) per exacerbation avoided, and €4124.79 (95 % CI 3281.69-5186.73) per 3-point increase in the ACT. The results of this study confirm the effectiveness of the addition of omalizumab to standard therapy in patients with uncontrolled severe persistent asthma.

  13. The Effect of Direct and Indirect Corrective Feedback on Iranian EFL Learners' Spelling Errors

    Science.gov (United States)

    Ghandi, Maryam; Maghsoudi, Mojtaba

    2014-01-01

    The aim of the current study was to investigate the impact of indirect corrective feedback on promoting Iranian high school students' spelling accuracy in English (as a foreign language). It compared the effect of direct feedback with indirect feedback on students' written work dictated by their teacher from Chicken Soup for the Mother and…

  14. Direct versus indirect revascularization procedures for moyamoya disease: a comparative effectiveness study.

    Science.gov (United States)

    Macyszyn, Luke; Attiah, Mark; Ma, Tracy S; Ali, Zarina; Faught, Ryan; Hossain, Alisha; Man, Karen; Patel, Hiren; Sobota, Rosanna; Zager, Eric L; Stein, Sherman C

    2017-05-01

    OBJECTIVE Moyamoya disease (MMD) is a chronic cerebrovascular disease that can lead to devastating neurological outcomes. Surgical intervention is the definitive treatment, with direct, indirect, and combined revascularization procedures currently employed by surgeons. The optimal surgical approach, however, remains unclear. In this decision analysis, the authors compared the effectiveness of revascularization procedures in both adult and pediatric patients with MMD. METHODS A comprehensive literature search was performed for studies of MMD. Using complication and success rates from the literature, the authors constructed a decision analysis model for treatment using a direct and indirect revascularization technique. Utility values for the various outcomes and complications were extracted from the literature examining preferences in similar clinical conditions. Sensitivity analysis was performed. RESULTS A structured literature search yielded 33 studies involving 4197 cases. Cases were divided into adult and pediatric populations. These were further subdivided into 3 different treatment groups: indirect, direct, and combined revascularization procedures. In the pediatric population at 5- and 10-year follow-up, there was no significant difference between indirect and combination procedures, but both were superior to direct revascularization. In adults at 4-year follow-up, indirect was superior to direct revascularization. CONCLUSIONS In the absence of factors that dictate a specific approach, the present decision analysis suggests that direct revascularization procedures are inferior in terms of quality-adjusted life years in both adults at 4 years and children at 5 and 10 years postoperatively, respectively. These findings were statistically significant (p indirect and combination procedures may offer optimal results at long-term follow-up.

  15. Improving screen-film chest radiography

    International Nuclear Information System (INIS)

    Shaikh, N.; Baker, R.A.

    1996-01-01

    Traditionally symmetric screens and double emulsion symmetric films with medium to wide latitutde are used for radiography of the chest. Beacuse of mismatch of transmitted exposure through the chest with limited latitude of the film, most of the dense areas of the chest are underexposed. Kodak's recent innovation of a unique asymmetry screen-film system (InSight) alleviates this problem. Our phantom measurement indicates that the InSight system offers wider recording range, and the flexible grid permits more positional latitude than conventional grids. Our five-year extensive clinical experience indicates that dense anatomic structures, such as mediastinum, retrocardiac and subdiaphragmatic, are more visible in the InSight system than in the conventional symmetric system. Similarly, a substantial improvement in image quality in portable chest imaging is realized by use of flexible grids because of scatter rejection and invisible grid lines. (author)

  16. Interpretation of neonatal chest radiography

    International Nuclear Information System (INIS)

    Yoon, Hye Kyung

    2016-01-01

    Plain radiographs for infants in the neonatal intensive care unit are obtained using the portable X-ray equipment in order to evaluate the neonatal lungs and also to check the position of the tubes and catheters used for monitoring critically-ill neonates. Neonatal respiratory distress is caused by a variety of medical or surgical disease conditions. Clinical information about the gestational week, respiratory symptoms, and any events during delivery is essential for interpretation of the neonatal chest radiographs. Awareness of common chest abnormality in the prematurely born or term babies is also very important for chest evaluation in the newborn. Furthermore, knowledge about complications such as air leaks and bronchopulmonary dysplasia following treatment are required to accurately inform the clinicians. The purpose of this article was to briefly review radiographic findings of chest diseases in newborns that are relatively common in daily practice

  17. Interpretation of neonatal chest radiography

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Hye Kyung [Dept. of Radiology, Kangwon National University Hospital, Chuncheon (Korea, Republic of)

    2016-05-15

    Plain radiographs for infants in the neonatal intensive care unit are obtained using the portable X-ray equipment in order to evaluate the neonatal lungs and also to check the position of the tubes and catheters used for monitoring critically-ill neonates. Neonatal respiratory distress is caused by a variety of medical or surgical disease conditions. Clinical information about the gestational week, respiratory symptoms, and any events during delivery is essential for interpretation of the neonatal chest radiographs. Awareness of common chest abnormality in the prematurely born or term babies is also very important for chest evaluation in the newborn. Furthermore, knowledge about complications such as air leaks and bronchopulmonary dysplasia following treatment are required to accurately inform the clinicians. The purpose of this article was to briefly review radiographic findings of chest diseases in newborns that are relatively common in daily practice.

  18. Cost effectiveness of preventing falls and improving mobility in people with Parkinson disease: protocol for an economic evaluation alongside a clinical trial

    Directory of Open Access Journals (Sweden)

    Menz Hylton B

    2008-09-01

    Full Text Available Abstract Background Cost of illness studies show that Parkinson disease (PD is costly for individuals, the healthcare system and society. The costs of PD include both direct and indirect costs associated with falls and related injuries. Methods This protocol describes a prospective economic analysis conducted alongside a randomised controlled trial (RCT. It evaluates whether physical therapy is more cost effective than usual care from the perspective of the health care system. Cost effectiveness will be evaluated using a three-way comparison of the cost per fall averted and the cost per quality adjusted life year saved across two physical therapy interventions and a control group. Conclusion This study has the potential to determine whether targetted physical therapy as an adjunct to standard care can be cost effective in reducing falls in people with PD. Trial Registration No: ACTRN12606000344594

  19. Simple X-ray versus ultrasonography examination in blunt chest trauma: effective tools of accurate diagnosis and considerations for rib fractures.

    Science.gov (United States)

    Hwang, Eun Gu; Lee, Yunjung

    2016-12-01

    Simple radiography is the best diagnostic tool for rib fractures caused by chest trauma, but it has some limitations. Thus, other tools are also being used. The aims of this study were to investigate the effectiveness of ultrasonography (US) for identifying rib fractures and to identify influencing factors of its effectiveness. Between October 2003 and August 2007, 201 patients with blunt chest trauma were available to undergo chest radiographic and US examinations for diagnosis of rib fractures. The two modalities were compared in terms of effectiveness based on simple radiographic readings and US examination results. We also investigated the factors that influenced the effectiveness of US examination. Rib fractures were detected on radiography in 69 patients (34.3%) but not in 132 patients. Rib fractures were diagnosed by using US examination in 160 patients (84.6%). Of the 132 patients who showed no rib fractures on radiography, 92 showed rib fractures on US. Among the 69 patients of rib fracture detected on radiography, 33 had additional rib fractures detected on US. Of the patients, 76 (37.8%) had identical radiographic and US results, and 125 (62.2%) had fractures detected on US that were previously undetected on radiography or additional fractures detected on US. Age, duration until US examination, and fracture location were not significant influencing factors. However, in the group without detected fractures on radiography, US showed a more significant effectiveness than in the group with detected fractures on radiography ( P =0.003). US examination could detect unnoticed rib fractures on simple radiography. US examination is especially more effective in the group without detected fractures on radiography. More attention should be paid to patients with chest trauma who have no detected fractures on radiography.

  20. Regionally adaptive histogram equalization of the chest

    International Nuclear Information System (INIS)

    Sherrier, R.H.; Johnson, G.A.

    1986-01-01

    Advances in digital chest radiography have resulted in the acquisition of high-quality digital images of the human chest. With these advances, there arises a genuine need for image processing algorithms, specific to chest images. The author has implemented the technique of histogram equalization, noting the problems encountered when it is adapted to chest images. These problems have been successfully solved with a regionally adaptive histogram equalization method. Histograms are calculated locally and then modified according to both the mean pixel value of a given region and certain characteristics of the cumulative distribution function. The method allows certain regions of the chest radiograph to be enhanced differentially