WorldWideScience

Sample records for holds shrinking reimbursement

  1. 41 CFR 102-37.115 - May a holding agency be reimbursed for costs incurred incident to a donation?

    Science.gov (United States)

    2010-07-01

    ... reimbursed for costs incurred incident to a donation? 102-37.115 Section 102-37.115 Public Contracts and... REGULATION PERSONAL PROPERTY 37-DONATION OF SURPLUS PERSONAL PROPERTY Holding Agency § 102-37.115 May a holding agency be reimbursed for costs incurred incident to a donation? Yes, you, as a holding agency, may...

  2. Shrink stope design using an inventory model

    Directory of Open Access Journals (Sweden)

    D. Taylor

    2003-12-01

    Full Text Available This paper addresses the fact that current practice in shrink-stoping in hard rock mining invariably ignores the inventory holding cost of the blasted ore. We believe, and show by example, that ignoring this cost could make the difference between profit and loss in an industry that, at present, needs all the help it can get.

  3. Agroecology for the Shrinking City

    Science.gov (United States)

    Many cities are experiencing long-term declines in population and economic activity. As a result, frameworks for urban sustainability need to address the unique challenges and opportunities of such shrinking cities. Shrinking, particularly in the U.S., has led to extensive vacant...

  4. Shrinking Cities or Urban Transformation

    DEFF Research Database (Denmark)

    Laursen, Lea Louise Holst

    Shrinking Cities or Urban Transformation is a PhD-thesis conducted at the Department of Architecture and Design, Aalborg University in the period 2004-2008. The PhD concerns the spatial changes that emerge in contemporary urbanity. Contemporary urbanity can among others be characterized as both...... growing and declining. On the one hand, a concentration of the urban into a highly urbanized nodal point is happening and on the other a deconcentration of the urban fabric in declining territories is taking place. The starting point for the dissertation is the term shrinking cities, which has been...... investigation of the cases Baltimore and Denmark is conducted. This shall shed light upon whether the theoretical assumptions correspond to what is happening in the real world. The introduction of the term urban transformation is the result of these investigations and a response to shrinking cities. Urban...

  5. Shrinking cities examined from a shrinking scale – the impact ...

    Science.gov (United States)

    Urban populations continue to increase globally and cities have become the dominant human habitat. However, the growth of cities is not universal. Shrinking cities face decreased income, reduced property values, and decreased tax revenue. Fewer people per unit area creates inefficiencies and higher costs for infrastructure maintenance and the provision of public amenities. However, population losses and economic distress are not equal in all neighborhoods, and in fact are quite heterogeneously distributed across the landscape. Broader statements about the trajectory of a shrinking city may mask underlying differences in economic, cultural, and environmental impacts as well as the ability of some neighborhoods to be resilient and adaptive to economic changes as well as climate change and other environmental stressors. This paper examines the recent impact of population loss in neighborhoods in the Río Piedras watershed in San Juan, Puerto Rico, on the provision of ecosystem services, material and energy flows, and ecological impacts, using public data and data collected previously in two household surveys. Using scenarios, we estimate future population changes and their potential positive and negative impacts on the environment and human well-being in these neighborhoods. This paper expands on prior research on shrinking cities by examining the impacts of population loss on urban social-ecological systems at the household and neighborhood scales. The purpose

  6. The Incredibly Shrinking World of Imagination.

    Science.gov (United States)

    Kassem, Lou

    1992-01-01

    Suggests that children's imaginations are not shrinking. Discusses seven ways in which English teachers, librarians, publishers, and authors have used adolescent literature in creative and imaginative ways. (RS)

  7. Reimbursement of school fees

    CERN Multimedia

    2003-01-01

    Members of the personnel are reminded that only school fees from educational establishments recognized by local legislation are reimbursed by the Organization. Human Resources Division Tel. 72862/74474

  8. Rigidity of complete generic shrinking Ricci solitons

    Science.gov (United States)

    Chu, Yawei; Zhou, Jundong; Wang, Xue

    2018-01-01

    Let (Mn , g , X) be a complete generic shrinking Ricci soliton of dimension n ≥ 3. In this paper, by employing curvature inequalities, the formula of X-Laplacian for the norm square of the trace-free curvature tensor, the weak maximum principle and the estimate of the scalar curvature of (Mn , g) , we prove some rigidity results for (Mn , g , X) . In particular, it is showed that (Mn , g , X) is isometric to Rn or a finite quotient of Sn under a pointwise pinching condition. Moreover, we establish several optimal inequalities and classify those shrinking solitons for equalities.

  9. Reimbursement of school fees

    CERN Multimedia

    2003-01-01

    In order to answer regular enquiries on this subject, members of the personnel are reminded that only school fees from educational establishments recognized as such by the competent authorities of the Member State concerned are reimbursed by the Organization. Human Resources Division Tel. 72862/74474

  10. Durability of shrink joints; Bestaendighet hos krympskarvar

    Energy Technology Data Exchange (ETDEWEB)

    Forsaeus Nilsson, Stefan; Saellberg, Sven-Erik

    2007-07-01

    About one third of all joint failures are caused by shrink seals losing adhesion, according to statistics from the Swedish District Heating Association. The present project was initiated upon request from the Authorisation Board of the Swedish District Heating Association in order to investigate the potential to enhance the quality of shrink joints. The purpose has been to provide a screening of the key properties of the joint systems currently available on the market. The aim has been to facilitate the choice of right materials and constructions to achieve the best functionality and cost effectiveness. The project has comprised a compilation of the views from industry representatives from manufacturers of shrink and sealing materials, pipe producers, joint contractors and district heating companies, and an experimental study where a number of joints were evaluated with respect to tightness and strength. The following joint systems took part in the investigation: Logstor SX; Canusa SuperCase; Raychem RayJoint; Powerpipe DTK with external seal Nitto NeoCover 1150 in one end and Raychem TPSM in the other; Logstor B2S med external seal Canusa KLD in one end and Raychem TPSM in the other. The joints were installed on pipes of diameters 160 mm and 450 mm. The installation was done under cold and dirty conditions, to simulate a field like worst-case scenario. After the installation, the joints were tested with respect to tightness. Peel strength and shear strength were evaluated before and after thermal ageing in +50 deg C for 70 days. Mechanical tests and ageing followed standardised procedure in EN 12068. A study of the shrink force relaxation in crosslinked and non-crosslinked polyethylene shrink sleeves was undertaken, by shrinking them onto aluminium cylinders and storing them in room temperature for about 2000 hours. The results show that it is clearly possible to install excellent shrink joints also under difficult conditions. In addition, thermal ageing does not

  11. Shrinking villages – trajectories for local development

    DEFF Research Database (Denmark)

    Nørgaard, Helle

    The New Rural Paradigm was introduced in 2006 as a policy emphasising investments rather than subsidies and aimed at integrating different sectoral policies in order to improve the coherence and effectiveness of public expenditure. The new rural paradigm also stresses a place-based approach...... and services e.g. schools as well as investment. Rural municipalities are challenged due to shrinking villages but by focussing on place bound resources there is a risk of reinforcing disparities between ‘weak’ and ‘strong’ communities as placed bound resources are unevenly distributed. This paper will address...

  12. Viscous flows stretching and shrinking of surfaces

    CERN Document Server

    Mehmood, Ahmer

    2017-01-01

    This authored monograph provides a detailed discussion of the boundary layer flow due to a moving plate. The topical focus lies on the 2- and 3-dimensional case, considering axially symmetric and unsteady flows. The author derives a criterion for the self-similar and non-similar flow, and the turbulent flow due to a stretching or shrinking sheet is also discussed. The target audience primarily comprises research experts in the field of boundary layer flow, but the book will also be beneficial for graduate students.

  13. Ecology for the shrinking city (JA) | Science Inventory | US ...

    Science.gov (United States)

    This article brings together the concepts of shrinking cities—the hundreds of cities worldwide experiencing long-term population loss—and ecology for the city. Ecology for the city is the application of a social–ecological understanding to shaping urban form and function along sustainable trajectories. Ecology for the shrinking city therefore acknowledges that urban transformations to sustainable trajectories may be quite different in shrinking cities as compared with growing cities. Shrinking cities are well poised for transformations, because shrinking is perceived as a crisis and can mobilize the social capacity to change. Ecology is particularly well suited to contribute solutions because of the extent of vacant land in shrinking cities that can be leveraged for ecosystem-services provisioning. A crucial role of an ecology for the shrinking city is identifying innovative pathways that create locally desired amenities that provide ecosystem services and contribute to urban sustainability at multiple scales. This paper brings together the concepts of ecology for the city and shrinking cities – the hundreds of cities worldwide experiencing long-term population loss. Ecology for the city is the application of social-ecological understanding to shaping urban form and function along sustainable trajectories. Ecology for the shrinking city acknowledges that urban transformations to sustainable trajectories may be quite different in shrinking cities as compa

  14. Shrinking the Need for Homeless Shelter Spaces

    Directory of Open Access Journals (Sweden)

    Ronald D. Kneebone

    2016-05-01

    Full Text Available Recent research has confirmed that only a minority of people who use emergency shelter beds are long-term users. Most shelter clients stay for short periods and do so relatively infrequently. These people use shelters as a temporary solution to problems that stem from poverty as opposed to problems arising from addiction or mental health problems. The implication is that addressing poverty may be an effective way of shrinking the need for emergency shelter beds. Our study uses information describing demographic characteristics and a measure of housing affordability in 51 Canadian cities to identify to what extent efforts at poverty reduction may enable the closing of emergency shelter beds. Across Canada in 2011, 15,493 permanent beds were available in 408 emergency shelters. The provision of emergency shelter beds varies widely across cities. Calgary, for example, provides more than twice as many beds per 100,000 people than does Vancouver or Toronto and more than four times the number provided in Montreal. The number of emergency beds provided is an indication not only of the number of homeless people but it is also a measure of the local response to the issue. We show that an effective strategy for shrinking the need for shelter beds is to provide improved income support to the very poor. Accounting for differences in climate, housing affordability, and demographics that may be associated with discrimination in housing markets, we show how a relatively modest increase in the incomes of those with very low incomes can shrink the need for emergency beds by nearly 20%. We also show that a modest increase in rent subsidies would have a similar impact. Still other policies that can prove effective are those that reduce the cost of building housing that can be profitably rented at prices those with low incomes can afford. These may involve tax incentives to builders and may call into question efforts at urban densification which makes low

  15. Holding fast.

    Science.gov (United States)

    Gourville, John T

    2005-06-01

    CEO Peter Walsh faces a classic innovator's dilemma. His company, Crescordia, produces high-quality metal plates, pins, and screws that orthopedic surgeons use to repair broken bones. In fact, because the company has for decades refused to compromise on quality, there are orthopedic surgeons who use nothing but Crescordia hardware. And now these customers have begun to clamor for the next generation technology: resorbable hardware. Resorbables offer clear advantages over the traditional hardware. Like dissolving sutures, resorbable plates and screws are made of biodegradable polymers. They hold up long enough to support a healing bone, then gradually and harmlessly disintegrate in the patient's body. Surgeons are especially looking forward to using resorbables on children, so kids won't have to undergo a second operation to remove the old hardware after their bones heal, a common procedure in pediatrics. The new products, however, are not yet reliable; they fail about 8% of the time, sometimes disintegrating before the bone completely heals and sometimes not ever fully disintegrating. That's why Crescordia, mindful of its hard-earned reputation, has delayed launching a line using the new technology. But time is running out. A few competitors have begun to sell resorbables despite their imperfections, and these companies are picking up market share. Should Crescordia join the fray and risk tarnishing its brand? Or should the company sit tight until it can offer a perfect product? Commenting on this fictional case study are Robert A. Lutz, vice chairman of product development at General Motors; Clayton M. Christensen, the Robert and Jane Cizik Professor of Business Administration at Harvard Business School; Jason Wittes, a senior equity analyst covering medical supplies and devices at Leerink Swann; and Nick Galakatos, a general partner of MPM Capital.

  16. A comparison of patient-centered and case-mix reimbursement for nursing home care.

    Science.gov (United States)

    Willemain, T R

    1980-01-01

    The trend in payment for nursing home services has been toward making finer distinctions amont patients and the rates at which their care is reimbursed. The ultimate in differentiation is patient-centered reimbursement, whereas each patient's rate is individually determined. This paper introduces a model of overpayment and under-payment for comparing the potential performance of alternative reimbursement schemes. The model is used in comparing the patient-centered approach with case-mix reimbursement, which assigns a single rate to all patients in a nursing home on the basis of the facility's case mix. Roughly speaking, the case-mix approach is preferable whenever the differences between patient's needs are smaller than the errors in needs assessment. Since this condition appears to hold in practice today, case-mix reimbursement seems preferable for the short term.

  17. 44 CFR 208.52 - Reimbursement procedures.

    Science.gov (United States)

    2010-10-01

    ... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Reimbursement procedures. 208... Reimbursement Claims and Appeals § 208.52 Reimbursement procedures. (a) General. A Sponsoring Agency must present a claim for reimbursement to DHS in such manner as the Assistant Administrator specifies . (b...

  18. Shrinking an arbitrary object as one desires using metamaterials

    Science.gov (United States)

    Jiang, Wei Xiang; Cui, Tie Jun; Yang, Xin Mi; Ma, Hui Feng; Cheng, Qiang

    2011-05-01

    Based on transformation optics, we present a shrinking device, which can transform an arbitrary object virtually into a small-size object with different material parameters as one desires. Such an illusion device will confuse the detectors or the viewers, and hence the real size and material parameters of the enclosed object cannot be perceived. We fabricated and measured a shrinking device by using metamaterials, which works at the nonresonant frequency and has low loss. The device has been validated by both numerical simulations and experiments on circular and square objects. Good shrinking performance has been demonstrated.

  19. Shrinking lung syndrome complicating pediatric systemic lupus erythematosus

    Energy Technology Data Exchange (ETDEWEB)

    Burns, Natalie S. [University of Washington Medical Center, Department of Radiology, Seattle, WA (United States); Stevens, Anne M. [Seattle Children' s Hospital, Division of Rheumatology, Department of Pediatrics, Seattle, WA (United States); Iyer, Ramesh S. [University of Washington School of Medicine, Seattle Children' s Hospital, Department of Radiology, Seattle, WA (United States)

    2014-10-15

    Systemic lupus erythematosis (SLE) can affect the lungs and pleura, usually manifesting with pleural effusions or diffuse parenchymal disease. A rare manifestation of SLE is shrinking lung syndrome, a severe restrictive respiratory disorder. While pleuropulmonary complications of pediatric SLE are common, shrinking lung syndrome is exceedingly rare in children. We present a case of a 13-year-old girl previously diagnosed with lupus, who developed severe dyspnea on exertion and restrictive pulmonary physiology. Her chest radiographs on presentation demonstrated low lung volumes, and CT showed neither pleural nor parenchymal disease. Fluoroscopy demonstrated poor diaphragmatic excursion. While shrinking lung syndrome is described and studied in adults, there is only sparse reference to shrinking lung syndrome in children. (orig.)

  20. Shrinking lung syndrome complicating pediatric systemic lupus erythematosus

    International Nuclear Information System (INIS)

    Burns, Natalie S.; Stevens, Anne M.; Iyer, Ramesh S.

    2014-01-01

    Systemic lupus erythematosis (SLE) can affect the lungs and pleura, usually manifesting with pleural effusions or diffuse parenchymal disease. A rare manifestation of SLE is shrinking lung syndrome, a severe restrictive respiratory disorder. While pleuropulmonary complications of pediatric SLE are common, shrinking lung syndrome is exceedingly rare in children. We present a case of a 13-year-old girl previously diagnosed with lupus, who developed severe dyspnea on exertion and restrictive pulmonary physiology. Her chest radiographs on presentation demonstrated low lung volumes, and CT showed neither pleural nor parenchymal disease. Fluoroscopy demonstrated poor diaphragmatic excursion. While shrinking lung syndrome is described and studied in adults, there is only sparse reference to shrinking lung syndrome in children. (orig.)

  1. Sustainability for Shrinking Cities | Science Inventory | US EPA

    Science.gov (United States)

    Shrinking cities are widespread throughout the world despite the rapidly increasing global urban population. These cities are attempting to transition to sustainable trajectories to improve the health and well-being of urban residents, to build their capacity to adapt to changing conditions and to cope with major events. The dynamics of shrinking cities are different than the dynamics of growing cities, and therefore intentional research and planning around creating sustainable cities is needed for shrinking cities. We propose research that can be applied to shrinking cities by identifying parallel challenges in growing cities and translating urban research and planning that is specific to each city’s dynamics. In addition, we offer applications of panarchy concepts to this problem. The contributions to this Special Issue take on this forward-looking planning task through drawing lessons for urban sustainability from shrinking cities, or translating general lessons from urban research to the context of shrinking cities. Humans are rapidly becoming an urban species, with greater populations in urban areas, increasing size of these urban areas, and increasing number of very large urban areas. As a consequence, much of what we know about cities is focused on how they grow and take shape, the strains that their growth puts on city infrastructure, the consequences for human and nonhuman inhabitants of these cities and their surroundings, and the policies which can

  2. How is intensive care reimbursed?

    DEFF Research Database (Denmark)

    Bittner, Martin-Immanuel; Donnelly, Maria; van Zanten, Arthur Rh

    2013-01-01

    Reimbursement schemes in intensive care are more complex than in other areas of healthcare, due to special procedures and high care needs. Knowledge regarding the principles of functioning in other countries can lead to increased understanding and awareness of potential for improvement. This can...... be achieved through mutual exchange of solutions found in other countries. In this review, experts from eight European countries explain their respective intensive care unit reimbursement schemes. Important conclusions include the apparent differences in the countries' reimbursement schemes---despite all...... of them originating from a DRG system, the high degree of complexity found, and the difficulties faced in several countries when collecting the data for this collaborative work. This review has been designed to help the intensivist clinician and researcher to understanding neighbouring countries...

  3. Electric Holding Company Areas

    Data.gov (United States)

    Department of Homeland Security — Holding companies are electric power utilities that have a holding company structure. This vector polygon layer represents the area served by electric power holding...

  4. 78 FR 51061 - TRICARE; Reimbursement of Sole Community Hospitals and Adjustment to Reimbursement of Critical...

    Science.gov (United States)

    2013-08-20

    ... DEPARTMENT OF DEFENSE 32 CFR Part 199 [DoD-2010-HA-0072] RIN 0720-AB41 TRICARE; Reimbursement of Sole Community Hospitals and Adjustment to Reimbursement of Critical Access Hospitals; Correction... TRICARE; Reimbursement of Sole Community Hospitals and Adjustment to Reimbursement of Critical Access...

  5. 14 CFR 1214.803 - Reimbursement policy.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Reimbursement policy. 1214.803 Section 1214... Spacelab Services § 1214.803 Reimbursement policy. (a) Reimbursement basis. (1) This policy is established...) Standard flight price. During this phase, customers covered by subpart 1214.1 or subpart 1214.2 shall...

  6. 23 CFR 140.807 - Reimbursable costs.

    Science.gov (United States)

    2010-04-01

    ... 23 Highways 1 2010-04-01 2010-04-01 false Reimbursable costs. 140.807 Section 140.807 Highways... Highway Agency Audit Expense § 140.807 Reimbursable costs. (a) Federal funds may be used to reimburse an SHA for the following types of project related audit costs: (1) Salaries, wages, and related costs...

  7. 47 CFR 27.1239 - Reimbursement obligation.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 2 2010-10-01 2010-10-01 false Reimbursement obligation. 27.1239 Section 27... Policies Governing the Transition of the 2500-2690 Mhz Band for Brs and Ebs § 27.1239 Reimbursement obligation. (a) A proponent may request reimbursement from BRS licensees and lessees, EBS lessees, and...

  8. 44 CFR 352.28 - Reimbursement.

    Science.gov (United States)

    2010-10-01

    ... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Reimbursement. 352.28 Section... Participation § 352.28 Reimbursement. In accordance with Executive Order 12657, Section 6(d), and to the extent permitted by law, FEMA will coordinate full reimbursement, either jointly or severally, to the agencies...

  9. 50 CFR 37.46 - Cost reimbursement.

    Science.gov (United States)

    2010-10-01

    ... 50 Wildlife and Fisheries 6 2010-10-01 2010-10-01 false Cost reimbursement. 37.46 Section 37.46... NATIONAL WILDLIFE REFUGE, ALASKA General Administration § 37.46 Cost reimbursement. (a) Each applicant for or holder of a special use permit issued under this part shall reimburse the Department for its...

  10. Reimbursement for critical care services in India

    Science.gov (United States)

    Jayaram, Raja; Ramakrishnan, Nagarajan

    2013-01-01

    There are significant variations in critical care practices, costs, and reimbursements in various countries. Of note, there is a paucity of reliable information on remuneration and reimbursement models for intensivists in India. This review article aims to analyze the existing reimbursement models in United States and United Kingdom and propose a frame-work model that may be applicable in India. PMID:23833469

  11. Green space development in shrinking cities – opportunities and constraints

    Directory of Open Access Journals (Sweden)

    Stefanie Rößler

    2008-01-01

    Full Text Available Green space development means both a strategy and a need to cope with the spatial transformation of cities as a consequence of socio-demographic change. This paper focuses on the opportunities and challenges of planning and implementing green spaces in shrinking cities. Based on a doctoral thesis, empirical results regarding the relevance of green spaces and strategies in the process of urban restructuring will be discussed. Concerned cities develop specific framework concepts to face spatial transformation. It is assumed that in shrinking cities the influence of green spaces and as well as their significance for urban form will change. Results of case studies in shrinking cities of Eastern Germany will be discussed with regard to their strategies and the instruments facing the challenges of green space development. The presented findings might be also relevant for urban development in (partially growing cities, enhancing green space development as a part of sustainable cities.

  12. Stratified Medicine and Reimbursement Issues

    Directory of Open Access Journals (Sweden)

    Hans-Joerg eFugel

    2012-10-01

    Full Text Available Stratified Medicine (SM has the potential to target patient populations who will most benefit from a therapy while reducing unnecessary health interventions associated with side effects. The link between clinical biomarkers/diagnostics and therapies provides new opportunities for value creation to strengthen the value proposition to pricing and reimbursement (P&R authorities. However, the introduction of SM challenges current reimbursement schemes in many EU countries and the US as different P&R policies have been adopted for drugs and diagnostics. Also, there is a lack of a consistent process for value assessment of more complex diagnostics in these markets. New, innovative approaches and more flexible P&R systems are needed to reflect the added value of diagnostic tests and to stimulate investments in new technologies. Yet, the framework for access of diagnostic–based therapies still requires further development while setting the right incentives and appropriate align stakeholders interests when realizing long- term patient benefits. This article addresses the reimbursement challenges of SM approaches in several EU countries and the US outlining some options to overcome existing reimbursement barriers for stratified medicine.

  13. Heat shrink formation of a corrugated thin film thermoelectric generator

    International Nuclear Information System (INIS)

    Sun, Tianlei; Peavey, Jennifer L.; David Shelby, M.; Ferguson, Scott; O’Connor, Brendan T.

    2015-01-01

    Highlights: • Demonstrate and characterize a thermoelectric generator with a corrugated geometry. • Employ a novel heat shrink fabrication approach compatible with low-cost processing. • Use thermal impedance modeling to explore design potential. • Corrugated design shown to be advantageous for low heat-flux density applications. - Abstract: A thin film thermoelectric (TE) generator with a corrugated architecture is demonstrated formed using a heat-shrink fabrication approach. Fabrication of the corrugated TE structure consists of depositing thin film thermoelectric elements onto a planar non-shrink polyimide substrate that is then sandwiched between two uniaxial stretch-oriented co-polyester (PET) films. The heat shrink PET films are adhered to the polyimide in select locations, such that when the structure is placed in a high temperature environment, the outer films shrink resulting in a corrugated core film and thermoelectric elements spanning between the outer PET films. The module has a cross-plane heat transfer architecture similar to a conventional bulk TE module, but with heat transfer in the plane of the thin film thermoelectric elements, which assists in maintaining a significant temperature difference across the thermoelectric junctions. In this demonstration, Ag and Ni films are used as the thermoelectric elements and a Seebeck coefficient of 14 μV K −1 is measured with a maximum power output of 0.22 nW per couple at a temperature difference of 7.0 K. We then theoretically consider the performance of this device architecture with high performance thermoelectric materials in the heat sink limited regime. The results show that the heat-shrink approach is a simple fabrication method that may be advantageous in large-area, low power density applications. The fabrication method is also compatible with simple geometric modification to achieve various form factors and power densities to customize the TE generator for a range of applications

  14. Self-expanding/shrinking structures by 4D printing

    Science.gov (United States)

    Bodaghi, M.; Damanpack, A. R.; Liao, W. H.

    2016-10-01

    The aim of this paper is to create adaptive structures capable of self-expanding and self-shrinking by means of four-dimensional printing technology. An actuator unit is designed and fabricated directly by printing fibers of shape memory polymers (SMPs) in flexible beams with different arrangements. Experiments are conducted to determine thermo-mechanical material properties of the fabricated part revealing that the printing process introduced a strong anisotropy into the printed parts. The feasibility of the actuator unit with self-expanding and self-shrinking features is demonstrated experimentally. A phenomenological constitutive model together with analytical closed-form solutions are developed to replicate thermo-mechanical behaviors of SMPs. Governing equations of equilibrium are developed for printed structures based on the non-linear Green-Lagrange strain tensor and solved implementing a finite element method along with an iterative incremental Newton-Raphson scheme. The material-structural model is then applied to digitally design and print SMP adaptive lattices in planar and tubular shapes comprising a periodic arrangement of SMP actuator units that expand and then recover their original shape automatically. Numerical and experimental results reveal that the proposed planar lattice as meta-materials can be employed for plane actuators with self-expanding/shrinking features or as structural switches providing two different dynamic characteristics. It is also shown that the proposed tubular lattice with a self-expanding/shrinking mechanism can serve as tubular stents and grippers for bio-medical or piping applications.

  15. Covering and Reimbursing Telehealth Services.

    Science.gov (United States)

    Blackman, Kate

    2016-01-01

    Policymakers who are striving to achieve better health care, improved health outcomes and lower costs are considering new strategies and technologies. Telehealth is a tool that uses technology to provide health services remotely, and state leaders are looking to it now more than ever as a way to address workforce gaps and reach underserved patients. Among the challenges facing state lawmakers who are working to introduce or expand telehealth is how to handle covering patients and reimbursing providers.

  16. 77 FR 22786 - Privately Owned Vehicle Mileage Reimbursement Rates

    Science.gov (United States)

    2012-04-17

    ... Owned Vehicle Mileage Reimbursement Rates AGENCY: Office of Governmentwide Policy (OGP), General... Privately Owned Vehicle Mileage Reimbursement Rates. SUMMARY: The General Services Administration's (GSA) special review of privately owned vehicle (POV) mileage reimbursement rates has resulted in adjusting the...

  17. 23 CFR 140.505 - Reimbursable costs.

    Science.gov (United States)

    2010-04-01

    ... 23 Highways 1 2010-04-01 2010-04-01 false Reimbursable costs. 140.505 Section 140.505 Highways... Administrative Settlement Costs-Contract Claims § 140.505 Reimbursable costs. (a) Federal funds may participate in administrative settlement costs which are: (1) Incurred after notice of claim, (2) Properly...

  18. 78 FR 46502 - Reimbursed Entertainment Expenses

    Science.gov (United States)

    2013-08-01

    ... is a reimbursement of travel expenses for food and beverages that Y pays in performing services as an... entertainment, amusement, recreation, or travel. * * * * * (f) * * * (2) * * * (iv) Reimbursed entertainment, food, or beverage expenses--(A) Introduction. In the case of any expenditure for entertainment...

  19. 7 CFR 215.8 - Reimbursement payments.

    Science.gov (United States)

    2010-01-01

    ... reimbursement for each half-pint (236 ml.) of milk served to children exceed the cost of the milk to the school or child care institution. (2) The rate of reimbursement for milk purchased and served free to needy... shall be the average cost of milk, i.e., the total cost of all milk purchased during the claim period...

  20. Modeling multidomain hydraulic properties of shrink-swell soils

    Science.gov (United States)

    Stewart, Ryan D.; Abou Najm, Majdi R.; Rupp, David E.; Selker, John S.

    2016-10-01

    Shrink-swell soils crack and become compacted as they dry, changing properties such as bulk density and hydraulic conductivity. Multidomain models divide soil into independent realms that allow soil cracks to be incorporated into classical flow and transport models. Incongruously, most applications of multidomain models assume that the porosity distributions, bulk density, and effective saturated hydraulic conductivity of the soil are constant. This study builds on a recently derived soil shrinkage model to develop a new multidomain, dual-permeability model that can accurately predict variations in soil hydraulic properties due to dynamic changes in crack size and connectivity. The model only requires estimates of soil gravimetric water content and a minimal set of parameters, all of which can be determined using laboratory and/or field measurements. We apply the model to eight clayey soils, and demonstrate its ability to quantify variations in volumetric water content (as can be determined during measurement of a soil water characteristic curve) and transient saturated hydraulic conductivity, Ks (as can be measured using infiltration tests). The proposed model is able to capture observed variations in Ks of one to more than two orders of magnitude. In contrast, other dual-permeability models assume that Ks is constant, resulting in the potential for large error when predicting water movement through shrink-swell soils. Overall, the multidomain model presented here successfully quantifies fluctuations in the hydraulic properties of shrink-swell soil matrices, and are suitable for use in physical flow and transport models based on Darcy's Law, the Richards Equation, and the advection-dispersion equation.

  1. Development of the DWPF canister temporary shrink-fit seal

    International Nuclear Information System (INIS)

    Kelker, J.W. Jr.

    1986-04-01

    The Defense Waste Processing Facility is being constructed at The Savannah River Plant for the containerization of high-level nuclear waste in a wasteform for eventual permanent disposal. The waste will be incorporated in molten glass and solidified in type 304L stainless steel canisters, 2-feet in diameter x 9-feet 10-inches long, containing a flanged 6-in.-diam pipe fill-nozzle. The canisters have a minimum wall thickness of 3/8 in. Utilizing the heat from the glass filling operation, a shrink-fit seal for a plug in the end of the canister fill nozzle was developed that: will withstand the radioactive environment; will prevent the spread of contamination, and will keep moisture and water from entering the canister during storage and decontamination of the canister by wet-frit blasting to remove smearable and oxide-film fixed radioactive nuclides; is removable and can be replaced by a new oversize plug in the event the seal fails the pressure decay leakage test ( -4 atm cc/sec helium); will keep the final weld closure clean and free of nuclear contamination; will withstand being pressed into the nozzle without exposing external contamination or completely breaking the seal; is reliable; and is easily installed. The seal consists of: a removable sleeve (with a tapered bore) which is shrink-fitted into the nozzle bore during canister fabrication; and a tapered plug which is placed into the sleeved nozzle after the canister is filled with radioactive molten glass. A leak-tight shrink-fit seal is formed between the nozzle, sleeve, and plug upon temperature equilibrium. The temporarily sealed canister is transferred from the Melt cell to the Decon cell, and the surface is decontaminated. Next it is transferred to the Weld/Test cell where the temporary seal is pressed down into the nozzle, revealing a clean cavity where the canister final closure weld is made

  2. pp wave big bangs: Matrix strings and shrinking fuzzy spheres

    International Nuclear Information System (INIS)

    Das, Sumit R.; Michelson, Jeremy

    2005-01-01

    We find pp wave solutions in string theory with null-like linear dilatons. These provide toy models of big bang cosmologies. We formulate matrix string theory in these backgrounds. Near the big bang 'singularity', the string theory becomes strongly coupled but the Yang-Mills description of the matrix string is weakly coupled. The presence of a second length scale allows us to focus on a specific class of non-Abelian configurations, viz. fuzzy cylinders, for a suitable regime of parameters. We show that, for a class of pp waves, fuzzy cylinders which start out big at early times dynamically shrink into usual strings at sufficiently late times

  3. Incentives for cooperation in quality improvement among hospitals--the impact of the reimbursement system.

    Science.gov (United States)

    Kesteloot, K; Voet, N

    1998-12-01

    Up to now, few analytical models have studied the incentives for cooperation in quality improvements among hospitals. Only those dealing with reimbursement systems have shown that, from the point of view of individual or competing hospitals, retrospective reimbursement is more likely to encourage quality improvements than prospective financing, while the reverse holds for efficiency improvements. This paper studies the incentives to improve the quality of hospital care, in an analytical model, taking into account the possibility of cooperative agreements, price besides non-price (quality) competition and quality improvements that may simultaneously increase demand, increase or reduce costs and spill over to rival hospitals. In this setting quality improvement efforts rise with the rate of prospective reimbursement, while the impact of the rate of retrospective reimbursement is ambiguous, but likely to be negative for quality improvements that are highly cost-reducting and create large spillovers. Cooperation may lead to more or less quality improvement than non-cooperative conduct, depending on the magnitude of spillovers and the degree of product market competition, relative to the net effect of quality on profits and the share of costs that is reimbursed retrospectively. Finally, the stability of cooperative agreements, supported by grim trigger strategies, is shown to depend upon exactly the opposite interaction between these factors.

  4. Equity in Medicaid Reimbursement for Otolaryngologists.

    Science.gov (United States)

    Conduff, Joseph H; Coelho, Daniel H

    2017-12-01

    Objective To study state Medicaid reimbursement rates for inpatient and outpatient otolaryngology services and to compare with federal Medicare benchmarks. Study Design State and federal database query. Setting Not applicable. Methods Based on Medicare claims data, 26 of the most common Current Procedural Terminology codes reimbursed to otolaryngologists were selected and the payments recorded. These were further divided into outpatient and operative services. Medicaid payment schemes were queried for the same services in 49 states and Washington, DC. The difference in Medicaid and Medicare payment in dollars and percentage was determined and the reimbursement per relative value unit calculated. Medicaid reimbursement differences (by dollar amount and by percentage) were qualified as a shortfall or excess as compared with the Medicare benchmark. Results Marked differences in Medicaid and Medicare reimbursement exist for all services provided by otolaryngologists, most commonly as a substantial shortfall. The Medicaid shortfall varied in amount among states, and great variability in reimbursement exists within and between operative and outpatient services. Operative services were more likely than outpatient services to have a greater Medicaid shortfall. Shortfalls and excesses were not consistent among procedures or states. Conclusions The variation in Medicaid payment models reflects marked differences in the value of the same work provided by otolaryngologists-in many cases, far less than federal benchmarks. These results question the fairness of the Medicaid reimbursement scheme in otolaryngology, with potential serious implications on access to care for this underserved patient population.

  5. Medicaid provider reimbursement policy for adult immunizations.

    Science.gov (United States)

    Stewart, Alexandra M; Lindley, Megan C; Cox, Marisa A

    2015-10-26

    State Medicaid programs establish provider reimbursement policy for adult immunizations based on: costs, private insurance payments, and percentage of Medicare payments for equivalent services. Each program determines provider eligibility, payment amount, and permissible settings for administration. Total reimbursement consists of different combinations of Current Procedural Terminology codes: vaccine, vaccine administration, and visit. Determine how Medicaid programs in the 50 states and the District of Columbia approach provider reimbursement for adult immunizations. Observational analysis using document review and a survey. Medicaid administrators in 50 states and the District of Columbia. Whether fee-for-service programs reimburse providers for: vaccines; their administration; and/or office visits when provided to adult enrollees. We assessed whether adult vaccination services are reimbursed when administered by a wide range of providers in a wide range of settings. Medicaid programs use one of 4 payment methods for adults: (1) a vaccine and an administration code; (2) a vaccine and visit code; (3) a vaccine code; and (4) a vaccine, visit, and administration code. Study results do not reflect any changes related to implementation of national health reform. Nine of fifty one programs did not respond to the survey or declined to participate, limiting the information available to researchers. Medicaid reimbursement policy for adult vaccines impacts provider participation and enrollee access and uptake. While programs have generally increased reimbursement levels since 2003, each program could assess whether current policies reflect the most effective approach to encourage providers to increase vaccination services. Copyright © 2015 Elsevier Ltd. All rights reserved.

  6. STUDY OF A SOIL WITH SWELLING AND SHRINKING PHENOMENA

    Directory of Open Access Journals (Sweden)

    G. Rogobete

    2012-12-01

    Full Text Available Vertisols are deep clayey soils, with more than 45 % clay, dominated by clay minerals, such as smectites, that expand upon wetting and shrink upon drying. The most important physical characteristics of Vertisols are a low hydraulic conductivity and stickiness when wet and high flow of water through the cracks when dry. They become very hard when dry and in all the time are difficult to work. During the rainy season, the cracks disappear and the soil becomes sticky and plastic with a very slippery surface which makes Vertisols in – trafficable when wet. Water movement in soil that change volume with water content is not well understood and management of swelling soil remains problematic. Swelling or shrinking result in vertical displacement of the wet soil, which involves gravitational work and contributes to an overburden component to the total potential of the soil water. Many swelling soil crack and the network of cracks provides pathways for rapid flow of water which prejudice application of theory based on Darcian flow. One – dimensional flow of water in a swelling system requires material balance equation for both the aqueous and solid phases. The analytical data offers some values particle – size distribution, compression, swelling degree and pressure, plasticity index, elastic modulus, triaxial shear, angle of shear and load carrying capacity in order to realize a foundation study for some constructions.

  7. Impact of Electrostatic Assist on Halftone Mottle in Shrink Films

    Directory of Open Access Journals (Sweden)

    Akshay V. Joshi

    2015-09-01

    Full Text Available Gravure printing delivers intricate print quality and exhibit better feasibility for printing long run packaging jobs. PVC and PETG are widely used shrink films printed by gravure process. The variation in ink transfer from gravure cells on to the substrate results in print mottle. The variation is inevitable and requires close monitoring with tight control on process parameters to deliver good dot fidelity. The electrostatic assist in gravure improves the ink transfer efficiency but is greatly influenced by ESA parameters such as air gap (distance between charge bar and impression roller and voltage. Moreover, it is imperative to study the combined effect of ESA and gravure process parameters such as line screen, viscosity and speed for the minimization of half-tone mottle in shrink films. A general full factorial design was performed for the above mentioned parameters to evaluate half-tone mottle. The significant levels of both the main and interactions were studied by ANOVA approach. The statistical analysis revealed the significance of all the process parameters with viscosity, line screen and voltage being the major contributors in minimization of half-tone mottle. The optimized setting showed reduction in halftone mottle by 33% and 32% for PVC and PET-G respectively. The developed regression model was tested that showed more than 95% predictability. Furthermore, the uniformity of dot was measured by image to non-image area (ratio distribution. The result showed reduction in halftone mottle with uniform dot distribution.

  8. The shrinking mining city: urban dynamics and contested territory.

    Science.gov (United States)

    Martinez-Fernandez, Cristina; Wu, Chung-Tong; Schatz, Laura K; Taira, Nobuhisa; Vargas-Hernández, José G

    2012-01-01

    Shrinking mining cities — once prosperous settlements servicing a mining site or a system of mining sites — are characterized by long-term population and/or economic decline. Many of these towns experience periods of growth and shrinkage, mirroring the ebbs and flows of international mineral markets which determine the fortunes of the dominant mining corporation upon which each of these towns heavily depends. This dependence on one main industry produces a parallel development in the fluctuations of both workforce and population. Thus, the strategies of the main company in these towns can, to a great extent, determine future developments and have a great impact on urban management plans. Climate conditions, knowledge, education and health services, as well as transportation links, are important factors that have impacted on lifestyles in mining cities, but it is the parallel development with the private sector operators (often a single corporation) that constitutes the distinctive feature of these cities and that ultimately defines their shrinkage. This article discusses shrinking mining cities in capitalist economies, the factors underpinning their development, and some of the planning and community challenges faced by these cities in Australia, Canada, Japan and Mexico.

  9. Rock Equity Holdings, LLC

    Science.gov (United States)

    The EPA is providing notice of an Administrative Penalty Assessment in the form of an Expedited Storm Water Settlement Agreement against Rock Equity Holdings, LLC, for alleged violations at The Cove at Kettlestone/98th Street Reconstruction located at 3015

  10. Breath-Holding Spells

    Science.gov (United States)

    ... reviewed: October 2016 More on this topic for: Parents Is It Normal for Children to Hold Their Breath? Taming Tempers Disciplining Your Child Disciplining Your Toddler Temper Tantrums Separation Anxiety View more About Us Contact Us Partners ...

  11. 7 CFR 1205.520 - Procedure for obtaining reimbursement.

    Science.gov (United States)

    2010-01-01

    ... application forms may be filed. In any such case, the reimbursement application shall show the names... Cotton Board shall make reimbursement to the importer. For joint applications, the reimbursement shall be... procedures prescribed in this section. (a) Application form. An importer shall obtain a reimbursement...

  12. 47 CFR 27.1168 - Triggering a Reimbursement Obligation.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 2 2010-10-01 2010-10-01 false Triggering a Reimbursement Obligation. 27.1168... a Reimbursement Obligation. (a) The clearinghouse will apply the following test to determine when an... reimbursement obligation exists, the clearinghouse will calculate the reimbursement amount in accordance with...

  13. 45 CFR 149.300 - General reimbursement rules.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false General reimbursement rules. 149.300 Section 149... REQUIREMENTS FOR THE EARLY RETIREE REINSURANCE PROGRAM Reimbursement Methods § 149.300 General reimbursement rules. Reimbursement under this program is conditioned on provision of accurate information by the...

  14. 49 CFR 22.27 - Eligible reimbursements to participating lenders.

    Science.gov (United States)

    2010-10-01

    ... reimbursement. Prior written approval from DOT OSDBU is required. Attorney fees will be reimbursed on a pro-rata... 49 Transportation 1 2010-10-01 2010-10-01 false Eligible reimbursements to participating lenders... PROGRAM (STLP) Participating Lenders § 22.27 Eligible reimbursements to participating lenders...

  15. 44 CFR 295.31 - Reimbursement of claim expenses.

    Science.gov (United States)

    2010-10-01

    ... § 295.31 Reimbursement of claim expenses. (a) FEMA will reimburse Claimants for the reasonable costs they incur in copying documentation requested by OCGFC. FEMA will also reimburse Claimants for the... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Reimbursement of claim...

  16. 76 FR 63844 - Federal Travel Regulation (FTR); Lodging Reimbursement

    Science.gov (United States)

    2011-10-14

    ... lodging I select affect my reimbursement? (a) Your agency will reimburse you for different types of...; Docket Number 2011-0024, Sequence 1] RIN 3090-AJ22 Federal Travel Regulation (FTR); Lodging Reimbursement... (GSA) is amending the Federal Travel Regulation (FTR) regarding reimbursement of lodging per diem...

  17. 49 CFR 577.11 - Reimbursement notification.

    Science.gov (United States)

    2010-10-01

    ...-notification remedies and identify the type of remedy eligible for reimbursement; (3) Identify any limits on..., and arguments, that all covered vehicles are under warranty or that no person would be eligible for...

  18. HEALTH INSURANCE: FIXED CONTRIBUTION AND REIMBURSEMENT MAXIMA

    CERN Document Server

    Human Resources Division

    2001-01-01

    Affected by the salary adjustments on 1 January 2001 and the evolution of the staff members and fellows population, the average reference salary, which is used as an index for fixed contributions and reimbursement maxima, has changed significantly. An adjustment of the amounts of the reimbursement maxima and the fixed contributions is therefore necessary, as from 1 January 2001. Reimbursement maxima The revised reimbursement maxima will appear on the leaflet summarizing the benefits for the year 2001, which will be sent out with the forthcoming issue of the CHIS Bull'. This leaflet will also be available from the divisional secretariats and from the UNIQA office at CERN. Fixed contributions The fixed contributions, applicable to some categories of voluntarily insured persons, are set as follows (amounts in CHF for monthly contributions) : voluntarily insured member of the personnel, with normal health insurance cover : 910.- (was 815.- in 2000) voluntarily insured member of the personnel, with reduced heal...

  19. HEALTH INSURANCE: CONTRIBUTIONS AND REIMBURSEMENT MAXIMAL

    CERN Document Server

    HR Division

    2000-01-01

    Affected by both the salary adjustment index on 1.1.2000 and the evolution of the staff members and fellows population, the average reference salary, which is used as an index for fixed contributions and reimbursement maximal, has changed significantly. An adjustment of the amounts of the reimbursement maximal and the fixed contributions is therefore necessary, as from 1 January 2000.Reimbursement maximalThe revised reimbursement maximal will appear on the leaflet summarising the benefits for the year 2000, which will soon be available from the divisional secretariats and from the AUSTRIA office at CERN.Fixed contributionsThe fixed contributions, applicable to some categories of voluntarily insured persons, are set as follows (amounts in CHF for monthly contributions):voluntarily insured member of the personnel, with complete coverage:815,- (was 803,- in 1999)voluntarily insured member of the personnel, with reduced coverage:407,- (was 402,- in 1999)voluntarily insured no longer dependent child:326,- (was 321...

  20. United Nations Reimbursements for DOD Troop Contributions

    National Research Council Canada - National Science Library

    1997-01-01

    .... Those rates together with the number of troops provided are used to calculate the level of reimbursement to be made to a participating country for the incremental costs incurred for providing troops...

  1. "Shrink-to-fit" superhydrophobicity: thermally-induced microscale wrinkling of thin hydrophobic multilayers fabricated on flexible shrink-wrap substrates.

    Science.gov (United States)

    Manna, Uttam; Carter, Matthew C D; Lynn, David M

    2013-06-11

    An approach to the design of flexible superhydrophobic surfaces based on thermally induced wrinkling of thin, hydrophobic polymer multilayers on heat-shrinkable polymer films is reported. This approach exploits shrinking processes common to "heat-shrink" plastics, and can thus be used to create "shrink-to-fit" superhydrophobic coatings on complex surfaces, manipulate the dimensions and densities of patterned features, and promote heat-activated repair of full-thickness defects. Copyright © 2013 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  2. Effect of shrink fitting and cutting on iron loss of permanent magnet motor

    International Nuclear Information System (INIS)

    Takahashi, N.; Morimoto, H.; Yunoki, Y.; Miyagi, D.

    2008-01-01

    Magnetic properties of a motor core are affected by the distortion due to the compression caused by shrink fitting and the distortion caused by punching, etc. In this paper, the B-H curve and iron loss of stator core of actual motor under shrink fitting are measured. It is shown that the maximum permeability is reduced by about 50%, and the iron loss is increased by about 30% due to the shrink fitting. It is illustrated that the loss of motor is increased by about 10%, 4% and 2% due to the shrink fitting, the cutting stress and the eddy current in rotor magnet, respectively

  3. Optimization of temperature field of tobacco heat shrink machine

    Science.gov (United States)

    Yang, Xudong; Yang, Hai; Sun, Dong; Xu, Mingyang

    2018-06-01

    A company currently shrinking machine in the course of the film shrinkage is not compact, uneven temperature, resulting in poor quality of the shrinkage of the surface film. To solve this problem, the simulation and optimization of the temperature field are performed by using the k-epsilon turbulence model and the MRF model in fluent. The simulation results show that after the mesh screen structure is installed at the suction inlet of the centrifugal fan, the suction resistance of the fan can be increased and the eddy current intensity caused by the high-speed rotation of the fan can be improved, so that the internal temperature continuity of the heat shrinkable machine is Stronger.

  4. Improved resolution of 3D printed scaffolds by shrinking.

    Science.gov (United States)

    Chia, Helena N; Wu, Benjamin M

    2015-10-01

    Three-dimensional printing (3DP) uses inkjet printheads to selectively deposit liquid binder to adjoin powder particles in a layer-by-layer fashion to create a computer-modeled 3D object. Two general approaches for 3DP have been described for biomedical applications (direct and indirect 3DP). The two approaches offer competing advantages, and both are limited by print resolution. This study describes a materials processing strategy to enhance 3DP resolution by controlled shrinking net-shape scaffolds. Briefly, porogen preforms are printed and infused with the desired monomer or polymer solution. After solidification or polymerization, the porogen is leached and the polymer is allowed to shrink by controlled drying. Heat treatment is performed to retain the dimensions against swelling forces. The main objective of this study is to determine the effects of polymer content and post-processing on dimension, microstructure, and thermomechanical properties of the scaffold. For polyethylene glycol diacrylate (PEG-DA), reducing polymer content corresponded with greater shrinkage with maximum shrinkage of ∼80 vol% at 20% vol% PEG-DA. The secondary heat treatment retains the microarchitecture and new dimensions of the scaffolds, even when the heat-treated scaffolds are immersed into water. To demonstrate shrinkage predictability, 3D components with interlocking positive and negative features were printed, processed, and fitted. This material processing strategy provides an alternative method to enhance the resolution of 3D scaffolds, for a wide range of polymers, without optimizing the binder-powder interaction physics to print each material combination. © 2014 Wiley Periodicals, Inc.

  5. Tube holding system

    International Nuclear Information System (INIS)

    Cunningham, R.C.

    1978-01-01

    A tube holding rig is described for the lateral support of tubes arranged in tight parcels in a heat exchanger. This tube holding rig includes not less than two tube supporting assemblies, with a space between them, located crosswise with respect to the tubes, each supporting assembly comprising a first set of parallel components in contact with the tubes, whilst a second set of components is also in contact with the tubes. These two sets of parts together define apertures through which the tubes pass [fr

  6. Reimbursement of analgesics for chronic pain.

    Science.gov (United States)

    Pedersen, Line; Hansen, Anneli Borge; Svendsen, Kristian; Skurtveit, Svetlana; Borchgrevink, Petter C; Fredheim, Olav Magnus S

    2012-11-27

    The prevalence of chronic non-malignant pain in Norway is between 24% and 30%. The proportion of the population using opioids for non-malignant pain on a long-term basis is around 1%. The purpose of our study was to investigate how many were prescribed analgesics on reimbursable prescription under reimbursement code -71 (chronic non-malignant pain) in 2009 and 2010, which analgesics were prescribed and whether prescribing practices were in accordance with national guidelines. We retrieved pseudonymised data from the National Prescription Database on all those who received drugs with reimbursement code -71 in 2009 and 2010. The data contain information on drug, dosage, formulation, reimbursement code and date of issue. 90,731 patients received reimbursement for drugs indicated for chronic non-malignant pain in 2010. Of these, 6,875 were given opioids, 33,242 received paracetamol, 25,865 non-steroid inflammatory drugs (NSAIDs), 20,654 amitryptiline and 16,507 gabapentin. Oxycodone was the most frequently prescribed opioid, followed by buprenorphine, tramadol and codeine/paracetamol. Of those who were prescribed opioids, 4,047 (59%) received mainly slow-release opioids, 2,631 (38%) also received benzodiazepines and 2,418 (35%) received benzodiazepine-like sleep medications. The number of patients who received analgesics and opioids on reimbursable prescriptions was low compared to the proportion of the population with chronic pain and the proportion using opioids long-term. 38% of those reimbursed for opioids also used benzodiazepines, which is contrary to official Norwegian guidelines.

  7. Medicaid provider reimbursement policy for adult immunizations☆

    Science.gov (United States)

    Stewart, Alexandra M.; Lindley, Megan C.; Cox, Marisa A.

    2015-01-01

    Background State Medicaid programs establish provider reimbursement policy for adult immunizations based on: costs, private insurance payments, and percentage of Medicare payments for equivalent services. Each program determines provider eligibility, payment amount, and permissible settings for administration. Total reimbursement consists of different combinations of Current Procedural Terminology codes: vaccine, vaccine administration, and visit. Objective Determine how Medicaid programs in the 50 states and the District of Columbia approach provider reimbursement for adult immunizations. Design Observational analysis using document review and a survey. Setting and participants Medicaid administrators in 50 states and the District of Columbia. Measurements Whether fee-for-service programs reimburse providers for: vaccines; their administration; and/or office visits when provided to adult enrollees. We assessed whether adult vaccination services are reimbursed when administered by a wide range of providers in a wide range of settings. Results Medicaid programs use one of 4 payment methods for adults: (1) a vaccine and an administration code; (2) a vaccine and visit code; (3) a vaccine code; and (4) a vaccine, visit, and administration code. Limitations Study results do not reflect any changes related to implementation of national health reform. Nine of fifty one programs did not respond to the survey or declined to participate, limiting the information available to researchers. Conclusions Medicaid reimbursement policy for adult vaccines impacts provider participation and enrollee access and uptake. While programs have generally increased reimbursement levels since 2003, each program could assess whether current policies reflect the most effective approach to encourage providers to increase vaccination services. PMID:26403369

  8. The application of homotopy analysis method for MHD viscous flow due to a shrinking sheet

    International Nuclear Information System (INIS)

    Sajid, M.; Hayat, T.

    2009-01-01

    This work is concerned with the magnetohydrodynamic (MHD) viscous flow due to a shrinking sheet. The cases of two dimensional and axisymmetric shrinking have been discussed. Exact series solution is obtained using the homotopy analysis method (HAM). The convergence of the obtained series solution is discussed explicitly. The obtained HAM solution is valid for all values of the suction parameter and Hartman number.

  9. Push-off tests and strength evaluation of joints combining shrink fitting with bonding

    Science.gov (United States)

    Yoneno, Masahiro; Sawa, Toshiyuki; Shimotakahara, Ken; Motegi, Yoichi

    1997-03-01

    Shrink fitted joints have been used in mechanical structures. Recently, joints combining shrink fitting with anaerobic adhesives bonded between the shrink fitted surfaces have been appeared in order to increase the joint strength. In this paper, push-off test was carried out on strength of joints combining shrink fitting with bonding by material testing machine. In addition, the push-off strength of shrink fitting joints without an anaerobic adhesive was also measured. In the experiments, the effects of the shrinking allowance and the outer diameter of the rings on the joint strength are examined. The interface stress distribution in bonded shrink fitted joints subjected to a push-off load is analyzed using axisymmetrical theory of elasticity as a four-body contact problem. Using the interface stress distribution, a method for estimating joint strength is proposed. The experimental results are in a fairly good agreement with the numerical results. It is found that the strength of combination joints is greater than that of shrink fitted joints.

  10. Casemix reimbursement: a Singapore Children's Hospital perspective.

    Science.gov (United States)

    Yoong, S L

    2001-07-01

    Casemix reimbursement was introduced to Singapore in October 1999 using the Australian National Diagnosis Related Groups Version 3.1 (AN-DRGs 3.1). The possible impact of this classification system on a Singapore Children's Hospital is discussed. Data on paediatric patients in KK Women's and Children's Hospital (KKH) were drawn from the inhouse Datamart warehouse system, and reviewed with regards to volume of patients, length of stay and charges. Several high cost categories were selected for a more in-depth review and discussed. The classification system and reimbursement method did not take into account the higher cost of treating children, thus penalising the Children's Hospital. The wide variety of cases treated also gave rise to difficulty in obtaining appropriate reimbursement. The lack of severity of illness measures was a drawback in the Diagnosis Related Group (DRG) for ventilated patients. The lack of outcome measures gave rise to potentially inequitable reimbursement in some high cost neonatal DRGs. While Casemix is an improvement over previous methods of providing Government funding in Singapore, particular aspects need to be reviewed, and reimbursement criteria refined to ensure equitable funding to Children's Hospital.

  11. CLAIMS FOR REIMBURSEMENT OF EDUCATION FEES

    CERN Multimedia

    Personnel Division

    1999-01-01

    REMINDERYou are reminded that, in accordance with Article R A 8.07 of the Staff Regulations 'the relevant bills shall be grouped so that not more than three claims in respect of each child are submitted in an academic year'.For this purpose:the academic year is defined as the period going from 1st September to 31st August, only paid bills can be subject to reimbursement, a claim for reimbursement of education fees may only include bills for expenses incurred during a given academic year for a given child, bills for one child may be grouped on a claim by periods of term, semester or academic year, the months of July and August should be included in the third term, or the second semester, or the academic year, for each dependent child, a maximum of 3 claims can be submitted for the reimbursement of expenses incurred during one academic year, therefore, any bill submitted for reimbursement after the third claim will not be reimbursed.Please make sure that you have received and paid all bills, including those for...

  12. The fairness of the PPS reimbursement methodology.

    Science.gov (United States)

    Gianfrancesco, F D

    1990-01-01

    In FY 1984 the Medicare program implemented a new method of reimbursing hospitals for inpatient services, the Prospective Payment System (PPS). Under this system, hospitals are paid a predetermined amount per Medicare discharge, which varies according to certain patient and hospital characteristics. This article investigates the presence of systematic biases and other potential imperfections in the PPS reimbursement methodology as revealed by its effects on Medicare operating ratios. The study covers the first three years of the PPS (approximately 1984-1986) and is based on hospital data from the Medicare cost reports and other related sources. Regression techniques were applied to these data to determine how Medicare operating ratios were affected by specific aspects of the reimbursement methodology. Several possible imbalances were detected. The potential undercompensation relating to these can be harmful to certain classes of hospitals and to the Medicare populations that they serve. PMID:2109738

  13. Vertical integration and optimal reimbursement policy.

    Science.gov (United States)

    Afendulis, Christopher C; Kessler, Daniel P

    2011-09-01

    Health care providers may vertically integrate not only to facilitate coordination of care, but also for strategic reasons that may not be in patients' best interests. Optimal Medicare reimbursement policy depends upon the extent to which each of these explanations is correct. To investigate, we compare the consequences of the 1997 adoption of prospective payment for skilled nursing facilities (SNF PPS) in geographic areas with high versus low levels of hospital/SNF integration. We find that SNF PPS decreased spending more in high integration areas, with no measurable consequences for patient health outcomes. Our findings suggest that integrated providers should face higher-powered reimbursement incentives, i.e., less cost-sharing. More generally, we conclude that purchasers of health services (and other services subject to agency problems) should consider the organizational form of their suppliers when choosing a reimbursement mechanism.

  14. Gamma irradiation effect on thermo shrink polyethylene tube: Case study

    International Nuclear Information System (INIS)

    Naurah Mat Isa; Siti Zulaiha Hairaldin; Mohd Yusof Hamzah; Zulkafli Ghazali

    2010-01-01

    The production technology of heat shrinkable tubes is based on the industrial usage of so-called memory effect in some polymers. Many polymers can be rendered heat shrinkable, particularly polyolefins by introducing crosslinking in the polymer backbone. Heat shrinkable tubes and moulded parts provide mechanical and/or chemical and/or electrical protection. . In this work, irradiation from Co-60 was used to impart crosslinking in polymer and thus modify their mechanical and thermal properties. Heat shrinkable or thermo shrink polyethylene (PE) tube with diameter 6.4 mm was selected to evaluate crosslinking behaviour from the gamma irradiation exposure at 5 different doses (120, 140, 160, 200 and 220 kGy). The gel content (%), tensile properties and thermal behavior and stability of the tubes were measured using DSC and TGA. Tubes irradiated at 140 kGy and 160 kGy showed better tensile properties than those at 120, 200 and 220 kGy doses. Maximum percent of crystallization was observed at 160 kGy and temperature required to crystallize is lower than melting temperature due to changes in molecular orientation. Thermal decomposition of the irradiated tubes occurred at 430-450 degree Celsius which is lower than the unirradiated sample. Gel content analysis for samples irradiated at 180-220 kGy yield up to 30 to 40 % gel fraction. Although the gel fractions are higher than other dose, the samples are expected to experience chain scission presumably due to localized gel formation. (author)

  15. Shrink-Induced Superhydrophobic and Antibacterial Surfaces in Consumer Plastics

    Science.gov (United States)

    Freschauf, Lauren R.; McLane, Jolie; Sharma, Himanshu; Khine, Michelle

    2012-01-01

    Structurally modified superhydrophobic surfaces have become particularly desirable as stable antibacterial surfaces. Because their self-cleaning and water resistant properties prohibit bacteria growth, structurally modified superhydrophobic surfaces obviate bacterial resistance common with chemical agents, and therefore a robust and stable means to prevent bacteria growth is possible. In this study, we present a rapid fabrication method for creating such superhydrophobic surfaces in consumer hard plastic materials with resulting antibacterial effects. To replace complex fabrication materials and techniques, the initial mold is made with commodity shrink-wrap film and is compatible with large plastic roll-to-roll manufacturing and scale-up techniques. This method involves a purely structural modification free of chemical additives leading to its inherent consistency over time and successive recasting from the same molds. Finally, antibacterial properties are demonstrated in polystyrene (PS), polycarbonate (PC), and polyethylene (PE) by demonstrating the prevention of gram-negative Escherichia coli (E. coli) bacteria growth on our structured plastic surfaces. PMID:22916100

  16. Breath-Hold Diving.

    Science.gov (United States)

    Fitz-Clarke, John R

    2018-03-25

    Breath-hold diving is practiced by recreational divers, seafood divers, military divers, and competitive athletes. It involves highly integrated physiology and extreme responses. This article reviews human breath-hold diving physiology beginning with an historical overview followed by a summary of foundational research and a survey of some contemporary issues. Immersion and cardiovascular adjustments promote a blood shift into the heart and chest vasculature. Autonomic responses include diving bradycardia, peripheral vasoconstriction, and splenic contraction, which help conserve oxygen. Competitive divers use a technique of lung hyperinflation that raises initial volume and airway pressure to facilitate longer apnea times and greater depths. Gas compression at depth leads to sequential alveolar collapse. Airway pressure decreases with depth and becomes negative relative to ambient due to limited chest compliance at low lung volumes, raising the risk of pulmonary injury called "squeeze," characterized by postdive coughing, wheezing, and hemoptysis. Hypoxia and hypercapnia influence the terminal breakpoint beyond which voluntary apnea cannot be sustained. Ascent blackout due to hypoxia is a danger during long breath-holds, and has become common amongst high-level competitors who can suppress their urge to breathe. Decompression sickness due to nitrogen accumulation causing bubble formation can occur after multiple repetitive dives, or after single deep dives during depth record attempts. Humans experience responses similar to those seen in diving mammals, but to a lesser degree. The deepest sled-assisted breath-hold dive was to 214 m. Factors that might determine ultimate human depth capabilities are discussed. © 2018 American Physiological Society. Compr Physiol 8:585-630, 2018. Copyright © 2018 American Physiological Society. All rights reserved.

  17. 'Shrink' losses in commercially sized corn silage piles: Quantifying total losses and where they occur.

    Science.gov (United States)

    Robinson, P H; Swanepoel, N; Heguy, J M; Price, T; Meyer, D M

    2016-01-15

    Silage 'shrink' (i.e., loss of fresh chopped crop between ensiling and feedout) represents a nutrient loss which can degrade air quality as volatile carbon compounds, degrade surface waterways due to seepage, or degrade aquifers due to seepage. Virtually no research has documented shrink in large silage piles. The term 'shrink' is often ill defined, but can be expressed as losses of wet weight (WW), oven dry matter (oDM), and oDM corrected for volatiles lost in the drying oven (vcoDM). Corn silage piles (4 wedge, 2 rollover/wedge, 1 bunker) from 950 to 12,204 tonnes as built, on concrete (4), soil (2) and a combination (1) in California's San Joaquin Valley, using a bacterial inoculant, covered within 24 h with an oxygen barrier inner film and black/white outer plastic, fed out using large front end loaders through an electronic feed tracking system, and from the 2013 crop year, were used. Shrink as WW, oDM and vcoDM were 90±17, 68±18 and 28±21 g/kg, suggesting that much WW shrink is water and much oDM shrink is volatiles lost during analytical oven drying. Most shrink occurred in the silage mass with losses from exposed silage faces, as well as between exposed face silage removal and the total mixed ration mixer, being low. Silage bulk density, exposed silage face management and face use rate did not have obvious impacts on any shrink measure, but age of the silage pile during silage feedout impacted shrink losses ('older' silage piles being higher), but most strongly for WW shrink. Real shrink losses (i.e., vcoDM) of large well managed corn silage piles are low, the exposed silage face is a small portion of losses, and many proposed shrink mitigations appeared ineffective, possibly because shrink was low overall and they are largely directed at the exposed silage face. Copyright © 2015 Elsevier B.V. All rights reserved.

  18. 7 CFR 3015.104 - Requesting advances or reimbursements.

    Science.gov (United States)

    2010-01-01

    ... outlays for the month covered. These estimates shall be made on a cash basis, even if the recipient uses an accrual accounting system. (b) Reimbursements. If payments are made through reimbursement or by...

  19. 48 CFR 416.405 - Cost-reimbursement incentive contracts.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Cost-reimbursement incentive contracts. 416.405 Section 416.405 Federal Acquisition Regulations System DEPARTMENT OF...-reimbursement incentive contracts. ...

  20. State Medicaid reimbursement for nursing homes, 1978-86

    Science.gov (United States)

    Swan, James H.; Harrington, Charlene; Grant, Leslie A.

    1988-01-01

    State Medicaid reimbursement methods and rates are reported for the period 1978-86 for skilled nursing and intermediate care facilities. A cross-sectional time series regression analysis of Medicaid reimbursement rates on methods showed that States using prospective class reimbursement had significantly lower rates for the period 1982-86. States using prospective facility-specific reimbursement methods had lower rates than retrospective methods in 1983-84. PMID:10312516

  1. 47 CFR 97.527 - Reimbursement for expenses.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 5 2010-10-01 2010-10-01 false Reimbursement for expenses. 97.527 Section 97... AMATEUR RADIO SERVICE Qualifying Examination Systems § 97.527 Reimbursement for expenses. VEs and VECs may be reimbursed by examinees for out-of-pocket expenses incurred in preparing, processing...

  2. 45 CFR 149.100 - Amount of reimbursement.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Amount of reimbursement. 149.100 Section 149.100... REQUIREMENTS FOR THE EARLY RETIREE REINSURANCE PROGRAM Reinsurance Amounts § 149.100 Amount of reimbursement... reimbursement in the amount of 80 percent of the costs for health benefits (net of negotiated price concessions...

  3. 44 CFR 206.8 - Reimbursement of other Federal agencies.

    Science.gov (United States)

    2010-10-01

    ... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Reimbursement of other... Reimbursement of other Federal agencies. (a) Assistance furnished under § 206.5 (a) or (b) of this subpart may... Administrator or the Regional Director may not approve reimbursement of costs incurred while performing work...

  4. 47 CFR 27.1184 - Triggering a reimbursement obligation.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 2 2010-10-01 2010-10-01 false Triggering a reimbursement obligation. 27.1184... reimbursement obligation. (a) The clearinghouse will apply the following test to determine when an AWS entity... paragraphs (a)(3)(i) and (ii) of this section, indicates that a reimbursement obligation exists, the...

  5. 48 CFR 52.243-2 - Changes-Cost-Reimbursement.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 2 2010-10-01 2010-10-01 false Changes-Cost-Reimbursement....243-2 Changes—Cost-Reimbursement. As prescribed in 43.205(b)(1), insert the following clause. The 30-day period may be varied according to agency procedures. Changes—Cost-Reimbursement (AUG 1987) (a) The...

  6. 48 CFR 52.249-6 - Termination (Cost-Reimbursement).

    Science.gov (United States)

    2010-10-01

    ...-Reimbursement). 52.249-6 Section 52.249-6 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION....249-6 Termination (Cost-Reimbursement). As prescribed in 49.503(a)(1), insert the following clause: Termination (Cost-Reimbursement) (MAY 2004) (a) The Government may terminate performance of work under this...

  7. 47 CFR 54.407 - Reimbursement for offering Lifeline.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 3 2010-10-01 2010-10-01 false Reimbursement for offering Lifeline. 54.407... (CONTINUED) UNIVERSAL SERVICE Universal Service Support for Low-Income Consumers § 54.407 Reimbursement for... carrier may receive universal service support reimbursement for each qualifying low-income consumer served...

  8. 77 FR 76487 - Privately Owned Vehicle Mileage Reimbursement Rates

    Science.gov (United States)

    2012-12-28

    ... Vehicle Mileage Reimbursement Rates AGENCY: Office of Governmentwide Policy (OGP), General Services... Mileage Reimbursement Rates. SUMMARY: The General Services Administration's annual privately owned vehicle (POV) mileage reimbursement rate reviews have resulted in new CY 2013 rates for the use of privately...

  9. 75 FR 62348 - Reimbursement Offsets for Medical Care or Services

    Science.gov (United States)

    2010-10-08

    ... DEPARTMENT OF VETERANS AFFAIRS 38 CFR Part 17 RIN 2900-AN55 Reimbursement Offsets for Medical Care... Veterans Affairs (VA) proposes to amend its regulations concerning the reimbursement of medical care and... situations where third-party payers are required to reimburse VA for costs related to care provided by VA to...

  10. 48 CFR 2052.215-77 - Travel approvals and reimbursement.

    Science.gov (United States)

    2010-10-01

    ... reimbursement. 2052.215-77 Section 2052.215-77 Federal Acquisition Regulations System NUCLEAR REGULATORY....215-77 Travel approvals and reimbursement. As prescribed at 2015.209-70(d), the contracting officer shall insert the following clause in cost reimbursement solicitations and contracts which require travel...

  11. 45 CFR 149.200 - Use of reimbursements.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Use of reimbursements. 149.200 Section 149.200 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS REQUIREMENTS FOR THE EARLY RETIREE REINSURANCE PROGRAM Use of Reimbursements § 149.200 Use of reimbursements...

  12. 44 CFR 208.35 - Reimbursement for Advisory.

    Science.gov (United States)

    2010-10-01

    ... Cooperative Agreements § 208.35 Reimbursement for Advisory. DHS will not reimburse costs incurred during an... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Reimbursement for Advisory. 208.35 Section 208.35 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY...

  13. 42 CFR 57.213a - Loan cancellation reimbursement.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Loan cancellation reimbursement. 57.213a Section 57... Professions Student Loans § 57.213a Loan cancellation reimbursement. (a) For loans made prior to October 22... credited to this insurance fund), and used only to reimburse the school for the institutional share of any...

  14. 75 FR 82029 - Privately Owned Vehicle Mileage Reimbursement Rates

    Science.gov (United States)

    2010-12-29

    ... Owned Vehicle Mileage Reimbursement Rates AGENCY: Office of Governmentwide Policy (OGP), General... Owned Vehicle Mileage Reimbursement Rates. SUMMARY: The General Services Administration's (GSA) annual privately owned vehicle (POV) mileage reimbursement rate reviews have resulted in new CY 2011 rates for the...

  15. 44 CFR 208.44 - Reimbursement for other costs.

    Science.gov (United States)

    2010-10-01

    ... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Reimbursement for other costs... Cooperative Agreements § 208.44 Reimbursement for other costs. (a) Except as allowed under paragraph (b) of this section, DHS will not reimburse other costs incurred preceding, during or upon the conclusion of...

  16. 45 CFR 149.315 - Reimbursement conditioned upon available funds.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Reimbursement conditioned upon available funds... TO HEALTH CARE ACCESS REQUIREMENTS FOR THE EARLY RETIREE REINSURANCE PROGRAM Reimbursement Methods § 149.315 Reimbursement conditioned upon available funds. Notwithstanding a sponsor's compliance with...

  17. 47 CFR 24.247 - Triggering a reimbursement obligation.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 2 2010-10-01 2010-10-01 false Triggering a reimbursement obligation. 24.247... Mhz Band § 24.247 Triggering a reimbursement obligation. (a) Licensed PCS. The clearinghouse will... the Proximity Threshold test indicates that a reimbursement obligation exists, the clearinghouse will...

  18. 48 CFR 47.104-3 - Cost-reimbursement contracts.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Cost-reimbursement... CONTRACT MANAGEMENT TRANSPORTATION General 47.104-3 Cost-reimbursement contracts. (a) 49 U.S.C. 10721 and... accrues to the Government, i.e., the Government shall pay the charges or directly and completely reimburse...

  19. 48 CFR 46.305 - Cost-reimbursement service contracts.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Cost-reimbursement service... CONTRACT MANAGEMENT QUALITY ASSURANCE Contract Clauses 46.305 Cost-reimbursement service contracts. The contracting officer shall insert the clause at 52.246-5, Inspection of Services—Cost Reimbursement, in...

  20. 48 CFR 16.405 - Cost-reimbursement incentive contracts.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Cost-reimbursement incentive contracts. 16.405 Section 16.405 Federal Acquisition Regulations System FEDERAL ACQUISITION...-reimbursement incentive contracts. See 16.301 for requirements applicable to all cost-reimbursement contracts...

  1. 48 CFR 46.303 - Cost-reimbursement supply contracts.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Cost-reimbursement supply... CONTRACT MANAGEMENT QUALITY ASSURANCE Contract Clauses 46.303 Cost-reimbursement supply contracts. The contracting officer shall insert the clause at 52.246-3, Inspection of Supplies—Cost-Reimbursement, in...

  2. 45 CFR 703.9 - Reimbursement of members.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 3 2010-10-01 2010-10-01 false Reimbursement of members. 703.9 Section 703.9... AND FUNCTIONS OF STATE ADVISORY COMMITTEES § 703.9 Reimbursement of members. (a) Advisory Committee members may be reimbursed by the Commission by a per diem subsistence allowance and for travel expenses at...

  3. 10 CFR 765.21 - Procedures for processing reimbursement claims.

    Science.gov (United States)

    2010-01-01

    ... Department shall complete a final review of all relevant information prior to making a reimbursement decision... 10 Energy 4 2010-01-01 2010-01-01 false Procedures for processing reimbursement claims. 765.21... AND THORIUM PROCESSING SITES Procedures for Submitting and Processing Reimbursement Claims § 765.21...

  4. 26 CFR 601.804 - Reimbursements.

    Science.gov (United States)

    2010-04-01

    ... provided for in cooperative agreements, the Internal Revenue Service will provide amounts to program.... Cooperative agreements will establish the items for which reimbursements will be allowed and the method of..., and accounting and financial control systems. (b) Direct, reasonable, and prudent expenses...

  5. 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)

  6. 24 CFR 5.632 - Utility reimbursements.

    Science.gov (United States)

    2010-04-01

    ... Section 8 Project-Based Assistance Family Payment § 5.632 Utility reimbursements. (a) Applicability. This... the utility supplier to pay the utility bill on behalf of the family. If the PHA elects to pay the utility supplier, the PHA must notify the family of the amount paid to the utility supplier. (3) In the...

  7. 77 FR 38173 - TRICARE Reimbursement Revisions

    Science.gov (United States)

    2012-06-27

    ... specific numeric diagnosis-related group values and replacing them with their narrative description. DATES... reference to specific DRG numbers and descriptions became obsolete, so we are removing the numeric... follows: Sec. 199.14 Provider reimbursement methods. * * * * * (a) * * * (1) * * * (ii) * * * (C) * * * (3...

  8. 14 CFR 1214.202 - Reimbursement policy.

    Science.gov (United States)

    2010-01-01

    ... according to the reimbursement schedule plus short term call-up additional costs. The additional costs will... services. (2) The price will be based on estimated costs. (3) The price will be held constant for flights...) Subsequent to the first three years, the price will be adjusted annually to insure that total operating costs...

  9. 77 FR 45520 - Reimbursed Entertainment Expenses

    Science.gov (United States)

    2012-08-01

    ... as compensation and wages, the employee may be able to deduct the expense as an employee business...(e)(3) has the same meaning as in section 62(2)(A) (dealing with employee business expenses, later... Reimbursed Entertainment Expenses AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice of...

  10. Effect of the Shrink Fit and Mechanical Tolerance on Reactor Coolant Pump Flywheel Integrity Evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Donghak [Korea KHNP Central Research Institute, Daejeon (Korea, Republic of)

    2015-10-15

    Reactor coolant pump (RCP) flywheel should satisfy the RCP flywheel integrity criteria of the US NRC standard review plan (SRP) 5.4.1.1 and regulatory guide (RG) 1.14. Shrink-fit and rotational stresses should be calculated to evaluate the integrity. In this paper the effects of the shrink fit and mechanical tolerance on the RCP flywheel integrity evaluation are studied. The shrink fit should be determined by the joint release speed and the stresses in the flywheel will be increased by the shrink fit. The stress at the interface between the hub and the outer wheel shows the highest value. The effect of the mechanical tolerance should be considered for the stress evaluation. And the effect of the mechanical tolerance should be not considered to determine the joint release speed.

  11. Effect of the Shrink Fit and Mechanical Tolerance on Reactor Coolant Pump Flywheel Integrity Evaluation

    International Nuclear Information System (INIS)

    Kim, Donghak

    2015-01-01

    Reactor coolant pump (RCP) flywheel should satisfy the RCP flywheel integrity criteria of the US NRC standard review plan (SRP) 5.4.1.1 and regulatory guide (RG) 1.14. Shrink-fit and rotational stresses should be calculated to evaluate the integrity. In this paper the effects of the shrink fit and mechanical tolerance on the RCP flywheel integrity evaluation are studied. The shrink fit should be determined by the joint release speed and the stresses in the flywheel will be increased by the shrink fit. The stress at the interface between the hub and the outer wheel shows the highest value. The effect of the mechanical tolerance should be considered for the stress evaluation. And the effect of the mechanical tolerance should be not considered to determine the joint release speed

  12. Shrink properties of crosslinked polymers as investigated by a novel method

    International Nuclear Information System (INIS)

    Dobo, J.; Forgacs, P.; Somogyi, A.

    1981-01-01

    In the production and use of shrink materials, the slightly radiation crosslinked polymers are repeatedly heated above and cooled below their melting point, while maintained in extended state. Their shrink properties were investigated by model experiments simulating the thermal and mechanical influences. First an Instron testing apparatus has been used. In this paper, results obtained with a home-made electronic dynamometer with programmable extension and programmable temperature control are reported. (author)

  13. Utilization of travel reimbursement in the Veterans Health Administration.

    Science.gov (United States)

    Nelson, Richard E; Hicken, Bret; Cai, Beilei; Dahal, Arati; West, Alan; Rupper, Randall

    2014-01-01

    To improve access to care, the Veterans Health Administration (VHA) increased its patient travel reimbursement rate from 11 to 28.5 cents per mile on February 1, 2008, and again to 41.5 cents per mile on November 17, 2008. We identified characteristics of veterans more likely to receive travel reimbursements and evaluated the impact of these increases on utilization of the benefit. We examined the likelihood of receiving any reimbursement, number of reimbursements, and dollar amount of reimbursements for VHA patients before and after both reimbursement rate increases. Because of our data's longitudinal nature, we used multivariable generalized estimating equation models for analysis. Rurality and categorical distance from the nearest VHA facility were examined in separate regressions. Our cohort contained 214,376 veterans. During the study period, the average number of reimbursements per veteran was higher for rural patients compared to urban patients, and for those living 50-75 miles from the nearest VHA facility compared to those living closer. Higher reimbursement rates led to more veterans obtaining reimbursement regardless of urban-rural residence or distance traveled to the nearest VHA facility. However, after the rate increases, urban veterans and veterans living reimbursement utilization slightly more than other patients. Our findings suggest an inverted U-shaped relationship between veterans' utilization of the VHA travel reimbursement benefit and travel distance. Both urban and rural veterans responded in roughly equal manner to changes to this benefit. © 2013 National Rural Health Association.

  14. Shrinking cities examined from a shrinking scale – the impact of household and neighborhood heterogeneity on changes in material and energy consumption, ecosystem services and environmental impact

    Science.gov (United States)

    Urban populations continue to increase globally and cities have become the dominant human habitat. However, the growth of cities is not universal. Shrinking cities face decreased income, reduced property values, and decreased tax revenue. Fewer people per unit area creates ineffi...

  15. Implementation of the 2011 Reimbursement Act in Poland: Desired and undesired effects of the changes in reimbursement policy.

    Science.gov (United States)

    Kawalec, Paweł; Sagan, Anna; Stawowczyk, Ewa; Kowalska-Bobko, Iwona; Mokrzycka, Anna

    2016-04-01

    The Act of 12 May 2011 on the Reimbursement of Medicines, Foodstuffs Intended for Particular Nutritional Uses and Medical Devices constitutes a major change of the reimbursement policy in Poland. The main aims of this Act were to rationalize the reimbursement policy and to reduce spending on reimbursed drugs. The Act seems to have met these goals: reimbursement policy (including pricing of reimbursed drugs) was overhauled and the expenditure of the National Health Fund on reimbursed drugs saw a significant decrease in the year following the Act's introduction. The annual savings achieved since then (mainly due to the introduction of risk sharing schemes), have made it possible to include new drugs into the reimbursement list and improve access to innovative drugs. However, at the same time, the decrease in prices of reimbursed drugs, that the Act brought about, led to an uncontrolled outflow of some of these drugs abroad and shortages in Poland. This paper analyses the main changes introduced by the Reimbursement Act and their implications. Since the Act came into force relatively recently, its full impact on the reimbursement policy is not yet possible to assess. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  16. Proof of payment for all reimbursement claims

    CERN Multimedia

    HR Department

    2006-01-01

    Members of the personnel are kindly requested to note that only documents proving that a payment has been made are accepted as proof of payment for any claims for reimbursement, including specifically the reimbursement of education fees. In particular, the following will be accepted as proof of payment: bank or post office bank statements indicating the name of the institution to which the payment was made; photocopies of cheques made out to the institution to which the payments were made together with bank statements showing the numbers of the relevant cheques; proof of payment in the form of discharged payment slips; invoices with acknowledgement of settlement, receipts, bank statements detailing operations crediting another account or similar documents. As a result, the following documents in particular will no longer be accepted as proof of payment: photocopies of cheques that are not submitted together with bank or post office bank statements showing the numbers of the relevant cheques; details of ...

  17. Medicaid reimbursement, prenatal care and infant health.

    Science.gov (United States)

    Sonchak, Lyudmyla

    2015-12-01

    This paper evaluates the impact of state-level Medicaid reimbursement rates for obstetric care on prenatal care utilization across demographic groups. It also uses these rates as an instrumental variable to assess the importance of prenatal care on birth weight. The analysis is conducted using a unique dataset of Medicaid reimbursement rates and 2001-2010 Vital Statistics Natality data. Conditional on county fixed effects, the study finds a modest, but statistically significant positive relationship between Medicaid reimbursement rates and the number of prenatal visits obtained by pregnant women. Additionally, higher rates are associated with an increase in the probability of obtaining adequate care, as well as a reduction in the incidence of going without any prenatal care. However, the effect of an additional prenatal visit on birth weight is virtually zero for black disadvantaged mothers, while an additional visit yields a substantial increase in birth weight of over 20 g for white disadvantaged mothers. Copyright © 2015 Elsevier B.V. All rights reserved.

  18. Shrinking, ageing, disconnecting? The resilience of (some) Danish small towns

    DEFF Research Database (Denmark)

    Fertner, Christian; Herslund, Lise Byskov; Carstensen, Trine Agervig

    2013-01-01

    , even if they are located peripheral to the big labour markets. We will discuss how far these approaches can enable a development which can withstand the general urban dynamics in Denmark. Reference: Groth, N. B. (ed.) 2013. Stationsbyernes situation, udfordringer og potentialer. En hvidbog (White book......This paper is based on findings of a project investigating the challenges and prospects of Danish service towns with 1000 to 5000 inhabitants (Groth and Fertner 2013). Small towns in general are often associated with being losers of globalisation and suffering under urban and economic decline...... play an important part in more development oriented issues as it is them that communicate with larger municipalities on issues of local concern and they fundraise through holding events for local activities and also for actual physical changes to take place in the towns. The current socio-economic...

  19. 77 FR 3460 - Reimbursement for Costs of Remedial Action at Active Uranium and Thorium Processing Sites

    Science.gov (United States)

    2012-01-24

    ... available funding, the approved claim amounts will be reimbursed on a prorated basis. All reimbursements are...., statutory increases in the reimbursement ceilings). Title X requires DOE to reimburse eligible uranium and... DEPARTMENT OF ENERGY Reimbursement for Costs of Remedial Action at Active Uranium and Thorium...

  20. 44 CFR 208.39 - Reimbursement for personnel costs incurred during Activation.

    Science.gov (United States)

    2010-10-01

    ...) Reimbursement of additional salary and overtime costs. DHS will reimburse any identified additional salary and...). (g) Reimbursement for Backfill costs upon Activation. DHS will reimburse the cost to Backfill System... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Reimbursement for personnel...

  1. Trends in Medicare Reimbursement for Orthopedic Procedures: 2000 to 2016.

    Science.gov (United States)

    Eltorai, Adam E M; Durand, Wesley M; Haglin, Jack M; Rubin, Lee E; Weiss, Arnold-Peter C; Daniels, Alan H

    2018-03-01

    Understanding trends in reimbursement is critical to the financial sustainability of orthopedic practices. Little research has examined physician fee trends over time for orthopedic procedures. This study evaluated trends in Medicare reimbursements for orthopedic surgical procedures. The Medicare Physician Fee Schedule was examined for Current Procedural Terminology code values for the most common orthopedic and nonorthopedic procedures between 2000 and 2016. Prices were adjusted for inflation to 2016-dollar values. To assess mean growth rate for each procedure and subspecialty, compound annual growth rates were calculated. Year-to-year dollar amount changes were calculated for each procedure and subspecialty. Reimbursement trends for individual procedures and across subspecialties were compared. Between 2000 and 2016, annual reimbursements decreased for all orthopedic procedures examined except removal of orthopedic implant. The orthopedic procedures with the greatest mean annual decreases in reimbursement were shoulder arthroscopy/decompression, total knee replacement, and total hip replacement. The orthopedic procedures with the least annual reimbursement decreases were carpal tunnel release and repair of ankle fracture. Rate of Medicare procedure reimbursement change varied between subspecialties. Trauma had the smallest decrease in annual change compared with spine, sports, and hand. Annual reimbursement decreased at a significantly greater rate for adult reconstruction procedures than for any of the other subspecialties. These findings indicate that reimbursement for procedures has steadily decreased, with the most rapid decrease seen in adult reconstruction. [Orthopedics. 2018; 41(2):95-102.]. Copyright 2018, SLACK Incorporated.

  2. Melting heat transfer in boundary layer stagnation-point flow towards a stretching/shrinking sheet

    International Nuclear Information System (INIS)

    Bachok, Norfifah; Ishak, Anuar; Pop, Ioan

    2010-01-01

    An analysis is carried out to study the steady two-dimensional stagnation-point flow and heat transfer from a warm, laminar liquid flow to a melting stretching/shrinking sheet. The governing partial differential equations are converted into ordinary differential equations by similarity transformation, before being solved numerically using the Runge-Kutta-Fehlberg method. Results for the skin friction coefficient, local Nusselt number, velocity profiles as well as temperature profiles are presented for different values of the governing parameters. Effects of the melting parameter, stretching/shrinking parameter and Prandtl number on the flow and heat transfer characteristics are thoroughly examined. Different from a stretching sheet, it is found that the solutions for a shrinking sheet are non-unique.

  3. Neural substrate of body size: illusory feeling of shrinking of the waist.

    Directory of Open Access Journals (Sweden)

    H Henrik Ehrsson

    2005-12-01

    Full Text Available The perception of the size and shape of one's body (body image is a fundamental aspect of how we experience ourselves. We studied the neural correlates underlying perceived changes in the relative size of body parts by using a perceptual illusion in which participants felt that their waist was shrinking. We scanned the brains of the participants using functional magnetic resonance imaging. We found that activity in the cortices lining the left postcentral sulcus and the anterior part of the intraparietal sulcus reflected the illusion of waist shrinking, and that this activity was correlated with the reported degree of shrinking. These results suggest that the perceived changes in the size and shape of body parts are mediated by hierarchically higher-order somatosensory areas in the parietal cortex. Based on this finding we suggest that relative size of body parts is computed by the integration of more elementary somatic signals from different body segments.

  4. Shrinking Cities and the Need for a Reinvented Understanding of the City

    DEFF Research Database (Denmark)

    Laursen, Lea Louise holst

    the contemporary city and maybe the understanding of the city needs to be updated in some areas, before we are able to do so. In this paper, the focus will be directed towards two themes which become present with the Shrinking Cities phenomenon and therefore seems important to discuss in order to understand...... the concept of Shrinking Cities. These two themes may affect the understanding of the existing city theory. The first theme is concerned with the physical understanding of the city where the traditional assumption about the city as a high density area, with buildings as the dominant structure, is questioned....... Here the concept of the city as an urban landscape will be introduced. The second theme points to the need for a discussion regarding the object of our planning when developing the cities. Previously, the purpose of city development has been growth and expansion, but with the Shrinking Cities...

  5. Mure skal holde zombierne ude

    DEFF Research Database (Denmark)

    Stockmarr, Leila

    2013-01-01

    Vi bygger som besatte mure og barrierer for at holde flygtninge ude og tæmme de negative konsekvenser af den neoliberale globalisering.......Vi bygger som besatte mure og barrierer for at holde flygtninge ude og tæmme de negative konsekvenser af den neoliberale globalisering....

  6. Tuition reimbursement for special education students.

    Science.gov (United States)

    Zirkel, P A

    1997-01-01

    The spring 1996 issue of The Future of Children on special education reviewed the legislative and litigation history of the Individuals with Disabilities Education Act (IDEA). This Revisiting article examines the impact of the two U.S. Supreme Court cases setting forth school districts' responsibility to reimburse parents of students with disabilities for private school tuition under certain circumstances. An extensive examination of published cases reveals that the number of cases litigated has increased but that the courts are no more likely to decide in favor of parents than they were before the Supreme Court rulings.

  7. Reminder : Reimbursement of education fees / accommodation fees

    CERN Multimedia

    2003-01-01

    Your attention is drawn to the 20 km distance limit set in Article R A 8.01 of the Staff Regulations, namely, that only accommodation fees of students attending an educational establishment which is more than 20 km from the place of residence and the duty station of the member of the personnel are reimbursed by the Organization, subject to the percentage rate and maximum amounts set out in this article and in Administrative Circular N° 12. Human Resources Division Tel : 72862 / 74474

  8. Reimbursement of education fees / accommodation fees

    CERN Multimedia

    2003-01-01

    Your attention is drawn to the 20 km distance limit set in Article R A 8.01 of the Staff Regulations, namely, that only accommodation fees of students attending an educational establishment which is more than 20 km from the place of residence and the duty station of the member of the personnel are reimbursed by the Organization, subject to the percentage rate and maximum amounts set out in this article and in Administrative Circular N° 12. Human Resources Division Tel: 72862 / 74474

  9. 7 CFR 400.712 - Research and development reimbursement, maintenance reimbursement, and user fees.

    Science.gov (United States)

    2010-01-01

    ...) Loss adjustment expenses; (vii) Sales commission; (viii) Marketing costs; (ix) Indirect overhead costs..., development, preparation or marketing of the policy; (xiii) Costs of making program changes as a result of any... submission may be eligible for a one-time payment of research and development costs and reimbursement of...

  10. 76 FR 39043 - TRICARE; Reimbursement of Sole Community Hospitals and Adjustment to Reimbursement of Critical...

    Science.gov (United States)

    2011-07-05

    ...: Federal Docket Management System Office, Room 3C843, 1160 Defense Pentagon, Washington, DC 20301-1160... paid under the Medicare Diagnosis- Related Group (DRG) method for all of that hospital's Medicare... reimbursement is usually substantially greater than what would be paid using the Diagnosis- Related Group (DRG...

  11. Effects of Brass (Cu3Zn2) as High Thermal Expansion Material on Shrink Disc Performance During High Thermal Loading

    Science.gov (United States)

    Mazlan, MIS; Mohd, SA; Bahar, ND; Aziz, SAA

    2018-03-01

    This research work is focused on shrink disc operation at high temperature. Geometrical and material design selections have been done by taking into consideration the existing shrink disc operating at high temperature condition. The existing shrink disc confronted slip between shaft and shaft sleeve during thermal loading condition. The assessment has been obtained through virtual experiment by using Finite Element Analysis (FEA) -Thermal Transient Stress for 900 seconds with 300 °C of thermal loading. This investigation consists of the current and improved version of shrink disc, where identical geometries and material properties were utilized. High Thermal Expansion (HTE) material has been introduced to overcome the current design of the shrink disc. Brass (Cu3Zn2) has been selected as the HTE material in the improved shrink disc design due to its high thermal expansion properties. The HTE has shown a significant improvement on the total contact area and contact pressure on the shaft and the shaft sleeve. The improved shrink disc embedded with HTE during thermal loading exhibit a minimum of 1244.1 mm2 of the total area on shaft and shaft sleeve which uninfluenced the total contact area at normal condition which is 1254.3 mm2. Meanwhile, the total pressure of improved shrink disc had an increment of 108.1 MPa while existing shrink disc total pressure has lost 17.2 MPa during thermal loading.

  12. Extending the shelf life of fresh sweet corn by shrink-wrapping, refrigeration, and irradiation

    International Nuclear Information System (INIS)

    Deak, T.

    1987-01-01

    Chemical, physical, sensory, and microbiological changes were monitored during storage of unwrapped and shrink-wrapped fresh sweet corn at 10 degree and 20 degree C. Wrapping essentially eliminated moisture loss and resulted in elevated carbon dioxide and decreased oxygen concentrations within packages. These effects, together with refrigeration markedly reduced the changes associated with senscence and post harvest deterioration, and hence resulted in at least a threefold extension in shelf life. The water-saturated atmosphere, however, enhanced microbial growth on shrink-wrapped corn. The initial microbial population was effectively decreased by treating the wrapped corn with 0.5 or 1.0 kGy (Co 60 ) irradiation

  13. How Credible Are Shrinking Wage Elasticities of Married Women Labour Supply?

    Directory of Open Access Journals (Sweden)

    Duo Qin

    2015-12-01

    Full Text Available This paper delves into the well-known phenomenon of shrinking wage elasticities for married women in the US over recent decades. The results of a novel model experimental approach via sample data ordering unveil considerable heterogeneity across different wage groups. Yet, surprisingly constant wage elasticity estimates are maintained within certain wage groups over time. In addition to those constant wage elasticity estimates, we find that the composition of working women into different wage groups has changed considerably, resulting in shrinking wage elasticity estimates at the aggregate level. These findings would be impossible to obtain had we not dismantled and discarded the instrumental variable estimation route.

  14. Variation in provider vaccine purchase prices and payer reimbursement.

    Science.gov (United States)

    Freed, Gary L; Cowan, Anne E; Gregory, Sashi; Clark, Sarah J

    2009-12-01

    The purpose of this work was to collect data regarding vaccine prices and reimbursements in private practices. Amid reports of physicians losing money on vaccines, there are limited supporting data to show how much private practices are paying for vaccines and how much they are being reimbursed by third-party payers. We conducted a cross-sectional survey of a convenience sample of private practices in 5 states (California, Georgia, Michigan, New York, and Texas) that purchase vaccines for administration to privately insured children/adolescents. Main outcome measures included prices paid to purchase vaccines recommended for children and adolescents and reimbursement from the 3 most common, non-Medicaid payers for vaccine purchase and administration. Detailed price and reimbursement data were provided by 76 practices. There was a considerable difference between the maximum and minimum prices paid by practices, ranging from $4 to more than $30 for specific vaccines. There was also significant variation in insurance reimbursement for vaccine purchase, with maximum and minimum reimbursements for a single vaccine differing from $8 to more than $80. Mean net yield per dose (reimbursement for vaccine purchase minus price paid per dose) varied across vaccines from a low of approximately $3 to more than $24. Reimbursement for the first dose of vaccine administered ranged from $0 to more than $26, with a mean of $16.62. There is a wide range of prices paid by practices for the same vaccine product and in the reimbursement for vaccines and administration fees by payers. This variation highlights the need for individual practices to understand their own costs and reimbursements and to seek opportunities to reduce costs and increase reimbursements.

  15. 77 FR 2297 - Office of Asset and Transportation Management; Privately Owned Vehicle Mileage Reimbursement Rates

    Science.gov (United States)

    2012-01-17

    ... of Asset and Transportation Management; Privately Owned Vehicle Mileage Reimbursement Rates AGENCY... Bulletin 12-02, Calendar Year (CY) 2012 Privately Owned Vehicle Mileage Reimbursement Rates. SUMMARY: The General Services Administration's (GSA) annual privately owned vehicle (POV) mileage reimbursement rate...

  16. 76 FR 19909 - International Terrorism Victim Expense Reimbursement Program

    Science.gov (United States)

    2011-04-11

    ... 1121-AA78 International Terrorism Victim Expense Reimbursement Program AGENCY: Office of Justice... promulgating this interim-final rule for its International Terrorism Victim Expense Reimbursement Program... international terrorism. DATES: Effective date: This interim-final rule is effective April 11, 2011. Comment...

  17. 5 CFR 2634.304 - Gifts and reimbursements.

    Science.gov (United States)

    2010-01-01

    ... manners: (1) If the gift has been newly purchased or is readily available in the market, the value shall... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Gifts and reimbursements. 2634.304....304 Gifts and reimbursements. (a) Gifts. Except as indicated in § 2634.308(b), each financial...

  18. 14 CFR 331.7 - What losses will be reimbursed?

    Science.gov (United States)

    2010-01-01

    ... PROVIDERS IN THE WASHINGTON, DC AREA General Provisions § 331.7 What losses will be reimbursed? (a) You may... which you are or were an operator or provider not been closed as the result of Federal government...-recurring, or unusual adjustments, and capital losses are normally ineligible for reimbursement. If you wish...

  19. Obtaining reimbursement in France and Italy for new diabetes products.

    Science.gov (United States)

    Schaefer, Elmar; Schnell, Gerald; Sonsalla, Jessica

    2015-01-01

    Manufacturers launching next-generation or innovative medical devices in Europe face a very heterogeneous reimbursement landscape, with each country having its own pathways, timing, requirements and success factors. We selected 2 markets for a deeper look into the reimbursement landscape: France, representing a country with central decision making with defined processes, and Italy, which delegates reimbursement decisions to the regional level, resulting in a less transparent approach to reimbursement. Based on our experience in working on various new product launches and analyzing recent reimbursement decisions, we found that payers in both countries do not reward improved next-generation products with incremental reimbursement. Looking at innovations, we observe that manufacturers face a challenging and lengthy process to obtain reimbursement. In addition, requirements and key success factors differ by country: In France, comparative clinical evidence and budget impact very much drive reimbursement decisions in terms of pricing and restrictions, whereas in Italy, regional key opinion leader (KOL) support and additional local observational data are key. © 2015 Diabetes Technology Society.

  20. 48 CFR 1316.405 - Cost-reimbursement incentive contracts.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Cost-reimbursement incentive contracts. 1316.405 Section 1316.405 Federal Acquisition Regulations System DEPARTMENT OF COMMERCE CONTRACTING METHODS AND CONTRACT TYPES TYPES OF CONTRACTS Incentive Contracts 1316.405 Cost-reimbursement...

  1. 42 CFR 57.313a - Loan cancellation reimbursement.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Loan cancellation reimbursement. 57.313a Section 57.313a Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GRANTS GRANTS FOR... Loans § 57.313a Loan cancellation reimbursement. In the event that insufficient funds are available to...

  2. 44 CFR 208.42 - Reimbursement for other administrative costs.

    Science.gov (United States)

    2010-10-01

    ... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Reimbursement for other administrative costs. 208.42 Section 208.42 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT... SYSTEM Response Cooperative Agreements § 208.42 Reimbursement for other administrative costs. Costs...

  3. 47 CFR 27.1233 - Reimbursement costs of transitioning.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 2 2010-10-01 2010-10-01 false Reimbursement costs of transitioning. 27.1233 Section 27.1233 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES... Policies Governing the Transition of the 2500-2690 Mhz Band for Brs and Ebs § 27.1233 Reimbursement costs...

  4. 48 CFR 216.405 - Cost-reimbursement incentive contracts.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Cost-reimbursement incentive contracts. 216.405 Section 216.405 Federal Acquisition Regulations System DEFENSE ACQUISITION... Contracts 216.405 Cost-reimbursement incentive contracts. ...

  5. 50 CFR 86.71 - How will I be reimbursed?

    Science.gov (United States)

    2010-10-01

    ... 50 Wildlife and Fisheries 6 2010-10-01 2010-10-01 false How will I be reimbursed? 86.71 Section 86.71 Wildlife and Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF THE INTERIOR...) PROGRAM How States Manage Grants § 86.71 How will I be reimbursed? For details on how we will pay you...

  6. 44 CFR 63.6 - Reimbursable relocation costs.

    Science.gov (United States)

    2010-10-01

    ... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Reimbursable relocation costs. 63.6 Section 63.6 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT... OF SECTION 1306(c) OF THE NATIONAL FLOOD INSURANCE ACT OF 1968 General § 63.6 Reimbursable relocation...

  7. State Variation in Medicaid Reimbursements for Orthopaedic Surgery.

    Science.gov (United States)

    Lalezari, Ramin M; Pozen, Alexis; Dy, Christopher J

    2018-02-07

    Medicaid reimbursements are determined by each state and are subject to variability. We sought to quantify this variation for commonly performed inpatient orthopaedic procedures. The 10 most commonly performed inpatient orthopaedic procedures, as ranked by the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample, were identified for study. Medicaid reimbursement amounts for those procedures were benchmarked to state Medicare reimbursement amounts in 3 ways: (1) ratio, (2) dollar difference, and (3) dollar difference divided by the relative value unit (RVU) amount. Variability was quantified by determining the range and coefficient of variation for those reimbursement amounts. The range of variability of Medicaid reimbursements among states exceeded $1,500 for all 10 procedures. The coefficients of variation ranged from 0.32 (hip hemiarthroplasty) to 0.57 (posterior or posterolateral lumbar interbody arthrodesis) (a higher coefficient indicates greater variability), compared with 0.07 for Medicare reimbursements for all 10 procedures. Adjusted as a dollar difference between Medicaid and Medicare per RVU, the median values ranged from -$8/RVU (total knee arthroplasty) to -$17/RVU (open reduction and internal fixation of the femur). Variability of Medicaid reimbursement for inpatient orthopaedic procedures among states is substantial. This variation becomes especially remarkable given recent policy shifts toward focusing reimbursements on value.

  8. 48 CFR 1816.405 - Cost-reimbursement incentive contracts.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Cost-reimbursement incentive contracts. 1816.405 Section 1816.405 Federal Acquisition Regulations System NATIONAL AERONAUTICS... 1816.405 Cost-reimbursement incentive contracts. [62 FR 3478, Jan. 23, 1997. Redesignated at 62 FR...

  9. 48 CFR 916.405 - Cost-reimbursement incentive contracts.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Cost-reimbursement incentive contracts. 916.405 Section 916.405 Federal Acquisition Regulations System DEPARTMENT OF ENERGY CONTRACTING METHODS AND CONTRACT TYPES TYPES OF CONTRACTS Incentive Contracts 916.405 Cost-reimbursement...

  10. 36 CFR 64.15 - Financial reporting requirements and reimbursements.

    Science.gov (United States)

    2010-07-01

    ... 36 Parks, Forests, and Public Property 1 2010-07-01 2010-07-01 false Financial reporting requirements and reimbursements. 64.15 Section 64.15 Parks, Forests, and Public Property NATIONAL PARK SERVICE... RIGHTS-OF-WAY § 64.15 Financial reporting requirements and reimbursements. Payments to applicants will...

  11. 78 FR 76626 - Privately Owned Vehicle Mileage Reimbursement Rates

    Science.gov (United States)

    2013-12-18

    ... Procedure GSA posts the POV mileage reimbursement rates, formerly published in 41 CFR Chapter 301, solely on... official travel. Notices published periodically in the Federal Register, such as this one, and the changes... reimbursement rates for Federal agencies. Dated: December 12, 2013. Carolyn Austin-Diggs, Acting Deputy...

  12. [Reimbursement of health apps by the German statutory health insurance].

    Science.gov (United States)

    Gregor-Haack, Johanna

    2018-03-01

    reimbursement category for "apps" does not exist in German statutory health insurance. Nevertheless different ways for reimbursement of digital health care products or processes exist. This article provides an overview and a description of the most relevant finance and reimbursement categories for apps in German statutory health insurance. The legal qualifications and preconditions of reimbursement in the context of single contracts with one health insurance fund will be discussed as well as collective contracts with national statutory health insurance funds. The benefit of a general outline appeals especially in respect to the numerous new players and products in the health care market. The article will highlight that health apps can challenge existing legal market access and reimbursement criteria and paths. At the same time, these criteria and paths exist. In terms of a learning system, they need to be met and followed.

  13. Contact Problem of Disk on Shaft Fixed by Induction Shrink Fit

    Czech Academy of Sciences Publication Activity Database

    Ulrych, B.; Kotlan, V.; Doležel, Ivo

    2012-01-01

    Roč. 88, 12B (2012), s. 32-34 ISSN 0033-2097 Institutional research plan: CEZ:AV0Z20760514 Keywords : induction shrink fit * contact problem * transfer of torque Subject RIV: BA - General Mathematics Impact factor: 0.244, year: 2011

  14. People’s climate in shrinking areas : the case of Heerlen, the Netherlands

    NARCIS (Netherlands)

    Nol Reverda; Maja Rocak; Maurice Hermans

    2011-01-01

    Chapter of a report that presents a case study of the City of Heerlen, Netherlands, a shrinking city that identifies cultural policy as an important factor in vitalising the city. Heerlen has made significant investments into culture and is experiencing a “cultural spring”. This promotes a positive

  15. The shrinking lung syndrome in systemic lupus erythematosus: improvement with corticosteroid therapy

    NARCIS (Netherlands)

    Oud, K. T. M.; Bresser, P.; ten Berge, R. J. M.; Jonkers, R. E.

    2005-01-01

    Respiratory manifestations of systemic lupus erythematosus (SLE) are frequent. The 'shrinking lung syndrome' (SLS) represents a rare complication of SLE. The pathogenesis and therapy of the SLS remains controversial. We report a series of five consecutive cases with the SLS of which we provide a

  16. Blue breath holding is benign.

    OpenAIRE

    Stephenson, J B

    1991-01-01

    In their recent publication in this journal, Southall et al described typical cyanotic breath holding spells, both in otherwise healthy children and in those with brainstem lesions and other malformations. Their suggestions regarding possible autonomic disturbances may require further study, but they have adduced no scientific evidence to contradict the accepted view that in the intact child blue breath holding spells are benign. Those families in which an infant suffers an 'apparently life t...

  17. A Comparison of Vacancy Dynamics between Growing and Shrinking Cities Using the Land Transformation Model

    Directory of Open Access Journals (Sweden)

    Jaekyung Lee

    2018-05-01

    Full Text Available Every city seeks opportunities to spur economic developments and, depending on its type, vacant land can be seen as a potential threat or an opportunity to achieve these developments. Although vacant land exists in all cities, the causes and effects of changes in vacant land can differ. Growing cities may have more vacant land than shrinking cities because of large scale annexation. Meanwhile, depopulation and economic downturn may increase the total amount of vacant and abandoned properties. Despite various causes of increase and decrease of vacant land, the ability to predict future vacancy patterns—where future vacant parcels may occur—could be a critical test to set up appropriate development strategies and land use policies, especially in shrinking cities, to manage urban decline and regeneration efforts more wisely. This study compares current and future vacancy patterns of a growing city (Fort Worth, TX, USA and a shrinking city (Chicago, IL, USA, by employing the Land Transformation Model (LTM to predict for future vacant lands. This research predicts and produces possible vacancy pattern scenarios by 2020 and deciphers the ranking of determinants of vacant land in each city type. The outcomes of this study indicate that the LTM can be useful for simulating vacancy patterns and the causes of vacancy vary in both growing and shrinking cities. Socio-economic factors such as unemployment rate and household income are powerful determinants of vacancy in a growing city, while physical and transportation-related conditions such as proximity to highways, vehicle accessibility, or building conditions show a stronger influence on increasing vacant land in a shrinking city.

  18. Nursing Home Cost Studies and Reimbursement Issues

    Science.gov (United States)

    Bishop, Christine E.

    1980-01-01

    This review of nursing home cost function research shows that certain provider and service characteristics are systematically associated with differences in the average cost of care. This information can be used to group providers for reasonable cost related rate-setting or to adjust their rates or rate ceilings. However, relationships between average cost and such service characteristics as patient mix, service intensity, and quality of care have not been fully delineated. Therefore, econometric cost functions cannot yet provide rate-setters with predictions about the cost of the efficient provision of nursing home care appropriate to patient needs. In any case, the design of reimbursement systems must be founded not only on technical information but also on public policy goals for long-term care. PMID:10309223

  19. Direct reimbursement. The future for organized dentistry.

    Science.gov (United States)

    Paul, D P

    2001-10-01

    Direct reimbursement, or DR, has been a popular topic in organized dentistry for much of the last decade, and the concept is beginning to be more widely known. This article explores the underpinnings of and future for DR. TYPES OF LITERATURE REVIEWED: This article is based on an online review of the dental, medical and business literature. The author explores the advantages of DR for patients, employers and dentists. He also presents purported disadvantages of DR, and refutes them. Organized dentistry's marketing efforts and the importance of third-party administrators also are examined. During the next several years, DR has the potential to become the vehicle of choice for financing much of the dental care provided in the United States. Dentists need to become more aware of what DR is and what it can offer the public. They then will be better able to promote DR, which is a significantly better payment system for dental care than any other available today.

  20. Nursing home cost studies and reimbursement issues.

    Science.gov (United States)

    Bishop, C E

    1980-01-01

    This review of nursing home cost function research shows that certain provider and service characteristics are systematically associated with differences in the average cost of care. This information can be used to group providers for reasonable cost related rate-setting or to adjust their rates or rate ceilings. However, relationships between average cost and such service characteristics as patient mix, service intensity, and quality of care have not been fully delineated. Therefore, econometric cost functions cannot yet provide rate-setters with predictions about the cost of the efficient provision of nursing home care appropriate to patient needs. In any case, the design of reimbursement systems must be founded not only on technical information but also on public policy goals for long-term care.

  1. Pricing and reimbursement of drugs in Ireland.

    Science.gov (United States)

    Barry, Michael; Tilson, Lesley; Ryan, Máirín

    2004-06-01

    Expenditure on healthcare in Ireland, which is mainly derived from taxation, has increased considerably in recent years to an estimated 9.2 billion euro in 2003. Pharmaceuticals account for approximately 10% of total healthcare expenditure. Approximately one-third of patients receive their medications free of charge whilst the remaining two-thirds are subject to a co-payment threshold of 78 euro per month, i.e. 936 euro per year. The price of medications in Ireland is linked to those of five other member states where the price to the wholesaler of any medication will not exceed the lesser of the currency-adjusted wholesale price in the United Kingdom or the average of wholesale prices in Denmark, France, Germany, The Netherlands and the United Kingdom. A price freeze at the introduction price has been in existence since 1993. Despite the price freeze, expenditure on medicines on the community drugs scheme has increased from 201 million euro in 1993 to 898 million euro in 2002. The two main factors contributing to the increased expenditure on medicines include "product mix", the prescribing of new and more expensive medication, and "volume effect" comprising growth in the number of prescription items. Changing demographics and the extension of the General Medical Services (GMS) Scheme to provide free medicines for all those over the age of 70 years have also contributed. Prior to reimbursement under the community drugs schemes, a medicine must be included in the GMS code book or positive list. A demonstration of cost-effectiveness is not a pre-requisite for reimbursement.

  2. Reimbursement rates and policies for primary molar pit-and-fissure sealants across state Medicaid programs.

    Science.gov (United States)

    Chi, Donald L; Singh, Jennifer

    2013-11-01

    Little is known about Medicaid policies regarding reimbursement for placement of sealants on primary molars. The authors identified Medicaid programs that reimbursed dentists for placing primary molar sealants and hypothesized that these programs had higher reimbursement rates than did state programs that did not reimburse for primary molar sealants. The authors obtained Medicaid reimbursement data from online fee schedules and determined whether each state Medicaid program reimbursed for primary molar sealants (no or yes). The outcome measure was the reimbursement rate for permanent tooth sealants (calculated in 2012 U.S. dollars). The authors compared mean reimbursement rates by using the t test (α = .05). Seventeen Medicaid programs reimbursed dentists for placing primary molar sealants (34 percent), and the mean reimbursement rate was $27.57 (range, $16.00 [Maine] to $49.68 [Alaska]). All 50 programs reimbursed dentists for placement of sealants on permanent teeth. The mean reimbursement for permanent tooth sealants was significantly higher in programs that reimbursed for primary molar sealants than in programs that did not ($28.51 and $23.67, respectively; P = .03). Most state Medicaid programs do not reimburse dentists for placing sealants on primary molars, but programs that do so have significantly higher reimbursement rates. Medicaid reimbursement rates are related to dentists' participation in Medicaid and children's dental care use. Reimbursement for placement of sealants on primary molars is a proxy for Medicaid program generosity.

  3. 78 FR 7750 - Summer Food Service Program; 2013 Reimbursement Rates

    Science.gov (United States)

    2013-02-04

    ...This notice informs the public of the annual adjustments to the reimbursement rates for meals served in the Summer Food Service Program for Children. These adjustments address changes in the Consumer Price Index, as required under the Richard B. Russell National School Lunch Act. The 2013 reimbursement rates are presented as a combined set of rates to highlight simplified cost accounting procedures. The 2013 rates are also presented individually, as separate operating and administrative rates of reimbursement, to show the effect of the Consumer Price Index adjustment on each rate.

  4. 77 FR 5228 - Summer Food Service Program; 2012 Reimbursement Rates

    Science.gov (United States)

    2012-02-02

    ...This notice informs the public of the annual adjustments to the reimbursement rates for meals served in the Summer Food Service Program for Children. These adjustments address changes in the Consumer Price Index, as required under the Richard B. Russell National School Lunch Act. The 2012 reimbursement rates are presented as a combined set of rates to highlight simplified cost accounting procedures. The 2012 rates are also presented individually, as separate operating and administrative rates of reimbursement, to show the effect of the Consumer Price Index adjustment on each rate.

  5. 76 FR 5328 - Summer Food Service Program; 2011 Reimbursement Rates

    Science.gov (United States)

    2011-01-31

    ...This notice informs the public of the annual adjustments to the reimbursement rates for meals served in the Summer Food Service Program for Children. These adjustments address changes in the Consumer Price Index, as required under the Richard B. Russell National School Lunch Act. The 2011 reimbursement rates are presented as a combined set of rates to highlight simplified cost accounting procedures that are extended nationwide by enactment of the Fiscal Year 2008 Consolidated Appropriations Act. The 2011 rates are also presented individually, as separate operating and administrative rates of reimbursement, to show the effect of the Consumer Price Index adjustment on each rate.

  6. 75 FR 3197 - Summer Food Service Program; 2010 Reimbursement Rates

    Science.gov (United States)

    2010-01-20

    ...This notice informs the public of the annual adjustments to the reimbursement rates for meals served in the Summer Food Service Program for Children. These adjustments address changes in the Consumer Price Index, as required under the Richard B. Russell National School Lunch Act. The 2010 reimbursement rates are presented as a combined set of rates to highlight simplified cost accounting procedures that are extended nationwide by enactment of the Fiscal Year 2008 Consolidated Appropriations Act. The 2010 rates are also presented individually, as separate operating and administrative rates of reimbursement, to show the effect of the Consumer Price Index adjustment on each rate.

  7. Capital budgeting and cost reimbursement in investor-owned and not-for-profit hospitals.

    Science.gov (United States)

    Hubbard, C M

    1983-01-01

    Net present value estimates cannot be made in health care finance without the appropriate cost reimbursement adjustments. The results of new regulations could radically alter the effects of reimbursement on capital budgeting. Debates on the effects of cost reimbursement on decision making in hospitals will continue as long as reimbursement exists in a manner that affects operating cash flows or the cost of capital.

  8. 45 CFR 2553.43 - What cost reimbursements are provided to RSVP volunteers?

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false What cost reimbursements are provided to RSVP... Reimbursements and Volunteer Assignments § 2553.43 What cost reimbursements are provided to RSVP volunteers? RSVP volunteers are provided the following cost reimbursements within the limits of the project's available...

  9. 76 FR 30696 - Reimbursement for Costs of Remedial Action at Active Uranium and Thorium Processing Sites

    Science.gov (United States)

    2011-05-26

    ... in the reimbursement ceilings). Title X requires DOE to reimburse eligible uranium and thorium... DEPARTMENT OF ENERGY Reimbursement for Costs of Remedial Action at Active Uranium and Thorium... reimbursement under Title X of the Energy Policy Act of 1992. In our Federal Register Notice of November 24...

  10. 45 CFR 2551.46 - What cost reimbursements are provided to Senior Companions?

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false What cost reimbursements are provided to Senior..., and Cost Reimbursements § 2551.46 What cost reimbursements are provided to Senior Companions? Cost reimbursements include: (a) Stipend. Senior Companions who are income eligible will receive a stipend in an...

  11. 76 FR 24871 - Reimbursement for Costs of Remedial Action at Active Uranium and Thorium Processing Sites

    Science.gov (United States)

    2011-05-03

    ... in the reimbursement ceilings). Title X requires DOE to reimburse eligible uranium and thorium... DEPARTMENT OF ENERGY Reimbursement for Costs of Remedial Action at Active Uranium and Thorium... reimbursement under Title X of the Energy Policy Act of 1992. DATES: In our Federal Register Notice of November...

  12. 77 FR 12925 - Federal Acquisition Regulation; Proper Use and Management of Cost-Reimbursement Contracts

    Science.gov (United States)

    2012-03-02

    ...-Reimbursement Contracts AGENCIES: Department of Defense (DoD), General Services Administration (GSA), and... addresses the use and management of cost- reimbursement contracts. DATES: Effective Date: April 2, 2012 FOR...-reimbursement contracts in the following three areas: 1. Circumstances when cost-reimbursement contracts are...

  13. 47 CFR 27.1166 - Reimbursement under the Cost-Sharing Plan.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 2 2010-10-01 2010-10-01 false Reimbursement under the Cost-Sharing Plan. 27... § 27.1166 Reimbursement under the Cost-Sharing Plan. (a) Registration of reimbursement rights. Claims for reimbursement under the cost-sharing plan are limited to relocation expenses incurred on or after...

  14. 45 CFR 2552.46 - What cost reimbursements are provided to Foster Grandparents?

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false What cost reimbursements are provided to Foster..., Status and Cost Reimbursements § 2552.46 What cost reimbursements are provided to Foster Grandparents? Cost reimbursements include: (a) Stipend. Foster Grandparents who are income eligible will receive a...

  15. 47 CFR 24.245 - Reimbursement under the Cost-Sharing Plan.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 2 2010-10-01 2010-10-01 false Reimbursement under the Cost-Sharing Plan. 24... 1850-1990 Mhz Band § 24.245 Reimbursement under the Cost-Sharing Plan. (a) Registration of reimbursement rights. (1) To obtain reimbursement, a PCS relocator must submit documentation of the relocation...

  16. 44 CFR 208.40 - Reimbursement of fringe benefit costs during Activation.

    Science.gov (United States)

    2010-10-01

    ... reimbursement sought from DHS. (c) DHS will not reimburse the Sponsoring Agency for fringe benefit costs for... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Reimbursement of fringe... RESCUE RESPONSE SYSTEM Response Cooperative Agreements § 208.40 Reimbursement of fringe benefit costs...

  17. Reimbursement issues facing patients, providers, and payers.

    Science.gov (United States)

    Antman, K

    1993-11-01

    Escalating costs of health care delivery and the current constraints imposed by the federal budget deficit seriously threaten to compromise patient care and innovative biomedical research. Recent third-party refusal to cover some patients treated in protocols has had considerable impact on trial research. In addition, reimbursement for conventional care sometimes has been refused if delivered as part of a study (e.g., MOPP therapy versus ABVD therapy) or for an indication that is not specifically cited on the Food and Drug Administration label. Who should cover the patient care costs of patients participating in clinical trials? One approach would have patients cover these costs themselves. A second approach is the reinstitution of patient care costs into research grants. A third possibility is that the pharmaceutical industry support patient care costs of clinical research. Historically, hospital expenses of patients participating in studies have been paid by health insurance policies. In the absence of a clinical trial, many patients would be treated with Food and Drug Administration-approved therapies despite a lack of substantial benefit. Such marginal treatments are compensated by third-party payers routinely. The current system is arbitrary and expensive, compromises research and development, and equates new treatment with no treatment. By refusing to reimburse the patient care costs of investigational therapy, third-party carriers are, in fact, making medical decisions. There is a growing and legitimate concern that the pace of clinical research will be impeded significantly at a time when many exciting developments will be ready for clinical trials. The molecular steps in carcinogenesis are being documented rapidly for common malignancies, such as colon cancer. Immunologic, biologic, and hormonal approaches, and emerging technologies, such as marrow transplant or antibody toxin conjugates, already are being studied in the clinic. Health policy legislation

  18. Flow past a permeable stretching/shrinking sheet in a nanofluid using two-phase model.

    Directory of Open Access Journals (Sweden)

    Khairy Zaimi

    Full Text Available The steady two-dimensional flow and heat transfer over a stretching/shrinking sheet in a nanofluid is investigated using Buongiorno's nanofluid model. Different from the previously published papers, in the present study we consider the case when the nanofluid particle fraction on the boundary is passively rather than actively controlled, which make the model more physically realistic. The governing partial differential equations are transformed into nonlinear ordinary differential equations by a similarity transformation, before being solved numerically by a shooting method. The effects of some governing parameters on the fluid flow and heat transfer characteristics are graphically presented and discussed. Dual solutions are found to exist in a certain range of the suction and stretching/shrinking parameters. Results also indicate that both the skin friction coefficient and the local Nusselt number increase with increasing values of the suction parameter.

  19. Shrink Tube Insulation Apparatus for Rebco Superconducting Tapes for Use in High Field Magnets

    CERN Document Server

    Whittington, Andrew

    An increasing number of applications require the use of high temperature superconductors (HTS) such as (RE=Rare Earth) Ba2Cu3O7-x (REBCO) coated conductors [1]. HTS conductors show particularly great potential for high field magnets applications [1] due to their high upper critical fields [2], But several groups have shown that REBCO coated conductors are prone to delamination failure [3] [4] [5]. Under relatively low transverse stress the HTS film separates from the substrate and the conductor degrades [6]. This is problematic due to high transverse stresses that occur in fully epoxy impregnated solenoids wound with this conductor. Application of thin walled heat shrink tubing introduces a weak plane around the conductor, preventing delamination degradation [7]. However, manual application of the shrink tubing is impractical, requiring three operators limited to insulating 100 m lengths or less of REBCO conductor. The high risk of damage to the conductor, also associated with this process, shows the need for...

  20. New approach to the exact solution of viscous flow due to stretching (shrinking and porous sheet

    Directory of Open Access Journals (Sweden)

    Azhar Ali

    Full Text Available Exact analytical solutions for the generalized stretching (shrinking of a porous surface, for the variable suction (injection velocity, is presented in this paper. The solution is generalized in the sense that the existing solutions that correspond to various stretching velocities are recovered as a special case of this study. A suitable similarity transformation is introduced to find self-similar solution of the non-linear governing equations. The flow is characterized by a few non-dimensional parameters signifying the problem completely. These parameters are such that the whole range of stretching (shrinking problems discussed earlier can be recovered by assigning appropriate values to these parameters. A key point of the whole narrative is that a number of earlier works can be abridged into one generalized problem through the introduction of a new similarity transformation and finding its exact solution encompassing all the earlier solutions. Keywords: Exact solutions, New similarities, Permeable and moving sheet

  1. 26 CFR 20.2205-1 - Reimbursement out of estate.

    Science.gov (United States)

    2010-04-01

    ... passing to, or in the possession of, any person other than the duly qualified executor or administrator... specific provisions giving the executor the right to reimbursement from life insurance beneficiaries and...

  2. 75 FR 37971 - Providing Stability and Security for Medicare Reimbursements

    Science.gov (United States)

    2010-06-30

    ... Part IV The President Memorandum of June 25, 2010--Providing Stability and Security for Medicare Reimbursements #0; #0; #0; Presidential Documents #0; #0; #0;#0;Federal Register / Vol. 75, No. 125 / Wednesday...

  3. The Holding Power of Anchors

    Indian Academy of Sciences (India)

    The efficiency of an anchor may be expressed as the ratio (holding force + weight of anchor). In dry sand .... the market at the beginning of the coming season in three sizes, namely 20, 35 and. 60 lb. These are ... Taylor frozen-flow hypothesis.

  4. The Capability to Hold Property

    NARCIS (Netherlands)

    Claassen, Rutger

    2015-01-01

    This paper discusses the question of whether a capability theory of justice (such as that of Martha Nussbaum) should accept a basic “capability to hold property.” Answering this question is vital for bridging the gap between abstract capability theories of justice and their institutional

  5. Rituximab in the treatment of shrinking lung syndrome in systemic lupus erythematosus.

    Science.gov (United States)

    Peñacoba Toribio, Patricia; Córica Albani, María Emilia; Mayos Pérez, Mercedes; Rodríguez de la Serna, Arturo

    2014-01-01

    Shrinking lung syndrome (SLS) is a rare manifestation of systemic lupus erythematosus. We report the case of a patient with non-responding SLS (neither to glucocorticoids nor immunosupresors), who showed remarkable improvement after the onset of treatment with rituximab. Although there is a little evidence, treatment with rituximab could be proposed in SLS when classical treatment fails. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  6. Adapt and cope : strategies for safeguarding the quality of life in a shrinking ageing region

    OpenAIRE

    Steinführer, Annett; Küpper, Patrick; Tautz, Alexandra

    2014-01-01

    "This article examines the adaptation and coping strategies that are in place to safeguard the quality of life in a shrinking ageing region. In particular, it is investigated which resources are available to local policy-makers and the older population in order to pursue this goal. Following an introduction to the debate of regional science about demographic change and its consequences, we introduce a theoretical differentiation between adaptation and coping. Adaptation strategies refer to th...

  7. Low-shrink airfield cement concrete with respect to thermal resistance

    Directory of Open Access Journals (Sweden)

    Linek Małgorzata

    2017-01-01

    Full Text Available The paper presents theoretical background to the occurrence and propagation of imposed thermal load deep inside the structure of airfield pavement. The standard composition of low-shrink cement concrete intended for airfield pavements was presented. The influence of recurring temperature changes on the extent of shrinkage deformations was assessed. The obtained lab test results, combined with observations and analysis of changes of the hardened concrete microstructure, allowed the authors to draw conclusions. It was proven that the suggested concrete mix composition makes it possible to obtain the concrete type of better developed internal microstructure. More micro air voids and reduced distance between the voids were proven, which provides increased frost resistance of concrete. The change of size, structure and quantity of the hydration products in the cement matrix and better developed contact sections resulted in the improvement of the mechanical parameters of hardened concrete. Low-shrink concrete in all analysed cases proved to have increased resistance to the variable environmental conditions. Increased concrete resistance is identified through reduced registered shrinkage deformations and growth of mechanical parameters of concrete. Low-shrink concrete used for airfield structure guarantees extended time of reliable pavement operation.

  8. MHD flow over a permeable stretching/shrinking sheet of a nanofluid with suction/injection

    Directory of Open Access Journals (Sweden)

    Sandeep Naramgari

    2016-06-01

    Full Text Available In this study we analyzed the influence of thermal radiation and chemical reaction on two dimensional steady magnetohydrodynamic flow of a nanofluid past a permeable stretching/shrinking sheet in the presence of suction/injection. We considered nanofluid volume fraction on the boundary is submissive controlled, which makes the present study entirely different from earlier studies and physically more realistic. The equations governing the flow are solved numerically. Effects of non-dimensional governing parameters on velocity, temperature and concentration profiles are discussed and presented through graphs. Also, coefficient of skin friction and local Nusselt number is investigated for stretching/shrinking and suction/injection cases separately and presented through tables. Comparisons with existed results are presented. Present results have an excellent agreement with the existed studies under some special assumptions. Results indicate that the enhancement in Brownian motion and thermophoresis parameters depreciates the nanoparticle concentration and increases the mass transfer rate. Dual solutions exist only for certain range of stretching/shrinking and suction/injection parameters.

  9. Growing Gardens in Shrinking Cities: A Solution to the Soil Lead Problem?

    Directory of Open Access Journals (Sweden)

    Kirsten Schwarz

    2016-02-01

    Full Text Available As cities shrink, they often leave a patchwork of vacancy on the landscape. The maintenance of vacant lands and eventual transformation to sustainable land uses is a challenge all cities face, but one that is particularly pronounced in shrinking cities. Vacant lands can support sustainability initiatives, specifically the expansion of urban gardens and local food production. However, many shrinking cities are the same aging cities that have experienced the highest soil lead burdens from their industrial past as well as the historic use of lead-based paint and leaded gasoline. Elevated soil lead is often viewed as a barrier to urban agriculture and managing for multiple ecosystem services, including food production and reduced soil lead exposure, remains a challenge. In this paper, we argue that a shift in framing the soil lead and gardening issue from potential conflict to potential solution can advance both urban sustainability goals and support healthy gardening efforts. Urban gardening as a potential solution to the soil lead problem stems from investment in place and is realized through multiple activities, in particular (1 soil management, including soil testing and the addition of amendments, and (2 social network and community building that leverages resources and knowledge.

  10. Timing of Clinical Billing Reimbursement for a Local Health Department.

    Science.gov (United States)

    McCullough, J Mac

    2016-01-01

    A major responsibility of a local health department (LHD) is to assure public health service availability throughout its jurisdiction. Many LHDs face expanded service needs and declining budgets, making billing for services an increasingly important strategy for sustaining public health service provision. Yet, little practice-based data exist to guide practitioners on what to expect financially, especially regarding timing of reimbursement receipt. This study provides results from one LHD on the lag from service delivery to reimbursement receipt. Reimbursement records for all transactions at Maricopa County Department of Public Health immunization clinics from January 2013 through June 2014 were compiled and analyzed to determine the duration between service and reimbursement. Outcomes included daily and cumulative revenues received. Time to reimbursement for Medicaid and private payers was also compared. Reimbursement for immunization services was received a median of 68 days after service. Payments were sometimes taken back by payers through credit transactions that occurred a median of 333 days from service. No differences in time to reimbursement between Medicaid and private payers were found. Billing represents an important financial opportunity for LHDs to continue to sustainably assure population health. Yet, the lag from service provision to reimbursement may complicate budgeting, especially in initial years of new billing activities. Special consideration may be necessary to establish flexibility in the budget-setting processes for services with clinical billing revenues, because funds for services delivered in one budget period may not be received in the same period. LHDs may also benefit from exploring strategies used by other delivery organizations to streamline billing processes.

  11. New Drug Reimbursement and Pricing Policy in Taiwan.

    Science.gov (United States)

    Chen, Gau-Tzu; Chang, Shu-Chen; Chang, Chee-Jen

    2018-05-01

    Taiwan has implemented a national health insurance system for more than 20 years now. The benefits of pharmaceutical products and new drug reimbursement scheme are determined by the Expert Advisory Meeting and the Pharmaceutical Benefit and Reimbursement Scheme (PBRS) Joint Committee in Taiwan. To depict the pharmaceutical benefits and reimbursement scheme for new drugs and the role of health technology assessment (HTA) in drug policy in Taiwan. All data were collected from the Expert Advisory Meeting and the PBRS meeting minutes; new drug applications with HTA reports were derived from the National Health Insurance Administration Web site. Descriptive statistics were used to analyze the timeline of a new drug from application submission to reimbursement effective, the distribution of approved price, and the approval rate for a new drug with/without local pharmacoeconomic study. After the second-generation national health insurance system, the timeline for a new drug from submission to reimbursement effective averages at 436 days, and that for an oncology drug reaches an average of 742 days. New drug approval rate is 67% and the effective rate (through the approval of the PBRS Joint Committee and the acceptance of the manufacturer) is 53%. The final approved price is 53.6% of the international median price and 70% of the proposed price by the manufacturer. Out of 95 HTA reports released during the period January 2011 to February 2017, 28 applications (30%) conducted an HTA with a local pharmacoeconomic study, and all (100%) received reimbursement approval. For the remaining 67 applications (70%) for which HTA was conducted without a local pharmacoeconomic analysis, 54 cases (81%) were reimbursed. New drug applications with local pharmacoeconomic studies are more likely to get reimbursement. Copyright © 2018. Published by Elsevier Inc.

  12. Similarities and differences between five European drug reimbursement systems

    OpenAIRE

    Franken, Margreet

    2012-01-01

    3349-357 Objectives: The aim of our study is to compare five European drug reimbursement systems, describe similarities and differences, and obtain insight into their strengths and weaknesses and formulate policy recommendations. Methods: We used the analytical Hutton Framework to assess in detail drug reimbursement systems in Austria, Belgium, France, the Netherlands, and Sweden. We investigated policy documents, explored literature, and conducted fifty-seven interviews with relevant s...

  13. Shrinking Bureaucracy

    Directory of Open Access Journals (Sweden)

    George Moldoveanu

    2007-07-01

    Full Text Available Bureaucracy and human creativity may be seen as the two extremes of a dimension when analyzing the continuous activity of organizations pursuing a goal or trying to achieve their objectives. The bureaucracy occurs and develops only if the outcome of the organizational activity is beneficial to both the consumers and the suppliers, or else this “organizational technique” should be shrunk using a managerial system in order that performances match the requirements of an open and democratic society.

  14. 31 CFR 800.217 - Hold.

    Science.gov (United States)

    2010-07-01

    ... and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF INVESTMENT... FOREIGN PERSONS Definitions § 800.217 Hold. The terms hold(s) and holding mean legal or beneficial ownership, whether direct or indirect, whether through fiduciaries, agents, or other means. ...

  15. SPECIALIZATION AND SUSTAINABLE DEVELOPMENT OF AGRICULTURAL HOLDINGS

    Directory of Open Access Journals (Sweden)

    Zofia Kołoszko-Chomentowska

    2016-03-01

    Full Text Available In the present article, an attempt was made to assess the sustainability of agricultural holdings with diff erent directions of production. Agricultural holdings in the Podlaskie voivodeship registered in the FADN system in 2011–2012 were investigated. Assessment accounted for agroecological indicators (share of permanent grasslands, share of cereals in crops, soil coverage with vegetation, stock density and economic indicators (profi tableness of land and labor. Analysis was conducted according to a classifi cation into agricultural holding types: fi eldcrops, dairy cattle, and granivores. Fieldcrop and granivore holdings achieved more favourable environmental sustainability indicators. Holdings specializing in dairy cattle breeding posed a threat to the natural environment, mainly due to their excessive stock density. Economic sustainability assessment showed that granivore holdings were assessed most favorably. In these holdings, holding income per full-time worker was 37% greater than in fi eldcrop holdings and 57% greater than in dairy cattle holdings.

  16. Expanding the applicable duration for shrink fitting of the ultrathin-walled reactor coolant pump rotor-can

    International Nuclear Information System (INIS)

    Li, Ruiqin; Zhang, Chi; Zhang, Liwen; Cui, Yan; Shen, Wenfei

    2017-01-01

    Highlights: •A thermal-mechanical coupled finite element model was developed to simulate the whole process. •Heat capacity added layer was used to extend the limited time for the process. •Shrink-fitted experiments were performed to verify the simulation results. -- Abstract: The rotor-can of reactor coolant pump (RCP) is generally assembled on the rotor using shrink fitting technique. The rotor-can is characterized by large height and ultrathin-walled cylinder, thus, its rigidity is weak and heat capacity is quite limited. The shrink fitting process has to be completed within a short limited-time, which makes it difficult for rotor to insert in the rotor-can completely. In order to solve this problem, a new method was proposed to extend the limited time by using a heat capacity added layer (HCAL) during the shrink fitting process. A thermal-mechanical coupled finite element (FE) model was developed to simulate the whole process. The transient heat exchange with a narrow gap between rotor and rotor-can during the shrink fitting process was taken into consideration. The limited time was predicted by calculating and analyzing the evolutions of temperature field and radial displacement field of the rotor-can. The simulation results indicate that the limited time of the shrink fitting process can be significantly extended with the increase of HCAL in thickness. Then, shrink fitting experiments were performed to confirm the extending effect of the HCAL. The experimental results of limited time show good agreement with the predicted values. The current results will certainly help the designer to improve the shrink fitting technique.

  17. Total 'shrink' losses, and where they occur, in commercially sized silage piles constructed from immature and mature cereal crops.

    Science.gov (United States)

    Robinson, P H; Swanepoel, N; Heguy, J M; Price, P; Meyer, D M

    2016-07-15

    Silage 'shrink' (i.e., fresh chop crop lost between ensiling and feedout) represents losses of potential animal nutrients which degrade air quality as volatile carbon compounds. Regulatory efforts have, in some cases, resulted in semi-mandatory mitigations (i.e., dairy farmers select a minimum number of mitigations from a list) to reduce silage shrink, mitigations often based on limited data of questionable relevance to large commercial silage piles where silage shrink may or may not be a problem of a magnitude equal to that assumed. Silage 'shrink' is generally ill defined, but can be expressed as losses of wet weight (WW), oven dry matter (oDM), and oDM corrected for volatiles lost during oven drying (vcoDM). As no research has documented shrink in large cereal silage piles, 6 piles ranging from 1456 to 6297tonnes (as built) were used. Three used cereal cut at an immature stage and three at a mature stage. Physiologically immature silages had generally higher (Plosses (vcoDM) of large well managed cereal silage piles were relatively low, and a lower potential contributor to aerosol emissions of volatile carbon compounds than has often been assumed. Losses from the silage mass and the exposed silage face were approximately equal contributors to vcoDM shrink. Mitigations to reduce these relatively low emission levels of volatile organic compounds from cereal silage piles should focus on the ensiled mass and the exposed silage face. Copyright © 2016 Elsevier B.V. All rights reserved.

  18. Reimbursement for school nursing health care services: position statement.

    Science.gov (United States)

    Lowe, Janet; Cagginello, Joan; Compton, Linda

    2014-09-01

    Children come to school with a variety of health conditions, varying from moderate health issues to multiple, severe chronic health illnesses that have a profound and direct impact on their ability to learn. The registered professional school nurse (hereinafter referred to as school nurse) provides medically necessary services in the school setting to improve health outcomes and promote academic achievement. The nursing services provided are reimbursable services in other health care settings, such as hospitals, clinics, and home care settings. The National Association of School Nurses (NASN) believes that school nursing services that are reimbursable nursing services in other health care systems should also be reimbursable services in the school setting, while maintaining the same high quality care delivery standards. Traditionally, local and state tax revenues targeted to fund education programs have paid for school nursing health services. School nurses are in a strategic position to advocate for improving clinical processes to better fit with community health care providers and to align reimbursements with proposed changes. Restructuring reimbursement programs will enable health care funding streams to assist in paying for school nursing services delivered to students in the school setting. Developing new innovative health financing opportunities will help to increase access, improve quality, and reduce costs. The goal is to promote a comprehensive and cost-effective health care delivery model that integrates schools, families, providers, and communities.

  19. A new delay line loops shrinking time-to-digital converter in low-cost FPGA

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Jie, E-mail: zhangjie071063@163.com [State Key Laboratory of Geodesy and Earth’s Dynamics, Institute of Geodesy and Geophysics, CAS, Wuhan, China, 430077 (China); University of Chinese Academy of Sciences, Beijing, China, 100049 (China); Zhou, Dongming [State Key Laboratory of Geodesy and Earth’s Dynamics, Institute of Geodesy and Geophysics, CAS, Wuhan, China, 430077 (China)

    2015-01-21

    The article provides the design and test results of a new time-to-digital converter (TDC) based on delay line loops shrinking method and implemented in a low-cost field programmable gate array (FPGA) device. A technique that achieves high resolution with low cost and flexibility is presented. The technique is based on two delay line loops which are used to directly shrink the measured time interval in the designed TDC, and the resolution is dependent on the difference between the entire delay times of the two delay line loops. In order to realize high resolution and eliminate temperature influence, the two delay line loops consist of the same delay cells with the same number. A delay-locked loop (DLL) is used to stabilize the resolution against process variations and ambient conditions. Meanwhile, one method is used to accurately evaluate the resolution of the implemented TDC. The converter has been implemented in a general-propose FPGA device (Actel SmartFusion A2F200M3). A single shot resolution of the implemented converter is 63.3 ps and the measurement standard deviation is about 61.7 ps within the measurement range of 5 ns. - Highlights: • We provide a new FPGA-integrated time-to-digital converter based on delay line loops method which used two delay line loops to directly shrink time intervals with only rising edges. • The two delay line loops consist of the same delay cells with the same number and symmetrical structure. • The resolution is dependent on the difference between the entire delays of the two delay line loops. • We use delay-locked loop to stabilize the resolution against temperature and supply voltage.

  20. High-resolution direct 3D printed PLGA scaffolds: print and shrink

    International Nuclear Information System (INIS)

    Chia, Helena N; Wu, Benjamin M

    2015-01-01

    Direct three-dimensional printing (3DP) produces the final part composed of the powder and binder used in fabrication. An advantage of direct 3DP is control over both the microarchitecture and macroarchitecture. Prints which use porogen incorporated in the powder result in high pore interconnectivity, uniform porosity, and defined pore size after leaching. The main limitations of direct 3DP for synthetic polymers are the use of organic solvents which can dissolve polymers used in most printheads and limited resolution due to unavoidable spreading of the binder droplet after contact with the powder. This study describes a materials processing strategy to eliminate the use of organic solvent during the printing process and to improve 3DP resolution by shrinking with a non-solvent plasticizer. Briefly, poly(lactic-co-glycolic acid) (PLGA) powder was prepared by emulsion solvent evaporation to form polymer microparticles. The printing powder was composed of polymer microparticles dry mixed with sucrose particles. After printing with a water-based liquid binder, the polymer microparticles were fused together to form a network by solvent vapor in an enclosed vessel. The sucrose is removed by leaching and the resulting scaffold is placed in a solution of methanol. The methanol acts as a non-solvent plasticizer and allows for polymer chain rearrangement and efficient packing of polymer chains. The resulting volumetric shrinkage is ∼80% at 90% methanol. A complex shape (honey-comb) was designed, printed, and shrunken to demonstrate isotropic shrinking with the ability to reach a final resolution of ∼400 μm. The effect of type of alcohol (i.e. methanol or ethanol), concentration of alcohol, and temperature on volumetric shrinking was studied. This study presents a novel materials processing strategy to overcome the main limitations of direct 3DP to produce high resolution PLGA scaffolds. (paper)

  1. High-resolution direct 3D printed PLGA scaffolds: print and shrink.

    Science.gov (United States)

    Chia, Helena N; Wu, Benjamin M

    2014-12-17

    Direct three-dimensional printing (3DP) produces the final part composed of the powder and binder used in fabrication. An advantage of direct 3DP is control over both the microarchitecture and macroarchitecture. Prints which use porogen incorporated in the powder result in high pore interconnectivity, uniform porosity, and defined pore size after leaching. The main limitations of direct 3DP for synthetic polymers are the use of organic solvents which can dissolve polymers used in most printheads and limited resolution due to unavoidable spreading of the binder droplet after contact with the powder. This study describes a materials processing strategy to eliminate the use of organic solvent during the printing process and to improve 3DP resolution by shrinking with a non-solvent plasticizer. Briefly, poly(lactic-co-glycolic acid) (PLGA) powder was prepared by emulsion solvent evaporation to form polymer microparticles. The printing powder was composed of polymer microparticles dry mixed with sucrose particles. After printing with a water-based liquid binder, the polymer microparticles were fused together to form a network by solvent vapor in an enclosed vessel. The sucrose is removed by leaching and the resulting scaffold is placed in a solution of methanol. The methanol acts as a non-solvent plasticizer and allows for polymer chain rearrangement and efficient packing of polymer chains. The resulting volumetric shrinkage is ∼80% at 90% methanol. A complex shape (honey-comb) was designed, printed, and shrunken to demonstrate isotropic shrinking with the ability to reach a final resolution of ∼400 μm. The effect of type of alcohol (i.e. methanol or ethanol), concentration of alcohol, and temperature on volumetric shrinking was studied. This study presents a novel materials processing strategy to overcome the main limitations of direct 3DP to produce high resolution PLGA scaffolds.

  2. A new delay line loops shrinking time-to-digital converter in low-cost FPGA

    International Nuclear Information System (INIS)

    Zhang, Jie; Zhou, Dongming

    2015-01-01

    The article provides the design and test results of a new time-to-digital converter (TDC) based on delay line loops shrinking method and implemented in a low-cost field programmable gate array (FPGA) device. A technique that achieves high resolution with low cost and flexibility is presented. The technique is based on two delay line loops which are used to directly shrink the measured time interval in the designed TDC, and the resolution is dependent on the difference between the entire delay times of the two delay line loops. In order to realize high resolution and eliminate temperature influence, the two delay line loops consist of the same delay cells with the same number. A delay-locked loop (DLL) is used to stabilize the resolution against process variations and ambient conditions. Meanwhile, one method is used to accurately evaluate the resolution of the implemented TDC. The converter has been implemented in a general-propose FPGA device (Actel SmartFusion A2F200M3). A single shot resolution of the implemented converter is 63.3 ps and the measurement standard deviation is about 61.7 ps within the measurement range of 5 ns. - Highlights: • We provide a new FPGA-integrated time-to-digital converter based on delay line loops method which used two delay line loops to directly shrink time intervals with only rising edges. • The two delay line loops consist of the same delay cells with the same number and symmetrical structure. • The resolution is dependent on the difference between the entire delays of the two delay line loops. • We use delay-locked loop to stabilize the resolution against temperature and supply voltage

  3. Do More Economists Hold Stocks?

    DEFF Research Database (Denmark)

    Christiansen, Charlotte; Joensen, Juanna Schröter; Rangvid, Jesper

    A unique data set enables us to test the hypothesis that more economists than otherwise identical investors hold stocks due to informational advantages. We confirm that economists have a significantly higher probability of participating in the stock market than investors with any other education......, even when controlling for several background characteristics. We make use of a large register-based panel data set containing detailed information on the educational attainments and various financial and socioeconomic variables. We model the stock market participation decision by the probit model...

  4. Shrinking Middle Class and Changing Income Distribution of Korea: 1995-2005

    OpenAIRE

    Joon-Woo Nahm

    2008-01-01

    This paper investigates the shrinking middle class hypothesis and reveals more details about recent trends in income distribution of Korea from 1995 to 2005. We find that the consensus view of a declining middle class is correct and the decline in the middle class splited equally into the lower class and the upper class in Korea. Furthermore, while the size and income share of the middle class declined, the share of the upper class increased rapidly and the share of the lower class remained s...

  5. Application of high-strength non-shrink cement based grouting material in nuclear power installations

    International Nuclear Information System (INIS)

    Li Zhong; Zuo Weiwei

    2011-01-01

    This paper briefly describes the related technical requirement of secondary grouting during the process of equipment installation in nuclear power projects. The method and procedure are introduced in detail from the aspects of acceptance, preparation, pouring, collecting and maintenance of the high-strength non-shrinking based pouring cement material, and the cautions during the construction is also provided. The factors affecting the quality of the field grouting is analyzed, and the measures to reduce or eliminate the micro-cracks during the process is provided. (authors)

  6. Allowance Holdings and Transfers Data Inventory

    Data.gov (United States)

    U.S. Environmental Protection Agency — The Allowance Holdings and Transfers Data Inventory contains measured data on holdings and transactions of allowances under the NOx Budget Trading Program (NBP), a...

  7. Reimbursement of VAT on written-off Receivables

    DEFF Research Database (Denmark)

    Florentsen, Bjarne; Møller, Michael; Nielsen, Niels Chr.

    2003-01-01

    In many OECD countries, a seller has a right to reimbursement of VAT (RVAT) she has paid on goods sold, but for which she has not yet received payment. Such reimbursement of VAT on receivables is economically inefficient. It leads to:@* Distortion of credit markets, by subsidizing direct credit...... at the cost of financial intermediaries.@* Price discrimination, by subsidizing buyers with low creditworthiness.@* A less efficient collection of bad debts, as trade with bad debts is made extremely expensive.The finance literature presents several `good' arguments in favor of trade credits, e.g. transaction...

  8. Trends in Medicaid Reimbursements for Insulin From 1991 Through 2014.

    Science.gov (United States)

    Luo, Jing; Avorn, Jerry; Kesselheim, Aaron S

    2015-10-01

    Insulin is a vital medicine for patients with diabetes mellitus. Newer, more expensive insulin products and the lack of generic insulins in the United States have increased costs for patients and insurers. To examine Medicaid payment trends for insulin products. Cost information is available for all 50 states and has been recorded since the 1990s. A time-series analysis comparing reimbursements and prices. Using state- and national-level Medicaid data from 1991 to 2014, we identified all patients who used 1 or more of the 16 insulin products that were continuously available in the United States between 2006 and 2014. Insulin products were classified into rapid-acting and long-acting analogs, short-acting, intermediate, and premixed insulins based on American Diabetes Association Guidelines. Inflation-adjusted payments made to pharmacies by Medicaid per 1 mL (100 IU) of insulin in 2014 US dollars. Since 1991, Medicaid reimbursement per unit (1 mL) of insulin dispensed has risen steadily. In the 1990s, Medicaid reimbursed pharmacies between $2.36 and $4.43 per unit. By 2014, reimbursement for short-acting insulins increased to $9.64 per unit; intermediate, $9.22; premixed, $14.79; and long-acting, $19.78. Medicaid reimbursement for rapid-acting insulin analogs rose to $19.81 per unit. The rate of increase in reimbursement was higher for insulins with patent protection ($0.20 per quarter) than without ($0.05 per quarter) (Preimbursements peaked at $407.4 million dollars in quarter 2 of 2014. Total volume peaked at 29.9 million units in quarter 4 of 2005 and was 21.2 million units in quarter 2 of 2014. Between 1991 and 2014, there was a near-exponential upward trend in Medicaid payments on a per-unit basis for a wide variety of insulin products regardless of formulation, duration of action, and whether the product was patented. Although reimbursements for newer, patent-protected insulin analogs increased at a faster rate than reimbursements for older insulins, payments

  9. An evaluation of current approaches to nursing home capital reimbursement.

    Science.gov (United States)

    Cohen, J; Holahan, J

    1986-01-01

    One of the more controversial issues in reimbursement policy is how to set the capital cost component of facilities rates. In this article we examine in detail the various approaches used by states to reimburse nursing homes for capital costs. We conclude that newer approaches that recognize the increasing value of nursing home assets over time, commonly called fair rental systems, are preferable to the methodologies that have been used historically in both the Medicare and the Medicaid programs to set capital rates. When properly designed, fair rental systems should provide more rational incentives and less encouragement of property manipulation than do more traditional systems, with little or no increase in state costs.

  10. A novel multi-responsive polyampholyte composite hydrogel with excellent mechanical strength and rapid shrinking rate.

    Science.gov (United States)

    Xu, Kun; Tan, Ying; Chen, Qiang; An, Huiyong; Li, Wenbo; Dong, Lisong; Wang, Pixin

    2010-05-15

    Series of hydrophilic core-shell microgels with cross-linked poly(N-isopropylacrylamide) (PNIPAAm) as core and poly(vinyl amine) (PVAm) as shell are synthesized via surfactant-free emulsion polymerization. Then, the microgels are treated with a small amount of potassium persulfate (KPS) to generate free radicals on the amine nitrogens of PVAm, which subsequently initiate the graft copolymerization of acrylic acid (AA), acryloyloxyethyl trimethyl ammonium chloride (DAC), and acrylamide (AAm) onto microgels to prepare multi-responsive composite hydrogels. The composite hydrogels consist of cross-linked ungrafted polyampholyte chains as the first network and microgels with grafted polyampholyte chains as graft point and second network and show surprising mechanical strength and rapid response rate. The investigation shows the compress strength of composite hydrogels is up to 17-30 MPa, which is 60-100 times higher than that of the hydrogel matrix. The composite hydrogel shows reversible switch of transmittance when traveling the lowest critical temperature (LCST) of microgels. When the composite hydrogel swollen in pH 2.86 solution at ambient condition is immersed into the pH 7.00 solution at 45 °C, a rapid dynamic shrinking can be observed. And the character time (τ) of shrinking dynamic of composite hydrogel is 251.9 min, which is less than that of hydrogel matrix (τ=2273.7 min). Copyright © 2010 Elsevier Inc. All rights reserved.

  11. The melt/shrink effect of low density thermoplastics insulates: Cone calorimeter tests

    Directory of Open Access Journals (Sweden)

    Xu Qiang

    2017-01-01

    Full Text Available The melt/shrink effects on the fire behavior of low density thermoplastic foam have been studied in a cone calorimeter. The experiments have been performed with four samples of expanded polystyrene foams having different thicknesses and two extruded polystyrene foams. Decrease in surface area and increase in density, characterizing the melt/shrink effect have been measured at different incident heat fluxes. Three of these foams tested have been also examined by burning tests at an incident heat flux of 50 kW/m2. It was assessed that the fire behavior predictions based the current literature models provided incorrect results if the cone test results were applied directly. However, the correct models provided adequate results when the initial burning area and the density of the molten foam were used to correct the initial cone calorimeter data. This communication refers to the fact that both the effective burning area and the density of the molten foam affect the cone calorimeter data, which requires consequent corrections to attain adequate predictions of models about the materials fire behavior.

  12. Shrinking of bumps by drawing scintillating fibres through a hot conical tool

    CERN Document Server

    Rodrigues Cavalcante, Ana Barbara; Gavardi, Laura; Joram, Christian; Kristic, Robert; Pierschel, Gerhard; Schneider, Thomas

    2016-01-01

    The LHCb SciFi tracker will be based on scintillating fibres with a nominal diameter of 250 $\\mu$m. A small length fraction of these fibres shows millimetre-scale fluctuations of the diameter, also known as bumps and necks. In particular, bumps exceeding a diameter of about 350 $\\mu$m are problematic as they can distort the winding pattern of the fibre mats over more extended regions. We present a method to reduce the diameter of large bumps to a diameter of 350 $\\mu$m by locally heating and pulling the fibre through a conical tool. The method has been proven to work for bumps up to 450 – 500 $\\mu$m diameter. Larger bumps need to be treated manually by a cut-and-glue technique which relies on UV-curing instant glue. The bump shrinking and cut-and-glue processes were integrated in a fibre diameter scanner at CERN. The central scanning and bump shrinking of all fibres is expected to minimise bump related issues at the four mat winding centres of the SciFi project.

  13. Particulate Matter Sources and Composition near a Shrinking Saline Lake (Salton Sea)

    Science.gov (United States)

    Frie, A. L.; Dingle, J. H.; Garrison, A.; Ying, S.; Bahreini, R.

    2017-12-01

    Dried lake beds (playas) are large dust sources in arid regions, and with increased global water demand many large lakes are shrinking. The Salton Sea is an example of one such lake in the early stages of desiccation, with about 15,000 acres of exposed playa. To quantify the impacts of the shrinking lake on airborne particulate matter(PM) composition, PM samples were collected in August of 2015 and February of 2016 near the Salton Sea, CA. These samples were analyzed for total elemental concentration of 15 elements. For these elements, enrichment factors relative to aluminum were calculated and PMF modeling was applied to deconvolve source factors. From these data, desert-like and playa-like sources were estimated to accounted for 45% and 9% of PM10 mass during these sampling periods. PMF results also revealed that playa sources account for 70% of PM10 Na, evidencing playa-driven PM compositional changes. Additionally, PM Se displayed strong seasonal variation, which is thought to be driven by Se volatilization within Salton Sea sediments, playas, or waters.

  14. Ultrasonic methods for locating hold-up

    International Nuclear Information System (INIS)

    Sinha, D.N.; Olinger, C.T.

    1995-01-01

    Hold-up remains one of the major contributing factors to unaccounted for materials and can be a costly problem in decontamination and decommissioning activities. Ultrasonic techniques are being developed to noninvasively monitor hold-up in process equipment where the inner surface of such equipment may be in contact with the hold-up material. These techniques may be useful in improving hold-up measurements as well as optimizing decontamination techniques

  15. The Magnetohydrodynamic Boundary Layer Flow of a Nanofluid past a Stretching/Shrinking Sheet with Slip Boundary Conditions

    Directory of Open Access Journals (Sweden)

    Syahira Mansur

    2014-01-01

    Full Text Available The magnetohydrodynamic (MHD boundary layer flow of a nanofluid past a stretching/shrinking sheet with velocity, thermal, and solutal slip boundary conditions is studied. Numerical solutions to the governing equations were obtained using a shooting method. The skin friction coefficient and the local Sherwood number increase as the stretching/shrinking parameter increases. However, the local Nusselt number decreases with increasing the stretching/shrinking parameter. The range of the stretching/shrinking parameter for which the solution exists increases as the velocity slip parameter and the magnetic parameter increase. For the shrinking sheet, the skin friction coefficient increases as the velocity slip parameter and the magnetic parameter increase. For the stretching sheet, it decreases when the velocity slip parameter and the magnetic parameter increase. The local Nusselt number diminishes as the thermal slip parameter increases while the local Sherwood number decreases with increasing the solutal slip parameter. The local Nusselt number is lower for higher values of Lewis number, Brownian motion parameter, and thermophoresis parameter.

  16. A Paradox of Town Spatial Development: The Growing Real Estate and Shrinking Town - a Case Study of Hsinchu County, Taiwan

    Science.gov (United States)

    Hung, Chi-Tung; Chuang, Mo-Hsiung; Lin, Wen-Yen

    2017-04-01

    The key factors of many discussions on shrinking towns are focusing at decreasing population and declining industries. Our study, using Hsinchu County as an example, has found that part of the county (Guanxi township) is following a typical and traditional town development pattern, while somewhere else of this county (Zhubei township) shows rapid growth in real estate but with a high vacancy rate. Even though the distance between Guanxi and Zhubei is less than 20 kilometers, the spatial development phenomenon of the two townships are both "shrinking" in the same county but very different in their developing paths. This study used GIS to overlay the maps from field survey and archive data, such as real estate prices of different years, environmental hazards and disaster records, local area power consumptions, and vulnerable population data, to clarify the causes and systems behind the shrinking phenomena of the two townships and to construct a theory of "shrinking town" in Taiwan. The contribution of this study is the findings of the tangling relations of the vulnerability from land-enclosure policy, the system design of local industrial development and urban planning, and structural factors of environmental hazards. Note: This study is part of the results from the Ministry of Science and Technology funding project (MOST 105-2621-M-120-002) KEYWORDS: shrinking town, environmental hazards, urban planning, spatial disasters, real estate development

  17. Hot embossing holographic images in BOPP shrink films through large-area roll-to-roll nanoimprint lithography

    Energy Technology Data Exchange (ETDEWEB)

    Jiang, Menglin; Lin, Shiwei, E-mail: linsw@hainu.edu.cn; Jiang, Wenkai; Pan, Nengqian

    2014-08-30

    Highlights: • High-quality holographic images were replicated in large-area shrink film. • Surface morphology evolution was analyzed in films embossed at different temperatures. • Optical, mechanical, and thermal characteristics were systematically analyzed. - Abstract: Diffraction grating-based holographic images have been successfully replicated in biaxially oriented polypropylene (BOPP) shrink films through large-area roll-to-roll nanoimprint technique. Such hot embossing of holographic images on BOPP films represents a promising means of creating novel security features in packaging applications. The major limitation of the high-quality replication is the relatively large thermal shrinkage of BOPP shrink film. However, although an appropriate shrinkage is demanded after embossing, over-shrinking not only causes distortion in embossed images, but also reduces the various properties of BOPP shrink films mainly due to the disappearance of orientation. The effects of embossing temperature on the mechanical, thermal and optical properties as well as polymer surface morphologies were systematically analyzed. The results show that the optimal process parameters are listed as follows: the embossing temperature at 104–110 °C, embossing force 6 kg/cm{sup 2} and film speed 32 m/min. The variation in flow behavior of polymer surface during hot embossing process is highly dependent on the temperature. In addition, the adhesion from the direct contact between the rubber press roller and polymer surfaces is suggested to cause the serious optical properties failure.

  18. 78 FR 53507 - Agency Information Collection (Beneficiary Travel Mileage Reimbursement Application Form...

    Science.gov (United States)

    2013-08-29

    ... DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900-NEW] Agency Information Collection (Beneficiary Travel Mileage Reimbursement Application Form) Activity Under OMB Review AGENCY: Veterans Health... Control No. 2900- NEW (Beneficiary Travel Mileage Reimbursement Application Form)'' in any correspondence...

  19. 48 CFR 428.307 - Insurance under cost-reimbursement contracts.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Insurance under cost-reimbursement contracts. 428.307 Section 428.307 Federal Acquisition Regulations System DEPARTMENT OF...-reimbursement contracts. ...

  20. 48 CFR 1028.307 - Insurance under cost-reimbursement contracts.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Insurance under cost-reimbursement contracts. 1028.307 Section 1028.307 Federal Acquisition Regulations System DEPARTMENT OF THE...-reimbursement contracts. ...

  1. 47 CFR 54.413 - Reimbursement for revenue forgone in offering a Link Up program.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 3 2010-10-01 2010-10-01 false Reimbursement for revenue forgone in offering a... § 54.413 Reimbursement for revenue forgone in offering a Link Up program. (a) Eligible telecommunications carriers may receive universal service support reimbursement for the revenue they forgo in...

  2. 48 CFR 52.246-5 - Inspection of Services-Cost-Reimbursement.

    Science.gov (United States)

    2010-10-01

    ...-Cost-Reimbursement. 52.246-5 Section 52.246-5 Federal Acquisition Regulations System FEDERAL... Provisions and Clauses 52.246-5 Inspection of Services—Cost-Reimbursement. As prescribed in 46.305, insert... furnishing of services, when a cost-reimbursement contract is contemplated: Inspection of Services—Cost...

  3. 75 FR 71677 - Reimbursement for Costs of Remedial Action at Active Uranium and Thorium Processing Sites

    Science.gov (United States)

    2010-11-24

    ... DEPARTMENT OF ENERGY Reimbursement for Costs of Remedial Action at Active Uranium and Thorium... in FY 2011 from eligible active uranium and thorium processing site licensees for reimbursement under... approximately $24.3 million of Recovery Act funds available for reimbursement in FY 2011, as well as the $10...

  4. 42 CFR 405.515 - Reimbursement for clinical laboratory services billed by physicians.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Reimbursement for clinical laboratory services... Criteria for Determining Reasonable Charges § 405.515 Reimbursement for clinical laboratory services billed... limitation on reimbursement for markups on clinical laboratory services billed by physicians. If a physician...

  5. Sustainable policy: Higher medication use & adherence during reimbursement of pharmacologic smoking cessation treatments

    NARCIS (Netherlands)

    Van Boven, J.F.; Vemer, P.

    2014-01-01

    Background: The discussion on the reimbursement of Smoking Cessation Treatment (SCT) has known many stages in The Netherlands. From January 2011, SCTs were reimbursed, until January 2012 when the reimbursement of nicotine replacement therapies (NRTs) and pharmacotherapeutic SCT (pSCT) was

  6. 42 CFR 405.1803 - Intermediary determination and notice of amount of program reimbursement.

    Science.gov (United States)

    2010-10-01

    ... program reimbursement. 405.1803 Section 405.1803 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... Provider Reimbursement Determinations and Appeals § 405.1803 Intermediary determination and notice of amount of program reimbursement. (a) General requirement. Upon receipt of a provider's cost report, or...

  7. 48 CFR 52.229-8 - Taxes-Foreign Cost-Reimbursement Contracts.

    Science.gov (United States)

    2010-10-01

    ...-Reimbursement Contracts. 52.229-8 Section 52.229-8 Federal Acquisition Regulations System FEDERAL ACQUISITION... Clauses 52.229-8 Taxes—Foreign Cost-Reimbursement Contracts. As prescribed in 29.402-2(a), insert the following clause: Taxes—Foreign Cost-Reimbursement Contracts (MAR 1990) (a) Any tax or duty from which the...

  8. 75 FR 34336 - Reimbursement Transportation Cost Payment Program for Geographically Disadvantaged Farmers and...

    Science.gov (United States)

    2010-06-17

    ... DEPARTMENT OF AGRICULTURE Farm Service Agency 7 CFR Part 755 RIN 0560-AI08 Reimbursement... Reimbursement Transportation Cost Payment (RTCP) Program for geographically disadvantaged farmers and ranchers.... To be eligible for reimbursement, the transportation costs must have been incurred in the FY for...

  9. 48 CFR 2452.232-71 - Voucher submission (cost-reimbursement).

    Science.gov (United States)

    2010-10-01

    ...-reimbursement). 2452.232-71 Section 2452.232-71 Federal Acquisition Regulations System DEPARTMENT OF HOUSING AND... Clauses 2452.232-71 Voucher submission (cost-reimbursement). As prescribed in 2432.908(c)(2), insert a clause substantially the same as the following in all cost-reimbursement solicitations and contracts...

  10. 48 CFR 452.232-70 - Reimbursement for Bond Premiums-Fixed-Price Construction Contracts.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Reimbursement for Bond... Provisions and Clauses 452.232-70 Reimbursement for Bond Premiums—Fixed-Price Construction Contracts. As prescribed in 432.111, insert the following clause: Reimbursement for Bond Premiums—Fixed-Price Construction...

  11. 45 CFR 149.610 - Secretary's authority to reopen and revise a reimbursement determination.

    Science.gov (United States)

    2010-10-01

    ... reimbursement determination. 149.610 Section 149.610 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES... of Data Inaccuracies § 149.610 Secretary's authority to reopen and revise a reimbursement determination. (a) The Secretary may reopen and revise a reimbursement determination upon the Secretary's own...

  12. 48 CFR 652.232-71 - Voucher Submission (Cost-Reimbursement).

    Science.gov (United States)

    2010-10-01

    ...-Reimbursement). 652.232-71 Section 652.232-71 Federal Acquisition Regulations System DEPARTMENT OF STATE CLAUSES... Voucher Submission (Cost-Reimbursement). As prescribed in 632.908(b), the contracting officer may insert a clause substantially the same as follows: Voucher Submission (Cost-Reimbursement) (AUG 1999) (a) General...

  13. 48 CFR 52.246-3 - Inspection of Supplies-Cost-Reimbursement.

    Science.gov (United States)

    2010-10-01

    ...-Cost-Reimbursement. 52.246-3 Section 52.246-3 Federal Acquisition Regulations System FEDERAL... Provisions and Clauses 52.246-3 Inspection of Supplies—Cost-Reimbursement. As prescribed in 46.303, insert... furnishing of supplies, when a cost-reimbursement contract is contemplated: Inspection of Supplies—Cost...

  14. 48 CFR 1352.228-71 - Deductibles under required insurance coverage-cost reimbursement.

    Science.gov (United States)

    2010-10-01

    ... insurance coverage-cost reimbursement. 1352.228-71 Section 1352.228-71 Federal Acquisition Regulations... Provisions and Clauses 1352.228-71 Deductibles under required insurance coverage—cost reimbursement. As... Coverage—Cost Reimbursement (APR 2010) (a) The contractor is required to present evidence of the amount of...

  15. 48 CFR 52.246-8 - Inspection of Research and Development-Cost-Reimbursement.

    Science.gov (United States)

    2010-10-01

    ... Development-Cost-Reimbursement. 52.246-8 Section 52.246-8 Federal Acquisition Regulations System FEDERAL... Provisions and Clauses 52.246-8 Inspection of Research and Development—Cost-Reimbursement. As prescribed in... (b) a cost-reimbursement contract is contemplated; unless use of the clause is impractical and the...

  16. 48 CFR 252.228-7000 - Reimbursement for war-hazard losses.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Reimbursement for war... CLAUSES Text of Provisions And Clauses 252.228-7000 Reimbursement for war-hazard losses. As prescribed in 228.370(a), use the following clause: Reimbursement for War-Hazard Losses (DEC 1991) (a) Costs for...

  17. 48 CFR 52.229-9 - Taxes-Cost-Reimbursement Contracts With Foreign Governments.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 2 2010-10-01 2010-10-01 false Taxes-Cost-Reimbursement... Provisions and Clauses 52.229-9 Taxes—Cost-Reimbursement Contracts With Foreign Governments. As prescribed in 29.402-2(b), insert the following clause: Taxes—Cost-Reimbursement Contracts With Foreign Governments...

  18. 48 CFR 219.7104 - Developmental assistance costs eligible for reimbursement or credit.

    Science.gov (United States)

    2010-10-01

    ... costs eligible for reimbursement or credit. 219.7104 Section 219.7104 Federal Acquisition Regulations... reimbursement or credit. (a) Developmental assistance provided under an approved mentor-protege agreement is... eligible for reimbursement are set forth in appendix I. (b) Before incurring any costs under the Program...

  19. 48 CFR 1552.211-73 - Level of effort-cost-reimbursement term contract.

    Science.gov (United States)

    2010-10-01

    ...-reimbursement term contract. 1552.211-73 Section 1552.211-73 Federal Acquisition Regulations System... Provisions and Clauses 1552.211-73 Level of effort—cost-reimbursement term contract. As prescribed in 1511.011-73, insert the following contract clause in cost-reimbursement term contracts including cost...

  20. 48 CFR 252.235-7001 - Indemnification under 10 U.S.C. 2354-cost reimbursement.

    Science.gov (United States)

    2010-10-01

    ....S.C. 2354-cost reimbursement. 252.235-7001 Section 252.235-7001 Federal Acquisition Regulations.... 2354—cost reimbursement. As prescribed in 235.070-3, use the following clause: Indemnification Under 10 U.S.C. 2354—Cost Reimbursement (DEC 1991) (a) This clause provides for indemnification under 10 U.S...

  1. 48 CFR 5152.245-9001 - Government property for installation support services (cost-reimbursement contracts).

    Science.gov (United States)

    2010-10-01

    ... installation support services (cost-reimbursement contracts). 5152.245-9001 Section 5152.245-9001 Federal... CONTRACT CLAUSES 5152.245-9001 Government property for installation support services (cost-reimbursement... Installation Support Services (Cost-Reimbursement Contracts) (OCT 1989) (DEV) (a) Government-furnished property...

  2. 44 CFR 208.37 - Reimbursement for equipment and supply costs incurred during Activation.

    Science.gov (United States)

    2010-10-01

    ... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Reimbursement for equipment... SEARCH AND RESCUE RESPONSE SYSTEM Response Cooperative Agreements § 208.37 Reimbursement for equipment and supply costs incurred during Activation. (a) Allowable costs. DHS will reimburse costs incurred...

  3. 76 FR 14543 - Federal Acquisition Regulation; Proper Use and Management of Cost-Reimbursement Contracts

    Science.gov (United States)

    2011-03-16

    ..., Sequence 1] RIN 9000-AL78 Federal Acquisition Regulation; Proper Use and Management of Cost-Reimbursement... other than firm-fixed-price contracts (e.g., cost-reimbursement, time-and-material, and labor-hour...-reimbursement contracts and identifies the following three areas that the Defense Acquisition Regulation Council...

  4. 48 CFR 831.7001-7 - Reimbursement for other supplies and services.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Reimbursement for other... Principles and Procedures 831.7001-7 Reimbursement for other supplies and services. VA will provide reimbursement for other services and assistance that may be authorized under provisions of applicable Chapter 31...

  5. 47 CFR 64.1170 - Reimbursement procedures where the subscriber has paid charges.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 3 2010-10-01 2010-10-01 false Reimbursement procedures where the subscriber... Preferred Telecommunications Service Providers § 64.1170 Reimbursement procedures where the subscriber has... reimburse the authorized carrier for reasonable expenses. (e) If the authorized carrier has not received...

  6. 48 CFR 49.603-5 - Cost-reimbursement contracts-partial termination.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Cost-reimbursement....603-5 Cost-reimbursement contracts—partial termination. [Insert the following in Block 14 of SF 30, Amendment of Solicitation/Modification of Contract, for settlement agreements for cost-reimbursement...

  7. 48 CFR 29.402-2 - Foreign cost-reimbursement contracts.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Foreign cost-reimbursement... GENERAL CONTRACTING REQUIREMENTS TAXES Contract Clauses 29.402-2 Foreign cost-reimbursement contracts. (a) The contracting officer shall insert the clause at 52.229-8, Taxes—Foreign Cost-Reimbursement...

  8. 48 CFR 46.308 - Cost-reimbursement research and development contracts.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Cost-reimbursement... ACQUISITION REGULATION CONTRACT MANAGEMENT QUALITY ASSURANCE Contract Clauses 46.308 Cost-reimbursement... of Research and Development—Cost-Reimbursement, in solicitations and contracts for research and...

  9. 48 CFR 28.307 - Insurance under cost-reimbursement contracts.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Insurance under cost-reimbursement contracts. 28.307 Section 28.307 Federal Acquisition Regulations System FEDERAL ACQUISITION...-reimbursement contracts. Cost-reimbursement contracts (and subcontracts, if the terms of the prime contract are...

  10. 49 CFR 599.303 - Agency disposition of dealer application for reimbursement.

    Science.gov (United States)

    2010-10-01

    ... reimbursement. 599.303 Section 599.303 Transportation Other Regulations Relating to Transportation (Continued... PROCEDURES FOR CONSUMER ASSISTANCE TO RECYCLE AND SAVE ACT PROGRAM Qualifying Transactions and Reimbursement § 599.303 Agency disposition of dealer application for reimbursement. (a) Application review. Upon...

  11. 12 CFR 701.33 - Reimbursement, insurance, and indemnification of officials and employees.

    Science.gov (United States)

    2010-01-01

    ... specifically excludes: (i) Payment (by reimbursement to an official or direct credit union payment to a third... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Reimbursement, insurance, and indemnification... Reimbursement, insurance, and indemnification of officials and employees. (a) Official. An official is a person...

  12. 45 CFR 1609.5 - Acceptance of reimbursement from a client.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false Acceptance of reimbursement from a client. 1609.5... CORPORATION FEE-GENERATING CASES § 1609.5 Acceptance of reimbursement from a client. (a) When a case results in recovery of damages or statutory benefits, a recipient may accept reimbursement from the client...

  13. 30 CFR 285.823 - Will MMS reimburse me for my expenses related to inspections?

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 2 2010-07-01 2010-07-01 false Will MMS reimburse me for my expenses related... Conducted Under SAPs, COPs and GAPs Inspections and Assessments § 285.823 Will MMS reimburse me for my expenses related to inspections? Upon request, MMS will reimburse you for food, quarters, and...

  14. 30 CFR 250.133 - Will MMS reimburse me for my expenses related to inspections?

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 2 2010-07-01 2010-07-01 false Will MMS reimburse me for my expenses related... Inspection of Operations § 250.133 Will MMS reimburse me for my expenses related to inspections? Upon request, MMS will reimburse you for food, quarters, and transportation that you provide for MMS representatives...

  15. 76 FR 58567 - Proposed Information Collection (Request for Transportation Expense Reimbursement) Activity...

    Science.gov (United States)

    2011-09-21

    ... (Request for Transportation Expense Reimbursement) Activity; Comment Request AGENCY: Veterans Benefits... needed to determine children with spina bifida eligibility for reimbursement of transportation expenses...: Request for Transportation Expense Reimbursement (38 CFR 21.8370). OMB Control Number: 2900-0580. Type of...

  16. Reimbursement of pharmaceuticals: Reference pricing versus health technology assessment

    NARCIS (Netherlands)

    M. Drummond (Michael); B. Jönsson (Bengt); F.F.H. Rutten (Frans); T. Stargardt (Tom)

    2011-01-01

    textabstractReference pricing and health technology assessment are policies commonly applied in order to obtain more value for money from pharmaceuticals. This study focussed on decisions about the initial price and reimbursement status of innovative drugs and discussed the consequences for market

  17. 41 CFR 101-39.104-2 - Reimbursement.

    Science.gov (United States)

    2010-07-01

    ...-INTERAGENCY FLEET MANAGEMENT SYSTEMS 39.1-Establishment, Modification, and Discontinuance of Interagency Fleet... 41 Public Contracts and Property Management 2 2010-07-01 2010-07-01 true Reimbursement. 101-39.104-2 Section 101-39.104-2 Public Contracts and Property Management Federal Property Management...

  18. 41 CFR 101-26.506-5 - Reimbursement for services.

    Science.gov (United States)

    2010-07-01

    ... 41 Public Contracts and Property Management 2 2010-07-01 2010-07-01 true Reimbursement for services. 101-26.506-5 Section 101-26.506-5 Public Contracts and Property Management Federal Property Management Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS SUPPLY AND PROCUREMENT 26-PROCUREMENT...

  19. 7 CFR 3015.84 - Request for advance or reimbursement.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 15 2010-01-01 2010-01-01 false Request for advance or reimbursement. 3015.84 Section 3015.84 Agriculture Regulations of the Department of Agriculture (Continued) OFFICE OF THE CHIEF FINANCIAL OFFICER, DEPARTMENT OF AGRICULTURE UNIFORM FEDERAL ASSISTANCE REGULATIONS Financial Reporting...

  20. 41 CFR 101-39.207 - Reimbursement for services.

    Science.gov (United States)

    2010-07-01

    ... sufficient to recover applicable costs. Failure by using agencies to reimburse GSA for vehicle services will... or neglect. (e) Agencies may be charged for recovery of expenses for repairs or services to GSA IFMS... services. 101-39.207 Section 101-39.207 Public Contracts and Property Management Federal Property...

  1. 44 CFR 208.36 - Reimbursement for Alert.

    Science.gov (United States)

    2010-10-01

    ... § 208.41 of this part. (4) Food and beverages for Task Force Members and Support Specialists when DHS does not provide meals during the Alert. DHS will limit food and beverage reimbursement to the amount... where such food and beverages were provided, multiplied by the number of personnel who received them. (b...

  2. Governance of conditional reimbursement practices in the Netherlands

    NARCIS (Netherlands)

    Boon, W.P.C.; Martins, Luis; Koopmanschap, Marc

    When entering the market, orphan drugs are associated with substantial prices and a high degree of uncertainty regarding safety and effectiveness. This makes decision making about the reimbursement of these drugs a complex exercise. To advance on this, the Dutch government introduced a conditional

  3. 20 CFR 61.102 - Disposition of reimbursement requests.

    Science.gov (United States)

    2010-04-01

    ... STATES CLAIMS FOR COMPENSATION UNDER THE WAR HAZARDS COMPENSATION ACT, AS AMENDED Reimbursement of...' Compensation to the disallowance or reduction of a claim within 60 days of the Office's decision. A carrier outside the United States has six months within which to file objections with the Associate Director. The...

  4. 77 FR 33470 - Reimbursement Rates for Calendar Year 2012

    Science.gov (United States)

    2012-06-06

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Indian Health Service Reimbursement Rates for Calendar Year 2012 AGENCY: Indian Health Service, HHS. ACTION: Notice. SUMMARY: Notice is given that the Director of Indian Health Service (IHS), under the authority of sections 321(a) and 322(b) of the Public...

  5. 75 FR 34147 - Reimbursement Rates for Calendar Year 2010

    Science.gov (United States)

    2010-06-16

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Indian Health Service Reimbursement Rates for Calendar Year 2010 AGENCY: Indian Health Service, HHS. ACTION: Notice. SUMMARY: Notice is given that the Director of Indian Health Service (IHS), under the authority of sections 321(a) and 322(b) of the Public...

  6. 77 FR 37421 - Reimbursement Rates for Calendar Year 2012 Correction

    Science.gov (United States)

    2012-06-21

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Indian Health Service Reimbursement Rates for Calendar Year 2012 Correction AGENCY: Indian Health Service, HHS. ACTION: Notice; correction. SUMMARY: The Indian Health Service published a document in the Federal Register on June 6, 2012, concerning rates for...

  7. 76 FR 24496 - Reimbursement Rates for Calendar Year 2011

    Science.gov (United States)

    2011-05-02

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Indian Health Service Reimbursement Rates for Calendar Year 2011 AGENCY: Indian Health Service, HHS. ACTION: Notice. SUMMARY: Notice is given that the Director of Indian Health Service (IHS), under the authority of sections 321(a) and 322(b) of the Public...

  8. The Case for Insurance Reimbursement of Couple Therapy.

    Science.gov (United States)

    Clawson, Robb E; Davis, Stephanie Y; Miller, Richard B; Webster, Tabitha N

    2017-08-22

    A case is made for why it may now be in the best interest of insurance companies to reimburse for marital therapy to treat marital distress. Relevant literature is reviewed with a considerable focus on the reasons that insurance companies would benefit from reimbursing marital therapy - the high costs of marital distress, the growing link between marital distress and a host of related physical and mental health problems, as well as the availability of empirically supported treatments for marital distress. This is followed by a focus on the major reasons insurance companies cite for not reimbursing marital therapy, along with a discussion of advances in several growing bodies of research to address these concerns. Main arguments include the direct medical offset costs of couple and family therapy (including for high utilizers of health insurance), and the fact that insurance companies already find it cost effective to reimburse for prevention of other health and psychological problems. This is followed by implications for practitioners and researchers. © 2017 American Association for Marriage and Family Therapy.

  9. 78 FR 22890 - Reimbursement Rates for Calendar Year 2013

    Science.gov (United States)

    2013-04-17

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Indian Health Service Reimbursement Rates for Calendar Year 2013 AGENCY: Indian Health Service, HHS. ACTION: Notice. SUMMARY: Notice is given that the Director of the Indian Health Service (IHS), under the authority of sections 321(a) and 322(b) of the...

  10. 42 CFR 413.5 - Cost reimbursement: General.

    Science.gov (United States)

    2010-10-01

    ... and profit-making organizations. (6) That there should be a recognition of the need of hospitals and... fide efforts at collection). (7) Charity and courtesy allowances are not includable, although “fringe... residents in the care of individual patients) furnished in a teaching hospital may be reimbursed as a...

  11. 78 FR 70244 - Electronic Interim Assistance Reimbursement Program

    Science.gov (United States)

    2013-11-25

    ..., Social Security Online, at http://www.socialsecurity.gov . SUPPLEMENTARY INFORMATION: Background To be... SOCIAL SECURITY ADMINISTRATION 20 CFR Part 416 [Docket No. SSA-2011-0104] RIN 0960-AH45 Electronic Interim Assistance Reimbursement Program AGENCY: Social Security Administration. ACTION: Notice of...

  12. 20 CFR 362.12 - Computation of amount of reimbursement.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Computation of amount of reimbursement. 362.12 Section 362.12 Employees' Benefits RAILROAD RETIREMENT BOARD INTERNAL ADMINISTRATION, POLICY AND... the cost of repair is the amount payable. (b) Depreciation in value of an item of personal property is...

  13. 36 CFR 14.22 - Reimbursement of costs.

    Science.gov (United States)

    2010-07-01

    ... acceptable to the authorized officer, by bond, guaranty, cash, certificate of deposit, or other means... acceptable to the authorized officer, by bond, guaranty, cash, certificate of deposit or other means... shall reimburse the United States for costs incurred by the United States in monitoring the construction...

  14. 40 CFR 66.74 - Payment or reimbursement.

    Science.gov (United States)

    2010-07-01

    ....74 Payment or reimbursement. (a) Within thirty days after any adjustment of a noncompliance penalty... timely payment of a deficiency shall pay a nonpayment penalty. The nonpayment penalty shall be calculated as of the due date of the deficiency payment and shall be equal to 20% of the deficiency not paid...

  15. Fabrication Process for Machined and Shrink-Fitted Impactor-Type Liners for the LOS Alamos Hedp Program

    Science.gov (United States)

    Randolph, B.

    2004-11-01

    Composite liners have been fabricated for the Los Alamos liner-driven High Energy Density Physics (HEDP) experiments using impactors formed by physical vapor deposition, and by machining and shrink fitting. Chemical vapor deposition has been proposed for some ATLAS liner applications. This paper describes the processes used to fabricate machined and shrink-fitted impactors; these processes have been used for copper impactors in 1100 aluminum liners and for 6061 T-6 aluminum impactors in 1100 aluminum liners. The most successful processes have been largely empirically developed and rely upon a combination of shrink-fitting and light press fitting. The processes used to date will be described along with some considerations for future composite liners for the HEDP Program.

  16. Towards Rural Land Use: Challenges for Oversizing Urban Perimeters in Shrinking Towns

    Science.gov (United States)

    Sá, João; Virtudes, Ana

    2017-12-01

    This article, based on the literature review, aims to study the challenges of the urban dispersion and oversizing of urban perimeters, in the cases where the towns are shrinking or spreading to the rural land-use. It is focused on the case of Portugal where during the last decades there was an escaping to the big cities alongside to the sea (Atlantic and Mediterranean) shore. In the Interior part of the country, which means near to the border with Spain, several towns are shrinking, despite their huge urban perimeters, proposed by the municipal master plans, since the middle of the nineties. Consequently, these urban perimeters are nowadays oversizing, with empty buildings and non-urbanized areas. At the same time, the social patterns of occupation of this territory have changed significantly, moving from a society with signs of rurality to an urban realm, understood not only in territorial terms but also regarding the current lifestyle. This deep changing has occurred not only in urbanistic terms but also in the economic, cultural and social organizations of the country, under a movement that corresponds to a decline of the small urban settlements in rural areas, far away from the cosmopolitan strip of land nearby the sea, in between the capital city, Lisbon and the second one Oporto. These transformations were not driven by any significant public policy for land-use actions. On the contrary, the production of urban areas, supporting the new model of economic and social development was largely left to the initiative of economic and social private agents and land owners. These agents were the leading responsible for the new urban developments and housing. In this sense, this research aims to present some strategies for the short time period regarding the devolution of urban areas to rural land use. In this sense, the next steps of spatial planning policies, under the role of local authorities (the 308 municipalities including Madeira and Azores islands, plus the

  17. Relating illness complexity to reimbursement in CKD patients.

    Science.gov (United States)

    Bessette, Russell W; Carter, Randy L

    2011-01-01

    Despite significant investments of federal and state dollars to transition patient medical records to an all-electronic system, a chasm still exists between health care quality and payment for it. A major reason for this gap is the difficulty in evaluating health care outcomes based on claims data. Since both payers and patients may not appreciate how illness complexity impacts treatment outcomes, it is difficult to determine fair provider compensation. Chronic kidney disease (CKD) typifies these problems and is often associated with comorbidities that impact cost, health, and work productivity. Thus, the objective of this study was to evaluate an illness complexity score (ICS) based on a linear regression of select blood values that might assist in predicting average monthly reimbursements in CKD patients. A second objective was to compare the results of this ICS prediction to results obtained by prediction of average monthly reimbursement using CKD stage. A third objective was to analyze the relationship between the change in ICS, estimated glomerular filtration rate (eGFR), and CKD stage over time to average monthly reimbursement. We calculated parsimonious values for select variables associated with CKD patients and compared the ICS to ordinal staging of renal disease. Data from 177 de-identified patients over 13 months was collected, which included 15 blood chemistry observations along with complete claims data for all medical expenses. To test for the relationship between average blood chemistry values, stages of CKD, age, and average monthly reimbursement, we modeled an association through a linear regression function of age, eGFR, and the Z-scores calculated from average monthly values of phosphorus, parathyroid hormone, glucose, hemoglobin, bicarbonate, albumin, creatinine, blood urea nitrogen, potassium, calcium, sodium, alkaline phosphatase, alanine aminotransferase, and white blood cells. The results of our study demonstrated that the association

  18. 78 FR 23162 - Supervision and Regulation Assessments for Bank Holding Companies and Savings and Loan Holding...

    Science.gov (United States)

    2013-04-18

    ... bank holding company's Consolidated Financial Statements for Bank Holding Companies (FR Y-9C) forms; \\3... Balance Sheet of the BHC's Consolidated Financial Statements for Bank Holding Companies (FR Y-9C) (OMB No... holding companies with $50 billion or more in total consolidated assets, and nonbank financial companies...

  19. Reimbursed Price of Orphan Drugs: Current Strategies and Potential Improvements.

    Science.gov (United States)

    Mincarone, Pierpaolo; Leo, Carlo Giacomo; Sabina, Saverio; Sarriá-Santamera, Antonio; Taruscio, Domenica; Serrano-Aguilar, Pedro Guillermo; Kanavos, Panos

    2017-01-01

    The pricing and reimbursement policies for pharmaceuticals are relevant to balance timely and equitable access for all patients, financial sustainability, and reward for valuable innovation. The proliferation of high-cost specialty medicines is particularly true in rare diseases (RDs) where the pricing mechanism is characterised by a lack of transparency. This work provides an overall picture of current strategies for the definition of the reimbursed prices of orphan drugs (ODs) and highlights some potential improvements. Current strategies and suggestions are presented along 4 dimensions: (1) comprehensive value assessment, (2) early dialogs among relevant stakeholders, (3) innovative reimbursement approaches, and (4) societal participation in producing ODs. Comprehensive value assessment could be achieved by clarifying the approach of distributive justice to adopt, ensuring a representative participation of stakeholders, and with a broad consideration of value-bearing factors. With respect to early dialogs, cross-border cooperation can be determinant to companies and agencies. The cost-benefit ratio of early dialogs needs to be demonstrated and the "regulatory capture" effect should be monitored. Innovative reimbursement approaches were developed to balance the need for evidence-based decisions with the timely access to innovative drugs. The societal participation in producing ODs needs to be recognised in a collaborating framework where adaptive agreements can be developed with mutual satisfaction. Such agreements could also impact on coverage and reimbursement decisions as additional elements for the determination of a comprehensive societal value of ODs. Further research is needed to investigate the highlighted open challenges so that RDs will not remain, in practical terms, orphan diseases. © 2017 S. Karger AG, Basel.

  20. An international comparison of reimbursement for DIEAP flap breast reconstruction.

    Science.gov (United States)

    Reid, A W N; Szpalski, C; Sheppard, N N; Morrison, C M; Blondeel, P N

    2015-11-01

    The deep inferior epigastric artery perforator (DIEAP) flap is currently considered the gold standard for autologous breast reconstruction. With the current economic climate and health cutbacks, we decided to survey reimbursement for DIEAP flaps performed at the main international centres in order to assess whether they are funded consistently. Data were collected confidentially from the main international centres by an anonymous questionnaire. Our results illustrate the wide disparity in international DIEAP flap breast reconstruction reimbursement: a unilateral DIEAP flap performed in New York, USA, attracts €20,759, whereas the same operation in Madrid, Spain, will only be reimbursed for €300. Only 35.7% of the surgeons can set up their own fee. Moreover, 85.7% of the participants estimated that the current fees are insufficient, and most of them feel that we are evolving towards an even lower reimbursement rate. In 55.8% of the countries represented, there is no DIEAP-specific coding; in comparison, 74.4% of the represented countries have a specific coding for transverse rectus abdominis (TRAM) flaps. Finally, despite the fact that DIEAP flaps have become the gold standard for breast reconstruction, they comprise only a small percentage of all the total number of breast reconstruction procedures performed (7-15%), with the only exception being Belgium (40%). Our results demonstrate that DIEAP flap breast reconstruction is inconsistently funded. Unfortunately though, it appears that the current reimbursement offered by many countries may dissuade institutions and surgeons from offering this procedure. However, substantial evidence exists supporting the cost-effectiveness of perforator flaps for breast reconstruction, and, in our opinion, the long-term clinical benefits for our patients are so important that this investment of time and money is absolutely essential. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons

  1. The Drug Reimbursement Decision-Making System in Iran.

    Science.gov (United States)

    Ansaripour, Amir; Uyl-de Groot, Carin A; Steenhoek, Adri; Redekop, William K

    2014-05-01

    Previous studies of health policies in Iran have not focused exclusively on the drug reimbursement process. The aim of this study was to describe the entire drug reimbursement process and the stakeholders, and discuss issues faced by policymakers. Review of documents describing the administrative rules and directives of stakeholders, supplemented by published statistics and interviews with experts and policymakers. Iran has a systematic process for the assessment, appraisal, and judgment of drug reimbursements. The two most important organizations in this process are the Food and Drug Organization, which considers clinical effectiveness, safety, and economic issues, and the Supreme Council of Health Insurance, which considers various criteria, including budget impact and cost-effectiveness. Ultimately, the Iranian Cabinet approves a drug and recommends its use to all health insurance organizations. Reimbursed drugs account for about 53.5% of all available drugs and 77.3% of drug expenditures. Despite its strengths, the system faces various issues, including conflicting stakeholder aims, lengthy decision-making duration, limited access to decision-making details, and rigidity in the assessment process. The Iranian drug reimbursement system uses decision-making criteria and a structured approach similar to those in other countries. Important shortcomings in the system include out-of-pocket contributions due to lengthy decision making, lack of transparency, and conflicting interests among stakeholders. Iranian policymakers should consider a number of ways to remedy these problems, such as case studies of individual drugs and closer examination of experiences in other countries. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  2. ALICE Holds Up to Challenge

    CERN Multimedia

    2006-01-01

    ALICE's main austenitic stainless steel support structure (the Space Frame) has recently gone through many tests that proved quite challenging: insuring the structure is sound and lowering it horizontally into the ALICE cavern. This structure is constructed to hold the large volume detectors, such as the Time Projection Chamber, Transition Radiation Detector and Time of Flight inside the ALICE solenoid magnet. After the final assembly at CERN, two large mobile cranes were needed for the job of lifting and turning the 14 tonne frame onto its side. Once shifted, it was placed in Building SX2, one of the surface assembly areas designated for ALICE. The structure, which is 8 m in diameter and 7 m long, underwent many tests in its new position. Geometric control tests were performed by measuring each of the 18 cells and placing wooden or metal samples constructed to the same dimensions as the real thing inside the structure. The most important check was the movement of the real Time Projection Chamber from its s...

  3. Stagnation point flow and heat transfer over a nonlinear shrinking sheet with slip effects

    Directory of Open Access Journals (Sweden)

    N.F. Fauzi

    2015-12-01

    Full Text Available In this paper, an investigation is performed to analyze the effects of the slip parameters A and B on the steady stagnation-point flow and heat transfer due to a shrinking sheet in a viscous and incompressible fluid. Using similarity transformations, the governing boundary layer equations are transformed into the nonlinear ordinary (similar differential equations. The transformed equations are solved numerically using the shooting method. The dual solutions for velocity and temperature distribution exist for certain values of the positive constant velocity and temperature slip parameters. Likewise, a stability analysis has been performed to find the nature of the dual solutions. The velocity slip will delay the boundary layer separation whereas the temperature slip does not affect the boundary layer separation.

  4. Plasticity, Swell-Shrink, and Microstructure of Phosphogypsum Admixed Lime Stabilized Expansive Soil

    Directory of Open Access Journals (Sweden)

    Jijo James

    2016-01-01

    Full Text Available The study involved utilization of an industrial waste, Phosphogypsum (PG, as an additive to lime stabilization of an expansive soil. Three lime dosages, namely, initial consumption of lime (ICL, optimum lime content (OLC, and less than ICL (LICL, were identified for the soil under study for stabilizing the soil. Along with lime, varying doses of PG were added to the soil for stabilization. The effect of stabilization was studied by performing index tests, namely, liquid limit, plastic limit, shrinkage limit, and free swell test, on pulverized remains of failed unconfined compression test specimens. The samples were also subjected to a microstructural study by means of scanning electron microscope. Addition of PG to lime resulted in improvement in the plasticity and swell-shrink characteristics. The microstructural study revealed the formation of a dense compact mass of stabilized soil.

  5. A shrinking particle model at leaching of titanium in ilmenite use HCl

    International Nuclear Information System (INIS)

    MV Purwani; Suyanti

    2016-01-01

    The research of ilmenite leaching has conducted. Ilmenite was tailings of zircon sand processing. Zircon sand processing tailings containing Zr, Ti, Nb and Fe. This research will be conducted to determine the kinetic leaching of Ti in HCl based shrinking core models. From the research results ilmenite leaching of Ti in HCl wear, it can be concluded that the 50 grams of ilmenite leaching wear 11 M HCl leaching, the higher temperature was conducted the greater of the Ti conversion. The mechanism of the leaching process was controlled by Sphere Reaction with formula equation 1- (1-α)1/3 = "k"."C"/"r"_o"ρ t = klt, the relationship between temperature (T) with the reaction rate constant (k), k = 61.744.e- 4553.3 / T or ln k = - 4553.3 / T + 4.123, the frequency factor A = 61.744, the activation energy E = 37.856 kJ/mol. (author)

  6. Dual solutions in boundary layer flow of Maxwell fluid over a porous shrinking sheet

    International Nuclear Information System (INIS)

    Bhattacharyya Krishnendu; Hayat Tasawar; Alsaedi Ahmed

    2014-01-01

    An analysis is carried out for dual solutions of the boundary layer flow of Maxwell fluid over a permeable shrinking sheet. In the investigation, a constant wall mass transfer is considered. With the help of similarity transformations, the governing partial differential equations (PDEs) are converted into a nonlinear self-similar ordinary differential equation (ODE). For the numerical solution of transformed self-similar ODE, the shooting method is applied. The study reveals that the steady flow of Maxwell fluid is possible with a smaller amount of imposed mass suction compared with the viscous fluid flow. Dual solutions for the velocity distribution are obtained. Also, the increase of Deborah number reduces the boundary layer thickness for both solutions. (electromagnetism, optics, acoustics, heat transfer, classical mechanics, and fluid dynamics)

  7. Numerical Simulation of Entropy Generation with Thermal Radiation on MHD Carreau Nanofluid towards a Shrinking Sheet

    Directory of Open Access Journals (Sweden)

    Muhammad Mubashir Bhatti

    2016-05-01

    Full Text Available In this article, entropy generation with radiation on non-Newtonian Carreau nanofluid towards a shrinking sheet is investigated numerically. The effects of magnetohydrodynamics (MHD are also taken into account. Firstly, the governing flow problem is simplified into ordinary differential equations from partial differential equations with the help of similarity variables. The solution of the resulting nonlinear differential equations is solved numerically with the help of the successive linearization method and Chebyshev spectral collocation method. The influence of all the emerging parameters is discussed with the help of graphs and tables. It is observed that the influence of magnetic field and fluid parameters oppose the flow. It is also analyzed that thermal radiation effects and the Prandtl number show opposite behavior on temperature profile. Furthermore, it is also observed that entropy profile increases for all the physical parameters.

  8. Symptoms of shrinking lung syndrome reveal systemic lupus erythematosus in a 12-year-old girl.

    Science.gov (United States)

    Meinicke, Holger; Heinzmann, Andrea; Geiger, Julia; Berner, Reinhard; Hufnagel, Markus

    2013-12-01

    While pleuropulmonary involvement in systemic lupus erythematosus (SLE) is a common occurrence, shrinking lung syndrome (SLS) is a rare complication of SLE, particularly in children. We report on a teenager girl with a primary SLE diagnosis, which was based upon clinical, imaging, lung-function and histological findings ascertained to be compatible with SLS. Following a pneumonia, the patient developed inflammatory residues in the lower lobes, an event that probably caused diaphragmatic immobility and subsequently led to SLS. Treatment response to steroids, cyclophosphamide and hydroxychloroquine in this case was excellent, and efficacy was more profound than previously has been reported in the literature with respect to pediatric patients. This case report argues that prognosis of SLS in SLE is likely to be favorable when the diagnosis is made early and the disease is treated appropriately. © 2012 Wiley Periodicals, Inc.

  9. Improvement of formability of high strength steel sheets in shrink flanging

    International Nuclear Information System (INIS)

    Hamedon, Z; Abe, Y; Mori, K

    2016-01-01

    In the shrinkage flanging, the wrinkling tends to occur due to compressive stress. The wrinkling will cause a difficulty in assembling parts, and severe wrinkling may leads to rupture of parts. The shrinkage flange of the ultra-high strength steel sheets not only defects the product by the occurrence of the wrinkling but also causes seizure and wear of the dies and shortens the life of dies. In the present study, a shape of a punch having gradual contact was optimized in order to prevent the wrinkling in shrinkage flanging of ultra-high strength steel sheets. The sheet was gradually bent from the corner of the sheet to reduce the compressive stress. The wrinkling in the shrink flanging of the ultra-high strength steel sheets was prevented by the punch having gradual contact. It was found that the punch having gradual contact is effective in preventing the occurrence of wrinkling in the shrinkage flanging. (paper)

  10. Drug reimbursement and GPs' prescribing decisions: a randomized case-vignette study about the pharmacotherapy of obesity associated with type 2 diabetes: how GPs react to drug reimbursement.

    Science.gov (United States)

    Verger, Pierre; Rolland, Sophie; Paraponaris, Alain; Bouvenot, Julien; Ventelou, Bruno

    2010-08-01

    This study sought to identify the effect of drug reimbursability--a decision made in France by the National Authority for Health--on physicians' prescribing practices for a diet drug such as rimonabant, approved for obese or overweight patients with type-2 diabetes. A cross-sectional survey of French general practitioners (GPs) presented a case-vignette about a patient for whom this drug is indicated in two alternative versions, differing only in its reimbursability, to two separate randomized subsamples of GPs in early 2007, before any decision was made about reimbursement. The results indicate that (i) more than 20% of GPs in private practice would be willing to prescribe a non-reimbursed diet drug for patients with obesity complicated by type 2 diabetes; (ii) the number of GPs willing to prescribe it would increase by 47.6% if the drug were reimbursed, and (iii) such a drug would be adopted at a higher rate by GPs who have regular contacts with pharmaceutical sales representatives. In France, unlike most other countries, drug reimbursement status is a signal of quality. However, our results suggest that a significant proportion of GPs would spontaneously adopt anti-obesity drugs even if they were not reimbursed. Decisions about reimbursement of pharmaceutical products should be made taking into account that reimbursement is likely to intensify prescription.

  11. Excess cash holdings and shareholder value

    OpenAIRE

    Lee, Edward; Powell, Ronan

    2011-01-01

    We examine the determinants of corporate cash holdings in Australia and the impact on shareholder wealth of holding excess cash. Our results show that a trade-off model best explains the level of a firm’s cash holdings in Australia. We find that 'transitory' excess cash firms earn significantly higher risk-adjusted returns compared to 'persistent' excess cash firms, suggesting that the market penalises firms that hoard cash. The marginal value of cash also declines with larger cash balances, ...

  12. 78 FR 21352 - Update on Reimbursement for Costs of Remedial Action at Active Uranium and Thorium Processing Sites

    Science.gov (United States)

    2013-04-10

    ... reimbursement ceilings). Title X requires DOE to reimburse eligible uranium and thorium licensees for certain... DEPARTMENT OF ENERGY Update on Reimbursement for Costs of Remedial Action at Active Uranium and... not currently available for reimbursement for cleanup work performed by licensees at eligible uranium...

  13. Parameter Sensitivity Study of the Unreacted-Core Shrinking Model: A Computer Activity for Chemical Reaction Engineering Courses

    Science.gov (United States)

    Tudela, Ignacio; Bonete, Pedro; Fullana, Andres; Conesa, Juan Antonio

    2011-01-01

    The unreacted-core shrinking (UCS) model is employed to characterize fluid-particle reactions that are important in industry and research. An approach to understand the UCS model by numerical methods is presented, which helps the visualization of the influence of the variables that control the overall heterogeneous process. Use of this approach in…

  14. Swelling and Shrinking Properties of Thermo-Responsive Polymeric Ionic Liquid Hydrogels with Embedded Linear pNIPAAM

    Directory of Open Access Journals (Sweden)

    Simon Gallagher

    2014-03-01

    Full Text Available In this study, varying concentrations of linear pNIPAAM have been incorporated for the first time into a thermo-responsive polymeric ionic liquid (PIL hydrogel, namely tributyl-hexyl phosphonium 3-sulfopropylacrylate (P-SPA, to produce semi-interpenetrating polymer networks. The thermal properties of the resulting hydrogels have been investigated along with their thermo-induced shrinking and reswelling capabilities. The semi-interpenetrating networks (IPN hydrogels were found to have improved shrinking and reswelling properties compared with their PIL counterpart. At elevated temperatures (50–80 °C, it was found that the semi-IPN with the highest concentration of hydrophobic pNIPAAM exhibited the highest shrinking percentage of ~40% compared to the conventional P-SPA, (27%. This trend was also found to occur for the reswelling measurements, with semi-IPN hydrogels producing the highest reswelling percentage of ~67%, with respect to its contracted state. This was attributed to an increase in water affinity due to the presence of hydrophilic pNIPAAM. Moreover, the presence of linear pNIPAAM in the polymer matrix leads to improved shrinking and reswelling response compared to the equivalent PIL.

  15. Measuring and partitioning soil respiration in sharkey shrink-swell clays under plantation grown short-rotation woody crops

    Science.gov (United States)

    Wilson G. Hood; Michael C. Tyree; Dylan N. Dillaway Dillaway; Theodor D. Leininger

    2015-01-01

    The Lower Mississippi Alluvial Valley (LMAV) offers an ecological niche for short-rotation woody crop (SRWC) production by mating marginal agricultural land with optimal growing conditions. Approximately 1.7 million ha within the LMAV consist of Sharkey shrink-swell clays. They are considered marginal in terms of traditional agricultural productivity due to their...

  16. Case-mix reimbursement for nursing home services: Simulation approach

    Science.gov (United States)

    Adams, E. Kathleen; Schlenker, Robert E.

    1986-01-01

    Nursing home reimbursement based on case mix is a matter of growing interest. Several States either use or are considering this reimbursement method. In this article, we present a method for evaluating key outcomes of such a change for Connecticut nursing homes. A simulation model is used to replicate payments under the case-mix systems used in Maryland, Ohio, and West Virginia. The findings indicate that, compared with the system presently used in Connecticut, these systems would better relate dollar payments to measure patient need, and for-profit homes would benefit relative to nonprofit homes. The Ohio methodology would impose the most additional costs, the West Virginia system would actually be somewhat less expensive in terms of direct patient care payments. PMID:10311776

  17. Relating illness complexity to reimbursement in CKD patients

    Directory of Open Access Journals (Sweden)

    Bessette RW

    2011-09-01

    Full Text Available Russell W Bessette1, Randy L Carter2,3 1Department of Health Sciences, Institute for Healthcare Informatics, 2Department of Biostatistics, 3Population Health Observatory, University at Buffalo, State University of New York, Buffalo, NY, USA Background: Despite significant investments of federal and state dollars to transition patient medical records to an all-electronic system, a chasm still exists between health care quality and payment for it. A major reason for this gap is the difficulty in evaluating health care outcomes based on claims data. Since both payers and patients may not appreciate how illness complexity impacts treatment outcomes, it is difficult to determine fair provider compensation. Objectives: Chronic kidney disease (CKD typifies these problems and is often associated with comorbidities that impact cost, health, and work productivity. Thus, the objective of this study was to evaluate an illness complexity score (ICS based on a linear regression of select blood values that might assist in predicting average monthly reimbursements in CKD patients. A second objective was to compare the results of this ICS prediction to results obtained by prediction of average monthly reimbursement using CKD stage. A third objective was to analyze the relationship between the change in ICS, estimated glomerular filtration rate (eGFR, and CKD stage over time to average monthly reimbursement. Methods: We calculated parsimonious values for select variables associated with CKD patients and compared the ICS to ordinal staging of renal disease. Data from 177 de-identified patients over 13 months was collected, which included 15 blood chemistry observations along with complete claims data for all medical expenses. To test for the relationship between average blood chemistry values, stages of CKD, age, and average monthly reimbursement, we modeled an association through a linear regression function of age, eGFR, and the Z-scores calculated from average

  18. Case-mix reimbursement for nursing home services: simulation approach.

    Science.gov (United States)

    Adams, E K; Schlenker, R E

    1986-01-01

    Nursing home reimbursement based on case mix is a matter of growing interest. Several States either use or are considering this reimbursement method. In this article, we present a method for evaluating key outcomes of such a change for Connecticut nursing homes. A simulation model is used to replicate payments under the case-mix systems used in Maryland, Ohio, and West Virginia. The findings indicate that, compared with the system presently used in Connecticut, these systems would better relate dollar payments to measure patient need, and for-profit homes would benefit relative to nonprofit homes. The Ohio methodology would impose the most additional costs, the West Virginia system would actually be somewhat less expensive in terms of direct patient care payments.

  19. Pricing and Reimbursement in U.S. Pharmaceutical Markets

    OpenAIRE

    Newhouse, Joseph Paul; Berndt, Ernst R.

    2010-01-01

    In this survey chapter on pricing and reimbursement in U.S. pharmaceutical markets, we first provide background information on important federal legislation, institutional details regarding distribution channel logistics, definitions of alternative price measures, related historical developments, and reasons why price discrimination is highly prevalent among branded pharmaceuticals. We then present a theoretical framework for the pricing of branded pharmaceuticals, without and then in the pre...

  20. HCPCS Coding: An Integral Part of Your Reimbursement Strategy.

    Science.gov (United States)

    Nusgart, Marcia

    2013-12-01

    The first step to a successful reimbursement strategy is to ensure that your wound care product has the most appropriate Healthcare Common Procedure Coding System (HCPCS) code (or billing) for your product. The correct HCPCS code plays an essential role in patient access to new and existing technologies. When devising a strategy to obtain a HCPCS code for its product, companies must consider a number of factors as follows: (1) Has the product gone through the Food and Drug Administration (FDA) regulatory process or does it need to do so? Will the FDA code designation impact which HCPCS code will be assigned to your product? (2) In what "site of service" do you intend to market your product? Where will your customers use the product? Which coding system (CPT ® or HCPCS) applies to your product? (3) Does a HCPCS code for a similar product already exist? Does your product fit under the existing HCPCS code? (4) Does your product need a new HCPCS code? What is the linkage, if any, between coding, payment, and coverage for the product? Researchers and companies need to start early and place the same emphasis on a reimbursement strategy as it does on a regulatory strategy. Your reimbursement strategy staff should be involved early in the process, preferably during product research and development and clinical trial discussions.

  1. Reimbursing Dentists for Smoking Cessation Treatment: Views From Dental Insurers

    Science.gov (United States)

    Wright, Shana; McNeely, Jennifer; Rotrosen, John; Winitzer, Rebecca F.; Pollack, Harold; Abel, Stephen; Metsch, Lisa

    2012-01-01

    Introduction: Screening and delivery of evidence-based interventions by dentists is an effective way to reduce tobacco use. However, dental visits remain an underutilized opportunity for the treatment of tobacco dependence. This is, in part, because the current reimbursement structure does not support expansion of dental providers’ role in this arena. The purpose of this study was to interview dental insurers to assess attitudes toward tobacco use treatment in dental practice, pros and cons of offering dental provider reimbursement, and barriers to instituting a tobacco use treatment-related payment policy for dental providers. Methods: Semi-structured interviews were conducted with 11 dental insurance company executives. Participants were identified using a targeted sampling method and represented viewpoints from a significant share of companies within the dental insurance industry. Results: All insurers believed that screening and intervention for tobacco use was an appropriate part of routine care during a dental visit. Several indicated a need for more evidence of clinical and cost-effectiveness before reimbursement for these services could be actualized. Lack of purchaser demand, questionable returns on investment, and segregation of the medical and dental insurance markets were cited as additional barriers to coverage. Conclusions: Dissemination of findings on efficacy and additional research on financial returns could help to promote uptake of coverage by insurers. Wider issues of integration between dental and medical care and payment systems must be addressed in order to expand opportunities for preventive services in dental care settings. PMID:22387994

  2. Inflation, operating cycle, and cash holdings

    Directory of Open Access Journals (Sweden)

    Yanchao Wang

    2014-12-01

    Full Text Available A corporate cash-holding strategy is a trade-off between the costs and benefits of holding cash. At the macrolevel, firms are inclined to adjust and optimize their cash-holding strategies in response to changes in purchasing power due to inflation. At the microlevel, the operating cycle, which indicates the speed and turnover of corporate cash flow, also influences the corporate cash-holding strategy. Firms flexibly adjust their cash-holding strategies in response to changes in the internal and external environment, which is referred to as the cash adjustment strategy. We examine these predicted relationships using a sample of listed firms in China’s stock market over the 1998–2009 period. Consistent with our predictions, the empirical results indicate a significant negative association between cash holdings and the CPI, but the relationship is reversed when the CPI reaches a certain level. There is also a U-shaped relationship between operating cycle and cash holdings, and this relationship is similarly influenced by changes in the inflation level. In examining the macroeconomic environment and microlevel firm-specific characteristics simultaneously, our findings supplement the literature on firms’ cash-holding strategies and provide theoretical and practical implications.

  3. Providing Mailing Cost Reimbursements: The Effect on Reporting Timeliness of Sexually Transmitted Diseases in Virginia.

    Science.gov (United States)

    Vasiliu, Oana E; Stover, Jeffrey A; Mays, Marissa J E; Bissette, Jennifer M; Dolan, Carrie B; Sirbu, Corina M

    2009-01-01

    We investigated the effect of providing mailing cost reimbursements to local health departments on the timeliness of the reporting of sexually transmitted diseases (STDs) in Virginia. The Division of Disease Prevention, Virginia Department of Health, provided mailing cost reimbursements to 31 Virginia health districts from October 2002 to December 2004. The difference (in days) between the diagnosis date (or date the STD paperwork was initiated) and the date the case/STD report was entered into the STD surveillance database was used in a negative binomial regression model against time (as divided into three periods-before, during, and after reimbursement) to estimate the effect of providing mailing cost reimbursements on reporting timeliness. We observed significant decreases in the number of days between diagnosis and reporting of a case, which were sustained after the reimbursement period ended, in 25 of the 31 health districts included in the analysis. We observed a significant initial decrease (during the reimbursement period) followed by a significant increase in the after-reimbursement phase in one health district. Two health districts had a significant initial decrease, while one health district had a significant decrease in reporting timeliness in the period after reimbursement. Two health districts showed no significant changes in the number of days to report to the central office. Providing reimbursements for mailing costs was statistically associated with improved STD reporting timeliness in almost all of Virginia's health districts. Sustained improvement after the reimbursement period ended is likely indicative of improved local health department reporting habits.

  4. Changes in Payer Mix and Physician Reimbursement After the Affordable Care Act and Medicaid Expansion

    Science.gov (United States)

    Jones, Christine D.; Scott, Serena J.; Anoff, Debra L.; Pierce, Read G.; Glasheen, Jeffrey J.

    2015-01-01

    Although uncompensated care for hospital-based care has fallen dramatically since the implementation of the Affordable Care Act and Medicaid expansion, the changes in hospital physician reimbursement are not known. We evaluated if payer mix and physician reimbursement by encounter changed between 2013 and 2014 in an academic hospitalist practice in a Medicaid expansion state. This was a retrospective cohort study of all general medicine inpatient admissions to an academic hospitalist group in 2013 and 2014. The proportion of encounters by payer and reimbursement/inpatient encounter were compared in 2013 versus 2014. A sensitivity analysis determined the relative contribution of different factors to the change in reimbursement/encounter. Among 37 540 and 40 397 general medicine inpatient encounters in 2013 and 2014, respectively, Medicaid encounters increased (17.3% to 30.0%, P reimbursement/encounter increased 4.2% from $79.98/encounter in 2013 to $83.36/encounter in 2014 (P reimbursement for encounter type by payer accounted for −0.7%, 0.8%, 2.0%, and 2.3% of the reimbursement change, respectively. From 2013 to 2014, Medicaid encounters increased, and uninsured and private payer encounters decreased within our hospitalist practice. Reimbursement/encounter also increased, much of which could be attributed to a change in payer mix. Further analyses of physician reimbursement in Medicaid expansion and non-expansion states would further delineate reimbursement changes that are directly attributable to Medicaid expansion. PMID:26310500

  5. An Analysis of Medicare Reimbursement to Ophthalmologists: Years 2012 to 2013.

    Science.gov (United States)

    Han, Everett; Baisiwala, Shivani; Jain, Atul; Bundorf, M Kate; Pershing, Suzann

    2017-10-01

    To analyze trends in utilization and payment of ophthalmic services in the Medicare population for years 2012 and 2013. Retrospective, cross-sectional study. A retrospective cross-sectional observational analysis was performed using publicly available Medicare Physician and Other Supplier aggregate file and the Physician and Other Supplier Public Use File. Variables analyzed included aggregate beneficiary demographics, Medicare payments to ophthalmologists, ophthalmic medical services provided, and the most common Medicare-reimbursed ophthalmic services. In 2013, total Medicare Part B reimbursement for ophthalmology was $5.8 billion, an increase of 3.6% from the previous year. From 2012 to 2013, the total number of ophthalmology services rendered increased by 2.2%, while average dollar amount reimbursed per ophthalmic service decreased by 5.4%. The top 5 highest reimbursed services accounted for 85% of total ophthalmic Medicare payments in 2013, an 11% increase from 2012. During 2013, drug reimbursement represented 32.8% of the total Medicare payments to ophthalmologists. Ranibizumab and aflibercept alone accounted for 95% of the entire $1.9 billion in drug reimbursements ophthalmologists in 2013. Medicare Part B reimbursement for ophthalmologists was primarily driven by use of anti-vascular endothelial growth factor (anti-VEGF) injections from 2012 to 2013. Of the total drug payments to ophthalmologists, biologic anti-VEGF agents ranibizumab and aflibercept accounted for 95% of all drug reimbursement. This is in contrast to other specialties, in which drug reimbursement represented only a small portion of Medicare reimbursement. Published by Elsevier Inc.

  6. A Cohort Analysis of Postbariatric Panniculectomy--Current Trends in Surgeon Reimbursement.

    Science.gov (United States)

    Aherrera, Andrew S; Pandya, Sonal N

    2016-01-01

    The overall number of patients undergoing body contouring procedures after massive weight loss (MWL) has progressively increased over the past decade. The purpose of this study was to evaluate the charges and reimbursements for panniculectomy after MWL at a large academic institution in Massachusetts. A retrospective review was performed and included all identifiable panniculectomy procedures performed at our institution between January 2008 and January 2014. The annual number of patients undergoing panniculectomy, the type of insurance coverage and reimbursement method of each patient, and the amounts billed and reimbursed were evaluated. During our study period, 114 patients underwent a medically necessary panniculectomy as a result of MWL. The average surgeon fee billed was $3496 ± $704 and the average amount reimbursed was $1271 ± $589. Ten cases (8.8%) had no reimbursements, 31 cases (21.8%) reimbursed less than $1000, 66 cases (57.9%) reimbursed between $1000 and $2000, and no cases reimbursed the full amount billed. When evaluated by type of insurance coverage, collection ratios were 37.4% ± 17.4% overall, 41.7% ± 16.4% for private insurance, and 24.0% ± 13.0% for Medicare/Medicaid insurance (P Reimbursements for panniculectomy are remarkably low, and in many instances, absent, despite obtaining previous preauthorization of medical necessity. Although panniculectomy is associated with improvements in quality of life and high levels of patient satisfaction, poor physician reimbursement for this labor intensive procedure may preclude access to appropriate care required by the MWL patient population.

  7. Multi-criteria assessment of socio-environmental aspects in shrinking cities. Experiences from eastern Germany

    International Nuclear Information System (INIS)

    Schetke, Sophie; Haase, Dagmar

    2008-01-01

    Demographic change and economic decline produce modified urban land use pattern and densities. Compared to the beginning of the 90s after the German reunification, nowadays massive housing and commercial vacancies followed by demolition and perforation come to pass in many cities of the former GDR. In consequence, a considerable surplus of urban brownfields has been created. Furthermore, the decline in the urban fabric affects social infrastructure and urban greenery of local neighbourhoods. Here, urban planning enters into 'uncharted territory' since it needs to assess the socio-environmental impact of shrinkage. In order to carry out such an evaluation quantitatively, a multi-criteria assessment scheme (MCA) was developed and applied. Firstly, we identified infrastructure and land use changes related to vacancy and demolition. Secondly, demolition scenarios for the coming 20 years were applied in order to give an idea for a long-term monitoring approach at the local district level. A multi-criteria indicator matrix quantifies the socio-environmental impact on both urban greenery and residents. Using it, we set demolition scenarios against urban 'quality of life' targets. Empirical evidence comes from Leipzig, in eastern Germany, a representative case study for urban shrinkage processes. The results show that shrinkage implies socio-environmental changes of residential livelihoods, however, does not simply increase or decrease the overall urban quality of life. The integrated assessment of all indicators identifies environmental and social opportunities, as well as the challenges a shrinking city is faced with

  8. Think You Can Shrink? A Proof-of-Concept Study for Men's Health Education Through Edutainment.

    Science.gov (United States)

    Ungar, Thomas; Norman, Cameron D; Knaak, Stephanie

    2017-01-01

    Connecting people to useful, actionable health resources is a substantive challenge that sits at the heart of health communication. Digital media provides means of producing, distributing and revising content and creates possibilities for new and multiple channels for reaching and engaging audiences, particularly when combined with social media. While there is much promise of digital media forms to deliver audiences and promote engagement, the health communication landscape is still largely hit-and-miss with few 'best practice' examples to follow. Proof-of-concept studies allow for a structured, focused exploration of ways to leverage the potential of digital media and learn what approaches have the promise to invest resources in amid a sea of possible options. Think You Can Shrink? (TYCS) is a multi-episode web series modelled on a reality TV show format. The show's key objective is to educate men and demonstrate, through modelling, ways men can support other men to encourage help-seeking behaviours and greater health communication, which in turn, may also lead to better health outcomes. Given the newness of the approach, the project was launched as a proof-of-concept study to explore: (a) whether this approach could engage the interest of men, (b) what initial impact this approach might induce and (c) the kind of audiences this approach might most appeal to.

  9. A kinetics study of acetic acid on cobalt leaching of spent LIBs: Shrinking Core Model

    Directory of Open Access Journals (Sweden)

    Setiawan Hendrik

    2018-01-01

    Full Text Available Lithium-ion batteries (LIBs are secondary rechargeable power sources which increasing production also leads to large amount of waste. In order to environmentally friendly reduce the waste, this work aimed to use acetic acid as a substitute leaching agent to leach Co metals which constitutes about 72.39% wt of the battery cathode. The leaching process was done in a three-necked-flask where calcined LIB cathode powder was mixed with acetic acid solution. The variables of the leaching process under investigation were solution pH, concentration of H2O2 in the solution, S/L ratio, temperature and reaction time. Experimental results showed that only temperature significantly influenced the leaching rate of Co. Since the process was exothermic, the maximum recovery decreased as temperature increased. Conventional shrinking core model that considers diffusion and irreversible surface reaction resistances was found not sufficient to predict the kinetics of the Co leaching with acetic acid. A more representative kinetics model that considers a reversible reaction of Co complex formation needs to be further developed.

  10. Shrinking lung syndrome as a manifestation of pleuritis: a new model based on pulmonary physiological studies.

    Science.gov (United States)

    Henderson, Lauren A; Loring, Stephen H; Gill, Ritu R; Liao, Katherine P; Ishizawar, Rumey; Kim, Susan; Perlmutter-Goldenson, Robin; Rothman, Deborah; Son, Mary Beth F; Stoll, Matthew L; Zemel, Lawrence S; Sandborg, Christy; Dellaripa, Paul F; Nigrovic, Peter A

    2013-03-01

    The pathophysiology of shrinking lung syndrome (SLS) is poorly understood. We sought to define the structural basis for this condition through the study of pulmonary mechanics in affected patients. Since 2007, most patients evaluated for SLS at our institutions have undergone standardized respiratory testing including esophageal manometry. We analyzed these studies to define the physiological abnormalities driving respiratory restriction. Chest computed tomography data were post-processed to quantify lung volume and parenchymal density. Six cases met criteria for SLS. All presented with dyspnea as well as pleurisy and/or transient pleural effusions. Chest imaging results were free of parenchymal disease and corrected diffusing capacities were normal. Total lung capacities were 39%-50% of predicted. Maximal inspiratory pressures were impaired at high lung volumes, but not low lung volumes, in 5 patients. Lung compliance was strikingly reduced in all patients, accompanied by increased parenchymal density. Patients with SLS exhibited symptomatic and/or radiographic pleuritis associated with 2 characteristic physiological abnormalities: (1) impaired respiratory force at high but not low lung volumes; and (2) markedly decreased pulmonary compliance in the absence of identifiable interstitial lung disease. These findings suggest a model in which pleural inflammation chronically impairs deep inspiration, for example through neural reflexes, leading to parenchymal reorganization that impairs lung compliance, a known complication of persistently low lung volumes. Together these processes could account for the association of SLS with pleuritis as well as the gradual symptomatic and functional progression that is a hallmark of this syndrome.

  11. clues: An R Package for Nonparametric Clustering Based on Local Shrinking

    Directory of Open Access Journals (Sweden)

    Fang Chang

    2010-02-01

    Full Text Available Determining the optimal number of clusters appears to be a persistent and controversial issue in cluster analysis. Most existing R packages targeting clustering require the user to specify the number of clusters in advance. However, if this subjectively chosen number is far from optimal, clustering may produce seriously misleading results. In order to address this vexing problem, we develop the R package clues to automate and evaluate the selection of an optimal number of clusters, which is widely applicable in the field of clustering analysis. Package clues uses two main procedures, shrinking and partitioning, to estimate an optimal number of clusters by maximizing an index function, either the CH index or the Silhouette index, rather than relying on guessing a pre-specified number. Five agreement indices (Rand index, Hubert and Arabie’s adjusted Rand index, Morey and Agresti’s adjusted Rand index, Fowlkes and Mallows index and Jaccard index, which measure the degree of agreement between any two partitions, are also provided in clues. In addition to numerical evidence, clues also supplies a deeper insight into the partitioning process with trajectory plots.

  12. Development of A Darcy-flow model applied to simulate the drying of shrinking media

    Directory of Open Access Journals (Sweden)

    S. Chemkhi

    2008-09-01

    Full Text Available A mathematical model is developed to describe the coupling between heat, mass, and momentum transfers and is applied to simulate the drying of saturated and shrinking media. This model is called "the Darcy-flow model", which is based on the fact that the liquid flow is induced by a pressure gradient. The main novelties of the model are that firstly no phenomenological law need be introduced by keeping solid mass conservation and solid volume conservation together and secondly we use the effective stresses notion strongly coupling mechanical behaviour with mass transport. The analysis is limited to the preheating and the constant rate drying periods because shrinkage occurs during these two periods for most materials. Our purpose is to simulate the drying process and to compare the results of the simulations and the experiments done on clay material to demonstrate the consistency of the model developed. One of the important conclusions is that is no correlation between moisture flow and moisture gradient.

  13. Crustal movements due to Iceland's shrinking ice caps mimic magma inflow signal at Katla volcano.

    Science.gov (United States)

    Spaans, Karsten; Hreinsdóttir, Sigrún; Hooper, Andrew; Ófeigsson, Benedikt Gunnar

    2015-05-20

    Many volcanic systems around the world are located beneath, or in close proximity to, ice caps. Mass change of these ice caps causes surface movements, which are typically neglected when interpreting surface deformation measurements around these volcanoes. These movements can however be significant, and may closely resemble movements due to magma accumulation. Here we show such an example, from Katla volcano, Iceland. Horizontal movements observed by GPS on the flank of Katla have led to the inference of significant inflow of magma into a chamber beneath the caldera, starting in 2000, and continuing over several years. We use satellite radar interferometry and GPS data to show that between 2001 and 2010, the horizontal movements seen on the flank can be explained by the response to the long term shrinking of ice caps, and that erratic movements seen at stations within the caldera are also not likely to signify magma inflow. It is important that interpretations of geodetic measurements at volcanoes in glaciated areas consider the effect of ice mass change, and previous studies should be carefully reevaluated.

  14. Energy Recovery from Solutions with Different Salinities Based on Swelling and Shrinking of Hydrogels

    KAUST Repository

    Zhu, Xiuping

    2014-06-17

    Several technologies, including pressure-retarded osmosis (PRO), reverse electrodialysis (RED), and capacitive mixing (CapMix), are being developed to recover energy from salinity gradients. Here, we present a new approach to capture salinity gradient energy based on the expansion and contraction properties of poly(acrylic acid) hydrogels. These materials swell in fresh water and shrink in salt water, and thus the expansion can be used to capture energy through mechanical processes. In tests with 0.36 g of hydrogel particles 300 to 600 μm in diameter, 124 mJ of energy was recovered in 1 h (salinity ratio of 100, external load of 210 g, water flow rate of 1 mL/min). Although these energy recovery rates were relatively lower than those typically obtained using PRO, RED, or CapMix, the costs of hydrogels are much lower than those of membranes used in PRO and RED. In addition, fouling might be more easily controlled as the particles can be easily removed from the reactor for cleaning. Further development of the technology and testing of a wider range of conditions should lead to improved energy recoveries and performance. © 2014 American Chemical Society.

  15. On multiple solutions of non-Newtonian Carreau fluid flow over an inclined shrinking sheet

    Science.gov (United States)

    Khan, Masood; Sardar, Humara; Gulzar, M. Mudassar; Alshomrani, Ali Saleh

    2018-03-01

    This paper presents the multiple solutions of a non-Newtonian Carreau fluid flow over a nonlinear inclined shrinking surface in presence of infinite shear rate viscosity. The governing boundary layer equations are derived for the Carreau fluid with infinite shear rate viscosity. The suitable transformations are employed to alter the leading partial differential equations to a set of ordinary differential equations. The consequential non-linear ODEs are solved numerically by an active numerical approach namely Runge-Kutta Fehlberg fourth-fifth order method accompanied by shooting technique. Multiple solutions are presented graphically and results are shown for various physical parameters. It is important to state that the velocity and momentum boundary layer thickness reduce with increasing viscosity ratio parameter in shear thickening fluid while opposite trend is observed for shear thinning fluid. Another important observation is that the wall shear stress is significantly decreased by the viscosity ratio parameter β∗ for the first solution and opposite trend is observed for the second solution.

  16. Energy Recovery from Solutions with Different Salinities Based on Swelling and Shrinking of Hydrogels

    KAUST Repository

    Zhu, Xiuping; Yang, Wulin; Hatzell, Marta C.; Logan, Bruce E.

    2014-01-01

    Several technologies, including pressure-retarded osmosis (PRO), reverse electrodialysis (RED), and capacitive mixing (CapMix), are being developed to recover energy from salinity gradients. Here, we present a new approach to capture salinity gradient energy based on the expansion and contraction properties of poly(acrylic acid) hydrogels. These materials swell in fresh water and shrink in salt water, and thus the expansion can be used to capture energy through mechanical processes. In tests with 0.36 g of hydrogel particles 300 to 600 μm in diameter, 124 mJ of energy was recovered in 1 h (salinity ratio of 100, external load of 210 g, water flow rate of 1 mL/min). Although these energy recovery rates were relatively lower than those typically obtained using PRO, RED, or CapMix, the costs of hydrogels are much lower than those of membranes used in PRO and RED. In addition, fouling might be more easily controlled as the particles can be easily removed from the reactor for cleaning. Further development of the technology and testing of a wider range of conditions should lead to improved energy recoveries and performance. © 2014 American Chemical Society.

  17. Shrinking of Binaries in a WIMPY Background at the Galactic Center

    Science.gov (United States)

    Hills, J. G.

    2001-12-01

    The nature of the dark matter in the Galactic Halo is still not clear. Constraints can be placed on it; e.g., it cannot be in baryons less massive than about 1022 grams (Hills, 1986, Astron. J. 92, 595). It may be in elementary weakly interacting massive particles, WIMPS. Apart from providing most of the mass of the Galaxy, the only known significant dynamical effect of WIMPS is to cause a gradual shrinking of tightly bound binaries (Hills 1983, Astron. J. 88, 1269) as they interact with the background soup of WIMPS. This effect may be observable in binaries close to the Galactic Center if a significant fraction of the mass density near the central black hole is from WIMPS. The requisite binaries would have to have orbital velocities greater than the local velocity dispersion of the WIMPS relative to the binary. The velocity dispersion increases near the black hole. The binary cannot be too close to the black hole or its tidal field will breakup the binary. If the local WIMP density is 107 g/cm3, the fractional rate of reduction in the binary orbital period is about 5 x 10-10/yr for a binary having a semimajor axis equal to 3 solar radii in a soup of WIMPS having a velocity dispersion of 200 km/s relative to the binary. This gradual erosion of the binary period may be detectable, particularly, if one of the binary components is a pulsar.

  18. Collective behaviors of book holding durations

    Science.gov (United States)

    Li, Ren-De; Guo, Qiang; Han, Jing-Ti; Liu, Jian-Guo

    2016-10-01

    Duration can directly reflect the collective reading behaviors of library user book holding. In this paper, by introducing the burstiness and memory coefficients, we empirically investigate the collective book holding behavior of three university libraries. The statistical results show that there are similar properties among the students with different backgrounds, presenting the burstiness = - 0.2 and memory = 0.5 for three datasets, which indicates that memory and random effects coexist in student book holding durations. In addition, we analyze the behavior patterns without duplicate durations by merging a series of books borrowed and returned at the same time. The results show the average burstiness B increases to -0.16 and memory M drops to 0.16 for three datasets, which indicates that both duplicate behavior and student's preference affect the memory effect. Furthermore, we present a model which assumes student's next book holding duration follows the previous one with probability p, and with probability 1 - p, the student would hold the book independently. The experimental results show that the presented model can reproduce the burstiness and memory effect of student book holding durations when p = 0.5 for empirical datasets and p = 0.2 for de-duplicate datasets, which indicate that the student's preferential holding behavior occurs with the probability p. This work helps in deeply understanding the regularity of duration-based human behaviors.

  19. International comparison of the factors influencing reimbursement of targeted anti-cancer drugs.

    Science.gov (United States)

    Lim, Carol Sunghye; Lee, Yun-Gyoo; Koh, Youngil; Heo, Dae Seog

    2014-11-29

    Reimbursement policies for anti-cancer drugs vary among countries even though they rely on the same clinical evidence. We compared the pattern of publicly funded drug programs and analyzed major factors influencing the differences. We investigated reimbursement policies for 19 indications with targeted anti-cancer drugs that are used variably across ten countries. The available incremental cost-effectiveness ratio (ICER) data were retrieved for each indication. Based on the comparison between actual reimbursement decisions and the ICERs, we formulated a reimbursement adequacy index (RAI): calculating the proportion of cost-effective decisions, either reimbursement of cost-effective indications or non-reimbursement of cost-ineffective indications, out of the total number of indications for each country. The relationship between RAI and other indices were analyzed, including governmental dependency on health technology assessment, as well as other parameters for health expenditure. All the data used in this study were gathered from sources publicly available online. Japan and France were the most likely to reimburse indications (16/19), whereas Sweden and the United Kingdom were the least likely to reimburse them (5/19 and 6/19, respectively). Indications with high cost-effectiveness values were more likely to be reimbursed (ρ = -0.68, P = 0.001). The three countries with high RAI scores each had a healthcare system that was financed by general taxation. Although reimbursement policies for anti-cancer drugs vary among countries, we found a strong correlation of reimbursements for those indications with lower ICERs. Countries with healthcare systems financed by general taxation demonstrated greater cost-effectiveness as evidenced by reimbursement decisions of anti-cancer drugs.

  20. Capital cost reimbursement to community hospitals under Federal health insurance programs.

    Science.gov (United States)

    Kinney, E D; Lefkowitz, B

    1982-01-01

    Issues in current capital cost reimbursement to community hospitals by Medicare and Medicaid are described, and options for change analyzed. Major reforms in the way the federal government pays for capital costs--in particular substitution of other methods of payment for existing depreciation reimbursement--could have significant impact on the structure of the health care system and on government expenditures. While such reforms are likely to engender substantial political opposition, they may be facilitated by broader changes in the reimbursement system.

  1. Municipal property acquisition patterns in a shrinking city: Evidence for the persistence of an urban growth paradigm in Buffalo, NY

    Directory of Open Access Journals (Sweden)

    Robert Mark Silverman

    2015-12-01

    Full Text Available The purpose of this article is to examine municipal property acquisition patterns in shrinking cities. We use data from the City of Buffalo’s municipal property auction records to analyze the spatial distribution of properties offered for sale in its annual tax foreclosure auction. In addition to these data, we examine demolition and building permit records. Our analysis suggests that cities like Buffalo follow strategies based on an urban growth paradigm when responding to abandonment. This paradigm operates under the assumption that growth is a constant and urban development is only limited by fiscal constraints, underdeveloped systems of urban governance, environmental degradation, and resistance by anti-growth coalitions. We recommend that planners in shrinking cities de-emphasize growth-based planning and focus on rightsizing strategies. These strategies are based on the assumption that growth is not a constant. Consequently, urban revitalization is concentrated in a smaller urban footprint.

  2. Reimbursed drugs in patients with sleep-disordered breathing: A static-charge-sensitive bed study.

    Science.gov (United States)

    Anttalainen, Ulla; Polo, Olli; Vahlberg, Tero; Saaresranta, Tarja

    2010-01-01

    Co-morbidities in men and women with sleep-disordered breathing (SDB) were compared retrospectively to an age-standardized, general Finnish population. The prevalence of diseases was based on the reimbursement refunds of medications. Two hundred thirty-three age- and BMI-matched male-female pairs and 368 consecutive women identified from our sleep recording database were included. Data on medication were gathered from the National Agency for Medicines and Social Insurance Institution database. Men with SDB had three-fold prevalence of reimbursed medication for diabetes and two-fold prevalence of reimbursed medication for chronic arrhythmia. Women with SDB had three-fold prevalence of reimbursed medication for thyroid insufficiency, and postmenopausal women had two-fold prevalence of reimbursed medication for psychosis. BMI and age did not explain prevalence of reimbursed medications for chronic arrhythmia or psychosis. In both genders with SDB, prevalence of reimbursed medications compared to the general population was two-fold for hypertension and seven-fold for asthma and/or chronic obstructive pulmonary disease (COPD). Partial upper airway obstruction was associated with three-fold prevalence of reimbursed medication for asthma and/or COPD in both genders and 60% reduced prevalence of reimbursed medication for hypertension in females matched for age and BMI. Co-morbidity profile differed between genders. Our results emphasize the importance of diagnosis and treatment of co-morbidities and partial upper airway obstruction. Copyright 2009 Elsevier B.V. All rights reserved.

  3. Changing patient classification system for hospital reimbursement in Romania.

    Science.gov (United States)

    Radu, Ciprian-Paul; Chiriac, Delia Nona; Vladescu, Cristian

    2010-06-01

    To evaluate the effects of the change in the diagnosis-related group (DRG) system on patient morbidity and hospital financial performance in the Romanian public health care system. Three variables were assessed before and after the classification switch in July 2007: clinical outcomes, the case mix index, and hospital budgets, using the database of the National School of Public Health and Health Services Management, which contains data regularly received from hospitals reimbursed through the Romanian DRG scheme (291 in 2009). The lack of a Romanian system for the calculation of cost-weights imposed the necessity to use an imported system, which was criticized by some clinicians for not accurately reflecting resource consumption in Romanian hospitals. The new DRG classification system allowed a more accurate clinical classification. However, it also exposed a lack of physicians' knowledge on diagnosing and coding procedures, which led to incorrect coding. Consequently, the reported hospital morbidity changed after the DRG switch, reflecting an increase in the national case-mix index of 25% in 2009 (compared with 2007). Since hospitals received the same reimbursement over the first two years after the classification switch, the new DRG system led them sometimes to change patients' diagnoses in order to receive more funding. Lack of oversight of hospital coding and reporting to the national reimbursement scheme allowed the increase in the case-mix index. The complexity of the new classification system requires more resources (human and financial), better monitoring and evaluation, and improved legislation in order to achieve better hospital resource allocation and more efficient patient care.

  4. Variation in Health Technology Assessment and Reimbursement Processes in Europe.

    Science.gov (United States)

    Akehurst, Ronald L; Abadie, Eric; Renaudin, Noël; Sarkozy, François

    2017-01-01

    It has been suggested that differences in health technology assessment (HTA) processes among countries, particularly within Europe, have led to inequity in patient access to new medicines. To provide an up-to-date snapshot analysis of the present status of HTA and reimbursement systems in select European countries, and to investigate the implications of these processes, especially with regard to delays in market and patient access. HTA and reimbursement processes were assessed through a review of published and gray literature, and through a series of interviews with HTA experts. To quantify the impact of differences among countries, we conducted case studies of 12 products introduced since 2009, including 10 cancer drugs. In addition to the differences in HTA and reimbursement processes among countries, the influence of particular sources of information differs among HTA bodies. The variation in the time from the authorization by the European Medicines Agency to the publication of HTA decisions was considerable, both within and among countries, with a general lack of transparency as to why some assessments take longer than others. In most countries, market access for oncology products can occur outside the HTA process, with sales often preceding HTA decisions. It is challenging even for those with considerable personal experience in European HTA processes to establish what is really happening in market access for new drugs. We recommend that efforts should be directed toward improving transparency in HTA, which should, in turn, lead to more effective processes. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  5. Reimbursement of care for severe trauma under SwissDRG.

    Science.gov (United States)

    Moos, Rudolf M; Sprengel, Kai; Jensen, Kai Oliver; Jentzsch, Thorsten; Simmen, Hans-Peter; Seifert, Burkhardt; Ciritsis, Bernhard; Neuhaus, Valentin; Volbracht, Jörk; Mehra, Tarun

    2016-01-01

    Treatment of patients with severe injuries is costly, with best results achieved in specialised care centres. However, diagnosis-related group (DRG)-based prospective payment systems have difficulties in depicting treatment costs for specialised care. We analysed reimbursement of care for severe trauma in the first 3 years after the introduction of the Swiss DRG reimbursement system (2012-2014). The study included all patients with solely basic insurance, hospital admission after 01.01.2011 and discharge in 2011 or 2012, who were admitted to the resuscitation room of the University Hospital of Zurich, aged ≥16 years and with an injury severity score (ISS) ≥16 (n = 364). Clinical, financial and administrative data were extracted from the electronic medical records. All cases were grouped into DRGs according to different SwissDRG versions. We considered results to be significant if p ≤0.002. The mean deficit decreased from 12 065 CHF under SwissDRG 1.0 (2012) to 2 902 CHF under SwissDRG 3.0 (2014). The main reason for the reduction of average deficits was a refinement of the DRG algorithm with a regrouping of 23 cases with an ISS ≥16 from MDC 01 to DRGs within MDC21A. Predictors of an increased total loss per case could be identified: for example, high total number of surgical interventions, surgeries on multiple anatomical regions or operations on the pelvis (p ≤0.002). Psychiatric diagnoses in general were also significant predictors of deficit per case (p<0.001). The reimbursement for care of severely injured patients needs further improvement. Cost neutral treatment was not possible under the first three versions of SwissDRG.

  6. Proton Therapy Expansion Under Current United States Reimbursement Models

    Energy Technology Data Exchange (ETDEWEB)

    Kerstiens, John [Indiana University Health Proton Therapy Center, Bloomington, Indiana (United States); Johnstone, Peter A.S., E-mail: pajohnst@iupui.edu [Indiana University Health Proton Therapy Center, Bloomington, Indiana (United States); Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana (United States)

    2014-06-01

    Purpose: To determine whether all the existing and planned proton beam therapy (PBT) centers in the United States can survive on a local patient mix that is dictated by insurers, not by number of patients. Methods and Materials: We determined current and projected cancer rates for 10 major US metropolitan areas. Using published utilization rates, we calculated patient percentages who are candidates for PBT. Then, on the basis of current published insurer coverage policies, we applied our experience of what would be covered to determine the net number of patients for whom reimbursement is expected. Having determined the net number of covered patients, we applied our average beam delivery times to determine the total number of minutes needed to treat that patient over the course of their treatment. We then calculated our expected annual patient capacity per treatment room to determine the appropriate number of treatment rooms for the area. Results: The population of patients who will be both PBT candidates and will have treatments reimbursed by insurance is significantly smaller than the population who should receive PBT. Coverage decisions made by insurers reduce the number of PBT rooms that are economically viable. Conclusions: The expansion of PBT centers in the US is not sustainable under the current reimbursement model. Viability of new centers will be limited to those operating in larger regional metropolitan areas, and few metropolitan areas in the US can support multiple centers. In general, 1-room centers require captive (non–PBT-served) populations of approximately 1,000,000 lives to be economically viable, and a large center will require a population of >4,000,000 lives. In areas with smaller populations or where or a PBT center already exists, new centers require subsidy.

  7. Shrinking windows of opportunity for oak seedling establishment in southern California mountains

    Science.gov (United States)

    Davis, Frank W.; Sweet, Lynn C.; Serra-Diaz, Josep M.; Franklin, Janet; McCullough, Ian M.; Flint, Alan L.; Flint, Lorraine E.; Dingman, John; Regan, Helen M.; Syphard, Alexandra D.; Hannah, Lee; Redmond, Kelly; Moritz, Max A.

    2016-01-01

    Seedling establishment is a critical step that may ultimately govern tree species’ distribution shifts under environmental change. Annual variation in the location of seed rain and microclimates results in transient “windows of opportunity” for tree seedling establishment across the landscape. These establishment windows vary at fine spatiotemporal scales that are not considered in most assessments of climate change impacts on tree species range dynamics and habitat displacement. We integrate field seedling establishment trials conducted in the southern Sierra Nevada and western Tehachapi Mountains of southern California with spatially downscaled grids of modeled water-year climatic water deficit (CWDwy) and mean August maximum daily temperature (Tmax) to map historical and projected future microclimates suitable for establishment windows of opportunity for Quercus douglasii, a dominant tree species of warm, dry foothill woodlands, and Q. kelloggii, a dominant of cooler, more mesic montane woodlands and forests. Based on quasi-binomial regression models, Q. douglasii seedling establishment is significantly associated with modeled CWDwy and to a lesser degree with modeled Tmax. Q. kelloggii seedling establishment is most strongly associated with Tmax and best predicted by a two-factor model including CWDwy and Tmax. Establishment niche models are applied to explore recruitment window dynamics in the western Tehachapi Mountains, where these species are currently widespread canopy dominants. Establishment windows are projected to decrease by 50–95%, shrinking locally to higher elevations and north-facing slopes by the end of this century depending on the species and climate scenario. These decreases in establishment windows suggest the potential for longer-term regional population declines of the species. While many additional processes regulate seedling establishment and growth, this study highlights the need to account for topoclimatic controls and

  8. Shrinking ponds in subarctic Alaska based on 1950-2002 remotely sensed images

    Science.gov (United States)

    Riordan, B.; Verbyla, D.; McGuire, A.D.

    2006-01-01

    Over the past 50 years, Alaska has experienced a warming climate with longer growing seasons, increased potential evapotranspiration, and permafrost warming. Research from the Seward Peninsula and Kenai Peninsula has demonstrated a substantial landscape-level trend in the reduction of surface water and number of closed-basin ponds. We investigated whether this drying trend occurred at nine other regions throughout Alaska. One study region was from the Arctic Coastal Plain where depp permafrost occurs continuously across the landscape. The other eight study regions were from the boreal forest regions where discontinuous permafrost occurs. Mean annual precipitation across the study regions ranged from 100 to over 700 min yr-1. We used remotely sensed imagery from the 1950s to 2002 to inventory over 10,000 closed-basin ponds from at least three periods from this time span. We found a reduction in the area and number of shallow, closed-basin ponds for all boreal regions. In contrast, the Arctic Coastal Plain region had negligible change in the area of closed-basin ponds. Since the 1950s, surface water area of closed-basin ponds included in this analysis decreased by 31 to 4 percent, and the total number of closed-basin ponds surveyed within each study region decreased from 54 to 5 percent. There was a significant increasing trend in annual mean temperature and potential evapotranspiration since the 1950s for all study regions. There was no significant trend in annual precipitation during the same period. The regional trend of shrinking ponds may be due to increased drainage as permafrost warms, or increased evapotranspiration during a warmer and extended growing season. Copyright 2006 by the American Geophysical Union.

  9. Comments on Hanford 2012 Accelerating Clean Up and Shrinking the Site

    International Nuclear Information System (INIS)

    SHERMAN, Y.T.

    2001-01-01

    In the late summer of 2000, the Department of Energy Richland Operations Office (RL) Manager, Keith Klein, announced his approach to cleanup of the Hanford Site in a document called ''Done in a Decade.'' He asked for comments and suggestions to improve the plan from employees and stakeholders. We received over 300 individual comments. Several of the comments and the Hanford Advisory Board objected to the title of the plan, leading us to change it to ''Hanford 2012 Accelerating Cleanup and Shrinking the Site.'' We addressed virtually all substantive comments, i.e. those that recommended a change in the text, better understanding of an Issue, or consideration of a new Mea, and incorporated editorial comments where appropriate. We thank all those who took time to comment. The new plan, ''Hanford 2012'', is a much better document because you did so. You will notice some things about the table: Comments are not quoted verbatim--most were paraphrased to conserve space; Comments were separated into one of four sections: general, the River, the Plateau, the Future; Commenters are not identified by name or organization; Comments are generally listed in the order in which they were received, several comments were repetitive, but differed slightly so we made an effort to respond to each one, despite apparent repetition; There are many acronyms used at the Hanford Site, most of which can be found on the Web at http:/Ewww.hanford.gov/acronyml. We have attempted to spell out each acronym the first time it's used in a comment/response with the following exceptions: DOE--Department of Energy; RL--Department of Energy, Richland Operations Office; and ORP--Department of Energy, Office of River Protection

  10. An examination of the shrinking-core model of sub-micron aluminum combustion

    Science.gov (United States)

    Buckmaster, John; Jackson, Thomas L.

    2013-04-01

    We revisit the shrinking-core model of sub-micron aluminum combustion with particular attention to the mass flux balance at the reaction front which necessarily leads to a displacement velocity of the alumina shell surrounding the liquid aluminum. For the planar problem this displacement simply leads to an equal displacement of the entire alumina layer, and therefore a straightforward mathematical framework can be constructed. In this way we are able to construct a single curve which defines the burn time for arbitrary values of the diffusion coefficient of O atoms, the reaction rate, the characteristic length of the combustion field, and the O atom mass concentration within the alumina provided that it is much smaller than the aluminum density. This demonstrates a transition between a 'd 2-t' law for fast chemistry and a 'd-t' law for slow chemistry. For the spherical geometry, the one of physical interest, the outward displacement velocity creates not a simple displacement, but a stress field which, when examined within the framework of linear elasticity, strongly suggests the creation of internal cracking. We note that if the molten aluminum is pushed into these cracks by the high internal pressure characteristic of the stress field, its surface, where reaction occurs, could be fractal in nature and affect the fundamental nature of the burning law. Indeed, if this ingredient is added to the planar model, a single curve for the burn time can again be derived, and this describes a transition from a 'd 2-t' law to a 'd ν-t' law, where 0<ν<1.

  11. Effect of irradiation on the properties of some shrinking polymer films

    International Nuclear Information System (INIS)

    Varsanyi, E.

    1974-01-01

    Shrinking polymer films (polyethylene, polyvinylidene chloride, polyester) suitable for use in the food industry were studied with the intention to determine the effect of radurizing doses (800 krad and below) on changes in the proportion of crystalline parts in the polymer, and on the tensile strength, elongation at break and shrinkage of the film. Changes in the crystalline/amorphous ratio in the polymer were determined by means of infra-red spectrophotometry. Calculations based on spectral data showed no significant changes in the ratio of crystalline fraction of any of the films, as a function of radurizing doses. Tensile strength and elongation at break tests were carried out by means of standardized instruments and methods. It was found that the tensile strength of the polyethylene film decreased by about 25% as an effect of irradiation, while the same treatment caused no significant changes in the elongation at break. The tensile strength of the polyvinylidene chloride film suffered a decrease of roughly 15%, its elongation at break an about 30% decrease when irradiated. Radiation treatment caused a decrease if less than 10% in tensile strength of the polyester film and a more than 10% change in elongation at break. The tests indicated no significant changes in the shrinkage of radiation treated polymers. The results of the tests led to the conclusion that radurizing doses caused no such change which would affect the applicability of polymer films to the wrapping and packaging of foods subjected to irradiation or would make the films unsuitable for the protection of the goods. (F.J.)

  12. Nattokinase, profibrinolytic enzyme, effectively shrinks the nasal polyp tissue and decreases viscosity of mucus.

    Science.gov (United States)

    Takabayashi, Tetsuji; Imoto, Yoshimasa; Sakashita, Masafumi; Kato, Yukinori; Tokunaga, Takahiro; Yoshida, Kanako; Narita, Norihiko; Ishizuka, Tamotsu; Fujieda, Shigeharu

    2017-10-01

    Chronic rhinosinusitis with nasal polyps (CRSwNP) is often comorbid with asthma and resistant to therapeutic interventions. We recently reported that excessive fibrin deposition caused by impairment of fibrinolysis might play pivotal role in forming nasal polyp. Nattokinase (NK), a serine protease produced by Bacillus subtilis, has been reported to be a strong fibrinolytic enzyme. NK could be a promising drug candidate for use in the treatment of both CRSwNP and asthma. The objective of this study was to investigate the effects of NK on nasal polyp tissues from patients with CRSwNP. The nasal discharge from patients with CRSwNP and sputum from subjects with asthma were also used to investigate whether NK influences the viscosity of mucus. To examine the effects on NK on nasal polyp tissues, pieces of nasal polyps were incubated either with saline or NK (10-1000 FU/ml) at 37 °C for 24 h. We assessed the presence of fibrin in nasal polyp tissue incubated with NK by means of immunohistochemistry. To examine the effects of NK on nasal discharge and sputum from patients with CRSwNP and asthma, respectively, were incubated with NK solution at 37 °C for 1 h. NK effectively shrinks the nasal polyp tissue through fibrin degradation. We also found that the viscosity of the nasal discharge and sputum from patients with CRSwNP and asthma, respectively, was significantly reduced by incubation with NK solution. NK may be an effective alternative therapeutic option in patients with CRSwNP and comorbid asthma by causing fibrin degradation. Copyright © 2017 Japanese Society of Allergology. Production and hosting by Elsevier B.V. All rights reserved.

  13. Heat-shrink tubing as a solid-phase microextraction coating for the enrichment and determination of phthalic acid esters.

    Science.gov (United States)

    Luo, Xi; He, Chengxia; Zhang, Feifang; Wang, Hailong; Yang, Bingcheng; Liang, Xinmiao

    2014-12-01

    Heat-shrink tubing, which shrinks in one plane only (its diameter) when heated, commonly used for sealing protection in electrical engineering, was found to be able to function as a solid-phase microextraction coating. Its utility was demonstrated for the determination of phthalic acid esters in an aqueous solution combined with high-performance liquid chromatography equipped with a UV absorbance detector. The preparation procedure was rather simple and only ∼10 min was needed. The fiber cost is extremely low (∼10 cent each). The parameters affecting the extraction were optimized. Heat-shrink tubing fiber exhibited a significant enrichment effect for the three examined phthalic acid esters and up to 931-fold enrichment factor was obtained. The limit of detection was <10 μg/L for all analytes. The operation repeatability and fiber-to-fiber reproducibility were 1.2-8.3 and 5.4-9.1%, respectively. It was successfully applied for the analysis of bottled drinking water with recoveries ranging from 90.1-100.5%. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  14. Heat shrink ability of electron-beam-modified thermoplastic elastomeric films from blends of ethylene-vinylacetate copolymer and polyethylene

    International Nuclear Information System (INIS)

    Chattopadhyay, S.; Chaki, T.K.; Bhowmick, Anil K.

    2000-01-01

    The heat shrink ability of electron-beam-irradiated thermoplastic elastomeric films from blends of ethylene-vinylacetate copolymer (EVA) and low-density polyethylene (LDPE) has been investigated in this paper. The effects of temperature, time and extent of stretching and shrinkage temperature and time have been reported. Based on the above data, the optimized conditions in terms of high heat shrinkage and low amnesia rating have been evaluated. Influence of radiation doses (0-500 kGy), multifunctional sensitizer levels (ditri methylol propane tetraacrylate, DTMPTA), and blend proportions on heat shrink ability has been explained with the help of gel fraction and X-ray data. With the increase in radiation dose, gel fraction increases, which in turn gives rise to low values of heat shrinkage and amnesia rating. At a constant radiation dose and blend ratio, percent heat shrinkage is found to decrease with increase in DTMPTA level. Gel content increases with the increase in EVA content of the blend at a constant radiation dose and monomer level, giving rise to decrease in heat shrink ability. Heat shrinkage increases with the increase in percent crystallinity, although the amnesia rating follows the reverse trend.

  15. Heat shrink ability of electron-beam-modified thermoplastic elastomeric films from blends of ethylene-vinylacetate copolymer and polyethylene

    Energy Technology Data Exchange (ETDEWEB)

    Chattopadhyay, S.; Chaki, T.K.; Bhowmick, Anil K. E-mail: anilkb@rtc.iitkgp.ernet.in

    2000-11-01

    The heat shrink ability of electron-beam-irradiated thermoplastic elastomeric films from blends of ethylene-vinylacetate copolymer (EVA) and low-density polyethylene (LDPE) has been investigated in this paper. The effects of temperature, time and extent of stretching and shrinkage temperature and time have been reported. Based on the above data, the optimized conditions in terms of high heat shrinkage and low amnesia rating have been evaluated. Influence of radiation doses (0-500 kGy), multifunctional sensitizer levels (ditri methylol propane tetraacrylate, DTMPTA), and blend proportions on heat shrink ability has been explained with the help of gel fraction and X-ray data. With the increase in radiation dose, gel fraction increases, which in turn gives rise to low values of heat shrinkage and amnesia rating. At a constant radiation dose and blend ratio, percent heat shrinkage is found to decrease with increase in DTMPTA level. Gel content increases with the increase in EVA content of the blend at a constant radiation dose and monomer level, giving rise to decrease in heat shrink ability. Heat shrinkage increases with the increase in percent crystallinity, although the amnesia rating follows the reverse trend.

  16. The science of shrinking human heads: tribal warfare and revenge among the South American Jivaro-Shuar.

    Science.gov (United States)

    Jandial, Rahul; Hughes, Samuel A; Aryan, Henry E; Marshall, Lawrence F; Levy, Michael L

    2004-11-01

    THE PRACTICE OF "head-shrinking" has been the proper domain not of Africa but rather of the denizens of South America. Specifically, in the post-Columbian period, it has been most famously the practice of a tribe of indigenous people commonly called the Jivaro or Jivaro-Shuar. The evidence suggests that the Jivaro-Shuar are merely the last group to retain a custom widespread in northwestern South America. In both ceramic and textile art of the pre-Columbian residents of Peru, the motif of trophy heads smaller than normal life-size heads commonly recurs; the motif is seen even in surviving carvings in stone and shell. Moreover, although not true shrunken heads, trophy heads found in late pre-Columbian and even post-Columbian graves of the region demonstrate techniques of display very similar to those used by the Jivaro-Shuar, at least some of which are best understood in the context of head-shrinking. Regardless, the Jivaro-Shuar and their practices provide an illustrative counterexample to popular myth regarding the culture and science of the shrinking of human heads.

  17. SOCIAL ACCOUNTING ASPECTS IN THE PREUNIVERSITY LEVEL REIMBURSEMENT OF STUDENTS

    Directory of Open Access Journals (Sweden)

    CENAR IULIANA

    2016-12-01

    Full Text Available The specific accounting approaches in preuniversity accounting are reduced, including the segment accounted for the reimbursementof students travel expenses and other benefits. This paper aims to outline an image of the social aspects of education in the preuniversity public education, represented by reimbursement to the beneficiaries of education, how they are reflected in accounting through the budget classification and disclosed to users via public media. Specifically, our approach refers to scholarships provided by the local administration to support learning, professionalscholarships, as well as various support programs for students who come from families with material difficulties, whose financial backer is the state through school inspectorates.

  18. Hospital payroll costs, productivity, and employment under prospective reimbursement.

    Science.gov (United States)

    Kidder, D; Sullivan, D

    1982-12-01

    This paper reports preliminary findings from the National Hospital Rate-Setting Study regarding the effects of State prospective reimbursement (PR) programs on measures of payroll costs and employment in hospitals. PR effects were estimated through reduced-form equations, using American Hospital Association Annual Survey data on over 2,700 hospitals from 1969 through 1978. These tests suggest that hospitals responded to PR by lowering payroll expenditures. PR also seems to have been associated with reductions in full-time equivalent staff per adjusted inpatient day. However, tests did not confirm the hypothesis that hospitals reduce payroll per full-time equivalent staff as a result of PR.

  19. Reimbursement of pharmaceuticals: reference pricing versus health technology assessment.

    Science.gov (United States)

    Drummond, Michael; Jönsson, Bengt; Rutten, Frans; Stargardt, Tom

    2011-06-01

    Reference pricing and health technology assessment are policies commonly applied in order to obtain more value for money from pharmaceuticals. This study focussed on decisions about the initial price and reimbursement status of innovative drugs and discussed the consequences for market access and cost. Four countries were studied: Germany, The Netherlands, Sweden and the United Kingdom. These countries have operated one, or both, of the two policies at certain points in time, sometimes in parallel. Drugs in four groups were considered: cholesterol-lowering agents, insulin analogues, biologic drugs for rheumatoid arthritis and "atypical" drugs for schizophrenia. Compared with HTA, reference pricing is a relatively blunt instrument for obtaining value for money from pharmaceuticals. Thus, its role in making reimbursement decisions should be limited to drugs which are therapeutically equivalent. HTA is a superior strategy for obtaining value for money because it addresses not only price but also the appropriate indications for the use of the drug and the relation between additional value and additional costs. However, given the relatively higher costs of conducting HTAs, the most efficient approach might be a combination of both policies.

  20. Did recent changes in Medicare reimbursement hit teaching hospitals harder?

    Science.gov (United States)

    Konetzka, R Tamara; Zhu, Jingsan; Volpp, Kevin G

    2005-11-01

    To inform the policy debate on Medicare reimbursement by examining the financial effects of the Balanced Budget Act of 1997 (BBA) and subsequent adjustments on major academic medical centers, minor teaching hospitals, and nonteaching hospitals. The authors simulated the impacts of BBA and subsequent BBA adjustments to predict the independent effects of changes in Medicare reimbursement on hospital revenues using 1997-2001 Medicare Cost Reports for all short-term acute-care hospitals in the United States. The authors also calculated actual (nonsimulated) operating and total margins among major teaching, minor teaching, and nonteaching hospitals to account for hospital response to the changes. The BBA and subsequent refinements reduced Medicare revenues to a greater degree in major teaching hospitals, but the fact that such hospitals had a smaller proportion of Medicare patients meant that the BBA reduced overall revenues by similar percentages across major, minor, and nonteaching hospitals. Consistently lower margins may have made teaching hospitals more vulnerable to cuts in Medicare support. Recent Medicare changes affected revenues at teaching and nonteaching hospitals more similarly than is commonly believed. However, the Medicare cuts under the BBA probably exacerbated preexisting financial strain on major teaching hospitals, and increased Medicare funding may not suffice to eliminate the strain. This report's findings are consistent with recent calls to support needed services of teaching hospitals through all-payer or general funds.

  1. Mass media constructions of 'socio-psychological epidemics' in sub-Saharan Africa: The case of genital shrinking in 11 countries.

    Science.gov (United States)

    de-Graft Aikins, Ama; Dzokoto, Vivian A; Yevak, Earl

    2015-11-01

    Genital shrinking is a recurring phenomenon with about 180 reported cases in sub-Saharan Africa over the last two decades. Transcending national boundaries, it results in distress for victims, mob violence against accused perpetrators and mass panic which law enforcement agencies struggle to contain. This article examines mass media construction and framing of genital shrinking within a social representations theory framework. Our analysis suggests the following: (1) mass media reports are informed by lay and expert perspectives; (2) three stocks of knowledge are drawn on interchangeably, with culture constituting a core representation; (3) lay and expert perspectives overlap on cultural and common-sense explanations of genital shrinking; and (4) scientific explanations are limited to individual pathophysiology and psychopathology and do not inform public opinion. We consider the implications of understanding genital shrinking for improving mass media constructions and dissemination of information on 'socio-psychological epidemics' that may have scientific explanations. © The Author(s) 2015.

  2. [Reimbursement of opiate substitution drugs to militaries in 2007].

    Science.gov (United States)

    d'Argouges, F; Desjeux, G; Marsan, P; Thevenin-Garron, V

    2012-09-01

    The use of psychoactive drugs by militaries is not compatible with the analytical skills and self-control required by their jobs. Military physicians take this problem into consideration by organising systematic drugs screening in the French forces. However, for technical reasons, opiates are not concerned by this screening with the agreement of the people concerned. The estimated number of militaries who use an opiate substitute may be an approach of heroin consumption in the French forces. This study describes buprenorphine and methadone reimbursements made during 2007 by the national military healthcare centre to French militaries. Each French soldier is affiliated to a special health insurance. The national military healthcare centre has in its information system, all the data concerning drug reimbursement made to French military personnel. This is a retrospective study of buprenorphine and methadone reimbursements made during 2007 by the military healthcare centre, to militaries from the three sectors of the French forces, and from the gendarmerie and joint forces. Only one reimbursement of one of these two drugs during this period allowed the patient to be included in our study. Daily drug dose and treatment steadiness profile have been calculated according to the criteria of the French monitoring centre for drugs and drug addiction. The criteria of the National guidelines against frauds have been used to identify misuse of these drugs. Doctors' shopping behaviour has also been studied. Finally, the nature of the prescriber and the consumption of other drugs in combination with opiate substitute have been analysed. One hundred and eighty-one military consumers of opiate substitute drugs (167 men and 14 women) participated. This sample included people from the three sectors of the French forces as well as from the gendarmerie and from the joint forces. The average age of the consumers was 26.6 years (20-42 years). The average length of service was 6.1 years

  3. 42 CFR 489.34 - Allowable charges: Hospitals participating in State reimbursement control systems or...

    Science.gov (United States)

    2010-10-01

    ... reimbursement control systems or demonstration projects. 489.34 Section 489.34 Public Health CENTERS FOR... CERTIFICATION PROVIDER AGREEMENTS AND SUPPLIER APPROVAL Allowable Charges § 489.34 Allowable charges: Hospitals participating in State reimbursement control systems or demonstration projects. A hospital receiving payment for...

  4. Recruitment in a Monopsonistic Labour Market: Will Travel Costs be reimbursed?

    NARCIS (Netherlands)

    Rouwendal, Jan; Ommeren, van Jos

    2007-01-01

    Reimbursement of commuting costs by employers has attracted little attention from economists. We develop a theoretical model of a monopsonistic employer who determines an optimal recruitment policy in a spatial labour market with search frictions and show that partial reimbursement of commuting cost

  5. 42 CFR 403.822 - Reimbursement of transitional assistance and associated sponsor requirements.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Reimbursement of transitional assistance and associated sponsor requirements. 403.822 Section 403.822 Public Health CENTERS FOR MEDICARE & MEDICAID... Prescription Drug Discount Card and Transitional Assistance Program § 403.822 Reimbursement of transitional...

  6. 48 CFR 228.307 - Insurance under cost-reimbursement contracts.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Insurance under cost-reimbursement contracts. 228.307 Section 228.307 Federal Acquisition Regulations System DEFENSE ACQUISITION....307 Insurance under cost-reimbursement contracts. ...

  7. 48 CFR 53.301-1437 - Settlement Proposal for Cost-Reimbursement Type Contracts.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 2 2010-10-01 2010-10-01 false Settlement Proposal for Cost-Reimbursement Type Contracts. 53.301-1437 Section 53.301-1437 Federal Acquisition Regulations...-1437 Settlement Proposal for Cost-Reimbursement Type Contracts. ER09DE97.012 [62 FR 64951, Dec. 9, 1997] ...

  8. 48 CFR 2052.215-78 - Travel approvals and reimbursement-Alternate 1.

    Science.gov (United States)

    2010-10-01

    ... reimbursement-Alternate 1. 2052.215-78 Section 2052.215-78 Federal Acquisition Regulations System NUCLEAR... Clauses 2052.215-78 Travel approvals and reimbursement—Alternate 1. As prescribed in 2015.209-70(d), the contracting officer shall insert the following clause in cost reimbursement solicitations and contracts which...

  9. 42 CFR 447.257 - FFP: Conditions relating to institutional reimbursement.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false FFP: Conditions relating to institutional reimbursement. 447.257 Section 447.257 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF...: Conditions relating to institutional reimbursement. FFP is not available for a State's expenditures for...

  10. 48 CFR 245.608-7 - Reimbursement of cost for transfer of contractor inventory.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Reimbursement of cost for transfer of contractor inventory. 245.608-7 Section 245.608-7 Federal Acquisition Regulations System... Reporting, Redistribution, and Disposal of Contractor Inventory 245.608-7 Reimbursement of cost for transfer...

  11. 48 CFR 3028.307 - Insurance under cost-reimbursement contracts.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 7 2010-10-01 2010-10-01 false Insurance under cost-reimbursement contracts. 3028.307 Section 3028.307 Federal Acquisition Regulations System DEPARTMENT OF HOMELAND... Insurance 3028.307 Insurance under cost-reimbursement contracts. ...

  12. 78 FR 40507 - Appendix B Guidelines for Reviewing Applications for Compensation and Reimbursement of Expenses...

    Science.gov (United States)

    2013-07-05

    ... DEPARTMENT OF JUSTICE Appendix B Guidelines for Reviewing Applications for Compensation and Reimbursement of Expenses Filed Under United States Code by Attorneys in Larger Chapter 11 Cases; Correction... reviewing applications for compensation and reimbursement of expenses filed by attorneys in larger chapter...

  13. 78 FR 56719 - Challenging Regulatory and Reimbursement Paradigms for Medical Devices in the Treatment of...

    Science.gov (United States)

    2013-09-13

    ...] Challenging Regulatory and Reimbursement Paradigms for Medical Devices in the Treatment of Metabolic Diseases... announcing a public workshop entitled ``Changing Regulatory and Reimbursement Paradigms for Medical Devices... registration information on the AGA Web site. If you need special accommodations due to a disability, please...

  14. 78 FR 69694 - Changing Regulatory and Reimbursement Paradigms for Medical Devices in the Treatment of Obesity...

    Science.gov (United States)

    2013-11-20

    ...] Changing Regulatory and Reimbursement Paradigms for Medical Devices in the Treatment of Obesity and... Administration (FDA) is announcing a public workshop entitled ``Changing Regulatory and Reimbursement Paradigms... information on the AGA Web site. If you need special accommodations due to a disability, please contact...

  15. Primary Care Physician and Patient Perceptions of Reimbursement for Total Knee and Hip Replacement.

    Science.gov (United States)

    Wiznia, Daniel H; Kim, Chang-Yeon; Wang, Yuexin; Swami, Nishwant; Pelker, Richard R

    2016-07-01

    The opinions of nonspecialists and patients will be important to determining reimbursements for specialists such as orthopedic surgeons. In addition, primary care physician (PCP) perceptions of reimbursements may affect utilization of orthopedic services. We distributed a web-based survey to PCPs, asking how much they believed orthopedic surgeons were reimbursed for total hip arthroplasty (THA) and total knee arthroplasty (TKA). We also proctored a paper-based survey to postoperative patients, asking how much orthopedic surgeons should be reimbursed. There was a significant difference between perceived and actual reimbursement values for THA and TKA. Hospital-affiliated PCPs estimated higher reimbursements for both THA ($1657 vs $838, P < .0001 for Medicaid and $2246 vs $1515, P = .018 for Medicare) and TKA ($1260 vs $903, P = .052 for Medicaid and $2022 vs $1514, P = .049 for Medicare). Similarly, larger practices estimated higher reimbursements for both THA ($1861 vs $838, P < .0001 for Medicaid and $2635 vs $1515, P = .004 for Medicare) and TKA ($1583 vs $903, P = .005 for Medicaid and $2380 vs $1514, P = .011 for Medicare). Compared to PCPs, patients estimated that orthopedic surgeons should be paid 4 times higher for both THA ($9787 vs $2235, P < .0001) and TKA ($9088 vs $2134, P < .0001). PCPs believe that reimbursements for orthopedic procedures are higher than actual values. The effect that these perceptions will have on efforts at cost reform and utilization of orthopedic services requires further study. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. 76 FR 73020 - Agency Information Collection (Request for Transportation Expense Reimbursement): Activity Under...

    Science.gov (United States)

    2011-11-28

    ... for Transportation Expense Reimbursement): Activity Under OMB Review AGENCY: Veterans Benefits... for Transportation Expense Reimbursement (38 CFR 21.8370). OMB Control Number: 2900-0580. Type of... transportation expenses. To be eligible, the child must provide supportive documentation of actual expenses...

  17. Does imminent threat capture and hold attention?

    Science.gov (United States)

    Koster, Ernst H W; Crombez, Geert; Van Damme, Stefaan; Verschuere, Bruno; De Houwer, Jan

    2004-09-01

    According to models of attention and emotion, threat captures and holds attention. In behavioral tasks, robust evidence has been found for attentional holding but not for attentional capture by threat. An important explanation for the absence of attentional capture effects is that the visual stimuli used posed no genuine threat. The present study investigated whether visual cues that signal an aversive white noise can elicit attentional capture and holding effects. Cues presented in an attentional task were simultaneously provided with a threat value through an aversive conditioning procedure. Response latencies showed that threatening cues captured and held attention. These results support recent views on attention to threat, proposing that imminent threat captures attention in everyone. (c) 2004 APA, all rights reserved

  18. 48 CFR 1428.311 - Solicitation provision and contract clause on liability insurance under cost-reimbursement...

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Solicitation provision and contract clause on liability insurance under cost-reimbursement contracts. 1428.311 Section 1428.311... under cost-reimbursement contracts. ...

  19. 48 CFR 528.311 - Solicitation provision and contract clause on liability insurance under cost-reimbursement...

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Solicitation provision and contract clause on liability insurance under cost-reimbursement contracts. 528.311 Section 528.311 Federal...-reimbursement contracts. ...

  20. 48 CFR 28.311 - Solicitation provision and contract clause on liability insurance under cost-reimbursement...

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Solicitation provision and contract clause on liability insurance under cost-reimbursement contracts. 28.311 Section 28.311 Federal...-reimbursement contracts. ...

  1. Shrink-induced graphene sensor for alpha-fetoprotein detection with low-cost self-assembly and label-free assay

    Science.gov (United States)

    Sando, Shota; Zhang, Bo; Cui, Tianhong

    2017-12-01

    Combination of shrink induced nano-composites technique and layer-by-layer (LbL) self-assembled graphene challenges controlling surface morphology. Adjusting shrink temperature achieves tunability on graphene surface morphology on shape memory polymers, and it promises to be an alternative in fields of high-surface-area conductors and molecular detection. In this study, self-assembled graphene on a shrink polymer substrate exhibits nanowrinkles after heating. Induced nanowrinkles on graphene with different shrink temperature shows distinct surface roughness and wettability. As a result, it becomes more hydrophilic with higher shrink temperatures. The tunable wettability promises to be utilized in, for example, microfluidic devices. The graphene on shrink polymer also exhibits capability of being used in sensing applications for pH and alpha-fetoprotein (AFP) detection with advantages of label free and low cost, due to self-assembly technique, easy functionalization, and antigen-antibody reaction on graphene surface. The detection limit of AFP detection is down to 1 pg/mL, and therefore the sensor also has a significant potential for biosensing as it relies on low-cost self-assembly and label-free assay.

  2. 12 CFR Appendix E to Part 360 - Hold File Structure

    Science.gov (United States)

    2010-01-01

    ... ReasonReason for the hold. Possible values are: Character (2). • LN = Loan Collateral Hold • LG = Court... structure of the data file to provide information to the FDIC for each legal or collateral hold placed on a...

  3. The Status of Billing and Reimbursement in Pediatric Obesity Treatment Programs

    Science.gov (United States)

    Gray, Jane Simpson; Filigno, Stephanie Spear; Santos, Melissa; Ward, Wendy L.; Davis, Ann M.

    2014-01-01

    Pediatric psychologists provide behavioral health services to children and adolescents diagnosed with medical conditions. Billing and reimbursement have been problematic throughout the history of pediatric psychology, and pediatric obesity is no exception. The challenges and practices of pediatric psychologists working with obesity are not well understood. Health and behavior codes were developed as one potential solution to aid in the reimbursement of pediatric psychologists who treat the behavioral health needs of children with medical conditions. This commentary discusses the current state of billing and reimbursement in pediatric obesity treatment programs and presents themes that have emerged from discussions with colleagues. These themes include variability in billing practices from program to program, challenges with specific billing codes, variability in reimbursement from state to state and insurance plan to insurance plan, and a general lack of practitioner awareness of code issues or reimbursement rates. Implications and future directions are discussed in terms of research, training, and clinical service. PMID:23224661

  4. The status of billing and reimbursement in pediatric obesity treatment programs.

    Science.gov (United States)

    Gray, Jane Simpson; Spear Filigno, Stephanie; Santos, Melissa; Ward, Wendy L; Davis, Ann M

    2013-07-01

    Pediatric psychologists provide behavioral health services to children and adolescents diagnosed with medical conditions. Billing and reimbursement have been problematic throughout the history of pediatric psychology, and pediatric obesity is no exception. The challenges and practices of pediatric psychologists working with obesity are not well understood. Health and behavior codes were developed as one potential solution to aid in the reimbursement of pediatric psychologists who treat the behavioral health needs of children with medical conditions. This commentary discusses the current state of billing and reimbursement in pediatric obesity treatment programs and presents themes that have emerged from discussions with colleagues. These themes include variability in billing practices from program to program, challenges with specific billing codes, variability in reimbursement from state to state and insurance plan to insurance plan, and a general lack of practitioner awareness of code issues or reimbursement rates. Implications and future directions are discussed in terms of research, training, and clinical service.

  5. Cash Holdings and Mutual Fund Performance

    OpenAIRE

    Mikhail Simutin

    2014-01-01

    Cash holdings of equity mutual funds impose a drag on fund performance but also allow managers to make quick investments in attractive stocks and satisfy outflows without costly fire sales. This article shows that actively managed equity funds with high abnormal cash—that is, with cash holdings in excess of the level predicted by fund attributes—outperform their low abnormal cash peers by over 2% per year. Managers carrying high abnormal cash compensate for the low return on cash by making su...

  6. Equal work for unequal pay: the gender reimbursement gap for healthcare providers in the United States.

    Science.gov (United States)

    Desai, Tejas; Ali, Sadeem; Fang, Xiangming; Thompson, Wanda; Jawa, Pankaj; Vachharajani, Tushar

    2016-10-01

    Gender disparities in income continue to exist, and many studies have quantified the gap between male and female workers. These studies paint an incomplete picture of gender income disparity because of their reliance on notoriously inaccurate or incomplete surveys. We quantified gender reimbursement disparity between female and male healthcare providers using objective, non-self-reported data and attempted to adjust the disparity against commonly held beliefs as to why it exists. We analysed over three million publicly available Medicare reimbursement claims for calendar year 2012 and compared the reimbursements received by male and female healthcare providers in 13 medical specialties. We adjusted these reimbursement totals against how hard providers worked, how productive each provider was, and their level of experience. We calculated a reimbursement differential between male and female providers by primary medical specialty. The overall adjusted reimbursement differential against female providers was -US$18 677.23 (95% CI -US$19 301.94 to -US$18 052.53). All 13 specialties displayed a negative reimbursement differential against female providers. Only two specialties had reimbursement differentials that were not statistically significant. After adjustment for how hard a physician works, his/her years of experience and his/her productivity, female healthcare providers are still reimbursed less than male providers. Using objective, non-survey data will provide a more accurate understanding of this reimbursement inequity and perhaps lead the medical profession (as a whole) towards a solution that can reverse this decades-old injustice. 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/

  7. Medicare payment data for spine reimbursement; important but flawed data for evaluating utilization of resources.

    Science.gov (United States)

    Menger, Richard P; Wolf, Michael E; Kukreja, Sunil; Sin, Anthony; Nanda, Anil

    2015-01-01

    Medicare data showing physician-specific reimbursement for 2012 were recently made public in the mainstream media. Given the ongoing interest in containing healthcare costs, we analyze these data in the context of the delivery of spinal surgery. Demographics of 206 leading surgeons were extracted including state, geographic area, residency training program, fellowship training, and academic affiliation. Using current procedural terminology (CPT) codes, information was evaluated regarding the number of lumbar laminectomies, lumbar fusions, add-on laminectomy levels, and anterior cervical fusions reimbursed by Medicare in 2012. In 2012 Medicare reimbursed the average neurosurgeon slightly more than an orthopedic surgeon for all procedures ($142,075 vs. $110,920), but this was not found to be statistically significant (P = 0.218). Orthopedic surgeons had a statistical trend illustrating increased reimbursement for lumbar fusions specifically, $1187 versus $1073 (P = 0.07). Fellowship trained spinal surgeons also, on average, received more from Medicare ($125,407 vs. $76,551), but again this was not statistically significant (P = 0.112). A surgeon in private practice, on average, was reimbursed $137,495 while their academic counterparts were reimbursed $103,144 (P = 0.127). Surgeons performing cervical fusions in the Centers for Disease Control West Region did receive statistically significantly less reimbursement for that procedure then those surgeons in other parts of the country (P = 0.015). Surgeons in the West were reimbursed on average $849 for CPT code 22,551 while those in the Midwest received $1475 per procedure. Medicare reimbursement data are fundamentally flawed in determining healthcare expenditure as it shows a bias toward delivery of care in specific patient demographics. However, neurosurgeons, not just policy makers, must take ownership to analyze, investigate, and interpret these data as it will affect healthcare reimbursement and delivery moving

  8. What are estimated reimbursements for lower extremity prostheses capable of surgical and nonsurgical lengthening?

    Science.gov (United States)

    Henderson, Eric R; Pepper, Andrew M; Letson, G Douglas

    2012-04-01

    Growing prostheses accommodate skeletally immature patients with bone tumors undergoing limb-preserving surgery. Early devices required surgical procedures for lengthening; recent devices lengthen without surgery. Expenses for newer expandable devices that lengthen without surgery are more than for their predecessors but overall reimbursement amounts are not known. We sought to determine reimbursement amounts associated with lengthening of growing prostheses requiring surgical and nonsurgical lengthening. We retrospectively reviewed 17 patients with growing prostheses requiring surgical expansion and eight patients with prostheses capable of nonsurgical expansion. Insurance documents were reviewed to determine the reimbursement for implantation, lengthening, and complications. Growth data were obtained from the literature. Mean reimbursement amounts of surgical and nonsurgical lengthenings were $9950 and $272, respectively. Estimated reimbursements associated with implantation of a growing prosthesis varied depending on age, sex, and location. The largest difference was found for 4-year-old boys with distal femoral replacement where reimbursement for expansion to maturity for surgical and nonsurgical lengthening prostheses would be $379,000 and $208,000, respectively. For children requiring more than one surgical expansion, net reimbursements were lower when a noninvasive lengthening device was used. Annual per-prosthesis maintenance reimbursements to address complications for surgical and nonsurgical lengthening prostheses were $3386 and $1856, respectively. This study showed that reimbursements for lengthening of growing endoprostheses capable of nonsurgical expansion may be less expensive in younger patients, particularly male patients undergoing distal femur replacement, than endoprostheses requiring surgical lengthening. Longer outcomes studies are required to see if reimbursements for complications differ between devices. Level III, economic and decision

  9. Changes in Payer Mix and Physician Reimbursement After the Affordable Care Act and Medicaid Expansion

    Directory of Open Access Journals (Sweden)

    Christine D. Jones MD, MS

    2015-08-01

    Full Text Available Although uncompensated care for hospital-based care has fallen dramatically since the implementation of the Affordable Care Act and Medicaid expansion, the changes in hospital physician reimbursement are not known. We evaluated if payer mix and physician reimbursement by encounter changed between 2013 and 2014 in an academic hospitalist practice in a Medicaid expansion state. This was a retrospective cohort study of all general medicine inpatient admissions to an academic hospitalist group in 2013 and 2014. The proportion of encounters by payer and reimbursement/inpatient encounter were compared in 2013 versus 2014. A sensitivity analysis determined the relative contribution of different factors to the change in reimbursement/encounter. Among 37 540 and 40 397 general medicine inpatient encounters in 2013 and 2014, respectively, Medicaid encounters increased (17.3% to 30.0%, P < .001, uninsured encounters decreased (18.4% to 6.3%, P < 0.001, and private payer encounters also decreased (14.1% to 13.3%, P = .001. The median reimbursement/encounter increased 4.2% from $79.98/encounter in 2013 to $83.36/encounter in 2014 (P < .001. In a sensitivity analysis, changes in length of stay, proportions in encounter type by payer, payer mix, and reimbursement for encounter type by payer accounted for −0.7%, 0.8%, 2.0%, and 2.3% of the reimbursement change, respectively. From 2013 to 2014, Medicaid encounters increased, and uninsured and private payer encounters decreased within our hospitalist practice. Reimbursement/encounter also increased, much of which could be attributed to a change in payer mix. Further analyses of physician reimbursement in Medicaid expansion and non-expansion states would further delineate reimbursement changes that are directly attributable to Medicaid expansion.

  10. 30 CFR 229.109 - Reimbursement for costs incurred by a State under the delegation of authority.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 2 2010-07-01 2010-07-01 false Reimbursement for costs incurred by a State... Administration of Delegations § 229.109 Reimbursement for costs incurred by a State under the delegation of..., on a quarterly basis, a summary of costs incurred for which the State is seeking reimbursement. Only...

  11. 10 CFR 765.30 - Reimbursement of costs incurred in accordance with a plan for subsequent remedial action.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Reimbursement of costs incurred in accordance with a plan... Procedures § 765.30 Reimbursement of costs incurred in accordance with a plan for subsequent remedial action. (a) This section establishes procedures governing reimbursements of costs of remedial action incurred...

  12. 41 CFR 301-11.621 - Must I file a claim to be reimbursed for the additional income taxes incurred?

    Science.gov (United States)

    2010-07-01

    ... be reimbursed for the additional income taxes incurred? 301-11.621 Section 301-11.621 Public... ALLOWABLE TRAVEL EXPENSES 11-PER DIEM EXPENSES Income Tax Reimbursement Allowance (ITRA), Tax Years 1995 and Thereafter Employee Responsibilities § 301-11.621 Must I file a claim to be reimbursed for the additional...

  13. 41 CFR 301-11.521 - Must I file a claim to be reimbursed for the additional income taxes incurred?

    Science.gov (United States)

    2010-07-01

    ... be reimbursed for the additional income taxes incurred? 301-11.521 Section 301-11.521 Public... ALLOWABLE TRAVEL EXPENSES 11-PER DIEM EXPENSES Income Tax Reimbursement Allowance (ITRA), Tax Years 1993 and 1994 Employee Responsibilities § 301-11.521 Must I file a claim to be reimbursed for the additional...

  14. 76 FR 79067 - Payment or Reimbursement for Emergency Treatment Furnished by Non-VA Providers in Non-VA...

    Science.gov (United States)

    2011-12-21

    ... DEPARTMENT OF VETERANS AFFAIRS 38 CFR Part 17 RIN 2900-AN49 Payment or Reimbursement for Emergency..., authorize the Secretary of Veterans Affairs to reimburse eligible veterans for costs related to non-VA.... Specifically, section 1725 authorizes reimbursement for emergency treatment for eligible veterans with...

  15. 42 CFR 411.22 - Reimbursement obligations of primary payers and entities that received payment from primary payers.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Reimbursement obligations of primary payers and... Provisions § 411.22 Reimbursement obligations of primary payers and entities that received payment from... reimburse CMS for any payment if it is demonstrated that the primary payer has or had a responsibility to...

  16. 43 CFR 404.36 - Will Reclamation reimburse me for the cost of an appraisal investigation or a feasibility study...

    Science.gov (United States)

    2010-10-01

    ... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false Will Reclamation reimburse me for the cost... Reclamation reimburse me for the cost of an appraisal investigation or a feasibility study that was not...) or (b). Reclamation will not reimburse you or provide program funding for any expenses related to an...

  17. 42 CFR 23.10 - Under what circumstances may a National Health Service Corps site's reimbursement obligation to...

    Science.gov (United States)

    2010-10-01

    ... Service Corps site's reimbursement obligation to the Federal Government be waived? 23.10 Section 23.10... National Health Service Corps site's reimbursement obligation to the Federal Government be waived? (a) The Secretary may waive in whole or in part the reimbursement requirements of section 334(a)(3) of the Act if he...

  18. 42 CFR 137.336 - What is the difference between fixed-price and cost-reimbursement agreements?

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false What is the difference between fixed-price and cost-reimbursement agreements? 137.336 Section 137.336 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND...-reimbursement agreements? (a) Cost-reimbursement agreements generally have one or more of the following...

  19. 76 FR 30598 - Payment or Reimbursement for Emergency Services for Nonservice-Connected Conditions in Non-VA...

    Science.gov (United States)

    2011-05-26

    ... DEPARTMENT OF VETERANS AFFAIRS 38 CFR Part 17 RIN 2900-AN86 Payment or Reimbursement for Emergency...) ``Payment or Reimbursement for Emergency Services for Nonservice-Connected Conditions in Non-VA Facilities... Reimbursement Act. Some of the revisions in this proposed rule are purely technical, matching the language of...

  20. 48 CFR 49.603-3 - Cost-reimbursement contracts-complete termination, if settlement includes cost.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Cost-reimbursement... Termination Forms and Formats 49.603-3 Cost-reimbursement contracts—complete termination, if settlement includes cost. [Insert the following in Block 14 of SF 30 for settlement of cost-reimbursement contracts...

  1. Are Economists More Likely to Hold Stocks?

    DEFF Research Database (Denmark)

    Christiansen, Charlotte; Joensen, Eyðfrið Juanna Schrøter; Rangvid, Jesper

    A unique data set enables us to test the hypothesis that due to informational advantages economists are more likely to hold stocks than otherwise identical investors. Weconfirm that economists have a significantly higher probability of participating in the stockmarket than investors with any other...

  2. 12 CFR 1732.7 - Record hold.

    Science.gov (United States)

    2010-01-01

    ... Banking OFFICE OF FEDERAL HOUSING ENTERPRISE OVERSIGHT, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT SAFETY AND SOUNDNESS RECORD RETENTION Record Retention Program § 1732.7 Record hold. (a) Definition. For... Enterprise or OFHEO that the Enterprise is to retain records relating to a particular issue in connection...

  3. Venezuela and Chavez: What the Future Holds...

    Science.gov (United States)

    2010-04-01

    government made public 26 presidential decrees that had been enacted. These acts: ...covered such areas as tourism , railways, social security, and...great prosperity or a harbinger of doom to the region, and for this reason the United States must prepare for the many paths that the future holds

  4. Empowerment Amongst Teachers Holding Leadership Positions

    Science.gov (United States)

    Avidov-Ungar, Orit; Friedman, Izhak; Olshtain, Elite

    2014-01-01

    This study used semi-structured in-depth interviews to explore empowerment patterns among teachers who hold leadership positions in school. Our qualitative analysis presents a hierarchical ladder with three types of empowerment amongst these teachers, ranging from limited empowerment through rewarding empowerment to change-enhancing empowerment.…

  5. Biosketch Ashok Venkitaraman holds the Ursula Zoellner ...

    Indian Academy of Sciences (India)

    ashok

    Ashok Venkitaraman holds the Ursula Zoellner Professorship of Cancer Research at the University of Cambridge, and is the Director of the Medical Research Council. (MRC) Cancer Cell Unit there. He learnt and practiced medicine at the Christian. Medical College, Vellore, before completing his Ph.D. at University College ...

  6. Package Holds Five Monolithic Microwave Integrated Circuits

    Science.gov (United States)

    Mysoor, Narayan R.; Decker, D. Richard; Olson, Hilding M.

    1996-01-01

    Packages protect and hold monolithic microwave integrated circuit (MMIC) chips while providing dc and radio-frequency (RF) electrical connections for chips undergoing development. Required to be compact, lightweight, and rugged. Designed to minimize undesired resonances, reflections, losses, and impedance mismatches.

  7. Individual shrink wrapping extends the storage life and maintains the quality of pomegranates (cvs. 'Mridula' and 'Bhagwa') at ambient and low temperature.

    Science.gov (United States)

    Sudhakar Rao, D V

    2018-01-01

    The present investigation was carried out to study the response of two commercial pomegranate cultivars to individual shrink wrapping in extending the storage life and quality maintenance. Pomegranate fruits ('Mridula' and 'Bhagwa') were individually shrink wrapped using three semi-permeable films (Cryovac ® BDF-2001, D-955 and normal LDPE) and stored at ambient (25-32 °C and 49-67% RH) and low temperature (8 °C and 75-80% RH). Shrink wrapping greatly reduced weight loss in both cultivars irrespective of the film used and storage temperature. Weight loss in shrink wrapped (D-955 film) 'Mridula' and 'Bhagwa' after 1 month storage at ambient temperature was respectively 1.40 and 1.05%, when compared to 22.92 and 22.53% in non-wrapped fruits. After 3 months at 8 °C, shrink wrapped 'Mridula' and 'Bhagwa' fruits lost only 0.43 and 0.68% weight respectively, compared to 17.23 and 21.67% in non-wrapped ones. Shrink wrapping significantly reduced the respiration rate at ambient temperature and the response varied with variety and film used. Shrink wrapped fruits of both cultivars retained the original peel colour (Hunter h∘ and C* values) to a maximum extent during 3 months storage at 8 °C and shelf-life period at ambient temperature. Irrespective of variety and film, shrink wrapping maintained the peel thickness and peel moisture content, significantly much higher than non-wrapped fruits at both temperatures. Compared to 'Mridula' cultivar, 'Bhagwa' responded well to shrink wrapping during prolonged storage at both temperatures with better maintenance of quality in terms of appearance, colour, juice content, TSS, acidity, sugars and sensory attributes. At ambient temperature, shrink wrapping with D-955 or LDPE film extended the storage life of 'Mridula' and 'Bhagwa' for 3 weeks and 1 month respectively, whereas at 8 °C both could be stored for 3 months with 3 days of shelf life.

  8. Pricing and reimbursement of drugs and medical devices in Hungary.

    Science.gov (United States)

    Gulácsi, L; Dávid, T; Dózsa, Cs

    2002-01-01

    Similarly to other countries of Central and Eastern Europe, Hungary has witnessed massive diffusion of healthcare technology such as drugs and medical devices since 1990. While substantial new pharmaceuticals, medical devices, and procedures have been liberalized, there has been no proper evaluation or training in their use. Healthcare providers have come to find themselves as entrepreneurs in private practice, while patients are acquiring an increasing awareness as customers of healthcare,demanding services in return for their taxes and contributions. This has led to extremely irrational patterns of investment in technology, with most an obvious waste of resources, while leaving basic needs unmet. Both the National Health Insurance Fund and the Ministry of Finance believe that the current pharmaceutical and medical device bill is too high. However, introducing a more transparent and flexible pricing and reimbursement framework may enable a more efficient allocation of the limited resources to be achieved.

  9. Extracorporeal membrane oxygenation: current clinical practice, coding, and reimbursement.

    Science.gov (United States)

    Schuerer, Douglas J E; Kolovos, Nikoleta S; Boyd, Kayla V; Coopersmith, Craig M

    2008-07-01

    Extracorporeal membrane oxygenation (ECMO) is a technique for providing life support for patients experiencing both pulmonary and cardiac failure by maintaining oxygenation and perfusion until native organ function is restored. ECMO is used routinely at many specialized hospitals for infants and less commonly for children with respiratory or cardiac failure from a variety of causes. Its usage is more controversial in adults, but select medical centers have reported favorable findings in patients with ARDS and other causes of severe pulmonary failure. ECMO is also rarely used as a rescue therapy in a small subset of adult patients with cardiac failure. This article will review the current uses and techniques of ECMO in the critical care setting as well as the evidence supporting its usage. In addition, current practice management related to coding and reimbursement for this intensive therapy will be discussed.

  10. Pricing and Reimbursement of Biosimilars in Central and Eastern European Countries

    Science.gov (United States)

    Kawalec, Paweł; Stawowczyk, Ewa; Tesar, Tomas; Skoupa, Jana; Turcu-Stiolica, Adina; Dimitrova, Maria; Petrova, Guenka I.; Rugaja, Zinta; Männik, Agnes; Harsanyi, Andras; Draganic, Pero

    2017-01-01

    Objectives: The aim of this study was to review the requirements for the reimbursement of biosimilars and to compare the reimbursement status, market share, and reimbursement costs of biosimilars in selected Central and Eastern European (CEE) countries. Methods: A questionnaire-based survey was conducted between November 2016 and January 2017 among experts from the following CEE countries: Bulgaria, Czech Republic, Croatia, Estonia, Hungary, Latvia, Lithuania, Poland, Slovakia, and Romania. The requirements for the pricing and reimbursement of biosimilars were reviewed for each country. Data on the extent of reimbursement of biologic drugs (separately for original products and biosimilars) in the years 2014 and 2015 were also collected for each country, along with data on the total pharmaceutical and total public health care budgets. Results: Our survey revealed that no specific criteria were applied for the pricing and reimbursement of biosimilars in the selected CEE countries; the price of biosimilars was usually reduced compared with original drugs and specific price discounts were common. Substitution and interchangeability were generally allowed, although in most countries they were at the discretion of the physician after a clinical assessment. Original biologic drugs and the corresponding biosimilars were usually in the same homogeneous group, and internal reference pricing was usually employed. The reimbursement rate of biosimilars in the majority of the countries was the same and amounted to 100%. Generally, the higher shares of expenditures were shown for the reimbursement of original drugs than for biosimilars, except for filgrastim, somatropin, and epoetin (alfa and zeta). The shares of expenditures on the reimbursement of biosimilar products ranged from 8.0% in Estonia in 2014 to 32.4% in Lithuania in 2015, and generally increased in 2015. The share of expenditures on reimbursement of biosimilars in the total pharmaceutical budget differed between the

  11. Trends in laboratory test volumes for Medicare Part B reimbursements, 2000-2010.

    Science.gov (United States)

    Shahangian, Shahram; Alspach, Todd D; Astles, J Rex; Yesupriya, Ajay; Dettwyler, William K

    2014-02-01

    Changes in reimbursements for clinical laboratory testing may help us assess the effect of various variables, such as testing recommendations, market forces, changes in testing technology, and changes in clinical or laboratory practices, and provide information that can influence health care and public health policy decisions. To date, however, there has been no report, to our knowledge, of longitudinal trends in national laboratory test use. To evaluate Medicare Part B-reimbursed volumes of selected laboratory tests per 10,000 enrollees from 2000 through 2010. Laboratory test reimbursement volumes per 10,000 enrollees in Medicare Part B were obtained from the Centers for Medicare & Medicaid Services (Baltimore, Maryland). The ratio of the most recent (2010) reimbursed test volume per 10,000 Medicare enrollees, divided by the oldest data (usually 2000) during this decade, called the volume ratio, was used to measure trends in test reimbursement. Laboratory tests with a reimbursement claim frequency of at least 10 per 10,000 Medicare enrollees in 2010 were selected, provided there was more than a 50% change in test reimbursement volume during the 2000-2010 decade. We combined the reimbursed test volumes for the few tests that were listed under more than one code in the Current Procedural Terminology (American Medical Association, Chicago, Illinois). A 2-sided Poisson regression, adjusted for potential overdispersion, was used to determine P values for the trend; trends were considered significant at P reimbursement volumes were electrolytes, digoxin, carbamazepine, phenytoin, and lithium, with volume ratios ranging from 0.27 to 0.64 (P reimbursement volumes were meprobamate, opiates, methadone, phencyclidine, amphetamines, cocaine, and vitamin D, with volume ratios ranging from 83 to 1510 (P reimbursement volumes increased for most of the selected tests, other tests exhibited statistically significant downward trends in annual reimbursement volumes. The observed

  12. Dual solutions of three-dimensional flow and heat transfer over a non-linearly stretching/shrinking sheet

    Science.gov (United States)

    Naganthran, Kohilavani; Nazar, Roslinda; Pop, Ioan

    2018-05-01

    This study investigated the influence of the non-linearly stretching/shrinking sheet on the boundary layer flow and heat transfer. A proper similarity transformation simplified the system of partial differential equations into a system of ordinary differential equations. This system of similarity equations is then solved numerically by using the bvp4c function in the MATLAB software. The generated numerical results presented graphically and discussed in the relevance of the governing parameters. Dual solutions found as the sheet stretched and shrunk in the horizontal direction. Stability analysis showed that the first solution is physically realizable whereas the second solution is not practicable.

  13. Reimbursement for Supportive Cancer Medications Through Private Insurance in Saskatchewan

    Science.gov (United States)

    Forte, Lindy; Olson, Colleen; Atchison, Carolyn; Gesy, Kathy

    2009-01-01

    Background: As demand for cancer treatment grows, and newer, more expensive drugs become available, public payers in Canada are finding it increasingly difficult to fund the full range of available cancer drugs. Objective: To determine the extent of private drug coverage for supportive cancer treatments in Saskatchewan, preparatory to exploring the potential for cost-sharing. Methods: Patients who presented for chemotherapy and who provided informed consent for participation were surveyed regarding their access to private insurance. Insurers were contacted to verify patients' level of coverage for supportive cancer medications. Groups with specified types of insurance were compared statistically in terms of age, income bracket, time required to assess insurance status, and amount of deductible. Logistic regression was used to determine the effect of patients' age and income on the probability of having insurance. Results: Of 169 patients approached to participate, 156 provided consent and completed the survey. Their mean age was 58.5 years. About two-fifths of all patients (64 or 41%) were in the lowest income bracket (up to $30 000). Sixty-three (40%) of the patients had private insurance for drugs, and 36 (57%) of these plans included reimbursement for supportive cancer medications. A deductible was in effect in 31 (49%) of the plans, a copayment in 28 (44%), and a maximum payment in 8 (13%). Income over $50 000 was a significant predictor of access to drug insurance (p = 0.003), but age was not significantly related to insurance status. Conclusions: A substantial proportion of cancer patients in this study had access to private insurance for supportive cancer drugs for which reimbursement is currently provided by the Saskatchewan Cancer Agency. Cost-sharing and optimal utilization of the multipayer environment might offer a greater opportunity for public payers to cover future innovative and supportive therapies for cancer, but further study is required to

  14. PRICING, REIMBURSEMENT, AND HEALTH TECHNOLOGY ASSESSMENT OF MEDICINAL PRODUCTS IN BULGARIA.

    Science.gov (United States)

    Benisheva-Dimitrova, Tatyana; Sidjimova, Dobriana; Cherneva, Daniela; Kralimarkov, Nikolay

    2017-01-01

    The aim of this study was to investigate the analysis, discussion, and challenges of the price and reimbursement process of medicinal products in Bulgaria in the period 2000-15 and health technology assessment (HTA) role in these processes. The dynamics of the reform, with respect to the healthcare and pharmaceutical sectors, are tracked by documentary review of regulations, articles, and reports in the European Union (EU), as well as analytical and historical analysis. Pricing and reimbursement processes have passed through a variety of committees between 2003 and 2012. Separate units for pricing and reimbursement of medicinal products were established in Bulgaria for the first time, in 2013, when an independent body, the National Council at Prices and Reimbursement of Medicinal Products, was set up to approve medicinal products with new international nonproprietary names (INN) for reimbursement in Bulgaria. Over the course of 2 years (2013-14), thirty-three new INNs were approved for reimbursement. In December 2015, a new HTA body was introduced, and assigned to the National Centre for Public Health and Analyses. Although Bulgaria has current legislation on pricing and reimbursement which is in accordance with the EU rules, there is no mechanism for reporting and monitoring these processes or the financial resources annually, so as to provide an overall objective assessment and analysis by year. Therefore, this financial assessment should become a national policy objective for the future.

  15. Florida's model of nursing home Medicaid reimbursement for disaster-related expenses.

    Science.gov (United States)

    Thomas, Kali S; Hyer, Kathryn; Brown, Lisa M; Polivka-West, LuMarie; Branch, Laurence G

    2010-04-01

    This study describes Florida's model of Medicaid nursing home (NH) reimbursement to compensate NHs for disaster-related expenses incurred as a result of 8 hurricanes within a 2-year period. This Florida model can serve as a demonstration for a national model for disaster-related reimbursement. Florida reimburses NHs for approved disaster-related costs through hurricane interim rate requests (IRRs). The state developed its unique Medicaid per diem rate temporary add-on by adapting its standard rate-setting reimbursement methodology. To understand the payment mechanisms and the costs that facilities incurred as a result of natural disasters, we examined the IRRs and cost reports for facilities requesting and receiving reimbursement. Cost reports and IRR applications indicated that Florida Medicaid spent close to $16 million to pay for hurricane-related costs to NHs. Without Florida's Hurricane IRR program, many facilities would have not been reimbursed for their hurricane-related costs. Florida's model is one that Medicare and other states should consider adopting to ensure that NHs receive adequate reimbursement for disaster-related expenses, including tornadoes, earthquakes, floods, blizzards, and other catastrophic events.

  16. The 22-Modifier in Reimbursement for Orthopedic Procedures: Hip Arthroplasty and Obesity Are Worth the Effort.

    Science.gov (United States)

    Smith, Eric L; Tybor, David J; Daniell, Hayley D; Naccarato, Laura A; Pevear, Mary E; Cassidy, Charles

    2018-02-21

    Orthopedic surgeons utilize the 22-modifier when billing for complex procedures under the American Medical Association's Current Procedural Terminology (CPT) for reasons such as excessive blood loss, anatomic abnormality, and morbid obesity, cases that would ideally be reimbursed at a higher rate to compensate for additional physician work and time. We investigated how the 22-modifier affects physician reimbursement in knee and hip arthroplasty. We queried hospital billing data from 2009 to 2016, identifying all cases performed at our urban tertiary care orthopedic center for knee arthroplasty (CPT codes 27438, 27447, 27487, and 27488) and hip arthroplasty (CPT codes 27130, 27132, 27134, 27236). We extracted patient insurance status and reimbursement data to compare the average reimbursement between cases with and without the 22-modifier. We analyzed data from 2605 procedures performed by 10 providers. There were 136 cases with 22-modifiers. For knee arthroplasty (n = 1323), the 22-modifier did not significantly increase reimbursement after adjusting for insurer, provider, and fiscal year (4.2% dollars higher on average, P = .159). For hip arthroplasty (n = 1282), cases with a 22-modifier had significantly higher reimbursement than those without the 22-modifier (6.2% dollars more, P = .049). For hip arthroplasty cases with a 22-modifier, those noting morbid obesity were reimbursed 29% higher than those cases with other etiology. The effect of the 22-modifier on reimbursement amount is differential between knee and hip arthroplasty. Hip arthroplasty procedures coded as 22-modifier are reimbursed more than those without the 22-modifier. Providers should consider these potential returns when considering submitting a 22-modifier. Copyright © 2018 Elsevier Inc. All rights reserved.

  17. 12 CFR 1252.1 - Enterprise portfolio holding criteria.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Enterprise portfolio holding criteria. 1252.1 Section 1252.1 Banks and Banking FEDERAL HOUSING FINANCE AGENCY ENTERPRISES PORTFOLIO HOLDINGS § 1252.1 Enterprise portfolio holding criteria. The Enterprises are required to comply with the portfolio holdings...

  18. 12 CFR 583.20 - Savings and loan holding company.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 5 2010-01-01 2010-01-01 false Savings and loan holding company. 583.20... REGULATIONS AFFECTING SAVINGS AND LOAN HOLDING COMPANIES § 583.20 Savings and loan holding company. The term savings and loan holding company means any company that directly or indirectly controls a savings...

  19. 76 FR 20459 - Savings and Loan Holding Company Application

    Science.gov (United States)

    2011-04-12

    ... DEPARTMENT OF THE TREASURY Office of Thrift Supervision Savings and Loan Holding Company... concerning the following information collection. Title of Proposal: Savings and Loan Holding Company... officer of a savings and loan holding company, or any individual who owns, controls, or holds with power...

  20. Regulation of Cross-holdings between European Companies

    DEFF Research Database (Denmark)

    Sørensen, Karsten Engsig

    2003-01-01

    Cross-holdings can be a barrier to takeovers, and they may have other disadvantages. This article analyses how cross-holdings may be regulated to avoid these negative effects.......Cross-holdings can be a barrier to takeovers, and they may have other disadvantages. This article analyses how cross-holdings may be regulated to avoid these negative effects....

  1. 12 CFR 225.124 - Foreign bank holding companies.

    Science.gov (United States)

    2010-01-01

    ... SYSTEM BANK HOLDING COMPANIES AND CHANGE IN BANK CONTROL (REGULATION Y) Regulations Financial Holding Companies Interpretations § 225.124 Foreign bank holding companies. (a) Effective December 1, 1971, the... 12 Banks and Banking 3 2010-01-01 2010-01-01 false Foreign bank holding companies. 225.124 Section...

  2. The incredible shrinking dewlap: signal size, skin elasticity, and mechanical design in the green anole lizard (Anolis carolinensis).

    Science.gov (United States)

    Lailvaux, Simon P; Leifer, Jack; Kircher, Bonnie K; Johnson, Michele A

    2015-10-01

    The expression of male secondary sexual traits can be dynamic, changing size, shape, color, or structure over the course of different seasons. However, the factors underlying such changes are poorly understood. In male Anolis carolinensis lizards, a morphological secondary sexual signal called the dewlap changes size seasonally within individuals. Here, we test the hypothesis that seasonal changes in male dewlap size are driven by increased use and extension of the dewlap in spring and summer, when males are breeding, relative to the winter and fall. We captured male green anole lizards prior to the onset of breeding and constrained the dewlap in half of them such that it could not be extended. We then measured dewlap area in the spring, summer, and winter, and dewlap skin and belly skin elasticity in summer and winter. Dewlaps in unconstrained males increase in area from spring to summer and then shrink in the winter, whereas the dewlaps of constrained males consistently shrink from spring to winter. Dewlap skin is significantly more elastic than belly skin, and skin overall is more elastic in the summer relative to winter. These results show that seasonal changes in dewlap size are a function of skin elasticity and display frequency, and suggest that the mechanical properties of signaling structures can have important implications for signal evolution and design.

  3. Encouraging smokers to quit: the cost effectiveness of reimbursing the costs of smoking cessation treatment.

    Science.gov (United States)

    Kaper, Janneke; Wagena, Edwin J; van Schayck, Constant P; Severens, Johan L

    2006-01-01

    Smoking cessation should be encouraged in order to increase life expectancy and reduce smoking-related healthcare costs. Results of a randomised trial suggested that reimbursing the costs of smoking cessation treatment (SCT) may lead to an increased use of SCT and an increased number of quitters versus no reimbursement. To assess whether reimbursement for SCT is a cost-effective intervention (from the Dutch societal perspective), we calculated the incremental costs per quitter and extrapolated this outcome to incremental costs per QALY saved versus no reimbursement. In the reimbursement trial, 1266 Dutch smokers were randomly assigned to the intervention or control group using a randomised double consent design. Reimbursement for SCT was offered to the intervention group for a period of 6 months. No reimbursement was offered to the control group. Prolonged abstinence from smoking was determined 6 months after the end of the reimbursement period. The QALYs gained from quitting were calculated until 80 years of age using data from the US. Costs (year 2002 values) were determined from the societal perspective during the reimbursement period (May-November 2002). Benefits were discounted at 4% per annum. The uncertainty of the incremental cost-effectiveness ratios was estimated using non-parametric bootstrapping. Eighteen participants in the control group (2.8%) and 35 participants in the intervention group (5.5%) successfully quit smoking. The costs per participant were 291 euro and 322 euro, respectively. If society is willing to pay 1000 euro or 10,000 euro for an additional 12-month quitter, the probability that reimbursement for SCT would be cost effective was 50% or 95%, respectively. If society is willing to pay 18,000 euro for a QALY, the probability that reimbursement for SCT would be cost effective was 95%. However, the external validity of the extrapolation from quitters to QALYs is uncertain and several assumptions had to be made. Reimbursement for SCT may

  4. Value-Based Reimbursement: Impact of Curtailing Physician Autonomy in Medical Decision Making.

    Science.gov (United States)

    Gupta, Dipti; Karst, Ingolf; Mendelson, Ellen B

    2016-02-01

    In this article, we define value in the context of reimbursement and explore the effect of shifting reimbursement paradigms on the decision-making autonomy of a women's imaging radiologist. The current metrics used for value-based reimbursement such as report turnaround time are surrogate measures that do not measure value directly. The true measure of a physician's value in medicine is accomplishment of better health outcomes, which, in breast imaging, are best achieved with a physician-patient relationship. Complying with evidence-based medicine, which includes data-driven best clinical practices, a physician's clinical expertise, and the patient's values, will improve our science and preserve the art of medicine.

  5. Saskatchewan Energy Holdings Ltd. consolidated financial statements

    Energy Technology Data Exchange (ETDEWEB)

    1991-01-01

    The consolidated financial statements of Saskatchewan Energy Holdings Ltd. (formerly Saskatchewan Energy Corporation) as of December 31, 1990, and the consolidated statements of earnings and retained earnings and changes in cash position for the year are presented. Data include an inventory of supplies, natural gas in storage, property, plant and equipment. Financial statements are also presented for the year ending December 31, 1989, with comparative figures for the seven months ending December 31, 1988.

  6. Saskatchewan Energy Holdings Ltd. consolidated financial statements

    International Nuclear Information System (INIS)

    1991-01-01

    The consolidated financial statements of Saskatchewan Energy Holdings Ltd. (formerly Saskatchewan Energy Corporation) as of December 31, 1990, and the consolidated statements of earnings and retained earnings and changes in cash position for the year are presented. Data include an inventory of supplies, natural gas in storage, property, plant and equipment. Financial statements are also presented for the year ending December 31, 1989, with comparative figures for the seven months ending December 31, 1988

  7. 12 CFR 584.2-2 - Permissible bank holding company activities of savings and loan holding companies.

    Science.gov (United States)

    2010-01-01

    ... savings and loan holding companies. 584.2-2 Section 584.2-2 Banks and Banking OFFICE OF THRIFT SUPERVISION, DEPARTMENT OF THE TREASURY SAVINGS AND LOAN HOLDING COMPANIES § 584.2-2 Permissible bank holding company activities of savings and loan holding companies. (a) General. For purposes of § 584.2(b)(6)(i) of this part...

  8. 12 CFR 225.82 - How does a bank holding company elect to become a financial holding company?

    Science.gov (United States)

    2010-01-01

    ... holding company to become a financial holding company shall not be effective if, during the period...) Effective date of election—(1) In general. An election filed by a bank holding company under paragraph (a... financial holding company is effective prior to the 31st day after the date that a complete declaration was...

  9. [Impact Reimbursement Act on the pharmaceutical market in Poland].

    Science.gov (United States)

    Giermaziak, Wojciech

    2014-04-01

    According to 12 may 2011 Reimbursement Act, the new regulations were introduced related to changes in so far in force rules on refunds of official prices and margins for drugs, foodstuffs of special purpose and medical products. After year of functioning of this regulation, in evaluation of the government, law gave measurable financial effects for public payer, sometimes through drastic actions, connected the of reduction of existing profits of manufacturers sector and importers drugs, as well wholesale and retail, both in treatment open and closed. Parallel to research and analysis of effects introduction in life act refund, conducted by government, to target current regulation possible negative phenomena can to be after-effects to regulation, systematically there are conducted analogous study to reputable companies specialized in evaluation and updating market Polish pharmaceutical, such as IMS Health Polska, Pharma Expert, Kamsoft, WHO and European a law firm. In their opinion to reimbursement act is the most serious regulation control system to introduced into Polish order legal, and first time for many years on such a large scale. Thoroughly changed policy of drugs State have important influence for all participants Polish pharmaceutical market, both those directly related to the drug trade, as the functioning doctors and health condition and financial Polish patient. Change in the way prices of drugs is determined as flexible to price formation mechanism, combining drugs similar profile pharmacological in so group limits and dependence of the level of refunds from application drug accordingly characteristics medicinal product, adaptation solutions to new law refund to the existing law about health services, gave measurable financial effect for the public payer. Rationalization expenses to NFZ, as main premise introduction refund act, created to broader than so far possibility to use new molecules of drugs, and the latest medical technology, even if in the

  10. 49 CFR 350.311 - What specific items are eligible for reimbursement under the MCSAP?

    Science.gov (United States)

    2010-10-01

    ... for reimbursement: (a) Personnel expenses, including recruitment and screening, training, salaries and..., special inspection equipment, vehicle maintenance, fuel, and oil. (c) Indirect expenses for facilities... data acquisition, storage, and analysis that are specifically identifiable as program-related to...

  11. Logistics Civil Augmentation Program Task Orders 130 and 151: Program Management, Reimbursement, and Transition

    National Research Council Canada - National Science Library

    Keays, Walt; Furbish, Glenn D

    2007-01-01

    .... Task orders under this contract can be either fixed price or cost reimbursable. In Iraq, the total cost of all 149 task orders issued under the LOGCAP contract as of March 4, 2007, is approximately $22.5 billion...

  12. 11 CFR 9004.6 - Expenditures for transportation and services made available to media personnel; reimbursements.

    Science.gov (United States)

    2010-01-01

    ... CANDIDATES TO PAYMENTS; USE OF PAYMENTS § 9004.6 Expenditures for transportation and services made available... by independent contractors. (d) Disposal of excess reimbursements. If the committee receives...

  13. 40 CFR 310.15 - How do I apply for reimbursement?

    Science.gov (United States)

    2010-07-01

    ... RESPONSE TO HAZARDOUS SUBSTANCE RELEASES Provisions How to Get Reimbursed § 310.15 How do I apply for... Management, Office of Solid Waste and Emergency Response, Environmental Protection Agency, 1200 Pennsylvania...

  14. 7 CFR 1710.109 - Reimbursement of general funds and interim financing.

    Science.gov (United States)

    2010-01-01

    ... LOANS AND GUARANTEES Loan Purposes and Basic Policies § 1710.109 Reimbursement of general funds and... replace interim financing used to finance equipment and facilities that were included in an RUS-approved...

  15. Financial Management: Accounting for Reimbursable Work Orders at Defense Finance and Accounting Service Charleston

    National Research Council Canada - National Science Library

    2003-01-01

    .... DFAS Charleston account managers who are responsible for managing reimbursable work orders for Navy, and DFAS Cleveland accountants who rely on the data could also benefit from the information in the report...

  16. Insurer views on reimbursement of preventive services in the dental setting: results from a qualitative study.

    Science.gov (United States)

    Feinstein-Winitzer, Rebecca T; Pollack, Harold A; Parish, Carrigan L; Pereyra, Margaret R; Abel, Stephen N; Metsch, Lisa R

    2014-05-01

    We explored insurers' perceptions regarding barriers to reimbursement for oral rapid HIV testing and other preventive screenings during dental care. We conducted semistructured interviews between April and October 2010 with a targeted sample of 13 dental insurance company executives and consultants, whose firms' cumulative market share exceeded 50% of US employer-based dental insurance markets. Participants represented viewpoints from a significant share of the dental insurance industry. Some preventive screenings, such as for oral cancer, received widespread insurer support and reimbursement. Others, such as population-based HIV screening, appeared to face many barriers to insurance reimbursement. The principal barriers were minimal employer demand, limited evidence of effectiveness and return on investment specific to dental settings, implementation and organizational constraints, lack of provider training, and perceived lack of patient acceptance. The dental setting is a promising venue for preventive screenings, and addressing barriers to insurance reimbursement for such services is a key challenge for public health policy.

  17. The impact of the fee-for-service reimbursement system on the ...

    African Journals Online (AJOL)

    The impact of the fee-for-service reimbursement system on the utilisation of health services: Part III. A comparison of caesarean section rates in white nulliparous women in the private and public sectors.

  18. CERN Health Insurance Scheme (CHIS) – Reimbursement of contraception and sterilisation

    CERN Multimedia

    HR Department

    2016-01-01

    In line with the practice in many Member States and in other international organisations based in Geneva, the CHIS will, as of 1 March 2016, reimburse upon presentation of a medical prescription:   contraceptive medicine (e.g. oral medicine or implant); intrauterine contraceptive devices; and medical sterilisation operations (vasectomy, tubal ligations). These methods of contraception will be considered as pharmaceutical costs or medical treatments, to which the reimbursement rate according to the general rule and the reimbursement bonus apply. Treatment undertaken, or paid for, before March 2016 will not be reimbursed. For more information, do not hesitate to contact the third-party administrator of the CHIS: UNIQA (Tel.: 72730 / uniqa-assurance@cern.ch).

  19. Toward a new payment system for inpatient rehabilitation. Part II: Reimbursing providers.

    Science.gov (United States)

    Saitto, Carlo; Marino, Claudia; Fusco, Danilo; Arcà, Massimo; Perucci, Carlo A

    2005-09-01

    The major fault with existing reimbursement systems lies in their failure to discriminate for the effectiveness of stay, both when paying per day and when paying per episode of treatment. We sought to define an average length of effective stay and recovery trends by impairment category, to design a prospective payment system that takes into account costs and expected recovery trends, and to compare the calculated reimbursement with the predicted costs estimated in a previous study (Saitto C, Marino C, Fusco D, et al. A new prospective payment system for inpatient rehabilitation. Part I: predicting resource consumption. Med Care. 2005;43:844-855). We considered all rehabilitation admissions from 5 Italian inpatient facilities during a 12-month period for which total cost of care had already been estimated and daily cost predicted through regression model. We ascertained recovery trends by impairment category through repeated MDS-PAC schedules and factorial analysis of functional status. We defined effective stay and daily resource consumption by impairment category and used these parameters to calculate reimbursement for the admission. We compared our reimbursement with predicted cost through regression analysis and evaluated the goodness of fit through residual analysis. We calculated reimbursement for 2079 admissions. The r(2) values for the reimbursement to cost correlation ranged from 0.54 in the whole population to 0.56 for "multiple trauma" to 0.85 for "other medical disorders." The best fit was found in the central quintiles of the cost and severity distributions. For each impairment category, we determined the number of days of effective hospital stay and the trends of functional gain. We demonstrated, at least within the Italian health care system, the feasibility of a reimbursement system that matches costs with functional recovery. By linking reimbursement to effective stay adjusted for trends of functional gain, we suggest it is possible to avoid both

  20. Restructuring in response to case mix reimbursement in nursing homes: a contingency approach.

    Science.gov (United States)

    Zinn, Jacqueline; Feng, Zhanlian; Mor, Vincent; Intrator, Orna; Grabowski, David

    2008-01-01

    Resident-based case mix reimbursement has become the dominant mechanism for publicly funded nursing home care. In 1998 skilled nursing facility reimbursement changed from cost-based to case mix adjusted payments under the Medicare Prospective Payment System for the costs of all skilled nursing facility care provided to Medicare recipients. In addition, as of 2004, 35 state Medicaid programs had implemented some form of case mix reimbursement. The purpose of the study is to determine if the implementation of Medicare and Medicaid case mix reimbursement increased the administrative burden on nursing homes, as evidenced by increased levels of nurses in administrative functions. The primary data for this study come from the Centers for Medicare and Medicaid Services Online Survey Certification and Reporting database from 1997 through 2004, a national nursing home database containing aggregated facility-level information, including staffing, organizational characteristics and resident conditions, on all Medicare/Medicaid certified nursing facilities in the country. We conducted multivariate regression analyses using a facility fixed-effects model to examine the effects of the implementation of Medicaid case mix reimbursement and Medicare Prospective Payment System on changes in the level of total administrative nurse staffing in nursing homes. Both Medicaid case mix reimbursement and Medicare Prospective Payment System increased the level of administrative nurse staffing, on average by 5.5% and 4.0% respectively. However, lack of evidence for a substitution effect suggests that any decline in direct care staffing after the introduction of case mix reimbursement is not attributable to a shift from clinical nursing resources to administrative functions. Our findings indicate that the administrative burden posed by case mix reimbursement has resource implications for all freestanding facilities. At the margin, the increased administrative burden imposed by case mix may

  1. The Effect of Tuition Reimbursement on Turnover: A Case Study Analysis

    OpenAIRE

    Colleen N. Flaherty

    2007-01-01

    Tuition reimbursement programs provide financial assistance for direct costs of education and are a type of general skills training program commonly offered by employers in the United States. Standard human capital theory argues that investment in firm-specific skills reduces turnover, while investment in general skills training could result in increased turnover. However, firms cite increased retention as a motivation for offering tuition reimbursement programs. This rationale for offering t...

  2. Health care information systems and formula-based reimbursement: an empirical study.

    Science.gov (United States)

    Palley, M A; Conger, S

    1995-01-01

    Current initiatives in health care administration use formula-based approaches to reimbursement. Examples of such approaches include capitation and diagnosis related groups (DRGs). These approaches seek to contain medical costs and to facilitate managerial control over scarce health care resources. This article considers various characteristics of formula-based reimbursement, their operationalization on hospital information systems, and how these relate to hospital compliance costs.

  3. Many southwest hosptials will receive decreased CMS reimbursement

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2013-11-01

    Full Text Available No abstract available. Article truncated at 150 words. More hospitals are receiving penalties than bonuses in the second year of the Centers for Medicare and Medicaid Services’ (CMS quality incentive program, and the average penalty is steeper than last year according to a report from Jordan Rau in Kaiser Health News (1. Southwest hospitals reflect that trend with New Mexico and Arizona exceeding the US average both in percentage of hospitals receiving penalties and the average size of the penalty (Table 1. Colorado approximated the national averages (Table 1. Most hospitals are gaining or losing <0.2% but in some instances the penalties are substantial. Gallup Indian Medical Center in New Mexico, a federal government hospital on the border of the Navajo Reservation, will be paid 1.14 percent less for each patient and New Mexico’s average of a -0.31% decline in reimbursement are the largest changes nationally. “This program is driving what we want in health care,” said Dr. …

  4. Nursing home reimbursement and the allocation of rehabilitation therapy resources.

    Science.gov (United States)

    Murtaugh, C M; Cooney, L M; DerSimonian, R R; Smits, H L; Fetter, R B

    1988-10-01

    Most public funding methods for long-term care do not adequately match payment rates with patient need for services. Case-mix payment systems are designed to encourage a more efficient and equitable allocation of limited health care resources. Even nursing home case-mix payment systems, however, do not currently provide the proper incentives to match rehabilitation therapy resources to a patient's needs. We were able to determine by a review of over 8,500 patients in 65 nursing homes that certain diagnoses, partial dependence in activities of daily living (ADLs), clear mental status, and improving medical status are associated with the provision of rehabilitation services to nursing home residents. These patient characteristics are clinically reasonable predictors of the need for therapy and should be considered for use in nursing home case-mix reimbursement systems. Primary payment source also was associated with the provision of rehabilitation services even after taking into account significant patient characteristics. It is unclear how much of the variation in service use across payers is due to differences in patient need as opposed to differences in the financial incentives associated with current payment methods.

  5. Rates, Amounts, and Determinants of Ambulatory Blood Pressure Monitoring Claim Reimbursements Among Medicare Beneficiaries

    Science.gov (United States)

    Kent, Shia T.; Shimbo, Daichi; Huang, Lei; Diaz, Keith M.; Viera, Anthony J.; Kilgore, Meredith; Oparil, Suzanne; Muntner, Paul

    2014-01-01

    Ambulatory blood pressure monitoring (ABPM) can be used to identify white coat hypertension and guide hypertensive treatment. We determined the percentage of ABPM claims submitted between 2007–2010 that were reimbursed. Among 1,970 Medicare beneficiaries with submitted claims, ABPM was reimbursed for 93.8% of claims that had an ICD-9 diagnosis code of 796.2 (“elevated blood pressure reading without diagnosis of hypertension”) versus 28.5% of claims without this code. Among claims without an ICD-9 diagnosis code of 796.2 listed, those for the component (e.g., recording, scanning analysis, physician review, reporting) versus full ABPM procedures and performed by institutional versus non-institutional providers were each more than two times as likely to be successfully reimbursed. Of the claims reimbursed, the median payment was $52.01 (25–75th percentiles: $32.95–$64.98). In conclusion, educating providers on the ABPM claims reimbursement process and evaluation of Medicare reimbursement may increase the appropriate use of ABPM and improve patient care. PMID:25492833

  6. Comparing pharmaceutical pricing and reimbursement policies in Croatia to the European Union Member States

    Science.gov (United States)

    Vogler, Sabine; Habl, Claudia; Bogut, Martina; Vončina, Luka

    2011-01-01

    Aim To perform a comparative analysis of the pharmaceutical pricing and reimbursement systems in Croatia and the 27 European Union (EU) Member States. Methods Knowledge about the pharmaceutical systems in Croatia and the 27 EU Member States was acquired by literature review and primary research with stakeholders. Results Pharmaceutical prices are controlled at all levels in Croatia, which is also the case in 21 EU Member States. Like many EU countries, Croatia also applies external price referencing, ie, compares prices with other countries. While the wholesale remuneration by a statutorily regulated linear mark-up is applied in Croatia and in several EU countries, the pharmacy compensation for dispensing reimbursable medicines in the form of a flat rate service fee in Croatia is rare among EU countries, which usually apply a linear or regressive pharmacy mark-up scheme. Like in most EU countries, the Croatian Social Insurance reimburses specific medicines at 100%, whereas patients are charged co-payments for other reimbursable medicines. Criteria for reimbursement include the medicine’s importance from the public health perspective, its therapeutic value, and relative effectiveness. In Croatia and in many EU Member States, reimbursement is based on a reference price system. Conclusion The Croatian pharmaceutical system is similar to those in the EU Member States. Key policies, like external price referencing and reference price systems, which have increasingly been introduced in EU countries are also applied in Croatia and serve the same purpose: to ensure access to medicines while containing public pharmaceutical expenditure. PMID:21495202

  7. Medicaid payment rates, case-mix reimbursement, and nursing home staffing--1996-2004.

    Science.gov (United States)

    Feng, Zhanlian; Grabowski, David C; Intrator, Orna; Zinn, Jacqueline; Mor, Vincent

    2008-01-01

    We examined the impact of state Medicaid payment rates and case-mix reimbursement on direct care staffing levels in US nursing homes. We used a recent time series of national nursing home data from the Online Survey Certification and Reporting system for 1996-2004, merged with annual state Medicaid payment rates and case-mix reimbursement information. A 5-category response measure of total staffing levels was defined according to expert recommended thresholds, and examined in a multinomial logistic regression model. Facility fixed-effects models were estimated separately for Registered Nurse (RN), Licensed Practical Nurse (LPN), and Certified Nurse Aide (CNA) staffing levels measured as average hours per resident day. Higher Medicaid payment rates were associated with increases in total staffing levels to meet a higher recommended threshold. However, these gains in overall staffing were accompanied by a reduction of RN staffing and an increase in both LPN and CNA staffing levels. Under case-mix reimbursement, the likelihood of nursing homes achieving higher recommended staffing thresholds decreased, as did levels of professional staffing. Independent of the effects of state, market, and facility characteristics, there was a significant downward trend in RN staffing and an upward trend in both LPN and CNA staffing. Although overall staffing may increase in response to more generous Medicaid reimbursement, it may not translate into improvements in the skill mix of staff. Adjusting for reimbursement levels and resident acuity, total staffing has not increased after the implementation of case-mix reimbursement.

  8. Regularities of Formation of the Labour Reimbursement Institute in the Market Economy

    Directory of Open Access Journals (Sweden)

    Povoroznyuk Inna M.

    2013-11-01

    Full Text Available The article considers theoretical issues of formation of the labour reimbursement institute in the market economy. It proves that functioning of the labour reimbursement institute identifies proportions of distribution of the total amount of expenditures on labour reimbursement between different professional and qualification groups of workers. Also, functioning of the labour reimbursement institute significantly influences proportions of distribution of income between owners of the means of production and hired labour, although, to a big extent, this institute is adapted, on the one hand, to the existing in the society forms of resolution of contradictions, inherent in means of production ownership relations, and, on the other hand, to the situation in a relevant labour market segment. However, the labour reimbursement institute itself significantly influences realisation of interests of employees and employers. The article states that wages in the modern economy should be understood as an incomplete labour reimbursement – the entrepreneur spends on an employee not only the sum of wages, but also uses other forms of resource provision of the processes of acquisition of certain benefits by the enterprise employees.

  9. Factors associated with non-reimbursable activity on an inpatient pediatric consultation-liaison service.

    Science.gov (United States)

    Bierenbaum, Melanie L; Katsikas, Steven; Furr, Allen; Carter, Bryan D

    2013-12-01

    The aim of this study was to identify factors contributing to clinician time spent in non-reimbursable activity on an inpatient pediatric consultation-liaison (C-L) service. A retrospective study was conducted using inpatient C-L service data on 1,246 consecutive referrals. For this patient population, the strongest predictor of level of non-reimbursable clinical activity was illness chronicity and the number of contacts with C-L service clinicians during their hospital stay. Patients with acute life-threatening illnesses required the highest mean amount of non-reimbursable service activity. On average, 28 % of total clinician time in completing a hospital consultation was spent in non-reimbursable activity. Effective C-L services require a proportion of time spent in non-reimbursable clinical activity, such as liaison and coordinating care with other providers. Identifying referral and systemic factors contributing to non-reimbursable activity can provide insight into budgeting/negotiating for institutional support for essential clinical and non-clinical functions in providing competent quality patient care.

  10. Medical Comorbidities Impact the Episode-of-Care Reimbursements of Total Hip Arthroplasty.

    Science.gov (United States)

    Rosas, Samuel; Sabeh, Karim G; Buller, Leonard T; Law, Tsun Yee; Roche, Martin W; Hernandez, Victor H

    2017-07-01

    Total hip arthroplasty (THA) costs are a source of great interest in the currently evolving health care market. The initiation of a bundled payment system has led to further research into costs drivers of this commonly performed procedure. One aspect that has not been well studied is the effect of comorbidities on the reimbursements of THA. The purpose of this study was to determine if common medical comorbidities affect these reimbursements. A retrospective, level of evidence III study was performed using the PearlDiver supercomputer to identify patients who underwent primary THA between 2007 and 2015. Patients were stratified by medical comorbidities and compared using the analysis of variance for reimbursements of the day of surgery, and over the 90-day postoperative period. A cohort of 250,343 patients was identified. Greatest reimbursements on the day of surgery were found among patients with a history of cirrhosis, morbid obesity, obesity, chronic kidney disease (CKD) and hepatitis C. Patients with cirrhosis, hepatitis C, chronic obstructive pulmonary disease, atrial fibrillation, and CKD incurred in the greatest reimbursements over the 90-day period after surgery. Medical comorbidities significantly impact reimbursements, and inferentially costs, after THA. The most costly comorbidities at 90 days include cirrhosis, hepatitis C, chronic obstructive pulmonary disease, atrial fibrillation, and CKD. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. School-located influenza vaccination with third-party billing: outcomes, cost, and reimbursement.

    Science.gov (United States)

    Kempe, Allison; Daley, Matthew F; Pyrzanowski, Jennifer; Vogt, Tara; Fang, Hai; Rinehart, Deborah J; Morgan, Nicole; Riis, Mette; Rodgers, Sarah; McCormick, Emily; Hammer, Anne; Campagna, Elizabeth J; Kile, Deidre; Dickinson, Miriam; Hambidge, Simon J; Shlay, Judith C

    2014-01-01

    To assess rates of immunization; costs of conducting clinics; and reimbursements for a school-located influenza vaccination (SLIV) program that billed third-party payers. SLIV clinics were conducted in 19 elementary schools in the Denver Public School district (September 2010 to February 2011). School personnel obtained parental consent, and a community vaccinator conducted clinics and performed billing. Vaccines For Children vaccine was available for eligible students. Parents were not billed for any fees. Data were collected regarding implementation costs and vaccine cost was calculated using published private sector prices. Reimbursement amounts were compared to costs. Overall, 30% of students (2784 of 9295) received ≥1 influenza vaccine; 39% (1079 of 2784) needed 2 doses and 80% received both. Excluding vaccine costs, implementation costs were $24.69 per vaccination. The percentage of vaccine costs reimbursed was 62% overall (82% from State Child Health Insurance Program (SCHIP), 50% from private insurance). The percentage of implementation costs reimbursed was 19% overall (23% from private, 27% from Medicaid, 29% from SCHIP and 0% among uninsured). Overall, 25% of total costs (implementation plus vaccine) were reimbursed. A SLIV program resulted in vaccination of nearly one third of elementary students. Reimbursement rates were limited by 1) school restrictions on charging parents fees, 2) low payments for vaccine administration from public payers and 3) high rates of denials from private insurers. Some of these problems might be reduced by provisions in the Affordable Care Act. Copyright © 2014 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  12. Comparing pharmaceutical pricing and reimbursement policies in Croatia to the European Union Member States.

    Science.gov (United States)

    Vogler, Sabine; Habl, Claudia; Bogut, Martina; Voncina, Luka

    2011-04-15

    To perform a comparative analysis of the pharmaceutical pricing and reimbursement systems in Croatia and the 27 European Union (EU) Member States. Knowledge about the pharmaceutical systems in Croatia and the 27 EU Member States was acquired by literature review and primary research with stakeholders. Pharmaceutical prices are controlled at all levels in Croatia, which is also the case in 21 EU Member States. Like many EU countries, Croatia also applies external price referencing, i.e., compares prices with other countries. While the wholesale remuneration by a statutorily regulated linear mark-up is applied in Croatia and in several EU countries, the pharmacy compensation for dispensing reimbursable medicines in the form of a flat rate service fee in Croatia is rare among EU countries, which usually apply a linear or regressive pharmacy mark-up scheme. Like in most EU countries, the Croatian Social Insurance reimburses specific medicines at 100%, whereas patients are charged co-payments for other reimbursable medicines. Criteria for reimbursement include the medicine's importance from the public health perspective, its therapeutic value, and relative effectiveness. In Croatia and in many EU Member States, reimbursement is based on a reference price system. The Croatian pharmaceutical system is similar to those in the EU Member States. Key policies, like external price referencing and reference price systems, which have increasingly been introduced in EU countries are also applied in Croatia and serve the same purpose: to ensure access to medicines while containing public pharmaceutical expenditure.

  13. Do financial incentives of introducing case mix reimbursement increase feeding tube use in nursing home residents?

    Science.gov (United States)

    Teno, Joan M; Feng, Zhanlian; Mitchell, Susan L; Kuo, Sylvia; Intrator, Orna; Mor, Vincent

    2008-05-01

    To determine whether adoption of Medicaid case mix reimbursement is associated with greater prevalence of feeding tube use in nursing home (NH) residents. Secondary analysis of longitudinal administrative data about the prevalence of feeding tube insertion and surveys of states' adoption of case mix reimbursement. NHs in the United States. NH residents at the time of NH inspection between 1993 and 2004. Facility prevalence of feeding tubes reported at the state inspection of NHs reported in the Online Survey, Certification and Reporting database and interviews with state policy makers regarding the adoption of case mix reimbursement. Between 1993 and 2004, 16 states adopted Resource Utilization Group case mix reimbursement. States varied in the prevalence of feeding tubes in their NHs. Although the use of feeding tube increased substantially over the years of the study, once temporal trends and facility fixed effects were accounted for, case mix reimbursement was not associated with greater prevalence of feeding tube use. The adoption of Medicaid case mix reimbursement was not associated with an increase in the prevalence of feeding tube use.

  14. A conceptual holding model for veterinary applications

    Directory of Open Access Journals (Sweden)

    Nicola Ferrè

    2014-05-01

    Full Text Available Spatial references are required when geographical information systems (GIS are used for the collection, storage and management of data. In the veterinary domain, the spatial component of a holding (of animals is usually defined by coordinates, and no other relevant information needs to be interpreted or used for manipulation of the data in the GIS environment provided. Users trying to integrate or reuse spatial data organised in such a way, frequently face the problem of data incompatibility and inconsistency. The root of the problem lies in differences with respect to syntax as well as variations in the semantic, spatial and temporal representations of the geographic features. To overcome these problems and to facilitate the inter-operability of different GIS, spatial data must be defined according to a “schema” that includes the definition, acquisition, analysis, access, presentation and transfer of such data between different users and systems. We propose an application “schema” of holdings for GIS applications in the veterinary domain according to the European directive framework (directive 2007/2/EC - INSPIRE. The conceptual model put forward has been developed at two specific levels to produce the essential and the abstract model, respectively. The former establishes the conceptual linkage of the system design to the real world, while the latter describes how the system or software works. The result is an application “schema” that formalises and unifies the information-theoretic foundations of how to spatially represent a holding in order to ensure straightforward information-sharing within the veterinary community.

  15. A mathematical model of aerosol holding chambers

    DEFF Research Database (Denmark)

    Zak, M; Madsen, J; Berg, E

    1999-01-01

    A mathematical model of aerosol delivery from holding chambers (spacers) was developed incorporating tidal volume (VT), chamber volume (Vch), apparatus dead space (VD), effect of valve insufficiency and other leaks, loss of aerosol by immediate impact on the chamber wall, and fallout of aerosol...... in the chamber with time. Four different spacers were connected via filters to a mechanical lung model, and aerosol delivery during "breathing" was determined from drug recovery from the filters. The formula correctly predicted the delivery of budesonide aerosol from the AeroChamber (Trudell Medical, London...

  16. The Economics of an Admissions Holding Unit.

    Science.gov (United States)

    Schreyer, Kraftin E; Martin, Richard

    2017-06-01

    With increasing attention to the actual cost of delivering care, return-on-investment calculations take on new significance. Boarded patients in the emergency department (ED) are harmful to clinical care and have significant financial opportunity costs. We hypothesize that investment in an admissions holding unit for admitted ED patients not only captures opportunity cost but also significantly lowers direct cost of care. This was a three-phase study at a busy urban teaching center with significant walkout rate. We first determined the true cost of maintaining a staffed ED bed for one patient-hour and compared it to alternative settings. The opportunity cost for patients leaving without being seen was then conservatively estimated. Lastly, a convenience sample of admitted patients boarding in the ED was observed continuously from one hour after decision-to-admit until physical departure from the ED to capture a record of every interaction with a nurse or physician. Personnel costs per patient bed-hour were $58.20 for the ED, $24.80 for an inpatient floor, $19.20 for the inpatient observation unit, and $10.40 for an admissions holding area. An eight-bed holding unit operating at practical capacity would free 57.4 hours of bed space in the ED and allow treatment of 20 additional patients. This could yield increased revenues of $27,796 per day and capture opportunity cost of $6.09 million over 219 days, in return for extra staffing costs of $218,650. Analysis of resources used for boarded patients was determined by continuous observation of a convenience sample of ED-boarded patients, which found near-zero interactions with both nursing and physicians during the boarding interval. Resource expense per ED bed-hour is more than twice that in non-critical care inpatient units. Despite the high cost of available resources, boarded non-critical patients receive virtually no nursing or physician attention. An admissions holding unit is remarkably effective in avoiding the

  17. Hold-down device for nuclear reactor

    International Nuclear Information System (INIS)

    Leclercq, J.; Bonnamour, M.

    1984-01-01

    The present device can be used in nuclear reactors and more particularly in pressurized water reactors consisting of coupled fuel assemblies, certain of which are equipped with non-displaceable elements carried by an unsertable member. The device comprises the unsertable member provided with at least two sets of springs which transmit the load of an upper structure common to the fuel assemblies ajacent that which supports the unsertable member. The device is used to hold-down fuel assemblies which are subjected to the forces of circulating coolant [fr

  18. The Economics of an Admissions Holding Unit

    Directory of Open Access Journals (Sweden)

    Kraftin E. Schreyer

    2017-05-01

    Full Text Available Introduction: With increasing attention to the actual cost of delivering care, return-on-investment calculations take on new significance. Boarded patients in the emergency department (ED are harmful to clinical care and have significant financial opportunity costs. We hypothesize that investment in an admissions holding unit for admitted ED patients not only captures opportunity cost but also significantly lowers direct cost of care. Methods: This was a three-phase study at a busy urban teaching center with significant walkout rate. We first determined the true cost of maintaining a staffed ED bed for one patient-hour and compared it to alternative settings. The opportunity cost for patients leaving without being seen was then conservatively estimated. Lastly, a convenience sample of admitted patients boarding in the ED was observed continuously from one hour after decision-to-admit until physical departure from the ED to capture a record of every interaction with a nurse or physician. Results: Personnel costs per patient bed-hour were $58.20 for the ED, $24.80 for an inpatient floor, $19.20 for the inpatient observation unit, and $10.40 for an admissions holding area. An eight-bed holding unit operating at practical capacity would free 57.4 hours of bed space in the ED and allow treatment of 20 additional patients. This could yield increased revenues of $27,796 per day and capture opportunity cost of $6.09 million over 219 days, in return for extra staffing costs of $218,650. Analysis of resources used for boarded patients was determined by continuous observation of a convenience sample of ED-boarded patients, which found near-zero interactions with both nursing and physicians during the boarding interval. Conclusion: Resource expense per ED bed-hour is more than twice that in non-critical care inpatient units. Despite the high cost of available resources, boarded non-critical patients receive virtually no nursing or physician attention. An

  19. MIM Holdings Limited 1984 annual report

    Energy Technology Data Exchange (ETDEWEB)

    1984-01-01

    M.I.M. Holdings Limited is a major mining and mineral processing company formed in 1970. The group traces its origins to 1924 following the discovery of silver lead zinc started in 1931 and parallel production of silver lead zinc ore at Mount Isa the previous year. Today the MIM group is a diversified mineral, coal and metal producing and marketing organisation. Details of the company's principal activities over the last year, and accounts and management information for the last year are presented.

  20. Reimbursing live organ donors for incurred non-medical expenses: a global perspective on policies and programs.

    Science.gov (United States)

    Sickand, M; Cuerden, M S; Klarenbach, S W; Ojo, A O; Parikh, C R; Boudville, N; Garg, A X

    2009-12-01

    Methods to reimburse living organ donors for the non-medical expenses they incur have been implemented in some jurisdictions and are being considered in others. A global understanding of existing legislation and programs would help decision makers implement and optimize policies and programs. We searched for and collected data from countries that practice living organ donation. We examined legislation and programs that facilitate reimbursement, focusing on policy mechanisms, eligibility criteria, program duration and types of expenses reimbursed. Of 40 countries, reimbursement is expressly legal in 16, unclear in 18, unspecified in 6 and expressly prohibited in 1. Donor reimbursement programs exist in 21 countries; 6 have been enacted in the last 5 years. Lost income is reimbursed in 17 countries, while travel, accommodation, meal and childcare costs are reimbursed in 12 to 19 countries. Ten countries have comprehensive programs, where all major cost categories are reimbursed to some extent. Out-of-country donors are reimbursed in 10 jurisdictions. Reimbursement is conditional on donor income in 7 countries, and recipient income in 2 countries. Many nations have programs that help living donors with their financial costs. These programs differ in operation and scope. Donors in other regions of the world are without support.

  1. Reimbursing Live Organ Donors for Incurred Non-Medical Expenses: A Global Perspective on Policies and Programs

    Science.gov (United States)

    Sickand, M.; Cuerden, M. S.; Klarenbach, S. W.; Ojo, A. O.; Parikh, C. R.; Boudville, N.; Garg, A. X.

    2015-01-01

    Methods to reimburse living organ donors for the non-medical expenses they incur have been implemented in some jurisdictions and are being considered in others. A global understanding of existing legislation and programs would help decision makers implement and optimize policies and programs. We searched for and collected data from countries that practice living organ donation. We examined legislation and programs that facilitate reimbursement, focusing on policy mechanisms, eligibility criteria, program duration and types of expenses reimbursed. Of 40 countries, reimbursement is expressly legal in 16, unclear in 18, unspecified in 6 and expressly prohibited in 1. Donor reimbursement programs exist in 21 countries; 6 have been enacted in the last 5 years. Lost income is reimbursed in 17 countries, while travel, accommodation, meal and childcare costs are reimbursed in 12 to 19 countries. Ten countries have comprehensive programs, where all major cost categories are reimbursed to some extent. Out-of-country donors are reimbursed in 10 jurisdictions. Reimbursement is conditional on donor income in 7 countries, and recipient income in 2 countries. Many nations have programs that help living donors with their financial costs. These programs differ in operation and scope. Donors in other regions of the world are without support. PMID:19788503

  2. Effect of chemical reaction, heat and mass transfer on nonlinear boundary layer past a porous shrinking sheet in the presence of suction

    International Nuclear Information System (INIS)

    Muhaimin; Kandasamy, Ramasamy; Hashim, Ishak

    2010-01-01

    This work is concerned with the viscous flow due to a shrinking sheet in the presence of suction with variable stream conditions. The cases of two-dimensional and axisymmetric shrinking have been discussed. The governing partial differential equations of the problem, subjected to their boundary conditions, are solved numerically by applying an efficient solution scheme for local nonsimilarity boundary layer analysis. Favorable comparison with previously published work is performed. Numerical results for the dimensionless velocity, temperature and concentration profiles as well as for the skin friction, heat and mass transfer and deposition rate are obtained and displayed graphically for pertinent parameters to show interesting aspects of the solution.

  3. Heat transfer in boundary layer stagnation-point flow towards a shrinking sheet with non-uniform heat flux

    International Nuclear Information System (INIS)

    Bhattacharyya Krishnendu

    2013-01-01

    In this paper, the effect of non-uniform heat flux on heat transfer in boundary layer stagnation-point flow over a shrinking sheet is studied. The variable boundary heat fluxes are considered of two types: direct power-law variation with the distance along the sheet and inverse power-law variation with the distance. The governing partial differential equations (PDEs) are transformed into non linear self-similar ordinary differential equations (ODEs) by similarity transformations, and then those are solved using very efficient shooting method. The direct variation and inverse variation of heat flux along the sheet have completely different effects on the temperature distribution. Moreover, the heat transfer characteristics in the presence of non-uniform heat flux for several values of physical parameters are also found to be interesting

  4. Radiation effect on boundary layer flow of an Eyring–Powell fluid over an exponentially shrinking sheet

    Directory of Open Access Journals (Sweden)

    Asmat Ara

    2014-12-01

    Full Text Available The aim of this paper was to examine the steady boundary layer flow of an Eyring–Powell model fluid due to an exponentially shrinking sheet. In addition, the heat transfer process in the presence of thermal radiation is considered. Using usual similarity transformations the governing equations have been transformed into non-linear ordinary differential equations. Homotopy analysis method (HAM is employed for the series solutions. The convergence of the obtained series solutions is carefully analyzed. Numerical values of the temperature gradient are presented and discussed. It is observed that velocity increases with an increase in mass suction S. In addition, for the temperature profiles opposite behavior is observed for increment in suction. Moreover, the thermal boundary layer thickness decreases due to increase in Prandtl number Pr and thermal radiation R.

  5. Stagnation point flow on bioconvection nanofluid over a stretching/shrinking surface with velocity and thermal slip effects

    Science.gov (United States)

    Chan, Sze Qi; Aman, Fazlina; Mansur, Syahira

    2017-09-01

    Nanofluid containing nanometer sized particles has become an ideal thermal conductivity medium for the flow and heat transfer in many industrial and engineering applications due to their high rate of heat transfer. However, swimming microorganisms are imposed into the nanofluid to overcome the instability of nanoparticles due to a bioconvection phenomenon. This paper investigates the stagnation point flow on bioconvection heat transfer of a nanofluid over a stretching/shrinking surface containing gyrotactic microorganisms. Velocity and thermal slip effects are the two conditions incorporated into the model. Similarity transformation is applied to reduce the governing nonlinear partial differential equations into the nonlinear ordinary differential equations. The transformed equations are then solved numerically. The results are displayed in the form of graphs and tables. The effects of these governing parameters on the skin friction coefficient, local Nusselt number, local Sherwood number and the local density of the motile microorganisms are analysed and discussed in details.

  6. Shrinking of cities in the Czech Republic and its reflection on society: Case study of Karviná City

    Directory of Open Access Journals (Sweden)

    Šerý Ondřej

    2018-01-01

    Full Text Available The shrinking of cities is a process that accompanies cities in post-conjunctural changes, when they are entering a phase of economic decline and the decline in population connected with it. The Ostrava- Karviná area is one of the economically problematic regions in the Czech Republic nowadays but it used to be ranked as one of the economic heartlands in the period of socialism. The region, dependent on bituminous coal mining and heavy industry, gradually began to decline after the year 1989 and one of the consequences is a significant decline in its population. This paper deals with identification of the causes and consequences of shrinking cities explained through the example of the town of Karviná through an analysis of quantitative data, questionnaire surveys, and semi-structured interviews. The questionnaire survey revealed that the main reason causing the departure of young and educated citizens is the lack of work opportunities. High unemployment and thus the presence of many socially disadvantaged people causes the atmosphere in the city to deteriorate, and this is accompanied by social problems, such as ageing of the population or criminality. Lack of safety of citizens and a bad environment are other reasons why young people leave the city. The decreasing number of citizens closes the vicious circle by leading to a lower demand for services, closing of shops and other services and increasing numbers of empty houses and flats. Another essential part of the paper is the question of possible measures by the local authority leading to the elimination of these undesirable phenomena, but also the belief in the necessity of help from the government.

  7. A Comparison of Reimbursement Recommendations by European HTA Agencies: Is There Opportunity for Further Alignment?

    Directory of Open Access Journals (Sweden)

    Nicola Allen

    2017-06-01

    Full Text Available Introduction: In Europe and beyond, the rising costs of healthcare and limited healthcare resources have resulted in the implementation of health technology assessment (HTA to inform health policy and reimbursement decision-making. European legislation has provided a harmonized route for the regulatory process with the European Medicines Agency, but reimbursement decision-making still remains the responsibility of each country. There is a recognized need to move toward a more objective and collaborative reimbursement environment for new medicines in Europe. Therefore, the aim of this study was to objectively assess and compare the national reimbursement recommendations of 9 European jurisdictions following European Medicines Agency (EMA recommendation for centralized marketing authorization.Methods: Using publicly available data and newly developed classification tools, this study appraised 9 European reimbursement systems by assessing HTA processes and the relationship between the regulatory, HTA and decision-making organizations. Each national HTA agency was classified according to two novel taxonomies. The System taxonomy, focuses on the position of the HTA agency within the national reimbursement system according to the relationship between the regulator, the HTA-performing agency, and the reimbursement decision-making coverage body. The HTA Process taxonomy distinguishes between the individual HTA agency's approach to economic and therapeutic evaluation and the inclusion of an independent appraisal step. The taxonomic groups were subsequently compared with national HTA recommendations.Results: This study identified European national reimbursement recommendations for 102 new active substances (NASs approved by the EMA from 2008 to 2012. These reimbursement recommendations were compared using a novel classification tool and identified alignment between the organizational structure of reimbursement systems (System taxonomy and HTA

  8. Small forest holdings could be combined for hunting leases

    Science.gov (United States)

    John J. Stransky; Lowell K. Halls

    1969-01-01

    Most forest land acreage in the South is in small holdings. Much-needed hunting land, and income for rural landowners, could be provided by combining small forest holdings into large units and teasing the hunting rights.

  9. BEACON: A Summary Framework to Overcome Potential Reimbursement Hurdles.

    Science.gov (United States)

    Dunlop, William C N; Mullins, C Daniel; Pirk, Olaf; Goeree, Ron; Postma, Maarten J; Enstone, Ashley; Heron, Louise

    2016-10-01

    To provide a framework for addressing payers' criteria during the development of pharmaceuticals. A conceptual framework was presented to an international health economic expert panel for discussion. A structured literature search (from 2010 to May 2015), using the following databases in Ovid: Medline(®) and Medline(®) In-Process (PubMed), Embase (Ovid), EconLit (EBSCOhost) and the National Health Service Economic Evaluation Database (NHS EED), and a 'grey literature' search, were conducted to identify existing criteria from the payer perspective. The criteria assessed by existing frameworks and guidelines were collated; the most commonly reported criteria were considered for inclusion in the framework. A mnemonic was conceived as a memory aide to summarise these criteria. Overall, 41 publications were identified as potentially relevant to the objective. Following further screening, 26 were excluded upon full-text review on the basis of no framework presented (n = 13), redundancy (n = 11) or abstract only (n = 2). Frameworks that captured criteria developed for or utilised by the pharmaceutical industry (n = 5) and reimbursement guidance (n = 10) were reviewed. The most commonly identified criteria-unmet need/patient burden, safety, efficacy, quality-of-life outcomes, environment, evidence quality, budget impact and comparator-were incorporated into the summary framework. For ease of communication, the following mnemonic was developed: BEACON (Burden/target population, Environment, Affordability/value, Comparator, Outcomes, Number of studies/quality of evidence). The BEACON framework aims to capture the 'essence' of payer requirements by addressing the most commonly described criteria requested by payers regarding the introduction of a new pharmaceutical.

  10. Rumours about blood and reimbursements in a microbicide gel trial.

    Science.gov (United States)

    Stadler, Jonathan; Saethre, Eirik

    2010-12-01

    A rumour that emerged during a microbicide gel trial tells the tale of clinic staff purchasing trial participants' blood. This paper documents the rumour and explores its divergent interpretations and meanings in relation to the context of the trial and the social and economic setting at two of the trial sites (Soweto and Orange Farm) in South Africa. The article is based on qualitative research conducted during the Microbicides Development Programme (MDP) 301 trial to evaluate a microbicide vaginal gel for HIV prevention in women. The research incorporated in-depth interviews with female trial participants and their male partners, focus group discussions with male and female community members, and participant observation in the trial clinic and community setting at the two sites. The article analyses the different perspectives among the clinic staff, community and trial participants in terms of which the rumour about the exchange of blood for cash is seen as: 1) the result of ignorance of the clinical trial procedures; 2) the exploitation of poor and vulnerable women; 3) an example of young women's desire for material gain; and 4) a reciprocal exchange of 'clean blood' for cash between women trial participants and the health services. We suggest that the rumours about selling blood verbalise notions of gender and morality while also providing an appraisal of the behaviour of young women and a critique of social relationships between foreign researchers and local participants. Through stories about the clinical trial procedures and its potential reimbursements, the participants were creating and reconfiguring social relationships. Ultimately, rumours are one way in which foreign enterprises such as a clinical trial are rendered local.

  11. Corporate Governance, Cash Holdings, and Firm Value: Evidence from Japan

    OpenAIRE

    Qi Luo; Toyohiko Hachiya

    2005-01-01

    This paper presents evidence on cash holdings for Japanese firms listed on the Tokyo Stock Exchange, focusing on the impact of corporate governance factors in cash holdings and the implication of cash holdings to firm value. We find that insider ownership and bank relations of firms play a significant role in determining cash holdings. Our results indicate that foreign stockholders select profitable firms to invest, and these firms have higher levels of cash. We document evidence that cash ho...

  12. Governance mechanisms, investment opportunity set and SMEs cash holdings

    OpenAIRE

    Belghitar, Yacine; Khan, James

    2013-01-01

    This study analyses the effect of firm characteristics and governance mechanisms on cash holdings for a sample of UK SMEs. The results show that UK SMEs with greater cash flow volatility and institutional investors hold more cash; whereas levered and dividend paying SMEs with non-executive ownership hold less cash. We also find that ownership structure is significant only in explaining the cash holdings for firms with high growth investment opportunities, and leverage is only significant in e...

  13. Pricing and reimbursement of orphan drugs: the need for more transparency

    Directory of Open Access Journals (Sweden)

    Simoens Steven

    2011-06-01

    Full Text Available Abstract Pricing and reimbursement of orphan drugs are an issue of high priority for policy makers, legislators, health care professionals, industry leaders, academics and patients. This study aims to conduct a literature review to provide insight into the drivers of orphan drug pricing and reimbursement. Although orphan drug pricing follows the same economic logic as drug pricing in general, the monopolistic power of orphan drugs results in high prices: a orphan drugs benefit from a period of marketing exclusivity; b few alternative health technologies are available; c third-party payers and patients have limited negotiating power; d manufacturers attempt to maximise orphan drug prices within the constraints of domestic pricing and reimbursement policies; and e substantial R&D costs need to be recouped from a small number of patients. Although these conditions apply to some orphan drugs, they do not apply to all orphan drugs. Indeed, the small number of patients treated with an orphan drug and the limited economic viability of orphan drugs can be questioned in a number of cases. Additionally, manufacturers have an incentive to game the system by artificially creating monopolistic market conditions. Given their high price for an often modest effectiveness, orphan drugs are unlikely to provide value for money. However, additional criteria are used to inform reimbursement decisions in some countries. These criteria may include: the seriousness of the disease; the availability of other therapies to treat the disease; and the cost to the patient if the medicine is not reimbursed. Therefore, the maximum cost per unit of outcome that a health care payer is willing to pay for a drug could be set higher for orphan drugs to which society attaches a high social value. There is a need for a transparent and evidence-based approach towards orphan drug pricing and reimbursement. Such an approach should be targeted at demonstrating the relative effectiveness

  14. Pricing and reimbursement of orphan drugs: the need for more transparency.

    Science.gov (United States)

    Simoens, Steven

    2011-06-17

    Pricing and reimbursement of orphan drugs are an issue of high priority for policy makers, legislators, health care professionals, industry leaders, academics and patients. This study aims to conduct a literature review to provide insight into the drivers of orphan drug pricing and reimbursement. Although orphan drug pricing follows the same economic logic as drug pricing in general, the monopolistic power of orphan drugs results in high prices: a) orphan drugs benefit from a period of marketing exclusivity; b) few alternative health technologies are available; c) third-party payers and patients have limited negotiating power; d) manufacturers attempt to maximise orphan drug prices within the constraints of domestic pricing and reimbursement policies; and e) substantial R&D costs need to be recouped from a small number of patients. Although these conditions apply to some orphan drugs, they do not apply to all orphan drugs. Indeed, the small number of patients treated with an orphan drug and the limited economic viability of orphan drugs can be questioned in a number of cases. Additionally, manufacturers have an incentive to game the system by artificially creating monopolistic market conditions. Given their high price for an often modest effectiveness, orphan drugs are unlikely to provide value for money. However, additional criteria are used to inform reimbursement decisions in some countries. These criteria may include: the seriousness of the disease; the availability of other therapies to treat the disease; and the cost to the patient if the medicine is not reimbursed. Therefore, the maximum cost per unit of outcome that a health care payer is willing to pay for a drug could be set higher for orphan drugs to which society attaches a high social value. There is a need for a transparent and evidence-based approach towards orphan drug pricing and reimbursement. Such an approach should be targeted at demonstrating the relative effectiveness, cost-effectiveness and

  15. Billing for pharmacists' cognitive services in physicians' offices: multiple methods of reimbursement.

    Science.gov (United States)

    Scott, Mollie Ashe; Hitch, William J; Wilson, Courtenay Gilmore; Lugo, Amy M

    2012-01-01

    To evaluate the charges and reimbursement for pharmacist services using multiple methods of billing and determine the number of patients that must be managed by a pharmacist to cover the cost of salary and fringe benefits. Large teaching ambulatory clinic in North Carolina. Annual charges and reimbursement, patient no-show rate, clinic capacity, number of patients seen monthly and annually, and number of patients that must be seen to pay for a pharmacist's salary and benefits. A total of 6,930 patient encounters were documented during the study period. Four different clinics were managed by the pharmacists, including anticoagulation, pharmacotherapy, osteoporosis, and wellness clinics. "Incident to" level 1 billing was used for the anticoagulation and pharmacotherapy clinics, whereas level 4 codes were used for the osteoporosis clinic. The wellness clinic utilized a negotiated fee-for-service model. Mean annual charges were $65,022, and the mean reimbursement rate was 47%. The mean charge and collection per encounter were $41 and $19, respectively. Eleven encounters per day were necessary to generate enough charges to pay for the cost of the pharmacist. Considering actual reimbursement rates, the number of patient encounters necessary increased to 24 per day. "What if" sensitivity analysis indicated that billing at the level of service provided instead of level 1 decreased the number of patients needed to be seen daily. Billing a level 4 visit necessitated that five patients would need to be seen daily to generate adequate charges. Taking into account the 47% reimbursement rate, 10 level 4 encounters per day were necessary to generate appropriate reimbursement to pay for the pharmacist. Unique opportunities for pharmacists to provide direct patient care in the ambulatory setting continue to develop. Use of a combination of billing methods resulted in sustainable reimbursement. The ability to bill at the level of service provided instead of a level 1 visit would

  16. Anticipated changes in reimbursements for US outpatient emergency department encounters after health reform.

    Science.gov (United States)

    Galarraga, Jessica E; Pines, Jesse M

    2014-04-01

    We study how reimbursements to emergency departments (EDs) for outpatient visits may be affected by the insurance coverage expansion of the Patient Protection and Affordable Care Act as previously uninsured patients gain coverage either through the Medicaid expansion or through health insurance exchanges. We conducted a secondary analysis of data (2005 to 2010) from the Medical Expenditure Panel Survey. We specified multiple linear regression models to examine differences in the payments, charges, and reimbursement ratios by insurance category. Comparisons were made between 2 groups to reflect likely movements in insurance status after the Patient Protection and Affordable Care Act implementation: (1) the uninsured who will be Medicaid eligible afterward versus Medicaid insured, and (2) the uninsured who will be Medicaid ineligible afterward versus the privately insured. From 2005 to 2010, as a percentage of total ED charges, outpatient ED encounters for Medicaid beneficiaries reimbursed 17% more than for uninsured individuals who will become Medicaid eligible after Patient Protection and Affordable Care Act implementation: 40.0% versus 34.0%, mean absolute difference=5.9%, 95% confidence interval 5.7% to 6.2%. During the same period, the privately insured reimbursed 39% more than for uninsured individuals who will not be Medicaid eligible after Patient Protection and Affordable Care Act implementation: 54.0% versus 38.8%, mean absolute difference=15.2%, 95% confidence interval 12.8% to 17.6%. Assuming historical reimbursement patterns remain after Patient Protection and Affordable Care Act implementation, outpatient ED encounters could reimburse considerably more for both the previously uninsured patients who will obtain Medicaid insurance and for those who move into private insurance products through health insurance exchanges. Although our study does provide insight into the future, multiple factors will ultimately influence reimbursements after implementation

  17. Quantitative evaluation of radiation oncologists' adaptability to lower reimbursing treatment programs.

    Science.gov (United States)

    Gill, Beant S; Beriwal, Sushil; Rajagopalan, Malolan S; Wang, Hong; Hodges, Kimberly; Greenberger, Joel S

    2015-01-01

    Rapid development of sophisticated modalities has challenged radiation oncologists to evaluate workflow and care delivery processes. Our study assesses treatment modality use and willingness to alter management with anticipated limitations in reimbursement and resources. A web-based survey was sent to 43 radiation oncologists in a National Cancer Institute-designated comprehensive cancer center network. The survey contained 7 clinical cases with various acceptable treatment options based on our institutional clinical pathways. Each case was presented in 3 modules with varying situations: (1) unlimited resources with current reimbursement, (2) restricted reimbursement (bundled payment), and (3) both restricted reimbursement and resources. Reimbursement rates were based on the 2013 Medicare fee schedule. Adoption of lower reimbursing options (LROs) was defined as the percentage of scenarios in which a respondent selected an LRO compared with baseline. Forty-three physicians completed the survey, 11 (26%) at academic and 32 (74%) at community facilities. When bundled payment was imposed (module 1 vs 2), an increase in willingness to adopt LROs was observed (median 11.1%). When physicians were limited to both bundled payment and resource restriction, adoption of LROs was more pronounced (module 1 vs 3; median 22.2%, P 25 years, P = .02). Radiation oncologists were more likely to choose lower reimbursing treatment options when both resource restriction and bundled payment were presented. Those with fewer years of clinical practice were less inclined to alter management, perhaps reflecting modern residency training. Future cost-utility analyses may help to better guide radiation oncologists in selection of LROs. Copyright © 2015 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

  18. 49 CFR 178.338-9 - Holding time.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 2 2010-10-01 2010-10-01 false Holding time. 178.338-9 Section 178.338-9... Specifications for Containers for Motor Vehicle Transportation § 178.338-9 Holding time. (a) “Holding time” is the time, as determined by testing, that will elapse from loading until the pressure of the contents...

  19. 76 FR 35085 - Savings and Loan Holding Company Application

    Science.gov (United States)

    2011-06-15

    ... DEPARTMENT OF THE TREASURY Office of Thrift Supervision Savings and Loan Holding Company... Proposal: Savings Loan Holding Company Application. OMB Number: 1550-0015. Form Numbers: H-(e). Description... that no company, or any director or officer of a savings and loan holding company, or any individual...

  20. Creditor rights, country governance, and corporate cash holdings

    NARCIS (Netherlands)

    Seifert, Bruce; Gonenc, Halit

    2016-01-01

    This study examines the impact of creditor rights and country governance on cash holdings using a sample of firms from 47 countries. We hypothesize that cash holdings are smaller when both creditor rights and country governance are high. In these circumstances firms will not need to hold as much

  1. 12 CFR 575.14 - Subsidiary holding companies.

    Science.gov (United States)

    2010-01-01

    ... follows: Federal MHC Subsidiary Holding Company Charter Section 1. Corporate title. The full corporate... subsidiary holding company available for distribution, in cash or in kind. Each share of common stock shall... 12 Banks and Banking 5 2010-01-01 2010-01-01 false Subsidiary holding companies. 575.14 Section...

  2. "Hold Harmless" Option for Staff Babysitting and Employee References

    Science.gov (United States)

    Bruno, Holly Elissa

    2010-01-01

    Help for educators and administrators may be on the way in the form of "hold harmless" documents that allow for flexibility in enforcing program policies. Having a "No Babysitting policy," and "Hold Harmless" documentation will not stop one's program from being sued. However, with the "No Babysitting policy" and "Hold Harmless" documentation…

  3. 78 FR 31590 - Sears Holdings Management Corporation, A Division Of Sears Holdings Corporation, Hoffman Estates...

    Science.gov (United States)

    2013-05-24

    ... (``My position at Sears had nothing to do with Analytics or space Management. I worked in Marketing... firm clarified that one petitioner supplied print marketing management services, another petitioner... DEPARTMENT OF LABOR Employment and Training Administration [TA-W-81,253] Sears Holdings Management...

  4. The Incredible Shrinking Cup Lab: Connecting with Ocean and Great Lakes Scientists to Investigate the Effect of Depth and Water Pressure on Polystyrene

    Science.gov (United States)

    Rose, Chantelle M.; Adams, Jacqueline M.; Hinchey, Elizabeth K.; Nestlerode, Janet A.; Patterson, Mark R.

    2013-01-01

    Pressure increases rapidly with depth in a water body. Ocean and Great Lakes scientists often use this physical feature of water as the basis of a fun pastime performed aboard research vessels around the world: the shrinking of polystyrene cups. Depending on the depth to which the cups are deployed, the results can be quite striking! Capitalizing…

  5. Reimbursement-Based Economics--What Is It and How Can We Use It to Inform Drug Policy Reform?

    Science.gov (United States)

    Coyle, Doug; Lee, Karen M; Mamdani, Muhammad; Sabarre, Kelley-Anne; Tingley, Kylie

    2015-01-01

    In Ontario, approximately $3.8 billion is spent annually on publicly funded drug programs. The annual growth in Ontario Public Drug Program (OPDP) expenditure has been limited to 1.2% over the course of 3 years. Concurrently, the Ontario Drug Policy Research Network (ODPRN) was appointed to conduct drug class review research relating to formulary modernization within the OPDP. Drug class reviews by ODPRN incorporate a novel methodological technique called reimbursement-based economics, which focuses on reimbursement strategies and may be particularly relevant for policy-makers. To describe the reimbursement-based economics approach. Reimbursement-based economics aims to identify the optimal reimbursement strategy for drug classes by incorporating a review of economic literature, comprehensive budget impact analyses, and consideration of cost-effectiveness. This 3-step approach is novel in its focus on the economic impact of alternate reimbursement strategies rather than individual therapies. The methods involved within the reimbursement-based approach are detailed. To facilitate the description, summary methods and findings from a recent application to formulary modernization with respect to the drug class tryptamine-based selective serotonin receptor agonists (triptans) used to treat migraine headaches are presented. The application of reimbursement-based economics in drug policy reforms allows policy-makers to consider the cost-effectiveness and budget impact of different reimbursement strategies allowing consideration of the trade-off between potential cost savings vs increased access to cost-effective treatments. © 2015 American Headache Society.

  6. Criteria for Drug Reimbursement Decision-Making: An Emerging Public Health Challenge in Bulgaria

    Directory of Open Access Journals (Sweden)

    Georgi Iskrov

    2016-02-01

    Full Text Available Background: During times of fiscal austerity, means of reimbursement decision-making are of particular interest for public health theory and practice. Introduction of advanced health technologies, growing health expenditures and increased public scrutiny over drug reimbursement decisions have pushed governments to consider mechanisms that promote the use of effective health technologies, while constraining costs. Aims: The study’s aim was to explore the current rationale of the drug reimbursement decision-making framework in Bulgaria. Our pilot research focused on one particular component of this process – the criteria used – because of the critical role that criteria are known to have in setting budgets and priorities in the field of public health. The analysis pursued two objectives: to identify important criteria relevant to drug reimbursement decision-making and to unveil relationships between theory and practice. Study Design: Cross-sectional study. Methods: The study was realized through a closed-ended survey on reimbursement criteria among four major public health stakeholders – medical professionals, patients, health authorities, and industry. Empirical outcomes were then cross-compared with the theoretical framework, as defined by current Bulgarian public health legislation. Analysis outlined what is done and what needs to be done in the field of public health reimbursement decision-making. Results: Bulgarian public health stakeholders agreed on 15 criteria to form a tentative optimal framework for drug reimbursement decision-making. The most apparent gap between the empirically found preferences and the official legislation is the lack of consideration for the strength of evidence in reimbursement decisions. Conclusion: Bulgarian policy makers need to address specific gaps, such as formal consideration for strength of evidence, explicit role of efficiency criteria, and means to effectively empower patient and citizen

  7. Multiple job holding, local labor markets, and the business cycle

    Directory of Open Access Journals (Sweden)

    Barry T. Hirsch

    2016-04-01

    Full Text Available Abstract About 5 % of US workers hold multiple jobs, which can exacerbate or mitigate employment changes over the business cycle. Theory is ambiguous and prior literature is not fully conclusive. We examine the relationship between multiple job holding and local unemployment rates using a large Current Population Survey data set of workers in urban labor markets during 1998–2013. Labor markets with high unemployment have moderately lower rates of multiple job holding. Yet no relationship between multiple job holding and unemployment is found within markets over time, with near-zero estimates being precisely estimated. Multiple job holding is largely acyclic. JEL Classification: J21

  8. Population impact of reimbursement for smoking cessation: a natural experiment in The Netherlands.

    Science.gov (United States)

    Willemsen, Marc C; Segaar, Dewi; van Schayck, Onno C P

    2013-03-01

    To report on the impact of financial reimbursement of pharmacotherapy for smoking cessation in combination with behavioural support on the number of enrollees to proactive counselling in the Dutch national quitline. Descriptive time-series analysis was used to compare quitline enrolment in 2010 and 2012 (no reimbursement) with 2011 (reimbursement). National smoking cessation quitline. Smokers signing up for proactive counselling. Treatment enrolment data recorded by the quitline as part of usual care from 2010, 2011 and 2012 (until May). In 2010, a total of 848 smokers started treatment. In 2011, 9091 smokers enrolled. In 2012, the number of enrollees dropped dramatically, even below the 2010 level. In addition, the proportion of smokers in the population dropped from 27.2% in 2010 to 24.7% in 2011. The introduction of a national reimbursement system in the Netherlands was associated with a more than 10-fold increase in telephone counselling for smoking cessation and suggests that reimbursement for smoking cessation contributed to improvements in public health. © 2012 The Authors, Addiction © 2012 Society for the Study of Addiction.

  9. Restrictions on the reimbursement policy with regard to retail marketing of medicinal products in Poland.

    Science.gov (United States)

    Zimmermann, Agnieszka

    2013-01-01

    On January 1, 2012, the law of 12 May 2011 on the reimbursement of medicines, food products of special nutritional purpose and medicinal products, intended to tighten up the reimbursement system, came into force in Poland. The new legislative act has significantly altered the previous principles of retail marketing of products subject to publicly financed reimbursement. First of all, the prices of reimbursed products have been unified through the introduction of fixed margins and prices and a ban--completely unknown until now--on using free market sales practices. These regulations are intended to lead to the abolition of price competition and its replacement with competition as to the quality of services provided by pharmacies. At the same time, entities engaged in retail marketing of medicinal products have been imposed a number of new obligations and highly repressive penalties for failure to fulfill them. The paper analyzes the legislative changes and points out the consequences, both those which can already be seen and the predictable ones. The assumed priority and criterion of evaluation of the reimbursement policy in question is its impact on the functioning of pharmacies which, according to the premises of Polish pharmaceutical law, should play the role of public health protection institutions.

  10. Does case-mix based reimbursement stimulate the development of process-oriented care delivery?

    Science.gov (United States)

    Vos, Leti; Dückers, Michel L A; Wagner, Cordula; van Merode, Godefridus G

    2010-11-01

    Reimbursement based on the total care of a patient during an acute episode of illness is believed to stimulate management and clinicians to reduce quality problems like waiting times and poor coordination of care delivery. Although many studies already show that this kind of case-mix based reimbursement leads to more efficiency, it remains unclear whether care coordination improved as well. This study aims to explore whether case-mix based reimbursement stimulates development of care coordination by the use of care programmes, and a process-oriented way of working. Data for this study were gathered during the winter of 2007/2008 in a survey involving all Dutch hospitals. Descriptive and structural equation modelling (SEM) analyses were conducted. SEM reveals that adoption of the case-mix reimbursement within hospitals' budgeting processes stimulates hospitals to establish care programmes by the use of process-oriented performance measures. However, the implementation of care programmes is not (yet) accompanied by a change in focus from function (the delivery of independent care activities) to process (the delivery of care activities as being connected to a chain of interdependent care activities). This study demonstrates that hospital management can stimulate the development of care programmes by the adoption of case-mix reimbursement within hospitals' budgeting processes. Future research is recommended to confirm this finding and to determine whether the establishment of care programmes will in time indeed lead to a more process-oriented view of professionals. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  11. Cost analysis of radiological interventional procedures and reimbursement within a clinic

    International Nuclear Information System (INIS)

    Strotzer, M.; Voelk, M.; Lenhart, M.; Fruend, R.; Feuerbach, S.

    2002-01-01

    Purpose: Analysis of costs for vascular radiological interventions on a per patient basis and comparison with reimbursement based on GOAe(Gebuehrenordnung fuer Aerzte) and DKG-NT (Deutsche Krankenhausgesellschaft-Nebenkostentarif). Material and Methods: The ten procedures most frequently performed within 12 months were evaluated. Personnel costs were derived from precise costs per hour and estimated procedure time for each intervention. Costs for medical devices were included. Reimbursement based on GOAewas calculated using the official conversion factor of 0.114 DM for each specific relative value unit and a multiplication factor of 1.0. The corresponding conversion factor for DKG-NT, determined by the DKG, was 0.168 DM. Results: A total of 832 interventional procedures were included. Marked differences between calculated costs and reimbursement rates were found. Regarding the ten most frequently performed procedures, there was a deficit of 1.06 million DM according GOAedata (factor 1.0) and 0.787 million DM according DKG-NT. The percentage of reimbursement was only 34.2 (GOAe; factor 1.0) and 51.3 (DKG-NT), respectively. Conclusion: Reimbursement of radiological interventional procedures based on GOAeand DKG-NT data is of limited value for economic controlling purposes within a hospital. (orig.) [de

  12. Reimbursement of hormonal contraceptives and the frequency of induced abortion among teenagers in Sweden.

    Science.gov (United States)

    Sydsjö, Adam; Sydsjö, Gunilla; Bladh, Marie; Josefsson, Ann

    2014-05-29

    Reduction in costs of hormonal contraceptives is often proposed to reduce rates of induced abortion among young women. This study investigates the relationship between rates of induced abortion and reimbursement of dispensed hormonal contraceptives among young women in Sweden. Comparisons are made with the Nordic countries Finland, Norway and Denmark. Official statistics on induced abortion and numbers of prescribed and dispensed hormonal contraceptives presented as "Defined Daily Dose/thousand women" (DDD/T) aged 15-19 years were compiled and related to levels of reimbursement in all Swedish counties by using public official data. The Swedish numbers of induced abortion were compared to those of Finland, Norway and Denmark. The main outcome measure was rates of induced abortion and DDD/T. No correlation was observed between rates of abortion and reimbursement among Swedish counties. Nor was any correlation found between sales of hormonal contraceptives and the rates of abortion. In a Nordic perspective, Finland and Denmark, which have no reimbursement at all, and Norway all have lower rates of induced abortion than Sweden. Reimbursement does not seem to be enough in order to reduce rates of induced abortion. Evidently, other factors such as attitudes, education, religion, tradition or cultural differences in each of Swedish counties as well as in the Nordic countries may be of importance. A more innovative approach is needed in order to facilitate safe sex and to protect young women from unwanted pregnancies.

  13. Surgeon Reimbursements in Maxillofacial Trauma Surgery: Effect of the Affordable Care Act in Ohio.

    Science.gov (United States)

    Khansa, Ibrahim; Khansa, Lara; Pearson, Gregory D

    2016-02-01

    Surgical treatment of maxillofacial injuries has historically been associated with low reimbursements, mainly because of the high proportion of uninsured patients. The Affordable Care Act, implemented in January of 2014, aimed to reduce the number of uninsured. If the Affordable Care Act achieves this goal, surgeons may benefit from improved reimbursement rates. The authors' purpose was to evaluate the effects of the Affordable Care Act on payor distribution and surgeon reimbursements for maxillofacial trauma surgery at their institution. A review of all patients undergoing surgery for maxillofacial trauma between January of 2012 and December of 2014 was conducted. Insurance status, and amounts billed and collected by the surgeon, were recorded. Patients treated before implementation of the Affordable Care Act were compared to those treated after. Five hundred twenty-three patients were analyzed. Three hundred thirty-four underwent surgery before implementation of the Affordable Care Act, and 189 patients underwent surgery after. After implementation of the Affordable Care Act, the proportion of uninsured decreased (27.2 percent to 11.1 percent; p reimbursement rate increased from 14.3 percent to 19.8 percent (p reimbursement rate increased. These trends should be followed over a longer term to determine the full effect of the Affordable Care Act.

  14. Committee Representation and Medicare Reimbursements-An Examination of the Resource-Based Relative Value Scale.

    Science.gov (United States)

    Gao, Y Nina

    2018-04-06

    The Resource-Based Relative Value Scale Update Committee (RUC) submits recommended reimbursement values for physician work (wRVUs) under Medicare Part B. The RUC includes rotating representatives from medical specialties. To identify changes in physician reimbursements associated with RUC rotating seat representation. Relative Value Scale Update Committee members 1994-2013; Medicare Part B Relative Value Scale 1994-2013; Physician/Supplier Procedure Summary Master File 2007; Part B National Summary Data File 2000-2011. I match service and procedure codes to specialties using 2007 Medicare billing data. Subsequently, I model wRVUs as a function of RUC rotating committee representation and level of code specialization. An annual RUC rotating seat membership is associated with a statistically significant 3-5 percent increase in Medicare expenditures for codes billed to that specialty. For codes that are performed by a small number of physicians, the association between reimbursement and rotating subspecialty representation is positive, 0.177 (SE = 0.024). For codes that are performed by a large number of physicians, the association is negative, -0.183 (SE = 0.026). Rotating representation on the RUC is correlated with overall reimbursement rates. The resulting differential changes may exacerbate existing reimbursement discrepancies between generalist and specialist practitioners. © Health Research and Educational Trust.

  15. A Survey of Home Enteral Nutrition Practices and Reimbursement in the Asia Pacific Region

    Directory of Open Access Journals (Sweden)

    Alvin Wong

    2018-02-01

    Full Text Available Literature regarding the use of home enteral nutrition (HEN and how it is reimbursed in the Asia Pacific region is limited. This research survey aims to determine the availability of HEN, the type of feeds and enteral access used, national reimbursement policies, the presence of nutrition support teams (NSTs, and clinical nutrition education in this region. An electronic questionnaire was sent to 20 clinical nutrition societies and leaders in the Asia Pacific region in August 2017, where thirteen countries responded. Comparison of HEN reimbursement and practice between countries of different income groups based on the World Bank’s data was investigated. Financial support for HEN is only available in 40% of the countries. An association was found between availability of financial support for HEN and health expenditure (r = 0.63, p = 0.021. High and middle-upper income countries use mainly commercial supplements for HEN, while lower-middle income countries use mainly blenderized diet. The presence of NSTs is limited, and only present mainly in acute settings. Sixty percent of the countries indicated an urgent need for funding and reimbursement of HEN. This survey demonstrates the varied clinical and economic situation in the Asia Pacific region. There is a lack of reimbursement, clinical support, and inadequate educational opportunities, especially for the lower-middle income countries.

  16. Cost and Reimbursement for Three Fibroid Treatments: Abdominal Hysterectomy, Abdominal Myomectomy, and Uterine Fibroid Embolization

    International Nuclear Information System (INIS)

    Goldberg, Jay; Bussard, Anne; McNeil, Jean; Diamond, James

    2007-01-01

    Purpose. To compare costs and reimbursements for three different treatments for uterine fibroids. Methods. Costs and reimbursements were collected and analyzed from the Thomas Jefferson University Hospital decision support database from 540 women who underwent abdominal hysterectomy (n 299), abdominal myomectomy (n = 105), or uterine fibroid embolization (UFE) (n = 136) for uterine fibroids during 2000-2002. We used the chi-square test and ANOVA, followed by Fisher's Least Significant Difference test, for statistical analysis. Results. The mean total hospital cost (US$) for UFE was $2,707, which was significantly less than for hysterectomy ($5,707) or myomectomy ($5,676) (p < 0.05). The mean hospital net income (hospital net reimbursement minus total hospital cost) for UFE was $57, which was significantly greater than for hysterectomy (-$572) or myomectomy (-$715) (p < 0.05). The mean professional (physician) reimbursements for UFE, hysterectomy, and myomectomy were $1,306, $979, and $1,078, respectively. Conclusion. UFE has lower hospital costs and greater hospital net income than abdominal hysterectomy or abdominal myomectomy for treating uterine fibroids. UFE may be more financially advantageous than hysterectomy or myomectomy for the insurer, hospital, and health care system. Costs and reimbursements may vary amongst different hospitals and regions

  17. Definition of a prospective payment system to reimburse emergency departments.

    Science.gov (United States)

    Levaggi, Rosella; Montefiori, Marcello

    2013-10-11

    Payers are increasingly turning to Prospective Payment Systems (PPSs) because they incentivize efficiency, but their application to emergency departments (EDs) is difficult because of the high level of uncertainty and variability in the cost of treating each patient.To the best of our knowledge, our work represents the first attempt at defining a PPS for this part of hospital activity. Data were specifically collected for this study and relate to 1011 patients who were triaged at an ED of a major Italian hospital, during 1 week in December 2010.The cost for each patient was analytically estimated by adding up several components: 1) physician and other staff costs that were imputed on the basis of the time each physician claimed to have spent treating the patient; 2) the cost for each test/treatment each patient actually underwent; 3) overhead costs, shared among patients using the time elapsed between first examination and discharge from the ED. The distribution of costs by triage code shows that, although the average cost increases across the four triage groups, the variance within each code is quite high. The maximum cost for a yellow code is €1074.7, compared with €680 for red, the most serious code. Using cluster analysis, the red code cluster is enveloped by yellow, and their costs are therefore indistinguishable, while green codes span all cost groups. This suggests that triage code alone is not a good proxy for the patient cost, and that other cost drivers need to be included. Crude triage codes cannot be used to define PPSs because they are not sufficiently correlated with costs and are characterized by large variances. However, if combined with other information, such as the number of laboratory and non-laboratory tests/examinations, it is possible to define cost groups that are sufficiently homogeneous to be reimbursed prospectively. This should discourage strategic behavior and allow the ED to break even or create profits, which can be reinvested to

  18. THE IMPACT OF SHRINKING HANFORD BOUNDARIES ON PERMITS FOR TOXIC AIR POLLUTANT EMISSIONS FROM THE HANFORD 200 WEST AREA

    International Nuclear Information System (INIS)

    JOHNSON, R.E.

    2005-01-01

    This presentation (CE-580. Graduate Seminar) presents a brief description of an approach to use a simpler dispersion modeling method (SCREEN3) in conjunction with joint frequency tables for Hanford wind conditions to evaluate the impacts of shrinking the Hanford boundaries on the current permits for facilities in the 200 West Area. To fulfill requirements for the graduate student project (CE-702. Master's Special Problems), this evaluation will be completed and published over the next two years. Air toxic emissions play an important role in environmental quality and require a state approved permit. One example relates to containers or waste that are designated as Transuranic Waste (TRU), which are required to have venting devices due to hydrogen generation. The Washington State Department of Ecology (Ecology) determined that the filters used did not meet the definition of a ''pressure relief device'' and that a permit application would have to be submitted by the Central Waste Complex (CWC) for criteria pollutant and toxic air pollutant (TAP) emissions in accordance with Washington Administrative Code (WAC) 173-400 and 173-460. The permit application submitted in 2000 to Ecology used Industrial Source Code III (ISCIII) dispersion modeling to demonstrate that it was not possible for CWC to release a sufficient quantity of fugitive Toxic Air Pollutant emissions that could exceed the Acceptable Source Impact Levels (ASILs) at the Hanford Site Boundary. The modeled emission rates were based on the diurnal breathing in and out through the vented drums (approximately 20% of the drums), using published vapor pressure, molecular weight, and specific gravity data for all 600+ compounds, with a conservative estimate of one exchange volume per day (208 liters per drum). Two permit applications were submitted also to Ecology for the Waste Receiving and Processing Facility and the T Plant Complex. Both permit applications were based on the Central Waste Complex approach, and

  19. Drivers of Medicare Reimbursement for Thoracolumbar Fusion: An Analysis of Data From The Centers For Medicare and Medicaid Services.

    Science.gov (United States)

    Khanna, Krishn; Padegimas, Eric M; Zmistowski, Benjamin; Howley, Michael; Verma, Kushagra

    2017-11-01

    A retrospective observational study. The purpose of this study is to examine the variation in thoracolumbar fusion (TLF) payment and determine the drivers of this variation. As health care spending continues to increase, variation in surgical procedures reimbursements has come under more scrutiny. TLF is an example of a high-cost, proven-benefit procedure that is often the focus of Centers for Medicare and Medicaid Services (CMS) administrators. There is a wide variation in TLF charges, but the drivers for this variation are not clear. Claims for TLF were identified in the CMS data by analyzing Diagnosis Related Group (DRG) number 460 ("Spinal Fusion Except Cervical without Major Complications or Comorbidities"). Data on factors that may impact cost of care were collected from four sources: the United States Census Bureau, CMS, the Dartmouth Atlas, and WWAMI Rural Health Research Center. These were then grouped into seven categories: quality, supply, demand, substitute treatment availability, patient characteristics, competitive factors, and provider characteristics. Predictive reimbursement models were created from the data using multivariate linear regression to understand the factors that influence TLF reimbursement. There was significant geographic variability in reimbursement. The largest contribution to reimbursement variation came from variables in the demand (ΔR = 13.4%, P reimbursement were provider charges (β = 0.37, P reimbursement in the region (β = 0.19, P reimbursement. There was wide variation in reimbursement for TLF across the U.S. The variables that drive TLF reimbursement variation include supply, demand, and competition. Interestingly, quality of care was not associated with increased TLF reimbursement. N/A.

  20. Payment or reimbursement for certain medical expenses for Camp Lejeune family members. Interim final rule.

    Science.gov (United States)

    2014-09-24

    The Department of Veterans Affairs (VA) is promulgating regulations to implement statutory authority to provide payment or reimbursement for hospital care and medical services provided to certain veterans' family members who resided at Camp Lejeune, North Carolina, for at least 30 days during the period beginning on January 1, 1957, and ending on December 31, 1987. Under this rule, VA will reimburse family members, or pay providers, for medical expenses incurred as a result of certain illnesses and conditions that may be attributed to exposure to contaminated drinking water at Camp Lejeune during this time period. Payment or reimbursement will be made within the limitations set forth in statute and Camp Lejeune family members will receive hospital care and medical services that are consistent with the manner in which we provide hospital care and medical services to Camp Lejeune veterans.

  1. Does Mixed Reimbursement Schemes Affect Hospital Activity and Productivity? An Analysis of the Case of Denmark

    DEFF Research Database (Denmark)

    Hansen, Xenia Brun; Bech, Mickael; Jakobsen, Mads Leth

    2013-01-01

    literature with a deeper understanding of such mixed reimbursement systems as well as empirically by identifying key design factors that determines the incentives embedded in such a mixed model. Furthermore, we describe how incentives vary in different designs of the mixed reimbursement scheme and assess...... whether different incentives affects the performance of hospitals regarding activity and productivity differently. Information on Danish reimbursement schemes has been collected from documents provided by the regional governments and through interviews with regional administrations. The data cover...... the period from 2007-2010. A theoretical framework identified the key factors in an ABF/block grant model to be the proportion of the national Diagnosis-Related Group (DRG) tariff above and below a predefined production target (i.e. the baseline); baseline calculations; the presence of kinks...

  2. Hospitals push back against reimbursement cuts due to Two-Midnight rule.

    Science.gov (United States)

    2016-04-01

    The American Hospital Association (AHA) and other hospitals are suing CMS, challenging the 0.2% cut in Medicare reimbursement that CMS instituted to compensate for the financial effect of the Two-Midnight rule. CMS' actuaries reported that inpatient claims are likely to increase under the rule, resulting in $220 million additional reimbursement for hospitals. Hospitals disagree and a study commissioned by the AHA concluded that the CMS study was based on data not available to the public and that data from the Medicare Provider and Analysis Review (MedPAR) would lead to a different conclusion. The AHA suit asks CMS to rescind the cut, restore the base rate for Medicare payments to its previous level, and reimburse hospitals retroactively for the reductions.

  3. Can medicaid reimbursement help give female condoms a second chance in the United States?

    Science.gov (United States)

    Witte, Susan S; Stefano, Kyle; Hawkins, Courtney

    2010-10-01

    The female condom is the only other barrier contraception method besides the male condom, and it is the only "woman-initiated" device for prevention of sexually transmitted infections. Although studies demonstrate high acceptability and effectiveness for this device, overall use in the United States remains low. The female condom has been available through Medicaid in many states since 1994. We provide the first published summary of data on Medicaid reimbursement for the female condom. Our findings demonstrate low rates of claims for female condoms but high rates of reimbursement. In light of the 2009 approval of a new, cheaper female condom and the recent passage of comprehensive health care reform, we call for research examining how health care providers can best promote consumer use of Medicaid reimbursement to obtain this important infection-prevention device.

  4. Is it good to be too light? Birth weight thresholds in hospital reimbursement systems.

    Science.gov (United States)

    Reif, Simon; Wichert, Sebastian; Wuppermann, Amelie

    2018-02-02

    Birth weight manipulation has been documented in per-case hospital reimbursement systems, in which hospitals receive more money for otherwise equal newborns with birth weight just below compared to just above specific birth weight thresholds. As hospitals receive more money for cases with weight below the thresholds, having a (reported) weight below a threshold could benefit the newborn. Also, these reimbursement thresholds overlap with diagnostic thresholds that have been shown to affect the quantity and quality of care that newborns receive. Based on the universe of hospital births in Germany from the years 2005-2011, we investigate whether weight below reimbursement relevant thresholds triggers different quantity and quality of care. We find that this is not the case, suggesting that hospitals' financial incentives with respect to birth weight do not directly impact the care that newborns receive. Copyright © 2018 Elsevier B.V. All rights reserved.

  5. Challenges with participant reimbursement: experiences from a post-trial access study.

    Science.gov (United States)

    Mngadi, Kathryn Therese; Frohlich, Janet; Montague, Carl; Singh, Jerome; Nkomonde, Nelisiwe; Mvandaba, Nomzamo; Ntombeka, Fanelesibonge; Luthuli, Londiwe; Abdool Karim, Quarraisha; Mansoor, Leila

    2015-11-01

    Reimbursement of trial participants remains a frequently debated issue, with specific guidance lacking. Trials combining post-trial access and implementation science may necessitate new strategies and models. CAPRISA 008, a post-trial access study testing the feasibility of using family planning services to rollout a prelicensure HIV prevention intervention, tried to balance the real-life scenario of no reimbursement for attendance at public sector clinics with that of a trial including some visits that focused on research procedures and others that focused on standard of care procedures. A reduced reimbursement was offered for 'standard of care' visits, meant primarily to cover transport costs to and from the clinic only. This impacted negatively on accrual, retention and participant morale, primarily due to the protracted delay in regulatory approval, during which time, the costs of living, including travel costs had increased. Relevant guidelines were reviewed and institutional policy was updated to incorporate the South African National Health Research Ethics Committee guidelines on reimbursement (taking into account participant time, travel and inconvenience). The reimbursement amount for 'standard of care' visits was increased accordingly. The question remains whether a trial that combines post-trial access with implementation science, with clear benefits for the participants and the provision of above standard medical care, should have reimbursement rates that approach those of a proof-of-concept trial, for 'standard of care' visits. 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/

  6. Seasonal influenza vaccination in China: Landscape of diverse regional reimbursement policy, and budget impact analysis.

    Science.gov (United States)

    Yang, Juan; Atkins, Katherine E; Feng, Luzhao; Pang, Mingfan; Zheng, Yaming; Liu, Xinxin; Cowling, Benjamin J; Yu, Hongjie

    2016-11-11

    To explore the current landscape of seasonal influenza vaccination across China, and estimate the budget of implementing a national "free-at-the-point-of-care" vaccination program for priority populations recommended by the World Health Organization. In 2014 and 2016, we conducted a survey across provincial Centers for Disease Control and Prevention to collect information on regional reimbursement policies for influenza vaccination, estimated the national uptake using distributed doses of influenza vaccines, and evaluated the budget using population size and vaccine cost obtained from official websites and literatures. Regular reimbursement policies for influenza vaccination are available in 61 mutually exclusive regions, comprising 8 provinces, 45 prefectures, and 8 counties, which were reimbursed by the local Government Financial Department or Basic Social Medical Insurance (BSMI). Finance-reimbursed vaccination was offered mainly for the elderly, and school children for free in Beijing, Dongli district in Tianjin, Karamay, Shenzhen and Xinxiang cities. BSMI-reimbursement policies were limited to specific medical insurance beneficiaries with distinct differences in the reimbursement fractions. The average national vaccination coverage was just 1.5-2.2% between 2004 and 2014. A free national vaccination program for priority populations (n=416million), would cost government US$ 757million (95% CI 726-789) annually (uptake rate=20%). An increasing number of regional governments have begun to pay, partially or fully, for influenza vaccination for selected groups. However, this small-scale policy approach has failed to increase national uptake. A free, nationwide vaccination program would require a substantial annual investment. A cost-effectiveness analysis is needed to identify the most efficient methods to improve coverage. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  7. Role of centralized review processes for making reimbursement decisions on new health technologies in Europe.

    Science.gov (United States)

    Stafinski, Tania; Menon, Devidas; Davis, Caroline; McCabe, Christopher

    2011-01-01

    The purpose of this study was to compare centralized reimbursement/coverage decision-making processes for health technologies in 23 European countries, according to: mandate, authority, structure, and policy options; mechanisms for identifying, selecting, and evaluating technologies; clinical and economic evidence expectations; committee composition, procedures, and factors considered; available conditional reimbursement options for promising new technologies; and the manufacturers' roles in the process. A comprehensive review of publicly available information from peer-reviewed literature (using a variety of bibliographic databases) and gray literature (eg, working papers, committee reports, presentations, and government documents) was conducted. Policy experts in each of the 23 countries were also contacted. All information collected was reviewed by two independent researchers. Most European countries have established centralized reimbursement systems for making decisions on health technologies. However, the scope of technologies considered, as well as processes for identifying, selecting, and reviewing them varies. All systems include an assessment of clinical evidence, compiled in accordance with their own guidelines or internationally recognized published ones. In addition, most systems require an economic evaluation. The quality of such information is typically assessed by content and methodological experts. Committees responsible for formulating recommendations or decisions are multidisciplinary. While criteria used by committees appear transparent, how they are operationalized during deliberations remains unclear. Increasingly, reimbursement systems are expressing interest in and/or implementing reimbursement policy options that extend beyond the traditional "yes," "no," or "yes with restrictions" options. Such options typically require greater involvement of manufacturers which, to date, has been limited. Centralized reimbursement systems have become an

  8. [Reimbursed health expenditures during the last year of life, in France, in the year 2008].

    Science.gov (United States)

    Ricci, P; Mezzarobba, M; Blotière, P O; Polton, D

    2013-02-01

    To measure the reimbursed health expenditures in the last year of life and the proportion it represents in total reimbursement costs in 2008, to analyse the structure of such expenditures and to identify costs by cause of death. Data were obtained from the French national insurance information system (SNIIRAM). Data from the national hospital discharge database were linked to the outpatient reimbursement database for patients covered by the general health insurance scheme (n=49 million persons). The cost of the last year of life was calculated for the exhaustive population (361,328 deaths in 2008). The supposed cause of death was mainly derived from the primary diagnosis of the last hospital stay during which the patient died. The average reimbursed expenses during the last year of life were estimated at 22,000 € per person in 2008, with 12,500 € accounting for public hospital costs. Reimbursed health expenditures varied according to different medical causes of death: 52,300 € for HIV disease and about 40,000 € for tumors. A negative effect of age on the expenditure during the last year of life was observed. Health care spending increased with shorter time before death, the last month of life corresponding to 28% of reimbursed expenditures during the last year of life. Health care use in the last year of life represented 10.5% of the total health expenditures in 2008. This study found results similar to those observed in the past or in other countries. Our results show in particular that the weight of health expenditures during the last year of life on total health expenditures remains stable over the years. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  9. A Regional Analysis of U.S. Insurance Reimbursement Guidelines for Massage Therapy.

    Science.gov (United States)

    Miccio, Robin S; Cowen, Virginia S

    2018-03-01

    Massage techniques fall within the scope of many different health care providers. Physical therapists, occupational therapists, and chiropractors receive insurance reimbursement for health care services, including massage. Although many patients pay out of pocket for massage services, it is unclear how the insurance company reimbursement policies factor provider qualifications into coverage. This project examined regional insurance reimbursement guidelines for massage therapy in relation to the role of the provider of massage services. A qualitative content analysis was used to explore guidelines for 26 health insurance policies across seven US companies providing coverage in the northeastern United States. Publicly available information relevant to massage was obtained from insurance company websites and extracted into a dataset for thematic analysis. Data obtained included practice guidelines, techniques, and provider requirements. Information from the dataset was coded and analyzed using descriptive statistics. Of the policies reviewed, 23% explicitly stated massage treatments were limited to 15-minute increments, 19% covered massage as one part of a comprehensive rehabilitation plan, and 27% required physician prescription. Massage techniques mentioned as qualifying for reimbursement included: Swedish, manual lymphatic drainage, mobilization/manipulation, myofascial release, and traction. Chiropractors, physical therapists, and occupational therapists could directly bill for massage. Massage therapists were specifically excluded as covered providers for seven (27%) policies. Although research supports massage for the treatment of a variety of conditions, the provider type has not been separately addressed. The reviewed policies that served the Northeastern states explicitly stated massage therapists could not bill insurance companies directly. The same insurance companies examined reimbursement for massage therapists in their western U.S. state policies. Other

  10. [Jurisdictions on the reimbursement of new medical technologies by public health insurance: A systematic review].

    Science.gov (United States)

    Ex, Patricia; Felgner, Susanne; Henschke, Cornelia

    2018-04-01

    In Germany reimbursement for new medical technologies is often enforced before a social court. It is likely that these judicial decisions also affect the sickness funds' decisions on requests for reimbursement and thus patient access to new technologies in general. The aim of this study was to identify the technologies that have repeatedly generated court actions and whether these actions have been successful. The focus was on differences between sectors, technology groups and indications. Based on this, we analysed in a case study whether judicial decisions on the reimbursement of the same technologies vary across the years. Based on a systematic review, we identified judicial decisions of German social courts on new technologies for the years 2011 to 2016. The analysis included social court decisions on reimbursements for technologies used in the treatment of individual patients. 284 judicial decisions on new technologies were considered in the analysis. In one third of the cases, the sickness funds were required to reimburse the costs, with a higher percentage in inpatient than in outpatient care. Technologies used in treatment of diseases of the eyes and the ears were granted most frequently. In cases involving similar circumstances the social courts sometimes came to conflicting decisions; these decisions are, in part, contradictory to subsequent assessments by the Joint Federal Committee (G-BA). Decisions as to whether reimbursement for new technologies is granted or not do not appear to follow a systematic approach. In the context of the seemingly innovation-friendly policy in inpatient care, there is uncertainty with regard to the "generally accepted state of medical knowledge." It is problematic for both patients and their treating physicians that over a number of years legal proceedings are being initiated for technologies that have not been subjected to a systematic assessment of their benefit. Copyright © 2018. Published by Elsevier GmbH.

  11. Soret and Dufour effects on convective heat and mass transfer in stagnation-point flow towards a shrinking surface

    International Nuclear Information System (INIS)

    Bhattacharyya, Krishnendu; Layek, G C; Seth, G S

    2014-01-01

    A mathematical model is presented to study the Soret and Dufour effects on the convective heat and mass transfer in stagnation-point flow of viscous incompressible fluid towards a shrinking surface. Suitable similarity transformations are used to convert the governing partial differential equations into self-similarity ordinary differential equations that are then numerically solved by shooting method. Dual solutions for temperature and concentration are obtained in the presence of Soret and Dufour effects. Graphical representations of the heat and mass transfer coefficients, the dimensionless thermal and solute profiles for various values of Prandtl number, Lewis number, Soret number and Dufour number are demonstrated. With Soret number the mass transfer coefficient which is related to mass transfer rate increases for both solutions and the heat transfer coefficient (related to heat transfer rate) for both solutions becomes larger with Dufour number. The Prandtl number causes reduction in heat and the mass transfer coefficients and similarly with the Lewis number mass transfer coefficient decreases. Also, double crossing over is found in dual dimensionless temperature profiles for increasing Soret number and in dual dimensionless concentration profiles for the increase in Dufour number. Due to the larger values of Dufour number the thermal boundary layer increases and for Prandtl number increment it decreases; whereas, the solute boundary layer thickness reduces with increasing values of Prandtl number and Lewis number. (paper)

  12. Stability analysis on the flow and heat transfer of nanofluid past a stretching/shrinking cylinder with suction effect

    Science.gov (United States)

    Bakar, Nor Ashikin Abu; Bachok, Norfifah; Arifin, Norihan Md.; Pop, Ioan

    2018-06-01

    The steady boundary layer flow over a stretching/shrinking cylinder with suction effect is numerically studied. Using a similarity transformations, the governing partial differential equations are transformed into a set of nonlinear differential equations and have been solved numerically using a bvp4c code in Matlab software. The nanofluid model used is taking into account the effects of Brownian motion and thermophoresis. The influences of the governing parameters namely the curvature parameter γ, mass suction parameter S, Brownian motion parameter Nb and thermophoresis parameter Nt on the flow, heat and mass transfers characteristics are presented graphically. The numerical results obtained for the skin friction coefficient, local Nusselt number and local Sherwood number are thoroughly determined and presented graphically for several values of the governing parameters. From our investigation, it is found that the non-unique (dual) solutions exist for a certain range of mass suction parameter. It is observed that as curvature parameter increases, the skin friction coefficient and heat transfer rate decrease, meanwhile the mass transfer rates increase. Moreover, the stability analysis showed that the first solution is linearly stable, while the second solution is linearly unstable.

  13. Modified Shrinking Core Model for Atomic Layer Deposition of TiO2 on Porous Alumina with Ultrahigh Aspect Ratio

    International Nuclear Information System (INIS)

    Park, Inhye; Leem, Jina; Lee, Hooyong; Min, Yosep

    2013-01-01

    When atomic layer deposition (ALD) is performed on a porous material by using an organometallic precursor, minimum exposure time of the precursor for complete coverage becomes much longer since the ALD is limited by Knudsen diffusion in the pores. In the previous report by Min et al. (Ref. 23), shrinking core model (SCM) was proposed to predict the minimum exposure time of diethylzinc for ZnO ALD on a porous cylindrical alumina monolith. According to the SCM, the minimum exposure time of the precursor is influenced by volumetric density of adsorption sites, effective diffusion coefficient, precursor concentration in gas phase and size of the porous monolith. Here we modify the SCM in order to consider undesirable adsorption of byproduct molecules. TiO 2 ALD was performed on the cylindrical alumina monolith by using titanium tetrachloride (TiCl 4 ) and water. We observed that the byproduct (i. e., HCl) of TiO 2 ALD can chemically adsorb on adsorption sites, unlike the behavior of the byproduct (i. e., ethane) of ZnO ALD. Consequently, the minimum exposure time of TiCl 4 (∼16 min) was significantly much shorter than that (∼71 min) of DEZ. The predicted minimum exposure time by the modified SCM well agrees with the observed time. In addition, the modified SCM gives an effective diffusion coefficient of TiCl 4 of ∼1.78 Χ 10 -2 cm 2 /s in the porous alumina monolith

  14. Transient basilar artery occlusion monitored by transcranial color Doppler presenting with a spectacular shrinking deficit: a case report

    Directory of Open Access Journals (Sweden)

    Del Sette Massimo

    2010-01-01

    Full Text Available Abstract Introduction We describe the case of a 79-year-old Caucasian Italian woman with a transient basilar occlusion monitored by transcranial Doppler, with subsequent recanalization and clinical shrinking deficit. This is the first case of transient basilar occlusive disease diagnosed and monitored by transcranial Doppler. This case is important and needs to be reported because transient basilar occlusion may be easily diagnosed if transcranial Doppler is performed. Case presentation A 79-year-old woman affected by chronic atrial fibrillation and not treated with oral anticoagulants, cardioverted to sinus rhythm during a gastric endoscopy. She then showed a sudden-onset loss of consciousness, horizontal and vertical gaze palsy, tetraparesis and bilateral miosis and coma. Two hours later, the symptoms resolved quickly, leaving no residual neurologic deficits. Transcranial Doppler examination showed a dampened flow in the basilar artery in the emergency examination and a restored flow when the symptoms resolved. Conclusion This is the first case of transient basilar occlusive disease diagnosed and monitored by transcranial Doppler. We believe that transcranial Doppler should be performed in all cases of unexplained acute loss of consciousness, in particular, if associated with signs of brainstem dysfunctions.

  15. Pre-Enrollment Reimbursement Patterns of Medicare Beneficiaries Enrolled in “At-Risk” HMOs

    Science.gov (United States)

    Eggers, Paul W.; Prihoda, Ronald

    1982-01-01

    The Health Care Financing Administration (HCFA) has initiated several demonstration projects to encourage HMOs to participate in the Medicare program under a risk mechanism. These demonstrations are designed to test innovative marketing techniques, benefit packages, and reimbursement levels. HCFA's current method for prospective payments to HMOs is based on the Adjusted Average Per Capita Cost (AAPCC). An important issue in prospective reimbursement is the extent to which the AAPCC adequately reflects the risk factors which arise out of the selection process of Medicare beneficiaries into HMOs. This study examines the pre-enrollment reimbursement experience of Medicare beneficiaries who enrolled in the demonstration HMOs to determine whether or not a non-random selection process took place. The three demonstration HMOs included in the study are the Fallon Community Health Plan, the Greater Marshfield Community Health Plan, and the Kaiser-Permanente medical program of Portland, Oregon. The study includes 18,085 aged Medicare beneficiaries who had enrolled in the three plans as of April, 1981. We included comparison groups consisting of a 5 percent random sample of aged Medicare beneficiaries (N = 11,240) living in the same geographic areas as the control groups. The study compares the groups by total Medicare reimbursements for the years 1976 through 1979. Adjustments were made for AAPCC factor differences in the groups (age, sex, institutional status, and welfare status). In two of the HMO areas there was evidence of a selection process among the HMOs enrollees. Enrollees in the Fallon and Kaiser health plans were found to have had 20 percent lower Medicare reimbursements than their respective comparison groups in the four years prior to enrollment. This effect was strongest for inpatient services, but a significant difference also existed for use of physician and outpatient services. In the Marshfield HMO there was no statistically significant difference in pre

  16. [Diagnostics and Eradication Therapy for MRSA Carriers in the Outpatient Sector: an Analysis of the Reimbursement Situation in the Light of Current Reimbursement Changes].

    Science.gov (United States)

    Schwendler, M; Hübner, C S; Fleßa, S

    2017-10-01

    Infection with methicillin-resistant Staphylococcus aureus (MRSA) occurs in both the inpatient and outpatient sector. The reimbursement for diagnostic services and eradication therapy in the outpatient sector was regulated for the first time on 01.04.2012 and after a 2-year test period, has been adopted into the standard range of care services. The aim of this retrospective study was to give an overview of the current situation in services and reimbursement in Germany and describe MRSA patients and their treatment in the outpatient sector. Secondary data, namely reimbursement data of the National Association of Statutory Health Insurance Physicians (KBV) und the Physicians' Association (KV) Mecklenburg-West Pomerania for the period 01/04/2012-31/03/2014 were analyzed. Results show that on the federal level, MRSA services amounting to € 3,235,870.18 have been reimbursed and that diagnostic costs exceed treatment costs. In Germany, 5,627 doctors invoiced services related to MRSA; 51,56% of these were general practitioners and 21,25% specialists in internal medicine working in general practice. In the KV Mecklenburg-Western Pomerania, patients were elderly (average age 69,13), cost for services were on average 27,76 €, and 76,85% of the patients were treated within one quarter. On the whole, there were regional differences in the identification and eradication of MRSA in the outpatient setting. In order to provide an extended base for a more efficient resource allocation in the health care sector, in addition to analysis of MRSA eradication from the medical point of view, attention needs to be paid to patient flow between the out- and inpatient sectors, as well as economic aspects. © Georg Thieme Verlag KG Stuttgart · New York.

  17. 41 CFR 301-71.207 - What internal policies and procedures must we establish for travel reimbursement?

    Science.gov (United States)

    2010-07-01

    ... AGENCY RESPONSIBILITIES 71-AGENCY TRAVEL ACCOUNTABILITY REQUIREMENTS Travel Claims for Reimbursement... should submit a travel claim (including whether to use a standard form or an agency form and whether the... and procedures must we establish for travel reimbursement? 301-71.207 Section 301-71.207 Public...

  18. 41 CFR 301-11.12 - How does the type of lodging I select affect my reimbursement?

    Science.gov (United States)

    2010-07-01

    ... lodgings. (Hotel/motel, boarding house, etc.) You will be reimbursed the single occupancy rate. (b) Government quarters. You will be reimbursed, as a lodging expense, the fee or service charge you pay for use... college dormitories or similar facilities or rooms not offered commercially but made available to the...

  19. 48 CFR 49.603-4 - Cost-reimbursement contracts-complete termination, with settlement limited to fee.

    Science.gov (United States)

    2010-10-01

    ... settlement limited to fee. [Insert the following in Block 14 of SF 30 for settlement of cost-reimbursement... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Cost-reimbursement contracts-complete termination, with settlement limited to fee. 49.603-4 Section 49.603-4 Federal...

  20. 41 CFR 102-3.130 - What policies apply to the appointment, and compensation or reimbursement of advisory committee...

    Science.gov (United States)

    2010-07-01

    ... committee staff person who is not a current Federal employee serving under an assignment must be appointed... the appointment, and compensation or reimbursement of advisory committee members, staff, and experts... compensation or reimbursement of advisory committee members, staff, and experts and consultants? In developing...