WorldWideScience

Sample records for risk adjustment

  1. Underwriters' view of risk - An adjuster's perspective

    International Nuclear Information System (INIS)

    Smith, M.

    1992-01-01

    This paper reviews how a risk assessment is performed by an insurance adjuster to determine rates and insurability of a client. It provides a historical perspective on insurance and how information systems are used to monitor past claims to determine future risk. Although this paper does not specifically address the oil and gas industry, it is informative in identifying how insurance rates are determined and risk assessments for various oil and gas operations are performed

  2. Competition Leverage : How the Demand Side Affects Optimal Risk Adjustment

    NARCIS (Netherlands)

    Bijlsma, M.; Boone, J.; Zwart, Gijsbert

    2011-01-01

    We study optimal risk adjustment in imperfectly competitive health insurance markets when high-risk consumers are less likely to switch insurer than low-risk consumers. First, we find that insurers still have an incentive to select even if risk adjustment perfectly corrects for cost differences

  3. 42 CFR 422.310 - Risk adjustment data.

    Science.gov (United States)

    2010-10-01

    ... that are used in the development and application of a risk adjustment payment model. (b) Data... (CONTINUED) MEDICARE PROGRAM MEDICARE ADVANTAGE PROGRAM Payments to Medicare Advantage Organizations § 422... risk adjustment factors used to adjust payments, as required under §§ 422.304(a) and (c). CMS also may...

  4. INSTITUTIONAL OWNERSHIP LEVEL AND RISK-ADJUSTED RETURN

    OpenAIRE

    Isaiah, Chioma; Li, Meng (Emma)

    2017-01-01

    This paper examines the relationship between the level of institutional ownership andrisk-adjusted return on stocks. We find a significant positive relationship between the level ofinstitutional ownership on a stock and its risk-adjusted return. This result holds both in the longrun and in shorter time periods. Our findings suggest that all things being equal, it is possible toobtain risk-adjusted return by going short on the stocks with low institutional ownership andgoing long on those with...

  5. Direct comparison of risk-adjusted and non-risk-adjusted CUSUM analyses of coronary artery bypass surgery outcomes.

    Science.gov (United States)

    Novick, Richard J; Fox, Stephanie A; Stitt, Larry W; Forbes, Thomas L; Steiner, Stefan

    2006-08-01

    We previously applied non-risk-adjusted cumulative sum methods to analyze coronary bypass outcomes. The objective of this study was to assess the incremental advantage of risk-adjusted cumulative sum methods in this setting. Prospective data were collected in 793 consecutive patients who underwent coronary bypass grafting performed by a single surgeon during a period of 5 years. The composite occurrence of an "adverse outcome" included mortality or any of 10 major complications. An institutional logistic regression model for adverse outcome was developed by using 2608 contemporaneous patients undergoing coronary bypass. The predicted risk of adverse outcome in each of the surgeon's 793 patients was then calculated. A risk-adjusted cumulative sum curve was then generated after specifying control limits and odds ratio. This risk-adjusted curve was compared with the non-risk-adjusted cumulative sum curve, and the clinical significance of this difference was assessed. The surgeon's adverse outcome rate was 96 of 793 (12.1%) versus 270 of 1815 (14.9%) for all the other institution's surgeons combined (P = .06). The non-risk-adjusted curve reached below the lower control limit, signifying excellent outcomes between cases 164 and 313, 323 and 407, and 667 and 793, but transgressed the upper limit between cases 461 and 478. The risk-adjusted cumulative sum curve never transgressed the upper control limit, signifying that cases preceding and including 461 to 478 were at an increased predicted risk. Furthermore, if the risk-adjusted cumulative sum curve was reset to zero whenever a control limit was reached, it still signaled a decrease in adverse outcome at 166, 653, and 782 cases. Risk-adjusted cumulative sum techniques provide incremental advantages over non-risk-adjusted methods by not signaling a decrement in performance when preoperative patient risk is high.

  6. Risk-adjusted capitation: recent experiences in The Netherlands.

    Science.gov (United States)

    van de Ven, W P; van Vliet, R C; van Barneveld, E M; Lamers, L M

    1994-01-01

    The market-oriented health care reforms taking place in the Netherlands show a clear resemblance to the proposals for managed competition in U.S. health care. In both countries good risk adjustment mechanisms that prevent cream skimming--that is, that prevent plans from selecting the best health risks--are critical to the success of the reforms. In this paper we present an overview of the Dutch reforms and of our research concerning risk-adjusted capitation payments. Although we are optimistic about the technical possibilities for solving the problem of cream skimming, the implementation of good risk-adjusted capitation is a long-term challenge.

  7. ACA Risk Adjustment - Overview, Context, and Challenges

    Data.gov (United States)

    U.S. Department of Health & Human Services — Volume 4, Issue 3 of the Medicare and Medicaid Research Review includes three articles describing the Department of Health and Human Services (HHS) developed risk...

  8. Risk adjusted financial costs of photovoltaics

    Energy Technology Data Exchange (ETDEWEB)

    Szabo, Sandor; Jaeger-Waldau, Arnulf [Joint Research Centre, Institute for Energy, Via E. Fermi 2749, I-21020 Ispra (Italy); Szabo, Laszlo [Joint Research Centre, Institute for Prospective Technological Studies C. Inca Garcilaso, 3. E-41092 Sevilla (Spain)

    2010-07-15

    Recent research shows significant differences in the levelised photovoltaics (PV) electricity cost calculations. The present paper points out that no unique or absolute cost figure can be justified, the correct solution is to use a range of cost figures that is determined in a dynamic power portfolio interaction within the financial scheme, support mechanism and industry cost reduction. The paper draws attention to the increasing role of financial investors in the PV segment of the renewable energy market and the importance they attribute to the risks of all options in the power generation portfolio. Based on these trends, a former version of a financing model is adapted to project the energy mix changes in the EU electricity market due to investors behaviour with different risk tolerance/aversion. The dynamic process of translating these risks into the return expectation in the financial appraisal and investment decision making is also introduced. By doing so, the paper sets up a potential electricity market trend with the associated risk perception and classification. The necessary risk mitigation tasks for all stakeholders in the PV market are summarised which aims to avoid the burden of excessive risk premiums in this market segment. (author)

  9. Risk adjusted financial costs of photovoltaics

    International Nuclear Information System (INIS)

    Szabo, Sandor; Jaeger-Waldau, Arnulf; Szabo, Laszlo

    2010-01-01

    Recent research shows significant differences in the levelised photovoltaics (PV) electricity cost calculations. The present paper points out that no unique or absolute cost figure can be justified, the correct solution is to use a range of cost figures that is determined in a dynamic power portfolio interaction within the financial scheme, support mechanism and industry cost reduction. The paper draws attention to the increasing role of financial investors in the PV segment of the renewable energy market and the importance they attribute to the risks of all options in the power generation portfolio. Based on these trends, a former version of a financing model is adapted to project the energy mix changes in the EU electricity market due to investors behaviour with different risk tolerance/aversion. The dynamic process of translating these risks into the return expectation in the financial appraisal and investment decision making is also introduced. By doing so, the paper sets up a potential electricity market trend with the associated risk perception and classification. The necessary risk mitigation tasks for all stakeholders in the PV market are summarised which aims to avoid the burden of excessive risk premiums in this market segment.

  10. The Persistence of Risk-Adjusted Mutual Fund Performance.

    OpenAIRE

    Elton, Edwin J; Gruber, Martin J; Blake, Christopher R

    1996-01-01

    The authors examine predictability for stock mutual funds using risk-adjusted returns. They find that past performance is predictive of future risk-adjusted performance. Applying modern portfolio theory techniques to past data improves selection and allows the authors to construct a portfolio of funds that significantly outperforms a rule based on past rank alone. In addition, they can form a combination of actively managed portfolios with the same risk as a portfolio of index funds but with ...

  11. Inappropriate use of payment weights to risk adjust readmission rates.

    Science.gov (United States)

    Fuller, Richard L; Goldfield, Norbert I; Averill, Richard F; Hughes, John S

    2012-01-01

    In this article, the authors demonstrate that the use of relative weights, as incorporated within the National Quality Forum-endorsed PacifiCare readmission measure, is inappropriate for risk adjusting rates of hospital readmission.

  12. Belgium: risk adjustment and financial responsibility in a centralised system.

    Science.gov (United States)

    Schokkaert, Erik; Van de Voorde, Carine

    2003-07-01

    Since 1995 Belgian sickness funds are partially financed through a risk adjustment system and are held partially financially responsible for the difference between their actual and their risk-adjusted expenditures. However, they did not get the necessary instruments for exerting a real influence on expenditures and the health insurance market has not been opened for new entrants. At the same time the sickness funds have powerful tools for risk selection, because they also dominate the market for supplementary health insurance. The present risk-adjustment system is based on the results of a regression analysis with aggregate data. The main proclaimed purpose of this system is to guarantee a fair treatment to all the sickness funds. Until now the danger of risk selection has not been taken seriously. Consumer mobility has remained rather low. However, since the degree of financial responsibility is programmed to increase in the near future, the potential profits from cream skimming will increase.

  13. A Machine Learning Framework for Plan Payment Risk Adjustment.

    Science.gov (United States)

    Rose, Sherri

    2016-12-01

    To introduce cross-validation and a nonparametric machine learning framework for plan payment risk adjustment and then assess whether they have the potential to improve risk adjustment. 2011-2012 Truven MarketScan database. We compare the performance of multiple statistical approaches within a broad machine learning framework for estimation of risk adjustment formulas. Total annual expenditure was predicted using age, sex, geography, inpatient diagnoses, and hierarchical condition category variables. The methods included regression, penalized regression, decision trees, neural networks, and an ensemble super learner, all in concert with screening algorithms that reduce the set of variables considered. The performance of these methods was compared based on cross-validated R 2 . Our results indicate that a simplified risk adjustment formula selected via this nonparametric framework maintains much of the efficiency of a traditional larger formula. The ensemble approach also outperformed classical regression and all other algorithms studied. The implementation of cross-validated machine learning techniques provides novel insight into risk adjustment estimation, possibly allowing for a simplified formula, thereby reducing incentives for increased coding intensity as well as the ability of insurers to "game" the system with aggressive diagnostic upcoding. © Health Research and Educational Trust.

  14. Can rent adjustment clauses reduce the income risk of farms?

    OpenAIRE

    Hotopp, Henning; Mußhoff, Oliver

    2012-01-01

    Risk management is gaining importance in agriculture. In addition to traditional instruments, new risk management instruments are increasingly being proposed. These proposals include the rent adjustment clauses (RACs), which seem to be an unusual instrument at first sight. In contrast with conventional instruments, RACs intentionally allow fixed-cost ‘rent payments’ to fluctuate. We investigate the whole-farm risk reduction potential of different types of RACs via a historical simulation....

  15. Incorporating Comorbidity Within Risk Adjustment for UK Pediatric Cardiac Surgery.

    Science.gov (United States)

    Brown, Katherine L; Rogers, Libby; Barron, David J; Tsang, Victor; Anderson, David; Tibby, Shane; Witter, Thomas; Stickley, John; Crowe, Sonya; English, Kate; Franklin, Rodney C; Pagel, Christina

    2017-07-01

    When considering early survival rates after pediatric cardiac surgery it is essential to adjust for risk linked to case complexity. An important but previously less well understood component of case mix complexity is comorbidity. The National Congenital Heart Disease Audit data representing all pediatric cardiac surgery procedures undertaken in the United Kingdom and Ireland between 2009 and 2014 was used to develop and test groupings for comorbidity and additional non-procedure-based risk factors within a risk adjustment model for 30-day mortality. A mixture of expert consensus based opinion and empiric statistical analyses were used to define and test the new comorbidity groups. The study dataset consisted of 21,838 pediatric cardiac surgical procedure episodes in 18,834 patients with 539 deaths (raw 30-day mortality rate, 2.5%). In addition to surgical procedure type, primary cardiac diagnosis, univentricular status, age, weight, procedure type (bypass, nonbypass, or hybrid), and era, the new risk factor groups of non-Down congenital anomalies, acquired comorbidities, increased severity of illness indicators (eg, preoperative mechanical ventilation or circulatory support) and additional cardiac risk factors (eg, heart muscle conditions and raised pulmonary arterial pressure) all independently increased the risk of operative mortality. In an era of low mortality rates across a wide range of operations, non-procedure-based risk factors form a vital element of risk adjustment and their presence leads to wide variations in the predicted risk of a given operation. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  16. Diagnostic Risk Adjustment for Medicaid: The Disability Payment System

    Science.gov (United States)

    Kronick, Richard; Dreyfus, Tony; Lee, Lora; Zhou, Zhiyuan

    1996-01-01

    This article describes a system of diagnostic categories that Medicaid programs can use for adjusting capitation payments to health plans that enroll people with disability. Medicaid claims from Colorado, Michigan, Missouri, New York, and Ohio are analyzed to demonstrate that the greater predictability of costs among people with disabilities makes risk adjustment more feasible than for a general population and more critical to creating health systems for people with disability. The application of our diagnostic categories to State claims data is described, including estimated effects on subsequent-year costs of various diagnoses. The challenges of implementing adjustment by diagnosis are explored. PMID:10172665

  17. Evaluating intergenerational risks: Probabillity adjusted rank-discounted utilitarianism

    OpenAIRE

    Asheim, Geir B.; Zuber, Stéphane

    2015-01-01

    Climate policies have stochastic consequences that involve a great number of generations. This calls for evaluating social risk (what kind of societies will future people be born into) rather than individual risk (what will happen to people during their own lifetimes). As a response we propose and axiomatize probability adjusted rank-discounted critical-level generalized utilitarianism (PARDCLU), through a key axiom that requires that the social welfare order both be ethical and satisfy first...

  18. Personality, emotional adjustment, and cardiovascular risk: marriage as a mechanism.

    Science.gov (United States)

    Smith, Timothy W; Baron, Carolynne E; Grove, Jeremy L

    2014-12-01

    A variety of aspects of personality and emotional adjustment predict the development and course of coronary heart disease (CHD), as do indications of marital quality (e.g., satisfaction, conflict, strain, disruption). Importantly, the personality traits and aspects of emotional adjustment that predict CHD are also related to marital quality. In such instances of correlated risk factors, traditional epidemiological and clinical research typically either ignores the potentially overlapping effects or examines independent associations through statistical controls, approaches that can misrepresent the key components and mechanisms of psychosocial effects on CHD. The interpersonal perspective in personality and clinical psychology provides an alternative and integrative approach, through its structural and process models of interpersonal behavior. We present this perspective on psychosocial risk and review research on its application to the integration of personality, emotional adjustment, and marital processes as closely interrelated influences on health and disease. © 2013 Wiley Periodicals, Inc.

  19. Risk-adjusted capitation: Recent experiences in the Netherlands

    NARCIS (Netherlands)

    W.P.M.M. van de Ven (Wynand); R.C.J.A. van Vliet (René); E.M. van Barneveld (Erik); L.M. Lamers (Leida)

    1994-01-01

    textabstractThe market-oriented health care reforms taking place in the Netherlands show a clear resemblance to the proposals for managed competition in U.S. health care. In both countries good risk adjustment mechanisms that prevent cream skimming--that is, that prevent plans from selecting the

  20. Risk-adjusted capitation: recent experiences in The Netherlands

    NARCIS (Netherlands)

    W.P.M.M. van de Ven (Wynand); E.M. van Barneveld (Erik); L.M. Lamers (Leida); R.C.J.A. van Vliet (René)

    1994-01-01

    textabstractThe market-oriented health care reforms taking place in the Netherlands show a clear resemblance to the proposals for managed competition in U.S. health care. In both countries good risk adjustment mechanisms that prevent cream skimming--that is, that

  1. Portfolio balancing and risk adjusted values under constrained budget conditions

    International Nuclear Information System (INIS)

    MacKay, J.A.; Lerche, I.

    1996-01-01

    For a given hydrocarbon exploration opportunity, the influences of value, cost, success probability and corporate risk tolerance provide an optimal working interest that should be taken in the opportunity in order to maximize the risk adjusted value. When several opportunities are available, but when the total budget is insufficient to take optimal working interest in each, an analytic procedure is given for optimizing the risk adjusted value of the total portfolio; the relevant working interests are also derived based on a cost exposure constraint. Several numerical illustrations are provided to exhibit the use of the method under different budget conditions, and with different numbers of available opportunities. When value, cost, success probability, and risk tolerance are uncertain for each and every opportunity, the procedure is generalized to allow determination of probable optimal risk adjusted value for the total portfolio and, at the same time, the range of probable working interest that should be taken in each opportunity is also provided. The result is that the computations of portfolio balancing can be done quickly in either deterministic or probabilistic manners on a small calculator, thereby providing rapid assessments of opportunities and their worth to a corporation. (Author)

  2. Spatial implications of covariate adjustment on patterns of risk

    DEFF Research Database (Denmark)

    Sabel, Clive Eric; Wilson, Jeff Gaines; Kingham, Simon

    2007-01-01

    Epidemiological studies that examine the relationship between environmental exposures and health often address other determinants of health that may influence the relationship being studied by adjusting for these factors as covariates. While disease surveillance methods routinely control...... for covariates such as deprivation, there has been limited investigative work on the spatial movement of risk at the intraurban scale due to the adjustment. It is important that the nature of any spatial relocation be well understood as a relocation to areas of increased risk may also introduce additional...... localised factors that influence the exposure-response relationship. This paper examines the spatial patterns of relative risk and clusters of hospitalisations based on an illustrative small-area example from Christchurch, New Zealand. A four-stage test of the spatial relocation effects of covariate...

  3. Diagnosis-Based Risk Adjustment for Medicare Capitation Payments

    Science.gov (United States)

    Ellis, Randall P.; Pope, Gregory C.; Iezzoni, Lisa I.; Ayanian, John Z.; Bates, David W.; Burstin, Helen; Ash, Arlene S.

    1996-01-01

    Using 1991-92 data for a 5-percent Medicare sample, we develop, estimate, and evaluate risk-adjustment models that utilize diagnostic information from both inpatient and ambulatory claims to adjust payments for aged and disabled Medicare enrollees. Hierarchical coexisting conditions (HCC) models achieve greater explanatory power than diagnostic cost group (DCG) models by taking account of multiple coexisting medical conditions. Prospective models predict average costs of individuals with chronic conditions nearly as well as concurrent models. All models predict medical costs far more accurately than the current health maintenance organization (HMO) payment formula. PMID:10172666

  4. Ants avoid superinfections by performing risk-adjusted sanitary care.

    Science.gov (United States)

    Konrad, Matthias; Pull, Christopher D; Metzler, Sina; Seif, Katharina; Naderlinger, Elisabeth; Grasse, Anna V; Cremer, Sylvia

    2018-03-13

    Being cared for when sick is a benefit of sociality that can reduce disease and improve survival of group members. However, individuals providing care risk contracting infectious diseases themselves. If they contract a low pathogen dose, they may develop low-level infections that do not cause disease but still affect host immunity by either decreasing or increasing the host's vulnerability to subsequent infections. Caring for contagious individuals can thus significantly alter the future disease susceptibility of caregivers. Using ants and their fungal pathogens as a model system, we tested if the altered disease susceptibility of experienced caregivers, in turn, affects their expression of sanitary care behavior. We found that low-level infections contracted during sanitary care had protective or neutral effects on secondary exposure to the same (homologous) pathogen but consistently caused high mortality on superinfection with a different (heterologous) pathogen. In response to this risk, the ants selectively adjusted the expression of their sanitary care. Specifically, the ants performed less grooming and more antimicrobial disinfection when caring for nestmates contaminated with heterologous pathogens compared with homologous ones. By modulating the components of sanitary care in this way the ants acquired less infectious particles of the heterologous pathogens, resulting in reduced superinfection. The performance of risk-adjusted sanitary care reveals the remarkable capacity of ants to react to changes in their disease susceptibility, according to their own infection history and to flexibly adjust collective care to individual risk.

  5. Risk Selection, Risk Adjustment and Choice: Concepts and Lessons from the Americas

    Science.gov (United States)

    Ellis, Randall P.; Fernandez, Juan Gabriel

    2013-01-01

    Interest has grown worldwide in risk adjustment and risk sharing due to their potential to contain costs, improve fairness, and reduce selection problems in health care markets. Significant steps have been made in the empirical development of risk adjustment models, and in the theoretical foundations of risk adjustment and risk sharing. This literature has often modeled the effects of risk adjustment without highlighting the institutional setting, regulations, and diverse selection problems that risk adjustment is intended to fix. Perhaps because of this, the existing literature and their recommendations for optimal risk adjustment or optimal payment systems are sometimes confusing. In this paper, we present a unified way of thinking about the organizational structure of health care systems, which enables us to focus on two key dimensions of markets that have received less attention: what choices are available that may lead to selection problems, and what financial or regulatory tools other than risk adjustment are used to influence these choices. We specifically examine the health care systems, choices, and problems in four countries: the US, Canada, Chile, and Colombia, and examine the relationship between selection-related efficiency and fairness problems and the choices that are allowed in each country, and discuss recent regulatory reforms that affect choices and selection problems. In this sample, countries and insurance programs with more choices have more selection problems. PMID:24284351

  6. Risk Selection, Risk Adjustment and Choice: Concepts and Lessons from the Americas

    Directory of Open Access Journals (Sweden)

    Randall P. Ellis

    2013-10-01

    Full Text Available Interest has grown worldwide in risk adjustment and risk sharing due to their potential to contain costs, improve fairness, and reduce selection problems in health care markets. Significant steps have been made in the empirical development of risk adjustment models, and in the theoretical foundations of risk adjustment and risk sharing. This literature has often modeled the effects of risk adjustment without highlighting the institutional setting, regulations, and diverse selection problems that risk adjustment is intended to fix. Perhaps because of this, the existing literature and their recommendations for optimal risk adjustment or optimal payment systems are sometimes confusing. In this paper, we present a unified way of thinking about the organizational structure of health care systems, which enables us to focus on two key dimensions of markets that have received less attention: what choices are available that may lead to selection problems, and what financial or regulatory tools other than risk adjustment are used to influence these choices. We specifically examine the health care systems, choices, and problems in four countries: the US, Canada, Chile, and Colombia, and examine the relationship between selection-related efficiency and fairness problems and the choices that are allowed in each country, and discuss recent regulatory reforms that affect choices and selection problems. In this sample, countries and insurance programs with more choices have more selection problems.

  7. Measurement Of Shariah Stock Performance Using Risk Adjusted Performance

    Directory of Open Access Journals (Sweden)

    Zuhairan Y Yunan

    2015-03-01

    Full Text Available The aim of this research is to analyze the shariah stock performance using risk adjusted performance method. There are three parameters to measure the stock performance i.e. Sharpe, Treynor, and Jensen. This performance’s measurements calculate the return and risk factor from shariah stocks. The data that used on this research is using the data of stocks at Jakarta Islamic Index. Sampling method that used on this paper is purposive sampling. This research is using ten companies as a sample. The result shows that from three parameters, the stock that have a best performance are AALI, ANTM, ASII, CPIN, INDF, KLBF, LSIP, and UNTR.DOI: 10.15408/aiq.v7i1.1364

  8. Risk-adjusted payment and performance assessment for primary care.

    Science.gov (United States)

    Ash, Arlene S; Ellis, Randall P

    2012-08-01

    Many wish to change incentives for primary care practices through bundled population-based payments and substantial performance feedback and bonus payments. Recognizing patient differences in costs and outcomes is crucial, but customized risk adjustment for such purposes is underdeveloped. Using MarketScan's claims-based data on 17.4 million commercially insured lives, we modeled bundled payment to support expected primary care activity levels (PCAL) and 9 patient outcomes for performance assessment. We evaluated models using 457,000 people assigned to 436 primary care physician panels, and among 13,000 people in a distinct multipayer medical home implementation with commercially insured, Medicare, and Medicaid patients. Each outcome is separately predicted from age, sex, and diagnoses. We define the PCAL outcome as a subset of all costs that proxies the bundled payment needed for comprehensive primary care. Other expected outcomes are used to establish targets against which actual performance can be fairly judged. We evaluate model performance using R(2)'s at patient and practice levels, and within policy-relevant subgroups. The PCAL model explains 67% of variation in its outcome, performing well across diverse patient ages, payers, plan types, and provider specialties; it explains 72% of practice-level variation. In 9 performance measures, the outcome-specific models explain 17%-86% of variation at the practice level, often substantially outperforming a generic score like the one used for full capitation payments in Medicare: for example, with grouped R(2)'s of 47% versus 5% for predicting "prescriptions for antibiotics of concern." Existing data can support the risk-adjusted bundled payment calculations and performance assessments needed to encourage desired transformations in primary care.

  9. Risk selection and risk adjustment: improving insurance in the individual and small group markets.

    Science.gov (United States)

    Baicker, Katherine; Dow, William H

    2009-01-01

    Insurance market reforms face the key challenge of addressing the threat that risk selection poses to the availability, of stable, high-value insurance policies that provide long-term risk protection. Many of the strategies in use today fail to address this breakdown in risk pooling, and some even exacerbate it. Flexible risk adjustment schemes are a promising avenue for promoting market stability and limiting insurer cream-skimming, potentially providing greater benefits at lower cost. Reforms intended to increase insurance coverage and the value of care delivered will be much more effective if implemented in conjunction with policies that address these fundamental selection issues.

  10. Risk-adjusted hospital outcomes for children's surgery.

    Science.gov (United States)

    Saito, Jacqueline M; Chen, Li Ern; Hall, Bruce L; Kraemer, Kari; Barnhart, Douglas C; Byrd, Claudia; Cohen, Mark E; Fei, Chunyuan; Heiss, Kurt F; Huffman, Kristopher; Ko, Clifford Y; Latus, Melissa; Meara, John G; Oldham, Keith T; Raval, Mehul V; Richards, Karen E; Shah, Rahul K; Sutton, Laura C; Vinocur, Charles D; Moss, R Lawrence

    2013-09-01

    BACKGROUND The American College of Surgeons National Surgical Quality Improvement Program-Pediatric was initiated in 2008 to drive quality improvement in children's surgery. Low mortality and morbidity in previous analyses limited differentiation of hospital performance. Participating institutions included children's units within general hospitals and free-standing children's hospitals. Cases selected by Current Procedural Terminology codes encompassed procedures within pediatric general, otolaryngologic, orthopedic, urologic, plastic, neurologic, thoracic, and gynecologic surgery. Trained personnel abstracted demographic, surgical profile, preoperative, intraoperative, and postoperative variables. Incorporating procedure-specific risk, hierarchical models for 30-day mortality and morbidities were developed with significant predictors identified by stepwise logistic regression. Reliability was estimated to assess the balance of information versus error within models. In 2011, 46 281 patients from 43 hospitals were accrued; 1467 codes were aggregated into 226 groupings. Overall mortality was 0.3%, composite morbidity 5.8%, and surgical site infection (SSI) 1.8%. Hierarchical models revealed outlier hospitals with above or below expected performance for composite morbidity in the entire cohort, pediatric abdominal subgroup, and spine subgroup; SSI in the entire cohort and pediatric abdominal subgroup; and urinary tract infection in the entire cohort. Based on reliability estimates, mortality discriminates performance poorly due to very low event rate; however, reliable model construction for composite morbidity and SSI that differentiate institutions is feasible. The National Surgical Quality Improvement Program-Pediatric expansion has yielded risk-adjusted models to differentiate hospital performance in composite and specific morbidities. However, mortality has low utility as a children's surgery performance indicator. Programmatic improvements have resulted in

  11. Health-Based Capitation Risk Adjustment in Minnesota Public Health Care Programs

    Science.gov (United States)

    Gifford, Gregory A.; Edwards, Kevan R.; Knutson, David J.

    2004-01-01

    This article documents the history and implementation of health-based capitation risk adjustment in Minnesota public health care programs, and identifies key implementation issues. Capitation payments in these programs are risk adjusted using an historical, health plan risk score, based on concurrent risk assessment. Phased implementation of capitation risk adjustment for these programs began January 1, 2000. Minnesota's experience with capitation risk adjustment suggests that: (1) implementation can accelerate encounter data submission, (2) administrative decisions made during implementation can create issues that impact payment model performance, and (3) changes in diagnosis data management during implementation may require changes to the payment model. PMID:25372356

  12. Risk-adjusted performance evaluation in three academic thoracic surgery units using the Eurolung risk models.

    Science.gov (United States)

    Pompili, Cecilia; Shargall, Yaron; Decaluwe, Herbert; Moons, Johnny; Chari, Madhu; Brunelli, Alessandro

    2018-01-03

    The objective of this study was to evaluate the performance of 3 thoracic surgery centres using the Eurolung risk models for morbidity and mortality. This was a retrospective analysis performed on data collected from 3 academic centres (2014-2016). Seven hundred and twenty-one patients in Centre 1, 857 patients in Centre 2 and 433 patients in Centre 3 who underwent anatomical lung resections were analysed. The Eurolung1 and Eurolung2 models were used to predict risk-adjusted cardiopulmonary morbidity and 30-day mortality rates. Observed and risk-adjusted outcomes were compared within each centre. The observed morbidity of Centre 1 was in line with the predicted morbidity (observed 21.1% vs predicted 22.7%, P = 0.31). Centre 2 performed better than expected (observed morbidity 20.2% vs predicted 26.7%, P models were successfully used as risk-adjusting instruments to internally audit the outcomes of 3 different centres, showing their applicability for future quality improvement initiatives. © The Author(s) 2018. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  13. 12 CFR 615.5210 - Risk-adjusted assets.

    Science.gov (United States)

    2010-01-01

    ... appropriate credit conversion factor in § 615.5212, is assigned to one of the risk categories specified in... risk-based capital requirement for the credit-enhanced assets, the risk-based capital required under..., determine the appropriate risk weight for any asset or credit equivalent amount that does not fit wholly...

  14. New ventures require accurate risk analyses and adjustments.

    Science.gov (United States)

    Eastaugh, S R

    2000-01-01

    For new business ventures to succeed, healthcare executives need to conduct robust risk analyses and develop new approaches to balance risk and return. Risk analysis involves examination of objective risks and harder-to-quantify subjective risks. Mathematical principles applied to investment portfolios also can be applied to a portfolio of departments or strategic business units within an organization. The ideal business investment would have a high expected return and a low standard deviation. Nonetheless, both conservative and speculative strategies should be considered in determining an organization's optimal service line and helping the organization manage risk.

  15. Health plans and selection: formal risk adjustment vs. market design and contracts.

    Science.gov (United States)

    Frank, R G; Rosenthal, M B

    2001-01-01

    In this paper, we explore the demand for risk adjustment by health plans that contract with private employers by considering the conditions under which plans might value risk adjustment. Three factors reduce the value of risk adjustment from the plans' point of view. First, only a relatively small segment of privately insured Americans face a choice of competing health plans. Second, health plans share much of their insurance risk with payers, providers, and reinsurers. Third, de facto experience rating that occurs during the premium negotiation process and management of coverage appear to substitute for risk adjustment. While the current environment has not generated much demand for risk adjustment, we reflect on its future potential.

  16. Monitoring risk-adjusted outcomes in congenital heart surgery: does the appropriateness of a risk model change with time?

    Science.gov (United States)

    Tsang, Victor T; Brown, Katherine L; Synnergren, Mats Johanssen; Kang, Nicholas; de Leval, Marc R; Gallivan, Steve; Utley, Martin

    2009-02-01

    Risk adjustment of outcomes in pediatric congenital heart surgery is challenging due to the great diversity in diagnoses and procedures. We have previously shown that variable life-adjusted display (VLAD) charts provide an effective graphic display of risk-adjusted outcomes in this specialty. A question arises as to whether the risk model used remains appropriate over time. We used a recently developed graphic technique to evaluate the performance of an existing risk model among those patients at a single center during 2000 to 2003 originally used in model development. We then compared the distribution of predicted risk among these patients with that among patients in 2004 to 2006. Finally, we constructed a VLAD chart of risk-adjusted outcomes for the latter period. Among 1083 patients between April 2000 and March 2003, the risk model performed well at predicted risks above 3%, underestimated mortality at 2% to 3% predicted risk, and overestimated mortality below 2% predicted risk. There was little difference in the distribution of predicted risk among these patients and among 903 patients between June 2004 and October 2006. Outcomes for the more recent period were appreciably better than those expected according to the risk model. This finding cannot be explained by any apparent bias in the risk model combined with changes in case-mix. Risk models can, and hopefully do, become out of date. There is scope for complacency in the risk-adjusted audit if the risk model used is not regularly recalibrated to reflect changing standards and expectations.

  17. Do insurers respond to risk adjustment? A long-term, nationwide analysis from Switzerland.

    Science.gov (United States)

    von Wyl, Viktor; Beck, Konstantin

    2016-03-01

    Community rating in social health insurance calls for risk adjustment in order to eliminate incentives for risk selection. Swiss risk adjustment is known to be insufficient, and substantial risk selection incentives remain. This study develops five indicators to monitor residual risk selection. Three indicators target activities of conglomerates of insurers (with the same ownership), which steer enrollees into specific carriers based on applicants' risk profiles. As a proxy for their market power, those indicators estimate the amount of premium-, health care cost-, and risk-adjustment transfer variability that is attributable to conglomerates. Two additional indicators, derived from linear regression, describe the amount of residual cost differences between insurers that are not covered by risk adjustment. All indicators measuring conglomerate-based risk selection activities showed increases between 1996 and 2009, paralleling the establishment of new conglomerates. At their maxima in 2009, the indicator values imply that 56% of the net risk adjustment volume, 34% of premium variability, and 51% cost variability in the market were attributable to conglomerates. From 2010 onwards, all indicators decreased, coinciding with a pre-announced risk adjustment reform implemented in 2012. Likewise, the regression-based indicators suggest that the volume and variance of residual cost differences between insurers that are not equaled out by risk adjustment have decreased markedly since 2009 as a result of the latest reform. Our analysis demonstrates that risk-selection, especially by conglomerates, is a real phenomenon in Switzerland. However, insurers seem to have reduced risk selection activities to optimize their losses and gains from the latest risk adjustment reform.

  18. Latino risk-adjusted mortality in the men screened for the Multiple Risk Factor Intervention Trial.

    Science.gov (United States)

    Thomas, Avis J; Eberly, Lynn E; Neaton, James D; Smith, George Davey

    2005-09-15

    Latinos are now the largest minority in the United States, but their distinctive health needs and mortality patterns remain poorly understood. Proportional hazards regressions were used to compare Latino versus White risk- and income-adjusted mortality over 25 years' follow-up from 5,846 Latino and 300,647 White men screened for the Multiple Risk Factor Intervention Trial. Men were aged 35-57 years and residing in 14 states when screened in 1973-1975. Data on coronary heart disease risk factors, self-reported race/ethnicity, and home addresses were obtained at baseline; income was estimated by linking addresses to census data. Mortality follow-up through 1999 was obtained using the National Death Index. The fully adjusted Latino/White hazard ratio for all-cause mortality was 0.82 (95% confidence interval (CI): 0.77, 0.87), based on 1,085 Latino and 73,807 White deaths; this pattern prevailed over time and across states (thus, likely across Latino subgroups). Hazard ratios were significantly greater than one for stroke (hazard ratio = 1.30, 95% CI: 1.01, 1.68), liver cancer (hazard ratio = 2.02, 95% CI: 1.21, 3.37), and infection (hazard ratio = 1.69, 95% CI: 1.24, 2.32). A substudy found only minor racial/ethnic differences in the quality of Social Security numbers, birth dates, soundex-adjusted names, and National Death Index searches. Results were not likely an artifact of return migration or incomplete mortality data.

  19. A Review on Methods of Risk Adjustment and their Use in Integrated Healthcare Systems

    Science.gov (United States)

    Juhnke, Christin; Bethge, Susanne

    2016-01-01

    Introduction: Effective risk adjustment is an aspect that is more and more given weight on the background of competitive health insurance systems and vital healthcare systems. The objective of this review was to obtain an overview of existing models of risk adjustment as well as on crucial weights in risk adjustment. Moreover, the predictive performance of selected methods in international healthcare systems should be analysed. Theory and methods: A comprehensive, systematic literature review on methods of risk adjustment was conducted in terms of an encompassing, interdisciplinary examination of the related disciplines. Results: In general, several distinctions can be made: in terms of risk horizons, in terms of risk factors or in terms of the combination of indicators included. Within these, another differentiation by three levels seems reasonable: methods based on mortality risks, methods based on morbidity risks as well as those based on information on (self-reported) health status. Conclusions and discussion: After the final examination of different methods of risk adjustment it was shown that the methodology used to adjust risks varies. The models differ greatly in terms of their included morbidity indicators. The findings of this review can be used in the evaluation of integrated healthcare delivery systems and can be integrated into quality- and patient-oriented reimbursement of care providers in the design of healthcare contracts. PMID:28316544

  20. Ensemble of trees approaches to risk adjustment for evaluating a hospital's performance.

    Science.gov (United States)

    Liu, Yang; Traskin, Mikhail; Lorch, Scott A; George, Edward I; Small, Dylan

    2015-03-01

    A commonly used method for evaluating a hospital's performance on an outcome is to compare the hospital's observed outcome rate to the hospital's expected outcome rate given its patient (case) mix and service. The process of calculating the hospital's expected outcome rate given its patient mix and service is called risk adjustment (Iezzoni 1997). Risk adjustment is critical for accurately evaluating and comparing hospitals' performances since we would not want to unfairly penalize a hospital just because it treats sicker patients. The key to risk adjustment is accurately estimating the probability of an Outcome given patient characteristics. For cases with binary outcomes, the method that is commonly used in risk adjustment is logistic regression. In this paper, we consider ensemble of trees methods as alternatives for risk adjustment, including random forests and Bayesian additive regression trees (BART). Both random forests and BART are modern machine learning methods that have been shown recently to have excellent performance for prediction of outcomes in many settings. We apply these methods to carry out risk adjustment for the performance of neonatal intensive care units (NICU). We show that these ensemble of trees methods outperform logistic regression in predicting mortality among babies treated in NICU, and provide a superior method of risk adjustment compared to logistic regression.

  1. The risk-adjusted performance of companies with female directors: A South African case

    Directory of Open Access Journals (Sweden)

    Mkhethwa Mkhize

    2013-04-01

    Full Text Available The objective of this research was to examine the effects of female directors on the risk-adjusted performance of firms listed on the JSE Securities Exchange of South Africa (the JSE. The theoretical underpinning for the relationship between representation of female directors and the risk-adjusted performance of companies was based on institutional theory. The hypothesis that there is no difference between the risk-adjusted performance of companies with female directors and that of companies without female directors was rejected. Implications of the results are discussed and suggestions for future research presented.

  2. Risk-adjusted Outcomes of Clinically Relevant Pancreatic Fistula Following Pancreatoduodenectomy: A Model for Performance Evaluation.

    Science.gov (United States)

    McMillan, Matthew T; Soi, Sameer; Asbun, Horacio J; Ball, Chad G; Bassi, Claudio; Beane, Joal D; Behrman, Stephen W; Berger, Adam C; Bloomston, Mark; Callery, Mark P; Christein, John D; Dixon, Elijah; Drebin, Jeffrey A; Castillo, Carlos Fernandez-Del; Fisher, William E; Fong, Zhi Ven; House, Michael G; Hughes, Steven J; Kent, Tara S; Kunstman, John W; Malleo, Giuseppe; Miller, Benjamin C; Salem, Ronald R; Soares, Kevin; Valero, Vicente; Wolfgang, Christopher L; Vollmer, Charles M

    2016-08-01

    To evaluate surgical performance in pancreatoduodenectomy using clinically relevant postoperative pancreatic fistula (CR-POPF) occurrence as a quality indicator. Accurate assessment of surgeon and institutional performance requires (1) standardized definitions for the outcome of interest and (2) a comprehensive risk-adjustment process to control for differences in patient risk. This multinational, retrospective study of 4301 pancreatoduodenectomies involved 55 surgeons at 15 institutions. Risk for CR-POPF was assessed using the previously validated Fistula Risk Score, and pancreatic fistulas were stratified by International Study Group criteria. CR-POPF variability was evaluated and hierarchical regression analysis assessed individual surgeon and institutional performance. There was considerable variability in both CR-POPF risk and occurrence. Factors increasing the risk for CR-POPF development included increasing Fistula Risk Score (odds ratio 1.49 per point, P ratio 3.30, P performance outliers were identified at the surgeon and institutional levels. Of the top 10 surgeons (≥15 cases) for nonrisk-adjusted performance, only 6 remained in this high-performing category following risk adjustment. This analysis of pancreatic fistulas following pancreatoduodenectomy demonstrates considerable variability in both the risk and occurrence of CR-POPF among surgeons and institutions. Disparities in patient risk between providers reinforce the need for comprehensive, risk-adjusted modeling when assessing performance based on procedure-specific complications. Furthermore, beyond inherent patient risk factors, surgical decision-making influences fistula outcomes.

  3. Risk-adjusted scoring systems in colorectal surgery.

    Science.gov (United States)

    Leung, Edmund; McArdle, Kirsten; Wong, Ling S

    2011-01-01

    Consequent to recent advances in surgical techniques and management, survival rate has increased substantially over the last 25 years, particularly in colorectal cancer patients. However, post-operative morbidity and mortality from colorectal cancer vary widely across the country. Therefore, standardised outcome measures are emphasised not only for professional accountability, but also for comparison between treatment units and regions. In a heterogeneous population, the use of crude mortality as an outcome measure for patients undergoing surgery is simply misleading. Meaningful comparisons, however, require accurate risk stratification of patients being analysed before conclusions can be reached regarding the outcomes recorded. Sub-specialised colorectal surgical units usually dedicated to more complex and high-risk operations. The need for accurate risk prediction is necessary in these units as both mortality and morbidity often are tools to justify the practice of high-risk surgery. The Acute Physiology And Chronic Health Evaluation (APACHE) is a system for classifying patients in the intensive care unit. However, APACHE score was considered too complex for general surgical use. The American Society of Anaesthesiologists (ASA) grade has been considered useful as an adjunct to informed consent and for monitoring surgical performance through time. ASA grade is simple but too subjective. The Physiological & Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) and its variant Portsmouth POSSUM (P-POSSUM) were devised to predict outcomes in surgical patients in general, taking into account of the variables in the case-mix. POSSUM has two parts, which include assessment of physiological parameters and operative scores. There are 12 physiological parameters and 6 operative measures. The physiological parameters are taken at the time of surgery. Each physiological parameter or operative variable is sub-divided into three or four levels with

  4. Use of surveillance data for prevention of healthcare-associated infection: risk adjustment and reporting dilemmas.

    LENUS (Irish Health Repository)

    O'Neill, Eoghan

    2009-08-01

    Healthcare-associated or nosocomial infection (HCAI) is of increasing importance to healthcare providers and the public. Surveillance is crucial but must be adjusted for risk, especially when used for interhospital comparisons or for public reporting.

  5. A simple signaling rule for variable life-adjusted display derived from an equivalent risk-adjusted CUSUM chart.

    Science.gov (United States)

    Wittenberg, Philipp; Gan, Fah Fatt; Knoth, Sven

    2018-04-17

    The variable life-adjusted display (VLAD) is the first risk-adjusted graphical procedure proposed in the literature for monitoring the performance of a surgeon. It displays the cumulative sum of expected minus observed deaths. It has since become highly popular because the statistic plotted is easy to understand. But it is also easy to misinterpret a surgeon's performance by utilizing the VLAD, potentially leading to grave consequences. The problem of misinterpretation is essentially caused by the variance of the VLAD's statistic that increases with sample size. In order for the VLAD to be truly useful, a simple signaling rule is desperately needed. Various forms of signaling rules have been developed, but they are usually quite complicated. Without signaling rules, making inferences using the VLAD alone is difficult if not misleading. In this paper, we establish an equivalence between a VLAD with V-mask and a risk-adjusted cumulative sum (RA-CUSUM) chart based on the difference between the estimated probability of death and surgical outcome. Average run length analysis based on simulation shows that this particular RA-CUSUM chart has similar performance as compared to the established RA-CUSUM chart based on the log-likelihood ratio statistic obtained by testing the odds ratio of death. We provide a simple design procedure for determining the V-mask parameters based on a resampling approach. Resampling from a real data set ensures that these parameters can be estimated appropriately. Finally, we illustrate the monitoring of a real surgeon's performance using VLAD with V-mask. Copyright © 2018 John Wiley & Sons, Ltd.

  6. Performance of Comorbidity, Risk Adjustment, and Functional Status Measures in Expenditure Prediction for Patients With Diabetes

    OpenAIRE

    Maciejewski, Matthew L.; Liu, Chuan-Fen; Fihn, Stephan D.

    2009-01-01

    OBJECTIVE?To compare the ability of generic comorbidity and risk adjustment measures, a diabetes-specific measure, and a self-reported functional status measure to explain variation in health care expenditures for individuals with diabetes. RESEARCH DESIGN AND METHODS?This study included a retrospective cohort of 3,092 diabetic veterans participating in a multisite trial. Two comorbidity measures, four risk adjusters, a functional status measure, a diabetes complication count, and baseline ex...

  7. Behavioral Risk Factors: Selected Metropolitan Area Risk Trends (SMART) MMSA Age-adjusted Prevalence Data (2011 to Present)

    Data.gov (United States)

    U.S. Department of Health & Human Services — 2011 to present. BRFSS SMART MMSA age-adjusted prevalence combined land line and cell phone data. The Selected Metropolitan Area Risk Trends (SMART) project uses the...

  8. Sperm competition risk drives rapid ejaculate adjustments mediated by seminal fluid.

    Science.gov (United States)

    Bartlett, Michael J; Steeves, Tammy E; Gemmell, Neil J; Rosengrave, Patrice C

    2017-10-31

    In many species, males can make rapid adjustments to ejaculate performance in response to sperm competition risk; however, the mechanisms behind these changes are not understood. Here, we manipulate male social status in an externally fertilising fish, chinook salmon ( Oncorhynchus tshawytscha ), and find that in less than 48 hr, males can upregulate sperm velocity when faced with an increased risk of sperm competition. Using a series of in vitro sperm manipulation and competition experiments, we show that rapid changes in sperm velocity are mediated by seminal fluid and the effect of seminal fluid on sperm velocity directly impacts paternity share and therefore reproductive success. These combined findings, completely consistent with sperm competition theory, provide unequivocal evidence that sperm competition risk drives plastic adjustment of ejaculate quality, that seminal fluid harbours the mechanism for the rapid adjustment of sperm velocity and that fitness benefits accrue to males from such adjustment.

  9. A method to adjust radiation dose-response relationships for clinical risk factors

    DEFF Research Database (Denmark)

    Appelt, Ane Lindegaard; Vogelius, Ivan R

    2012-01-01

    Several clinical risk factors for radiation induced toxicity have been identified in the literature. Here, we present a method to quantify the effect of clinical risk factors on radiation dose-response curves and apply the method to adjust the dose-response for radiation pneumonitis for patients...

  10. Risk adjustment and the fear of markets: the case of Belgium.

    Science.gov (United States)

    Schokkaert, E; Van de Voorde, C

    2000-02-01

    In Belgium the management and administration of the compulsory and universal health insurance is left to a limited number of non-governmental non-profit sickness funds. Since 1995 these sickness funds are partially financed in a prospective way. The risk adjustment scheme is based on a regression model to explain medical expenditures for different social groups. Medical supply is taken out of the formula to construct risk-adjusted capitation payments. The risk-adjustment formula still leaves scope for risk selection. At the same time, the sickness funds were not given the instruments to exert a real influence on expenditures and the health insurance market has not been opened for new entrants. As a consequence, Belgium runs the danger of ending up in a situation with little incentives for efficiency and considerable profits from cream skimming.

  11. The Experience of Risk-Adjusted Capitation Payment for Family Physicians in Iran: A Qualitative Study.

    Science.gov (United States)

    Esmaeili, Reza; Hadian, Mohammad; Rashidian, Arash; Shariati, Mohammad; Ghaderi, Hossien

    2016-04-01

    When a country's health system is faced with fundamental flaws that require the redesign of financing and service delivery, primary healthcare payment systems are often reformed. This study was conducted with the purpose of exploring the experiences of risk-adjusted capitation payment of urban family physicians in Iran when it comes to providing primary health care (PHC). This is a qualitative study using the framework method. Data were collected via digitally audio-recorded semi-structured interviews with 24 family physicians and 5 executive directors in two provinces of Iran running the urban family physician pilot program. The participants were selected using purposive and snowball sampling. The codes were extracted using inductive and deductive methods. Regarding the effects of risk-adjusted capitation on the primary healthcare setting, five themes with 11 subthemes emerged, including service delivery, institutional structure, financing, people's behavior, and the challenges ahead. Our findings indicated that the health system is enjoying some major changes in the primary healthcare setting through the implementation of risk-adjusted capitation payment. With regard to the current challenges in Iran's health system, using risk-adjusted capitation as a primary healthcare payment system can lead to useful changes in the health system's features. However, future research should focus on the development of the risk-adjusted capitation model.

  12. Conference Innovations in Derivatives Market : Fixed Income Modeling, Valuation Adjustments, Risk Management, and Regulation

    CERN Document Server

    Grbac, Zorana; Scherer, Matthias; Zagst, Rudi

    2016-01-01

    This book presents 20 peer-reviewed chapters on current aspects of derivatives markets and derivative pricing. The contributions, written by leading researchers in the field as well as experienced authors from the financial industry, present the state of the art in: • Modeling counterparty credit risk: credit valuation adjustment, debit valuation adjustment, funding valuation adjustment, and wrong way risk. • Pricing and hedging in fixed-income markets and multi-curve interest-rate modeling. • Recent developments concerning contingent convertible bonds, the measuring of basis spreads, and the modeling of implied correlations. The recent financial crisis has cast tremendous doubts on the classical view on derivative pricing. Now, counterparty credit risk and liquidity issues are integral aspects of a prudent valuation procedure and the reference interest rates are represented by a multitude of curves according to their different periods and maturities. A panel discussion included in the book (featuring D...

  13. Beyond preadoptive risk: The impact of adoptive family environment on adopted youth's psychosocial adjustment.

    Science.gov (United States)

    Ji, Juye; Brooks, Devon; Barth, Richard P; Kim, Hansung

    2010-07-01

    Adopted children often are exposed to preadoptive stressors--such as prenatal substance exposure, child maltreatment, and out-of-home placements--that increase their risks for psychosocial maladjustment. Psychosocial adjustment of adopted children emerges as the product of pre- and postadoptive factors. This study builds on previous research, which fails to simultaneously assess the influences of pre- and postadoptive factors, by examining the impact of adoptive family sense of coherence on adoptee's psychosocial adjustment beyond the effects of preadoptive risks. Using a sample of adoptive families (n = 385) taking part in the California Long Range Adoption Study, structural equation modeling analyses were performed. Results indicate a significant impact of family sense of coherence on adoptees' psychosocial adjustment and a considerably less significant role of preadoptive risks. The findings suggest the importance of assessing adoptive family's ability to respond to stress and of helping families to build and maintain their capacity to cope with stress despite the sometimes fractious pressures of adoption.

  14. Health-based risk adjustment: is inpatient and outpatient diagnostic information sufficient?

    Science.gov (United States)

    Lamers, L M

    Adequate risk adjustment is critical to the success of market-oriented health care reforms in many countries. Currently used risk adjusters based on demographic and diagnostic cost groups (DCGs) do not reflect expected costs accurately. This study examines the simultaneous predictive accuracy of inpatient and outpatient morbidity measures and prior costs. DCGs, pharmacy cost groups (PCGs), and prior year's costs improve the predictive accuracy of the demographic model substantially. DCGs and PCGs seem complementary in their ability to predict future costs. However, this study shows that the combination of DCGs and PCGs still leaves room for cream skimming.

  15. Risk-adjusted survival after tissue versus mechanical aortic valve replacement: a 23-year assessment.

    Science.gov (United States)

    Gaca, Jeffrey G; Clare, Robert M; Rankin, J Scott; Daneshmand, Mani A; Milano, Carmelo A; Hughes, G Chad; Wolfe, Walter G; Glower, Donald D; Smith, Peter K

    2013-11-01

    Detailed analyses of risk-adjusted outcomes after mitral valve surgery have documented significant survival decrements with tissue valves at any age. Several recent studies of prosthetic aortic valve replacement (AVR) also have suggested a poorer performance of tissue valves, although analyses have been limited to small matched series. The study aim was to test the hypothesis that AVR with tissue valves is associated with a lower risk-adjusted survival, as compared to mechanical valves. Between 1986 and 2009, primary isolated AVR, with or without coronary artery bypass grafting (CABG), was performed with currently available valve types in 2148 patients (1108 tissue valves, 1040 mechanical). Patients were selected for tissue valves to be used primarily in the elderly. Baseline and operative characteristics were documented prospectively with a consistent variable set over the entire 23-year period. Follow up was obtained with mailed questionnaires, supplemented by National Death Index searches. The average time to death or follow up was seven years, and follow up for survival was 96.2% complete. Risk-adjusted survival characteristics for the two groups were evaluated using a Cox proportional hazards model with stepwise selection of candidate variables. Differences in baseline characteristics between groups were (tissue versus mechanical): median age 73 versus 61 years; non-elective surgery 32% versus 28%; CABG 45% versus 35%; median ejection fraction 55% versus 55%; renal failure 6% versus 1%; diabetes 18% versus 7% (pvalves; however, after risk adjustment for the adverse profiles of tissue valve patients, no significant difference was observed in survival after tissue or mechanical AVR. Thus, the hypothesis did not hold, and risk-adjusted survival was equivalent, of course qualified by the fact that selection bias was evident. With selection criteria that employed tissue AVR more frequently in elderly patients, tissue and mechanical valves achieved similar survival

  16. Does risk-adjusted payment influence primary care providers’ decision on where to set up practices?

    DEFF Research Database (Denmark)

    Anell, Anders; Dackehag, Margareta; Dietrichson, Jens

    2018-01-01

    Background: Providing equal access to healthcare is an important objective in most health care systems. It is especially pertinent in systems like the Swedish primary care market, where private providers are free to establish themselves in any part of the country. To improve equity in access...... to care, 15 out 21 county councils in Sweden have implemented risk-adjusted capitation based on the Care Need Index, which increases capitation to primary care centers with a large share of patients with unfavorable socioeconomic and demographic characteristics. Our aim is to estimate the effects of using...... Index values. Results: Risk-adjusted capitation significantly increases the number of private primary care centers in areas with relatively high Care Need Index values. The adjustment results in a changed distribution of private centers within county councils; the total number of private centers does...

  17. Evidence that Risk Adjustment is Unnecessary in Estimates of the User Cost of Money

    Directory of Open Access Journals (Sweden)

    Diego A. Restrepo-Tobón

    2015-12-01

    Full Text Available Investors value the  special attributes of monetary assets (e.g.,  exchangeability, liquidity, and safety  and pay a premium for holding them in the form of a lower return rate. The user cost of holding monetary assets can be measured approximately by the difference between the  returns on illiquid risky assets and  those of safer liquid assets. A more appropriate measure should adjust this difference by the  differential risk of the  assets in question. We investigate the  impact that time  non-separable preferences has on the  estimation of the  risk-adjusted user cost of money. Using U.K. data from 1965Q1 to 2011Q1, we estimate a habit-based asset pricing model  with money  in the utility function and  find that the  risk  adjustment for risky monetary assets is negligible. Thus, researchers can dispense with risk adjusting the  user cost of money  in constructing monetary aggregate indexes.

  18. A comparison of internal versus external risk-adjustment for monitoring clinical outcomes

    NARCIS (Netherlands)

    Koetsier, Antonie; de Keizer, Nicolette; Peek, Niels

    2011-01-01

    Internal and external prognostic models can be used to calculate severity of illness adjusted mortality risks. However, it is unclear what the consequences are of using an external model instead of an internal model when monitoring an institution's clinical performance. Theoretically, using an

  19. Assessing At-Risk Youth Using the Reynolds Adolescent Adjustment Screening Inventory with a Latino Population

    Science.gov (United States)

    Balkin, Richard S.; Cavazos, Javier, Jr.; Hernandez, Arthur E.; Garcia, Roberto; Dominguez, Denise L.; Valarezo, Alexandra

    2013-01-01

    Factor analyses were conducted on scores from the Reynolds Adolescent Adjustment Screening Inventory (RAASI; Reynolds, 2001) representing at-risk Latino youth. The 4-factor model of the RAASI did not exhibit a good fit. However, evidence of generalizability for Latino youth was noted. (Contains 3 tables.)

  20. Measuring Profitability Impacts of Information Technology: Use of Risk Adjusted Measures.

    Science.gov (United States)

    Singh, Anil; Harmon, Glynn

    2003-01-01

    Focuses on understanding how investments in information technology are reflected in the income statements and balance sheets of firms. Shows that the relationship between information technology investments and corporate profitability is much better explained by using risk-adjusted measures of corporate profitability than using the same measures…

  1. School Adjustment of Pupils with ADHD: Cognitive, Emotional and Temperament Risk Factors

    Science.gov (United States)

    Sanchez-Perez, Noelia; Gonzalez-Salinas, Carmen

    2013-01-01

    From different research perspectives, the cognitive and emotional characteristics associated with ADHD in children have been identified as risk factors for the development of diverse adjustment problems in the school context. Research in nonclinical population can additionally help in understanding ADHD deficits, since children with specific…

  2. Prior use of durable medical equipment as a risk adjuster for health-based capitation

    NARCIS (Netherlands)

    R.C. van Kleef (Richard); R.C.J.A. van Vliet (René)

    2010-01-01

    textabstractThis paper examines a new risk adjuster for capitation payments to Dutch health plans, based on the prior use of durable medical equipment (DME). The essence is to classify users of DME in a previous year into clinically homogeneous classes and to apply the resulting classification as a

  3. 48 CFR 215.404-71-3 - Contract type risk and working capital adjustment.

    Science.gov (United States)

    2010-10-01

    .... Cost-plus-incentive-free (4) 1.0 0 to 2. Cost-plus-fixed-fee (4) 0.5 0 to 1. Time-and-materials... considered cost-plus-fixed-fee contracts for the purposes of assigning profit values. They shall not receive... CONTRACTING BY NEGOTIATION Contract Pricing 215.404-71-3 Contract type risk and working capital adjustment. (a...

  4. A risk adjustment approach to estimating the burden of skin disease in the United States.

    Science.gov (United States)

    Lim, Henry W; Collins, Scott A B; Resneck, Jack S; Bolognia, Jean; Hodge, Julie A; Rohrer, Thomas A; Van Beek, Marta J; Margolis, David J; Sober, Arthur J; Weinstock, Martin A; Nerenz, David R; Begolka, Wendy Smith; Moyano, Jose V

    2018-01-01

    Direct insurance claims tabulation and risk adjustment statistical methods can be used to estimate health care costs associated with various diseases. In this third manuscript derived from the new national Burden of Skin Disease Report from the American Academy of Dermatology, a risk adjustment method that was based on modeling the average annual costs of individuals with or without specific diseases, and specifically tailored for 24 skin disease categories, was used to estimate the economic burden of skin disease. The results were compared with the claims tabulation method used in the first 2 parts of this project. The risk adjustment method estimated the direct health care costs of skin diseases to be $46 billion in 2013, approximately $15 billion less than estimates using claims tabulation. For individual skin diseases, the risk adjustment cost estimates ranged from 11% to 297% of those obtained using claims tabulation for the 10 most costly skin disease categories. Although either method may be used for purposes of estimating the costs of skin disease, the choice of method will affect the end result. These findings serve as an important reference for future discussions about the method chosen in health care payment models to estimate both the cost of skin disease and the potential cost impact of care changes. Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  5. 12 CFR Appendix B to Part 3 - Risk-Based Capital Guidelines; Market Risk Adjustment

    Science.gov (United States)

    2010-01-01

    ...) The bank must have a risk control unit that reports directly to senior management and is independent... management systems at least annually. (c) Market risk factors. The bank's internal model must use risk.... Section 4. Internal Models (a) General. For risk-based capital purposes, a bank subject to this appendix...

  6. Anesthesiologist- and System-Related Risk Factors for Risk-Adjusted Pediatric Anesthesia-Related Cardiac Arrest.

    Science.gov (United States)

    Zgleszewski, Steven E; Graham, Dionne A; Hickey, Paul R; Brustowicz, Robert M; Odegard, Kirsten C; Koka, Rahul; Seefelder, Christian; Navedo, Andres T; Randolph, Adrienne G

    2016-02-01

    Pediatric anesthesia-related cardiac arrest (ARCA) is an uncommon but potentially preventable adverse event. Infants and children with more severe underlying disease are at highest risk. We aimed to identify system- and anesthesiologist-related risk factors for ARCA. We analyzed a prospectively collected patient cohort data set of anesthetics administered from 2000 to 2011 to children at a large tertiary pediatric hospital. Pre-procedure systemic disease level was characterized by ASA physical status (ASA-PS). Two reviewers independently reviewed cardiac arrests and categorized their anesthesia relatedness. Factors associated with ARCA in the univariate analyses were identified for reevaluation after adjustment for patient age and ASA-PS. Cardiac arrest occurred in 142 of 276,209 anesthetics (incidence 5.1/10,000 anesthetics); 72 (2.6/10,000 anesthetics) were classified as anesthesia-related. In the univariate analyses, risk of ARCA was much higher in cardiac patients and for anesthesiologists with lower annual caseload and/or fewer annual days delivering anesthetics (all P risk adjustment for ASA-PS ≥ III and age ≤ 6 months, however, the association with lower annual days delivering anesthetics remained (P = 0.03), but the other factors were no longer significant. Case-mix explained most associations between higher risk of pediatric ARCA and anesthesiologist-related variables at our institution, but the association with fewer annual days delivering anesthetics remained. Our findings highlight the need for rigorous adjustment for patient risk factors in anesthesia patient safety studies.

  7. Dynamic probability control limits for risk-adjusted CUSUM charts based on multiresponses.

    Science.gov (United States)

    Zhang, Xiang; Loda, Justin B; Woodall, William H

    2017-07-20

    For a patient who has survived a surgery, there could be several levels of recovery. Thus, it is reasonable to consider more than two outcomes when monitoring surgical outcome quality. The risk-adjusted cumulative sum (CUSUM) chart based on multiresponses has been developed for monitoring a surgical process with three or more outcomes. However, there is a significant effect of varying risk distributions on the in-control performance of the chart when constant control limits are applied. To overcome this disadvantage, we apply the dynamic probability control limits to the risk-adjusted CUSUM charts for multiresponses. The simulation results demonstrate that the in-control performance of the charts with dynamic probability control limits can be controlled for different patient populations because these limits are determined for each specific sequence of patients. Thus, the use of dynamic probability control limits for risk-adjusted CUSUM charts based on multiresponses allows each chart to be designed for the corresponding patient sequence of a surgeon or a hospital and therefore does not require estimating or monitoring the patients' risk distribution. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

  8. Rational Multi-curve Models with Counterparty-risk Valuation Adjustments

    DEFF Research Database (Denmark)

    Crépey, Stéphane; Macrina, Andrea; Nguyen, Tuyet Mai

    2016-01-01

    We develop a multi-curve term structure set-up in which the modelling ingredients are expressed by rational functionals of Markov processes. We calibrate to London Interbank Offer Rate swaptions data and show that a rational two-factor log-normal multi-curve model is sufficient to match market da...... with regulatory obligations. In order to compute counterparty-risk valuation adjustments, such as credit valuation adjustment, we show how default intensity processes with rational form can be derived. We flesh out our study by applying the results to a basis swap contract....... with accuracy. We elucidate the relationship between the models developed and calibrated under a risk-neutral measure Q and their consistent equivalence class under the real-world probability measure P. The consistent P-pricing models are applied to compute the risk exposures which may be required to comply...

  9. Use of risk-adjusted CUSUM charts to monitor 30-day mortality in Danish hospitals

    Directory of Open Access Journals (Sweden)

    Rasmussen TB

    2018-04-01

    Full Text Available Thomas Bøjer Rasmussen, Sinna Pilgaard Ulrichsen, Mette Nørgaard Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark Background: Monitoring hospital outcomes and clinical processes as a measure of clinical performance is an integral part of modern health care. The risk-adjusted cumulative sum (CUSUM chart is a frequently used sequential analysis technique that can be implemented to monitor a wide range of different types of outcomes.Objective: The aim of this study was to describe how risk-adjusted CUSUM charts based on population-based nationwide medical registers were used to monitor 30-day mortality in Danish hospitals and to give an example on how alarms of increased hospital mortality from the charts can guide further in-depth analyses.Materials and methods: We used routinely collected administrative data from the Danish National Patient Registry and the Danish Civil Registration System to create risk-adjusted CUSUM charts. We monitored 30-day mortality after hospital admission with one of 77 selected diagnoses in 24 hospital units in Denmark in 2015. The charts were set to detect a 50% increase in 30-day mortality, and control limits were determined by simulations.Results: Among 1,085,576 hospital admissions, 441,352 admissions had one of the 77 selected diagnoses as their primary diagnosis and were included in the risk-adjusted CUSUM charts. The charts yielded a total of eight alarms of increased mortality. The median of the hospitals’ estimated average time to detect a 50% increase in 30-day mortality was 50 days (interquartile interval, 43;54. In the selected example of an alarm, descriptive analyses indicated performance problems with 30-day mortality following hip fracture surgery and diagnosis of chronic obstructive pulmonary disease.Conclusion: The presented implementation of risk-adjusted CUSUM charts can detect significant increases in 30-day mortality within 2 months, on average, in most

  10. State infant mortality: an ecologic study to determine modifiable risks and adjusted infant mortality rates.

    Science.gov (United States)

    Paul, David A; Mackley, Amy; Locke, Robert G; Stefano, John L; Kroelinger, Charlan

    2009-05-01

    To determine factors contributing to state infant mortality rates (IMR) and develop an adjusted IMR in the United States for 2001 and 2002. Ecologic study of factors contributing to state IMR. State IMR for 2001 and 2002 were obtained from the United States linked death and birth certificate data from the National Center for Health Statistics. Factors investigated using multivariable linear regression included state racial demographics, ethnicity, state population, median income, education, teen birth rate, proportion of obesity, smoking during pregnancy, diabetes, hypertension, cesarean delivery, prenatal care, health insurance, self-report of mental illness, and number of in-vitro fertilization procedures. Final risk adjusted IMR's were standardized and states were compared with the United States adjusted rates. Models for IMR in individual states in 2001 (r2 = 0.66, P < 0.01) and 2002 (r2 = 0.81, P < 0.01) were tested. African-American race, teen birth rate, and smoking during pregnancy remained independently associated with state infant mortality rates for 2001 and 2002. Ninety five percent confidence intervals (CI) were calculated around the regression lines to model the expected IMR. After adjustment, some states maintained a consistent IMR; for instance, Vermont and New Hampshire remained low, while Delaware and Louisiana remained high. However, other states such as Mississippi, which have traditionally high infant mortality rates, remained within the expected 95% CI for IMR after adjustment indicating confounding affected the initial unadjusted rates. Non-modifiable demographic variables, including the percentage of non-Hispanic African-American and Hispanic populations of the state are major factors contributing to individual variation in state IMR. Race and ethnicity may confound or modify the IMR in states that shifted inside or outside the 95% CI following adjustment. Other factors including smoking during pregnancy and teen birth rate, which are

  11. Risk-adjusted antibiotic consumption in 34 public acute hospitals in Ireland, 2006 to 2014

    Science.gov (United States)

    Oza, Ajay; Donohue, Fionnuala; Johnson, Howard; Cunney, Robert

    2016-01-01

    As antibiotic consumption rates between hospitals can vary depending on the characteristics of the patients treated, risk-adjustment that compensates for the patient-based variation is required to assess the impact of any stewardship measures. The aim of this study was to investigate the usefulness of patient-based administrative data variables for adjusting aggregate hospital antibiotic consumption rates. Data on total inpatient antibiotics and six broad subclasses were sourced from 34 acute hospitals from 2006 to 2014. Aggregate annual patient administration data were divided into explanatory variables, including major diagnostic categories, for each hospital. Multivariable regression models were used to identify factors affecting antibiotic consumption. Coefficient of variation of the root mean squared errors (CV-RMSE) for the total antibiotic usage model was very good (11%), however, the value for two of the models was poor (> 30%). The overall inpatient antibiotic consumption increased from 82.5 defined daily doses (DDD)/100 bed-days used in 2006 to 89.2 DDD/100 bed-days used in 2014; the increase was not significant after risk-adjustment. During the same period, consumption of carbapenems increased significantly, while usage of fluoroquinolones decreased. In conclusion, patient-based administrative data variables are useful for adjusting hospital antibiotic consumption rates, although additional variables should also be employed. PMID:27541730

  12. [Family characteristics, organic risk factors, psychopathological picture and premorbid adjustment of hospitalized adolescent patients].

    Science.gov (United States)

    Małkiewicz-Borkowska, M; Namysłowska, I; Siewierska, A; Puzyńska, E; Sredniawa, H; Zechowski, C; Iwanek, A; Ruszkowska, E

    1996-01-01

    The relation of some family characteristics such as cohesion and adaptability with organic risk factors, developmental psychopathology, clinical picture and premorbid adjustment was assessed in the group of 100 hospitalized adolescent patients and families. We found correlation between: some of organic risk factors (pathology of neonatal period, pathology of early childhood), some of indicators of developmental psychopathology (eating disorders, conduct disorders), some of clinical signs (mannerism, grandiosity, hostility, suspciousness, disturbances of content of thinking), premorbid adjustment, and variables related to families, described before. We think that biological variables characterizing child (pathology of neonatal period, pathology of early childhood) have an influence on some family characteristics as independent variable. General system theory and circular thinking support these conclusions. In order to verify them, it is necessary to undertake further investigations, based on other methodology, using this results as preliminary findings.

  13. Funding issues for Victorian hospitals: the risk-adjusted vision beyond casemix funding.

    Science.gov (United States)

    Antioch, K; Walsh, M

    2000-01-01

    This paper discusses casemix funding issues in Victoria impacting on teaching hospitals. For casemix payments to be acceptable, the average price and cost weights must be set at an appropriate standard. The average price is based on a normative, policy basis rather than benchmarking. The 'averaging principle' inherent in cost weights has resulted in some AN-DRG weights being too low for teaching hospitals that are key State-wide providers of high complexity services such as neurosurgery and trauma. Casemix data have been analysed using international risk adjustment methodologies to successfully negotiate with the Victorian State Government for specified grants for several high complexity AN-DRGs. A risk-adjusted capitation funding model has also been developed for cystic fibrosis patients treated by The Alfred, called an Australian Health Maintenance Organisation (AHMO). This will facilitate the development of similar models by both the Victorian and Federal governments.

  14. Screening techniques, sustainability and risk adjusted returns. : - A quantitative study on the Swedish equity funds market

    OpenAIRE

    Ögren, Tobias; Forslund, Petter

    2017-01-01

    Previous studies have primarily compared the performance of sustainable equity funds and non-sustainable equity funds. A meta-analysis over 85 different studies in the field concludes that there is no statistically significant difference in risk-adjusted returns when comparing sustainable funds and non-sustainable funds. This study is thus an extension on previous studies where the authors have chosen to test the two most common sustainability screening techniques to test if there is a differ...

  15. The Impact of Capital Structure on Economic Capital and Risk Adjusted Performance

    OpenAIRE

    Porteous, Bruce; Tapadar, Pradip

    2008-01-01

    The impact that capital structure and capital asset allocation have on financial services firm economic capital and risk adjusted performance is considered. A stochastic modelling approach is used in conjunction with banking and insurance examples. It is demonstrated that gearing up Tier 1 capital with Tier 2 capital can be in the interests of bank Tier 1 capital providers, but may not always be so for insurance Tier 1 capital providers. It is also shown that, by allocating a bank or insuranc...

  16. Does Risk-Adjusted Payment Influence Primary Care Providers' Decision on Where to Set Up Practices?

    DEFF Research Database (Denmark)

    Dietrichson, Jens; Anell, Anders; Dackehag, Margareta

    Providing equal access to health care is an important objective in most health care systems. It is especially pertinent in systems like the Swedish primary care market, where providers are free to establish themselves in any part of the country. To improve equity in access to care, 15 out 21 county...... of private primary care centers in areas with unfavorable socioeconomic and demographic characteristics. More generally, this result indicates that risk-adjusted capitation can significantly affect private providers’ establishment decisions....

  17. Improved implementation of the risk-adjusted Bernoulli CUSUM chart to monitor surgical outcome quality.

    Science.gov (United States)

    Keefe, Matthew J; Loda, Justin B; Elhabashy, Ahmad E; Woodall, William H

    2017-06-01

    The traditional implementation of the risk-adjusted Bernoulli cumulative sum (CUSUM) chart for monitoring surgical outcome quality requires waiting a pre-specified period of time after surgery before incorporating patient outcome information. We propose a simple but powerful implementation of the risk-adjusted Bernoulli CUSUM chart that incorporates outcome information as soon as it is available, rather than waiting a pre-specified period of time after surgery. A simulation study is presented that compares the performance of the traditional implementation of the risk-adjusted Bernoulli CUSUM chart to our improved implementation. We show that incorporating patient outcome information as soon as it is available leads to quicker detection of process deterioration. Deterioration of surgical performance could be detected much sooner using our proposed implementation, which could lead to the earlier identification of problems. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  18. Household adjustment to flood risk: a survey of coastal residents in Texas and Florida, United States.

    Science.gov (United States)

    Brody, Samuel D; Lee, Yoonjeong; Highfield, Wesley E

    2017-07-01

    Individual households have increasingly borne responsibility for reducing the adverse impacts of flooding on their property. Little observational research has been conducted, however, at the household level to examine the major factors contributing to the selection of a particular household adjustment. This study addresses the issue by evaluating statistically the factors influencing the adoption of various household flood hazard adjustments. The results indicate that respondents with higher-value homes or longer housing tenure are more likely to adopt structural and expensive techniques. In addition, the information source and the Community Rating System (CRS) score for the jurisdiction where the household is located have a significant bearing on household adjustment. In contrast, proximity to risk zones and risk perception yield somewhat mixed results or behave counter to assumptions in the literature. The study findings provide insights that will be of value to governments and decision-makers interested in encouraging homeowners to take protective action given increasing flood risk. © 2017 The Author(s). Disasters © Overseas Development Institute, 2017.

  19. Suboptimal decision making by children with ADHD in the face of risk: Poor risk adjustment and delay aversion rather than general proneness to taking risks.

    Science.gov (United States)

    Sørensen, Lin; Sonuga-Barke, Edmund; Eichele, Heike; van Wageningen, Heidi; Wollschlaeger, Daniel; Plessen, Kerstin Jessica

    2017-02-01

    Suboptimal decision making in the face of risk (DMR) in children with attention-deficit hyperactivity disorder (ADHD) may be mediated by deficits in a number of different neuropsychological processes. We investigated DMR in children with ADHD using the Cambridge Gambling Task (CGT) to distinguish difficulties in adjusting to changing probabilities of choice outcomes (so-called risk adjustment) from general risk proneness, and to distinguish these 2 processes from delay aversion (the tendency to choose the least delayed option) and impairments in the ability to reflect on choice options. Based on previous research, we predicted that suboptimal performance on this task in children with ADHD would be primarily relate to problems with risk adjustment and delay aversion rather than general risk proneness. Drug naïve children with ADHD (n = 36), 8 to 12 years, and an age-matched group of typically developing children (n = 34) performed the CGT. As predicted, children with ADHD were not more prone to making risky choices (i.e., risk proneness). However, they had difficulty adjusting to changing risk levels and were more delay aversive-with these 2 effects being correlated. Our findings add to the growing body of evidence that children with ADHD do not favor risk taking per se when performing gambling tasks, but rather may lack the cognitive skills or motivational style to appraise changing patterns of risk effectively. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  20. Risk adjustment for case mix and the effect of surgeon volume on morbidity.

    Science.gov (United States)

    Maas, Matthew B; Jaff, Michael R; Rordorf, Guy A

    2013-06-01

    Retrospective studies of large administrative databases have shown higher mortality for procedures performed by low-volume surgeons, but the adequacy of risk adjustment in those studies is in doubt. To determine whether the relationship between surgeon volume and outcomes is an artifact of case mix using a prospective sample of carotid endarterectomy cases. Observational cohort study from January 1, 2008, through December 31, 2010, with preoperative, immediate postoperative, and 30-day postoperative assessments acquired by independent monitors. Urban, tertiary academic medical center. All 841 patients who underwent carotid endarterectomy performed by a vascular surgeon or cerebrovascular neurosurgeon at the institution. Carotid endarterectomy without another concurrent surgery. Stroke, death, and other surgical complications occurring within 30 days of surgery along with other case data. A low-volume surgeon performed 40 or fewer cases per year. Variables used in a comparison administrative database study, as well as variables identified by our univariate analysis, were used for adjusted analyses to assess for an association between low-volume surgeons and the rate of stroke and death as well as other complications. RESULTS The rate of stroke and death was 6.9% for low-volume surgeons and 2.0% for high-volume surgeons (P = .001). Complications were similarly higher (13.4% vs 7.2%, P = .008). Low-volume surgeons performed more nonelective cases. Low-volume surgeons were significantly associated with stroke and death in the unadjusted analysis as well as after adjustment with variables used in the administrative database study (odds ratio, 3.61; 95% CI, 1.70-7.67, and odds ratio, 3.68; 95% CI, 1.72-7.89, respectively). However, adjusting for the significant disparity of American Society of Anesthesiologists Physical Status classification in case mix eliminated the effect of surgeon volume on the rate of stroke and death (odds ratio, 1.65; 95% CI, 0.59-4.64) and other

  1. Refining Risk Adjustment for the Proposed CMS Surgical Hip and Femur Fracture Treatment Bundled Payment Program.

    Science.gov (United States)

    Cairns, Mark A; Ostrum, Robert F; Clement, R Carter

    2018-02-21

    The U.S. Centers for Medicare & Medicaid Services (CMS) has been considering the implementation of a mandatory bundled payment program, the Surgical Hip and Femur Fracture Treatment (SHFFT) model. However, bundled payments without appropriate risk adjustment may be inequitable to providers and may restrict access to care for certain patients. The SHFFT proposal includes adjustment using the Diagnosis-Related Group (DRG) and geographic location. The goal of the current study was to identify and quantify patient factors that could improve risk adjustment for SHFFT bundled payments. We retrospectively reviewed a 5% random sample of Medicare data from 2008 to 2012. A total of 27,898 patients were identified who met SHFFT inclusion criteria (DRG 480, 481, and 482). Reimbursement was determined for each patient over the bundle period (the surgical hospitalization and 90 days of post-discharge care). Multivariable regression was performed to test demographic factors, comorbidities, geographic location, and specific surgical procedures for associations with reimbursement. The average reimbursement was $23,632 ± $17,587. On average, reimbursements for male patients were $1,213 higher than for female patients (p payments; e.g., reimbursement for those ≥85 years of age averaged $2,282 ± $389 less than for those aged 65 to 69 (p reimbursement, but dementia was associated with lower payments, by an average of $2,354 ± $243 (p reimbursement ranging from $22,527 to $24,033. Less common procedures varied by >$20,000 in average reimbursement (p reimbursement (p reimbursed by an average of $10,421 ± $543 more than DRG 482. Payments varied significantly by state (p ≤ 0.01). Risk adjustment incorporating specific comorbidities demonstrated better performance than with use of DRG alone (r = 0.22 versus 0.15). Our results suggest that the proposed SHFFT bundled payment model should use more robust risk-adjustment methods to ensure that providers are reimbursed fairly and that

  2. Risk adjustment models for short-term outcomes after surgical resection for oesophagogastric cancer.

    Science.gov (United States)

    Fischer, C; Lingsma, H; Hardwick, R; Cromwell, D A; Steyerberg, E; Groene, O

    2016-01-01

    Outcomes for oesophagogastric cancer surgery are compared with the aim of benchmarking quality of care. Adjusting for patient characteristics is crucial to avoid biased comparisons between providers. The study objective was to develop a case-mix adjustment model for comparing 30- and 90-day mortality and anastomotic leakage rates after oesophagogastric cancer resections. The study reviewed existing models, considered expert opinion and examined audit data in order to select predictors that were consequently used to develop a case-mix adjustment model for the National Oesophago-Gastric Cancer Audit, covering England and Wales. Models were developed on patients undergoing surgical resection between April 2011 and March 2013 using logistic regression. Model calibration and discrimination was quantified using a bootstrap procedure. Most existing risk models for oesophagogastric resections were methodologically weak, outdated or based on detailed laboratory data that are not generally available. In 4882 patients with oesophagogastric cancer used for model development, 30- and 90-day mortality rates were 2·3 and 4·4 per cent respectively, and 6·2 per cent of patients developed an anastomotic leak. The internally validated models, based on predictors selected from the literature, showed moderate discrimination (area under the receiver operating characteristic (ROC) curve 0·646 for 30-day mortality, 0·664 for 90-day mortality and 0·587 for anastomotic leakage) and good calibration. Based on available data, three case-mix adjustment models for postoperative outcomes in patients undergoing curative surgery for oesophagogastric cancer were developed. These models should be used for risk adjustment when assessing hospital performance in the National Health Service, and tested in other large health systems. © 2015 BJS Society Ltd Published by John Wiley & Sons Ltd.

  3. Mate guarding in the Seychelles warbler is energetically costly and adjusted to paternity risk.

    Science.gov (United States)

    Komdeur, J

    2001-10-22

    Males may increase their fitness through extra-pair copulations (copulations outside the pair bond) that result in extra-pair fertilizations, but also risk lost paternity when they leave their own mate unguarded. The fitness costs of cuckoldry for Seychelles warblers (Acrocephalus sechellensis) are considerable because warblers have a single-egg clutch and, given the short breeding season, no time for a successful replacement clutch. Neighbouring males are the primary threat to a male's genetic paternity. Males minimize their loss of paternity by guarding their mates to prevent them from having extra-pair copulations during their fertile period. Here, I provide experimental evidence that mate-guarding behaviour is energetically costly and that the expression of this trade-off is adjusted to paternity risk (local male density). Free-living males that were induced to reduce mate guarding spent significantly more time foraging and gained significantly better body condition than control males. The larger the reduction in mate guarding, the more pronounced was the increase in foraging and body condition (accounting for food availability). An experimental increase in paternity risk resulted in an increase in mate-guarding intensity and a decrease in foraging and body condition, and vice versa. This is examined using both cross-sectional and longitudinal data. This study on the Seychelles warbler offers experimental evidence that mate guarding is energetically costly and adjusted to paternity risk.

  4. One idea of portfolio risk control for absolute return strategy risk adjustments by signals from correlation behavior

    Science.gov (United States)

    Nishiyama, N.

    2001-12-01

    Absolute return strategy provided from fund of funds (FOFs) investment schemes is the focus in Japanese Financial Community. FOFs investment mainly consists of hedge fund investment and it has two major characteristics which are low correlation against benchmark index and little impact from various external changes in the environment given maximizing return. According to the historical track record of survival hedge funds in this business world, they maintain a stable high return and low risk. However, one must keep in mind that low risk would not be equal to risk free. The failure of Long-term capital management (LTCM) that took place in the summer of 1998 was a symbolized phenomenon. The summer of 1998 exhibited a certain limitation of traditional value at risk (VaR) and some possibility that traditional VaR could be ineffectual to the nonlinear type of fluctuation in the market. In this paper, I try to bring self-organized criticality (SOC) into portfolio risk control. SOC would be well known as a model of decay in the natural world. I analyzed nonlinear type of fluctuation in the market as SOC and applied SOC to capture complicated market movement using threshold point of SOC and risk adjustments by scenario correlation as implicit signals. Threshold becomes the control parameter of risk exposure to set downside floor and forecast extreme nonlinear type of fluctuation under a certain probability. Simulation results would show synergy effect of portfolio risk control between SOC and absolute return strategy.

  5. Variation In Accountable Care Organization Spending And Sensitivity To Risk Adjustment: Implications For Benchmarking.

    Science.gov (United States)

    Rose, Sherri; Zaslavsky, Alan M; McWilliams, J Michael

    2016-03-01

    Spending targets (or benchmarks) for accountable care organizations (ACOs) participating in the Medicare Shared Savings Program must be set carefully to encourage program participation while achieving fiscal goals and minimizing unintended consequences, such as penalizing ACOs for serving sicker patients. Recently proposed regulatory changes include measures to make benchmarks more similar for ACOs in the same area with different historical spending levels. We found that ACOs vary widely in how their spending levels compare with those of other local providers after standard case-mix adjustments. Additionally adjusting for survey measures of patient health meaningfully reduced the variation in differences between ACO spending and local average fee-for-service spending, but substantial variation remained, which suggests that differences in care efficiency between ACOs and local non-ACO providers vary widely. Accordingly, measures to equilibrate benchmarks between high- and low-spending ACOs--such as setting benchmarks to risk-adjusted average fee-for-service spending in an area--should be implemented gradually to maintain participation by ACOs with high spending. Use of survey information also could help mitigate perverse incentives for risk selection and upcoding and limit unintended consequences of new benchmarking methodologies for ACOs serving sicker patients. Project HOPE—The People-to-People Health Foundation, Inc.

  6. Impact of selected risk factors on quality-adjusted life expectancy in Denmark

    DEFF Research Database (Denmark)

    Brønnum-Hansen, Henrik; Juel, Knud; Davidsen, Michael

    2007-01-01

    AIMS: The construct quality-adjusted life years (QALYs) combines mortality and overall health status and can be used to quantify the impact of risk factors on population health. The purpose of the study was to estimate the impact of tobacco smoking, high alcohol consumption, physical inactivity...... Health Survey 2000, and Danish EQ-5D values. RESULTS: The quality-adjusted life expectancy of 25-year-olds was 10-11 QALYs shorter for heavy smokers than for those who never smoke. The difference in life expectancy was 9-10 years. Men and women with high alcohol consumption could expect to lose about 5...... and 3 QALYs, respectively. Sedentary persons could expect to have about 7 fewer QALYs than physically active persons. Obesity shortened QALYs by almost 3 for men and 6 for women. CONCLUSIONS: Smoking, high alcohol consumption, physical inactivity, and obesity strongly reduce life expectancy and health...

  7. Regression Trees Identify Relevant Interactions: Can This Improve the Predictive Performance of Risk Adjustment?

    Science.gov (United States)

    Buchner, Florian; Wasem, Jürgen; Schillo, Sonja

    2017-01-01

    Risk equalization formulas have been refined since their introduction about two decades ago. Because of the complexity and the abundance of possible interactions between the variables used, hardly any interactions are considered. A regression tree is used to systematically search for interactions, a methodologically new approach in risk equalization. Analyses are based on a data set of nearly 2.9 million individuals from a major German social health insurer. A two-step approach is applied: In the first step a regression tree is built on the basis of the learning data set. Terminal nodes characterized by more than one morbidity-group-split represent interaction effects of different morbidity groups. In the second step the 'traditional' weighted least squares regression equation is expanded by adding interaction terms for all interactions detected by the tree, and regression coefficients are recalculated. The resulting risk adjustment formula shows an improvement in the adjusted R 2 from 25.43% to 25.81% on the evaluation data set. Predictive ratios are calculated for subgroups affected by the interactions. The R 2 improvement detected is only marginal. According to the sample level performance measures used, not involving a considerable number of morbidity interactions forms no relevant loss in accuracy. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  8. Breeds of risk-adjusted fundamentalist strategies in an order-driven market

    Science.gov (United States)

    LiCalzi, Marco; Pellizzari, Paolo

    2006-01-01

    This paper studies an order-driven stock market where agents have heterogeneous estimates of the fundamental value of the risky asset. The agents are budget-constrained and follow a value-based trading strategy which buys or sells depending on whether the price of the asset is below or above its risk-adjusted fundamental value. This environment generates returns that are remarkably leptokurtic and fat-tailed. By extending the study over a grid of different parameters for the fundamentalist trading strategy, we exhibit the existence of monotone relationships between the bid-ask spread demanded by the agents and several statistics of the returns. We conjecture that this effect, coupled with positive dependence of the risk premium on the volatility, generates positive feedbacks that might explain volatility bursts.

  9. PACE and the Medicare+Choice risk-adjusted payment model.

    Science.gov (United States)

    Temkin-Greener, H; Meiners, M R; Gruenberg, L

    2001-01-01

    This paper investigates the impact of the Medicare principal inpatient diagnostic cost group (PIP-DCG) payment model on the Program of All-Inclusive Care for the Elderly (PACE). Currently, more than 6,000 Medicare beneficiaries who are nursing home certifiable receive care from PACE, a program poised for expansion under the Balanced Budget Act of 1997. Overall, our analysis suggests that the application of the PIP-DCG model to the PACE program would reduce Medicare payments to PACE, on average, by 38%. The PIP-DCG payment model bases its risk adjustment on inpatient diagnoses and does not capture adequately the risk of caring for a population with functional impairments.

  10. Reliability of risk-adjusted outcomes for profiling hospital surgical quality.

    Science.gov (United States)

    Krell, Robert W; Hozain, Ahmed; Kao, Lillian S; Dimick, Justin B

    2014-05-01

    Quality improvement platforms commonly use risk-adjusted morbidity and mortality to profile hospital performance. However, given small hospital caseloads and low event rates for some procedures, it is unclear whether these outcomes reliably reflect hospital performance. To determine the reliability of risk-adjusted morbidity and mortality for hospital performance profiling using clinical registry data. A retrospective cohort study was conducted using data from the American College of Surgeons National Surgical Quality Improvement Program, 2009. Participants included all patients (N = 55,466) who underwent colon resection, pancreatic resection, laparoscopic gastric bypass, ventral hernia repair, abdominal aortic aneurysm repair, and lower extremity bypass. Outcomes included risk-adjusted overall morbidity, severe morbidity, and mortality. We assessed reliability (0-1 scale: 0, completely unreliable; and 1, perfectly reliable) for all 3 outcomes. We also quantified the number of hospitals meeting minimum acceptable reliability thresholds (>0.70, good reliability; and >0.50, fair reliability) for each outcome. For overall morbidity, the most common outcome studied, the mean reliability depended on sample size (ie, how high the hospital caseload was) and the event rate (ie, how frequently the outcome occurred). For example, mean reliability for overall morbidity was low for abdominal aortic aneurysm repair (reliability, 0.29; sample size, 25 cases per year; and event rate, 18.3%). In contrast, mean reliability for overall morbidity was higher for colon resection (reliability, 0.61; sample size, 114 cases per year; and event rate, 26.8%). Colon resection (37.7% of hospitals), pancreatic resection (7.1% of hospitals), and laparoscopic gastric bypass (11.5% of hospitals) were the only procedures for which any hospitals met a reliability threshold of 0.70 for overall morbidity. Because severe morbidity and mortality are less frequent outcomes, their mean

  11. Usefulness of administrative databases for risk adjustment of adverse events in surgical patients.

    Science.gov (United States)

    Rodrigo-Rincón, Isabel; Martin-Vizcaíno, Marta P; Tirapu-León, Belén; Zabalza-López, Pedro; Abad-Vicente, Francisco J; Merino-Peralta, Asunción; Oteiza-Martínez, Fabiola

    2016-03-01

    The aim of this study was to assess the usefulness of clinical-administrative databases for the development of risk adjustment in the assessment of adverse events in surgical patients. The study was conducted at the Hospital of Navarra, a tertiary teaching hospital in northern Spain. We studied 1602 hospitalizations of surgical patients from 2008 to 2010. We analysed 40 comorbidity variables included in the National Surgical Quality Improvement (NSQIP) Program of the American College of Surgeons using 2 sources of information: The clinical and administrative database (CADB) and the data extracted from the complete clinical records (CR), which was considered the gold standard. Variables were catalogued according to compliance with the established criteria: sensitivity, positive predictive value and kappa coefficient >0.6. The average number of comorbidities per study participant was 1.6 using the CR and 0.95 based on CADB (p<.0001). Thirteen types of comorbidities (accounting for 8% of the comorbidities detected in the CR) were not identified when the CADB was the source of information. Five of the 27 remaining comorbidities complied with the 3 established criteria; 2 pathologies fulfilled 2 criteria, whereas 11 fulfilled 1, and 9 did not fulfil any criterion. CADB detected prevalent comorbidities such as comorbid hypertension and diabetes. However, the CABD did not provide enough information to assess the variables needed to perform the risk adjustment proposed by the NSQIP for the assessment of adverse events in surgical patients. Copyright © 2015. Publicado por Elsevier España, S.L.U.

  12. Behavioural adjustment in response to increased predation risk: a study in three duck species.

    Directory of Open Access Journals (Sweden)

    Cédric Zimmer

    Full Text Available Predation directly triggers behavioural decisions designed to increase immediate survival. However, these behavioural modifications can have long term costs. There is therefore a trade-off between antipredator behaviours and other activities. This trade-off is generally considered between vigilance and only one other behaviour, thus neglecting potential compensations. In this study, we considered the effect of an increase in predation risk on the diurnal time-budget of three captive duck species during the wintering period. We artificially increased predation risk by disturbing two groups of 14 mallard and teals at different frequencies, and one group of 14 tufted ducks with a radio-controlled stressor. We recorded foraging, vigilance, preening and sleeping durations the week before, during and after disturbance sessions. Disturbed groups were compared to an undisturbed control group. We showed that in all three species, the increase in predation risk resulted in a decrease in foraging and preening and led to an increase in sleeping. It is worth noting that contrary to common observations, vigilance did not increase. However, ducks are known to be vigilant while sleeping. This complex behavioural adjustment therefore seems to be optimal as it may allow ducks to reduce their predation risk. Our results highlight the fact that it is necessary to encompass the whole individual time-budget when studying behavioural modifications under predation risk. Finally, we propose that studies of behavioural time-budget changes under predation risk should be included in the more general framework of the starvation-predation risk trade-off.

  13. Direct risk standardisation: a new method for comparing casemix adjusted event rates using complex models.

    Science.gov (United States)

    Nicholl, Jon; Jacques, Richard M; Campbell, Michael J

    2013-10-29

    Comparison of outcomes between populations or centres may be confounded by any casemix differences and standardisation is carried out to avoid this. However, when the casemix adjustment models are large and complex, direct standardisation has been described as "practically impossible", and indirect standardisation may lead to unfair comparisons. We propose a new method of directly standardising for risk rather than standardising for casemix which overcomes these problems. Using a casemix model which is the same model as would be used in indirect standardisation, the risk in individuals is estimated. Risk categories are defined, and event rates in each category for each centre to be compared are calculated. A weighted sum of the risk category specific event rates is then calculated. We have illustrated this method using data on 6 million admissions to 146 hospitals in England in 2007/8 and an existing model with over 5000 casemix combinations, and a second dataset of 18,668 adult emergency admissions to 9 centres in the UK and overseas and a published model with over 20,000 casemix combinations and a continuous covariate. Substantial differences between conventional directly casemix standardised rates and rates from direct risk standardisation (DRS) were found. Results based on DRS were very similar to Standardised Mortality Ratios (SMRs) obtained from indirect standardisation, with similar standard errors. Direct risk standardisation using our proposed method is as straightforward as using conventional direct or indirect standardisation, always enables fair comparisons of performance to be made, can use continuous casemix covariates, and was found in our examples to have similar standard errors to the SMR. It should be preferred when there is a risk that conventional direct or indirect standardisation will lead to unfair comparisons.

  14. Risk adjustment methods for Home Care Quality Indicators (HCQIs based on the minimum data set for home care

    Directory of Open Access Journals (Sweden)

    Hirdes John P

    2005-01-01

    Full Text Available Abstract Background There has been increasing interest in enhancing accountability in health care. As such, several methods have been developed to compare the quality of home care services. These comparisons can be problematic if client populations vary across providers and no adjustment is made to account for these differences. The current paper explores the effects of risk adjustment for a set of home care quality indicators (HCQIs based on the Minimum Data Set for Home Care (MDS-HC. Methods A total of 22 home care providers in Ontario and the Winnipeg Regional Health Authority (WRHA in Manitoba, Canada, gathered data on their clients using the MDS-HC. These assessment data were used to generate HCQIs for each agency and for the two regions. Three types of risk adjustment methods were contrasted: a client covariates only; b client covariates plus an "Agency Intake Profile" (AIP to adjust for ascertainment and selection bias by the agency; and c client covariates plus the intake Case Mix Index (CMI. Results The mean age and gender distribution in the two populations was very similar. Across the 19 risk-adjusted HCQIs, Ontario CCACs had a significantly higher AIP adjustment value for eight HCQIs, indicating a greater propensity to trigger on these quality issues on admission. On average, Ontario had unadjusted rates that were 0.3% higher than the WRHA. Following risk adjustment with the AIP covariate, Ontario rates were, on average, 1.5% lower than the WRHA. In the WRHA, individual agencies were likely to experience a decline in their standing, whereby they were more likely to be ranked among the worst performers following risk adjustment. The opposite was true for sites in Ontario. Conclusions Risk adjustment is essential when comparing quality of care across providers when home care agencies provide services to populations with different characteristics. While such adjustment had a relatively small effect for the two regions, it did

  15. Risk adjustment methods for Home Care Quality Indicators (HCQIs) based on the minimum data set for home care

    Science.gov (United States)

    Dalby, Dawn M; Hirdes, John P; Fries, Brant E

    2005-01-01

    Background There has been increasing interest in enhancing accountability in health care. As such, several methods have been developed to compare the quality of home care services. These comparisons can be problematic if client populations vary across providers and no adjustment is made to account for these differences. The current paper explores the effects of risk adjustment for a set of home care quality indicators (HCQIs) based on the Minimum Data Set for Home Care (MDS-HC). Methods A total of 22 home care providers in Ontario and the Winnipeg Regional Health Authority (WRHA) in Manitoba, Canada, gathered data on their clients using the MDS-HC. These assessment data were used to generate HCQIs for each agency and for the two regions. Three types of risk adjustment methods were contrasted: a) client covariates only; b) client covariates plus an "Agency Intake Profile" (AIP) to adjust for ascertainment and selection bias by the agency; and c) client covariates plus the intake Case Mix Index (CMI). Results The mean age and gender distribution in the two populations was very similar. Across the 19 risk-adjusted HCQIs, Ontario CCACs had a significantly higher AIP adjustment value for eight HCQIs, indicating a greater propensity to trigger on these quality issues on admission. On average, Ontario had unadjusted rates that were 0.3% higher than the WRHA. Following risk adjustment with the AIP covariate, Ontario rates were, on average, 1.5% lower than the WRHA. In the WRHA, individual agencies were likely to experience a decline in their standing, whereby they were more likely to be ranked among the worst performers following risk adjustment. The opposite was true for sites in Ontario. Conclusions Risk adjustment is essential when comparing quality of care across providers when home care agencies provide services to populations with different characteristics. While such adjustment had a relatively small effect for the two regions, it did substantially affect the

  16. Psychosocial Adjustment and Sibling Relationships in Siblings of Children with Autism Spectrum Disorder: Risk and Protective Factors

    Science.gov (United States)

    Walton, Katherine M.; Ingersoll, Brooke R.

    2015-01-01

    This study compared sibling adjustment and relationships in siblings of children with Autism Spectrum Disorder (ASD-Sibs; n = 69) and siblings of children with typical development (TD-Sibs; n = 93). ASD-Sibs and TD-Sibs demonstrated similar emotional/behavioral adjustment. Older male ASD-Sibs were at increased risk for difficulties. Sibling…

  17. Impact of Race/Ethnicity and Socioeconomic Status on Risk-Adjusted Hospital Readmission Rates Following Hip and Knee Arthroplasty.

    Science.gov (United States)

    Martsolf, Grant R; Barrett, Marguerite L; Weiss, Audrey J; Kandrack, Ryan; Washington, Raynard; Steiner, Claudia A; Mehrotra, Ateev; SooHoo, Nelson F; Coffey, Rosanna

    2016-08-17

    Readmission rates following total hip arthroplasty (THA) and total knee arthroplasty (TKA) are increasingly used to measure hospital performance. Readmission rates that are not adjusted for race/ethnicity and socioeconomic status, patient risk factors beyond a hospital's control, may not accurately reflect a hospital's performance. In this study, we examined the extent to which risk-adjusting for race/ethnicity and socioeconomic status affected hospital performance in terms of readmission rates following THA and TKA. We calculated 2 sets of risk-adjusted readmission rates by (1) using the Centers for Medicare & Medicaid Services standard risk-adjustment algorithm that incorporates patient age, sex, comorbidities, and hospital effects and (2) adding race/ethnicity and socioeconomic status to the model. Using data from the Healthcare Cost and Utilization Project, 2011 State Inpatient Databases, we compared the relative performances of 1,194 hospitals across the 2 methods. Addition of race/ethnicity and socioeconomic status to the risk-adjustment algorithm resulted in (1) little or no change in the risk-adjusted readmission rates at nearly all hospitals; (2) no change in the designation of the readmission rate as better, worse, or not different from the population mean at >99% of the hospitals; and (3) no change in the excess readmission ratio at >97% of the hospitals. Inclusion of race/ethnicity and socioeconomic status in the risk-adjustment algorithm led to a relative-performance change in readmission rates following THA and TKA at socioeconomic status in risk-adjusted THA and TKA readmission rates used for hospital accountability, payment, and public reporting. Prognostic Level III. See instructions for Authors for a complete description of levels of evidence. Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.

  18. Improving Risk Adjustment for Mortality After Pediatric Cardiac Surgery: The UK PRAiS2 Model.

    Science.gov (United States)

    Rogers, Libby; Brown, Katherine L; Franklin, Rodney C; Ambler, Gareth; Anderson, David; Barron, David J; Crowe, Sonya; English, Kate; Stickley, John; Tibby, Shane; Tsang, Victor; Utley, Martin; Witter, Thomas; Pagel, Christina

    2017-07-01

    Partial Risk Adjustment in Surgery (PRAiS), a risk model for 30-day mortality after children's heart surgery, has been used by the UK National Congenital Heart Disease Audit to report expected risk-adjusted survival since 2013. This study aimed to improve the model by incorporating additional comorbidity and diagnostic information. The model development dataset was all procedures performed between 2009 and 2014 in all UK and Ireland congenital cardiac centers. The outcome measure was death within each 30-day surgical episode. Model development followed an iterative process of clinical discussion and development and assessment of models using logistic regression under 25 × 5 cross-validation. Performance was measured using Akaike information criterion, the area under the receiver-operating characteristic curve (AUC), and calibration. The final model was assessed in an external 2014 to 2015 validation dataset. The development dataset comprised 21,838 30-day surgical episodes, with 539 deaths (mortality, 2.5%). The validation dataset comprised 4,207 episodes, with 97 deaths (mortality, 2.3%). The updated risk model included 15 procedural, 11 diagnostic, and 4 comorbidity groupings, and nonlinear functions of age and weight. Performance under cross-validation was: median AUC of 0.83 (range, 0.82 to 0.83), median calibration slope and intercept of 0.92 (range, 0.64 to 1.25) and -0.23 (range, -1.08 to 0.85) respectively. In the validation dataset, the AUC was 0.86 (95% confidence interval [CI], 0.82 to 0.89), and the calibration slope and intercept were 1.01 (95% CI, 0.83 to 1.18) and 0.11 (95% CI, -0.45 to 0.67), respectively, showing excellent performance. A more sophisticated PRAiS2 risk model for UK use was developed with additional comorbidity and diagnostic information, alongside age and weight as nonlinear variables. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  19. Development and Evaluation of an Automated Machine Learning Algorithm for In-Hospital Mortality Risk Adjustment Among Critical Care Patients.

    Science.gov (United States)

    Delahanty, Ryan J; Kaufman, David; Jones, Spencer S

    2018-06-01

    Risk adjustment algorithms for ICU mortality are necessary for measuring and improving ICU performance. Existing risk adjustment algorithms are not widely adopted. Key barriers to adoption include licensing and implementation costs as well as labor costs associated with human-intensive data collection. Widespread adoption of electronic health records makes automated risk adjustment feasible. Using modern machine learning methods and open source tools, we developed and evaluated a retrospective risk adjustment algorithm for in-hospital mortality among ICU patients. The Risk of Inpatient Death score can be fully automated and is reliant upon data elements that are generated in the course of usual hospital processes. One hundred thirty-one ICUs in 53 hospitals operated by Tenet Healthcare. A cohort of 237,173 ICU patients discharged between January 2014 and December 2016. The data were randomly split into training (36 hospitals), and validation (17 hospitals) data sets. Feature selection and model training were carried out using the training set while the discrimination, calibration, and accuracy of the model were assessed in the validation data set. Model discrimination was evaluated based on the area under receiver operating characteristic curve; accuracy and calibration were assessed via adjusted Brier scores and visual analysis of calibration curves. Seventeen features, including a mix of clinical and administrative data elements, were retained in the final model. The Risk of Inpatient Death score demonstrated excellent discrimination (area under receiver operating characteristic curve = 0.94) and calibration (adjusted Brier score = 52.8%) in the validation dataset; these results compare favorably to the published performance statistics for the most commonly used mortality risk adjustment algorithms. Low adoption of ICU mortality risk adjustment algorithms impedes progress toward increasing the value of the healthcare delivered in ICUs. The Risk of Inpatient Death

  20. Disease-Specific Trends of Comorbidity Coding and Implications for Risk Adjustment in Hospital Administrative Data.

    Science.gov (United States)

    Nimptsch, Ulrike

    2016-06-01

    To investigate changes in comorbidity coding after the introduction of diagnosis related groups (DRGs) based prospective payment and whether trends differ regarding specific comorbidities. Nationwide administrative data (DRG statistics) from German acute care hospitals from 2005 to 2012. Observational study to analyze trends in comorbidity coding in patients hospitalized for common primary diseases and the effects on comorbidity-related risk of in-hospital death. Comorbidity coding was operationalized by Elixhauser diagnosis groups. The analyses focused on adult patients hospitalized for the primary diseases of heart failure, stroke, and pneumonia, as well as hip fracture. When focusing the total frequency of diagnosis groups per record, an increase in depth of coding was observed. Between-hospital variations in depth of coding were present throughout the observation period. Specific comorbidity increases were observed in 15 of the 31 diagnosis groups, and decreases in comorbidity were observed for 11 groups. In patients hospitalized for heart failure, shifts of comorbidity-related risk of in-hospital death occurred in nine diagnosis groups, in which eight groups were directed toward the null. Comorbidity-adjusted outcomes in longitudinal administrative data analyses may be biased by nonconstant risk over time, changes in completeness of coding, and between-hospital variations in coding. Accounting for such issues is important when the respective observation period coincides with changes in the reimbursement system or other conditions that are likely to alter clinical coding practice. © Health Research and Educational Trust.

  1. Desirability of Outcome Ranking (DOOR) and Response Adjusted for Duration of Antibiotic Risk (RADAR).

    Science.gov (United States)

    Evans, Scott R; Rubin, Daniel; Follmann, Dean; Pennello, Gene; Huskins, W Charles; Powers, John H; Schoenfeld, David; Chuang-Stein, Christy; Cosgrove, Sara E; Fowler, Vance G; Lautenbach, Ebbing; Chambers, Henry F

    2015-09-01

    Clinical trials that compare strategies to optimize antibiotic use are of critical importance but are limited by competing risks that distort outcome interpretation, complexities of noninferiority trials, large sample sizes, and inadequate evaluation of benefits and harms at the patient level. The Antibacterial Resistance Leadership Group strives to overcome these challenges through innovative trial design. Response adjusted for duration of antibiotic risk (RADAR) is a novel methodology utilizing a superiority design and a 2-step process: (1) categorizing patients into an overall clinical outcome (based on benefits and harms), and (2) ranking patients with respect to a desirability of outcome ranking (DOOR). DOORs are constructed by assigning higher ranks to patients with (1) better overall clinical outcomes and (2) shorter durations of antibiotic use for similar overall clinical outcomes. DOOR distributions are compared between antibiotic use strategies. The probability that a randomly selected patient will have a better DOOR if assigned to the new strategy is estimated. DOOR/RADAR represents a new paradigm in assessing the risks and benefits of new strategies to optimize antibiotic use. © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  2. Monitoring risk-adjusted medical outcomes allowing for changes over time.

    Science.gov (United States)

    Steiner, Stefan H; Mackay, R Jock

    2014-10-01

    We consider the problem of monitoring and comparing medical outcomes, such as surgical performance, over time. Performance is subject to change due to a variety of reasons including patient heterogeneity, learning, deteriorating skills due to aging, etc. For instance, we expect inexperienced surgeons to improve their skills with practice. We propose a graphical method to monitor surgical performance that incorporates risk adjustment to account for patient heterogeneity. The procedure gives more weight to recent outcomes and down-weights the influence of outcomes further in the past. The chart is clinically interpretable as it plots an estimate of the failure rate for a "standard" patient. The chart also includes a measure of uncertainty in this estimate. We can implement the method using historical data or start from scratch. As the monitoring proceeds, we can base the estimated failure rate on a known risk model or use the observed outcomes to update the risk model as time passes. We illustrate the proposed method with an example from cardiac surgery. © The Author 2013. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  3. Profile of congenital heart disease and correlation to risk adjustment for surgery; an echocardiographic study

    International Nuclear Information System (INIS)

    Akhtar, K.; Ahmed, W.

    2008-01-01

    To determine the pattern and profile of Congenital Heart Diseases (CHD) in paediatric patients (age 1 day to 18 years) presenting to a paediatric tertiary referral centre and its correlation to risk adjustment for surgery for congenital heart disease. Over a period of 6 months, 1149 cases underwent 2-D echocardiography. It was a non-probability purposive sampling. This study showed 25% of all referrals had normal hearts. A male preponderance (38%) was observed from 1 year to 5 years age group. Nineteen percent of the cases were categorized as cyanotic CHD with the remaining as acyanotic variety. Tetralogy of Fallot (TOF) represented 10%, Ventricular Septal Defects (VSD) 24%, followed by Patent Ductus Arteriosus (PDA) and Atrial Septal Defect (ASD), which comprised 6.6% and 6.5% respectively. VSD was the most common association in patients with more complex CHD (10%) followed by PDA in 3% and ASD in 1.2% of the cases. Most of the cases were category 2 in the RACHS-1 scoring system. VSD and TOF formed the major groups of cases profiled. Most of the cases recommended for surgery for congenital heart disease belonged to the risk category 2 (28.1%) followed by the risk category 1 (12.7%) of the RACHS-1 scoring system. (author)

  4. Risk adjusted surgical audit in gynaecological oncology: P-POSSUM does not predict outcome.

    Science.gov (United States)

    Das, N; Talaat, A S; Naik, R; Lopes, A D; Godfrey, K A; Hatem, M H; Edmondson, R J

    2006-12-01

    To assess the Physiological and Operative Severity Score for the enumeration of mortality and morbidity (POSSUM) and its validity for use in gynaecological oncology surgery. All patients undergoing gynaecological oncology surgery at the Northern Gynaecological Oncology Centre (NGOC) Gateshead, UK over a period of 12months (2002-2003) were assessed prospectively. Mortality and morbidity predictions using the Portsmouth modification of the POSSUM algorithm (P-POSSUM) were compared to the actual outcomes. Performance of the model was also evaluated using the Hosmer and Lemeshow Chi square statistic (testing the goodness of fit). During this period 468 patients were assessed. The P-POSSUM appeared to over predict mortality rates for our patients. It predicted a 7% mortality rate for our patients compared to an observed rate of 2% (35 predicted deaths in comparison to 10 observed deaths), a difference that was statistically significant (H&L chi(2)=542.9, d.f. 8, prisk of mortality for gynaecological oncology patients undergoing surgery. The P-POSSUM algorithm will require further adjustments prior to adoption for gynaecological cancer surgery as a risk adjusted surgical audit tool.

  5. A Proportional Hazards Regression Model for the Subdistribution with Covariates-adjusted Censoring Weight for Competing Risks Data

    DEFF Research Database (Denmark)

    He, Peng; Eriksson, Frank; Scheike, Thomas H.

    2016-01-01

    function by fitting the Cox model for the censoring distribution and using the predictive probability for each individual. Our simulation study shows that the covariate-adjusted weight estimator is basically unbiased when the censoring time depends on the covariates, and the covariate-adjusted weight......With competing risks data, one often needs to assess the treatment and covariate effects on the cumulative incidence function. Fine and Gray proposed a proportional hazards regression model for the subdistribution of a competing risk with the assumption that the censoring distribution...... and the covariates are independent. Covariate-dependent censoring sometimes occurs in medical studies. In this paper, we study the proportional hazards regression model for the subdistribution of a competing risk with proper adjustments for covariate-dependent censoring. We consider a covariate-adjusted weight...

  6. [Do laymen understand information about hospital quality? An empirical verification using risk-adjusted mortality rates as an example].

    Science.gov (United States)

    Sander, Uwe; Kolb, Benjamin; Taheri, Fatemeh; Patzelt, Christiane; Emmert, Martin

    2017-11-01

    The effect of public reporting to improve quality in healthcare is reduced by the limited intelligibility of information about the quality of healthcare providers. This may result in worse health-related choices especially for older people and those with lower levels of education. There is, as yet, little information as to whether laymen understand the concepts behind quality comparisons and if this comprehension is correlated with hospital choices. An instrument with 20 items was developed to analyze the intelligibility of five technical terms which were used in German hospital report cards to explain risk-adjusted death rates. Two online presentations of risk-adjusted death rates for five hospitals in the style of hospital report cards were developed. An online survey of 353 volunteers tested the comprehension of the risk-adjusted mortality rates and included an experimental hospital choice. The intelligibility of five technical terms was tested: risk-adjusted, actual and expected death rate, reference range and national average. The percentages of correct answers for the five technical terms were in the range of 75.0-60.2%. Between 23.8% and 5.1% of the respondents were not able to answer the question about the technical term itself. The least comprehensible technical terms were "risk-adjusted death rate" and "reference range". The intelligibility of the 20 items that were used to test the comprehension of the risk-adjusted mortality was between 89.5% and 14.2%. The two items that proved to be least comprehensible were related to the technical terms "risk-adjusted death rate" and "reference range". For all five technical terms it was found that a better comprehension correlated significantly with better hospital choices. We found a better than average intelligibility for the technical terms "actual and expected death rate" and for "national average". The least understandable were "risk-adjusted death rate" and "reference range". Since the self

  7. Risk-adjusted capitation funding models for chronic disease in Australia: alternatives to casemix funding.

    Science.gov (United States)

    Antioch, K M; Walsh, M K

    2002-01-01

    Under Australian casemix funding arrangements that use Diagnosis-Related Groups (DRGs) the average price is policy based, not benchmarked. Cost weights are too low for State-wide chronic disease services. Risk-adjusted Capitation Funding Models (RACFM) are feasible alternatives. A RACFM was developed for public patients with cystic fibrosis treated by an Australian Health Maintenance Organization (AHMO). Adverse selection is of limited concern since patients pay solidarity contributions via Medicare levy with no premium contributions to the AHMO. Sponsors paying premium subsidies are the State of Victoria and the Federal Government. Cost per patient is the dependent variable in the multiple regression. Data on DRG 173 (cystic fibrosis) patients were assessed for heteroskedasticity, multicollinearity, structural stability and functional form. Stepwise linear regression excluded non-significant variables. Significant variables were 'emergency' (1276.9), 'outlier' (6377.1), 'complexity' (3043.5), 'procedures' (317.4) and the constant (4492.7) (R(2)=0.21, SE=3598.3, F=14.39, Probpayment (constant). The model explained 21% of the variance in cost per patient. The payment rate is adjusted by a best practice annual admission rate per patient. The model is a blended RACFM for in-patient, out-patient, Hospital In The Home, Fee-For-Service Federal payments for drugs and medical services; lump sum lung transplant payments and risk sharing through cost (loss) outlier payments. State and Federally funded home and palliative services are 'carved out'. The model, which has national application via Coordinated Care Trials and by Australian States for RACFMs may be instructive for Germany, which plans to use Australian DRGs for casemix funding. The capitation alternative for chronic disease can improve equity, allocative efficiency and distributional justice. The use of Diagnostic Cost Groups (DCGs) is a promising alternative classification system for capitation arrangements.

  8. Premorbid adjustment in individuals at ultra-high risk for developing psychosis

    DEFF Research Database (Denmark)

    Dannevang, Anders; Randers, Lasse; Gondan, Matthias

    2017-01-01

    between childhood and early adolescence. The UHR individuals had more premorbid adjustment difficulties on both the social and academic scale, and on the individual PAS scales. Conclusion: From childhood UHR individuals have lower levels of social and academic premorbid adjustment compared to healthy...... and academic scales were computed. Results: Compared to the healthy controls the UHR individuals’ social and academic premorbid adjustment declined across age periods. Social premorbid adjustment declined particularly between late adolescence and adulthood. Academic premorbid adjustment declined particularly...

  9. The risk-adjusted vision beyond casemix (DRG) funding in Australia. International lessons in high complexity and capitation.

    Science.gov (United States)

    Antioch, Kathryn M; Walsh, Michael K

    2004-06-01

    Hospitals throughout the world using funding based on diagnosis-related groups (DRG) have incurred substantial budgetary deficits, despite high efficiency. We identify the limitations of DRG funding that lack risk (severity) adjustment for State-wide referral services. Methods to risk adjust DRGs are instructive. The average price in casemix funding in the Australian State of Victoria is policy based, not benchmarked. Average cost weights are too low for high-complexity DRGs relating to State-wide referral services such as heart and lung transplantation and trauma. Risk-adjusted specified grants (RASG) are required for five high-complexity respiratory, cardiology and stroke DRGs incurring annual deficits of $3.6 million due to high casemix complexity and government under-funding despite high efficiency. Five stepwise linear regressions for each DRG excluded non-significant variables and assessed heteroskedasticity and multicollinearlity. Cost per patient was the dependent variable. Significant independent variables were age, length-of-stay outliers, number of disease types, diagnoses, procedures and emergency status. Diagnosis and procedure severity markers were identified. The methodology and the work of the State-wide Risk Adjustment Working Group can facilitate risk adjustment of DRGs State-wide and for Treasury negotiations for expenditure growth. The Alfred Hospital previously negotiated RASG of $14 million over 5 years for three trauma and chronic DRGs. Some chronic diseases require risk-adjusted capitation funding models for Australian Health Maintenance Organizations as an alternative to casemix funding. The use of Diagnostic Cost Groups can facilitate State and Federal government reform via new population-based risk adjusted funding models that measure health need.

  10. Risk and Protective Factors at Age 16: Psychological Adjustment in Children With a Cleft Lip and/or Palate.

    Science.gov (United States)

    Feragen, Kristin Billaud; Stock, Nicola Marie; Kvalem, Ingela Lundin

    2015-09-01

    Explore psychological functioning in adolescents with a cleft at age 16 from a broad perspective, including cognitive, emotional, behavioral, appearance-related, and psychosocial adjustment. High-risk groups were identified within each area of adjustment to investigate whether vulnerable adolescents were found across domains or whether risk was limited to specific areas of adjustment. Cross-sectional data based on psychological assessments at age 16 (N = 857). The effect of gender, cleft visibility, and the presence of an additional condition were investigated on all outcome variables. Results were compared with large national samples. Hopkins Symptom Checklist, Harter Self-Perception Scale for Adolescents, Child Experience Questionnaire, and Satisfaction With Appearance scale. The main factor influencing psychological adjustment across domains was gender, with girls in general reporting more psychological problems, as seen in reference groups. The presence of an additional condition also negatively affected some of the measures. No support was found for cleft visibility as a risk factor except for dissatisfaction with appearance. Correlation analyses of risk groups seem to point to an association between social and emotional risk and between social risk and dissatisfaction with appearance. Associations between other domains were found to be weak. The results point to areas of both risk and strength in adolescents born with a cleft lip and/or palate. Future research should investigate how protective factors could counteract potential risk in adolescents with a cleft.

  11. Adjustment of lifetime risks of space radiation-induced cancer by the healthy worker effect and cancer misclassification

    Directory of Open Access Journals (Sweden)

    Leif E. Peterson

    2015-12-01

    Conclusions. The typical life table approach for projecting lifetime risk of radiation-induced cancer mortality and incidence for astronauts and radiation workers can be improved by adjusting for HWE while simulating the uncertainty of input rates, input excess risk coefficients, and bias correction factors during multiple Monte Carlo realizations of the life table.

  12. A risk-adjusted O-E CUSUM with monitoring bands for monitoring medical outcomes.

    Science.gov (United States)

    Sun, Rena Jie; Kalbfleisch, John D

    2013-03-01

    In order to monitor a medical center's survival outcomes using simple plots, we introduce a risk-adjusted Observed-Expected (O-E) Cumulative SUM (CUSUM) along with monitoring bands as decision criterion.The proposed monitoring bands can be used in place of a more traditional but complicated V-shaped mask or the simultaneous use of two one-sided CUSUMs. The resulting plot is designed to simultaneously monitor for failure time outcomes that are "worse than expected" or "better than expected." The slopes of the O-E CUSUM provide direct estimates of the relative risk (as compared to a standard or expected failure rate) for the data being monitored. Appropriate rejection regions are obtained by controlling the false alarm rate (type I error) over a period of given length. Simulation studies are conducted to illustrate the performance of the proposed method. A case study is carried out for 58 liver transplant centers. The use of CUSUM methods for quality improvement is stressed. Copyright © 2013, The International Biometric Society.

  13. Population-Adjusted Street Connectivity, Urbanicity and Risk of Obesity in the U.S

    Science.gov (United States)

    Wang, Fahui; Wen, Ming; Xu, Yanqing

    2013-01-01

    Street connectivity, defined as the number of (3-way or more) intersections per area unit, is an important index of built environments as a proxy for walkability in a neighborhood. This paper examines its geographic variations across the rural-urban continuum (urbanicity), major racial-ethnic groups and various poverty levels. The population-adjusted street connectivity index is proposed as a better measure than the regular index for a large area such as county due to likely concentration of population in limited space within the large area. Based on the data from the Behavioral Risk Factor Surveillance System (BRFSS), this paper uses multilevel modeling to analyze its association with physical activity and obesity while controlling for various individual and county-level variables. Analysis of data subsets indicates that the influences of individual and county-level variables on obesity risk vary across areas of different urbanization levels. The positive influence of street connectivity on obesity control is limited to the more but not the mostly urbanized areas. This demonstrates the value of obesogenic environment research in different geographic settings, helps us reconcile and synthesize some seemingly contradictory results reported in different studies, and also promotes that effective policies need to be highly sensitive to the diversity of demographic groups and geographically adaptable. PMID:23667278

  14. A STUDY ON THE RISK-ADJUSTED PERFORMANCE OF MUTUAL FUNDS INDUSTRY IN INDIA

    Directory of Open Access Journals (Sweden)

    Shivangi Agarwal

    2017-04-01

    Full Text Available Investing through mutual funds has gained interest in recent years as it offers optimal risk adjusted returns to investors. The Indian market is no exception and has witnessed a multifold growth in mutual funds over the years. As of 2016, the Indian market is crowded with over two thousand mutual fund schemes, each promising higher returns compared to their peers. This comes as a challenge for an ordinary investor to select the best portfolio to invest making it critical to analyse the performance of these funds. While understanding and analysing the historical performance of mutual funds do not guarantee future performance, however, this may give an idea of how the fund is likely to perform in different market conditions. In this research we address multiple research issues. These include measuring the performance of selected mutual schemes on the basis of risk and return and compare the performance of these selected schemes with benchmark index to see whether the scheme is outperforming or underperforming the benchmark. We also rank funds on the basis of performance and suggest strategies to invest in a mutual fund and therefore, our findings have significant relevance for investing public.

  15. Risk-Adjusted Analysis of Relevant Outcome Drivers for Patients after More Than Two Kidney Transplants

    Directory of Open Access Journals (Sweden)

    Lampros Kousoulas

    2015-01-01

    Full Text Available Renal transplantation is the treatment of choice for patients suffering end-stage renal disease, but as the long-term renal allograft survival is limited, most transplant recipients will face graft loss and will be considered for a retransplantation. The goal of this study was to evaluate the patient and graft survival of the 61 renal transplant recipients after second or subsequent renal transplantation, transplanted in our institution between 1990 and 2010, and to identify risk factors related to inferior outcomes. Actuarial patient survival was 98.3%, 94.8%, and 88.2% after one, three, and five years, respectively. Actuarial graft survival was 86.8%, 80%, and 78.1% after one, three, and five years, respectively. Risk-adjusted analysis revealed that only age at the time of last transplantation had a significant influence on patient survival, whereas graft survival was influenced by multiple immunological and surgical factors, such as the number of HLA mismatches, the type of immunosuppression, the number of surgical complications, need of reoperation, primary graft nonfunction, and acute rejection episodes. In conclusion, third and subsequent renal transplantation constitute a valid therapeutic option, but inferior outcomes should be expected among elderly patients, hyperimmunized recipients, and recipients with multiple operations at the site of last renal transplantation.

  16. Relevance of the c-statistic when evaluating risk-adjustment models in surgery.

    Science.gov (United States)

    Merkow, Ryan P; Hall, Bruce L; Cohen, Mark E; Dimick, Justin B; Wang, Edward; Chow, Warren B; Ko, Clifford Y; Bilimoria, Karl Y

    2012-05-01

    The measurement of hospital quality based on outcomes requires risk adjustment. The c-statistic is a popular tool used to judge model performance, but can be limited, particularly when evaluating specific operations in focused populations. Our objectives were to examine the interpretation and relevance of the c-statistic when used in models with increasingly similar case mix and to consider an alternative perspective on model calibration based on a graphical depiction of model fit. From the American College of Surgeons National Surgical Quality Improvement Program (2008-2009), patients were identified who underwent a general surgery procedure, and procedure groups were increasingly restricted: colorectal-all, colorectal-elective cases only, and colorectal-elective cancer cases only. Mortality and serious morbidity outcomes were evaluated using logistic regression-based risk adjustment, and model c-statistics and calibration curves were used to compare model performance. During the study period, 323,427 general, 47,605 colorectal-all, 39,860 colorectal-elective, and 21,680 colorectal cancer patients were studied. Mortality ranged from 1.0% in general surgery to 4.1% in the colorectal-all group, and serious morbidity ranged from 3.9% in general surgery to 12.4% in the colorectal-all procedural group. As case mix was restricted, c-statistics progressively declined from the general to the colorectal cancer surgery cohorts for both mortality and serious morbidity (mortality: 0.949 to 0.866; serious morbidity: 0.861 to 0.668). Calibration was evaluated graphically by examining predicted vs observed number of events over risk deciles. For both mortality and serious morbidity, there was no qualitative difference in calibration identified between the procedure groups. In the present study, we demonstrate how the c-statistic can become less informative and, in certain circumstances, can lead to incorrect model-based conclusions, as case mix is restricted and patients become

  17. Quality measurement in the shunt treatment of hydrocephalus: analysis and risk adjustment of the Revision Quotient.

    Science.gov (United States)

    Piatt, Joseph H; Freibott, Christina E

    2014-07-01

    OBJECT.: The Revision Quotient (RQ) has been defined as the ratio of the number of CSF shunt revisions to the number of new shunt insertions for a particular neurosurgical practice in a unit of time. The RQ has been proposed as a quality measure in the treatment of childhood hydrocephalus. The authors examined the construct validity of the RQ and explored the feasibility of risk stratification under this metric. The Kids' Inpatient Database for 1997, 2000, 2003, 2006, and 2009 was queried for admissions with diagnostic codes for hydrocephalus and procedural codes for CSF shunt insertion or revision. Revision quotients were calculated for hospitals that performed 12 or more shunt insertions annually. The univariate associations of hospital RQs with a variety of institutional descriptors were analyzed, and a generalized linear model of the RQ was constructed. There were 12,244 admissions (34%) during which new shunts were inserted, and there were 23,349 admissions (66%) for shunt revision. Three hundred thirty-four annual RQs were calculated for 152 different hospitals. Analysis of variance in hospital RQs over the 5 years of study data supports the construct validity of the metric. The following factors were incorporated into a generalized linear model that accounted for 41% of the variance of the measured RQs: degree of pediatric specialization, proportion of initial case mix in the infant age group, and proportion with neoplastic hydrocephalus. The RQ has construct validity. Risk adjustment is feasible, but the risk factors that were identified relate predominantly to patterns of patient flow through the health care system. Possible advantages of an alternative metric, the Surgical Activity Ratio, are discussed.

  18. Public Reporting of Primary Care Clinic Quality: Accounting for Sociodemographic Factors in Risk Adjustment and Performance Comparison.

    Science.gov (United States)

    Wholey, Douglas R; Finch, Michael; Kreiger, Rob; Reeves, David

    2018-01-03

    Performance measurement and public reporting are increasingly being used to compare clinic performance. Intended consequences include quality improvement, value-based payment, and consumer choice. Unintended consequences include reducing access for riskier patients and inappropriately labeling some clinics as poor performers, resulting in tampering with stable care processes. Two analytic steps are used to maximize intended and minimize unintended consequences. First, risk adjustment is used to reduce the impact of factors outside providers' control. Second, performance categorization is used to compare clinic performance using risk-adjusted measures. This paper examines the effects of methodological choices, such as risk adjusting for sociodemographic factors in risk adjustment and accounting for patients clustering by clinics in performance categorization, on clinic performance comparison for diabetes care, vascular care, asthma, and colorectal cancer screening. The population includes all patients with commercial and public insurance served by clinics in Minnesota. Although risk adjusting for sociodemographic factors has a significant effect on quality, it does not explain much of the variation in quality. In contrast, taking into account the nesting of patients within clinics in performance categorization has a substantial effect on performance comparison.

  19. Process monitoring in intensive care with the use of cumulative expected minus observed mortality and risk-adjusted P charts.

    Science.gov (United States)

    Cockings, Jerome G L; Cook, David A; Iqbal, Rehana K

    2006-02-01

    A health care system is a complex adaptive system. The effect of a single intervention, incorporated into a complex clinical environment, may be different from that expected. A national database such as the Intensive Care National Audit & Research Centre (ICNARC) Case Mix Programme in the UK represents a centralised monitoring, surveillance and reporting system for retrospective quality and comparative audit. This can be supplemented with real-time process monitoring at a local level for continuous process improvement, allowing early detection of the impact of both unplanned and deliberately imposed changes in the clinical environment. Demographic and UK Acute Physiology and Chronic Health Evaluation II (APACHE II) data were prospectively collected on all patients admitted to a UK regional hospital between 1 January 2003 and 30 June 2004 in accordance with the ICNARC Case Mix Programme. We present a cumulative expected minus observed (E-O) plot and the risk-adjusted p chart as methods of continuous process monitoring. We describe the construction and interpretation of these charts and show how they can be used to detect planned or unplanned organisational process changes affecting mortality outcomes. Five hundred and eighty-nine adult patients were included. The overall death rate was 0.78 of predicted. Calibration showed excess survival in ranges above 30% risk of death. The E-O plot confirmed a survival above that predicted. Small transient variations were seen in the slope that could represent random effects, or real but transient changes in the quality of care. The risk-adjusted p chart showed several observations below the 2 SD control limits of the expected mortality rate. These plots provide rapid analysis of risk-adjusted performance suitable for local application and interpretation. The E-O chart provided rapid easily visible feedback of changes in risk-adjusted mortality, while the risk-adjusted p chart allowed statistical evaluation. Local analysis of

  20. The New York Sepsis Severity Score: Development of a Risk-Adjusted Severity Model for Sepsis.

    Science.gov (United States)

    Phillips, Gary S; Osborn, Tiffany M; Terry, Kathleen M; Gesten, Foster; Levy, Mitchell M; Lemeshow, Stanley

    2018-05-01

    In accordance with Rory's Regulations, hospitals across New York State developed and implemented protocols for sepsis recognition and treatment to reduce variations in evidence informed care and preventable mortality. The New York Department of Health sought to develop a risk assessment model for accurate and standardized hospital mortality comparisons of adult septic patients across institutions using case-mix adjustment. Retrospective evaluation of prospectively collected data. Data from 43,204 severe sepsis and septic shock patients from 179 hospitals across New York State were evaluated. Prospective data were submitted to a database from January 1, 2015, to December 31, 2015. None. Maximum likelihood logistic regression was used to estimate model coefficients used in the New York State risk model. The mortality probability was estimated using a logistic regression model. Variables to be included in the model were determined as part of the model-building process. Interactions between variables were included if they made clinical sense and if their p values were less than 0.05. Model development used a random sample of 90% of available patients and was validated using the remaining 10%. Hosmer-Lemeshow goodness of fit p values were considerably greater than 0.05, suggesting good calibration. Areas under the receiver operator curve in the developmental and validation subsets were 0.770 (95% CI, 0.765-0.775) and 0.773 (95% CI, 0.758-0.787), respectively, indicating good discrimination. Development and validation datasets had similar distributions of estimated mortality probabilities. Mortality increased with rising age, comorbidities, and lactate. The New York Sepsis Severity Score accurately estimated the probability of hospital mortality in severe sepsis and septic shock patients. It performed well with respect to calibration and discrimination. This sepsis-specific model provides an accurate, comprehensive method for standardized mortality comparison of adult

  1. [Risk adjusted assessment of quality of perinatal centers - results of perinatal/neonatal quality surveillance in Saxonia].

    Science.gov (United States)

    Koch, R; Gmyrek, D; Vogtmann, Ch

    2005-12-01

    The weak point of the country-wide perinatal/neonatal quality surveillance as a tool for evaluation of achievements of a distinct clinic, is the ignorance of interhospital differences in the case-mix of patients. Therefore, that approach can not result in a reliable bench marking. To adjust the results of quality assessment of different hospitals according to their risk profile of patients by multivariate analysis. The perinatal/neonatal data base of 12.783 newborns of the saxonian quality surveillance from 1998 to 2000 was analyzed. 4 relevant quality indicators of newborn outcome -- a) severe intraventricular hemorrhage in preterm infants 2500 g and d) hypoxic-ischemic encephalopathy -- were targeted to find out specific risk predictors by considering 26 risk factors. A logistic regression model was used to develop the risk predictors. Risk predictors for the 4 quality indicators could be described by 3 - 9 out of 26 analyzed risk factors. The AUC (ROC)-values for these quality indicators were 82, 89, 89 and 89 %, what signifies their reliability. Using the new specific predictors for calculation the risk adjusted incidence rates of quality indicator yielded in some remarkable changes. The apparent differences in the outcome criteria of analyzed hospitals were found to be much less pronounced. The application of the proposed method for risk adjustment of quality indicators makes it possible to perform a more objective comparison of neonatal outcome criteria between different hospitals or regions.

  2. A Comparative Study of CAPM and Seven Factors Risk Adjusted Return Model

    Directory of Open Access Journals (Sweden)

    Madiha Riaz Bhatti

    2014-12-01

    Full Text Available This study is a comparison and contrast of the predictive powers of two asset pricing models: CAPM and seven factor risk-return adjusted model, to explain the cross section of stock rate of returns in the financial sector listed at Karachi Stock Exchange (KSE. To test the models daily returns from January 2013 to February 2014 have been taken and the excess returns of portfolios are regressed on explanatory variables. The results of the tested models indicate that the models are valid and applicable in the financial market of Pakistan during the period under study, as the intercepts are not significantly different from zero. It is consequently established from the findings that all the explanatory variables explain the stock returns in the financial sector of KSE. In addition, the results of this study show that addition of more explanatory variables to the single factor CAPM results in reasonably high values of R2. These results provide substantial support to fund managers, investors and financial analysts in making investment decisions.

  3. Balancing the risks and benefits of drinking water disinfection: disability adjusted life-years on the scale.

    OpenAIRE

    Havelaar, A H; De Hollander, A E; Teunis, P F; Evers, E G; Van Kranen, H J; Versteegh, J F; Van Koten, J E; Slob, W

    2000-01-01

    To evaluate the applicability of disability adjusted life-years (DALYs) as a measure to compare positive and negative health effects of drinking water disinfection, we conducted a case study involving a hypothetical drinking water supply from surface water. This drinking water supply is typical in The Netherlands. We compared the reduction of the risk of infection with Cryptosporidium parvum by ozonation of water to the concomitant increase in risk of renal cell cancer arising from the produc...

  4. Case‐mix adjustment in non‐randomised observational evaluations: the constant risk fallacy

    OpenAIRE

    Nicholl, Jon

    2007-01-01

    Observational studies comparing groups or populations to evaluate services or interventions usually require case‐mix adjustment to account for imbalances between the groups being compared. Simulation studies have, however, shown that case‐mix adjustment can make any bias worse.

  5. Measuring Risk-adjusted Customer Lifetime Value and its Impact on Relationship Marketing Strategies and Shareholder Value

    OpenAIRE

    Ryals, Lynette; Knox, Simon

    2005-01-01

    The calculations which underlie efforts to balance marketing spending on customer acquisition and customer retention are usually based on either single- period customer profitability or forecasts of customer lifetime value (CLTV). This paper argues instead for risk-adjusted CLTV, which is termed the economic value (EV) of a customer, as the means for marketing to assess both customer profitability and shareholder value gains.

  6. Performance evaluation of inpatient service in Beijing: a horizontal comparison with risk adjustment based on Diagnosis Related Groups.

    Science.gov (United States)

    Jian, Weiyan; Huang, Yinmin; Hu, Mu; Zhang, Xiumei

    2009-04-30

    The medical performance evaluation, which provides a basis for rational decision-making, is an important part of medical service research. Current progress with health services reform in China is far from satisfactory, without sufficient regulation. To achieve better progress, an effective tool for evaluating medical performance needs to be established. In view of this, this study attempted to develop such a tool appropriate for the Chinese context. Data was collected from the front pages of medical records (FPMR) of all large general public hospitals (21 hospitals) in the third and fourth quarter of 2007. Locally developed Diagnosis Related Groups (DRGs) were introduced as a tool for risk adjustment and performance evaluation indicators were established: Charge Efficiency Index (CEI), Time Efficiency Index (TEI) and inpatient mortality of low-risk group cases (IMLRG), to reflect respectively work efficiency and medical service quality. Using these indicators, the inpatient services' performance was horizontally compared among hospitals. Case-mix Index (CMI) was used to adjust efficiency indices and then produce adjusted CEI (aCEI) and adjusted TEI (aTEI). Poisson distribution analysis was used to test the statistical significance of the IMLRG differences between different hospitals. Using the aCEI, aTEI and IMLRG scores for the 21 hospitals, Hospital A and C had relatively good overall performance because their medical charges were lower, LOS shorter and IMLRG smaller. The performance of Hospital P and Q was the worst due to their relatively high charge level, long LOS and high IMLRG. Various performance problems also existed in the other hospitals. It is possible to develop an accurate and easy to run performance evaluation system using Case-Mix as the tool for risk adjustment, choosing indicators close to consumers and managers, and utilizing routine report forms as the basic information source. To keep such a system running effectively, it is necessary to

  7. Adjustment for smoking reduces radiation risk: fifth analysis of mortality of nuclear industry workers in Japan, 1999-2010

    Energy Technology Data Exchange (ETDEWEB)

    Kudo, S.; Ishida, J.; Yoshimoto, K.; Mizuno, S.; Ohshima, S.; Kasagi, F., E-mail: s_kudo@rea.or.jp [Instituto of Radiation Epidemiology, Radiation Effects Association, 1-9-16 Kajicho, Chiyoda-ku, 101-0044 Tokyo (Japan)

    2015-10-15

    Full text: Many cohort studies among nuclear industry workers have been carried out to determine the possible health effects of low-level radiation. In those studies, confounding factors, for example, age was adjusted to exclude the effect of difference of mortality by age to estimate radiation risk. But there are few studies adjusting for smoking that is known as a strong factor which affects mortality. Radiation Effects Association (Rea) initiated a cohort study of nuclear industry workers mortality in 1990. To examine non-radiation factors confounding on the mortality risk among the radiation workers, Rea have performed life-style questionnaire surveys among the part of workers at 1997 and 2003 and found the correlation between radiation dose and smoking rate. Mortality follow-up were made on 75,442 male respondents for an average of 8.3 years during the observation period 1999-2010. Estimates of Excess Relative Risk percent (Err %) per 10 mSv were obtained by using the Poisson regression. The Err for all causes was statistically significant (1.05 (90 % CI 0.31 : 1.80)), but no longer significant after adjusting for smoking (0.45 (-0.24 : 1.13)). The Err for all cancers excluding leukemia was not significant (0.92 (-0.30 : 2.16)), but after adjusting for smoking, it decreased (0.36 (-0.79 : 1.50)). Thus smoking has a large effect to obscure a radiation risk, so adjustment for smoking is important to estimate radiation risk. (Author)

  8. Adjustment for smoking reduces radiation risk: fifth analysis of mortality of nuclear industry workers in Japan, 1999-2010

    International Nuclear Information System (INIS)

    Kudo, S.; Ishida, J.; Yoshimoto, K.; Mizuno, S.; Ohshima, S.; Kasagi, F.

    2015-10-01

    Full text: Many cohort studies among nuclear industry workers have been carried out to determine the possible health effects of low-level radiation. In those studies, confounding factors, for example, age was adjusted to exclude the effect of difference of mortality by age to estimate radiation risk. But there are few studies adjusting for smoking that is known as a strong factor which affects mortality. Radiation Effects Association (Rea) initiated a cohort study of nuclear industry workers mortality in 1990. To examine non-radiation factors confounding on the mortality risk among the radiation workers, Rea have performed life-style questionnaire surveys among the part of workers at 1997 and 2003 and found the correlation between radiation dose and smoking rate. Mortality follow-up were made on 75,442 male respondents for an average of 8.3 years during the observation period 1999-2010. Estimates of Excess Relative Risk percent (Err %) per 10 mSv were obtained by using the Poisson regression. The Err for all causes was statistically significant (1.05 (90 % CI 0.31 : 1.80)), but no longer significant after adjusting for smoking (0.45 (-0.24 : 1.13)). The Err for all cancers excluding leukemia was not significant (0.92 (-0.30 : 2.16)), but after adjusting for smoking, it decreased (0.36 (-0.79 : 1.50)). Thus smoking has a large effect to obscure a radiation risk, so adjustment for smoking is important to estimate radiation risk. (Author)

  9. Age-adjusted high-sensitivity troponin T cut-off value for risk stratification of pulmonary embolism.

    Science.gov (United States)

    Kaeberich, Anja; Seeber, Valerie; Jiménez, David; Kostrubiec, Maciej; Dellas, Claudia; Hasenfuß, Gerd; Giannitsis, Evangelos; Pruszczyk, Piotr; Konstantinides, Stavros; Lankeit, Mareike

    2015-05-01

    High-sensitivity troponin T (hsTnT) helps in identifying pulmonary embolism patients at low risk of an adverse outcome. In 682 normotensive pulmonary embolism patients we investigate whether an optimised hsTnT cut-off value and adjustment for age improve the identification of patients at elevated risk. Overall, 25 (3.7%) patients had an adverse 30-day outcome. The established hsTnT cut-off value of 14 pg·mL(-1) retained its high prognostic value (OR (95% CI) 16.64 (2.24-123.74); p=0.006) compared with the cut-off value of 33 pg·mL(-1) calculated by receiver operating characteristic analysis (7.14 (2.64-19.26); pvalue of 45 pg·mL(-1) but not the established cut-off value of 14 pg·mL(-1) predicted an adverse outcome. An age-adjusted hsTnT cut-off value (≥14 pg·mL(-1) for patients aged risk (12.4% adverse outcome). Risk assessment of normotensive pulmonary embolism patients was improved by the introduction of an age-adjusted hsTnT cut-off value. A three-step approach helped identify patients at higher risk of an adverse outcome who might benefit from advanced therapy. Copyright ©ERS 2015.

  10. Behavioral Risk Factor Surveillance System (BRFSS) Age-Adjusted Prevalence Data (2011 to present)

    Data.gov (United States)

    U.S. Department of Health & Human Services — 2011 to present. BRFSS combined land line and cell phone age-adjusted prevalence data. The BRFSS is a continuous, state-based surveillance system that collects...

  11. Development and Validation of Perioperative Risk-Adjustment Models for Hip Fracture Repair, Total Hip Arthroplasty, and Total Knee Arthroplasty.

    Science.gov (United States)

    Schilling, Peter L; Bozic, Kevin J

    2016-01-06

    Comparing outcomes across providers requires risk-adjustment models that account for differences in case mix. The burden of data collection from the clinical record can make risk-adjusted outcomes difficult to measure. The purpose of this study was to develop risk-adjustment models for hip fracture repair (HFR), total hip arthroplasty (THA), and total knee arthroplasty (TKA) that weigh adequacy of risk adjustment against data-collection burden. We used data from the American College of Surgeons National Surgical Quality Improvement Program to create derivation cohorts for HFR (n = 7000), THA (n = 17,336), and TKA (n = 28,661). We developed logistic regression models for each procedure using age, sex, American Society of Anesthesiologists (ASA) physical status classification, comorbidities, laboratory values, and vital signs-based comorbidities as covariates, and validated the models with use of data from 2012. The derivation models' C-statistics for mortality were 80%, 81%, 75%, and 92% and for adverse events were 68%, 68%, 60%, and 70% for HFR, THA, TKA, and combined procedure cohorts. Age, sex, and ASA classification accounted for a large share of the explained variation in mortality (50%, 58%, 70%, and 67%) and adverse events (43%, 45%, 46%, and 68%). For THA and TKA, these three variables were nearly as predictive as models utilizing all covariates. HFR model discrimination improved with the addition of comorbidities and laboratory values; among the important covariates were functional status, low albumin, high creatinine, disseminated cancer, dyspnea, and body mass index. Model performance was similar in validation cohorts. Risk-adjustment models using data from health records demonstrated good discrimination and calibration for HFR, THA, and TKA. It is possible to provide adequate risk adjustment using only the most predictive variables commonly available within the clinical record. This finding helps to inform the trade-off between model performance and data

  12. Cumulative socioeconomic status risk, allostatic load, and adjustment: a prospective latent profile analysis with contextual and genetic protective factors.

    Science.gov (United States)

    Brody, Gene H; Yu, Tianyi; Chen, Yi-fu; Kogan, Steven M; Evans, Gary W; Beach, Steven R H; Windle, Michael; Simons, Ronald L; Gerrard, Meg; Gibbons, Frederick X; Philibert, Robert A

    2013-05-01

    The health disparities literature has identified a common pattern among middle-aged African Americans that includes high rates of chronic disease along with low rates of psychiatric disorders despite exposure to high levels of cumulative socioeconomic status (SES) risk. The current study was designed to test hypotheses about the developmental precursors to this pattern. Hypotheses were tested with a representative sample of 443 African American youths living in the rural South. Cumulative SES risk and protective processes were assessed at ages 11-13 years; psychological adjustment was assessed at ages 14-18 years; genotyping at the 5-HTTLPR was conducted at age 16 years; and allostatic load (AL) was assessed at age 19 years. A latent profile analysis identified 5 profiles that evinced distinct patterns of SES risk, AL, and psychological adjustment, with 2 relatively large profiles designated as focal profiles: a physical health vulnerability profile characterized by high SES risk/high AL/low adjustment problems, and a resilient profile characterized by high SES risk/low AL/low adjustment problems. The physical health vulnerability profile mirrored the pattern found in the adult health disparities literature. Multinomial logistic regression analyses indicated that carrying an s allele at the 5-HTTLPR and receiving less peer support distinguished the physical health vulnerability profile from the resilient profile. Protective parenting and planful self-regulation distinguished both focal profiles from the other 3 profiles. The results suggest the public health importance of preventive interventions that enhance coping and reduce the effects of stress across childhood and adolescence.

  13. Auditing Neonatal Intensive Care: Is PREM a Good Alternative to CRIB for Mortality Risk Adjustment in Premature Infants?

    Science.gov (United States)

    Guenther, Kilian; Vach, Werner; Kachel, Walter; Bruder, Ingo; Hentschel, Roland

    2015-01-01

    Comparing outcomes at different neonatal intensive care units (NICUs) requires adjustment for intrinsic risk. The Clinical Risk Index for Babies (CRIB) is a widely used risk model, but it has been criticized for being affected by therapeutic decisions. The Prematurity Risk Evaluation Measure (PREM) is not supposed to be prone to treatment bias, but has not yet been validated. We aimed to validate the PREM, compare its accuracy to that of the original and modified versions of the CRIB and CRIB-II, and examine the congruence of risk categorization. Very-low-birth-weight (VLBW) infants with a gestational age (GA) auditing. It could be useful to combine scores. © 2015 S. Karger AG, Basel.

  14. Risk adjustment model of credit life insurance using a genetic algorithm

    Science.gov (United States)

    Saputra, A.; Sukono; Rusyaman, E.

    2018-03-01

    In managing the risk of credit life insurance, insurance company should acknowledge the character of the risks to predict future losses. Risk characteristics can be learned in a claim distribution model. There are two standard approaches in designing the distribution model of claims over the insurance period i.e, collective risk model and individual risk model. In the collective risk model, the claim arises when risk occurs is called individual claim, accumulation of individual claim during a period of insurance is called an aggregate claim. The aggregate claim model may be formed by large model and a number of individual claims. How the measurement of insurance risk with the premium model approach and whether this approach is appropriate for estimating the potential losses occur in the future. In order to solve the problem Genetic Algorithm with Roulette Wheel Selection is used.

  15. Can parents adjust to the idea that their child is at risk for a sudden death?: Psychological impact of risk for Long QT Syndrome

    NARCIS (Netherlands)

    Hendriks, Karin S. W. H.; Grosfeld, F. J. M.; van Tintelen, J. P.; van Langen, I. M.; Wilde, A. A. M.; van den Bout, J.; ten Kroode, H. F. J.

    2005-01-01

    Can a parent adjust to the idea that its child is at risk for a sudden death? This question is raised by a diagnostic procedure in which children were tested for an inherited Long QT Syndrome (LQTS). This potentially life-threatening but treatable cardiac arrhythmia syndrome may cause sudden death,

  16. Can parents adjust to the idea that their child is at risk for a sudden death? : Psychological impact of risk for Long QT Syndrome

    NARCIS (Netherlands)

    Hendriks, Karin S. W. H.; Grosfeld, FJM; van Tintelen, JP; van Langen, IM; Wilde, AAM; van den Bout, J; ten Kroode, HFJ

    2005-01-01

    Can a parent adjust to the idea that its child is at risk for a sudden death? This question is raised by a diagnostic procedure in which children were tested for an inherited Long QT Syndrome (LQTS). This potentially life-threatening but treatable cardiac arrhythmia syndrome may cause sudden death,

  17. Evaluating the Investment Benefit of Multinational Enterprises' International Projects Based on Risk Adjustment: Evidence from China

    Science.gov (United States)

    Chen, Chong

    2016-01-01

    This study examines the international risks faced by multinational enterprises to understand their impact on the evaluation of investment projects. Moreover, it establishes a 'three-dimensional' theoretical framework of risk identification to analyse the composition of international risk indicators of multinational enterprises based on the theory…

  18. Pathways of Parenting Style on Adolescents' College Adjustment, Academic Achievement, and Alcohol Risk

    Science.gov (United States)

    Kenney, Shannon R.; Lac, Andrew; Hummer, Justin F.; Grimaldi, Elizabeth M.; LaBrie, Joseph W.

    2015-01-01

    This study examined the pathways of parenting style (permissive, authoritarian, and authoritative) to alcohol consumption and consequences through the mediators of college adjustment and academic achievement (grade point average [GPA]). Participants were 289 students from a private, mid-size, West Coast university (mean age 19.01 years, 58.8%…

  19. Willingness to pay for a quality-adjusted life year: an evaluation of attitudes towards risk and preferences

    OpenAIRE

    Martín-Fernández, Jesus; Polentinos-Castro, Elena; del Cura-González, Ma Isabel; Ariza-Cardiel, Gloria; Abraira, Victor; Gil-LaCruz, Ana Isabel; García-Pérez, Sonia

    2014-01-01

    Background This paper examines the Willingness to Pay (WTP) for a quality-adjusted life year (QALY) expressed by people who attended the healthcare system as well as the association of attitude towards risk and other personal characteristics with their response. Methods Health-state preferences, measured by EuroQol (EQ-5D-3L), were combined with WTP for recovering a perfect health state. WTP was assessed using close-ended, iterative bidding, contingent valuation method. Data on demographic an...

  20. Gender adjustment or stratification in discerning upper extremity musculoskeletal disorder risk?

    Science.gov (United States)

    Silverstein, Barbara; Fan, Z Joyce; Smith, Caroline K; Bao, Stephen; Howard, Ninica; Spielholz, Peregrin; Bonauto, David; Viikari-Juntura, Eira

    2009-03-01

    The aim was to explore whether "adjustment" for gender masks important exposure differences between men and women in a study of rotator cuff syndrome (RCS) and carpal tunnel syndrome (CTS) and work exposures. This cross-sectional study of 733 subjects in 12 health care and manufacturing workplaces used detailed individual health and work exposure assessment methods. Multiple logistic regression analysis was used to compare gender stratified and adjusted models. Prevalence of RCS and CTS among women was 7.1% and 11.3% respectively, and among men 7.8% and 6.4%. In adjusted (gender, age, body mass index) multivariate analyses of RCS and CTS, gender was not statistically significantly different. For RCS, upper arm flexion >/=45 degrees and forceful pinch increased the odds in the gender-adjusted model (OR 2.66, 95% CI 1.26-5.59) but primarily among women in the stratified analysis (OR 6.68, 95% CI 1.81-24.66 versus OR 1.45, 95% CI 0.53-4.00). For CTS, wrist radial/ulnar deviation >/=4% time and lifting >/=4.5kg >3% time, the adjusted OR was higher for women (OR 4.85, 95% CI 2.12-11.11) and in the gender stratified analyses, the odds were increased for both genders (women OR 5.18, 95% CI 1.70-15.81 and men OR 3.63, 95% CI 1.08-12.18). Gender differences in response to physical work exposures may reflect gender segregation in work and potential differences in pinch and lifting capacity. Reduction in these exposures may reduce prevalence of upper extremity disorders for all workers.

  1. Alternative Payment Models Should Risk-Adjust for Conversion Total Hip Arthroplasty: A Propensity Score-Matched Study.

    Science.gov (United States)

    McLawhorn, Alexander S; Schairer, William W; Schwarzkopf, Ran; Halsey, David A; Iorio, Richard; Padgett, Douglas E

    2017-12-06

    For Medicare beneficiaries, hospital reimbursement for nonrevision hip arthroplasty is anchored to either diagnosis-related group code 469 or 470. Under alternative payment models, reimbursement for care episodes is not further risk-adjusted. This study's purpose was to compare outcomes of primary total hip arthroplasty (THA) vs conversion THA to explore the rationale for risk adjustment for conversion procedures. All primary and conversion THAs from 2007 to 2014, excluding acute hip fractures and cancer patients, were identified in the National Surgical Quality Improvement Program database. Conversion and primary THA patients were matched 1:1 using propensity scores, based on preoperative covariates. Multivariable logistic regressions evaluated associations between conversion THA and 30-day outcomes. A total of 2018 conversions were matched to 2018 primaries. There were no differences in preoperative covariates. Conversions had longer operative times (148 vs 95 minutes, P reimbursement models shift toward bundled payment paradigms, conversion THA appears to be a procedure for which risk adjustment is appropriate. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Inclusion of Highest Glasgow Coma Scale Motor Component Score in Mortality Risk Adjustment for Benchmarking of Trauma Center Performance.

    Science.gov (United States)

    Gomez, David; Byrne, James P; Alali, Aziz S; Xiong, Wei; Hoeft, Chris; Neal, Melanie; Subacius, Harris; Nathens, Avery B

    2017-12-01

    The Glasgow Coma Scale (GCS) is the most widely used measure of traumatic brain injury (TBI) severity. Currently, the arrival GCS motor component (mGCS) score is used in risk-adjustment models for external benchmarking of mortality. However, there is evidence that the highest mGCS score in the first 24 hours after injury might be a better predictor of death. Our objective was to evaluate the impact of including the highest mGCS score on the performance of risk-adjustment models and subsequent external benchmarking results. Data were derived from the Trauma Quality Improvement Program analytic dataset (January 2014 through March 2015) and were limited to the severe TBI cohort (16 years or older, isolated head injury, GCS ≤8). Risk-adjustment models were created that varied in the mGCS covariates only (initial score, highest score, or both initial and highest mGCS scores). Model performance and fit, as well as external benchmarking results, were compared. There were 6,553 patients with severe TBI across 231 trauma centers included. Initial and highest mGCS scores were different in 47% of patients (n = 3,097). Model performance and fit improved when both initial and highest mGCS scores were included, as evidenced by improved C-statistic, Akaike Information Criterion, and adjusted R-squared values. Three-quarters of centers changed their adjusted odds ratio decile, 2.6% of centers changed outlier status, and 45% of centers exhibited a ≥0.5-SD change in the odds ratio of death after including highest mGCS score in the model. This study supports the concept that additional clinical information has the potential to not only improve the performance of current risk-adjustment models, but can also have a meaningful impact on external benchmarking strategies. Highest mGCS score is a good potential candidate for inclusion in additional models. Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  3. The Use of the Kurtosis-Adjusted Cumulative Noise Exposure Metric in Evaluating the Hearing Loss Risk for Complex Noise.

    Science.gov (United States)

    Xie, Hong-Wei; Qiu, Wei; Heyer, Nicholas J; Zhang, Mei-Bian; Zhang, Peng; Zhao, Yi-Ming; Hamernik, Roger P

    2016-01-01

    To test a kurtosis-adjusted cumulative noise exposure (CNE) metric for use in evaluating the risk of hearing loss among workers exposed to industrial noises. Specifically, to evaluate whether the kurtosis-adjusted CNE (1) provides a better association with observed industrial noise-induced hearing loss, and (2) provides a single metric applicable to both complex (non-Gaussian [non-G]) and continuous or steady state (Gaussian [G]) noise exposures for predicting noise-induced hearing loss (dose-response curves). Audiometric and noise exposure data were acquired on a population of screened workers (N = 341) from two steel manufacturing plants located in Zhejiang province and a textile manufacturing plant located in Henan province, China. All the subjects from the two steel manufacturing plants (N = 178) were exposed to complex noise, whereas the subjects from textile manufacturing plant (N = 163) were exposed to a G continuous noise. Each subject was given an otologic examination to determine their pure-tone HTL and had their personal 8-hr equivalent A-weighted noise exposure (LAeq) and full-shift noise kurtosis statistic (which is sensitive to the peaks and temporal characteristics of noise exposures) measured. For each subject, an unadjusted and kurtosis-adjusted CNE index for the years worked was created. Multiple linear regression analysis controlling for age was used to determine the relationship between CNE (unadjusted and kurtosis adjusted) and the mean HTL at 3, 4, and 6 kHz (HTL346) among the complex noise-exposed group. In addition, each subject's HTLs from 0.5 to 8.0 kHz were age and sex adjusted using Annex A (ISO-1999) to determine whether they had adjusted high-frequency noise-induced hearing loss (AHFNIHL), defined as an adjusted HTL shift of 30 dB or greater at 3.0, 4.0, or 6.0 kHz in either ear. Dose-response curves for AHFNIHL were developed separately for workers exposed to G and non-G noise using both unadjusted and adjusted CNE as the exposure

  4. Flexible Multi-Objective Transmission Expansion Planning with Adjustable Risk Aversion

    Directory of Open Access Journals (Sweden)

    Jing Qiu

    2017-07-01

    Full Text Available This paper presents a multi-objective transmission expansion planning (TEP framework. Rather than using the conventional deterministic reliability criterion, a risk component based on the probabilistic reliability criterion is incorporated into the TEP objectives. This risk component can capture the stochastic nature of power systems, such as load and wind power output variations, component availability, and incentive-based demand response (IBDR costs. Specifically, the formulation of risk value after risk aversion is explicitly given, and it aims to provide network planners with the flexibility to conduct risk analysis. Thus, a final expansion plan can be selected according to individual risk preferences. Moreover, the economic value of IBDR is modeled and integrated into the cost objective. In addition, a relatively new multi-objective evolutionary algorithm called the MOEA/D is introduced and employed to find Pareto optimal solutions, and tradeoffs between overall cost and risk are provided. The proposed approach is numerically verified on the Garver’s six-bus, IEEE 24-bus RTS and Polish 2383-bus systems. Case study results demonstrate that the proposed approach can effectively reduce cost and hedge risk in relation to increasing wind power integration.

  5. Risk Adjusted Production Efficiency of Maize Farmers in Ethiopia: Implication for Improved Maize Varieties Adoption

    Directory of Open Access Journals (Sweden)

    Sisay Diriba Lemessa

    2017-09-01

    Full Text Available This study analyzes the technical efficiency and production risk of 862 maize farmers in major maize producing regions of Ethiopia. It employs the stochastic frontier approach (SFA to estimate the level of technical efficiencies of stallholder farmers. The stochastic frontier approach (SFA uses flexible risk properties to account for production risk. Thus, maize production variability is assessed from two perspectives, the production risk and the technical efficiency. The study also attempts to determine the socio-economic and farm characteristics that influence technical efficiency of maize production in the study area. The findings of the study showed the existence of both production risk and technical inefficiency in maize production process. Input variables (amounts per hectare such as fertilizer and labor positively influence maize output. The findings also show that farms in the study area exhibit decreasing returns to scale. Fertilizer and ox plough days reduce output risk while labor and improved seed increase output risk. The mean technical efficiency for maize farms is 48 percent. This study concludes that production risk and technical inefficiency prevents the maize farmers from realizing their frontier output. The best factors that improve the efficiency of the maize farmers in the study area include: frequency of extension contact, access to credit and use of intercropping. It was also realized that altitude and terracing in maize farms had influence on farmer efficiency.

  6. Lung cancer among coal miners, ore miners and quarrymen : smoking-adjusted risk estimates from the synergy pooled analysis of case-control studies

    NARCIS (Netherlands)

    Taeger, Dirk; Pesch, Beate; Kendzia, Benjamin; Behrens, Thomas; Jöckel, Karl-Heinz; Dahmann, Dirk; Siemiatycki, Jack; Kromhout, Hans; Vermeulen, Roel; Peters, Susan; Olsson, Ann; Brüske, Irene; Wichmann, Heinz-Erich; Stücker, Isabelle; Guida, Florence; Tardón, Adonina; Merletti, Franco; Mirabelli, Dario; Richiardi, Lorenzo; Pohlabeln, Hermann; Ahrens, Wolfgang; Landi, Maria Teresa; Caporaso, Neil; Pesatori, Angela Cecilia; Mukeriya, Anush; Szeszenia-Dabrowska, Neonila; Lissowska, Jolanta; Gustavsson, Per; Field, John; Marcus, Michael W; Fabianova, Eleonora; 't Mannetje, Andrea; Pearce, Neil; Rudnai, Peter; Bencko, Vladimir; Janout, Vladimir; Dumitru, Rodica Stanescu; Foretova, Lenka; Forastiere, Francesco; John McLaughlin, John McLaughlin; Paul Demers, Paul Demers; Bas Bueno-de-Mesquita, Bas Bueno-de-Mesquita; Joachim Schüz, Joachim Schüz; Kurt Straif, Kurt Straif; Brüning, Thomas

    2015-01-01

    OBJECTIVES: Working in mines and quarries has been associated with an elevated lung cancer risk but with inconsistent results for coal miners. This study aimed to estimate the smoking-adjusted lung cancer risk among coal miners and compare the risk pattern with lung cancer risks among ore miners and

  7. The HHS-HCC Risk Adjustment Model for Individual and Small

    Data.gov (United States)

    U.S. Department of Health & Human Services — Volume 4, Issue 3 of the Medicare and Medicaid Research Review includes three articles describing the Department of Health and Human Services (HHS) developed risk...

  8. Are Chinese consumers at risk due to exposure to metals in crayfish? A bioaccessibility-adjusted probabilistic risk assessment.

    Science.gov (United States)

    Peng, Qian; Nunes, Luís M; Greenfield, Ben K; Dang, Fei; Zhong, Huan

    2016-03-01

    Freshwater crayfish, the world's third largest crustacean species, has been reported to accumulate high levels of metals, while the current knowledge of potential risk associated with crayfish consumption lags behind that of finfish. We provide the first estimate of human health risk associated with crayfish (Procambarus clarkii) consumption in China, the world's largest producer and consumer of crayfish. We performed Monte Carlo Simulation on a standard risk model parameterized with local data on metal concentrations, bioaccessibility (φ), crayfish consumption rate, and consumer body mass. Bioaccessibility of metals in crayfish was found to be variable (68-95%) and metal-specific, suggesting a potential influence of metal bioaccessibility on effective metal intake. However, sensitivity analysis suggested risk of metals via crayfish consumption was predominantly explained by consumption rate (explaining >92% of total risk estimate variability), rather than metals concentration, bioaccessibility, or body mass. Mean metal concentrations (As, Cd, Cu, Ni, Pb, Se and Zn) in surveyed crayfish samples from 12 provinces in China conformed to national safety standards. However, risk calculation of φ-modified hazard quotient (HQ) and hazard index (HI) suggested that crayfish metals may pose a health risk for very high rate consumers, with a HI of over 24 for the highest rate consumers. Additionally, the φ-modified increased lifetime risk (ILTR) for carcinogenic effects due to the presence of As was above the acceptable level (10(-5)) for both the median (ILTR=2.5×10(-5)) and 90th percentile (ILTR=1.8×10(-4)), highlighting the relatively high risk of As in crayfish. Our results suggest a need to consider crayfish when assessing human dietary exposure to metals and associated health risks, especially for high crayfish-consuming populations, such as in China, USA and Sweden. Copyright © 2016 Elsevier Ltd. All rights reserved.

  9. A comparative evaluation of risk-adjustment models for benchmarking amputation-free survival after lower extremity bypass.

    Science.gov (United States)

    Simons, Jessica P; Goodney, Philip P; Flahive, Julie; Hoel, Andrew W; Hallett, John W; Kraiss, Larry W; Schanzer, Andres

    2016-04-01

    Providing patients and payers with publicly reported risk-adjusted quality metrics for the purpose of benchmarking physicians and institutions has become a national priority. Several prediction models have been developed to estimate outcomes after lower extremity revascularization for critical limb ischemia, but the optimal model to use in contemporary practice has not been defined. We sought to identify the highest-performing risk-adjustment model for amputation-free survival (AFS) at 1 year after lower extremity bypass (LEB). We used the national Society for Vascular Surgery Vascular Quality Initiative (VQI) database (2003-2012) to assess the performance of three previously validated risk-adjustment models for AFS. The Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL), Finland National Vascular (FINNVASC) registry, and the modified Project of Ex-vivo vein graft Engineering via Transfection III (PREVENT III [mPIII]) risk scores were applied to the VQI cohort. A novel model for 1-year AFS was also derived using the VQI data set and externally validated using the PIII data set. The relative discrimination (Harrell c-index) and calibration (Hosmer-May goodness-of-fit test) of each model were compared. Among 7754 patients in the VQI who underwent LEB for critical limb ischemia, the AFS was 74% at 1 year. Each of the previously published models for AFS demonstrated similar discriminative performance: c-indices for BASIL, FINNVASC, mPIII were 0.66, 0.60, and 0.64, respectively. The novel VQI-derived model had improved discriminative ability with a c-index of 0.71 and appropriate generalizability on external validation with a c-index of 0.68. The model was well calibrated in both the VQI and PIII data sets (goodness of fit P = not significant). Currently available prediction models for AFS after LEB perform modestly when applied to national contemporary VQI data. Moreover, the performance of each model was inferior to that of the novel VQI-derived model

  10. Why and when is ethnic harassment a risk for immigrant adolescents' school adjustment? understanding the processes and conditions.

    Science.gov (United States)

    Bayram Özdemir, Sevgi; Stattin, Håkan

    2014-08-01

    Ethnically harassed immigrant youth are at risk for experiencing a wide range of school adjustment problems. However, it is still unclear why and under what conditions experiencing ethnic harassment leads to school adjustment difficulties. To address this limitation in the literature, we examined two important questions. First, we investigated whether self-esteem and/or depressive symptoms would mediate the associations between ethnic harassment and poor school adjustment among immigrant youth. Second, we examined whether immigrant youths' perception of school context would play a buffering role in the pathways between ethnic harassment and school adjustment difficulties. The sample (n = 330; M age = 14.07, SD = .90; 49% girls at T1) was drawn from a longitudinal study in Sweden. The results revealed that experiencing ethnic harassment led to a decrease in immigrant youths' self-esteem over time, and that youths' expectations of academic failure increased. Further, youths' relationships with their teachers and their perceptions of school democracy moderated the mediation processes. Specifically, when youth had poor relationships with their teachers or perceived their school context as less democratic, being exposed to ethnic harassment led to a decrease in their self-esteem. In turn, they reported low school satisfaction and perceived themselves as being unsuccessful in school. Such indirect effects were not observed when youth had high positive relationships with their teachers or perceived their school as offering a democratic environment. These findings highlight the importance of understanding underlying processes and conditions in the examination of the effects of ethnic devaluation experiences in order to reach a more comprehensive understanding of immigrant youths' school adjustment.

  11. Behavioral adjustments of African herbivores to predation risk by lions: spatiotemporal variations influence habitat use.

    Science.gov (United States)

    Valeix, M; Loveridge, A J; Chamaillé-Jammes, S; Davidson, Z; Murindagomo, F; Fritz, H; Macdonald, D W

    2009-01-01

    Predators may influence their prey populations not only through direct lethal effects, but also through indirect behavioral changes. Here, we combined spatiotemporal fine-scale data from GPS radio collars on lions with habitat use information on 11 African herbivores in Hwange National Park (Zimbabwe) to test whether the risk of predation by lions influenced the distribution of herbivores in the landscape. Effects of long-term risk of predation (likelihood of lion presence calculated over four months) and short-term risk of predation (actual presence of lions in the vicinity in the preceding 24 hours) were contrasted. The long-term risk of predation by lions appeared to influence the distributions of all browsers across the landscape, but not of grazers. This result strongly suggests that browsers and grazers, which face different ecological constraints, are influenced at different spatial and temporal scales in the variation of the risk of predation by lions. The results also show that all herbivores tend to use more open habitats preferentially when lions are in their vicinity, probably an effective anti-predator behavior against such an ambush predator. Behaviorally induced effects of lions may therefore contribute significantly to structuring African herbivore communities, and hence possibly their effects on savanna ecosystems.

  12. Balancing the risks and benefits of drinking water disinfection: disability adjusted life-years on the scale.

    Science.gov (United States)

    Havelaar, A H; De Hollander, A E; Teunis, P F; Evers, E G; Van Kranen, H J; Versteegh, J F; Van Koten, J E; Slob, W

    2000-04-01

    To evaluate the applicability of disability adjusted life-years (DALYs) as a measure to compare positive and negative health effects of drinking water disinfection, we conducted a case study involving a hypothetical drinking water supply from surface water. This drinking water supply is typical in The Netherlands. We compared the reduction of the risk of infection with Cryptosporidium parvum by ozonation of water to the concomitant increase in risk of renal cell cancer arising from the production of bromate. We applied clinical, epidemiologic, and toxicologic data on morbidity and mortality to calculate the net health benefit in DALYs. We estimated the median risk of infection with C. parvum as 10(-3)/person-year. Ozonation reduces the median risk in the baseline approximately 7-fold, but bromate is produced in a concentration above current guideline levels. However, the health benefits of preventing gastroenteritis in the general population and premature death in patients with acquired immunodeficiency syndrome outweigh health losses by premature death from renal cell cancer by a factor of > 10. The net benefit is approximately 1 DALY/million person-years. The application of DALYs in principle allows us to more explicitly compare the public health risks and benefits of different management options. In practice, the application of DALYs may be hampered by the substantial degree of uncertainty, as is typical for risk assessment.

  13. Male crickets adjust ejaculate quality with both risk and intensity of sperm competition.

    Science.gov (United States)

    Simmons, Leigh W; Denholm, Amy; Jackson, Chantelle; Levy, Esther; Madon, Ewa

    2007-10-22

    Sperm competition theory predicts that males should increase their expenditure on the ejaculate with increasing risk of sperm competition, but decrease their expenditure with increasing intensity. There is accumulating evidence for sperm competition theory, based on examinations of testes size and/or the numbers of sperm ejaculated. However, recent studies suggest that ejaculate quality can also be subject to selection by sperm competition. We used experimental manipulations of the risk and intensity of sperm competition in the cricket, Teleogryllus oceanicus. We found that males produced ejaculates with a greater percentage of live sperm when they had encountered a rival male prior to mating. However, when mating with a female that presented a high intensity of sperm competition, males did not respond to risk, but produced ejaculates with a reduced percentage of live sperm. Our data suggest that males exhibit a fine-tuned hierarchy of responses to these cues of sperm competition.

  14. Identifying Military and Combat Specific Risk Factors for Child Adjustment: Comparing High and Low Risk Military Families and Civilian Families

    Science.gov (United States)

    2016-06-01

    separation and the potentially destabilizing impact of deployment on the remaining caregiver and daily routines. The project entails the assessment of...milestones, and; 2) examine the role of spousal-perceived Service Member risk on caregiver behaviors associated with parental deployment in the prediction...n/a INTRODUCTION There is an emerging consensus that parental combat deployment may increase risk for child development; but details on what the

  15. Mate guarding in the Seychelles warbler is energetically costly and adjusted to paternity risk

    NARCIS (Netherlands)

    Komdeur, Jan

    2001-01-01

    Males may increase their fitness through extra-pair copulations (copulations outside the pair bond) that result in extra-pair fertilizations, but also risk lost paternity when they leave their own mate unguarded. The fitness costs of cuckoldry for Seychelles warblers (Acrocephalus sechellensis) are

  16. Risk-adjusted impact of administrative costs on the distribution of terminal wealth for long-term investment.

    Science.gov (United States)

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

    2014-01-01

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

  17. Risk adjustment policy options for casemix funding: international lessons in financing reform.

    Science.gov (United States)

    Antioch, Kathryn M; Ellis, Randall P; Gillett, Steve; Borovnicar, Daniel; Marshall, Ric P

    2007-09-01

    This paper explores modified hospital casemix payment formulae that would refine the diagnosis-related group (DRG) system in Victoria, Australia, which already makes adjustments for teaching, severity and demographics. We estimate alternative casemix funding methods using multiple regressions for individual hospital episodes from 2001 to 2003 on 70 high-deficit DRGs, focussing on teaching hospitals where the largest deficits have occurred. Our casemix variables are diagnosis- and procedure-based severity markers, counts of diagnoses and procedures, disease types, complexity, day outliers, emergency admission and "transfers in." The results are presented for four policy options that vary according to whether all of the dollars or only some are reallocated, whether all or some hospitals are used and whether the alternatives augment or replace existing payments. While our approach identifies variables that help explain patient cost variations, hospital-level simulations suggest that the approaches explored would only reduce teaching hospital underpayment by about 10%. The implications of various policy options are discussed.

  18. Scalability of a Methodology for Generating Technical Trading Rules with GAPs Based on Risk-Return Adjustment and Incremental Training

    Science.gov (United States)

    de La Cal, E. A.; Fernández, E. M.; Quiroga, R.; Villar, J. R.; Sedano, J.

    In previous works a methodology was defined, based on the design of a genetic algorithm GAP and an incremental training technique adapted to the learning of series of stock market values. The GAP technique consists in a fusion of GP and GA. The GAP algorithm implements the automatic search for crisp trading rules taking as objectives of the training both the optimization of the return obtained and the minimization of the assumed risk. Applying the proposed methodology, rules have been obtained for a period of eight years of the S&P500 index. The achieved adjustment of the relation return-risk has generated rules with returns very superior in the testing period to those obtained applying habitual methodologies and even clearly superior to Buy&Hold. This work probes that the proposed methodology is valid for different assets in a different market than previous work.

  19. Secrets of Success in a Landscape of Fear: Urban Wild Boar Adjust Risk Perception and Tolerate Disturbance

    Directory of Open Access Journals (Sweden)

    Milena Stillfried

    2017-12-01

    Full Text Available In urban areas with a high level of human disturbance, wildlife has to adjust its behavior to deal with the so called “landscape of fear.” This can be studied in risk perception during movement in relation to specific habitat types, whereby individuals trade-off between foraging and disturbance. Due to its high behavioral plasticity and increasing occurrence in urban environments, wild boar (Sus scrofa is an excellent model organism to study adjustment to urbanization. With the help of GPS tracking, space use of 11 wild boar from Berlin's metropolitan region was analyzed: we aimed at understanding how animals adjust space use to deal with the landscape of fear in urban areas compared to rural areas. We compared use vs. availability with help of generalized linear mixed models. First, we studied landscape types selected by rural vs. urban wild boar, second, we analyzed distances of wild boar locations to each of the landscape types. Finally, we mapped the resulting habitat selection probability to predict hotspots of human-wildlife conflicts. A higher tolerance to disturbance in urban wild boar was shown by a one third shorter flight distance and by an increased re-use of areas close to the trap. Urban wild boar had a strong preference for natural landscapes such as swamp areas, green areas and deciduous forests, and areas with high primary productivity, as indicated by high NDVI (normalized difference vegetation index values. The areas selected by urban wild boar were often located closely to roads and houses. The spatial distribution maps show that a large area of Berlin would be suitable for urban wild boar but not their rural conspecifics, with the most likely reason being a different perception of anthropogenic disturbance. Wild boar therefore showed considerable behavioral plasticity suitable to adjust to human-dominated environments in a potentially evolutionarily adaptive manner.

  20. Evaluating variation in use of definitive therapy and risk-adjusted prostate cancer mortality in England and the USA.

    Science.gov (United States)

    Sachdeva, Ashwin; van der Meulen, Jan H; Emberton, Mark; Cathcart, Paul J

    2015-02-24

    Prostate cancer mortality (PCM) in the USA is among the lowest in the world, whereas PCM in England is among the highest in Europe. This paper aims to assess the association of variation in use of definitive therapy on risk-adjusted PCM in England as compared with the USA. Observational study. Cancer registry data from England and the USA. Men diagnosed with non-metastatic prostate cancer (PCa) in England and the USA between 2004 and 2008. Competing-risks survival analyses to estimate subhazard ratios (SHR) of PCM adjusted for age, ethnicity, year of diagnosis, Gleason score (GS) and clinical tumour (cT) stage. 222,163 men were eligible for inclusion. Compared with American patients, English patients were more likely to present at an older age (70-79 years: England 44.2%, USA 29.3%, pUSA 8.6%, pUSA 11.2%, pUSA 77%, pUSA. This difference may be explained by less frequent use of definitive therapy in England. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  1. Risk-adjusted econometric model to estimate postoperative costs: an additional instrument for monitoring performance after major lung resection.

    Science.gov (United States)

    Brunelli, Alessandro; Salati, Michele; Refai, Majed; Xiumé, Francesco; Rocco, Gaetano; Sabbatini, Armando

    2007-09-01

    The objectives of this study were to develop a risk-adjusted model to estimate individual postoperative costs after major lung resection and to use it for internal economic audit. Variable and fixed hospital costs were collected for 679 consecutive patients who underwent major lung resection from January 2000 through October 2006 at our unit. Several preoperative variables were used to develop a risk-adjusted econometric model from all patients operated on during the period 2000 through 2003 by a stepwise multiple regression analysis (validated by bootstrap). The model was then used to estimate the postoperative costs in the patients operated on during the 3 subsequent periods (years 2004, 2005, and 2006). Observed and predicted costs were then compared within each period by the Wilcoxon signed rank test. Multiple regression and bootstrap analysis yielded the following model predicting postoperative cost: 11,078 + 1340.3X (age > 70 years) + 1927.8X cardiac comorbidity - 95X ppoFEV1%. No differences between predicted and observed costs were noted in the first 2 periods analyzed (year 2004, $6188.40 vs $6241.40, P = .3; year 2005, $6308.60 vs $6483.60, P = .4), whereas in the most recent period (2006) observed costs were significantly lower than the predicted ones ($3457.30 vs $6162.70, P model may be used as a methodologic template for economic audit in our specialty and complement more traditional outcome measures in the assessment of performance.

  2. Adjustments of the Pesticide Risk Index Used in Environmental Policy in Flanders.

    Science.gov (United States)

    Fevery, Davina; Peeters, Bob; Lenders, Sonia; Spanoghe, Pieter

    2015-01-01

    Indicators are used to quantify the pressure of pesticides on the environment. Pesticide risk indicators typically require weighting environmental exposure by a no effect concentration. An indicator based on spread equivalents (ΣSeq) is used in environmental policy in Flanders (Belgium). The pesticide risk for aquatic life is estimated by weighting active ingredient usage by the ratio of their maximum allowable concentration and their soil halflife. Accurate estimates of total pesticide usage in the region are essential in such calculations. Up to 2012, the environmental impact of pesticides was estimated on sales figures provided by the Federal Government. Since 2013, pesticide use is calculated based on results from the Farm Accountancy Data Network (FADN). The estimation of pesticide use was supplemented with data for non-agricultural use based on sales figures of amateur use provided by industry and data obtained from public services. The Seq-indicator was modified to better reflect reality. This method was applied for the period 2009-2012 and showed differences between estimated use and sales figures of pesticides. The estimated use of pesticides based on accountancy data is more accurate compared to sales figures. This approach resulted in a better view on pesticide use and its respective environmental impact in Flanders.

  3. Adjustments of the Pesticide Risk Index Used in Environmental Policy in Flanders.

    Directory of Open Access Journals (Sweden)

    Davina Fevery

    Full Text Available Indicators are used to quantify the pressure of pesticides on the environment. Pesticide risk indicators typically require weighting environmental exposure by a no effect concentration. An indicator based on spread equivalents (ΣSeq is used in environmental policy in Flanders (Belgium. The pesticide risk for aquatic life is estimated by weighting active ingredient usage by the ratio of their maximum allowable concentration and their soil halflife. Accurate estimates of total pesticide usage in the region are essential in such calculations. Up to 2012, the environmental impact of pesticides was estimated on sales figures provided by the Federal Government. Since 2013, pesticide use is calculated based on results from the Farm Accountancy Data Network (FADN. The estimation of pesticide use was supplemented with data for non-agricultural use based on sales figures of amateur use provided by industry and data obtained from public services. The Seq-indicator was modified to better reflect reality. This method was applied for the period 2009-2012 and showed differences between estimated use and sales figures of pesticides. The estimated use of pesticides based on accountancy data is more accurate compared to sales figures. This approach resulted in a better view on pesticide use and its respective environmental impact in Flanders.

  4. Performance of risk-adjusted control charts to monitor in-hospital mortality of intensive care unit patients: A simulation study

    NARCIS (Netherlands)

    Koetsier, Antonie; de Keizer, Nicolette F.; de Jonge, Evert; Cook, David A.; Peek, Niels

    2012-01-01

    Objectives: Increases in case-mix adjusted mortality may be indications of decreasing quality of care. Risk-adjusted control charts can be used for in-hospital mortality monitoring in intensive care units by issuing a warning signal when there are more deaths than expected. The aim of this study was

  5. The need for unique risk adjustment for surgical site infections at a high-volume, tertiary care center with inherent high-risk colorectal procedures.

    Science.gov (United States)

    Gorgun, E; Benlice, C; Hammel, J; Hull, T; Stocchi, L

    2017-08-01

    The aim of the present study was to create a unique risk adjustment model for surgical site infection (SSI) in patients who underwent colorectal surgery (CRS) at the Cleveland Clinic (CC) with inherent high risk factors by using a nationwide database. The American College of Surgeons National Surgical Quality Improvement Program database was queried to identify patients who underwent CRS between 2005 and 2010. Initially, CC cases were identified from all NSQIP data according to case identifier and separated from the other NSQIP centers. Demographics, comorbidities, and outcomes were compared. Logistic regression analyses were used to assess the association between SSI and center-related factors. A total of 70,536 patients met the inclusion criteria and underwent CRS, 1090 patients (1.5%) at the CC and 69,446 patients (98.5%) at other centers. Male gender, work-relative value unit, diagnosis of inflammatory bowel disease, pouch formation, open surgery, steroid use, and preoperative radiotherapy rates were significantly higher in the CC cases. Overall morbidity and individual postoperative complication rates were found to be similar in the CC and other centers except for the following: organ-space SSI and sepsis rates (higher in the CC cases); and pneumonia and ventilator dependency rates (higher in the other centers). After covariate adjustment, the estimated degree of difference between the CC and other institutions with respect to organ-space SSI was reduced (OR 1.38, 95% CI 1.08-1.77). The unique risk adjustment strategy may provide center-specific comprehensive analysis, especially for hospitals that perform inherently high-risk procedures. Higher surgical complexity may be the reason for increased SSI rates in the NSQIP at tertiary care centers.

  6. Introducing risk adjustment and free health plan choice in employer-based health insurance: Evidence from Germany.

    Science.gov (United States)

    Pilny, Adam; Wübker, Ansgar; Ziebarth, Nicolas R

    2017-12-01

    To equalize differences in health plan premiums due to differences in risk pools, the German legislature introduced a simple Risk Adjustment Scheme (RAS) based on age, gender and disability status in 1994. In addition, effective 1996, consumers gained the freedom to choose among hundreds of existing health plans, across employers and state-borders. This paper (a) estimates RAS pass-through rates on premiums, financial reserves, and expenditures and assesses the overall RAS impact on market price dispersion. Moreover, it (b) characterizes health plan switchers and investigates their annual and cumulative switching rates over time. Our main findings are based on representative enrollee panel data linked to administrative RAS and health plan data. We show that sickness funds with bad risk pools and high pre-RAS premiums lowered their total premiums by 42 cents per additional euro allocated by the RAS. Consequently, post-RAS, health plan prices converged but not fully. Because switchers are more likely to be white collar, young and healthy, the new consumer choice resulted in more risk segregation and the amount of money redistributed by the RAS increased over time. Copyright © 2017 Elsevier B.V. All rights reserved.

  7. Calculating disability-adjusted life years (DALY) as a measure of excess cancer risk following radiation exposure

    International Nuclear Information System (INIS)

    Shimada, K; Kai, M

    2015-01-01

    This paper has proposed that disability-adjusted life year (DALY) can be used as a measure of radiation health risk. DALY is calculated as the sum of years of life lost (YLL) and years lived with disability (YLD). This multidimensional concept can be expressed as a risk index without a probability measure to avoid the misuse of the current radiation detriment at low doses. In this study, we calculated YLL and YLD using Japanese population data by gender. DALY for all cancers in Japan per 1 Gy per person was 0.84 year in men and 1.34 year in women. The DALY for all cancers in the Japanese baseline was 4.8 in men and 3.5 in women. When we calculated the ICRP detriment from the same data, DALYs for the cancer sites were similar to the radiation detriment in the cancer sites, excluding leukemia, breast and thyroid cancer. These results suggested that the ICRP detriment overestimate the weighting fraction of leukemia risk and underestimate the weighting fraction of breast and thyroid cancer. A big advantage over the ICRP detriment is that DALY can calculate the risk components for non-fatal diseases without the data of lethality. This study showed that DALY is a practical tool that can compare many types of diseases encountered in public health. (paper)

  8. Antenatal steroids and risk of bronchopulmonary dysplasia: a lack of effect or a case of over-adjustment?

    Science.gov (United States)

    Gagliardi, Luigi; Bellù, Roberto; Rusconi, Franca; Merazzi, Daniele; Mosca, Fabio

    2007-07-01

    Although antenatal steroids reduce risk factors for bronchopulmonary dysplasia (BPD) in preterm infants, their effect on BPD is conflicting. We hypothesised that the lack of protective effect found in some studies could derive from over-adjustment during analysis, caused by controlling for factors intermediate in the causal pathway between treatment and outcome. We prospectively studied a cohort of infants 23-32 weeks gestation steroids. In univariable analysis, steroids were not significantly protective against BPD; some intermediate factors (mechanical ventilation, greater severity of illness as measured by Clinical Risk Index for Babies score, patent ductus arteriosus) were significantly positively associated with (i.e. were risk factors for) BPD (OR = 11.0, 1.55, 4.42, respectively, all P steroids (OR = 0.58, 0.92, and 0.58, respectively, all P steroid-treated infants had a lower risk of BPD (OR 0.59 [95% CI 0.36, 0.97], P = 0.036); male sex (OR = 2.08), late-onset sepsis (OR = 4.26), and birthweight (OR = 0.63 for 100 g increase) were also associated with BPD, all P effect of steroids disappeared; ventilation (OR = 3.03), increased illness severity (OR = 1.11), and patent ductus arteriosus (OR = 1.90) were significant risk factors. This study suggests that including variables that are potential mediators in the causal chain can obscure the ability to detect a protective effect of treatment. We observed such a phenomenon in our analyses of the relationship between antenatal steroids and BPD, suggesting that steroid effect is partly mediated through a reduction in the classical risk factors.

  9. An in-depth assessment of a diagnosis-based risk adjustment model based on national health insurance claims: the application of the Johns Hopkins Adjusted Clinical Group case-mix system in Taiwan

    Directory of Open Access Journals (Sweden)

    Weiner Jonathan P

    2010-01-01

    Full Text Available Abstract Background Diagnosis-based risk adjustment is becoming an important issue globally as a result of its implications for payment, high-risk predictive modelling and provider performance assessment. The Taiwanese National Health Insurance (NHI programme provides universal coverage and maintains a single national computerized claims database, which enables the application of diagnosis-based risk adjustment. However, research regarding risk adjustment is limited. This study aims to examine the performance of the Adjusted Clinical Group (ACG case-mix system using claims-based diagnosis information from the Taiwanese NHI programme. Methods A random sample of NHI enrollees was selected. Those continuously enrolled in 2002 were included for concurrent analyses (n = 173,234, while those in both 2002 and 2003 were included for prospective analyses (n = 164,562. Health status measures derived from 2002 diagnoses were used to explain the 2002 and 2003 health expenditure. A multivariate linear regression model was adopted after comparing the performance of seven different statistical models. Split-validation was performed in order to avoid overfitting. The performance measures were adjusted R2 and mean absolute prediction error of five types of expenditure at individual level, and predictive ratio of total expenditure at group level. Results The more comprehensive models performed better when used for explaining resource utilization. Adjusted R2 of total expenditure in concurrent/prospective analyses were 4.2%/4.4% in the demographic model, 15%/10% in the ACGs or ADGs (Aggregated Diagnosis Group model, and 40%/22% in the models containing EDCs (Expanded Diagnosis Cluster. When predicting expenditure for groups based on expenditure quintiles, all models underpredicted the highest expenditure group and overpredicted the four other groups. For groups based on morbidity burden, the ACGs model had the best performance overall. Conclusions Given the

  10. An in-depth assessment of a diagnosis-based risk adjustment model based on national health insurance claims: the application of the Johns Hopkins Adjusted Clinical Group case-mix system in Taiwan.

    Science.gov (United States)

    Chang, Hsien-Yen; Weiner, Jonathan P

    2010-01-18

    Diagnosis-based risk adjustment is becoming an important issue globally as a result of its implications for payment, high-risk predictive modelling and provider performance assessment. The Taiwanese National Health Insurance (NHI) programme provides universal coverage and maintains a single national computerized claims database, which enables the application of diagnosis-based risk adjustment. However, research regarding risk adjustment is limited. This study aims to examine the performance of the Adjusted Clinical Group (ACG) case-mix system using claims-based diagnosis information from the Taiwanese NHI programme. A random sample of NHI enrollees was selected. Those continuously enrolled in 2002 were included for concurrent analyses (n = 173,234), while those in both 2002 and 2003 were included for prospective analyses (n = 164,562). Health status measures derived from 2002 diagnoses were used to explain the 2002 and 2003 health expenditure. A multivariate linear regression model was adopted after comparing the performance of seven different statistical models. Split-validation was performed in order to avoid overfitting. The performance measures were adjusted R2 and mean absolute prediction error of five types of expenditure at individual level, and predictive ratio of total expenditure at group level. The more comprehensive models performed better when used for explaining resource utilization. Adjusted R2 of total expenditure in concurrent/prospective analyses were 4.2%/4.4% in the demographic model, 15%/10% in the ACGs or ADGs (Aggregated Diagnosis Group) model, and 40%/22% in the models containing EDCs (Expanded Diagnosis Cluster). When predicting expenditure for groups based on expenditure quintiles, all models underpredicted the highest expenditure group and overpredicted the four other groups. For groups based on morbidity burden, the ACGs model had the best performance overall. Given the widespread availability of claims data and the superior explanatory

  11. What is the empirical evidence that hospitals with higher-risk adjusted mortality rates provide poorer quality care? A systematic review of the literature

    Directory of Open Access Journals (Sweden)

    Mohammed Mohammed A

    2007-06-01

    Full Text Available Abstract Background Despite increasing interest and publication of risk-adjusted hospital mortality rates, the relationship with underlying quality of care remains unclear. We undertook a systematic review to ascertain the extent to which variations in risk-adjusted mortality rates were associated with differences in quality of care. Methods We identified studies in which risk-adjusted mortality and quality of care had been reported in more than one hospital. We adopted an iterative search strategy using three databases – Medline, HealthSTAR and CINAHL from 1966, 1975 and 1982 respectively. We identified potentially relevant studies on the basis of the title or abstract. We obtained these papers and included those which met our inclusion criteria. Results From an initial yield of 6,456 papers, 36 studies met the inclusion criteria. Several of these studies considered more than one process-versus-risk-adjusted mortality relationship. In total we found 51 such relationships in a widen range of clinical conditions using a variety of methods. A positive correlation between better quality of care and risk-adjusted mortality was found in under half the relationships (26/51 51% but the remainder showed no correlation (16/51 31% or a paradoxical correlation (9/51 18%. Conclusion The general notion that hospitals with higher risk-adjusted mortality have poorer quality of care is neither consistent nor reliable.

  12. Phenotypic plasticity in anti-intraguild predator strategies: mite larvae adjust their behaviours according to vulnerability and predation risk.

    Science.gov (United States)

    Walzer, Andreas; Schausberger, Peter

    2013-05-01

    Interspecific threat-sensitivity allows prey to maximize the net benefit of antipredator strategies by adjusting the type and intensity of their response to the level of predation risk. This is well documented for classical prey-predator interactions but less so for intraguild predation (IGP). We examined threat-sensitivity in antipredator behaviour of larvae in a predatory mite guild sharing spider mites as prey. The guild consisted of the highly vulnerable intraguild (IG) prey and weak IG predator Phytoseiulus persimilis, the moderately vulnerable IG prey and moderate IG predator Neoseiulus californicus and the little vulnerable IG prey and strong IG predator Amblyseius andersoni. We videotaped the behaviour of the IG prey larvae of the three species in presence of either a low- or a high-risk IG predator female or predator absence and analysed time, distance, path shape and interaction parameters of predators and prey. The least vulnerable IG prey A. andersoni was insensitive to differing IGP risks but the moderately vulnerable IG prey N. californicus and the highly vulnerable IG prey P. persimilis responded in a threat-sensitive manner. Predator presence triggered threat-sensitive behavioural changes in one out of ten measured traits in N. californicus larvae but in four traits in P. persimilis larvae. Low-risk IG predator presence induced a typical escape response in P. persimilis larvae, whereas they reduced their activity in the high-risk IG predator presence. We argue that interspecific threat-sensitivity may promote co-existence of IG predators and IG prey and should be common in predator guilds with long co-evolutionary history.

  13. Willingness to pay for a quality-adjusted life year: an evaluation of attitudes towards risk and preferences.

    Science.gov (United States)

    Martín-Fernández, Jesus; Polentinos-Castro, Elena; del Cura-González, Ma Isabel; Ariza-Cardiel, Gloria; Abraira, Victor; Gil-LaCruz, Ana Isabel; García-Pérez, Sonia

    2014-07-03

    This paper examines the Willingness to Pay (WTP) for a quality-adjusted life year (QALY) expressed by people who attended the healthcare system as well as the association of attitude towards risk and other personal characteristics with their response. Health-state preferences, measured by EuroQol (EQ-5D-3L), were combined with WTP for recovering a perfect health state. WTP was assessed using close-ended, iterative bidding, contingent valuation method. Data on demographic and socioeconomic characteristics, as well as usage of health services by the subjects were collected. The attitude towards risk was evaluated by collecting risky behaviors data, by the subject's self-evaluation, and through lottery games. Six hundred and sixty two subjects participated and 449 stated a utility inferior to 1. WTP/QALY ratios varied significantly when payments with personal money (mean €10,119; median €673) or through taxes (mean €28,187; median €915) were suggested. Family income, area income, higher education level, greater use of healthcare services, and the number of co-inhabitants were associated with greater WTP/QALY ratios. Age and female gender were associated with lower WTP/QALY ratios. Risk inclination was independently associated with a greater WTP/QALY when "out of pocket" payments were suggested. Clear discrepancies were demonstrated between linearity and neutrality towards risk assumptions and experimental results. WTP/QALY ratios vary noticeably based on demographic and socioeconomic characteristics of the subject, but also on their attitude towards risk. Knowing the expression of preferences by patients from this outcome measurement can be of interest for health service planning.

  14. Competing Risk Approach (CRA) for Estimation of Disability Adjusted Life Years (DALY's) for Female Breast Cancer in India.

    Science.gov (United States)

    Kunnavil, Radhika; Thirthahalli, Chethana; Nooyi, Shalini Chandrashekar; Shivaraj, N S; Murthy, Nandagudi Srinivasa

    2015-10-01

    Competing Risk Approach (CRA) has been used to compute burden of disease in terms of Disability Adjusted Life Years (DALYs) based on a life table for an initially disease-free cohort over time. To compute Years of Life Lost (YLL) due to premature mortality, Years of life lost due to Disability (YLD), DALYs and loss in expectation of life (LEL) using competing risk approach for female breast cancer patients for the year 2008 in India. The published data on breast cancer by age & sex, incidence & mortality for the year 2006-2008 relating to six population based cancer registries (PBCR) under Indian Council of Medical Research (ICMR), general mortality rates of 2007 in India, published in national health profile 2010; based on Sample Registration System (SRS) were utilized for computations. Three life tables were constructed by applying attrition of factors: (i) risk of death from all causes ('a'; where a is the general death rate); (ii) risk of incidence and that of death from causes other than breast cancer ('b-a+c'; where 'b' is the incidence of breast cancer and 'c' is the mortality of breast cancer); and (iii) risk of death from all other causes after excluding cancer mortality ('a-c'). Taking the differences in Total Person Years Lived (TPYL), YLD and YLL were derived along with LEL. CRA revealed that the DALYs were 40209 per 100,000 females in the life time of 0-70+ years with a LEL of 0.11 years per person. Percentage of YLL to DALYs was 28.20% in the cohort. The method of calculation of DALYs based on the CRA is simple and this will help to identify the burden of diseases using minimal information in terms of YLL, YLD, DALYs and LEL.

  15. Mandatory pooling as a supplement to risk-adjusted capitation payments in a competitive health insurance market.

    Science.gov (United States)

    Van Barneveld, E M; Lamers, L M; van Vliet, R C; van de Ven, W P

    1998-07-01

    Risk-adjusted capitation payments (RACPs) to competing health insurers are an essential element of market-oriented health care reforms in many countries. RACPs based on demographic variables only are insufficient, because they leave ample room for cream skimming. However, the implementation of improved RACPs does not appear to be straightforward. A solution might be to supplement imperfect RACPs with a form of mandatory pooling that reduces the incentives for cream skimming. In a previous paper it was concluded that high-risk pooling (HRP), is a promising supplement to RACPs. The purpose of this paper is to compare HRP with two other main variants of mandatory pooling. These variants are called excess-of-loss (EOL) and proportional pooling (PP). Each variant includes ex post compensations to insurers for some members which depend to various degrees on actually incurred costs. Therefore, these pooling variants reduce the incentives for cream skimming which are inherent in imperfect RACPs, but they also reduce the incentives for efficiency and cost containment. As a rough measure of the latter incentives we use the percentage of total costs for which an insurer is at risk. This paper analyzes which of the three main pooling variants yields the greatest reduction of incentives for cream skimming given such a percentage. The results show that HRP is the most effective of the three pooling variants.

  16. Risk and protection factors in the peer context: how do other children contribute to the psychosocial adjustment of the adolescent?

    Directory of Open Access Journals (Sweden)

    Marie-Hélène Véronneau

    2014-03-01

    Full Text Available As children become adolescents, peers assume greater importance in their lives. Peer experiences can either help them thrive or negatively affect their psychosocial adjustment. In this review article definitions for the types of peer experiences are provided followed by an overview of common psychosocial issues encountered by adolescents. Past research that has pointed to risk and protection factors that emerge from peer experiences during adolescence and the role of peer influences in the context of current issues relevant to adolescent education are discussed. Research suggests that friendships with deviant peers, involvement in bullying and the experience of rejection from the overall peer group are related to adjustment problems, whereas friendships with prosocial and academically oriented peers and social acceptance in the peer group are related to healthy development. Friendship quality, popularity among peers, and involvement in friendship cliques cannot be clearly categorized as either positive or negative influences, because they interact with other factors in shaping the development of adolescents. The promotion of social skills and positive youth leadership as an integral part of the student's learning process in school is recommended.

  17. A risk-adjusted financial model to estimate the cost of a video-assisted thoracoscopic surgery lobectomy programme.

    Science.gov (United States)

    Brunelli, Alessandro; Tentzeris, Vasileios; Sandri, Alberto; McKenna, Alexandra; Liew, Shan Liung; Milton, Richard; Chaudhuri, Nilanjan; Kefaloyannis, Emmanuel; Papagiannopoulos, Kostas

    2016-05-01

    To develop a clinically risk-adjusted financial model to estimate the cost associated with a video-assisted thoracoscopic surgery (VATS) lobectomy programme. Prospectively collected data of 236 VATS lobectomy patients (August 2012-December 2013) were analysed retrospectively. Fixed and variable intraoperative and postoperative costs were retrieved from the Hospital Accounting Department. Baseline and surgical variables were tested for a possible association with total cost using a multivariable linear regression and bootstrap analyses. Costs were calculated in GBP and expressed in Euros (EUR:GBP exchange rate 1.4). The average total cost of a VATS lobectomy was €11 368 (range €6992-€62 535). Average intraoperative (including surgical and anaesthetic time, overhead, disposable materials) and postoperative costs [including ward stay, high dependency unit (HDU) or intensive care unit (ICU) and variable costs associated with management of complications] were €8226 (range €5656-€13 296) and €3029 (range €529-€51 970), respectively. The following variables remained reliably associated with total costs after linear regression analysis and bootstrap: carbon monoxide lung diffusion capacity (DLCO) 0.05) in 86% of the samples. A hypothetical patient with COPD and DLCO less than 60% would cost €4270 more than a patient without COPD and with higher DLCO values (€14 793 vs €10 523). Risk-adjusting financial data can help estimate the total cost associated with VATS lobectomy based on clinical factors. This model can be used to audit the internal financial performance of a VATS lobectomy programme for budgeting, planning and for appropriate bundled payment reimbursements. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  18. Risk adjustment of health-care performance measures in a multinational register-based study: A pragmatic approach to a complicated topic

    Directory of Open Access Journals (Sweden)

    Tron Anders Moger

    2014-03-01

    Full Text Available Objectives: Health-care performance comparisons across countries are gaining popularity. In such comparisons, the risk adjustment methodology plays a key role for meaningful comparisons. However, comparisons may be complicated by the fact that not all participating countries are allowed to share their data across borders, meaning that only simple methods are easily used for the risk adjustment. In this study, we develop a pragmatic approach using patient-level register data from Finland, Hungary, Italy, Norway, and Sweden. Methods: Data on acute myocardial infarction patients were gathered from health-care registers in several countries. In addition to unadjusted estimates, we studied the effects of adjusting for age, gender, and a number of comorbidities. The stability of estimates for 90-day mortality and length of stay of the first hospital episode following diagnosis of acute myocardial infarction is studied graphically, using different choices of reference data. Logistic regression models are used for mortality, and negative binomial models are used for length of stay. Results: Results from the sensitivity analysis show that the various models of risk adjustment give similar results for the countries, with some exceptions for Hungary and Italy. Based on the results, in Finland and Hungary, the 90-day mortality after acute myocardial infarction is higher than in Italy, Norway, and Sweden. Conclusion: Health-care registers give encouraging possibilities to performance measurement and enable the comparison of entire patient populations between countries. Risk adjustment methodology is affected by the availability of data, and thus, the building of risk adjustment methodology must be transparent, especially when doing multinational comparative research. In that case, even basic methods of risk adjustment may still be valuable.

  19. Response Adjusted for Days of Antibiotic Risk (RADAR): evaluation of a novel method to compare strategies to optimize antibiotic use.

    Science.gov (United States)

    Schweitzer, V A; van Smeden, M; Postma, D F; Oosterheert, J J; Bonten, M J M; van Werkhoven, C H

    2017-12-01

    The Response Adjusted for Days of Antibiotic Risk (RADAR) statistic was proposed to improve the efficiency of trials comparing antibiotic stewardship strategies to optimize antibiotic use. We studied the behaviour of RADAR in a non-inferiority trial in which a β-lactam monotherapy strategy (n = 656) was non-inferior to fluoroquinolone monotherapy (n = 888) for patients with moderately severe community-acquired pneumonia. Patients were ranked according to clinical outcome, using five or eight categories, and antibiotic use. RADAR was calculated as the probability that the β-lactam group had a more favourable ranking than the fluoroquinolone group. To investigate the sensitivity of RADAR to detrimental clinical outcome we simulated increasing rates of 90-day mortality in the β-lactam group and performed the RADAR and non-inferiority analysis. The RADAR of the β-lactam group compared with the fluoroquinolone group was 60.3% (95% CI 57.9%-62.7%) using five and 58.4% (95% CI 56.0%-60.9%) using eight clinical outcome categories, all in favour of β-lactam. Sample sizes for RADAR were 38% (250/653) and 89% (580/653) of the non-inferiority sample size calculation, using five or eight clinical outcome categories, respectively. With simulated mortality rates, loss of non-inferiority of the β-lactam group occurred at a relative risk of 1.125 in the conventional analysis, whereas using RADAR the β-lactam group lost superiority at a relative risk of mortality of 1.25 and 1.5, with eight and five clinical outcome categories, respectively. RADAR favoured β-lactam over fluoroquinolone therapy for community-acquired pneumonia. Although RADAR required fewer patients than conventional non-inferiority analysis, the statistic was less sensitive to detrimental outcomes. Copyright © 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  20. Burden of typhoid fever in low-income and middle-income countries: a systematic, literature-based update with risk-factor adjustment.

    Science.gov (United States)

    Mogasale, Vittal; Maskery, Brian; Ochiai, R Leon; Lee, Jung Seok; Mogasale, Vijayalaxmi V; Ramani, Enusa; Kim, Young Eun; Park, Jin Kyung; Wierzba, Thomas F

    2014-10-01

    No access to safe water is an important risk factor for typhoid fever, yet risk-level heterogeneity is unaccounted for in previous global burden estimates. Since WHO has recommended risk-based use of typhoid polysaccharide vaccine, we revisited the burden of typhoid fever in low-income and middle-income countries (LMICs) after adjusting for water-related risk. We estimated the typhoid disease burden from studies done in LMICs based on blood-culture-confirmed incidence rates applied to the 2010 population, after correcting for operational issues related to surveillance, limitations of diagnostic tests, and water-related risk. We derived incidence estimates, correction factors, and mortality estimates from systematic literature reviews. We did scenario analyses for risk factors, diagnostic sensitivity, and case fatality rates, accounting for the uncertainty in these estimates and we compared them with previous disease burden estimates. The estimated number of typhoid fever cases in LMICs in 2010 after adjusting for water-related risk was 11·9 million (95% CI 9·9-14·7) cases with 129 000 (75 000-208 000) deaths. By comparison, the estimated risk-unadjusted burden was 20·6 million (17·5-24·2) cases and 223 000 (131 000-344 000) deaths. Scenario analyses indicated that the risk-factor adjustment and updated diagnostic test correction factor derived from systematic literature reviews were the drivers of differences between the current estimate and past estimates. The risk-adjusted typhoid fever burden estimate was more conservative than previous estimates. However, by distinguishing the risk differences, it will allow assessment of the effect at the population level and will facilitate cost-effectiveness calculations for risk-based vaccination strategies for future typhoid conjugate vaccine. Copyright © 2014 Mogasale et al. Open Access article distributed under the terms of CC BY-NC-SA. Published by .. All rights reserved.

  1. The Effect of Adding Comorbidities to Current Centers for Disease Control and Prevention Central-Line-Associated Bloodstream Infection Risk-Adjustment Methodology.

    Science.gov (United States)

    Jackson, Sarah S; Leekha, Surbhi; Magder, Laurence S; Pineles, Lisa; Anderson, Deverick J; Trick, William E; Woeltje, Keith F; Kaye, Keith S; Stafford, Kristen; Thom, Kerri; Lowe, Timothy J; Harris, Anthony D

    2017-09-01

    BACKGROUND Risk adjustment is needed to fairly compare central-line-associated bloodstream infection (CLABSI) rates between hospitals. Until 2017, the Centers for Disease Control and Prevention (CDC) methodology adjusted CLABSI rates only by type of intensive care unit (ICU). The 2017 CDC models also adjust for hospital size and medical school affiliation. We hypothesized that risk adjustment would be improved by including patient demographics and comorbidities from electronically available hospital discharge codes. METHODS Using a cohort design across 22 hospitals, we analyzed data from ICU patients admitted between January 2012 and December 2013. Demographics and International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) discharge codes were obtained for each patient, and CLABSIs were identified by trained infection preventionists. Models adjusting only for ICU type and for ICU type plus patient case mix were built and compared using discrimination and standardized infection ratio (SIR). Hospitals were ranked by SIR for each model to examine and compare the changes in rank. RESULTS Overall, 85,849 ICU patients were analyzed and 162 (0.2%) developed CLABSI. The significant variables added to the ICU model were coagulopathy, paralysis, renal failure, malnutrition, and age. The C statistics were 0.55 (95% CI, 0.51-0.59) for the ICU-type model and 0.64 (95% CI, 0.60-0.69) for the ICU-type plus patient case-mix model. When the hospitals were ranked by adjusted SIRs, 10 hospitals (45%) changed rank when comorbidity was added to the ICU-type model. CONCLUSIONS Our risk-adjustment model for CLABSI using electronically available comorbidities demonstrated better discrimination than did the CDC model. The CDC should strongly consider comorbidity-based risk adjustment to more accurately compare CLABSI rates across hospitals. Infect Control Hosp Epidemiol 2017;38:1019-1024.

  2. Odds per adjusted standard deviation: comparing strengths of associations for risk factors measured on different scales and across diseases and populations.

    Science.gov (United States)

    Hopper, John L

    2015-11-15

    How can the "strengths" of risk factors, in the sense of how well they discriminate cases from controls, be compared when they are measured on different scales such as continuous, binary, and integer? Given that risk estimates take into account other fitted and design-related factors-and that is how risk gradients are interpreted-so should the presentation of risk gradients. Therefore, for each risk factor X0, I propose using appropriate regression techniques to derive from appropriate population data the best fitting relationship between the mean of X0 and all the other covariates fitted in the model or adjusted for by design (X1, X2, … , Xn). The odds per adjusted standard deviation (OPERA) presents the risk association for X0 in terms of the change in risk per s = standard deviation of X0 adjusted for X1, X2, … , Xn, rather than the unadjusted standard deviation of X0 itself. If the increased risk is relative risk (RR)-fold over A adjusted standard deviations, then OPERA = exp[ln(RR)/A] = RR(s). This unifying approach is illustrated by considering breast cancer and published risk estimates. OPERA estimates are by definition independent and can be used to compare the predictive strengths of risk factors across diseases and populations. © The Author 2015. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  3. The relationship between the C-statistic of a risk-adjustment model and the accuracy of hospital report cards: a Monte Carlo Study.

    Science.gov (United States)

    Austin, Peter C; Reeves, Mathew J

    2013-03-01

    Hospital report cards, in which outcomes following the provision of medical or surgical care are compared across health care providers, are being published with increasing frequency. Essential to the production of these reports is risk-adjustment, which allows investigators to account for differences in the distribution of patient illness severity across different hospitals. Logistic regression models are frequently used for risk adjustment in hospital report cards. Many applied researchers use the c-statistic (equivalent to the area under the receiver operating characteristic curve) of the logistic regression model as a measure of the credibility and accuracy of hospital report cards. To determine the relationship between the c-statistic of a risk-adjustment model and the accuracy of hospital report cards. Monte Carlo simulations were used to examine this issue. We examined the influence of 3 factors on the accuracy of hospital report cards: the c-statistic of the logistic regression model used for risk adjustment, the number of hospitals, and the number of patients treated at each hospital. The parameters used to generate the simulated datasets came from analyses of patients hospitalized with a diagnosis of acute myocardial infarction in Ontario, Canada. The c-statistic of the risk-adjustment model had, at most, a very modest impact on the accuracy of hospital report cards, whereas the number of patients treated at each hospital had a much greater impact. The c-statistic of a risk-adjustment model should not be used to assess the accuracy of a hospital report card.

  4. The impact of aortic manipulation on neurologic outcomes after coronary artery bypass surgery: a risk-adjusted study.

    Science.gov (United States)

    Kapetanakis, Emmanouil I; Stamou, Sotiris C; Dullum, Mercedes K C; Hill, Peter C; Haile, Elizabeth; Boyce, Steven W; Bafi, Ammar S; Petro, Kathleen R; Corso, Paul J

    2004-11-01

    Cerebral embolization of atherosclerotic plaque debris caused by aortic manipulation during conventional coronary artery bypass grafting (CABG) is a major mechanism of postoperative cerebrovascular accidents (CVA). Off-pump CABG (OPCABG) reduces stroke rates by minimizing aortic manipulation. Consequently, the effect of different levels of aortic manipulation on neurologic outcomes after CABG surgery was examined. From January 1998 to June 2002, 7,272 patients underwent isolated CABG surgery through three levels of aortic manipulation: full plus tangential (side-biting) aortic clamp application (on-pump surgery; n = 4,269), only tangential aortic clamp application (OPCABG surgery; n = 2,527) or an "aortic no-touch" technique (OPCABG surgery; n = 476). A risk-adjusted logistic regression analysis was performed to establish the likelihood of postoperative stroke with each technique. Preoperative risk factors for stroke from the literature, and those found significant in a univariable model were used. A significant association for postoperative stroke correspondingly increasing with the extent of aortic manipulation was demonstrated by the univariable analysis (CVA incidence respectively increasing from 0.8% to 1.6% to a maximum of 2.2%, p < 0.01). In the logistic regression model, patients who had a full and a tangential aortic clamp applied were 1.8 times more likely to have a stroke versus those without any aortic manipulation (95% confidence interval: 1.15 to 2.74, p < 0.01) and 1.7 times more likely to develop a postoperative stroke than those with only a tangential aortic clamp applied (95% confidence interval: 1.11 to 2.48, p < 0.01). Aortic manipulation during CABG is a contributing mechanism for postoperative stroke. The incidence of postoperative stroke increases with increased levels of aortic manipulation.

  5. Risk adjustment models for interhospital comparison of CS rates using Robson's ten group classification system and other socio-demographic and clinical variables.

    Science.gov (United States)

    Colais, Paola; Fantini, Maria P; Fusco, Danilo; Carretta, Elisa; Stivanello, Elisa; Lenzi, Jacopo; Pieri, Giulia; Perucci, Carlo A

    2012-06-21

    Caesarean section (CS) rate is a quality of health care indicator frequently used at national and international level. The aim of this study was to assess whether adjustment for Robson's Ten Group Classification System (TGCS), and clinical and socio-demographic variables of the mother and the fetus is necessary for inter-hospital comparisons of CS rates. The study population includes 64,423 deliveries in Emilia-Romagna between January 1, 2003 and December 31, 2004, classified according to theTGCS. Poisson regression was used to estimate crude and adjusted hospital relative risks of CS compared to a reference category. Analyses were carried out in the overall population and separately according to the Robson groups (groups I, II, III, IV and V-X combined). Adjusted relative risks (RR) of CS were estimated using two risk-adjustment models; the first (M1) including the TGCS group as the only adjustment factor; the second (M2) including in addition demographic and clinical confounders identified using a stepwise selection procedure. Percentage variations between crude and adjusted RRs by hospital were calculated to evaluate the confounding effect of covariates. The percentage variations from crude to adjusted RR proved to be similar in M1 and M2 model. However, stratified analyses by Robson's classification groups showed that residual confounding for clinical and demographic variables was present in groups I (nulliparous, single, cephalic, ≥37 weeks, spontaneous labour) and III (multiparous, excluding previous CS, single, cephalic, ≥37 weeks, spontaneous labour) and IV (multiparous, excluding previous CS, single, cephalic, ≥37 weeks, induced or CS before labour) and to a minor extent in groups II (nulliparous, single, cephalic, ≥37 weeks, induced or CS before labour) and IV (multiparous, excluding previous CS, single, cephalic, ≥37 weeks, induced or CS before labour). The TGCS classification is useful for inter-hospital comparison of CS section rates, but

  6. Convexity Adjustments

    DEFF Research Database (Denmark)

    M. Gaspar, Raquel; Murgoci, Agatha

    2010-01-01

    A convexity adjustment (or convexity correction) in fixed income markets arises when one uses prices of standard (plain vanilla) products plus an adjustment to price nonstandard products. We explain the basic and appealing idea behind the use of convexity adjustments and focus on the situations...

  7. Psychosocial Adjustment over a Two-Year Period in Children Referred for Learning Problems: Risk, Resilience, and Adaptation.

    Science.gov (United States)

    Sorensen, Lisa G.; Forbes, Peter W.; Bernstein, Jane H.; Weiler, Michael D.; Mitchell, William M.; Waber, Deborah P.

    2003-01-01

    A 2-year study evaluated the relationship among psychosocial adjustment, changes in academic skills, and contextual factors in 100 children (ages 7-11) with learning problems. Contextual variables were significantly associated with psychosocial adaptation, including the effectiveness of the clinical assessment, extent of academic support, and the…

  8. Parental Dysphoria and Children's Adjustment: Marital Conflict Styles, Children's Emotional Security, and Parenting as Mediators of Risk

    Science.gov (United States)

    Du Rocher Schudlich, Tina D.; Cummings, E. Mark

    2007-01-01

    Dimensions of martial conflict, children's emotional security regarding interparental conflict, and parenting style were examined as mediators between parental dysphoria and child adjustment. A community sample of 262 children, ages 8-16, participated with their parents. Behavioral observations were made of parents' interactions during marital…

  9. The predictive value of an adjusted COPD assessment test score on the risk of respiratory-related hospitalizations in severe COPD patients.

    Science.gov (United States)

    Barton, Christopher A; Bassett, Katherine L; Buckman, Julie; Effing, Tanja W; Frith, Peter A; van der Palen, Job; Sloots, Joanne M

    2017-02-01

    We evaluated whether a chronic obstructive pulmonary disease (COPD) assessment test (CAT) with adjusted weights for the CAT items could better predict future respiratory-related hospitalizations than the original CAT. Two focus groups (respiratory nurses and physicians) generated two adjusted CAT algorithms. Two multivariate logistic regression models for infrequent (≤1/year) versus frequent (>1/year) future respiratory-related hospitalizations were defined: one with the adjusted CAT score that correlated best with future hospitalizations and one with the original CAT score. Patient characteristics related to future hospitalizations ( p ≤ 0.2) were also entered. Eighty-two COPD patients were included. The CAT algorithm derived from the nurse focus group was a borderline significant predictor of hospitalization risk (odds ratio (OR): 1.07; 95% confidence interval (CI): 1.00-1.14; p = 0.050) in a model that also included hospitalization frequency in the previous year (OR: 3.98; 95% CI: 1.30-12.16; p = 0.016) and anticholinergic risk score (OR: 3.08; 95% CI: 0.87-10.89; p = 0.081). Presence of ischemic heart disease and/or heart failure appeared 'protective' (OR: 0.17; 95% CI: 0.05-0.62; p = 0.007). The original CAT score was not significantly associated with hospitalization risk. In conclusion, as a predictor of respiratory-related hospitalizations, an adjusted CAT score was marginally significant (although the original CAT score was not). 'Previous respiratory-related hospitalizations' was the strongest factor in this equation.

  10. Risk, Conflict, Mothers' Parenting, and Children's Adjustment in Low-Income, Mexican Immigrant, and Mexican American Families.

    Science.gov (United States)

    Dumka, Larry E.; Roosa, Mark W.; Jackson, Kristina M.

    1997-01-01

    Reports on a test of a risk-stress process model. Examines the influence of mothers' supportive parenting and inconsistent discipline practices on risk factors and family conflict as these affect children's conduct disorder and depression. Tests on 121 families indicate that mothers' supportive patenting partially mediated family conflict effects…

  11. Environmental factors and social adjustment as predictors of a first psychosis in subjects at ultra high risk

    NARCIS (Netherlands)

    Dragt, Sara; Nieman, Dorien H.; Veltman, Doede; Becker, Hiske E.; van de Fliert, Reinaud; de Haan, Lieuwe; Linszen, Don H.

    2011-01-01

    BACKGROUND: The onset of schizophrenia is associated with genetic, symptomatic, social and environmental risk factors. The aim of the present study was to determine which environmental factors may contribute to a prediction of a first psychotic episode in subjects at Ultra High Risk (UHR) for

  12. Refined estimates of local recurrence risks by DCIS score adjusting for clinicopathological features: a combined analysis of ECOG-ACRIN E5194 and Ontario DCIS cohort studies.

    Science.gov (United States)

    Rakovitch, E; Gray, R; Baehner, F L; Sutradhar, R; Crager, M; Gu, S; Nofech-Mozes, S; Badve, S S; Hanna, W; Hughes, L L; Wood, W C; Davidson, N E; Paszat, L; Shak, S; Sparano, J A; Solin, L J

    2018-06-01

    Better tools are needed to estimate local recurrence (LR) risk after breast-conserving surgery (BCS) for DCIS. The DCIS score (DS) was validated as a predictor of LR in E5194 and Ontario DCIS cohort (ODC) after BCS. We combined data from E5194 and ODC adjusting for clinicopathological factors to provide refined estimates of the 10-year risk of LR after treatment by BCS alone. Data from E5194 and ODC were combined. Patients with positive margins or multifocality were excluded. Identical Cox regression models were fit for each study. Patient-specific meta-analysis was used to calculate precision-weighted estimates of 10-year LR risk by DS, age, tumor size and year of diagnosis. The combined cohort includes 773 patients. The DS and age at diagnosis, tumor size and year of diagnosis provided independent prognostic information on the 10-year LR risk (p ≤ 0.009). Hazard ratios from E5194 and ODC cohorts were similar for the DS (2.48, 1.95 per 50 units), tumor size ≤ 1 versus  > 1-2.5 cm (1.45, 1.47), age ≥ 50 versus  15%) 10-year LR risk after BCS alone compared to utilization of DS alone or clinicopathological factors alone. The combined analysis provides refined estimates of 10-year LR risk after BCS for DCIS. Adding information on tumor size and age at diagnosis to the DS adjusting for year of diagnosis provides improved LR risk estimates to guide treatment decision making.

  13. COX-2 rs689466, rs5275, and rs20417 polymorphisms and risk of head and neck squamous cell carcinoma: a meta-analysis of adjusted and unadjusted data

    International Nuclear Information System (INIS)

    Leng, Wei-Dong; Wen, Xiu-Jie; Kwong, Joey S. W.; Huang, Wei; Chen, Jian-Gang; Zeng, Xian-Tao

    2016-01-01

    Numerous case–control studies have been performed to investigate the association between three cyclooxygenase-2 (COX-2) polymorphisms (rs20417 (−765G > C), rs689466 (−1195G > A), and rs5275 (8473 T > C)) and the risk of head and neck squamous cell carcinoma (HNSCC). However, the results were inconsistent. Therefore, we conducted this meta-analysis to investigate the association. We searched in PubMed, Embase, and Web of Science up to January 20, 2015 (last updated on May 12, 2016). Two independent reviewers extracted the data. Odds ratios (ORs) with their 95 % confidence intervals (CIs) were used to assess the association. All statistical analyses were performed using the Review Manager (RevMan) 5.2 software. Finally 8 case–control studies were included in this meta-analysis. For unadjusted data, an association with increased risk was observed in three genetic models in COX-2 rs689466 polymorphism; however, COX-2 rs5275 and rs20417 polymorphisms were not related to HNSCC risk in this study. The pooled results from adjusted data all revealed non-significant association between these three polymorphisms and risk of HNSCC. We also found a similar result in the subgroup analyses, based on both unadjusted data and adjusted data. Current results suggest that COX-2 rs689466, rs5275, and rs20417 polymorphisms are not associated with HNSCC. Further large and well-designed studies are necessary to validate this association

  14. Infections and risk-adjusted length of stay and hospital mortality in Polish Neonatology Intensive Care Units

    Directory of Open Access Journals (Sweden)

    A. Różańska

    2015-06-01

    Conclusions: The general condition of VLBW infants statistically increase both their risk of mortality and LOS; this is in contrast to the presence of infection, which significantly prolonged LOS only.

  15. A typology of interpartner conflict and maternal parenting practices in high-risk families: examining spillover and compensatory models and implications for child adjustment.

    Science.gov (United States)

    Sturge-Apple, Melissa L; Davies, Patrick T; Cicchetti, Dante; Fittoria, Michael G

    2014-11-01

    The present study incorporates a person-based approach to identify spillover and compartmentalization patterns of interpartner conflict and maternal parenting practices in an ethnically diverse sample of 192 2-year-old children and their mothers who had experienced higher levels of socioeconomic risk. In addition, we tested whether sociocontextual variables were differentially predictive of theses profiles and examined how interpartner-parenting profiles were associated with children's physiological and psychological adjustment over time. As expected, latent class analyses extracted three primary profiles of functioning: adequate functioning, spillover, and compartmentalizing families. Furthermore, interpartner-parenting profiles were differentially associated with both sociocontextual predictors and children's adjustment trajectories. The findings highlight the developmental utility of incorporating person-based approaches to models of interpartner conflict and maternal parenting practices.

  16. Is use of fall risk-increasing drugs in an elderly population associated with an increased risk of hip fracture, after adjustment for multimorbidity level

    DEFF Research Database (Denmark)

    Thorell, Kristine; Ranstad, Karin; Midlöv, Patrik

    2014-01-01

    BACKGROUND: Risk factors for hip fracture are well studied because of the negative impact on patients and the community, with mortality in the first year being almost 30% in the elderly. Age, gender and fall risk-increasing drugs, identified by the National Board of Health and Welfare in Sweden......, are well known risk factors for hip fracture, but how multimorbidity level affects the risk of hip fracture during use of fall risk-increasing drugs is to our knowledge not as well studied. This study explored the relationship between use of fall risk-increasing drugs in combination with multimorbidity...... level and risk of hip fracture in an elderly population. METHODS: Data were from Östergötland County, Sweden, and comprised the total population in the county aged 75 years and older during 2006. The odds ratio (OR) for hip fracture during use of fall risk-increasing drugs was calculated by multivariate...

  17. The Impact of Disability and Social Determinants of Health on Condition-Specific Readmissions beyond Medicare Risk Adjustments: A Cohort Study.

    Science.gov (United States)

    Meddings, Jennifer; Reichert, Heidi; Smith, Shawna N; Iwashyna, Theodore J; Langa, Kenneth M; Hofer, Timothy P; McMahon, Laurence F

    2017-01-01

    Readmission rates after pneumonia, heart failure, and acute myocardial infarction hospitalizations are risk-adjusted for age, gender, and medical comorbidities and used to penalize hospitals. To assess the impact of disability and social determinants of health on condition-specific readmissions beyond current risk adjustment. Retrospective cohort study of Medicare patients using 1) linked Health and Retirement Study-Medicare claims data (HRS-CMS) and 2) Healthcare Cost and Utilization Project State Inpatient Databases (Florida, Washington) linked with ZIP Code-level measures from the Census American Community Survey (ACS-HCUP). Multilevel logistic regression models assessed the impact of disability and selected social determinants of health on readmission beyond current risk adjustment. Outcomes measured were readmissions ≤30 days after hospitalizations for pneumonia, heart failure, or acute myocardial infarction. HRS-CMS models included disability measures (activities of daily living [ADL] limitations, cognitive impairment, nursing home residence, home healthcare use) and social determinants of health (spouse, children, wealth, Medicaid, race). ACS-HCUP model measures were ZIP Code-percentage of residents ≥65 years of age with ADL difficulty, spouse, income, Medicaid, and patient-level and hospital-level race. For pneumonia, ≥3 ADL difficulties (OR 1.61, CI 1.079-2.391) and prior home healthcare needs (OR 1.68, CI 1.204-2.355) increased readmission in HRS-CMS models (N = 1631); ADL difficulties (OR 1.20, CI 1.063-1.352) and 'other' race (OR 1.14, CI 1.001-1.301) increased readmission in ACS-HCUP models (N = 27,297). For heart failure, children (OR 0.66, CI 0.437-0.984) and wealth (OR 0.53, CI 0.349-0.787) lowered readmission in HRS-CMS models (N = 2068), while black (OR 1.17, CI 1.056-1.292) and 'other' race (OR 1.14, CI 1.036-1.260) increased readmission in ACS-HCUP models (N = 37,612). For acute myocardial infarction, nursing home status

  18. Cumulative Socioeconomic Status Risk, Allostatic Load, and Adjustment: A Prospective Latent Profile Analysis with Contextual and Genetic Protective Factors

    Science.gov (United States)

    Brody, Gene H.; Yu, Tianyi; Chen, Yi-Fu; Kogan, Steven M.; Evans, Gary W.; Beach, Steven R. H.; Windle, Michael; Simons, Ronald L.; Gerrard, Meg; Gibbons, Frederick X.; Philibert, Robert A.

    2013-01-01

    The health disparities literature has identified a common pattern among middle-aged African Americans that includes high rates of chronic disease along with low rates of psychiatric disorders despite exposure to high levels of cumulative socioeconomic status (SES) risk. The current study was designed to test hypotheses about the developmental…

  19. Acculturation and Adjustment in Latino Adolescents: How Cultural Risk Factors and Assets Influence Multiple Domains of Adolescent Mental Health

    Science.gov (United States)

    Smokowski, Paul; Buchanan, Rachel L.; Bacallao, Martica L.

    2009-01-01

    The purpose of this study was to examine the relationships among risk factors, cultural assets, and Latino adolescent mental health outcomes. We extend past research by using a longitudinal design and evaluating direct and moderated acculturation effects across a range of internalizing, externalizing, and academic engagement outcomes. The sample…

  20. Asymmetric adjustment

    NARCIS (Netherlands)

    2010-01-01

    A method of adjusting a signal processing parameter for a first hearing aid and a second hearing aid forming parts of a binaural hearing aid system to be worn by a user is provided. The binaural hearing aid system comprises a user specific model representing a desired asymmetry between a first ear

  1. External adjustment of unmeasured confounders in a case-control study of benzodiazepine use and cancer risk

    DEFF Research Database (Denmark)

    Thygesen, Lau Caspar; Pottegård, Anton; Ersbøll, Annette Kjaer

    2017-01-01

    AIMS: Previous studies have reported diverging results on the association between benzodiazepine use and cancer risk. METHODS: We investigated this association in a matched case-control study including incident cancer cases during 2002-2009 in the Danish Cancer Registry (n = 94 923) and age......% confidence interval 1.00-1.19) and for smoking-related cancers from 1.20 to 1.10 (95% confidence interval 1.00-1.21). CONCLUSION: We conclude that the increased risk observed in the solely register-based study could partly be attributed to unmeasured confounding....... PSs were used: The error-prone PS using register-based confounders and the calibrated PS based on both register- and survey-based confounders, retrieved from the Health Interview Survey. RESULTS: Register-based data showed that cancer cases had more diagnoses, higher comorbidity score and more co...

  2. FDG PET/CT diagnostic criteria may need adjustment based on MRI to estimate the presurgical risk of extrapelvic infiltration in patients with uterine endometrial cancer

    Energy Technology Data Exchange (ETDEWEB)

    Sudo, Satoko; Sakuragi, Noriaki [Hokkaido University Graduate School of Medicine, Department of Gynecology, Sapporo (Japan); Hattori, Naoya; Manabe, Osamu; Hirata, Kenji; Tamaki, Nagara [Hokkaido University Graduate School of Medicine, Department of Nuclear Medicine, Kitaku, Sapporo (Japan); Kato, Fumi; Mimura, Rie; Magota, Keiichi; Sugimori, Hiroyuki [Hokkaido University Graduate School of Medicine, Department of Diagnostic and Interventional Radiology, Sapporo (Japan)

    2015-04-01

    The staging of endometrial cancer requires surgery which carries the risk of morbidity. FDG PET/CT combined with anatomical imaging may reduce the number of unnecessary lymphadenectomies by demonstrating the risk of extrapelvic infiltration. The purpose of this study was to optimize FDG PET/CT diagnostic criteria for risk assessment in endometrial cancer after first-line risk triage with MRI. The study population comprised 37 patients who underwent curative surgery for the treatment of endometrial cancer. First, the risk of extrapelvic infiltration was triaged using MRI. Second, multiple glucose metabolic profiles of the primary lesion were assessed with FDG PET/CT, and these were correlated with the histopathological risk of extrapelvic infiltration including lymphovascular space invasion (LVSI) and high-grade malignancy (grades 2 and 3). The results of histological correlation were used to adjust FDG PET/CT diagnostic criteria. Presurgical assessment using MRI was positive for deep (>50 %) myometrial invasion in 17 patients. The optimal FDG PET/CT diagnostic criteria vary depending on the results of MRI. Specifically, SUVmax (≥16.0) was used to indicate LVSI risk with an overall diagnostic accuracy of 88.2 % in patients with MRI findings showing myometrial invasion. High-grade malignancy did not correlate with any of metabolic profiles in this patient group. In the remaining patients without myometrial invasion, lesion glycolysis (LG) or metabolic volume were better indicators of LVSI than SUVmax with the same diagnostic accuracy of 80.0 %. In addition, LG (≥26.9) predicted high-grade malignancy with an accuracy of 72.2 %. Using the optimized cut-off criteria for LVSI, glucose metabolic profiling of primary lesions correctly predicted lymph node metastasis with an accuracy of 73.0 %, which was comparable with the accuracy of visual assessment for lymph node metastasis using MRI and FDG PET/CT. FDG PET/CT diagnostic criteria may need adjustment based on the

  3. Compensatory Postural Adjustments in an Oculus Virtual Reality Environment and the Risk of Falling in Alzheimer's Disease

    Directory of Open Access Journals (Sweden)

    Miguel F. Gago

    2016-06-01

    Full Text Available Background/Aims: Alzheimer's disease (AD patients have an impaired ability to quickly reweight central sensory dependence in response to unexpected body perturbations. Herein, we aim to study provoked compensatory postural adjustments (CPAs in a conflicting sensory paradigm with unpredictable visual displacements using virtual reality goggles. Methods: We used kinematic time-frequency analyses of two frequency bands: a low-frequency band (LB; 0.3-1.5 Hz; mechanical strategy and a high-frequency band (HB; 1.5-3.5 Hz; cognitive strategy. We enrolled 19 healthy subjects (controls and 21 AD patients, divided according to their previous history of falls. Results: The AD faller group presented higher-power LB CPAs, reflecting their worse inherent postural stability. The AD patients had a time lag in their HB CPA reaction. Conclusion: The slower reaction by CPA in AD may be a reflection of different cognitive resources including body schema self-perception, visual motion, depth perception, or a different state of fear and/or anxiety.

  4. Effect of Laparoscopic Adjustable Gastric Banding on Metabolic Syndrome and Its Risk Factors in Morbidly Obese Adolescents

    Directory of Open Access Journals (Sweden)

    Rushika Conroy

    2011-01-01

    Full Text Available We examined the effect of laparoscopic adjustable gastric banding (LAGB on weight loss, inflammatory markers, and components of the Metabolic Syndrome (MeS in morbidly obese adolescents and determined if those with MeS lose less weight post-LAGB than those without. Data from 14–18 yr adolescents were obtained at baseline, 6 and 12 months following LAGB. Significant weight loss and improvements in MeS components were observed 6 months and one year following LAGB. The incidence of MeS declined 56.8% after 6 months and 69.6% after 12 months. There was no significant difference in amount of weight lost post-LAGB between those with and without MeS at either timepoint. Correlations between change in weight parameters and components of MeS in those with and without MeS at baseline were examined and found to vary by diagnostic category. LAGB is effective for short-term improvement in weight, inflammatory markers, and components of MeS in morbidly obese adolescents.

  5. The Problem with the Low-Tax Backlash: Rethinking Corporate Tax Policies to Adjust for Uneven Reputational Risks

    Directory of Open Access Journals (Sweden)

    Jack M. Mintz

    2015-05-01

    Full Text Available When a major corporation is found to be paying little or no taxes, public backlash and media furor over the issue may ensue. Some governments may well be just fine with it, while others like U.S. may take steps to ensure companies pay more tax. Sometimes, companies being in a non-taxpaying position properly reflects appropriate tax policy. That explanation, however, does not sell lattés, which is why in 2012, after the British public grew outraged over the discovery that Starbucks was paying no corporate taxes in the U.K., the coffee retailer actually volunteered to just write a cheque to the government. The reputational damage to Starbucks’ brand, the company calculated, was not worth the money it was saving in avoiding taxes, even if it was doing so perfectly legally. The fear of this kind of reputational damage can foil the very taxation policies that governments design specifically as a means to tax corporations fairly, efficiently and competitively. It may be good tax policy to allow corporations various deductions, or the ability to carry forward or carry back losses, but it can be politically vexatious. U.S. President Barack Obama demonstrated that explicitly when he suggested certain American companies using so-called tax inversions to relocate their headquarters to low-tax jurisdictions, were failing in their “economic patriotism.” Yet more multinationals than ever are legally and quite appropriately using tax strategies to minimize their taxes in various jurisdictions to the point where they are paying little to no corporate tax. For some corporations, the risk of public backlash is greater than it is for others: Starbucks and Facebook, being consumer-facing companies with a great deal of brand goodwill, have a lot more at risk than do Pfizer and Oracle. This risk makes the playing field for taxation less level, jeopardizing the fundamental tax principle of horizontal equity — that those of similar means should pay similar

  6. Risk-adjustment models for heart failure patients' 30-day mortality and readmission rates: the incremental value of clinical data abstracted from medical charts beyond hospital discharge record.

    Science.gov (United States)

    Lenzi, Jacopo; Avaldi, Vera Maria; Hernandez-Boussard, Tina; Descovich, Carlo; Castaldini, Ilaria; Urbinati, Stefano; Di Pasquale, Giuseppe; Rucci, Paola; Fantini, Maria Pia

    2016-09-06

    Hospital discharge records (HDRs) are routinely used to assess outcomes of care and to compare hospital performance for heart failure. The advantages of using clinical data from medical charts to improve risk-adjustment models remain controversial. The aim of the present study was to evaluate the additional contribution of clinical variables to HDR-based 30-day mortality and readmission models in patients with heart failure. This retrospective observational study included all patients residing in the Local Healthcare Authority of Bologna (about 1 million inhabitants) who were discharged in 2012 from one of three hospitals in the area with a diagnosis of heart failure. For each study outcome, we compared the discrimination of the two risk-adjustment models (i.e., HDR-only model and HDR-clinical model) through the area under the ROC curve (AUC). A total of 1145 and 1025 patients were included in the mortality and readmission analyses, respectively. Adding clinical data significantly improved the discrimination of the mortality model (AUC = 0.84 vs. 0.73, p < 0.001), but not the discrimination of the readmission model (AUC = 0.65 vs. 0.63, p = 0.08). We identified clinical variables that significantly improved the discrimination of the HDR-only model for 30-day mortality following heart failure. By contrast, clinical variables made little contribution to the discrimination of the HDR-only model for 30-day readmission.

  7. Surgeon length of service and risk-adjusted outcomes: linked observational analysis of the UK National Adult Cardiac Surgery Audit Registry and General Medical Council Register.

    Science.gov (United States)

    Hickey, Graeme L; Grant, Stuart W; Freemantle, Nick; Cunningham, David; Munsch, Christopher M; Livesey, Steven A; Roxburgh, James; Buchan, Iain; Bridgewater, Ben

    2014-09-01

    To explore the relationship between in-hospital mortality following adult cardiac surgery and the time since primary clinical qualification for the responsible consultant cardiac surgeon (a proxy for experience). Retrospective analysis of prospectively collected national registry data over a 10-year period using mixed-effects multiple logistic regression modelling. Surgeon experience was defined as the time between the date of surgery and award of primary clinical qualification. UK National Health Service hospitals performing cardiac surgery between January 2003 and December 2012. All patients undergoing coronary artery bypass grafts and/or valve surgery under the care of a consultant cardiac surgeon. All-cause in-hospital mortality. A total of 292,973 operations performed by 273 consultant surgeons (with lengths of service from 11.2 to 42.0 years) were included. Crude mortality increased approximately linearly until 33 years service, before decreasing. After adjusting for case-mix and year of surgery, there remained a statistically significant (p=0.002) association between length of service and in-hospital mortality (odds ratio 1.013; 95% CI 1.005-1.021 for each year of 'experience'). Consultant cardiac surgeons take on increasingly complex surgery as they gain experience. With this progression, the incidence of adverse outcomes is expected to increase, as is demonstrated in this study. After adjusting for case-mix using the EuroSCORE, we observed an increased risk of mortality in patients operated on by longer serving surgeons. This finding may reflect under-adjustment for risk, unmeasured confounding or a real association. Further research into outcomes over the time course of surgeon's careers is required. © The Royal Society of Medicine.

  8. Salary adjustments

    CERN Multimedia

    HR Department

    2008-01-01

    In accordance with decisions taken by the Finance Committee and Council in December 2007, salaries are adjusted with effect from 1 January 2008. Scale of basic salaries and scale of stipends paid to fellows (Annex R A 5 and R A 6 respectively): increased by 0.71% with effect from 1 January 2008. As a result of the stability of the Geneva consumer price index, following elements do not increase: a) Family Allowance, Child Allowance and Infant Allowance (Annex R A 3). b) Reimbursement of education fees: maximum amounts of reimbursement (Annex R A 4.01) for the academic year 2007/2008. Related adjustments will be implemented, wherever applicable, to Paid Associates and Students. As in the past, the actual percentage increase of each salary position may vary, due to the application of a constant step value and the rounding effects. Human Resources Department Tel. 73566

  9. Salary adjustments

    CERN Multimedia

    HR Department

    2008-01-01

    In accordance with decisions taken by the Finance Committee and Council in December 2007, salaries are adjusted with effect from 1 January 2008. Scale of basic salaries and scale of stipends paid to fellows (Annex R A 5 and R A 6 respectively): increased by 0.71% with effect from 1 January 2008. As a result of the stability of the Geneva consumer price index, the following elements do not increase: a)\tFamily Allowance, Child Allowance and Infant Allowance (Annex R A 3); b)\tReimbursement of education fees: maximum amounts of reimbursement (Annex R A 4.01) for the academic year 2007/2008. Related adjustments will be applied, wherever applicable, to Paid Associates and Students. As in the past, the actual percentage increase of each salary position may vary, due to the application of a constant step value and rounding effects. Human Resources Department Tel. 73566

  10. Shaft adjuster

    Science.gov (United States)

    Harry, Herbert H.

    1989-01-01

    Apparatus and method for the adjustment and alignment of shafts in high power devices. A plurality of adjacent rotatable angled cylinders are positioned between a base and the shaft to be aligned which when rotated introduce an axial offset. The apparatus is electrically conductive and constructed of a structurally rigid material. The angled cylinders allow the shaft such as the center conductor in a pulse line machine to be offset in any desired alignment position within the range of the apparatus.

  11. Adjustable collimator

    International Nuclear Information System (INIS)

    Carlson, R.W.; Covic, J.; Leininger, G.

    1981-01-01

    In a rotating fan beam tomographic scanner there is included an adjustable collimator and shutter assembly. The assembly includes a fan angle collimation cylinder having a plurality of different length slots through which the beam may pass for adjusting the fan angle of the beam. It also includes a beam thickness cylinder having a plurality of slots of different widths for adjusting the thickness of the beam. Further, some of the slots have filter materials mounted therein so that the operator may select from a plurality of filters. Also disclosed is a servo motor system which allows the operator to select the desired fan angle, beam thickness and filter from a remote location. An additional feature is a failsafe shutter assembly which includes a spring biased shutter cylinder mounted in the collimation cylinders. The servo motor control circuit checks several system conditions before the shutter is rendered openable. Further, the circuit cuts off the radiation if the shutter fails to open or close properly. A still further feature is a reference radiation intensity monitor which includes a tuning-fork shaped light conducting element having a scintillation crystal mounted on each tine. The monitor is placed adjacent the collimator between it and the source with the pair of crystals to either side of the fan beam

  12. The adjusted Global AntiphosPholipid Syndrome Score (aGAPSS) for risk stratification in young APS patients with acute myocardial infarction.

    Science.gov (United States)

    Radin, M; Schreiber, K; Costanzo, P; Cecchi, I; Roccatello, D; Baldovino, S; Bazzan, M; Cuadrado, M J; Sciascia, S

    2017-08-01

    Young adults with acute myocardial infarction are a critical group to examine for the purpose of risk factor stratification and modification. In this study we aimed to assess the clinical utility of the adjusted Global AntiphosPholipid Syndrome Score (aGAPSS) for the risk stratification of acute myocardial infarction in a cohort of young patients with antiphospholipid syndrome (APS). The analysis included 83 consecutive APS patients (≤50years old) who presented with arterial or venous thromboembolic events. Data on cardiovascular risk factors and antiphospholipid antibodies (aPL) positivity were retrospectively collected. The aGAPSS was calculated by adding the points corresponding to the risk factors, based on a linear transformation derived from the ß-regression coefficient as follows: 3 for hyperlipidaemia, 1 for arterial hypertension, 5 for aCL IgG/IgM, 4 for anti-b2 glycoprotein I IgG/IgM and 4 for LA. Higher aGAPSS values were observed in patients with acute myocardial infarction when compared to the others [mean aGAPSS 11.9 (S.D. 4.15, range 4-18) Vs. mean aGAPSS 9.2 (S.D. 5.1, range 1-17); T test: psyndrome compared to patients with a history of peripheral or cerebrovascular arterial thrombotic events [mean aGAPSS 11.9 (S.D. 4.15, range 4-18) Vs. mean aGAPSS 6.7 (S.D. 5.7, range 1-17); T test: P<0.005]. The aGAPSS is based upon a quantitative score and could aid risk stratifying APS patients younger than 50years for the likelihood of developing coronary thrombotic events and may guide pharmacological treatment for high-risk patients. Copyright © 2017 Elsevier B.V. All rights reserved.

  13. Improved outcome for children with acute lymphoblastic leukemia after risk-adjusted intensive therapy: a single institution experience

    International Nuclear Information System (INIS)

    Al-Nasser, A.; El-Solh, H.; Al-Mahr, M.

    2008-01-01

    Because of need for more comprehensive information on the least toxic and most effective forms of therapy for children with acute lymphoblastic leukemia (ALL), we reviewed our experience in the treatment of children with ALL at King Faisal Specialist Hospital and Research Centre (KFSHRC) and King Fahd National Center for Children's Cancer and Research (KFNCCCR) over a period of 18 years with a focus on patient characteristics and outcome. During the period of 1981 to 1988, records of children with ALL were retrospectively reviewed with respect to clinical presentation, laboratory findings, risk factors, stratification, therapy and outcome. The protocols used in treatment included 4 local protocols (KFSH 81, 84, 87 and 90) and subsequently. Children's Cancer Group (CCG) protocols and these were grouped as Era (1981-1992) and Era 2 (1993-1998). Of 509 children with ALL treated during this period, 316 were treated using local protocols and 193 using CCG protocols. Drugs used in Era 1 included a 4-drug induction using etoposid (VP-16) instead of L-asparaginase. Consolidation was based on high dose methotexate (MTX) 1g/m2 and maintenance was based on oral mercaptopurine (6-MP) and MTX with periodic pulses using intravenous teniposide (VM-26), Ara-C, L-asparaginase, adriamycin, prednisone, VP-16 cyclophosphamide .International protocols were introduced in Era 2, which was also marked by intensification of early treatment, a wider selection of cytoreductive agents, and the alternating use of non-cross-resistant pairs of drugs using the post-remission period. The end of induction remission rate improved from 90% in Era 1 to 95% in Era 2, which was of borderline statistical significance (P=0.49). The 5-year event-free survival (EFS) improved from 30.6% in Era 1 to 64.2% in Era 2 (P<.001). Improvement in outcome was achieved without any significant increase in morbidity or mortality, due to improvement in both systemic therapy and supportive care. The most important

  14. Comparison of the performance of the CMS Hierarchical Condition Category (CMS-HCC) risk adjuster with the Charlson and Elixhauser comorbidity measures in predicting mortality.

    Science.gov (United States)

    Li, Pengxiang; Kim, Michelle M; Doshi, Jalpa A

    2010-08-20

    The Centers for Medicare and Medicaid Services (CMS) has implemented the CMS-Hierarchical Condition Category (CMS-HCC) model to risk adjust Medicare capitation payments. This study intends to assess the performance of the CMS-HCC risk adjustment method and to compare it to the Charlson and Elixhauser comorbidity measures in predicting in-hospital and six-month mortality in Medicare beneficiaries. The study used the 2005-2006 Chronic Condition Data Warehouse (CCW) 5% Medicare files. The primary study sample included all community-dwelling fee-for-service Medicare beneficiaries with a hospital admission between January 1st, 2006 and June 30th, 2006. Additionally, four disease-specific samples consisting of subgroups of patients with principal diagnoses of congestive heart failure (CHF), stroke, diabetes mellitus (DM), and acute myocardial infarction (AMI) were also selected. Four analytic files were generated for each sample by extracting inpatient and/or outpatient claims for each patient. Logistic regressions were used to compare the methods. Model performance was assessed using the c-statistic, the Akaike's information criterion (AIC), the Bayesian information criterion (BIC) and their 95% confidence intervals estimated using bootstrapping. The CMS-HCC had statistically significant higher c-statistic and lower AIC and BIC values than the Charlson and Elixhauser methods in predicting in-hospital and six-month mortality across all samples in analytic files that included claims from the index hospitalization. Exclusion of claims for the index hospitalization generally led to drops in model performance across all methods with the highest drops for the CMS-HCC method. However, the CMS-HCC still performed as well or better than the other two methods. The CMS-HCC method demonstrated better performance relative to the Charlson and Elixhauser methods in predicting in-hospital and six-month mortality. The CMS-HCC model is preferred over the Charlson and Elixhauser methods

  15. Managing commodity risks in highway contracts : quantifying premiums, accounting for correlations among risk factors, and designing optimal price-adjustment contracts.

    Science.gov (United States)

    2011-09-01

    It is a well-known fact that macro-economic conditions, such as prices of commodities (e.g. oil, : cement and steel) affect the cost of construction projects. In a volatile market environment, highway : agencies often pass such risk to contractors us...

  16. Malnutrition Increases With Obesity and Is a Stronger Independent Risk Factor for Postoperative Complications: A Propensity-Adjusted Analysis of Total Hip Arthroplasty Patients.

    Science.gov (United States)

    Fu, Michael C; D'Ambrosia, Christopher; McLawhorn, Alexander S; Schairer, William W; Padgett, Douglas E; Cross, Michael B

    2016-11-01

    Obesity is frequently associated with complications after total hip arthroplasty (THA) and is often concomitant with malnutrition. The purpose of this study was to investigate the independent morbidity risk of malnutrition relative to obesity. The National Surgical Quality Improvement Program from 2005 to 2013 was queried for elective primary THA cases. Malnutrition was defined as albumin malnutrition with 30-day outcomes. A total of 40,653 THA cases were identified, of which 20,210 (49.7%) had preoperative albumin measurements. Propensity score adjustment successfully reduced potential selection bias, with P > .05 for differences between those with and without albumin data. Malnutrition incidence increased from 2.8% in obese I to 5.7% in obese III patients. With multivariable propensity-adjusted logistic regression, malnutrition was a more robust predictor than any obesity class for any postoperative complication(s) (odds ratio [OR] 1.61, 95% confidence interval [CI] 1.25-2.08), major complications (OR 1.63, 95% CI 1.21-2.19), respiratory complications (OR 2.35, 95% CI 1.27-4.37), blood transfusions (OR 1.71, 95% CI 1.44-2.03), and extended length of stay (OR 1.35, 95% CI 1.14-1.59). Malnutrition incidence increased significantly from obese I to obese III patients and was a stronger and more consistent predictor than obesity of complications after THA. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. High-dose chemotherapy for patients with high-risk breast cancer: a clinical and economic assessment using a quality-adjusted survival analysis.

    Science.gov (United States)

    Marino, Patricia; Roché, Henri; Moatti, Jean-Paul

    2008-04-01

    The benefit of high-dose chemotherapy (HDC) has not been clearly demonstrated. It may offer disease-free survival improvement at the expense of major toxicity and increasing cost. We evaluated the trade-offs between toxicity, relapse, and costs using a quality-adjusted time without symptoms or toxicity (Q-TWiST) analysis. The analysis was conducted in the context of a randomized trial (PEGASE 01) evaluating the benefit of HDC for 314 patients with high-risk breast cancer. A Q-TWiST analysis was first performed to compare HDC with standard chemotherapy. We then used the results of this Q-TWiST analysis to inform a cost per quality-adjusted life-year (QALY) comparison between treatments. Q-TWiST durations were in favor of HDC, whatever the weighting coefficients used for the analysis. This benefit was significant when the weighting coefficient related to the time spent after relapse was low (0.78), HDC offered no benefit. For intermediate values, the results depended on the weighting coefficient attributed to the toxicity period. The incremental cost per QALY ranged from 12,691euro/QALY to 26,439euro/QALY, according to the coefficients used to weight toxicity and relapse. The benefits of HDC outweigh the burdens of treatment for a wide range of utility coefficients. Economic impact is not a barrier to HDC diffusion in this situation. Nevertheless, no significant benefit was demonstrated for a certain range of utility values.

  18. Differences in case-mix can influence the comparison of standardised mortality ratios even with optimal risk adjustment: an analysis of data from paediatric intensive care.

    Science.gov (United States)

    Manktelow, Bradley N; Evans, T Alun; Draper, Elizabeth S

    2014-09-01

    The publication of clinical outcomes for consultant surgeons in 10 specialties within the NHS has, along with national clinical audits, highlighted the importance of measuring and reporting outcomes with the aim of monitoring quality of care. Such information is vital to be able to identify good and poor practice and to inform patient choice. The need to adequately adjust outcomes for differences in case-mix has long been recognised as being necessary to provide 'like-for-like' comparisons between providers. However, directly comparing values of the standardised mortality ratio (SMR) between different healthcare providers can be misleading even when the risk-adjustment perfectly quantifies the risk of a poor outcome in the reference population. An example is shown from paediatric intensive care. Using observed case-mix differences for 33 paediatric intensive care units (PICUs) in the UK and Ireland for 2009-2011, SMRs were calculated under four different scenarios where, in each scenario, all of the PICUs were performing identically for each patient type. Each scenario represented a clinically plausible difference in outcome from the reference population. Despite the fact that the outcome for any patient was the same no matter which PICU they were to be admitted to, differences between the units were seen when compared using the SMR: scenario 1, 1.07-1.21; scenario 2, 1.00-1.14; scenario 3, 1.04-1.13; scenario 4, 1.00-1.09. Even if two healthcare providers are performing equally for each type of patient, if their patient populations differ in case-mix their SMRs will not necessarily take the same value. Clinical teams and commissioners must always keep in mind this weakness of the SMR when making decisions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  19. City-Level Adult Stroke Prevalence in Relation to Remote Sensing Derived PM2.5 Adjusting for Unhealthy Behaviors and Medical Risk Factors

    Science.gov (United States)

    Hu, Z.

    2018-04-01

    This research explores the use of PM2.5 gird derived from remote sensing for assessing the effect of long-term exposure to PM2.5 (ambient air pollution of particulate matter with an aerodynamic diameter of 2.5 μm or less) on stroke, adjusting for unhealthy behaviors and medical risk factors. Health data was obtained from the newly published CDC "500 Cities Project" which provides city- and census tract-level small area estimates for chronic disease risk factors, and clinical preventive service use for the largest 500 cities in the United States. PM2.5 data was acquired from the "The Global Annual PM2.5 Grids from MODIS, MISR and SeaWiFS Aerosol Optical Depth (AOD), V1 (1998-2012)" datasets. Average PM2.5 were calculated for each city using a GIS zonal statistics function. Map data visualization and pattern comparison, univariate linear regression, and a multivariate linear regression model fitted using a generalized linear model via penalized maximum likelihood found that long-term exposure to ambient PM2.5 may increase the risk of stroke. Increasing physical activity, reducing smoking and body weight, enough sleeping, controlling diseases such as blood pressure, coronary heart disease, diabetes, and cholesterol, may mitigate the effect. PM2.5 grids derived from moderate resolution satellite remote sensing imagery may offer a unique opportunity to fill the data gap due to limited ground monitoring at broader scales. The evidence of raised stroke prevalence risk in high PM2.5 areas would support targeting of policy interventions on such areas to reduce pollution levels and protect human health.

  20. CITY-LEVEL ADULT STROKE PREVALENCE IN RELATION TO REMOTE SENSING DERIVED PM2.5 ADJUSTING FOR UNHEALTHY BEHAVIORS AND MEDICAL RISK FACTORS

    Directory of Open Access Journals (Sweden)

    Z. Hu

    2018-04-01

    Full Text Available This research explores the use of PM2.5 gird derived from remote sensing for assessing the effect of long-term exposure to PM2.5 (ambient air pollution of particulate matter with an aerodynamic diameter of 2.5 μm or less on stroke, adjusting for unhealthy behaviors and medical risk factors. Health data was obtained from the newly published CDC “500 Cities Project” which provides city- and census tract-level small area estimates for chronic disease risk factors, and clinical preventive service use for the largest 500 cities in the United States. PM2.5 data was acquired from the “The Global Annual PM2.5 Grids from MODIS, MISR and SeaWiFS Aerosol Optical Depth (AOD, V1 (1998–2012” datasets. Average PM2.5 were calculated for each city using a GIS zonal statistics function. Map data visualization and pattern comparison, univariate linear regression, and a multivariate linear regression model fitted using a generalized linear model via penalized maximum likelihood found that long-term exposure to ambient PM2.5 may increase the risk of stroke. Increasing physical activity, reducing smoking and body weight, enough sleeping, controlling diseases such as blood pressure, coronary heart disease, diabetes, and cholesterol, may mitigate the effect. PM2.5 grids derived from moderate resolution satellite remote sensing imagery may offer a unique opportunity to fill the data gap due to limited ground monitoring at broader scales. The evidence of raised stroke prevalence risk in high PM2.5 areas would support targeting of policy interventions on such areas to reduce pollution levels and protect human health.

  1. Risk-adjusted survival for adults following in-hospital cardiac arrest by day of week and time of day: observational cohort study

    Science.gov (United States)

    Robinson, Emily J; Power, Geraldine S; Nolan, Jerry; Soar, Jasmeet; Spearpoint, Ken; Gwinnutt, Carl; Rowan, Kathryn M

    2016-01-01

    Background Internationally, hospital survival is lower for patients admitted at weekends and at night. Data from the UK National Cardiac Arrest Audit (NCAA) indicate that crude hospital survival was worse after in-hospital cardiac arrest (IHCA) at night versus day, and at weekends versus weekdays, despite similar frequency of events. Objective To describe IHCA demographics during three day/time periods—weekday daytime (Monday to Friday, 08:00 to 19:59), weekend daytime (Saturday and Sunday, 08:00 to 19:59) and night-time (Monday to Sunday, 20:00 to 07:59)—and to compare the associated rates of return of spontaneous circulation (ROSC) for >20 min (ROSC>20 min) and survival to hospital discharge, adjusted for risk using previously developed NCAA risk models. To consider whether any observed difference could be attributed to differences in the case mix of patients resident in hospital and/or the administered care. Methods We performed a prospectively defined analysis of NCAA data from 27 700 patients aged ≥16 years receiving chest compressions and/or defibrillation and attended by a hospital-based resuscitation team in response to a resuscitation (2222) call in 146 UK acute hospitals. Results Risk-adjusted outcomes (OR (95% CI)) were worse (p20 min 0.88 (0.81 to 0.95); hospital survival 0.72 (0.64 to 0.80)), and night-time (ROSC>20 min 0.72 (0.68 to 0.76); hospital survival 0.58 (0.54 to 0.63)) compared with weekday daytime. The effects were stronger for non-shockable than shockable rhythms, but there was no significant interaction between day/time of arrest and age, or day/time of arrest and arrest location. While many daytime IHCAs involved procedures, restricting the analyses to IHCAs in medical admissions with an arrest location of ward produced results that are broadly in line with the primary analyses. Conclusions IHCAs attended by the hospital-based resuscitation team during nights and weekends have substantially worse outcomes than during

  2. Risk-adjusted survival for adults following in-hospital cardiac arrest by day of week and time of day: observational cohort study.

    Science.gov (United States)

    Robinson, Emily J; Smith, Gary B; Power, Geraldine S; Harrison, David A; Nolan, Jerry; Soar, Jasmeet; Spearpoint, Ken; Gwinnutt, Carl; Rowan, Kathryn M

    2016-11-01

    Internationally, hospital survival is lower for patients admitted at weekends and at night. Data from the UK National Cardiac Arrest Audit (NCAA) indicate that crude hospital survival was worse after in-hospital cardiac arrest (IHCA) at night versus day, and at weekends versus weekdays, despite similar frequency of events. To describe IHCA demographics during three day/time periods-weekday daytime (Monday to Friday, 08:00 to 19:59), weekend daytime (Saturday and Sunday, 08:00 to 19:59) and night-time (Monday to Sunday, 20:00 to 07:59)-and to compare the associated rates of return of spontaneous circulation (ROSC) for >20 min (ROSC>20 min) and survival to hospital discharge, adjusted for risk using previously developed NCAA risk models. To consider whether any observed difference could be attributed to differences in the case mix of patients resident in hospital and/or the administered care. We performed a prospectively defined analysis of NCAA data from 27 700 patients aged ≥16 years receiving chest compressions and/or defibrillation and attended by a hospital-based resuscitation team in response to a resuscitation (2222) call in 146 UK acute hospitals. Risk-adjusted outcomes (OR (95% CI)) were worse (p20 min 0.88 (0.81 to 0.95); hospital survival 0.72 (0.64 to 0.80)), and night-time (ROSC>20 min 0.72 (0.68 to 0.76); hospital survival 0.58 (0.54 to 0.63)) compared with weekday daytime. The effects were stronger for non-shockable than shockable rhythms, but there was no significant interaction between day/time of arrest and age, or day/time of arrest and arrest location. While many daytime IHCAs involved procedures, restricting the analyses to IHCAs in medical admissions with an arrest location of ward produced results that are broadly in line with the primary analyses. IHCAs attended by the hospital-based resuscitation team during nights and weekends have substantially worse outcomes than during weekday daytimes. Organisational or care differences at

  3. Improving Results of Elective Abdominal Aortic Aneurysm Repair at a Low-Volume Hospital by Risk-Adjusted Selection of Treatment in the Endovascular Era

    International Nuclear Information System (INIS)

    Wibmer, Andreas; Meyer, Bernhard; Albrecht, Thomas; Buhr, Heinz-Johannes; Kruschewski, Martin

    2009-01-01

    open repair was reduced from 8.5% to 3.7% (p = 0.414). In conclusion, by risk-adjusted selection of treatment and frequent application of EVAR, it is possible to improve perioperative outcome of elective AAA repair at a low-volume hospital. Mortality figures are similar to those of recent trials at high-volume centers, as reported in the literature.

  4. Risk-adjusted morbidity in teaching hospitals correlates with reported levels of communication and collaboration on surgical teams but not with scale measures of teamwork climate, safety climate, or working conditions.

    Science.gov (United States)

    Davenport, Daniel L; Henderson, William G; Mosca, Cecilia L; Khuri, Shukri F; Mentzer, Robert M

    2007-12-01

    Since the Institute of Medicine patient safety reports, a number of survey-based measures of organizational climate safety factors (OCSFs) have been developed. The goal of this study was to measure the impact of OCSFs on risk-adjusted surgical morbidity and mortality. Surveys were administered to staff on general/vascular surgery services during a year. Surveys included multiitem scales measuring OCSFs. Additionally, perceived levels of communication and collaboration with coworkers were assessed. The National Surgical Quality Improvement Program was used to assess risk-adjusted morbidity and mortality. Correlations between outcomes and OCSFs were calculated and between outcomes and communication/collaboration with attending and resident doctors, nurses, and other providers. Fifty-two sites participated in the survey: 44 Veterans Affairs and 8 academic medical centers. A total of 6,083 surveys were returned, for a response rate of 52%. The OCSF measures of teamwork climate, safety climate, working conditions, recognition of stress effects, job satisfaction, and burnout demonstrated internal validity but did not correlate with risk-adjusted outcomes. Reported levels of communication/collaboration with attending and resident doctors correlated with risk-adjusted morbidity. Survey-based teamwork, safety climate, and working conditions scales are not confirmed to measure organizational factors that influence risk-adjusted surgical outcomes. Reported communication/collaboration with attending and resident doctors on surgical services influenced patient morbidity. This suggests the importance of doctors' coordination and decision-making roles on surgical teams in providing high-quality and safe care. We propose risk-adjusted morbidity as an effective measure of surgical patient safety.

  5. The predictive value of an adjusted COPD assessment test score on the risk of respiratory-related hospitalizations in severe COPD patients.

    NARCIS (Netherlands)

    Sloots, Joanne M; Barton, Christopher A; Buckman, Julie; Bassett, Katherine L.; van der Palen, Job; Frith, Peter A.; Effing, Tanja

    2017-01-01

    We evaluated whether a chronic obstructive pulmonary disease (COPD) assessment test (CAT) with adjusted weights for the CAT items could better predict future respiratory-related hospitalizations than the original CAT. Two focus groups (respiratory nurses and physicians) generated two adjusted CAT

  6. [Susceptibility to strategy of the drug component of the IPHCC+RxGroups classification system in a risk-adjusted morbidity compensation scheme--a conceptional and data-supported analysis].

    Science.gov (United States)

    Behrend, C; Felder, S; Busse, R

    2007-01-01

    A report commissioned by the German Ministry of Health recommends to the existing scheme for calculating risk-adjusted transfers to sickness funds supplement with the IPHCC+RxGroups method. The method is based on inpatient diagnoses and prescribed drugs as health status measures deduced from prior use. The present study investigates the sickness fund's expected net return from gaming based on the drug component of the risk adjuster. The study explores three possible strategies using the RxGroups method. For the stimulations, insurees are assigned to additional indications or to higher valued RxGroups within the same indication. Then, costs and financial benefits attributable to the altered drug use are estimated and compared with the status quo. The study uses 2000 and 2001 sample data of more than 370,000 insurees of Germany's company-based sickness funds system (BKK). While upgrading increases overall costs, it can be beneficial for the individual sickness funds. Their net return crucially depends on the number of sickness funds gaming the system: the more participating in the game, the smaller is the average net return. Moreover, not participating often is even worse, which in turn points to a prisoner's dilemma. When extending the risk adjustment scheme in social health insurance, the German legislator should take into account the perverse incentives of risk adjusters such as the described prescription drug model.

  7. [Factors affecting in-hospital mortality in patients with sepsis: Development of a risk-adjusted model based on administrative data from German hospitals].

    Science.gov (United States)

    König, Volker; Kolzter, Olaf; Albuszies, Gerd; Thölen, Frank

    2018-05-01

    Inpatient administrative data from hospitals is already used nationally and internationally in many areas of internal and public quality assurance in healthcare. For sepsis as the principal condition, only a few published approaches are available for Germany. The aim of this investigation is to identify factors influencing hospital mortality by employing appropriate analytical methods in order to improve the internal quality management of sepsis. The analysis was based on data from 754,727 DRG cases of the CLINOTEL hospital network charged in 2015. The association then included 45 hospitals of all supply levels with the exception of university hospitals (range of beds: 100 to 1,172 per hospital). Cases of sepsis were identified via the ICD codes of their principal diagnosis. Multiple logistic regression analysis was used to determine the factors influencing in-hospital lethality for this population. The model was developed using sociodemographic and other potential variables that could be derived from the DRG data set, and taking into account current literature data. The model obtained was validated with inpatient administrative data of 2016 (51 hospitals, 850,776 DRG cases). Following the definition of the inclusion criteria, 5,608 cases of sepsis (2016: 6,384 cases) were identified in 2015. A total of 12 significant and, over both years, stable factors were identified, including age, severity of sepsis, reason for hospital admission and various comorbidities. The AUC value of the model, as a measure of predictability, is above 0.8 (H-L test p>0.05, R 2 value=0.27), which is an excellent result. The CLINOTEL model of risk adjustment for in-hospital lethality can be used to determine the mortality probability of patients with sepsis as principal diagnosis with a very high degree of accuracy, taking into account the case mix. Further studies are needed to confirm whether the model presented here will prove its value in the internal quality assurance of hospitals

  8. Adjustment of nitrogen fertilization to the needs of plants and limitations posed by the risk of nitrate accumulation and pollution of the soil and subsoil

    Energy Technology Data Exchange (ETDEWEB)

    Muller, J C

    1980-01-01

    In chalky Champagne, nitrogen balance is study to adjust availability to plant response. For this, it is necessary to know some parameters whose measurement is obtained progressively; plants exportation, nitrogen transformations in terms of transport processes in soil system, kinetic of mineralization of soil organic nitrogen, plants residus and agricultural waste waters. Lysimeters with rotation of Champagne (wheat, sugarbeet, potatoes...) are used to measure losses of nitrogen and follow transport of nitrates by mean of soil solution captors. Comparisons with field results, lysimeters results and laboratory experimentations are used to adjust an experimental model. Two examples show: 1) Nitrogen fertilizer requirement for wheat. 2) Possibility of maximum application for agricultural waste waters.

  9. Reciprocal Influences Between Maternal Parenting and Child Adjustment in a High-risk Population: A Five-Year Cross-Lagged Analysis of Bidirectional Effects

    Science.gov (United States)

    Barbot, Baptiste; Crossman, Elizabeth; Hunter, Scott R.; Grigorenko, Elena L.; Luthar, Suniya S.

    2014-01-01

    This study examines longitudinally the bidirectional influences between maternal parenting (behaviors and parenting stress) and mothers' perceptions of their children's adjustment, in a multivariate approach. Data was gathered from 361 low-income mothers (many with psychiatric diagnoses) reporting on their parenting behavior, parenting stress and their child's adjustment, in a two-wave longitudinal study over 5 years. Measurement models were developed to derive four broad parenting constructs (Involvement, Control, Rejection, and Stress) and three child adjustment constructs (Internalizing problems, Externalizing problems, and Social competence). After measurement invariance of these constructs was confirmed across relevant groups and over time, both measurement models were integrated in a single crossed-lagged regression analysis of latent constructs. Multiple reciprocal influence were observed between parenting and perceived child adjustment over time: Externalizing and internalizing problems in children were predicted by baseline maternal parenting behaviors, while child social competence was found to reduce parental stress and increase parental involvement and appropriate monitoring. These findings on the motherhood experience are discussed in light of recent research efforts to understand mother-child bi-directional influences, and their potential for practical applications. PMID:25089759

  10. A Best Evidence Synthesis of Literacy Instruction on the Social Adjustment of Students with or At-Risk for Behavior Disorders

    Science.gov (United States)

    Nelson, J. Ron; Lane, Kathleen L.; Benner, Gregory J.; Kim, Ockjean

    2011-01-01

    The findings of a best-evidence synthesis of the collateral effect of literacy instruction on the social adjustment of students are reported. The goal of the synthesis was to extend the work of Wanzek, Vaughn, Kim, and Cavanaugh (2006) by (a) reviewing treatment-outcomes conducted using group design methodology; (b) focusing on a more defined set…

  11. Delayed heart rate recovery after exercise as a risk factor of incident type 2 diabetes mellitus after adjusting for glycometabolic parameters in men.

    Science.gov (United States)

    Yu, Tae Yang; Jee, Jae Hwan; Bae, Ji Cheol; Hong, Won-Jung; Jin, Sang-Man; Kim, Jae Hyeon; Lee, Moon-Kyu

    2016-10-15

    Some studies have reported that delayed heart rate recovery (HRR) after exercise is associated with incident type 2 diabetes mellitus (T2DM). This study aimed to investigate the longitudinal association of delayed HRR following a graded exercise treadmill test (GTX) with the development of T2DM including glucose-associated parameters as an adjusting factor in healthy Korean men. Analyses including fasting plasma glucose, HOMA-IR, HOMA-β, and HbA1c as confounding factors and known confounders were performed. HRR was calculated as peak heart rate minus heart rate after a 1-min rest (HRR 1). Cox proportional hazards model was used to quantify the independent association between HRR and incident T2DM. During 9082 person-years of follow-up between 2006 and 2012, there were 180 (10.1%) incident cases of T2DM. After adjustment for age, BMI, systolic BP, diastolic BP, smoking status, peak heart rate, peak oxygen uptake, TG, LDL-C, HDL-C, fasting plasma glucose, HOMA-IR, HOMA-β, and HbA1c, the hazard ratios (HRs) [95% confidence interval (CI)] of incident T2DM comparing the second and third tertiles to the first tertile of HRR 1 were 0.867 (0.609-1.235) and 0.624 (0.426-0.915), respectively (p for trend=0.017). As a continuous variable, in the fully-adjusted model, the HR (95% CI) of incident T2DM associated with each 1 beat increase in HRR 1 was 0.980 (0.960-1.000) (p=0.048). This study demonstrated that delayed HRR after exercise predicts incident T2DM in men, even after adjusting for fasting glucose, HOMA-IR, HOMA-β, and HbA1c. However, only HRR 1 had clinical significance. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  12. The relationship between effectiveness and costs measured by a risk-adjusted case-mix system: multicentre study of Catalonian population data bases

    Directory of Open Access Journals (Sweden)

    Flor-Serra Ferran

    2009-06-01

    Full Text Available Abstract Background The main objective of this study is to measure the relationship between morbidity, direct health care costs and the degree of clinical effectiveness (resolution of health centres and health professionals by the retrospective application of Adjusted Clinical Groups in a Spanish population setting. The secondary objectives are to determine the factors determining inadequate correlations and the opinion of health professionals on these instruments. Methods/Design We will carry out a multi-centre, retrospective study using patient records from 15 primary health care centres and population data bases. The main measurements will be: general variables (age and sex, centre, service [family medicine, paediatrics], and medical unit, dependent variables (mean number of visits, episodes and direct costs, co-morbidity (Johns Hopkins University Adjusted Clinical Groups Case-Mix System and effectiveness. The totality of centres/patients will be considered as the standard for comparison. The efficiency index for visits, tests (laboratory, radiology, others, referrals, pharmaceutical prescriptions and total will be calculated as the ratio: observed variables/variables expected by indirect standardization. The model of cost/patient/year will differentiate fixed/semi-fixed (visits costs of the variables for each patient attended/year (N = 350,000 inhabitants. The mean relative weights of the cost of care will be obtained. The effectiveness will be measured using a set of 50 indicators of process, efficiency and/or health results, and an adjusted synthetic index will be constructed (method: percentile 50. The correlation between the efficiency (relative-weights and synthetic (by centre and physician indices will be established using the coefficient of determination. The opinion/degree of acceptance of physicians (N = 1,000 will be measured using a structured questionnaire including various dimensions. Statistical analysis: multiple regression

  13. The adjusted Global AntiphosPholipid Syndrome Score (aGAPSS) for risk stratification in young APS patients with acute myocardial infarction

    DEFF Research Database (Denmark)

    Radin, M; Schreiber, K; Costanzo, P

    2017-01-01

    PL) positivity were retrospectively collected. The aGAPSS was calculated by adding the points corresponding to the risk factors, based on a linear transformation derived from the ß-regression coefficient as follows: 3 for hyperlipidaemia, 1 for arterial hypertension, 5 for aCL IgG/IgM, 4 for anti-b2 glycoprotein...... aid risk stratifying APS patients younger than 50years for the likelihood of developing coronary thrombotic events and may guide pharmacological treatment for high-risk patients....

  14. The high-density lipoprotein-adjusted SCORE model worsens SCORE-based risk classification in a contemporary population of 30 824 Europeans

    DEFF Research Database (Denmark)

    Mortensen, Martin B; Afzal, Shoaib; Nordestgaard, Børge G

    2015-01-01

    .8 years of follow-up, 339 individuals died of CVD. In the SCORE target population (age 40-65; n = 30,824), fewer individuals were at baseline categorized as high risk (≥5% 10-year risk of fatal CVD) using SCORE-HDL compared with SCORE (10 vs. 17% in men, 1 vs. 3% in women). SCORE-HDL did not improve...... with SCORE, but deteriorated risk classification based on NRI. Future guidelines should consider lower decision thresholds and prioritize CVD morbidity and people above age 65....

  15. The bystander effect model of Brenner and Sachs fitted to lung cancer data in 11 cohorts of underground miners, and equivalence of fit of a linear relative risk model with adjustment for attained age and age at exposure

    International Nuclear Information System (INIS)

    Little, M P

    2004-01-01

    Bystander effects following exposure to α-particles have been observed in many experimental systems, and imply that linearly extrapolating low dose risks from high dose data might materially underestimate risk. Brenner and Sachs (2002 Int. J. Radiat. Biol. 78 593-604; 2003 Health Phys. 85 103-8) have recently proposed a model of the bystander effect which they use to explain the inverse dose rate effect observed for lung cancer in underground miners exposed to radon daughters. In this paper we fit the model of the bystander effect proposed by Brenner and Sachs to 11 cohorts of underground miners, taking account of the covariance structure of the data and the period of latency between the development of the first pre-malignant cell and clinically overt cancer. We also fitted a simple linear relative risk model, with adjustment for age at exposure and attained age. The methods that we use for fitting both models are different from those used by Brenner and Sachs, in particular taking account of the covariance structure, which they did not, and omitting certain unjustifiable adjustments to the miner data. The fit of the original model of Brenner and Sachs (with 0 y period of latency) is generally poor, although it is much improved by assuming a 5 or 6 y period of latency from the first appearance of a pre-malignant cell to cancer. The fit of this latter model is equivalent to that of a linear relative risk model with adjustment for age at exposure and attained age. In particular, both models are capable of describing the observed inverse dose rate effect in this data set

  16. Annual Adjustment Factors

    Data.gov (United States)

    Department of Housing and Urban Development — The Department of Housing and Urban Development establishes the rent adjustment factors - called Annual Adjustment Factors (AAFs) - on the basis of Consumer Price...

  17. NET SALARY ADJUSTMENT

    CERN Multimedia

    Finance Division

    2001-01-01

    On 15 June 2001 the Council approved the correction of the discrepancy identified in the net salary adjustment implemented on 1st January 2001 by retroactively increasing the scale of basic salaries to achieve the 2.8% average net salary adjustment approved in December 2000. We should like to inform you that the corresponding adjustment will be made to your July salary. Full details of the retroactive adjustments will consequently be shown on your pay slip.

  18. Inclusion of Functional Status Measures in the Risk Adjustment of 30-Day Mortality After Transcatheter Aortic Valve Replacement: A Report From the Society of Thoracic Surgeons/American College of Cardiology TVT Registry.

    Science.gov (United States)

    Arnold, Suzanne V; O'Brien, Sean M; Vemulapalli, Sreekanth; Cohen, David J; Stebbins, Amanda; Brennan, J Matthew; Shahian, David M; Grover, Fred L; Holmes, David R; Thourani, Vinod H; Peterson, Eric D; Edwards, Fred H

    2018-03-26

    The aim of this study was to develop and validate a risk adjustment model for 30-day mortality after transcatheter aortic valve replacement (TAVR) that accounted for both standard clinical factors and pre-procedural health status and frailty. Assessment of risk for TAVR is important both for patient selection and provider comparisons. Prior efforts for risk adjustment have focused on in-hospital mortality, which is easily obtainable but can be biased because of early discharge of ill patients. Using data from patients who underwent TAVR as part of the Society of Thoracic Surgeons/American College of Cardiology TVT (Transcatheter Valve Therapy) Registry (June 2013 to May 2016), a hierarchical logistic regression model to estimate risk for 30-day mortality after TAVR based only on pre-procedural factors and access site was developed and internally validated. The model included factors from the original TVT Registry in-hospital mortality model but added the Kansas City Cardiomyopathy Questionnaire (health status) and gait speed (5-m walk test). Among 21,661 TAVR patients at 188 sites, 1,025 (4.7%) died within 30 days. Independent predictors of 30-day death included older age, low body weight, worse renal function, peripheral artery disease, home oxygen, prior myocardial infarction, left main coronary artery disease, tricuspid regurgitation, nonfemoral access, worse baseline health status, and inability to walk. The predicted 30-day mortality risk ranged from 1.1% (lowest decile of risk) to 13.8% (highest decile of risk). The model was able to stratify risk on the basis of patient factors with good discrimination (C = 0.71 [derivation], C = 0.70 [split-sample validation]) and excellent calibration, both overall and in key patient subgroups. A clinical risk model was developed for 30-day death after TAVR that included clinical data as well as health status and frailty. This model will facilitate tracking outcomes over time as TAVR expands to lower risk patients and

  19. Parental Acceptance-Rejection, Childhood Trauma, Emotion Regulation, and Psychological Adjustment as the Risk Factors of Psychopathic Tendencies in Adolescents of Pakistan

    Directory of Open Access Journals (Sweden)

    Saba Walayat

    2017-06-01

    Full Text Available The present study aimed to explore the psychopathic tendencies in relation to childhood trauma, psychological adjustment, emotion regulation and parental patterns of acceptance-rejection towards their adolescents and the influence of demographic variables in socio-cultural context of Pakistan. Translated versions of Parental Acceptance-Rejection Questionnaire; Child PARQ, Childhood Trauma Questionnaire, Personality Assessment Questionnaire, Emotion Regulation Questionnaire, Youth Psychopathic Trait Inventory and bio-data form containing information regarding different demographic variables were used in order to collect the data from the participants. The sample consisted of 600 adolescents (281 males; 319 females with age ranged between 13 and 17 were selected with convenient random sampling from different private and public schools of the three major cities of Punjab; Lahore, Gujrat and Sialkot. The results indicated psychological maladjustment as the most significant predictor of psychopathic tendencies. However, emotion regulation appeared to be as the most significant predictor of psychopathic tendencies in male adolescents and parental acceptance-rejection (mother in female adolescents. The results further indicated that age, father’s education and profession, mother’s education and monthly income are significant determinants of psychopathic tendencies in participants of the study.

  20. Repatriation Adjustment: Literature Review

    Directory of Open Access Journals (Sweden)

    Gamze Arman

    2009-12-01

    Full Text Available Expatriation is a widely studied area of research in work and organizational psychology. After expatriates accomplish their missions in host countries, they return to their countries and this process is called repatriation. Adjustment constitutes a crucial part in repatriation research. In the present literature review, research about repatriation adjustment was reviewed with the aim of defining the whole picture in this phenomenon. Present research was classified on the basis of a theoretical model of repatriation adjustment. Basic frame consisted of antecedents, adjustment, outcomes as main variables and personal characteristics/coping strategies and organizational strategies as moderating variables.

  1. Development and Validation of an Agency for Healthcare Research and Quality Indicator for Mortality After Congenital Heart Surgery Harmonized With Risk Adjustment for Congenital Heart Surgery (RACHS-1) Methodology.

    Science.gov (United States)

    Jenkins, Kathy J; Koch Kupiec, Jennifer; Owens, Pamela L; Romano, Patrick S; Geppert, Jeffrey J; Gauvreau, Kimberlee

    2016-05-20

    The National Quality Forum previously approved a quality indicator for mortality after congenital heart surgery developed by the Agency for Healthcare Research and Quality (AHRQ). Several parameters of the validated Risk Adjustment for Congenital Heart Surgery (RACHS-1) method were included, but others differed. As part of the National Quality Forum endorsement maintenance process, developers were asked to harmonize the 2 methodologies. Parameters that were identical between the 2 methods were retained. AHRQ's Healthcare Cost and Utilization Project State Inpatient Databases (SID) 2008 were used to select optimal parameters where differences existed, with a goal to maximize model performance and face validity. Inclusion criteria were not changed and included all discharges for patients model includes procedure risk group, age (0-28 days, 29-90 days, 91-364 days, 1-17 years), low birth weight (500-2499 g), other congenital anomalies (Clinical Classifications Software 217, except for 758.xx), multiple procedures, and transfer-in status. Among 17 945 eligible cases in the SID 2008, the c statistic for model performance was 0.82. In the SID 2013 validation data set, the c statistic was 0.82. Risk-adjusted mortality rates by center ranged from 0.9% to 4.1% (5th-95th percentile). Congenital heart surgery programs can now obtain national benchmarking reports by applying AHRQ Quality Indicator software to hospital administrative data, based on the harmonized RACHS-1 method, with high discrimination and face validity. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  2. ADJUSTABLE CHIP HOLDER

    DEFF Research Database (Denmark)

    2009-01-01

    An adjustable microchip holder for holding a microchip is provided having a plurality of displaceable interconnection pads for connecting the connection holes of a microchip with one or more external devices or equipment. The adjustable microchip holder can fit different sizes of microchips...

  3. Overall survival in lower IPSS risk MDS by receipt of iron chelation therapy, adjusting for patient-related factors and measuring from time of first red blood cell transfusion dependence: an MDS-CAN analysis.

    Science.gov (United States)

    Leitch, Heather A; Parmar, Ambica; Wells, Richard A; Chodirker, Lisa; Zhu, Nancy; Nevill, Thomas J; Yee, Karen W L; Leber, Brian; Keating, Mary-Margaret; Sabloff, Mitchell; St Hilaire, Eve; Kumar, Rajat; Delage, Robert; Geddes, Michelle; Storring, John M; Kew, Andrea; Shamy, April; Elemary, Mohamed; Lenis, Martha; Mamedov, Alexandre; Ivo, Jessica; Francis, Janika; Zhang, Liying; Buckstein, Rena

    2017-10-01

    Analyses suggest iron overload in red blood cell (RBC) transfusion-dependent (TD) patients with myleodysplastic syndrome (MDS) portends inferior overall survival (OS) that is attenuated by iron chelation therapy (ICT) but may be biassed by unbalanced patient-related factors. The Canadian MDS Registry prospectively measures frailty, comorbidity and disability. We analysed OS by receipt of ICT, adjusting for these patient-related factors. TD International Prognostic Scoring System (IPSS) low and intermediate-1 risk MDS, at RBC TD, were included. Predictive factors for OS were determined. A matched pair analysis considering age, revised IPSS, TD severity, time from MDS diagnosis to TD, and receipt of disease-modifying agents was conducted. Of 239 patients, 83 received ICT; frailty, comorbidity and disability did not differ from non-ICT patients. Median OS from TD was superior in ICT patients (5·2 vs. 2·1 years; P MDS, adjusting for age, frailty, comorbidity, disability, revised IPSS, TD severity, time to TD and receiving disease-modifying agents. This provides additional evidence that ICT may confer clinical benefit. © 2017 John Wiley & Sons Ltd.

  4. Adjusting estimative prediction limits

    OpenAIRE

    Masao Ueki; Kaoru Fueda

    2007-01-01

    This note presents a direct adjustment of the estimative prediction limit to reduce the coverage error from a target value to third-order accuracy. The adjustment is asymptotically equivalent to those of Barndorff-Nielsen & Cox (1994, 1996) and Vidoni (1998). It has a simpler form with a plug-in estimator of the coverage probability of the estimative limit at the target value. Copyright 2007, Oxford University Press.

  5. Adjustable Pitot Probe

    Science.gov (United States)

    Ashby, George C., Jr.; Robbins, W. Eugene; Horsley, Lewis A.

    1991-01-01

    Probe readily positionable in core of uniform flow in hypersonic wind tunnel. Formed of pair of mating cylindrical housings: transducer housing and pitot-tube housing. Pitot tube supported by adjustable wedge fairing attached to top of pitot-tube housing with semicircular foot. Probe adjusted both radially and circumferentially. In addition, pressure-sensing transducer cooled internally by water or other cooling fluid passing through annulus of cooling system.

  6. Risk of surgical site infection, acute kidney injury, and Clostridium difficile infection following antibiotic prophylaxis with vancomycin plus a beta-lactam versus either drug alone: A national propensity-score-adjusted retrospective cohort study.

    Directory of Open Access Journals (Sweden)

    Westyn Branch-Elliman

    2017-07-01

    Full Text Available The optimal regimen for perioperative antimicrobial prophylaxis is controversial. Use of combination prophylaxis with a beta-lactam plus vancomycin is increasing; however, the relative risks and benefits associated with this strategy are unknown. Thus, we sought to compare postoperative outcomes following administration of 2 antimicrobials versus a single agent for the prevention of surgical site infections (SSIs. Potential harms associated with combination regimens, including acute kidney injury (AKI and Clostridium difficile infection (CDI, were also considered.Using a multicenter, national Veterans Affairs (VA cohort, all patients who underwent cardiac, orthopedic joint replacement, vascular, colorectal, and hysterectomy procedures during the period from 1 October 2008 to 30 September 2013 and who received planned manual review of perioperative antimicrobial prophylaxis regimen and manual review for the 30-day incidence of SSI were included. Using a propensity-adjusted log-binomial regression model stratified by type of surgical procedure, the association between receipt of 2 antimicrobials (vancomycin plus a beta-lactam versus either single agent alone (vancomycin or a beta-lactam and SSI was evaluated. Measures of association were adjusted for age, diabetes, smoking, American Society of Anesthesiologists score, preoperative methicillin-resistant Staphylococcus aureus (MRSA status, and receipt of mupirocin. The 7-day incidence of postoperative AKI and 90-day incidence of CDI were also measured. In all, 70,101 procedures (52,504 beta-lactam only, 5,089 vancomycin only, and 12,508 combination with 2,466 (3.5% SSIs from 109 medical centers were included. Among cardiac surgery patients, combination prophylaxis was associated with a lower incidence of SSI (66/6,953, 0.95% than single-agent prophylaxis (190/12,834, 1.48%; crude risk ratio [RR] 0.64, 95% CI 0.49, 0.85; adjusted RR 0.61, 95% CI 0.46, 0.83. After adjusting for SSI risk, no

  7. Risk of surgical site infection, acute kidney injury, and Clostridium difficile infection following antibiotic prophylaxis with vancomycin plus a beta-lactam versus either drug alone: A national propensity-score-adjusted retrospective cohort study.

    Science.gov (United States)

    Branch-Elliman, Westyn; Ripollone, John E; O'Brien, William J; Itani, Kamal M F; Schweizer, Marin L; Perencevich, Eli; Strymish, Judith; Gupta, Kalpana

    2017-07-01

    The optimal regimen for perioperative antimicrobial prophylaxis is controversial. Use of combination prophylaxis with a beta-lactam plus vancomycin is increasing; however, the relative risks and benefits associated with this strategy are unknown. Thus, we sought to compare postoperative outcomes following administration of 2 antimicrobials versus a single agent for the prevention of surgical site infections (SSIs). Potential harms associated with combination regimens, including acute kidney injury (AKI) and Clostridium difficile infection (CDI), were also considered. Using a multicenter, national Veterans Affairs (VA) cohort, all patients who underwent cardiac, orthopedic joint replacement, vascular, colorectal, and hysterectomy procedures during the period from 1 October 2008 to 30 September 2013 and who received planned manual review of perioperative antimicrobial prophylaxis regimen and manual review for the 30-day incidence of SSI were included. Using a propensity-adjusted log-binomial regression model stratified by type of surgical procedure, the association between receipt of 2 antimicrobials (vancomycin plus a beta-lactam) versus either single agent alone (vancomycin or a beta-lactam) and SSI was evaluated. Measures of association were adjusted for age, diabetes, smoking, American Society of Anesthesiologists score, preoperative methicillin-resistant Staphylococcus aureus (MRSA) status, and receipt of mupirocin. The 7-day incidence of postoperative AKI and 90-day incidence of CDI were also measured. In all, 70,101 procedures (52,504 beta-lactam only, 5,089 vancomycin only, and 12,508 combination) with 2,466 (3.5%) SSIs from 109 medical centers were included. Among cardiac surgery patients, combination prophylaxis was associated with a lower incidence of SSI (66/6,953, 0.95%) than single-agent prophylaxis (190/12,834, 1.48%; crude risk ratio [RR] 0.64, 95% CI 0.49, 0.85; adjusted RR 0.61, 95% CI 0.46, 0.83). After adjusting for SSI risk, no association

  8. Convexity Adjustments for ATS Models

    DEFF Research Database (Denmark)

    Murgoci, Agatha; Gaspar, Raquel M.

    . As a result we classify convexity adjustments into forward adjustments and swaps adjustments. We, then, focus on affine term structure (ATS) models and, in this context, conjecture convexity adjustments should be related of affine functionals. In the case of forward adjustments, we show how to obtain exact...

  9. Sustainable urban regime adjustments

    DEFF Research Database (Denmark)

    Quitzau, Maj-Britt; Jensen, Jens Stissing; Elle, Morten

    2013-01-01

    The endogenous agency that urban governments increasingly portray by making conscious and planned efforts to adjust the regimes they operate within is currently not well captured in transition studies. There is a need to acknowledge the ambiguity of regime enactment at the urban scale. This direc...

  10. Sickness presence, sick leave and adjustment latitude

    Directory of Open Access Journals (Sweden)

    Joachim Gerich

    2014-10-01

    Full Text Available Objectives: Previous research on the association between adjustment latitude (defined as the opportunity to adjust work efforts in case of illness and sickness absence and sickness presence has produced inconsistent results. In particular, low adjustment latitude has been identified as both a risk factor and a deterrent of sick leave. The present study uses an alternative analytical strategy with the aim of joining these results together. Material and Methods: Using a cross-sectional design, a random sample of employees covered by the Upper Austrian Sickness Fund (N = 930 was analyzed. Logistic and ordinary least square (OLS regression models were used to examine the association between adjustment latitude and days of sickness absence, sickness presence, and an estimator for the individual sickness absence and sickness presence propensity. Results: A high level of adjustment latitude was found to be associated with a reduced number of days of sickness absence and sickness presence, but an elevated propensity for sickness absence. Conclusions: Employees with high adjustment latitude experience fewer days of health complaints associated with lower rates of sick leave and sickness presence compared to those with low adjustment latitude. In case of illness, however, high adjustment latitude is associated with a higher pro­bability of taking sick leave rather than sickness presence.

  11. Using Trauma and Injury Severity Score (TRISS)-based analysis in the development of regional risk adjustment tools to trend quality in a voluntary trauma system: the experience of the Trauma Foundation of Northeast Ohio.

    Science.gov (United States)

    Mancuso, C; Barnoski, A; Tinnell, C; Fallon, W

    2000-04-01

    Presently, no trauma system exists in Ohio. Since 1993, all hospitals in Cuyahoga County (CUY), northeast Ohio (n = 22) provide data to a trauma registry. In return, each received hospital-specific data, comparison data by trauma care level and a county-wide aggregate summary. This report describes the results of this approach in our region. All cases were entered by paper abstract or electronic download. Interrater reliability audits and z score analysis was performed by using the Major Trauma Outcome Study and the CUY 1994 baseline groups. Risk adjustment of mortality data was performed using statistical modeling and logistic regression (Trauma and Injury Severity Score, Major Trauma Outcome Study, CUY). Trauma severity measures were defined. In 1995, 3,375 patients were entered. Two hundred ninety-one died (8.6%). Severity measures differed by level of trauma care, indicating differences in case mix. Probability of survival was lowest in the Level I centers, highest in the acute care hospitals. Outcomes z scores demonstrated survival differences for all levels. In a functioning trauma system, the most severely injured patients should be cared for at the trauma centers. A low volume at acute care hospitals is desirable. By using Trauma and Injury Severity Score with community-specific constants, NE Ohio is accomplishing these goals. The Level I performance data are an interesting finding compared with the data from the Level II centers in the region

  12. Premium adjustment: actuarial analysis on epidemiological models ...

    African Journals Online (AJOL)

    In this paper, we analyse insurance premium adjustment in the context of an epidemiological model where the insurer's future financial liability is greater than the premium from patients. In this situation, it becomes extremely difficult for the insurer since a negative reserve would severely increase its risk of insolvency, ...

  13. Downhole adjustable bent assemblies

    International Nuclear Information System (INIS)

    Askew, W.E.

    1992-01-01

    This patent describes downhole adjustable apparatus for creating a bend angle in order to affect the inclination of a drilled borehole. It comprises an upper tubular member having an upper portion and a lower portion; lower tubular member having an upper portion and a lower portion; one of the portions being received within the other for relative rotational movement about an axis that is inclined with respect to the the longitudinal axes of the members, whereby in a first rotational position the longitudinal axes have one geometrical relationship, and in a second rotational position the longitudinal axes have a second, different geometrical relationship

  14. Adjustment disorder: current perspectives

    Directory of Open Access Journals (Sweden)

    Zelviene P

    2018-01-01

    Full Text Available Paulina Zelviene, Evaldas Kazlauskas Department of Clinical and Organizational Psychology, Vilnius University, Vilnius, Lithuania Abstract: Adjustment disorder (AjD is among the most often diagnosed mental disorders in clinical practice. This paper reviews current status of AjD research and discusses scientific and clinical issues associated with AjD. AjD has been included in diagnostic classifications for over 50 years. Still, the diagnostic criteria for AjD remain vague and cause difficulties to mental health professionals. Controversies in definition resulted in the lack of reliable and valid measures of AjD. Epidemiological data on prevalence of AjD is scarce and not reliable because prevalence data are biased by the diagnostic algorithm, which is usually developed for each study, as no established diagnostic standards for AjD are available. Considerable changes in the field of AjD could follow after the release of the 11th edition of International Classification of Diseases (ICD-11. A new AjD symptom profile was introduced in ICD-11 with 2 main symptoms as follows: 1 preoccupation and 2 failure to adapt. However, differences between the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and ICD-11 AjD diagnostic criteria could result in diverse research findings in the future. The best treatment approach for AjD remains unclear, and further treatment studies are needed to provide AjD treatment guidelines to clinicians. Keywords: adjustment disorder, review, diagnosis, prevalence, treatment, DSM, ICD

  15. Continuously adjustable Pulfrich spectacles

    Science.gov (United States)

    Jacobs, Ken; Karpf, Ron

    2011-03-01

    A number of Pulfrich 3-D movies and TV shows have been produced, but the standard implementation has inherent drawbacks. The movie and TV industries have correctly concluded that the standard Pulfrich 3-D implementation is not a useful 3-D technique. Continuously Adjustable Pulfrich Spectacles (CAPS) is a new implementation of the Pulfrich effect that allows any scene containing movement in a standard 2-D movie, which are most scenes, to be optionally viewed in 3-D using inexpensive viewing specs. Recent scientific results in the fields of human perception, optoelectronics, video compression and video format conversion are translated into a new implementation of Pulfrich 3- D. CAPS uses these results to continuously adjust to the movie so that the viewing spectacles always conform to the optical density that optimizes the Pulfrich stereoscopic illusion. CAPS instantly provides 3-D immersion to any moving scene in any 2-D movie. Without the glasses, the movie will appear as a normal 2-D image. CAPS work on any viewing device, and with any distribution medium. CAPS is appropriate for viewing Internet streamed movies in 3-D.

  16. Adjustment Criterion and Algorithm in Adjustment Model with Uncertain

    Directory of Open Access Journals (Sweden)

    SONG Yingchun

    2015-02-01

    Full Text Available Uncertainty often exists in the process of obtaining measurement data, which affects the reliability of parameter estimation. This paper establishes a new adjustment model in which uncertainty is incorporated into the function model as a parameter. A new adjustment criterion and its iterative algorithm are given based on uncertainty propagation law in the residual error, in which the maximum possible uncertainty is minimized. This paper also analyzes, with examples, the different adjustment criteria and features of optimal solutions about the least-squares adjustment, the uncertainty adjustment and total least-squares adjustment. Existing error theory is extended with new observational data processing method about uncertainty.

  17. Derivation of a chemical-specific adjustment factor (CSAF) for use in the assessment of risk from chronic exposure to ethylene glycol: Application of international programme for chemical safety guidelines

    International Nuclear Information System (INIS)

    Palmer, Robert B.; Brent, Jeffrey

    2005-01-01

    The International Programme for Chemical Safety (IPCS) has developed a set of guidelines ('the Guidance') for the establishment of Chemical-Specific Adjustment Factors (CSAFs) for in the assessment of toxicity risk to the human population as a result of chemical exposure. The development of case studies is encouraged in the Guidance document and comments on them have been encouraged by the IPCS. One provision in the Guidance is for the determination of CSAFs based on human data. We present a case study of the use of the Guidance for the determination of the CSAF for ethylene glycol (EG) primarily utilizing clinically obtained data. The most relevant endpoint for this analysis was deemed to be acute renal injury. These data were applied based on an assessment of the known pharmaco/toxico-kinetic properties of EG. Because of the lack of both bioaccumulation of EG and reports of chronic or progressive renal injury from EG, it was concluded that the most appropriate model of chronic exposure is one of repeated acute episodes. The most relevant exposure metric was determined to be plasma glycolate concentration. Based on a prospective human study of EG-poisoned patients, the NOAEL for glycolate was found to be 10.1 mM. This value is similar to that obtained from animal data. The application of the Guidelines to this data resulted in a CSAF of 10.24, corresponding to a daily EG dose of 43.7 mg/kg/day. In 2000, Health Canada (HC) produced an animal data-based analysis of the maximum tolerated dose of EG. The results of our analysis are compared with those of HC, and the strengths and weaknesses of these two data types related to EG are discussed

  18. Adjustable continence balloons

    DEFF Research Database (Denmark)

    Kjær, Line; Fode, Mikkel; Nørgaard, Nis

    2012-01-01

    Abstract Objective. This study aimed to evaluate the results of the Danish experience with the ProACT urinary continence device inserted in men with stress urinary incontinence. Material and methods. The ProACT was inserted in 114 patients. Data were registered prospectively. The main endpoints...... in urinary leakage > 50% was seen in 72 patients (80%). Complications were seen in 23 patients. All of these were treated successfully by removal of the device in the outpatient setting followed by replacement of the device. Another eight patients had a third balloon inserted to improve continence further....... Fourteen patients (12%) ended up with an artificial sphincter or a urethral sling. Sixty patients (63%) experienced no discomfort and 58 (61%) reported being dry or markedly improved. Overall, 50 patients (53%) reported being very or predominantly satisfied. Conclusions. Adjustable continence balloons seem...

  19. Metric adjusted skew information

    DEFF Research Database (Denmark)

    Hansen, Frank

    2008-01-01

    ) that vanishes for observables commuting with the state. We show that the skew information is a convex function on the manifold of states. It also satisfies other requirements, proposed by Wigner and Yanase, for an effective measure-of-information content of a state relative to a conserved observable. We...... establish a connection between the geometrical formulation of quantum statistics as proposed by Chentsov and Morozova and measures of quantum information as introduced by Wigner and Yanase and extended in this article. We show that the set of normalized Morozova-Chentsov functions describing the possible......We extend the concept of Wigner-Yanase-Dyson skew information to something we call "metric adjusted skew information" (of a state with respect to a conserved observable). This "skew information" is intended to be a non-negative quantity bounded by the variance (of an observable in a state...

  20. Risk

    Science.gov (United States)

    Cole, Stephen R.; Hudgens, Michael G.; Brookhart, M. Alan; Westreich, Daniel

    2015-01-01

    The epidemiologist primarily studies transitions between states of health and disease. The purpose of the present article is to define a foundational parameter for such studies, namely risk. We begin simply and build to the setting in which there is more than 1 event type (i.e., competing risks or competing events), as well as more than 1 treatment or exposure level of interest. In the presence of competing events, the risks are a set of counterfactual cumulative incidence functions for each treatment. These risks can be depicted visually and summarized numerically. We use an example from the study of human immunodeficiency virus to illustrate concepts. PMID:25660080

  1. Adolescent Mothers' Adjustment to Parenting.

    Science.gov (United States)

    Samuels, Valerie Jarvis; And Others

    1994-01-01

    Examined adolescent mothers' adjustment to parenting, self-esteem, social support, and perceptions of baby. Subjects (n=52) responded to questionnaires at two time periods approximately six months apart. Mothers with higher self-esteem at Time 1 had better adjustment at Time 2. Adjustment was predicted by Time 2 variables; contact with baby's…

  2. HPGe detector shielding adjustment

    International Nuclear Information System (INIS)

    Trnkova, L.; Rulik, P.

    2008-01-01

    Low-level background shielding of HPGe detectors is used mainly for environmental samples with very low content of radionuclides. National Radiation Protection Institute (SURO) in Prague is equipped with 14 HPGe detectors with relative efficiency up to 150%. The detectors are placed in a room built from materials with low content of natural radionuclides and equipped with a double isolation of the floor against radon. Detectors themselves are placed in lead or steel shielding. Steel shielding with one of these detectors with relative efficiency of 100% was chosen to be rebuilt to achieve lower minimum detectable activity (MDA). Additional lead and copper shielding was built up inside the original steel shielding to reduce the volume of the inner space and filled with nitrogen by means of evaporating liquid nitrogen. The additional lead and copper shielding, consequent reduction of the inner volume and supply of evaporated nitrogen, caused a decrease of the background count and accordingly MDA values as well. The effect of nitrogen evaporation on the net areas of peaks belonging to radon daughters is significant. The enhanced shielding adjustment has the biggest influence in low energy range, what can be seen in collected data. MDA values in energy range from 30 keV to 400 keV decreased to 0.65-0.85 of original value, in energy range from 400 keV to 2 MeV they fell to 0.70-0.97 of original value. (authors)

  3. A review of statistical estimators for risk-adjusted length of stay: analysis of the Australian and new Zealand Intensive Care Adult Patient Data-Base, 2008-2009.

    Science.gov (United States)

    Moran, John L; Solomon, Patricia J

    2012-05-16

    For the analysis of length-of-stay (LOS) data, which is characteristically right-skewed, a number of statistical estimators have been proposed as alternatives to the traditional ordinary least squares (OLS) regression with log dependent variable. Using a cohort of patients identified in the Australian and New Zealand Intensive Care Society Adult Patient Database, 2008-2009, 12 different methods were used for estimation of intensive care (ICU) length of stay. These encompassed risk-adjusted regression analysis of firstly: log LOS using OLS, linear mixed model [LMM], treatment effects, skew-normal and skew-t models; and secondly: unmodified (raw) LOS via OLS, generalised linear models [GLMs] with log-link and 4 different distributions [Poisson, gamma, negative binomial and inverse-Gaussian], extended estimating equations [EEE] and a finite mixture model including a gamma distribution. A fixed covariate list and ICU-site clustering with robust variance were utilised for model fitting with split-sample determination (80%) and validation (20%) data sets, and model simulation was undertaken to establish over-fitting (Copas test). Indices of model specification using Bayesian information criterion [BIC: lower values preferred] and residual analysis as well as predictive performance (R2, concordance correlation coefficient (CCC), mean absolute error [MAE]) were established for each estimator. The data-set consisted of 111663 patients from 131 ICUs; with mean(SD) age 60.6(18.8) years, 43.0% were female, 40.7% were mechanically ventilated and ICU mortality was 7.8%. ICU length-of-stay was 3.4(5.1) (median 1.8, range (0.17-60)) days and demonstrated marked kurtosis and right skew (29.4 and 4.4 respectively). BIC showed considerable spread, from a maximum of 509801 (OLS-raw scale) to a minimum of 210286 (LMM). R2 ranged from 0.22 (LMM) to 0.17 and the CCC from 0.334 (LMM) to 0.149, with MAE 2.2-2.4. Superior residual behaviour was established for the log-scale estimators

  4. Covariate-adjusted measures of discrimination for survival data

    DEFF Research Database (Denmark)

    White, Ian R; Rapsomaniki, Eleni; Frikke-Schmidt, Ruth

    2015-01-01

    by the study design (e.g. age and sex) influence discrimination and can make it difficult to compare model discrimination between studies. Although covariate adjustment is a standard procedure for quantifying disease-risk factor associations, there are no covariate adjustment methods for discrimination...... statistics in censored survival data. OBJECTIVE: To develop extensions of the C-index and D-index that describe the prognostic ability of a model adjusted for one or more covariate(s). METHOD: We define a covariate-adjusted C-index and D-index for censored survival data, propose several estimators......, and investigate their performance in simulation studies and in data from a large individual participant data meta-analysis, the Emerging Risk Factors Collaboration. RESULTS: The proposed methods perform well in simulations. In the Emerging Risk Factors Collaboration data, the age-adjusted C-index and D-index were...

  5. Risk

    Science.gov (United States)

    Barshi, Immanuel

    2016-01-01

    Speaking up, i.e. expressing ones concerns, is a critical piece of effective communication. Yet, we see many situations in which crew members have concerns and still remain silent. Why would that be the case? And how can we assess the risks of speaking up vs. the risks of keeping silent? And once we do make up our minds to speak up, how should we go about it? Our workshop aims to answer these questions, and to provide us all with practical tools for effective risk assessment and effective speaking-up strategies..

  6. Social and Emotional Adjustment of Siblings of Children with Autism

    Science.gov (United States)

    Pilowsky, Tammy; Yirmiya, Nurit; Doppelt, Osnat; Gross-Tsur, Varda; Shalev, Ruth S.

    2004-01-01

    Background: Social and emotional adjustment of siblings of children with autism was examined, to explore their risk or resilience to effects of genetic liability and environmental factors involved in having a sibling with autism. Method: Social-emotional adjustment, behavior problems, socialization skills, and siblings' relationships were compared…

  7. The Effect of Family Communication Patterns on Adopted Adolescent Adjustment

    Science.gov (United States)

    Rueter, Martha A.; Koerner, Ascan F.

    2008-01-01

    Adoption and family communication both affect adolescent adjustment. We proposed that adoption status and family communication interact such that adopted adolescents in families with certain communication patterns are at greater risk for adjustment problems. We tested this hypothesis using a community-based sample of 384 adoptive and 208…

  8. Adjusted Money's Worth Ratios in Life Annuities

    OpenAIRE

    Jaime Casassus; Eduardo Walker

    2013-01-01

    The Money's Worth Ratio (MWR) measures an annuity's actuarial fairness. It is calculated as the discounted present value of expected future payments divided by its cost. We argue that from the perspective of annuitants, this measure may overestimate the value-for-money obtained, since it does not adjust for liquidity or risk factors. Measuring these factors is challenging, requiring detailed knowledge of assets, liabilities, and of the stochastic processes followed by them. Using a multi-fact...

  9. Development of Bioavailability Adjustment Factors: A Feasibility Study

    National Research Council Canada - National Science Library

    Rembish, Steve

    2000-01-01

    The primary purpose of this effort is to investigate the feasibility of developing and using bioavailability adjustment factors to modify intake assumptions used in risk assessments on a site-specific basis...

  10. Metric-adjusted skew information

    DEFF Research Database (Denmark)

    Liang, Cai; Hansen, Frank

    2010-01-01

    on a bipartite system and proved superadditivity of the Wigner-Yanase-Dyson skew informations for such states. We extend this result to the general metric-adjusted skew information. We finally show that a recently introduced extension to parameter values 1 ...We give a truly elementary proof of the convexity of metric-adjusted skew information following an idea of Effros. We extend earlier results of weak forms of superadditivity to general metric-adjusted skew information. Recently, Luo and Zhang introduced the notion of semi-quantum states...... of (unbounded) metric-adjusted skew information....

  11. Neonatal mortality: description and effect of hospital of birth after risk adjustment Mortalidade neonatal: descrição e efeito do hospital de nascimento após ajuste de risco

    Directory of Open Access Journals (Sweden)

    Aluísio J D Barros

    2008-02-01

    Full Text Available OBJECTIVE: To assess the effect of hospital of birth on neonatal mortality. METHODS: A birth cohort study was carried out in Pelotas, Southern Brazil, in 2004. All hospital births were assessed by daily visits to all maternity hospitals and 4558 deliveries were included in the study. Mothers were interviewed regarding potential risk factors. Deaths were monitored through regular visits to hospitals, cemeteries and register offices. Two independent pediatricians established the underlying cause of death based on information obtained from medical records and home visits to parents. Logistic regression was used to estimate the effect of hospital of birth, controlling for confounders related to maternal and newborn characteristics, according to a conceptual model. RESULTS: Neonatal mortality rate was 12.7‰ and it was highly influenced by birthweight, gestational age, and socioeconomic variables. Immaturity was responsible for 65% of neonatal deaths, followed by congenital anomalies, infections and intrapartum asphyxia. Adjusting for maternal characteristics, a three-fold increase in neonatal mortality was seen between similar complexity hospitals. The effect of hospital remained, though lower, after controlling for newborn characteristics. CONCLUSIONS: Neonatal mortality was high, mainly related to immaturity, and varied significantly across maternity hospitals. Further investigations comparing delivery care practices across hospitals are needed to better understand NMR variation and to develop strategies for neonatal mortality reduction.OBJETIVO: Avaliar o efeito de hospital de nascimento na ocorrência de mortalidade neonatal. MÉTODOS: Uma coorte de nascimentos foi iniciada em Pelotas, em 2004. Todos os nascimentos hospitalares foram estudados em visitas diárias às maternidades da cidade, incluindo-se 4.558 recém-nascidos. As mães foram entrevistadas sobre fatores de risco em potencial e as mortes, monitoradas com visitas regulares aos

  12. A complete generalized adjustment criterion

    NARCIS (Netherlands)

    Perković, Emilija; Textor, Johannes; Kalisch, Markus; Maathuis, Marloes H.

    2015-01-01

    Covariate adjustment is a widely used approach to estimate total causal effects from observational data. Several graphical criteria have been developed in recent years to identify valid covariates for adjustment from graphical causal models. These criteria can handle multiple causes, latent

  13. Parental Divorce and Children's Adjustment.

    Science.gov (United States)

    Lansford, Jennifer E

    2009-03-01

    This article reviews the research literature on links between parental divorce and children's short-term and long-term adjustment. First, I consider evidence regarding how divorce relates to children's externalizing behaviors, internalizing problems, academic achievement, and social relationships. Second, I examine timing of the divorce, demographic characteristics, children's adjustment prior to the divorce, and stigmatization as moderators of the links between divorce and children's adjustment. Third, I examine income, interparental conflict, parenting, and parents well-being as mediators of relations between divorce and children's adjustment. Fourth, I note the caveats and limitations of the research literature. Finally, I consider notable policies related to grounds for divorce, child support, and child custody in light of how they might affect children s adjustment to their parents divorce. © 2009 Association for Psychological Science.

  14. Normal Stress or Adjustment Disorder?

    Science.gov (United States)

    ... disorder is a type of stress-related mental illness that can affect your feelings, thoughts and behaviors. Signs and symptoms of an adjustment disorder can include: Anxiety Poor school or work performance Relationship problems Sadness ...

  15. Time-adjusted variable resistor

    Science.gov (United States)

    Heyser, R. C.

    1972-01-01

    Timing mechanism was developed effecting extremely precisioned highly resistant fixed resistor. Switches shunt all or portion of resistor; effective resistance is varied over time interval by adjusting switch closure rate.

  16. A primer on counterparty valuation adjustments in South Africa

    Directory of Open Access Journals (Sweden)

    Gary Wayne van Vuuren

    2014-11-01

    Full Text Available Counterparty valuation adjustment (CVA risk accounts for losses due to the deterioration in credit quality of derivative counterparties with large credit spreads. Of the losses attributed to counterparty credit risk incurred during the financial crisis of 2008-9 were due to CVA risk; the remaining third were due to actual defaults. Regulatory authorities have acknowledged and included this risk in the new Basel III rules. The capital implications of CVA risk in the South African milieu are explored, as well as the sensitivity of CVA risk components to market variables. Proposed methodologies for calculating changes in CVA are found to be unstable and unreliable at high average spread levels.

  17. Adjustable chain trees for proteins

    DEFF Research Database (Denmark)

    Winter, Pawel; Fonseca, Rasmus

    2012-01-01

    A chain tree is a data structure for changing protein conformations. It enables very fast detection of clashes and free energy potential calculations. A modified version of chain trees that adjust themselves to the changing conformations of folding proteins is introduced. This results in much...... tighter bounding volume hierarchies and therefore fewer intersection checks. Computational results indicate that the efficiency of the adjustable chain trees is significantly improved compared to the traditional chain trees....

  18. Electronic gaming and psychosocial adjustment.

    Science.gov (United States)

    Przybylski, Andrew K

    2014-09-01

    The rise of electronic games has driven both concerns and hopes regarding their potential to influence young people. Existing research identifies a series of isolated positive and negative effects, yet no research to date has examined the balance of these potential effects in a representative sample of children and adolescents. The objective of this study was to explore how time spent playing electronic games accounts for significant variation in positive and negative psychosocial adjustment using a representative cohort of children aged 10 to 15 years. A large sample of children and adolescents aged 10 to 15 years completed assessments of psychosocial adjustment and reported typical daily hours spent playing electronic games. Relations between different levels of engagement and indicators of positive and negative psychosocial adjustment were examined, controlling for participant age and gender and weighted for population representativeness. Low levels (3 hours daily) of game engagement was linked to key indicators of psychosocial adjustment. Low engagement was associated with higher life satisfaction and prosocial behavior and lower externalizing and internalizing problems, whereas the opposite was found for high levels of play. No effects were observed for moderate play levels when compared with non-players. The links between different levels of electronic game engagement and psychosocial adjustment were small (Games consistently but not robustly associated with children's adjustment in both positive and negative ways, findings that inform policy-making as well as future avenues for research in the area. Copyright © 2014 by the American Academy of Pediatrics.

  19. [Adjustment disorder and DSM-5: A review].

    Science.gov (United States)

    Appart, A; Lange, A-K; Sievert, I; Bihain, F; Tordeurs, D

    2017-02-01

    ineffectiveness of drug therapy. The literature suggests a psychotherapeutic approach to treat adjustment disorder. Emotional reactions triggered by life events are responsible for full therapy agendas and for the rush in emergency rooms and hospitals. The reflex when faced with crying, insomnia or suicidal thoughts to give a diagnostic of major depressive disorder s is generally accepted by everyone. The elevated risk to commit suicide and the approved success of remission or healing through treatment (psychotherapy) are two major reasons why several studies promote the importance and the need to identify the adjustment disorder of our patients. Copyright © 2016 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

  20. Apparently conclusive meta-analyses may be inconclusive--Trial sequential analysis adjustment of random error risk due to repetitive testing of accumulating data in apparently conclusive neonatal meta-analyses

    DEFF Research Database (Denmark)

    Brok, Jesper; Thorlund, Kristian; Wetterslev, Jørn

    2008-01-01

    BACKGROUND: Random error may cause misleading evidence in meta-analyses. The required number of participants in a meta-analysis (i.e. information size) should be at least as large as an adequately powered single trial. Trial sequential analysis (TSA) may reduce risk of random errors due to repeti......BACKGROUND: Random error may cause misleading evidence in meta-analyses. The required number of participants in a meta-analysis (i.e. information size) should be at least as large as an adequately powered single trial. Trial sequential analysis (TSA) may reduce risk of random errors due...

  1. Adjustment of nursing home quality indicators

    Directory of Open Access Journals (Sweden)

    Hirdes John P

    2010-04-01

    Full Text Available Abstract Background This manuscript describes a method for adjustment of nursing home quality indicators (QIs defined using the Center for Medicaid & Medicare Services (CMS nursing home resident assessment system, the Minimum Data Set (MDS. QIs are intended to characterize quality of care delivered in a facility. Threats to the validity of the measurement of presumed quality of care include baseline resident health and functional status, pattern of comorbidities, and facility case mix. The goal of obtaining a valid facility-level estimate of true quality of care should include adjustment for resident- and facility-level sources of variability. Methods We present a practical and efficient method to achieve risk adjustment using restriction and indirect and direct standardization. We present information on validity by comparing QIs estimated with the new algorithm to one currently used by CMS. Results More than half of the new QIs achieved a "Moderate" validation level. Conclusions Given the comprehensive approach and the positive findings to date, research using the new quality indicators is warranted to provide further evidence of their validity and utility and to encourage their use in quality improvement activities.

  2. Fiscal Adjustment in IMF-Supported Adjustment Programmes: The ...

    African Journals Online (AJOL)

    Fiscal adjustment is an essential element of macro-economic stability and economic growth. Given that economic growth is the most powerful weapon in the fight for higher living standards, poor growth performance in African countries, has been a challenge to economists, policy makers and international development ...

  3. Acculturation, personality, and psychological adjustment.

    Science.gov (United States)

    Ahadi, Stephan A; Puente-Díaz, Rogelio

    2011-12-01

    Two studies investigated relationships between traditional indicators of acculturation, cultural distance, acculturation strategies, and basic dimensions of personality as they pertain to psychological adjustment among Hispanic students. Although personality characteristics have been shown to be important determinants of psychological well-being, acculturation research has put less emphasis on the role of personality in the well-being of immigrants. Hierarchical regression analysis showed that basic dimensions of personality such as extraversion and neuroticism were strongly related to psychological adjustment. Acculturation strategies did not mediate the effect of personality variables, but cultural resistance made a small, independent contribution to the explanation of some aspects of negative psychological adjustment. The implications of the results were discussed.

  4. GPU Parallel Bundle Block Adjustment

    Directory of Open Access Journals (Sweden)

    ZHENG Maoteng

    2017-09-01

    Full Text Available To deal with massive data in photogrammetry, we introduce the GPU parallel computing technology. The preconditioned conjugate gradient and inexact Newton method are also applied to decrease the iteration times while solving the normal equation. A brand new workflow of bundle adjustment is developed to utilize GPU parallel computing technology. Our method can avoid the storage and inversion of the big normal matrix, and compute the normal matrix in real time. The proposed method can not only largely decrease the memory requirement of normal matrix, but also largely improve the efficiency of bundle adjustment. It also achieves the same accuracy as the conventional method. Preliminary experiment results show that the bundle adjustment of a dataset with about 4500 images and 9 million image points can be done in only 1.5 minutes while achieving sub-pixel accuracy.

  5. Kinematic adjustments to seismic recordings

    Energy Technology Data Exchange (ETDEWEB)

    Telegin, A.N.; Levii, N.V.; Volovik, U.M.

    1981-01-01

    The introduction of kinematic adjustments by adding the displaced blocks is studied theoretically and in test seismograms. The advantage to this method resulting from the weight variation in the trace is demonstrated together with its kinematic drawback. A variation on the displaced block addition method that does not involve realignment of the travel time curves and that has improved amplitude characteristics is proposed.

  6. Children's adjustment to their divorced parents' new relationships.

    Science.gov (United States)

    Isaacs, Ar

    2002-08-01

    With new relationships common after divorce, researchers have tried to determine the factors that predict how well children adjust to their stepfamily. The many potential factors are often grouped into the categories of family process, individual risk and vulnerability, and ecological variables. Family process is concentrated on the impact of disrupted family relationships; positive outcomes are associated with low conflict and authoritative parenting. Individual risk and vulnerability includes attributes of the child and the adults; positive outcomes are associated with children who have an easy temperament. Adolescents and girls may have particular difficulty adjusting. Ecological perspectives include the larger social environment such as peers and school.

  7. Algorithm for lamotrigine dose adjustment before, during, and after pregnancy

    DEFF Research Database (Denmark)

    Sabers, A

    2012-01-01

    Sabers A. Algorithm for lamotrigine dose adjustment before, during, and after pregnancy. Acta Neurol Scand: DOI: 10.1111/j.1600-0404.2011.01627.x. © 2011 John Wiley & Sons A/S. Background -  Treatment with lamotrigine (LTG) during pregnancy is associated with a pronounced risk of seizure deterior......Sabers A. Algorithm for lamotrigine dose adjustment before, during, and after pregnancy. Acta Neurol Scand: DOI: 10.1111/j.1600-0404.2011.01627.x. © 2011 John Wiley & Sons A/S. Background -  Treatment with lamotrigine (LTG) during pregnancy is associated with a pronounced risk of seizure...

  8. Birth-Order Complementarity and Marital Adjustment.

    Science.gov (United States)

    Vos, Cornelia J. Vanderkooy; Hayden, Delbert J.

    1985-01-01

    Tested the influence of birth-order complementarity on marital adjustment among 327 married women using the Spanier Dyadic Adjustment Scale (1976). Birth-order complementarity was found to be unassociated with marital adjustment. (Author/BL)

  9. Parenting Perfectionism and Parental Adjustment

    OpenAIRE

    Lee, Meghan A.; Schoppe-Sullivan, Sarah J.; Kamp Dush, Claire M.

    2012-01-01

    The parental role is expected to be one of the most gratifying and rewarding roles in life. As expectations of parenting become ever higher, the implications of parenting perfectionism for parental adjustment warrant investigation. Using longitudinal data from 182 couples, this study examined the associations between societal- and self-oriented parenting perfectionism and new mothers’ and fathers’ parenting self-efficacy, stress, and satisfaction. For mothers, societal-oriented parenting perf...

  10. Suicidal Tendency Among Adolescents With Adjustment Disorder.

    Science.gov (United States)

    Ferrer, Laia; Kirchner, Teresa

    2015-01-01

    Adolescents with adjustment disorder (AD) are at risk of presenting suicidal symptoms. Certain personality traits are linked to suicidal tendencies. There is a lack of information about the link between suicide and personality patterns in adolescents with AD. To identify the personality characteristics that predispose to or prevent the development of suicidal ideation and behavior among adolescents with AD. We recruited 108 adolescents with AD at a public mental health center near Barcelona (Spain). They were administered the Inventario de Riesgo Suicida para Adolescentes (IRIS) to assess suicidal symptoms, as well as the Millon Adolescent Clinical Inventory (MACI) and the 16PF Adolescent Personality Questionnaire (16PF-APQ) to appraise personality features. Doleful personality emerged as the principal risk for suicidal symptoms. The conforming personality pattern exerted a protective effect, and emotional stability was associated with low levels of suicidal tendencies. Among the Big Five factors, anxiety had the highest explanatory power for suicidal tendencies. Certain personality characteristics are associated with heightened or reduced risk of suicidal tendencies in adolescents with AD. Their identification is important for clinicians designing treatment programs for these patients.

  11. 12 CFR 19.240 - Inflation adjustments.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 1 2010-01-01 2010-01-01 false Inflation adjustments. 19.240 Section 19.240... PROCEDURE Civil Money Penalty Inflation Adjustments § 19.240 Inflation adjustments. (a) The maximum amount... Civil Penalties Inflation Adjustment Act of 1990 (28 U.S.C. 2461 note) as follows: ER10NO08.001 (b) The...

  12. Parental Care Aids, but Parental Overprotection Hinders, College Adjustment

    Science.gov (United States)

    Klein, Matthew B.; Pierce, John D., Jr.

    2010-01-01

    Previous work has shown that students who have troublesome relationships with their parents show higher risk factors for poorer college adjustment. In the present study, we focused on the balance between two key aspects of parenting style, parental care and overprotection, as they affect the transition to college life. Eighty-three undergraduate…

  13. Adjustable extender for instrument module

    International Nuclear Information System (INIS)

    Sevec, J.B.; Stein, A.D.

    1975-01-01

    A blank extender module used to mount an instrument module in front of its console for repair or test purposes has been equipped with a rotatable mount and means for locking the mount at various angles of rotation for easy accessibility. The rotatable mount includes a horizontal conduit supported by bearings within the blank module. The conduit is spring-biased in a retracted position within the blank module and in this position a small gear mounted on the conduit periphery is locked by a fixed pawl. The conduit and instrument mount can be pulled into an extended position with the gear clearing the pawl to permit rotation and adjustment of the instrument

  14. Adjustable Tooling for Bending Brake

    Science.gov (United States)

    Ellis, J. M.

    1986-01-01

    Deep metal boxes and other parts easily fabricated. Adjustable tooling jig for bending brake accommodates spacing blocks and either standard male press-brake die or bar die. Holds spacer blocks, press-brake die, bar window die, or combination of three. Typical bending operations include bending of cut metal sheet into box and bending of metal strip into bracket with multiple inward 90 degree bends. By increasing free space available for bending sheet-metal parts jig makes it easier to fabricate such items as deep metal boxes or brackets with right-angle bends.

  15. Risk management for whales

    OpenAIRE

    Cont, R; Wagalath, L

    2016-01-01

    We propose framework for modeling portfolio risk which integrates market risk with liquidation costs which may arise in stress scenarios. Our model provides a systematic method for computing liquidation-adjusted risk measures for a portfolio. Calculation of Liquidation-adjusted VaR (LVaR) for sample portfolios reveals a substantial impact of liquidation costs on portfolio risk for portfolios with large concentrated positions.

  16. Perceived parenting and adolescents’ adjustment

    Directory of Open Access Journals (Sweden)

    Joana Jaureguizar

    2018-05-01

    Full Text Available Abstract Adolescence is an important developmental period that is characterised by heightened problems of adjustment. The aim of this study is to analyse adolescents’ adjustment, and to explore the typologies and dimensions of parenting, and thus to determine the relationships between these factors. The sample comprised 1285 adolescent students aged 12 to 16 from the Basque Country (Spain. The students filled out the self-report of the Behavior Assessment System for Children (BASC and the Parental Acceptance-Rejection/Control Questionnaire, (PARQ/Control. Differences by age were found in the adolescents’ school maladjustment and parenting style perception. Moreover, perceptions of little parental warmth were related to higher levels of clinical and school maladjustment, and the lower the parental control, the greater the clinical maladjustment. Finally, the results obtained revealed that the interaction between the mothers’ and fathers’ parenting styles was significant only for clinical maladjustment; those students with neglectful mothers and authoritative fathers presented the highest level of clinical maladjustment, followed by other combinations of neglectful mothers. Furthermore, the students from neglectful and authoritarian families presented the highest levels of school maladjustment, without differences between neglectful and authoritarian or between indulgent and authoritative families.

  17. Adjustment and Optimization of the Cropping Systems under Water Constraint

    Directory of Open Access Journals (Sweden)

    Pingli An

    2016-11-01

    Full Text Available The water constraint on agricultural production receives growing concern with the increasingly sharp contradiction between demand and supply of water resources. How to mitigate and adapt to potential water constraint is one of the key issues for ensuring food security and achieving sustainable agriculture in the context of climate change. It has been suggested that adjustment and optimization of cropping systems could be an effective measure to improve water management and ensure food security. However, a knowledge gap still exists in how to quantify potential water constraint and how to select appropriate cropping systems. Here, we proposed a concept of water constraint risk and developed an approach for the evaluation of the water constraint risks for agricultural production by performing a case study in Daxing District, Beijing, China. The results show that, over the whole growth period, the order of the water constraint risks of crops from high to low was wheat, rice, broomcorn, foxtail millet, summer soybean, summer peanut, spring corn, and summer corn, and the order of the water constraint risks of the cropping systems from high to low was winter wheat-summer grain crops, rice, broomcorn, foxtail millet, and spring corn. Our results are consistent with the actual evolving process of cropping system. This indicates that our proposed method is practicable to adjust and optimize the cropping systems to mitigate and adapt to potential water risks. This study provides an insight into the adjustment and optimization of cropping systems under resource constraints.

  18. Culture, emotion regulation, and adjustment.

    Science.gov (United States)

    Matsumoto, David; Yoo, Seung Hee; Nakagawa, Sanae

    2008-06-01

    This article reports differences across 23 countries on 2 processes of emotion regulation--reappraisal and suppression. Cultural dimensions were correlated with country means on both and the relationship between them. Cultures that emphasized the maintenance of social order--that is, those that were long-term oriented and valued embeddedness and hierarchy--tended to have higher scores on suppression, and reappraisal and suppression tended to be positively correlated. In contrast, cultures that minimized the maintenance of social order and valued individual Affective Autonomy and Egalitarianism tended to have lower scores on Suppression, and Reappraisal and Suppression tended to be negatively correlated. Moreover, country-level emotion regulation was significantly correlated with country-level indices of both positive and negative adjustment. (PsycINFO Database Record (c) 2008 APA, all rights reserved).

  19. Pricing a Collateralized Derivative Trade with a Funding Value Adjustment

    Directory of Open Access Journals (Sweden)

    Chadd B. Hunzinger

    2015-01-01

    Full Text Available The 2008 credit crisis changed the manner in which derivative trades are conducted. One of these changes is the posting of collateral in a trade to mitigate the counterparty credit risk. Another is the realization that banks are not risk-free and, as a result, cannot borrow at the risk-free rate any longer. The latter led banks to introduced the controversial adjustment to derivative prices, known as a funding value adjustment (FVA, which is interlinked with the posting of collateral. In this paper, we extend the Cox, Ross and Rubinstein (CRR discrete-time model to include collateral and FVA. We prove that this derived model is a discrete analogue of Piterbarg’s partial differential equation (PDE, which describes the price of a collateralized derivative. The fact that the two models coincide is also verified by numerical implementation of the results that we obtain.

  20. Mexican-origin parents' work conditions and adolescents' adjustment.

    Science.gov (United States)

    Wheeler, Lorey A; Updegraff, Kimberly A; Crouter, Ann

    2015-06-01

    Mexican-origin parents' work experiences are a distal extrafamilial context for adolescents' adjustment. This 2-wave multiinformant study examined the prospective mechanisms linking parents' work conditions (i.e., self-direction, work pressure, workplace discrimination) to adolescents' adjustment (i.e., educational expectations, depressive symptoms, risky behavior) across the transition to high school drawing on work socialization and spillover models. We examined the indirect effects of parental work conditions on adolescent adjustment through parents' psychological functioning (i.e., depressive symptoms, role overload) and aspects of the parent-adolescent relationship (i.e., parental solicitation, parent-adolescent conflict), as well as moderation by adolescent gender. Participants were 246 predominantly immigrant, Mexican-origin, 2-parent families who participated in home interviews when adolescents were approximately 13 and 15 years of age. Results supported the positive impact of fathers' occupational self-direction on all 3 aspects of adolescents' adjustment through decreased father-adolescent conflict, after controlling for family socioeconomic status and earner status, and underemployment. Parental work pressure and discrimination were indirectly linked to adolescents' adjustment, with different mechanisms emerging for mothers and fathers. Adolescents' gender moderated the associations between fathers' self-direction and girls' depressive symptoms, and fathers' experiences of discrimination and boys' risk behavior. Results suggest that Mexican-origin mothers' and fathers' perceptions of work conditions have important implications for multiple domains of adolescents' adjustment across the transition to high school. (c) 2015 APA, all rights reserved).

  1. Theory of Work Adjustment Personality Constructs.

    Science.gov (United States)

    Lawson, Loralie

    1993-01-01

    To measure Theory of Work Adjustment personality and adjustment style dimensions, content-based scales were analyzed for homogeneity and successively reanalyzed for reliability improvement. Three sound scales were developed: inflexibility, activeness, and reactiveness. (SK)

  2. 12 CFR 313.55 - Salary adjustments.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 4 2010-01-01 2010-01-01 false Salary adjustments. 313.55 Section 313.55 Banks and Banking FEDERAL DEPOSIT INSURANCE CORPORATION PROCEDURE AND RULES OF PRACTICE PROCEDURES FOR CORPORATE DEBT COLLECTION Salary Offset § 313.55 Salary adjustments. Any negative adjustment to pay arising...

  3. Do fair value adjustments influence dividend policy?

    NARCIS (Netherlands)

    Goncharov, I.; van Triest, S.

    2011-01-01

    We examine the impact of positive fair value adjustments on dividend policy. If fair value adjustments are transitory in nature and managers are able to assess their implications for future earnings, fair value adjustments in net income is expected to have no distribution consequences. However,

  4. 24 CFR 5.611 - Adjusted income.

    Science.gov (United States)

    2010-04-01

    ... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Adjusted income. 5.611 Section 5... Serving Persons with Disabilities: Family Income and Family Payment; Occupancy Requirements for Section 8 Project-Based Assistance Family Income § 5.611 Adjusted income. Adjusted income means annual income (as...

  5. 12 CFR 1780.80 - Inflation adjustments.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Inflation adjustments. 1780.80 Section 1780.80... DEVELOPMENT RULES OF PRACTICE AND PROCEDURE RULES OF PRACTICE AND PROCEDURE Civil Money Penalty Inflation Adjustments § 1780.80 Inflation adjustments. The maximum amount of each civil money penalty within OFHEO's...

  6. 7 CFR 1744.64 - Budget adjustment.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 11 2010-01-01 2010-01-01 false Budget adjustment. 1744.64 Section 1744.64... Disbursement of Funds § 1744.64 Budget adjustment. (a) If more funds are required than are available in a budget account, the borrower may request RUS's approval of a budget adjustment to use funds from another...

  7. An adjustable linear Halbach array

    Energy Technology Data Exchange (ETDEWEB)

    Hilton, J.E., E-mail: James.Hilton@csiro.au [CSIRO Mathematics, Informatics and Statistics, Clayton South, VIC 3169 (Australia); McMurry, S.M. [School of Physics, Trinity College, Dublin (Ireland)

    2012-07-15

    The linear Halbach array is a well-known planar magnetic structure capable, in the idealized case, of generating a one-sided magnetic field. We show that such a field can be created from an array of uniformly magnetized rods, and rotating these rods in an alternating fashion can smoothly transfer the resultant magnetic field through the plane of the device. We examine an idealized model composed of infinite line dipoles and carry out computational simulations on a realizable device using a magnetic boundary element method. Such an arrangement can be used for an efficient latching device, or to produce a highly tunable field in the space above the device. - Highlights: Black-Right-Pointing-Pointer We model an adjustable 'one-sided' flux sheet made up of a series of dipolar magnetic field sources. Black-Right-Pointing-Pointer We show that magnetic field can be switched from one side of sheet to other by a swap rotation of each of magnetic sources. Black-Right-Pointing-Pointer Investigations show that such an arrangement is practical and can easily be fabricated. Black-Right-Pointing-Pointer The design has a wide range of potential applications.

  8. Control of Adjustable Compliant Actuators

    Directory of Open Access Journals (Sweden)

    Berno J.E. Misgeld

    2014-05-01

    Full Text Available Adjustable compliance or variable stiffness actuators comprise an additional element to elastically decouple the actuator from the load and are increasingly applied to human-centered robotic systems. The advantages of such actuators are of paramount importance in rehabilitation robotics, where requirements demand safe interaction between the therapy system and the patient. Compliant actuator systems enable the minimization of large contact forces arising, for example, from muscular spasticity and have the ability to periodically store and release energy in cyclic movements. In order to overcome the loss of bandwidth introduced by the elastic element and to guarantee a higher range in force/torque generation, new actuator designs consider variable or nonlinear stiffness elements, respectively. These components cannot only be adapted to the walking speed or the patient condition, but also entail additional challenges for feedback control. This paper introduces a novel design method for an impedance-based controller that fulfills the control objectives and compares the performance and robustness to a classical cascaded control approach. The new procedure is developed using a non-standard positive-real Η2 controller design and is applied to a loop-shaping approach. Robust norm optimal controllers are designed with regard to the passivity of the actuator load-impedance transfer function and the servo control problem. Classical cascaded and positive-real Η2 controller designs are validated and compared in simulations and in a test bench using a passive elastic element of varying stiffness.

  9. An adjustable linear Halbach array

    International Nuclear Information System (INIS)

    Hilton, J.E.; McMurry, S.M.

    2012-01-01

    The linear Halbach array is a well-known planar magnetic structure capable, in the idealized case, of generating a one-sided magnetic field. We show that such a field can be created from an array of uniformly magnetized rods, and rotating these rods in an alternating fashion can smoothly transfer the resultant magnetic field through the plane of the device. We examine an idealized model composed of infinite line dipoles and carry out computational simulations on a realizable device using a magnetic boundary element method. Such an arrangement can be used for an efficient latching device, or to produce a highly tunable field in the space above the device. - Highlights: ► We model an adjustable ‘one-sided’ flux sheet made up of a series of dipolar magnetic field sources. ► We show that magnetic field can be switched from one side of sheet to other by a swap rotation of each of magnetic sources. ► Investigations show that such an arrangement is practical and can easily be fabricated. ► The design has a wide range of potential applications.

  10. Social Adjustment of At-Risk Technology Education Students

    Science.gov (United States)

    Ernst, Jeremy V.; Moye, Johnny J.

    2013-01-01

    Individual technology education students' subgroup dynamic informs progressions of research while apprising technology teacher educators and classroom technology education teachers of intricate differences between students. Recognition of these differences help educators realize that classroom structure, instruction, and activities must be…

  11. Risk-Adjusted Returns and Stock Market Games.

    Science.gov (United States)

    Kagan, Gary; And Others

    1995-01-01

    Maintains that stock market games are designed to provide students with a background for investing in securities, especially stocks. Reviews two games used with secondary students, analyzes statistical data from these experiences, and considers weaknesses in the games. (CFR)

  12. Child Adjustment to Parental Combat Deployment: Risk and Resilience Models

    Science.gov (United States)

    2012-03-01

    include words even if bottle). FOODS 1. apple 2. banana 3. bread 4. butter 5. cake 6. candy 7. cereal 8. cheese 9~ coffee 10. cookie 11... obsessions (describe): () 1 2 41. Impulsive or acts without thinking 0 1 2 10. Can’t sit still, restless, or hyperactive () 1 2 42. Would rather be

  13. Comparison between clinical significance of height-adjusted and weight-adjusted appendicular skeletal muscle mass.

    Science.gov (United States)

    Furushima, Taishi; Miyachi, Motohiko; Iemitsu, Motoyuki; Murakami, Haruka; Kawano, Hiroshi; Gando, Yuko; Kawakami, Ryoko; Sanada, Kiyoshi

    2017-02-13

    This study aimed to compare relationships between height- or weight-adjusted appendicular skeletal muscle mass (ASM/Ht 2 or ASM/Wt) and risk factors for cardiometabolic diseases or osteoporosis in Japanese men and women. Subjects were healthy Japanese men (n = 583) and women (n = 1218). The study population included a young group (310 men and 357 women; age, 18-40 years) and a middle-aged and elderly group (273 men and 861 women; age, ≥41 years). ASM was measured by dual-energy X-ray absorptiometry. The reference values for class 1 and 2 sarcopenia in each sex were defined as values one and two standard deviations below the sex-specific means of the young group, respectively. The reference values for class 1 and 2 sarcopenia defined by ASM/Ht 2 were 7.77 and 6.89 kg/m 2 in men and 6.06 and 5.31 kg/m 2 in women, respectively. The reference values for ASM/Wt were 35.0 and 32.0% in men and 29.6 and 26.4% in women, respectively. In both men and women, ASM/Wt was negatively correlated with higher triglycerides (TG) and positively correlated with serum high-density lipoprotein cholesterol (HDL-C), but these associations were not found in height-adjusted ASM. In women, TG, systolic blood pressure, and diastolic blood pressure in sarcopenia defined by ASM/Wt were significantly higher than those in normal subjects, but these associations were not found in sarcopenia defined by ASM/Ht 2 . Whole-body and regional bone mineral density in sarcopenia defined by ASM/Ht 2 were significantly lower than those in normal subjects, but these associations were not found in sarcopenia defined by ASM/Wt. Weight-adjusted definition was able to identify cardiometabolic risk factors such as TG and HDL-C while height-adjusted definition could identify factors for osteoporosis.

  14. Depletion calculations of adjuster rods in Darlington

    Energy Technology Data Exchange (ETDEWEB)

    Arsenault, B.; Tsang, K., E-mail: benoit.arsenault@amecfw.com, E-mail: kwok.tsang@amecfw.com [AMEC Foster Wheeler, Toronto, ON (Canada)

    2015-07-01

    This paper describes the simulation methodology and reactivity worth calculated for aged adjuster rods in the Darlington core. ORIGEN-S IST was applied to simulate the isotope transmutation process of the stainless steel and titanium adjusters. The compositions were used in DRAGON-IST to calculate the change in incremental properties of aged adjusters. Pre-simulations of the reactivity worth of the stainless steel and titanium adjusters in Darlington were performed using RFSP-IST and the results showed that the titanium adjuster rods exhibit faster reactivity-worth drop than that of stainless steel rods. (author)

  15. Artificial muscles with adjustable stiffness

    International Nuclear Information System (INIS)

    Mutlu, Rahim; Alici, Gursel

    2010-01-01

    This paper reports on a stiffness enhancement methodology based on using a suitably designed contact surface with which cantilevered-type conducting polymer bending actuators are in contact during operation. The contact surface constrains the bending behaviour of the actuators. Depending on the topology of the contact surface, the resistance of the polymer actuators to deformation, i.e. stiffness, is varied. As opposed to their predecessors, these polymer actuators operate in air. Finite element analysis and modelling are used to quantify the effect of the contact surface on the effective stiffness of a trilayer cantilevered beam, which represents a one-end-free, the-other-end-fixed polypyrrole (PPy) conducting polymer actuator under a uniformly distributed load. After demonstrating the feasibility of the adjustable stiffness concept, experiments were conducted to determine the stiffness of bending-type conducting polymer actuators in contact with a range (20–40 mm in radius) of circular contact surfaces. The numerical and experimental results presented demonstrate that the stiffness of the actuators can be varied using a suitably profiled contact surface. The larger the radius of the contact surface is, the higher is the stiffness of the polymer actuators. The outcomes of this study suggest that, although the stiffness of the artificial muscles considered in this study is constant for a given geometric size, and electrical and chemical operation conditions, it can be changed in a nonlinear fashion to suit the stiffness requirement of a considered application. The stiffness enhancement methodology can be extended to other ionic-type conducting polymer actuators

  16. Factors Influencing Adjustment in Siblings of Children with Autism Spectrum Disorders

    Science.gov (United States)

    Meyer, Katherine A.; Ingersoll, Brooke; Hambrick, David Z.

    2011-01-01

    Siblings of children with autism spectrum disorders (ASD) may be at an increased risk of adjustment problems. To examine possible predictors of adjustment difficulties in siblings, 70 mothers with at least one child with ASD and one typical child completed surveys of symptom severity in the child with ASD, impact of the child with ASD on the…

  17. Poverty and Children's Adjustment. Developmental Clinical Psychology and Psychiatry, Volume 41.

    Science.gov (United States)

    Luthar, Suniya S.

    The focus of this book is on the risk and protective processes that modify the effects of poverty on children's social and emotional adjustment. The attempt is to integrate findings of empirical research conducted over the past three decades on the adjustment of children facing socioeconomic deprivation. The chapters are: (1)…

  18. Parents' Promotion of Psychological Autonomy, Psychological Control, and Mexican-American Adolescents' Adjustment

    Science.gov (United States)

    Sher-Censor, Efrat; Parke, Ross D.; Coltrane, Scott

    2011-01-01

    Mexican-American adolescents are at an elevated risk for adjustment difficulties. In an effort to identify parenting practices that can affect the adjustment of Mexican-American youth, the current study examined parents' promotion of psychological autonomy and parents' psychological control as perceived by Mexican-American early adolescents, and…

  19. TREE AGE AS ADJUSTMENT FACTOR TO NDVI

    OpenAIRE

    Elias Fernando Berra; Denise Cybis Fontana; Tatiana Mora Kuplich

    2018-01-01

    ABSTRACT This study aimed to increase satellite-derived Normalized Difference Vegetation Index (NDVI) sensitivity to biophysical parameters changes with aid of a forest age-based adjustment factor. This factor is defined as a ratio between stand age and age of rotation, which value multiplied by Landsat-5/TM-derived NDVI generated the so-called adjusted index NDVI_a. Soil Adjusted Vegetation Index (SAVI) was also calculated. The relationship between these vegetation indices (VI) with Eucalypt...

  20. Neutron spectrum adjustment. The role of covariances

    International Nuclear Information System (INIS)

    Remec, I.

    1992-01-01

    Neutron spectrum adjustment method is shortly reviewed. Practical example dealing with power reactor pressure vessel exposure rates determination is analysed. Adjusted exposure rates are found only slightly affected by the covariances of measured reaction rates and activation cross sections, while the multigroup spectra covariances were found important. Approximate spectra covariance matrices, as suggested in Astm E944-89, were found useful but care is advised if they are applied in adjustments of spectra at locations without dosimetry. (author) [sl

  1. A Simple Measure of Price Adjustment Coefficients.

    OpenAIRE

    Damodaran, Aswath

    1993-01-01

    One measure of market efficiency is the speed with which prices adjust to new information. The author develops a simple approach to estimating these price adjustment coefficients by using the information in return processes. This approach is used to estimate t he price adjustment coefficients for firms listed on the NYSE and the A MEX as well as for over-the-counter stocks. The author finds evidence of a lagged adjustment to new information in shorter return intervals for firms in all market ...

  2. Correlational indicators of psychosocial adjustment among senior ...

    African Journals Online (AJOL)

    There was a significant joint contribution of the independent variables (sense of coherence, optimism and self-efficacy) to the prediction of psychosocial adjustment. This suggested that the three independent variables combined accounted for 30.4% (Adj.R2= .304) variation in the prediction of psychosocial adjustment.

  3. Parenting Styles and Adjustment in Gifted Children

    Science.gov (United States)

    Pilarinos, Vassiliki; Solomon, C. R.

    2017-01-01

    The present study examined the relationship between parenting styles and the psychosocial adjustment of 48 children aged 7 to 11 years, each of whom had been identified as gifted on the basis of a score of 130 or above on the Wechsler Intelligence Scale for Children--Fourth Edition. Parenting styles and child psychosocial adjustment were measured…

  4. 14 CFR Appendix - Example of SIFL Adjustment

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Example of SIFL Adjustment Aeronautics and Space OFFICE OF THE SECRETARY, DEPARTMENT OF TRANSPORTATION (AVIATION PROCEEDINGS) POLICY STATEMENTS... taxes for rate purposes. Pt. 399, Subpt. C, Example Example of SIFL Adjustment [Methodology for...

  5. relationship between parenting styles and marital adjustment

    African Journals Online (AJOL)

    PROF. BARTH EKWEME

    positive and significant joint relationship between the parenting styles and marital adjustment of married ... correlate significantly with marital adjustment of married teachers in secondary ... In other words, it refers to the management of ... dealing with each other so as to reduce ill-feeling. ..... Behavior exchange in happy.

  6. Psychologica and social adjustment to blindness: Understanding ...

    African Journals Online (AJOL)

    Psychologica and social adjustment to blindness: Understanding from two groups of blind people in Ilorin, Nigeria. ... Background: Blindness can cause psychosocial distress leading to maladjustment if not mitigated. Maladjustment is a secondary burden that further reduces quality of life of the blind. Adjustment is often ...

  7. 28 CFR 11.7 - Salary adjustments.

    Science.gov (United States)

    2010-07-01

    ... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Salary adjustments. 11.7 Section 11.7 Judicial Administration DEPARTMENT OF JUSTICE DEBT COLLECTION Administration of Debt Collection § 11.7 Salary adjustments. The following debts shall not be subject to the salary offset procedures of § 11.8...

  8. 7 CFR 718.110 - Adjustments.

    Science.gov (United States)

    2010-01-01

    ... MARKETING QUOTAS, ACREAGE ALLOTMENTS, AND PRODUCTION ADJUSTMENT PROVISIONS APPLICABLE TO MULTIPLE PROGRAMS... in order to avoid a marketing quota penalty if such person: (1) Notifies the county committee of such... committee; and (2) Pays the cost of a farm inspection to determine the adjusted acreage prior to the date...

  9. Does Fall History Influence Residential Adjustments?

    Science.gov (United States)

    Leland, Natalie; Porell, Frank; Murphy, Susan L.

    2011-01-01

    Purpose of the study: To determine whether reported falls at baseline are associated with an older adult's decision to make a residential adjustment (RA) and the type of adjustment made in the subsequent 2 years. Design and Methods: Observations (n = 25,036) were from the Health and Retirement Study, a nationally representative sample of…

  10. 10 CFR 905.34 - Adjustment provisions.

    Science.gov (United States)

    2010-01-01

    ... continue to take place based on existing contract/marketing criteria principles. ... 10 Energy 4 2010-01-01 2010-01-01 false Adjustment provisions. 905.34 Section 905.34 Energy DEPARTMENT OF ENERGY ENERGY PLANNING AND MANAGEMENT PROGRAM Power Marketing Initiative § 905.34 Adjustment...

  11. relationship between parenting styles and marital adjustment

    African Journals Online (AJOL)

    PROF. BARTH EKWEME

    The relationship between permissive parenting style and marital adjustment was also very low, positive and insignificant. There was a low, positive and significant joint relationship between the parenting styles and marital adjustment of married teachers in secondary schools in Obio/Akpor Local Government Area of Rivers ...

  12. Equity Mispricing and Leverage Adjustment Costs

    NARCIS (Netherlands)

    Warr, R.S.; Elliott, W.B.; Koeter-Kant, J.; Oztekin, O.

    2012-01-01

    We find that equity mispricing impacts the speed at which firms adjust to their target leverage (TL) and does so in predictable ways depending on whether the firm is over- or underlevered. For example, firms that are above their TL and should therefore issue equity (or retire debt) adjust more

  13. Consanguineous Marriage and Marital Adjustment in Turkey.

    Science.gov (United States)

    Fisiloglu, Hurol

    2001-01-01

    Investigates the relationship between consanguineous marriage and marital adjustment in Turkey. The results of the study show that the consanguineous marriage group had significantly lower marital adjustment and had more conflict with extended family than the nonconsanguineous marriage group. The finding is discussed in the context of research and…

  14. Religiousity, Spirituality and Adolescents' Self-Adjustment

    Science.gov (United States)

    Japar, Muhammad; Purwati

    2014-01-01

    Religiuosity, spirituality, and adolescents' self-adjustment. The objective of this study is to test the correlation among religiosity, spirituality and adolescents' self-adjustment. A quantitative approach was employed in this study. Data were collected from 476 junior high schools students of 13 State Junior High Schools and one Junior High…

  15. Adjustment Following Disability: Representative Case Studies.

    Science.gov (United States)

    Heinemann, Allen W.; Shontz, Franklin C.

    1984-01-01

    Examined adjustment following physical disability using the representative case method with two persons with quadriplegia. Results highlighted the importance of previously established coping styles as well as the role of the environment in adjustment. Willingness to mourn aided in later growth. (JAC)

  16. Adjustment of the Internal Tax Scale

    CERN Multimedia

    2013-01-01

    In application of Article R V 2.03 of the Staff Regulations, the internal tax scale has been adjusted with effect on 1 January 2012. The new scale may be consulted via the CERN Admin e-guide.  The notification of internal annual tax certificate for the financial year 2012 takes into account this adjustment. HR Department (Tel. 73907)

  17. Adjustable Speed Drives - Future Challenges and Applications

    DEFF Research Database (Denmark)

    Blaabjerg, Frede; Thoegersen, Paul

    2004-01-01

    The main trends within Adjustable Drives in industrial and appliance applications for the next decade are discussed based on the newest developments seen on the market and a few historical trends. Different drive configurations are presented and the general demands to adjustable speed drives...

  18. Cultural Distance Asymmetry in Expatriate Adjustment

    DEFF Research Database (Denmark)

    Selmer, Jan; Chiu, Randy K.; Shenkar, Oded

    2007-01-01

    of the assignment. Design/methodology/approach - Using a two-flow sample of US expatriates in Germany and German expatriates in the USA, we examine and compare the psychological and socio-cultural adjustment of each group of executives. Findings - Controlling for the length of assignment, we find that German...... expatriates in the USA were better adjusted, both socio-culturally and psychologically, than American expatriates in Germany. These results support the asymmetry hypothesis and call into question previous findings attesting to the relationship between CD and expatriate adjustment. Originality......Purpose - The current literature implicitly assumes a symmetric impact of cultural distance (CD) on expatriate adjustment. By using distance as a predictor of adjustment, the literature has rendered the direction of the flow irrelevant: a US expatriate in Germany is presumed to face the same hurdle...

  19. Premorbid adjustment and neuropsychological performance in schizophrenia.

    Science.gov (United States)

    Silverstein, Marshall L; Mavrolefteros, George; Close, David

    2002-01-01

    To examine the relationship between premorbid adjustment and neuropsychological deficit in schizophrenia, this report examined retrospective ratings of social and school adjustment during three age epochs (childhood, early adolescence, and late adolescence) as predictors of neurocognitive performance in 61 clinically and pharmacologically stabilized schizophrenia outpatients. Results indicated greater cognitive deficits when premorbid adjustment was unfavorable, particularly for measures of attention and executive functions. Premorbid number and quality of peer relationships and psychosocial adaptation to the school environment were more closely related to neuropsychological performance during adulthood than were premorbid withdrawal and premorbid academic performance. Early onset of poor premorbid adjustment rather than deterioration from childhood to adolescence was associated with greater neuropsychological disturbance in adulthood. It is suggested that childhood onset of premorbid deficits in selective areas of social and academic adjustment appears to influence the cognitive performance seen in adult schizophrenia. This study is consistent with findings from other related reports; it extends these findings to a larger and clinically stabilized sample.

  20. Leverage Aversion and Risk Parity

    DEFF Research Database (Denmark)

    Asness, Clifford; Frazzini, Andrea; Heje Pedersen, Lasse

    2012-01-01

    The authors show that leverage aversion changes the predictions of modern portfolio theory: Safer assets must offer higher risk-adjusted returns than riskier assets. Consuming the high risk-adjusted returns of safer assets requires leverage, creating an opportunity for investors with the ability...... to apply leverage. Risk parity portfolios exploit this opportunity by equalizing the risk allocation across asset classes, thus overweighting safer assets relative to their weight in the market portfolio....

  1. Role of Osmotic Adjustment in Plant Productivity

    Energy Technology Data Exchange (ETDEWEB)

    Gebre, G.M.

    2001-01-11

    Successful implementation of short rotation woody crops requires that the selected species and clones be productive, drought tolerant, and pest resistant. Since water is one of the major limiting factors in poplar (Populus sp.) growth, there is little debate for the need of drought tolerant clones, except on the wettest of sites (e.g., lower Columbia River delta). Whether drought tolerance is compatible with productivity remains a debatable issue. Among the many mechanisms of drought tolerance, dehydration postponement involves the maintenance of high leaf water potential due to, for example, an adequate root system. This trait is compatible with productivity, but requires available soil moisture. When the plant leaf water potential and soil water content decline, the plant must be able to survive drought through dehydration tolerance mechanisms, such as low osmotic potential or osmotic adjustment. Osmotic adjustment and low osmotic potential are considered compatible with growth and yield because they aid in the maintenance of leaf turgor. However, it has been shown that turgor alone does not regulate cell expansion or stomatal conductance and, therefore, the role of osmotic adjustment is debated. Despite this finding, osmotic adjustment has been correlated with grain yield in agronomic crop species, and gene markers responsible for osmotic adjustment are being investigated to improve drought tolerance in productive progenies. Although osmotic adjustment and low osmotic potentials have been investigated in several forest tree species, few studies have investigated the relationship between osmotic adjustment and growth. Most of these studies have been limited to greenhouse or container-grown plants. Osmotic adjustment and rapid growth have been specifically associated in Populus and black spruce (Picea mariuna (Mill.) B.S.P.) progenies. We tested whether these relationships held under field conditions using several poplar clones. In a study of two hybrid poplar

  2. Adjustment and mental health problem in prisoners

    Directory of Open Access Journals (Sweden)

    Sudhinta Sinha

    2010-01-01

    Full Text Available Background : "Crime" is increasing day by day in our society not only in India but also all over the world. In turn, the number of prisoners is also increasing at the same rate. They remain imprisoned for a long duration or in some cases for the whole life. Living in a prison for long time becomes difficult for all inmates. So they often face adjustment and mental health problems. Recent findings suggest that mental illness rate in prison is three times higher than in the general population. Objective: The aim of the present study was to investigate the adjustment and the mental health problem and its relation in the prisoners. Materials and Methods : In the present study, 37 male prisoners of district jail of Dhanbad District of Jharkhand were selected on purposive sampling basis. Each prisoner was given specially designed Performa - Personal Data Sheet, General Health Questionnaire-12 and Bell Adjustment Inventory. Appropriate statistical tools were used to analyze the data. Results: The results obtained showed poor adjustment in social and emotional areas on the adjustment scale. The study also revealed a significant association between adjustment and mental health problem in the prisoners. Conclusion: The prisoners were found to have poor social and emotional adjustment which has strong association with their mental health.

  3. 39 CFR 3010.25 - Limitation on unused rate adjustment authority rate adjustments.

    Science.gov (United States)

    2010-07-01

    ... only be applied together with inflation-based limitation rate adjustments or when inflation-based... used in lieu of an inflation-based limitation rate adjustment. ... 39 Postal Service 1 2010-07-01 2010-07-01 false Limitation on unused rate adjustment authority...

  4. Adjustment to Cancer: Anxiety and Distress (PDQ)

    Science.gov (United States)

    ... with adjustment disorders. Individual (one-to-one) and group counseling have been shown to help cancer patients with ... to-one) counseling. Couple and family counseling. Crisis counseling. Group therapy. Self-help groups. Other treatments used to ...

  5. Adjusting water resources management to climate change

    Energy Technology Data Exchange (ETDEWEB)

    Riebsame, W E

    1988-01-01

    The nature of climate impacts and adjustment in water supply and flood management is discussed, and a case study of water manager response to climate fluctuation in California's Sacramento Basin is presented. The case illuminates the effect on climate impact and response of traditional management approaches, the dynamic qualities of maturing water systems, socially imposed constraints, and climate extremes. A dual pattern of crisis-response and gradual adjustment emerges, and specific mechanisms for effecting adjustment of water management systems are identified. The case study, and broader trends in US water development, suggest that oversized structural capacity, the traditional adjustment to climate variability in water resources, may prove less feasible in the future as projects become smaller and new facilities are delayed by economic and environmental concerns.

  6. Theatre Practice and Social Adjustment in Nigeria

    African Journals Online (AJOL)

    Nneka Umera-Okeke

    Media Sociology Lecturer ... adjustments in favour of local processes to drive social and economic .... needs the need to meet the requirements of all motivated efficiency, a certain degree of .... Centre for Production of Tourism, Arts and Culture.

  7. Annual adjustments to 2015 financial benefits

    CERN Multimedia

    HR Department

    2015-01-01

    In accordance with recommendations made by the Finance Committee and decisions taken by Council in December 2014, no adjustments have been made to basic salaries and stipends, subsistence allowances or family benefits as at 1 January 2015.

  8. Annual adjustments to 2016 financial benefits

    CERN Multimedia

    HR Department

    2016-01-01

    In accordance with recommendations made by the Finance Committee and decisions taken by the Council in December 2015, no adjustments have been made to basic salaries and stipends, subsistence allowances or family benefits as at 1 January 2016.  

  9. Annual adjustments to 2014 financial benefits

    CERN Multimedia

    2013-01-01

    In accordance with recommendations made by the Finance Committee and decisions taken by Council in December 2013, no adjustments have been made to basic salaries and stipends, subsistence allowances or family benefits as at 1 January 2014. HR Department

  10. Marital Adjustment and Psychological Distress in Japan

    Science.gov (United States)

    Li, Angela; Robustelli, Briana L.; Whisman, Mark A.

    2016-01-01

    This study was conducted to examine the association between marital adjustment and psychological distress in a large, probability sample of married adults in Japan (N = 710) from the Midlife Development in Japan (MIDJA) study. Results indicate that positive and negative dimensions of marital adjustment were significantly associated with dimensional and categorical measures of psychological distress. Furthermore, the associations between marital adjustment and psychological distress remained significant when statistically controlling for neuroticism, quality of friend and family relationships, and demographic variables. These results demonstrate that the well-established association between marital adjustment and psychological distress found in European-American countries is also found in Japan. Findings support continued research on marital functioning and psychological distress in East Asian countries. PMID:28082761

  11. Speed of adjustment: Evidence from Borsa Istanbul

    Directory of Open Access Journals (Sweden)

    Emrah Arioglu

    2014-06-01

    Full Text Available In this study, we investigate the speed of adjustment for leverage ratios of firms listed on Borsa Istanbul, in order to investigate the prediction of the trade-off theory, regarding capital structure rebalancing. For this purpose, we estimate the speed of adjustment by using Generalized Method of Moments system estimation technique. The results of this estimation suggest the speed of adjustment as approximately 29%. This significant speed of adjustment is consistent with the prediction of trade-off theory, which suggests that firms follow target capital structures and when the firms' leverage ratios deviate from these targets; they make financial decisions with the goal of closing the gap between the previous year's leverage and target leverage of the current period.

  12. Adjustment model of thermoluminescence experimental data

    International Nuclear Information System (INIS)

    Moreno y Moreno, A.; Moreno B, A.

    2002-01-01

    This model adjusts the experimental results for thermoluminescence according to the equation: I (T) = I (a i * exp (-1/b i * (T-C i )) where: a i , b i , c i are the i-Th peak adjusted to a gaussian curve. The adjustments of the curve can be operated manual or analytically using the macro function and the solver.xla complement installed previously in the computational system. In this work it is shown: 1. The information of experimental data from a LiF curve obtained from the Physics Institute of UNAM which the data adjustment model is operated in the macro type. 2. A LiF curve of four peaks obtained from Harshaw information simulated in Microsoft Excel, discussed in previous works, as a reference not in macro. (Author)

  13. Annual adjustments to 2013 financial benefits

    CERN Multimedia

    2013-01-01

    In accordance with recommendations made by the Finance Committee and decisions taken by Council in December 2012, no adjustments have been made to basic salaries and stipends, subsistence allowances or family benefits as at 1 January 2013. HR Department

  14. Determinants of intercultural adjustment among expatriate spouses

    NARCIS (Netherlands)

    Ali, Anees; Van der Zee, K.I.; Sanders, G

    The adaptation of expatriate families to a host country seems crucial to successful fulfilment of international business assignments. The present study focused on personality, family characteristics and characteristics of expatriates' work life as determinants of the intercultural adjustment of

  15. Price Changes, Resource Adjustments and Rational Expectations

    DEFF Research Database (Denmark)

    Hoffmann, Kira

    This study investigates the relationship between the accuracy of managerial demand expectations, resource adjustment decisions and selling price changes. In line with rational expectation theory, it is argued that managers adjust resources and selling prices differently in response to expected...... that cost elasticity is higher when a demand decrease is expected among companies with similar exposure to demand uncertainty. Overall, this implies that managerial competences in predicting future demand significantly determines firms’ profitability; especially when demand uncertainty is high...

  16. Proximal and distal adjustments of reaching behavior in preterm infants.

    Science.gov (United States)

    de Toledo, Aline Martins; Soares, Daniele de Almeida; Tudella, Eloisa

    2011-01-01

    The authors aimed to investigate proximal and distal adjustments of reaching behavior and grasping in 5-, 6-, and 7-month-old preterm infants. Nine low-risk preterm and 10 full-term infants participated. Both groups showed the predominance of unimanual reaching, an age-related increase in the frequency of vertical-oriented and open hand movement, and also an increase in successful grasping from 6 to 7 months. The frequency of open hand was higher in the preterm group at 6 months. Intrinsic restrictions imposed by prematurity did not seem to have impaired reaching performance of preterm infants throughout the months of age.

  17. Riesgo cardiovascular, calidad de Vida y años de vida ajustados por calidad: un estudio de caso Risco cardiovascular, qualidade de vida e anos de vida ajustados por qualidade: um estudo de caso Cardiovascular risk, quality of life and quality-adjusted years of life: a case report

    Directory of Open Access Journals (Sweden)

    Sandra Lorena Duque Henao

    2010-03-01

    ção dos pacientes em programa de promoção e prevenção de ECV está relacionada com redução no risco e melhoria na qualidade de vida.Objective: to determine the ratio cost-utility of cardiovascular diseases (CVD promotion and prevention programs in a health care providing institution in the city of Medellin (Colombia. Methodology: the preventive program was compared before and after with the conventional control scheme under the design of a quasi experimental study evaluation with a non equivalent control group. Between the studied groups’ differences of the following results were evaluated at the end of the first and second year: Framingham score, direct cost of the program, quality of life, health indexes and quality-adjusted years of life. Results: in the evaluated groups a statistically meaningful difference was found between the initial and final moments for the variables:Framingham score, direct cost of the program, quality of life, health indexes and quality-adjusted years of life. Conclusion: the participation of patients in CVD prevention and promotion programs is related with risk reduction and a better quality of life.

  18. Topics in data adjustment theory and applications

    International Nuclear Information System (INIS)

    Hwang, R.N.

    1988-01-01

    The methodologies of the uncertainty analysis and data adjustment have been well-developed and widely used abroad since the early 70's. With limited amount of covariance data on the differential cross section and the integral experiments available at the time, their accomplishments are, indeed, astounding. The fundamental adjustment equations, however, remain qualitatively unchanged. For the past few year, extensive efforts on these subjects have also begun at ANL in order to utilize the massive amount of integral experiments accumulated over years to provide the basis for improving the reactor parameters encountered in various design calculations. Pertinent covariance matrices and sensitivity matrices of the existing integral experiments have been evaluated and systematically compiled in the data files along with the cross section covariance data derived from the ENDF-B/V for the 21 group structure currently under consideration. A production code GMADJ that provides the adjusted quantities for a large number of cross section types has been developed by Poenitz for routine applications. The primary purpose of the present paper is to improve understanding of the application oriented issues important to the data adjustment theory and the subsequent usage of the adjusted quantities in the design calculations in support of these activities. 30 refs., 12 figs., 5 tabs

  19. Low Risk Anomalies?

    DEFF Research Database (Denmark)

    Schneider, Paul; Wagner, Christian; Zechner, Josef

    This paper shows theoretically and empirically that beta- and volatility-based low risk anomalies are driven by return skewness. The empirical patterns concisely match the predictions of our model that endogenizes the role of skewness for stock returns through default risk. With increasing downside...... risk, the standard capital asset pricing model (CAPM) increasingly overestimates expected equity returns relative to firms' true (skew-adjusted) market risk. Empirically, the profitability of betting against beta/volatility increases with firms' downside risk, and the risk-adjusted return differential...... of betting against beta/volatility among low skew firms compared to high skew firms is economically large. Our results suggest that the returns to betting against beta or volatility do not necessarily pose asset pricing puzzles but rather that such strategies collect premia that compensate for skew risk...

  20. Lipid Adjustment for Chemical Exposures: Accounting for Concomitant Variables

    Science.gov (United States)

    Li, Daniel; Longnecker, Matthew P.; Dunson, David B.

    2013-01-01

    Background Some environmental chemical exposures are lipophilic and need to be adjusted by serum lipid levels before data analyses. There are currently various strategies that attempt to account for this problem, but all have their drawbacks. To address such concerns, we propose a new method that uses Box-Cox transformations and a simple Bayesian hierarchical model to adjust for lipophilic chemical exposures. Methods We compared our Box-Cox method to existing methods. We ran simulation studies in which increasing levels of lipid-adjusted chemical exposure did and did not increase the odds of having a disease, and we looked at both single-exposure and multiple-exposures cases. We also analyzed an epidemiology dataset that examined the effects of various chemical exposures on the risk of birth defects. Results Compared with existing methods, our Box-Cox method produced unbiased estimates, good coverage, similar power, and lower type-I error rates. This was the case in both single- and multiple-exposure simulation studies. Results from analysis of the birth-defect data differed from results using existing methods. Conclusion Our Box-Cox method is a novel and intuitive way to account for the lipophilic nature of certain chemical exposures. It addresses some of the problems with existing methods, is easily extendable to multiple exposures, and can be used in any analyses that involve concomitant variables. PMID:24051893

  1. HIV quality report cards: impact of case-mix adjustment and statistical methods.

    Science.gov (United States)

    Ohl, Michael E; Richardson, Kelly K; Goto, Michihiko; Vaughan-Sarrazin, Mary; Schweizer, Marin L; Perencevich, Eli N

    2014-10-15

    There will be increasing pressure to publicly report and rank the performance of healthcare systems on human immunodeficiency virus (HIV) quality measures. To inform discussion of public reporting, we evaluated the influence of case-mix adjustment when ranking individual care systems on the viral control quality measure. We used data from the Veterans Health Administration (VHA) HIV Clinical Case Registry and administrative databases to estimate case-mix adjusted viral control for 91 local systems caring for 12 368 patients. We compared results using 2 adjustment methods, the observed-to-expected estimator and the risk-standardized ratio. Overall, 10 913 patients (88.2%) achieved viral control (viral load ≤400 copies/mL). Prior to case-mix adjustment, system-level viral control ranged from 51% to 100%. Seventeen (19%) systems were labeled as low outliers (performance significantly below the overall mean) and 11 (12%) as high outliers. Adjustment for case mix (patient demographics, comorbidity, CD4 nadir, time on therapy, and income from VHA administrative databases) reduced the number of low outliers by approximately one-third, but results differed by method. The adjustment model had moderate discrimination (c statistic = 0.66), suggesting potential for unadjusted risk when using administrative data to measure case mix. Case-mix adjustment affects rankings of care systems on the viral control quality measure. Given the sensitivity of rankings to selection of case-mix adjustment methods-and potential for unadjusted risk when using variables limited to current administrative databases-the HIV care community should explore optimal methods for case-mix adjustment before moving forward with public reporting. Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2014. This work is written by (a) US Government employee(s) and is in the public domain in the US.

  2. Adjustment of the 235U Fission Spectrum

    International Nuclear Information System (INIS)

    GRIFFIN, PATRICK J.; WILLIAMS, J.G.

    1999-01-01

    The latest nuclear data are used to examine the sensitivity of the least squares adjustment of the 235 U fission spectrum to the measured reaction rates, dosimetry cross sections, and prior spectrum covariance matrix. All of these parameters were found to be very important in the spectrum adjustment. The most significant deficiency in the nuclear data is the absence of a good prior covariance matrix. Covariance matrices generated from analytic models of the fission spectra have been used in the past. This analysis reveals some unusual features in the covariance matrix produced with this approach. Specific needs are identified for improved nuclear data to better determine the 235 U spectrum. An improved 235 U covariance matrix and adjusted spectrum are recommended for use in radiation transport sensitivity analyses

  3. Adjustments to financial and social benefits

    CERN Multimedia

    HR Department

    2010-01-01

    In accordance with recommendations made by the Finance Committee in November 2009 and decisions taken by the Council in December 2009, certain financial benefits have been adjusted with effect from 1 January 2010. An increase of 1.6% has been applied to the scale of basic salaries and to stipends paid to Fellows (Annexes R A 5 and R A 6 of the Staff Rules and Regulations, respectively). The adjusted amounts are available from the HR Department intranet site or from departmental secretariats. As a result of the evolution of the Geneva consumer price index, no adjustments have been made to the subsistence allowances of Paid Associates and Students (Annex R A 7 of the Staff Rules and Regulations). The following social benefits also remain unchanged: Family, child and infant allowances (Annex R A 3 of the Staff Rules and Regulations). Payment ceilings of education fees (Annex R A 4 of the Staff Rules and Regulations). Tel. 70674 (Classification and Remuneration Service)

  4. Attachment style and adjustment to divorce.

    Science.gov (United States)

    Yárnoz-Yaben, Sagrario

    2010-05-01

    Divorce is becoming increasingly widespread in Europe. In this study, I present an analysis of the role played by attachment style (secure, dismissing, preoccupied and fearful, plus the dimensions of anxiety and avoidance) in the adaptation to divorce. Participants comprised divorced parents (N = 40) from a medium-sized city in the Basque Country. The results reveal a lower proportion of people with secure attachment in the sample group of divorcees. Attachment style and dependence (emotional and instrumental) are closely related. I have also found associations between measures that showed a poor adjustment to divorce and the preoccupied and fearful attachment styles. Adjustment is related to a dismissing attachment style and to the avoidance dimension. Multiple regression analysis confirmed that secure attachment and the avoidance dimension predict adjustment to divorce and positive affectivity while preoccupied attachment and the anxiety dimension predicted negative affectivity. Implications for research and interventions with divorcees are discussed.

  5. Speed of adjustment and market structure

    International Nuclear Information System (INIS)

    Lanza, A.

    1991-01-01

    This paper studies the relationship between changes in costs and prices in the gasoline market in the Federal Republic of Germany for the period 1980-90. We shall use an econometric model, and distinguish two stages in the transmission of cost changes to prices. The first is the adjustment of gasoline prices ex-refinery to changes in the price of crude oil, and the second is the adjustment of gasoline price (net of taxes) at the pump to ex-refinery prices. The study of price adjustments to cost changes involves the analysis of two inter-related but different phenomena. The first is the speed of adjustment, defined here as the mean of the length of the time periods required for the transmission of the full effect of an exogenous shock from the independent to the dependent variable of the econometric model used in the analysis. The second relates to possible asymmetries in the response of prices to increases and decreases in costs. Both phenomena are closely related to the structure of the market. The common assumption is that the first is negatively correlated to the degree of competition, and that the second is an indication of the prevailing market structure. The main findings of this paper are as follows: (a) at the refinery level there is only weak evidence of asymmetrical reaction; the average lag in case of crude price increases or decreases is about three months; (b) at the consumers' level, the speed of adjustment was lower when the ex-refinery price was declining than when it was rising; the adjustment lag was about 6.07 months when ex-refinery prices were declining and 5.37 months when they were rising. (author)

  6. Managing risks

    International Nuclear Information System (INIS)

    Nathwani, J.S.

    1993-01-01

    The three principles to guide regulating authorities are: Risks shall be managed to maximize the total expected net benefit to society; The safety benefit to be promoted is quality-adjusted life expectancy; Decisions for the public in regard to health and safety must be open and apply across the entire range of hazards to life and health. Based on the principle that excessive spending on health and safety, or lack of necessary development, may cause poverty and thereby actually decrease (adjusted) life expectancy, the author has developed a Life Product Index which gives comparable results to the Human Development Index promoted by the United Nations Development Program. These two social indicators can be used for purposes such as project evaluation, choosing between alternative technologies, or evaluation of health and safety programs

  7. Kinematic synthesis of adjustable robotic mechanisms

    Science.gov (United States)

    Chuenchom, Thatchai

    1993-01-01

    Conventional hard automation, such as a linkage-based or a cam-driven system, provides high speed capability and repeatability but not the flexibility required in many industrial applications. The conventional mechanisms, that are typically single-degree-of-freedom systems, are being increasingly replaced by multi-degree-of-freedom multi-actuators driven by logic controllers. Although this new trend in sophistication provides greatly enhanced flexibility, there are many instances where the flexibility needs are exaggerated and the associated complexity is unnecessary. Traditional mechanism-based hard automation, on the other hand, neither can fulfill multi-task requirements nor are cost-effective mainly due to lack of methods and tools to design-in flexibility. This dissertation attempts to bridge this technological gap by developing Adjustable Robotic Mechanisms (ARM's) or 'programmable mechanisms' as a middle ground between high speed hard automation and expensive serial jointed-arm robots. This research introduces the concept of adjustable robotic mechanisms towards cost-effective manufacturing automation. A generalized analytical synthesis technique has been developed to support the computational design of ARM's that lays the theoretical foundation for synthesis of adjustable mechanisms. The synthesis method developed in this dissertation, called generalized adjustable dyad and triad synthesis, advances the well-known Burmester theory in kinematics to a new level. While this method provides planar solutions, a novel patented scheme is utilized for converting prescribed three-dimensional motion specifications into sets of planar projections. This provides an analytical and a computational tool for designing adjustable mechanisms that satisfy multiple sets of three-dimensional motion specifications. Several design issues were addressed, including adjustable parameter identification, branching defect, and mechanical errors. An efficient mathematical scheme for

  8. Mitral valve repair with adjustable ring annuloplasty.

    Science.gov (United States)

    Andreas, Martin; Haberl, Thomas; Paul Werner, Paul Werner; Guri, Jani; Kocher, Alfred; Hamza, Ouafa; Podesser, Bruno; Laufer, Guenther

    2018-02-28

    We demonstrate the technical aspects of a novel adjustable mitral ring. This new ring was implanted in a female landrace pig, for training and educational purposes. It can be adjusted independently in the P1, P2 and P3 segments, if required, to treat  recurrent mitral regurgitation, and this is a key difference to comparable devices. The first-in-man implantation is anticipated in the near future. © The Author 2016. Published by MMCTS on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  9. Simultaneous neutron and gamma spectrum adjustment

    International Nuclear Information System (INIS)

    Remec, I.

    1996-01-01

    The spectrum adjustment procedure was extended to simultaneous neutron and gamma spectrum adjustment, and the feasibility of this technique is demonstrated in the analysis of HFIR dosimetry experiments. Conditions in which gamma rays may contribute considerably to radiation damage in steels are discussed. Beryllium helium accumulation fluence monitors (HAFMs) were found to be good monitors in gamma fields of intensities high enough to contribute to steel embrittlement. Use of 237 Np, 238 U, and 9 Be HAFM as gamma dosimeters is proposed for high-dose irradiations in high-energy, high-intensity gamma fields

  10. Cultural similarity and adjustment of expatriate academics

    DEFF Research Database (Denmark)

    Selmer, Jan; Lauring, Jakob

    2009-01-01

    The findings of a number of recent empirical studies of business expatriates, using different samples and methodologies, seem to support the counter-intuitive proposition that cultural similarity may be as difficult to adjust to as cultural dissimilarity. However, it is not obvious...... and non-EU countries. Results showed that although the perceived cultural similarity between host and home country for the two groups of investigated respondents was different, there was neither any difference in their adjustment nor in the time it took for them to become proficient. Implications...

  11. Factors Moderating the Relationship Between Childhood Trauma and Premorbid Adjustment in First-Episode Schizophrenia.

    Science.gov (United States)

    Kilian, S; Burns, J K; Seedat, S; Asmal, L; Chiliza, B; Du Plessis, S; Olivier, M R; Kidd, M; Emsley, R

    2017-01-01

    Childhood trauma is a recognised risk factor for schizophrenia. It has been proposed that childhood trauma interferes with normal neurodevelopment, thereby establishing a biological vulnerability to schizophrenia. Poor premorbid adjustment is frequently a precursor to schizophrenia, and may be a manifestation of neurodevelopmental compromise. We investigated the relationship between childhood trauma and premorbid adjustment in 77 patients with first-episode schizophrenia spectrum disorders. We also investigated possible mediating roles for other selected risk factors in the relationship. We found several significant correlations between different trauma types and both social and academic premorbid adjustment from childhood to late adolescence. There were no significant moderating effects for family history of schizophrenia or family history of psychiatric disorder. History of obstetric complications, substance abuse and poor motor coordination weakened some of the associations between childhood trauma and premorbid adjustment, while poor sequencing of motor acts strengthened the association. Our results confirm previous studies indicating an association between childhood trauma and premorbid adjustment. Results indicate a general rather than specific association, apparent with different types of trauma, and affecting both social and academic components of premorbid adjustment across childhood, early and late adolescence. Further, our results suggest a complex interplay of various risk factors, supporting the notion of different pathways to psychosis.

  12. [Remuneration distribution - should morbidity-dependent overall remuneration also be distributed after adjustments for morbidity?].

    Science.gov (United States)

    Walendzik, A; Trottmann, M; Leonhardt, R; Wasem, J

    2013-04-01

    In the 2009 reform of the German collective remuneration system for outpatient medical care, on the level of overall remuneration, the morbidity risk was transferred to the health funds fulfilling a long-term demand of physicians. Nevertheless not transferring morbidity adjustment to the levels of physician groups and singular practices can lead to budgets not related to patient needs and to incentives for risk selection for individual doctors. The systematics of the distribution of overall remuneration in the German remuneration system for outpatient care are analysed focusing on the aspect of morbidity adjustment. Using diagnostic and pharmaceutical information of about half a million insured subjects, a risk adjustment model able to predict individual expenditures for outpatient care for different provider groups is presented. This model enables to additively split the individual care burden into several parts attributed to different physician groups. Conditions for the use of the model in the distribution of overall remuneration between physician groups are developed. A simulation of the use of diagnoses-based risk adjustment in standard service volumes then highlights the conditions for a successfull installation of standard service volumes representing a higher degree of risk adjustment. The presented estimation model is generally applicable for the distribution of overall remuneration to different physician groups. The simulation of standard service volumes using diagnosis-based risk adjustment does not provide a more accurate prediction of the expenditures on the level of physician practices than the age-related calculation currently used in the German remuneration system for outpatient medical care. Using elements of morbidity-based risk adjustment the current German collective system for outpatient medical care could be transformed towards a higher degree of distributional justice concerning medical care for patients and more appropriate incentives

  13. Heterogeneity in the Speed of Adjustment toward Target Leverage

    DEFF Research Database (Denmark)

    Elsas, Ralf; Florysiak, David

    2011-01-01

    Estimating the speed of adjustment toward target leverage using the standard partial adjustment model assumes that all firms within the sample adjust at the same (average) pace. Dynamic capital structure theory predicts heterogeneity in adjustment speed due to firm-specific adjustment costs. Appl...

  14. Do Daily Retail Gasoline Prices adjust Asymmetrically?

    NARCIS (Netherlands)

    L.J.H. Bettendorf (Leon); S.A. van der Geest (Stéphanie); G. Kuper

    2005-01-01

    textabstractThis paper analyzes adjustments in the Dutch retail gasoline prices. We estimate an error correction model on changes in the daily retail price for gasoline (taxes excluded) for the period 1996-2004 taking care of volatility clustering by estimating an EGARCH model. It turns out the

  15. Do daily retail gasoline prices adjust asymmetrically?

    NARCIS (Netherlands)

    Bettendorf, L.; van der Geest, S. A.; Kuper, G. H.

    2009-01-01

    This paper analyses adjustments in the Dutch retail gasoline prices. We estimate an error correction model on changes in the daily retail price for gasoline (taxes excluded) for the period 1996-2004, taking care of volatility clustering by estimating an EGARCH model. It turns out that the volatility

  16. [Relationship between family variables and conjugal adjustment].

    Science.gov (United States)

    Jiménez-Picón, Nerea; Lima-Rodríguez, Joaquín-Salvador; Lima-Serrano, Marta

    2018-04-01

    To determine whether family variables, such as type of relationship, years of marriage, existence of offspring, number of members of family, stage of family life cycle, transition between stages, perceived social support, and/or stressful life events are related to conjugal adjustment. A cross-sectional and correlational study using questionnaires. Primary care and hospital units of selected centres in the province of Seville, Spain. Consecutive stratified sampling by quotas of 369 heterosexual couples over 18years of age, who maintained a relationship, with or without children, living in Seville. A self-report questionnaire for the sociodemographic variables, and the abbreviated version of the Dyadic Adjustment Scale, Questionnaire MOS Perceived Social Support, and Social Readjustment Rating Scale, were used. Descriptive and inferential statistics were performed with correlation analysis and multivariate regression. Statistically significant associations were found between conjugal adjustment and marriage years (r=-10: Pfamily life cycle (F=2.65; Pfamily life cycle stage (mature-aged stage) on conjugal adjustment (R2=.21; F=9.9; df=356; Prelationship. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  17. Stress and adjustment in diabetes mellitus.

    Science.gov (United States)

    Parveen, S; Singh, S B

    1999-01-01

    Stress and adjustment in diabetics is studied in order to know the influence of maladjustment and stress in the causation of the disease. The sample of study consists of 100 diabetics patients, 100 nonpsychosomatic and 100 normal person. Results obtained are discussed in detail. It is concluded that maladjustment and stress are important contributing factors in' diabetes mellitus.

  18. Stochastic Strategy Adjustment in Coordination Games

    NARCIS (Netherlands)

    Kosfeld, M.

    1999-01-01

    We explore a model of equilibrium selection in coordination games, where agents stochastically adjust their strategies to changes in their local environment. Instead of playing perturbed best-response, we assume that agents follow a rule of "switching to better strategies more likely". We relate

  19. Associations between faith, distress and mental adjustment

    DEFF Research Database (Denmark)

    Johannessen-Henry, Christine Tind

    2013-01-01

    = −0.79, CI −0.92; −0.66) and increased adjustment to cancer (fighting spirit, anxious preoccupation, helplessness-hopelessness). Specific aspects of faith were associated with high confusion-bewilderment and tension-anxiety, but also lower score on vigor-activity, and with higher anxious...

  20. Macroeconomic shocks and firms' labor adjustment

    DEFF Research Database (Denmark)

    Eriksson, Tor

    2013-01-01

    This article discusses some recent research which aims at producing evidence on how firms adjust their employment in response to output shocks using micro-level data and with a particular focus on the relationship between worker and job flows. The evidence presented is mainly based on Danish data...

  1. Social Adjustment and Personality Development in Children.

    Science.gov (United States)

    Roff, Merrill; And Others

    This book describes a series of studies included in a 5-year program of research on the social adjustment of school children in the third through sixth grades. The sample consists of a total of 40,000 children from Texas and Minnesota, including a small subsample of 5,000 used in a 4-year longitudinal study. Peer acceptance-rejection scores…

  2. Work Adjustment of Vocational Education Teachers.

    Science.gov (United States)

    Muncrief, Martha Crawford

    To investigate work adjustment of vocational education teachers, a nation-wide study was conducted focusing on vocational needs, job satisfaction, and job success. The study involved 180 secondary teachers from three vocational areas, business, home economics, and industrial education. A multistage sampling process was utilized to select…

  3. Extendable linearised adjustment model for deformation analysis

    NARCIS (Netherlands)

    Hiddo Velsink

    2015-01-01

    Author supplied: "This paper gives a linearised adjustment model for the affine, similarity and congruence transformations in 3D that is easily extendable with other parameters to describe deformations. The model considers all coordinates stochastic. Full positive semi-definite covariance matrices

  4. Extendable linearised adjustment model for deformation analysis

    NARCIS (Netherlands)

    Velsink, H.

    2015-01-01

    This paper gives a linearised adjustment model for the affine, similarity and congruence transformations in 3D that is easily extendable with other parameters to describe deformations. The model considers all coordinates stochastic. Full positive semi-definite covariance matrices and correlation

  5. An Adjustment Restriction on Fish Quota

    NARCIS (Netherlands)

    Dijk, van Diana; Hendrix, E.M.T.; Haijema, Rene; Groeneveld, R.A.; Ierland, van E.C.

    2017-01-01

    Management objectives of the European Union for North Sea fish stocks are shifting towards considering both biological sustainability and economic benefits. As part of multiannual management plans, an adjustment restriction on fish quota has been introduced. Its objective is to obtain an

  6. Output filters for AC adjustable speed drives

    DEFF Research Database (Denmark)

    Blaabjerg, Frede; Hanigovszki, Norbert; Landkildehus, Jorn, Jorn

    2007-01-01

    The standard industrial solution for adjustable speed drives (ASD) is the use of induction motors (IM) fed by voltage-source inverters (VSI). The inverter generates a pulsewidth modulated (PWM) voltage, with dv/dt values of about 6 kV/¿s or even more. In three-leg inverters for three-phase appli...

  7. Frequency adjustable MEMS vibration energy harvester

    Science.gov (United States)

    Podder, P.; Constantinou, P.; Amann, A.; Roy, S.

    2016-10-01

    Ambient mechanical vibrations offer an attractive solution for powering the wireless sensor nodes of the emerging “Internet-of-Things”. However, the wide-ranging variability of the ambient vibration frequencies pose a significant challenge to the efficient transduction of vibration into usable electrical energy. This work reports the development of a MEMS electromagnetic vibration energy harvester where the resonance frequency of the oscillator can be adjusted or tuned to adapt to the ambient vibrational frequency. Micro-fabricated silicon spring and double layer planar micro-coils along with sintered NdFeB micro-magnets are used to construct the electromagnetic transduction mechanism. Furthermore, another NdFeB magnet is adjustably assembled to induce variable magnetic interaction with the transducing magnet, leading to significant change in the spring stiffness and resonance frequency. Finite element analysis and numerical simulations exhibit substantial frequency tuning range (25% of natural resonance frequency) by appropriate adjustment of the repulsive magnetic interaction between the tuning and transducing magnet pair. This demonstrated method of frequency adjustment or tuning have potential applications in other MEMS vibration energy harvesters and micromechanical oscillators.

  8. 49 CFR 1135.1 - Quarterly adjustment.

    Science.gov (United States)

    2010-10-01

    ... subsequent amendments thereto. In addition, the AAR shall calculate the productivity-adjusted RCAF as..., the Association of American Railroads (AAR) shall calculate and file with the Board by the fifth day... all-inclusive index of railroad costs and calculate and file the RCAF unadjusted for changes in...

  9. Gender Differences in International Students' Adjustment

    Science.gov (United States)

    Lee, Seungcheol Austin; Park, Hee Sun; Kim, Wonsun

    2009-01-01

    As gender roles in the society are being rapidly redefined, female students today are showing outstanding academic prowess and pursuing higher education. The current study recruited Korean international students (n = 76) enrolled in universities in the US and examined gender differences in academic adjustment. The findings of the current study…

  10. 22 CFR 142.44 - Academic adjustments.

    Science.gov (United States)

    2010-04-01

    ... services and actions. Recipients need not provide attendants, individually prescribed devices, readers for... adjustments. (a) Academic requirements. A recipient to which this subpart applies shall make such... applicant or student. Academic requirements that the recipient can demonstrate are essential to the...

  11. 45 CFR 605.44 - Academic adjustments.

    Science.gov (United States)

    2010-10-01

    ... impairments, and other similar services and actions. Recipients need not provide attendents, individually... Postsecondary Education § 605.44 Academic adjustments. (a) Academic requirements. A recipient to which this..., against a qualified handicapped applicant or student. Academic requirements that the recipient can...

  12. 15 CFR 8b.22 - Academic adjustments.

    Science.gov (United States)

    2010-01-01

    ... actions. Recipients need not provide attendants, individually prescribed devices, readers for personal use... Secondary Education § 8b.22 Academic adjustments. (a) Academic requirements. A recipient to which this..., against a qualified handicapped applicant or student. Academic requirements that the recipient can...

  13. 24 CFR 882.410 - Rent adjustments.

    Science.gov (United States)

    2010-04-01

    ... PROGRAM) SECTION 8 MODERATE REHABILITATION PROGRAMS Special Procedures for Moderate Rehabilitation-Basic... Annual Adjustment Factor by the base rents. However, if the amounts borrowed to finance the rehabilitation costs or to finance purchase of the property are subject to a variable rate or are otherwise...

  14. 19 CFR 201.205 - Salary adjustments.

    Science.gov (United States)

    2010-04-01

    ... 19 Customs Duties 3 2010-04-01 2010-04-01 false Salary adjustments. 201.205 Section 201.205 Customs Duties UNITED STATES INTERNATIONAL TRADE COMMISSION GENERAL RULES OF GENERAL APPLICATION Debt... of coverage, or a change in coverage, under a Federal benefits program requiring periodic deductions...

  15. Predictors of College Adjustment among Hispanic Students

    Science.gov (United States)

    Yazedjian, Ani; Toews, Michelle L.

    2006-01-01

    The purpose of this study is to assess personal and interpersonal predictors of college adjustment among a sample of 190 first-year Hispanic students. Specifically, we examined the extent to which personal factors such as self-esteem, acculturation, and ethnic identity and interpersonal factors such as parental education and parental attachment…

  16. Psychosocial Adjustment Needs of Menopausal Women | Dimkpa ...

    African Journals Online (AJOL)

    The purpose of this study was to examine the psychosocial adjustment needs of menopausal women. The population of the study consisted of 623 menopausal women who were out-patients in Federal Medical Centre and a private hospital in Yenagoa Local Government Area, Bayelsa State of. Nigeria. The sample ...

  17. Host country language ability and expatriate adjustment

    DEFF Research Database (Denmark)

    Selmer, Jan; Lauring, Jakob

    2015-01-01

    countries, one with an easy, relatively simple language and the other with a difficult, highly complex language. Consistent with Goal-Setting Theory, results indicated a relative advantage of expatriates’ language ability in terms of their adjustment in the host country with the difficult language...

  18. Vietnamese Graduate International Student Repatriates: Reverse Adjustment

    Science.gov (United States)

    Le, Anh T.; LaCost, Barbara Y.

    2017-01-01

    The purpose of this study is to explore the experiences of Vietnamese international students who have returned to Vietnam after graduation from a U.S. higher education institution. The findings suggest that participants found it harder to readjust to Vietnam than to adjust to the U.S. even though they had lived most of their lives in Vietnam. Time…

  19. Stabilization and structural adjustment in Mozambique

    DEFF Research Database (Denmark)

    Tarp, Finn; Arndt, Channing; Jensen, Henning Tarp

    2000-01-01

    This paper outlines the complex historical legacy and structural adjustment efforts in Mozambique in addition to reviewing recent economic developments. An in-depth analysis of new and more reliable national accounts data show that macroeconomic stabilization has occurred through recovery from...

  20. Frequency adjustable MEMS vibration energy harvester

    International Nuclear Information System (INIS)

    Podder, P; Constantinou, P; Roy, S; Amann, A

    2016-01-01

    Ambient mechanical vibrations offer an attractive solution for powering the wireless sensor nodes of the emerging “Internet-of-Things”. However, the wide-ranging variability of the ambient vibration frequencies pose a significant challenge to the efficient transduction of vibration into usable electrical energy. This work reports the development of a MEMS electromagnetic vibration energy harvester where the resonance frequency of the oscillator can be adjusted or tuned to adapt to the ambient vibrational frequency. Micro-fabricated silicon spring and double layer planar micro-coils along with sintered NdFeB micro-magnets are used to construct the electromagnetic transduction mechanism. Furthermore, another NdFeB magnet is adjustably assembled to induce variable magnetic interaction with the transducing magnet, leading to significant change in the spring stiffness and resonance frequency. Finite element analysis and numerical simulations exhibit substantial frequency tuning range (25% of natural resonance frequency) by appropriate adjustment of the repulsive magnetic interaction between the tuning and transducing magnet pair. This demonstrated method of frequency adjustment or tuning have potential applications in other MEMS vibration energy harvesters and micromechanical oscillators. (paper)

  1. Occupational adjustment of immigrants in the Netherlands

    NARCIS (Netherlands)

    Zorlu, A.

    2013-01-01

    This article examines the speed of the occupational adjustment of immigrants using Labour Force Surveys 2004 and 2005 from Statistics Netherlands. The analysis provides new evidence that immigrants start with jobs at the lower levels of skill distribution. Their occupational achievement improves

  2. Inflation - Adjusted Accounting and Corporate Value Redefinition ...

    African Journals Online (AJOL)

    This paper, therefore, addresses the twisty advocacy and seeming intricacy of Inflation-Adjusted Accounting Systems (IAAS), with a view to illuminating the translational hurdles. The results abundantly necessitate the expeditious consolidation of a more robust framework to fix impending inhibitors such as lack of awareness, ...

  3. The academic adjustment scale : Measuring the adjustment of permanent resident or sojourner students

    NARCIS (Netherlands)

    Anderson, Joel R.; Guan, Yao; Koc, Yasin

    In this paper we developed and validated the Academic Adjustment Scale (AAS) - a new scale for measuring academic adjustment, which was developed with a focus on student sojourners who temporarily relocate to a new culture for the purpose of tertiary education, but also is validated for use with

  4. The Impact of Adjustment for Socioeconomic Status on Comparisons of Cancer Incidence between Two European Countries

    International Nuclear Information System (INIS)

    Donnelly, D. W.; Gavin, A.; Hegarty, A.

    2013-01-01

    Cancer incidence rates vary considerably between countries and by socioeconomic status (SES). We investigate the impact of SES upon the relative cancer risk in two neighbouring countries. Methods. Data on 229,824 cases for 16 cancers diagnosed in 1995-2007 were extracted from the cancer registries in Northern Ireland (NI) and Republic of Ireland (RoI). Cancers in the two countries were compared using incidence rate ratios (IRRs) adjusted for age and age plus area-based SES. Results. Adjusting for SES in addition to age had a considerable impact on NI/RoI comparisons for cancers strongly related to SES. Before SES adjustment, lung cancer incidence rates were 11% higher for males and 7% higher for females in NI, while after adjustment, the IRR was not statistically significant. Cervical cancer rates were lower in NI than in RoI after adjustment for age (IRR: 0.90 (0.84-0.97)), with this difference increasing after adjustment for SES (IRR: 0.85 (0.79-0.92)). For cancers with a weak or nonexistent relationship to SES, adjustment for SES made little difference to the IRR. Conclusion. Socioeconomic factors explain some international variations but also obscure other crucial differences; thus, adjustment for these factors should not become part of international comparisons.

  5. The Impact of Adjustment for Socioeconomic Status on Comparisons of Cancer Incidence between Two European Countries

    Directory of Open Access Journals (Sweden)

    David W. Donnelly

    2013-01-01

    Full Text Available Background. Cancer incidence rates vary considerably between countries and by socioeconomic status (SES. We investigate the impact of SES upon the relative cancer risk in two neighbouring countries. Methods. Data on 229,824 cases for 16 cancers diagnosed in 1995–2007 were extracted from the cancer registries in Northern Ireland (NI and Republic of Ireland (RoI. Cancers in the two countries were compared using incidence rate ratios (IRRs adjusted for age and age plus area-based SES. Results. Adjusting for SES in addition to age had a considerable impact on NI/RoI comparisons for cancers strongly related to SES. Before SES adjustment, lung cancer incidence rates were 11% higher for males and 7% higher for females in NI, while after adjustment, the IRR was not statistically significant. Cervical cancer rates were lower in NI than in RoI after adjustment for age (IRR: 0.90 (0.84–0.97, with this difference increasing after adjustment for SES (IRR: 0.85 (0.79–0.92. For cancers with a weak or nonexistent relationship to SES, adjustment for SES made little difference to the IRR. Conclusion. Socioeconomic factors explain some international variations but also obscure other crucial differences; thus, adjustment for these factors should not become part of international comparisons.

  6. Negative life events and school adjustment among Chinese nursing students: The mediating role of psychological capital.

    Science.gov (United States)

    Liu, Chunqin; Zhao, Yuanyuan; Tian, Xiaohong; Zou, Guiyuan; Li, Ping

    2015-06-01

    Adjustment difficulties of college students are common and their school adjustment has gained wide concern in recent years. Negative life events and psychological capital (PsyCap) have been associated with school adjustment. However, the potential impact of negative life events on PsyCap, and whether PsyCap mediates the relationship between negative life events and school adjustment among nursing students have not been studied. To investigate the relationship among negative life events, PsyCap, and school adjustment among five-year vocational high school nursing students in China and the mediating role of PsyCap between negative life events and school adjustment. A cross-sectional survey design was conducted. 643 five-year vocational high school nursing students were recruited from three public high vocational colleges in Shandong of China. Adolescent Self-Rating Life Event Checklist (ASLEC), the Psychological Capital Questionnaire for Adolescent Students scale (PCQAS), and the Chinese College Student Adjustment Scale (CCSAS) were used in this study. Hierarchical linear regression analyses were performed to explore the mediating role of PsyCap. Negative life events were negatively associated with the dimensions of school adjustment (interpersonal relationship adaptation, learning adaptation, campus life adaptation, career adaptation, emotional adaptation, self-adaptation, and degree of satisfaction). PsyCap was positively associated with the dimensions of school adjustment and negatively associated with negative life events. PsyCap partially mediated the relationship between negative life events and school adjustment. Negative life events may increase the risk of school maladjustment in individuals with low PsyCap. Interventions designed to increase nursing students' PsyCap might buffer the stress of adverse life events, and thereby, enhance students' positive adjustment to school. Copyright © 2015 Elsevier Ltd. All rights reserved.

  7. Should adjustment disorder be conceptualized as transitional disorder? In pursuit of adjustment disorders definition.

    Science.gov (United States)

    Israelashvili, Moshe

    2012-12-01

    The DSM classification of an adjustment disorder is frequently criticized for not being well differentiated from other disorders. A possible reason for this is the vague definition of the term adjustment in social science literature. Hence, the current paper discusses the definition of adjustment and its implications for understanding maladjustment. Differential definitions of the terms adjustment, adaptation, socialization and coping are outlined, leading to the proposition that each one of them represents a different type of demand that is imposed on an individual who encounters a transitional event. Moreover, the four types of demands might be the possible sources of maladjustment. Helping people in transition requires an identification of the source, or combination of sources, that have led to the adjustment problem first, followed by the implementation of an adequate helping approach.

  8. No trauma of the cervical spine. Automatic headrest adjustment; Kein HWS-Trauma. Kopfstuetze automatisch naeher am Kopf

    Energy Technology Data Exchange (ETDEWEB)

    Schmuck, M.; Gaebelein, J. [Proma GmbH, Lichtenfels (Germany)

    2005-06-01

    A new headrest system developed by Proma considerably reduces the risk of injuries of the cervical spine. The idea behind it is simple and innovative: Apart from the automatic height adjustment, the headrest also has an automatic adjustment function to keep it in a position close to the head. (orig.)

  9. Lack of adjustment latitude at work as a trigger of taking sick leave-a Swedish case-crossover study.

    Directory of Open Access Journals (Sweden)

    Hanna Hultin

    Full Text Available OBJECTIVES: Research has shown that individuals reporting a low level of adjustment latitude, defined as having few possibilities to temporarily adjust work demands to illness, have a higher risk of sick leave. To what extent lack of adjustment latitude influences the individual when making the decision to take sick leave is unknown. We hypothesize that ill individuals are more likely to take sick leave on days when they experience a lack of adjustment latitude at work than on days with access to adjustment latitude. METHODS: A case-crossover design was applied to 546 sick-leave spells, extracted from a cohort of 1 430 employees at six Swedish workplaces, with a 3-12 month follow-up of all new sick-leave spells. Exposure to lack of adjustment latitude on the first sick-leave day was compared with exposure during several types of control periods sampled from the previous two months for the same individual. RESULTS: Only 35% of the respondents reported variations in access to adjustment latitude, and 19% reported a constant lack of adjustment latitude during the two weeks prior to the sick-leave spell. Among those that did report variation, the risk of sick leave was lower on days with lack of adjustment latitude, than on days with access (Odds Ratio 0.36, 95% Confidence Interval 0.25-0.52. CONCLUSIONS: This is the first study to show the influence of adjustment latitude on the decision to take sick leave. Among those with variations in exposure, lack of adjustment latitude was a deterrent of sick leave, which is contrary to the à priori hypothesis. These results indicate that adjustment latitude may not only capture long-lasting effects of a flexible working environment, but also temporary possibilities to adjust work to being absent. Further studies are needed to disentangle the causal mechanisms of adjustment latitude on sick-leave.

  10. Cultural Novelty and Adjustment: Western Business Expatriates in China

    DEFF Research Database (Denmark)

    Selmer, Jan

    2006-01-01

    Western business expatriates in China. Three sociocultural adjustment variables were examined; general, interaction and work adjustment. Although a negative relationship was hypothesized between cultural novelty and the three adjustment variables, results of the hierarchical multiple regression analysis...

  11. The effectiveness of ski bindings and their professional adjustment for preventing alpine skiing injuries.

    Science.gov (United States)

    Finch, C F; Kelsall, H L

    1998-06-01

    This article presents a critical review of the extent to which alpine ski bindings and their adjustment have been formally demonstrated to prevent injuries. It considers a range of evidence, from anecdotal evidence and informed opinion to biomechanical studies, testing of equipment, epidemiological studies and controlled field evaluations. A total of 15 published studies examining the effectiveness of bindings and their adjustment were identified. All of these included anecdotal or informed opinion, and all but one focused on equipment design. Seven studies involved the testing of bindings or binding prototypes, 2 studies presented biomechanical models of the forces involved in binding operation, 6 reported an epidemiological evaluation of ski bindings and 2 considered skiers' behaviours towards binding adjustment. Some of the reviewed articles relate to the study of the biomechanics of ski bindings and their release in response to various loads and loading patterns. Other studies examined the contribution of bindings and binding-release to lower extremity, equipment-related injuries, the effect of various methods of binding adjustment on injury risk and the determinants of skiers' behaviour relating to professional binding adjustment. Most of the evidence suggests that currently used bindings are insufficient for the multidirectional release required to reduce the risk of injury to the lower limb, especially at the knee. This evidence suggests that further technical developments and innovations are required. The standard of the manufacture of bindings and boots also needs to be considered. The optimal adjustment of bindings using a testing device has been shown to be associated with a reduced risk of lower extremity injury. Generally, however, the adjustment of bindings has been shown to be inadequate, especially for children's bindings. Recommendations for further research, development and implementation with respect to ski binding and their adjustment are given

  12. Medications for Sleep Schedule Adjustments in Athletes.

    Science.gov (United States)

    Baird, Matthew B; Asif, Irfan M

    Sleep schedule adjustments are common requirements of modern-day athletes. Many nonpharmacologic and pharmacologic strategies exist to facilitate circadian rhythm shifts to maximize alertness and performance during competition. This review summarizes the evidence for commonly used pharmacologic agents and presents recommendations for the sports medicine provider. MEDLINE searches were performed using the following keywords: sleep aids, circadian rhythm adjustment, athletes and sleep, caffeine and sports, melatonin and athletes, and sleep aids and sports. Pertinent articles were extracted and discussed. Clinical review. Level 2. There are very few available studies investigating pharmacologic sleep aids in athletes. Data from studies involving shift workers and airline personnel are more abundant and were used to formulate recommendations and conclusions. Melatonin, caffeine, and nonbenzodiazepine sleep aids have a role in facilitating sleep schedule changes in athletes and maximizing sports performance through sleep enhancement.

  13. Nuclear Data Parameter Adjustment BNL-INL

    International Nuclear Information System (INIS)

    Palmiotti, G.; Hoblit, S.; Herman, M.; Nobre, G.P.A.; Palumbo, A.; Hiruta, H.; Salvatores, M.

    2013-01-01

    This presentation reports on the consistent adjustment of nuclear data parameters performed within a BNL-INL collaboration. The main advantage compared to the classical adjustment of multigroup constants is to provide final nuclear data constrained by the nuclear reaction theory and consistent with both differential and integral measurements. The feasibility of a single-isotope assimilation was tested on a few priority materials ( 23 Na, 56 Fe, 105 Pd, 235,238 U, 239 Pu) using a selection of clean integral experiments. The multi-isotope assimilation is under study for the Big-3 ( 235,238 U, 239 Pu). This work shows that a consistent assimilation is feasible, but there are pitfalls to avoid (e.g. non-linearity, cross section fluctuations) and prerequisites (e.g. realistic covariances, good prior, realistic weighting of differential and integral experiments). Finally, only all experimental information combined with the state of the art modelling may provide a 'right' answer

  14. Article mounting and position adjustment stage

    Science.gov (United States)

    Cutburth, Ronald W.; Silva, Leonard L.

    1988-01-01

    An improved adjustment and mounting stage of the type used for the detection of laser beams is disclosed. A ring sensor holder has locating pins on a first side thereof which are positioned within a linear keyway in a surrounding housing for permitting reciprocal movement of the ring along the keyway. A rotatable ring gear is positioned within the housing on the other side of the ring from the linear keyway and includes an oval keyway which drives the ring along the linear keyway upon rotation of the gear. Motor-driven single-stage and dual (x, y) stage adjustment systems are disclosed which are of compact construction and include a large laser transmission hole.

  15. Markup cyclicality, employment adjustment, and financial constraints

    OpenAIRE

    Askildsen, Jan Erik; Nilsen, Øivind Anti

    2001-01-01

    We investigate the existence of markups and their cyclical behaviour. Markup is not directly observed. Instead, it is given as a price-cost relation that is estimated from a dynamic model of the firm. The model incorporates potential costly employment adjustments and takes into consideration that firms may be financially constrained. When considering size of the future labour stock, financially constrained firms may behave as if they have a higher discount factor, which may affect the realise...

  16. Adjustment problems and residential care environment

    OpenAIRE

    Jan Sebastian Novotný

    2015-01-01

    Problem: Residential care environment represents a specific social space that is associated with a number of negative consequences, covering most aspects of children and youth functioning. The paper analyzes of the presence of adjustment problems among adolescents from institutional care environment and compares this results with a population of adolescents who grew up in a family. Methods: The sample consisted of two groups of adolescents. The first group included 285 adolescents currently g...

  17. Learning-parameter adjustment in neural networks

    Science.gov (United States)

    Heskes, Tom M.; Kappen, Bert

    1992-06-01

    We present a learning-parameter adjustment algorithm, valid for a large class of learning rules in neural-network literature. The algorithm follows directly from a consideration of the statistics of the weights in the network. The characteristic behavior of the algorithm is calculated, both in a fixed and a changing environment. A simple example, Widrow-Hoff learning for statistical classification, serves as an illustration.

  18. Mechanism of laser micro-adjustment

    International Nuclear Information System (INIS)

    Shen Hong

    2008-01-01

    Miniaturization is a requirement in engineering to produce competitive products in the field of optical and electronic industries. Laser micro-adjustment is a new and promising technology for sheet metal actuator systems. Efforts have been made to understand the mechanisms of metal plate forming using a laser heating source. Three mechanisms have been proposed for describing the laser forming processes in different scenarios, namely the temperature gradient mechanism (TGM), buckling mechanism and upsetting mechanism (UM). However, none of these mechanisms can fully describe the deformation mechanisms involved in laser micro-adjustment. Based on the thermal and elastoplastic analyses, a coupled TGM and UM are presented in this paper to illustrate the thermal mechanical behaviours of two-bridge actuators when applying a laser forming process. To validate the proposed coupling mechanism, numerical simulations are carried out and the corresponding results demonstrate the mechanism proposed. The mechanism of the micro-laser adjustment could be taken as a supplement to the laser forming process.

  19. Player Modeling for Intelligent Difficulty Adjustment

    Science.gov (United States)

    Missura, Olana; Gärtner, Thomas

    In this paper we aim at automatically adjusting the difficulty of computer games by clustering players into different types and supervised prediction of the type from short traces of gameplay. An important ingredient of video games is to challenge players by providing them with tasks of appropriate and increasing difficulty. How this difficulty should be chosen and increase over time strongly depends on the ability, experience, perception and learning curve of each individual player. It is a subjective parameter that is very difficult to set. Wrong choices can easily lead to players stopping to play the game as they get bored (if underburdened) or frustrated (if overburdened). An ideal game should be able to adjust its difficulty dynamically governed by the player’s performance. Modern video games utilise a game-testing process to investigate among other factors the perceived difficulty for a multitude of players. In this paper, we investigate how machine learning techniques can be used for automatic difficulty adjustment. Our experiments confirm the potential of machine learning in this application.

  20. Adjustments to financial and social benefits

    CERN Document Server

    HR Department

    2009-01-01

    In accordance with decisions taken by the Finance Committee and Council in December 2008, certain financial and social benefits will be adjusted with effect from 1st January 2009. An increase of 2.7% will be applied to the scale of basic salaries and the scale of stipends paid to Fellows (Annexes R A 5 and R A 6 of the Staff Rules and Regulations, respectively). As a result of the evolution of the Geneva consumer price index, the following financial elements will increase by 3.2%: a) Family Allowance, Child Allowance and Infant Allowance (Annex R A 3 of the Staff Rules and Regulations) b) Payment of education fees: payment ceilings (Annex R A 4 of the Staff Rules and Regulations) for the academic year 2008/2009. As a result of the evolution of the Geneva consumer price index, adjustments will be applied to the subsistence allowances of Paid Associates and Students. The adjusted amounts are available in Departmental Secretariats. Human Resources Department Tel. 70674

  1. Group size adjustment to ecological demand in a cooperative breeder.

    Science.gov (United States)

    Zöttl, Markus; Frommen, Joachim G; Taborsky, Michael

    2013-04-07

    Environmental factors can determine which group size will maximize the fitness of group members. This is particularly important in cooperative breeders, where group members often serve different purposes. Experimental studies are yet lacking to check whether ecologically mediated need for help will change the propensity of dominant group members to accept immigrants. Here, we manipulated the perceived risk of predation for dominant breeders of the cooperatively breeding cichlid fish Neolamprologus pulcher to test their response to unrelated and previously unknown immigrants. Potential immigrants were more readily accepted if groups were exposed to fish predators or egg predators than to herbivorous fish or control situations lacking predation risk. Our data are consistent with both risk dilution and helping effects. Egg predators were presented before spawning, which might suggest that the fish adjust acceptance rates also to a potential future threat. Dominant group members of N. pulcher apparently consider both present and future need of help based on ecological demand. This suggests that acceptance of immigrants and, more generally, tolerance of group members on demand could be a widespread response to ecological conditions in cooperatively breeding animals.

  2. Psychological Adjustment of Siblings of Children with Autism Spectrum Disorder in Hong Kong.

    Science.gov (United States)

    Chan, J Yn; Lai, K Yc

    2016-12-01

    Findings about the psychological adjustment of siblings of children with autism spectrum disorder have been inconsistent in western literature and little is known among non-western societies. This study explored the psychological adjustment of siblings of children with autism spectrum disorder in Hong Kong. A total of 116 families with siblings of children with autism spectrum disorders co-morbid with learning disability were included in the study. Parents completed questionnaires about sibling emotional and behavioural adjustment, and their own mental well-being, quality of life, and family functioning. Siblings completed a questionnaire on their relationship with the autistic proband. Parent ratings did not reveal any significant negative impact on the emotional and behavioural adjustment of the typically developing siblings of children with autism spectrum disorder, but there were concerns about their peer relationships and weak prosocial behaviours. When cut-off scores were used to screen for risk of mental health problems, a quarter of the siblings warranted further assessment. Parents' quality of life and family functioning were significant predictors of sibling adjustment. In managing children with autism spectrum disorder, it is necessary to bear in mind the adjustment of their siblings, especially their peer relationships and prosocial behaviour. Adopting a holistic approach to address the psychosocial needs of the parents can facilitate sibling adjustment.

  3. Relationship Between Resilience, Adjustment, and Psychological Functioning After Traumatic Brain Injury: A Preliminary Report.

    Science.gov (United States)

    Lukow, Herman R; Godwin, Emilie E; Marwitz, Jennifer H; Mills, Ana; Hsu, Nancy H; Kreutzer, Jeffrey S

    2015-01-01

    To examine the relationship between resilience, psychological distress, adjustment, and community participation after traumatic brain injury (TBI). Large university health system. Adult survivors of mild to severe TBI (N = 96). Descriptive, preliminary. The Connor-Davidson Resilience Scale (10-item version) was used to assess resilience, the Brief Symptom Inventory (BSI-18) was used to characterize psychological distress, and the Mayo-Portland Adaptability Index (MPAI-4) was used to measure ability, adjustment, and participation. Resilience scores were substantially lower than those of the general population. Significant relationships were found between resilience, psychological distress, and adjustment. Partial correlations (adjusting for the other MPAI-4 indices) showed significant correlation (P MPAI-4 Adjustment and resilience. Partial correlations (adjusting for the other BSI-18 scales) also showed significance for Depression (P < .01) and resilience. Resilience scores differed significantly (P < .001) between individuals meeting BSI-18 caseness criteria for psychological distress (n = 55) and those not meeting criteria (n = 41). Individuals with TBI are at risk for low resilience, which was found to correlate with psychological distress and psychosocial maladjustment. Developing interventions to strengthen resilience skills has the potential to improve postinjury psychosocial adjustment, an important area for future research.

  4. The additive and interactive effects of parenting and temperament in predicting adjustment problems of children of divorce.

    Science.gov (United States)

    Lengua, L J; Wolchik, S A; Sandler, I N; West, S G

    2000-06-01

    Investigated the interaction between parenting and temperament in predicting adjustment problems in children of divorce. The study utilized a sample of 231 mothers and children, 9 to 12 years old, who had experienced divorce within the previous 2 years. Both mothers' and children's reports on parenting, temperament, and adjustment variables were obtained and combined to create cross-reporter measures of the variables. Parenting and temperament were directly and independently related to outcomes consistent with an additive model of their effects. Significant interactions indicated that parental rejection was more strongly related to adjustment problems for children low in positive emotionality, and inconsistent discipline was more strongly related to adjustment problems for children high in impulsivity. These findings suggest that children who are high in impulsivity may be at greater risk for developing problems, whereas positive emotionality may operate as a protective factor, decreasing the risk of adjustment problems in response to negative parenting.

  5. The Student's Adjustment Inventory Manual | Tanyi | IFE PsychologIA

    African Journals Online (AJOL)

    The term school adjustment according to this study relates directly to personality formation of a child at school. Personality also here refers to stable behaviors in the process of adjustment. Stable forms of adjustment or adaptations can be regarded as traits of personality. School adjustment therefore, is a behavioural pattern ...

  6. 13 CFR 315.6 - Firm eligibility for Adjustment Assistance.

    Science.gov (United States)

    2010-01-01

    ... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Firm eligibility for Adjustment..., DEPARTMENT OF COMMERCE TRADE ADJUSTMENT ASSISTANCE FOR FIRMS General Provisions § 315.6 Firm eligibility for Adjustment Assistance. (a) Firms participate in the Trade Adjustment Assistance for Firms program in...

  7. 26 CFR 1.1368-2 - Accumulated adjustments account (AAA).

    Science.gov (United States)

    2010-04-01

    ... 26 Internal Revenue 11 2010-04-01 2010-04-01 true Accumulated adjustments account (AAA). 1.1368-2... adjustments account (AAA). (a) Accumulated adjustments account—(1) In general. The accumulated adjustments account is an account of the S corporation and is not apportioned among shareholders. The AAA is relevant...

  8. 78 FR 5722 - Civil Monetary Penalty Inflation Adjustment

    Science.gov (United States)

    2013-01-28

    ... Civil Monetary Penalty Inflation Adjustment AGENCY: U.S. Army Corps of Engineers, DoD. ACTION: Direct... for inflation. The adjustment of civil penalties to account for inflation is required by the Federal Civil Penalties Inflation Adjustment Act of 1990, as amended. Since we have not made any adjustments to...

  9. 12 CFR 263.65 - Civil penalty inflation adjustments.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 3 2010-01-01 2010-01-01 false Civil penalty inflation adjustments. 263.65... Money Penalties § 263.65 Civil penalty inflation adjustments. (a) Inflation adjustments. In accordance with the Federal Civil Penalties Inflation Adjustment Act of 1990 (28 U.S.C. 2461 note), the Board has...

  10. 76 FR 74625 - Civil Monetary Penalties Inflation Adjustment

    Science.gov (United States)

    2011-12-01

    ...-2011] RIN 1125-AA69 Civil Monetary Penalties Inflation Adjustment AGENCIES: U.S. Customs and Border... adjust for inflation certain civil monetary penalties assessed under the Immigration and Nationality Act... assessed under the INA. The Federal Civil Penalties Inflation Adjustment Act of 1990 (Adjustment Act...

  11. Psychologic adjustment to irreversible vision loss in adults: a systematic review.

    Science.gov (United States)

    Senra, Hugo; Barbosa, Fernando; Ferreira, Patrícia; Vieira, Cristina R; Perrin, Paul B; Rogers, Heather; Rivera, Diego; Leal, Isabel

    2015-04-01

    To summarize relevant evidence investigating the psychologic adjustment to irreversible vision loss (IVL) in adults. Irreversible vision loss entails a challenging medical condition in which rehabilitation outcomes are strongly dependent on the patient's psychologic adjustment to illness and impairment. So far, no study has systematically reviewed the psychologic adjustment to IVL in adults. We reviewed all articles examining the psychologic adjustment to IVL in adults. We included articles published in English in peer-reviewed journals. We performed a keyword literature search using 4 databases (PubMed, EBSCO, Cochrane Library, and Science Direct) for all years through July 2014. We assessed risk of bias of selected studies using the RTI Item Bank for Assessing Risk of Bias and Confounding for Observational Studies of Interventions or Exposures and the Cochrane risk of bias tool for randomized controlled trials. Of a total of 3948 citations retrieved, we selected 52 eligible studies published between 1946 and 2014. The majority of studies were observational and cross-sectional in nature. Our review suggests that high levels of depression occur during the adjustment to IVL. Better adjustment to IVL was associated with greater acceptance of vision loss and use of instrumental coping, good social support, positivity, and use of assistive aids. The overall findings indicate that IVL often has negative effects on patients' quality of life and mental health and that such effects tend to remain over time. Specific factors and variables associated with the adjustment to IVL need to be clarified through further in-depth and longitudinal research. Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

  12. Factors protecting against the development of adjustment difficulties in young adults exposed to childhood sexual abuse.

    Science.gov (United States)

    Lynskey, M T; Fergusson, D M

    1997-12-01

    The aims of this study were to identify the factors which discriminated young people exposed to childhood sexual abuse (CSA) who developed psychiatric disorder or adjustment difficulties in young adulthood from those young people exposed to CSA who did not develop psychiatric disorder or adjustment difficulties by age 18. Data were gathered on a birth cohort of 1,025 New Zealand children studied from birth to the age of 18 on (a) exposure to CSA; (b) patterns of psychiatric disorder and adjustment difficulties at age 18 years; (c) factors that may have influenced responses to CSA including characteristics of the abuse, parental bonding, parental characteristics, and adolescent peer affiliations. Just over 10% of the cohort reported CSA. Those reporting CSA were at increased risks of a range of difficulties at age 18 (depression, anxiety, conduct disorder, alcohol abuse/dependence, other substance abuse/dependence, post sexual abuse trauma, attempted suicide). However, not all of those exposed to CSA developed difficulties and approximately a quarter of those exposed to CSA did not meet criteria for any adjustment difficulty. Further analysis suggested that the extent of adjustment difficulties in those exposed to CSA was influenced by two additional factors: (a) the extent of affiliations with delinquent or substance using peers in adolescence; and (b) the extent of paternal care or support in childhood. The findings of this study suggest that while young people exposed to CSA are at increased risks of psychiatric disorder and adjustment difficulties in young adulthood, not all individuals exposed to CSA will develop adjustment difficulties. Important factors protecting against the development of adjustment difficulties in young people experiencing CSA appear to be the nature and quality of peer and family relationships.

  13. Adjustment problems and residential care environment

    Directory of Open Access Journals (Sweden)

    Jan Sebastian Novotný

    2015-01-01

    Full Text Available Problem: Residential care environment represents a specific social space that is associated with a number of negative consequences, covering most aspects of children and youth functioning. The paper analyzes of the presence of adjustment problems among adolescents from institutional care environment and compares this results with a population of adolescents who grew up in a family. Methods: The sample consisted of two groups of adolescents. The first group included 285 adolescents currently growing up in an residential care environment, aged 13 to 21 (M = 16.23, SD = 1.643. The second group consisted of 214 adolescents growing up in a family, aged 15 to 20 (M = 17.07, SD = 1.070. We used a questionnaire Youth Self Report. Data were analyzed using descriptive statistics and MANOVA. Results: Results showed that adolescents in residential care exhibit higher average values in all adjustment problems. Also, in the context of diagnostic categories are the residential care adolescents more frequently in non-normal range (borderline and clinical, primarily in the border range. The greatest differences were reflected in the Thought problems and Rule-breaking behavior. MANOVA showed a significant multivariate effect between groups of adolescents, Hotelling's T = .803, F(8, 490 = 49.202, p <.001, d = .445 (large effect. Univariate analysis further showed a significant effect for Withdrawn/depressed (p = .044, d = .089, small effect, Somatic complaints (p = .002, d = .139, medium effect, Social problems (p = 004, d = .127, a small effect, Thought problems (p <.001, d = .633, strong effect, Attention problems (p <.001, d = .320,strong effect, Rule-breaking behavior (p <.001 , d = .383, strong effect, and Aggressive behavior (p = 015, d = .110, small effect. Results for the dimension of Anxious/depressed were not significant (p = .159. Discussion: The results didn’t confirmed the assumption that more than 30% of residential care adolescents have adjustment

  14. MODULAR BUNDLE ADJUSTMENT FOR PHOTOGRAMMETRIC COMPUTATIONS

    Directory of Open Access Journals (Sweden)

    N. Börlin

    2018-05-01

    Full Text Available In this paper we investigate how the residuals in bundle adjustment can be split into a composition of simple functions. According to the chain rule, the Jacobian (linearisation of the residual can be formed as a product of the Jacobians of the individual steps. When implemented, this enables a modularisation of the computation of the bundle adjustment residuals and Jacobians where each component has limited responsibility. This enables simple replacement of components to e.g. implement different projection or rotation models by exchanging a module. The technique has previously been used to implement bundle adjustment in the open-source package DBAT (Börlin and Grussenmeyer, 2013 based on the Photogrammetric and Computer Vision interpretations of Brown (1971 lens distortion model. In this paper, we applied the technique to investigate how affine distortions can be used to model the projection of a tilt-shift lens. Two extended distortion models were implemented to test the hypothesis that the ordering of the affine and lens distortion steps can be changed to reduce the size of the residuals of a tilt-shift lens calibration. Results on synthetic data confirm that the ordering of the affine and lens distortion steps matter and is detectable by DBAT. However, when applied to a real camera calibration data set of a tilt-shift lens, no difference between the extended models was seen. This suggests that the tested hypothesis is false and that other effects need to be modelled to better explain the projection. The relatively low implementation effort that was needed to generate the models suggest that the technique can be used to investigate other novel projection models in photogrammetry, including modelling changes in the 3D geometry to better understand the tilt-shift lens.

  15. Modular Bundle Adjustment for Photogrammetric Computations

    Science.gov (United States)

    Börlin, N.; Murtiyoso, A.; Grussenmeyer, P.; Menna, F.; Nocerino, E.

    2018-05-01

    In this paper we investigate how the residuals in bundle adjustment can be split into a composition of simple functions. According to the chain rule, the Jacobian (linearisation) of the residual can be formed as a product of the Jacobians of the individual steps. When implemented, this enables a modularisation of the computation of the bundle adjustment residuals and Jacobians where each component has limited responsibility. This enables simple replacement of components to e.g. implement different projection or rotation models by exchanging a module. The technique has previously been used to implement bundle adjustment in the open-source package DBAT (Börlin and Grussenmeyer, 2013) based on the Photogrammetric and Computer Vision interpretations of Brown (1971) lens distortion model. In this paper, we applied the technique to investigate how affine distortions can be used to model the projection of a tilt-shift lens. Two extended distortion models were implemented to test the hypothesis that the ordering of the affine and lens distortion steps can be changed to reduce the size of the residuals of a tilt-shift lens calibration. Results on synthetic data confirm that the ordering of the affine and lens distortion steps matter and is detectable by DBAT. However, when applied to a real camera calibration data set of a tilt-shift lens, no difference between the extended models was seen. This suggests that the tested hypothesis is false and that other effects need to be modelled to better explain the projection. The relatively low implementation effort that was needed to generate the models suggest that the technique can be used to investigate other novel projection models in photogrammetry, including modelling changes in the 3D geometry to better understand the tilt-shift lens.

  16. BASACF, Integral Neutron Spectra Adjustment and Dosimetry

    International Nuclear Information System (INIS)

    Tichy, Milos

    1996-01-01

    1 - Description of program or function: Adjustment of a neutron spectrum based on integral detector measurements and calculation of an integral dosimetric quantity (integral flux, d.p.a., dose equivalent) and its variance. The program requires measured data (activities and their covariance matrix) and a priori information (spectrum, dosimetry cross sections, integral quantity conversion factor and their covariance matrices). All a priori covariance matrices can be read in from a file prepared by some other code or can be generated by means of three different methods (by subroutines included in the program). A subroutine which can normalize the a priori flux to measured data is also included. The program provides also adjusted dosimetry cross sections (with covariance matrix) so that it can be used for an adjustment of cross sections (or response functions of e.g. Bonner balls) by measurements in well-known neutron spectra. 2 - Method of solution: Bayesian theorem on conditional probability applied to linearized relation between activities, dosimetry cross sections and flux. All probability distributions are supposed to be normal and this supposition leads to minimizing of the same functional as least squares method (STAY'SL). This task is solved by a covariance filter method which avoids any matrix inversion and is numerically robust and stable. 3 - Restrictions on the complexity of the problem: This version can use 45 energy groups and 5 detectors and occupies 310 kB of main memory. This restriction can be modified according to available memory. The covariance matrix of activities is supposed diagonal. A solution is produced for any set of input data but in the case of non-consistent data, when measured activities do not match the a priori flux, the solution is not very meaningful

  17. Use of the adjustable trans-obturator male sling system for the ...

    African Journals Online (AJOL)

    M.S. El Badry

    2016-03-25

    Mar 25, 2016 ... procedure for the treatment of male urinary incontinence. It has the advantage of ... However, a lack of postoperative adjustment and the risk of dis- location of the ... of male SUI due to different etiological factors. Subjects and ...

  18. Adjustable intragastric balloons: a 12-month pilot trial in endoscopic weight loss management

    NARCIS (Netherlands)

    Machytka, Evzen; Klvana, Pavel; Kornbluth, Asher; Peikin, Steven; Mathus-Vliegen, Lisbeth E. M.; Gostout, Christopher; Lopez-Nava, Gontrand; Shikora, Scott; Brooks, Jeffrey

    2011-01-01

    Intragastric balloons are associated with (1) early period intolerance, (2) diminished effect within 3-4 months, and (3) bowel obstruction risk mandating removal at 6 months. The introduction of an adjustable balloon could improve comfort and offer greater efficacy. A migration prevention function,

  19. Comparing treatment effects after adjustment with multivariable Cox proportional hazards regression and propensity score methods

    NARCIS (Netherlands)

    Martens, Edwin P; de Boer, Anthonius; Pestman, Wiebe R; Belitser, Svetlana V; Stricker, Bruno H Ch; Klungel, Olaf H

    PURPOSE: To compare adjusted effects of drug treatment for hypertension on the risk of stroke from propensity score (PS) methods with a multivariable Cox proportional hazards (Cox PH) regression in an observational study with censored data. METHODS: From two prospective population-based cohort

  20. Potential Mediators of Adjustment for Preschool Children Exposed to Intimate Partner Violence

    Science.gov (United States)

    Miller, Laura E.; Howell, Kathryn H.; Graham-Bermann, Sandra A.

    2012-01-01

    Objective: Living in a home where violence is present places young children at great risk for developing emotional, behavioral, cognitive, and health problems. While many studies have examined direct relationships between violence exposure and adjustment, fewer have considered how children's mental health problems may interact over time. The…

  1. Socioeconomic Stress and Academic Adjustment among Asian American Adolescents: The Protective Role of Family Obligation

    Science.gov (United States)

    Kiang, Lisa; Andrews, Kandace; Stein, Gabriela L.; Supple, Andrew J.; Gonzalez, Laura M.

    2013-01-01

    Socioeconomic stress has long been found to place youth at risk, with low family income conferring disadvantages in adolescents' school achievement and success. This study investigates the role of socioeconomic stress on academic adjustment, and pinpoints family obligation as a possible buffer of negative associations. We examined direct and…

  2. Emotional adjustment of children and adolescents with haemophilia in relation to the HIV threat

    NARCIS (Netherlands)

    Boswerger, M. G.; Fijnvandraat, K.; van Veldhuizen, A. M.; Rosendaal, F. R.; Peters, M.

    1997-01-01

    A Dutch nation-wide study on young haemophilia patients, whose former treatment placed them at risk for HIV infection, was done to examine the effect of HIV testing, HIV status, disclosure of HIV status and the child's experiences with disease-related information on emotional adjustment. In the

  3. Permanent multipole magnets with adjustable strength

    International Nuclear Information System (INIS)

    Halbach, K.

    1983-01-01

    Preceded by a short discussion of the motives for using permanent magnets in accelerators, a new type of permanent magnet for use in accelerators is presented. The basic design and most important properties of a quadrople will be described that uses both steel and permanent magnet material. The field gradient produced by this magnet can be adjusted without changing any other aspect of the field produced by this quadrupole. The generalization of this concept to produce other multipole fields, or combination of multipole fields, will also be presented

  4. An Integrative Psychotherapy of Postpartum Adjustment

    Directory of Open Access Journals (Sweden)

    Carol Merle-Fishman

    2010-12-01

    Full Text Available Becoming a mother is a time of transition, transformation and sometimes trauma. The immediacy of meeting the needs of an infant, combined with the immediacy of becoming a mother, often collide to produce depression, anxiety and stress. Shame, confusion, isolation and cultural expectations often prevent women from seeking the postpartum support they need, which may result in long lasting depression, anxiety and unresolved trauma. Integrative Psychotherapy, Transactional Analysis and Attachment Theory offer ways to understand postpartum adjustment as well as methodologies for addressing this unique developmental event in the life of women.

  5. Tuning permanent magnets with adjustable field clamps

    International Nuclear Information System (INIS)

    Schermer, R.I.

    1987-01-01

    The effective length of a permanent-magnet assembly can be varied by adjusting the geometrical parameters of a field clamp. This paper presents measurements on a representative dipole and quadrupole as the field clamp is withdrawn axially or radially. The detailed behavior depends upon the magnet multipolarity and geometry. As a rule-of-thumb, a 3-mm-thick iron plate placed at one end plane of the magnet will shorten the length by one-third of the magnet bore radius

  6. Problems of state adjustment the telecommunications industry

    Directory of Open Access Journals (Sweden)

    Tregub Ilona Vladimirovna

    2015-08-01

    Full Text Available The paper presents the mechanism of state adjustment of the telecommunications industry companies, providing the additional mobile services (VAS-services, by determining the optimal rates of tax and non-tax payments to the budget. Method is based on the approach of A. Laffer, who showed the possibility of existence an optimal tax rate, which provides, on the one hand, the maximum flow of funds in the budget, on the other hand, preserves the incentives of entrepreneurship. In the present paper, we study the dependence of revenues to the Reserve Fund on the size of the contribution rate and the coefficient of profitability of enterprises providing VAS-services.

  7. Permanent multipole magnets with adjustable strength

    International Nuclear Information System (INIS)

    Halbach, K.

    1983-03-01

    Preceded by a short discussion of the motives for using permanent magnets in accelerators, a new type of permanent magnet for use in accelerators is presented. The basic design and most important properties of a quadrupole will be described that uses both steel and permanent magnet material. The field gradient produced by this magnet can be adjusted without changing any other aspect of the field produced by this quadrupole. The generalization of this concept to produce other multipole fields, or combination of multipole fields, will also be presented

  8. Adjustable Speed Drives and Power Quality

    DEFF Research Database (Denmark)

    Davari, Pooya; Yang, Yongheng; Zare, Firuz

    2016-01-01

    This paper provides an overview and proposes cost-effective and efficient opportunities in improving power quality in Adjustable Speed Drive (ASD) systems. In particular, an Electronic Inductor (EI) technique has been used in single drives to overcome the existing challenges in conventional...... frontend rectifiers even at partial loading conditions. Moreover, the effectiveness of the EI technique along with a phase-shifted current control in terms of improved grid current quality in multi-drive configurations is addressed. Furthermore, a novel DC-link current modulation scheme for multi...

  9. The Mediating Role of Psychological Adjustment between Peer Victimization and Social Adjustment in Adolescence.

    Science.gov (United States)

    Romera, Eva M; Gómez-Ortiz, Olga; Ortega-Ruiz, Rosario

    2016-01-01

    There is extensive scientific evidence of the serious psychological and social effects that peer victimization may have on students, among them internalizing problems such as anxiety or negative self-esteem, difficulties related to low self-efficacy and lower levels of social adjustment. Although a direct relationship has been observed between victimization and these effects, it has not yet been analyzed whether there is a relationship of interdependence between all these measures of psychosocial adjustment. The aim of this study was to examine the relationship between victimization and difficulties related to social adjustment among high school students. To do so, various explanatory models were tested to determine whether psychological adjustment (negative self-esteem, social anxiety and social self-efficacy) could play a mediating role in this relationship, as suggested by other studies on academic adjustment. The sample comprised 2060 Spanish high school students (47.9% girls; mean age = 14.34). The instruments used were the scale of victimization from European Bullying Intervention Project Questionnaire , the negative scale from Rosenberg Self-Esteem Scale, Social Anxiety Scale for Adolescents and a general item about social self-efficacy, all of them self-reports. Structural equation modeling was used to analyze the data. The results confirmed the partial mediating role of negative self-esteem, social anxiety and social self-efficacy between peer victimization and social adjustment and highlight the importance of empowering victimized students to improve their self-esteem and self-efficacy and prevent social anxiety. Such problems lead to the avoidance of social interactions and social reinforcement, thus making it difficult for these students to achieve adequate social adjustment.

  10. The Mediating Role of Psychological Adjustment between Peer Victimization and Social Adjustment in Adolescence

    Directory of Open Access Journals (Sweden)

    Eva M. Romera

    2016-11-01

    Full Text Available There is extensive scientific evidence of the serious psychological and social effects that peer victimization may have on students, among them internalizing problems such as anxiety or negative self-esteem, difficulties related to low self-efficacy and lower levels of social adjustment. Although a direct relationship has been observed between victimization and these effects, it has not yet been analyzed whether there is a relationship of interdependence between all these measures of psychosocial adjustment. The aim of this study was to examine the relationship between victimization and difficulties related to social adjustment among high school students. To do so, various explanatory models were tested to determine whether psychological adjustment (negative self-esteem, social anxiety and social self-efficacy could play a mediating role in this relationship, as suggested by other studies on academic adjustment. The sample comprised 2060 Spanish high school students (47.9% girls; mean age = 14.34. The instruments used were the scale of victimization from European Bullying Intervention Project Questionnaire, the negative scale from Rosenberg Self-Esteem Scale, Social Anxiety Scale for Adolescents and a general item about social self-efficacy, all of them self-reports. Structural equation modeling was used to analyze the data. The results confirmed the partial mediating role of negative self-esteem, social anxiety and social self-efficacy between peer victimization and social adjustment and highlight the importance of empowering victimized students to improve their self-esteem and self-efficacy and prevent social anxiety. Such problems lead to the avoidance of social interactions and social reinforcement, thus making it difficult for these students to achieve adequate social adjustment.

  11. Effect of gender on psychosocial adjustment of colorectal cancer survivors with ostomy.

    Science.gov (United States)

    Gautam, Sital; Poudel, Anju

    2016-12-01

    Stoma can pose extensive challenges for colorectal cancer survivors. Identifying the psychological and social adjustment among them and how it differs by gender will aid in identifying those particularly at risk of having poor adjustment and in planning programs to improve their adjustment. The purpose of this study was to determine the effect of gender on psychosocial adjustment of colorectal cancer survivors with ostomy. A descriptive cross sectional study was carried out in the stoma clinic of B.P. Koirala Memorial Cancer Hospital, Bharatpur, Nepal. A purposive sample of 122 patients with ostomy was taken from the above mentioned setting. Selection criteria included colorectal cancer survivors having ostomy for at least 6 months. Data on socio-demographic and clinical variables were collected. Psychosocial adjustment was measured using Ostomy Adjustment Inventory-23 (OAI-23). A total of 122 patients were included in the study. Mean time since ostomy surgery was 2.53 and 1.98 years for men and women respectively. Both men and women had significant impairment in the psychosocial adjustment, however, men had significantly lower psychosocial adjustment score (37.68±12.96 vs . 43.45±12.81, t=-2.47, P=0.015) at 95% CI as compared to women and they reported more negative emotions. Furthermore, men significantly predicted low acceptance {β=-3.078, P=0.023, ΔR 2 =0.036, F [4,117] =7.90, Postomy should be monitored for psychosocial concerns in regular basis and health care providers should tailor care based on their need. Approaches of survivorship care and psychosocial interventions in colorectal cancer survivors with ostomy should take into account gender specific concerns and requirements to aid adjustment.

  12. Adjustment of legally binding local plans

    DEFF Research Database (Denmark)

    Hvingel, Line Træholt; Aunsborg, Christian; Christensen, Finn Kjær

    2012-01-01

    Traditionally, and by law, new urban areas in Denmark are regulated and planned through legally binding local plans. Recently a tendency has occurred: The municipalities make the legally binding local plans quite open for future adjustment, and they are using a substantial amount of ‘empowerment ...... the considerations of legal rights, the extend of the legal use of empowerment provisions and the combination of the use of legal binding local plans and other legal instruments such as easements and sales agreements.......Traditionally, and by law, new urban areas in Denmark are regulated and planned through legally binding local plans. Recently a tendency has occurred: The municipalities make the legally binding local plans quite open for future adjustment, and they are using a substantial amount of ‘empowerment...... provisions’ which empower the municipalities to later ruling. This way of making plans postpones the actual regulation of an area (i.e. the planning permission) making it an individual ruling for instance at the application of building permits. Case studies show examples of this way of regulating an area...

  13. Adjustable electronic load-alarm relay

    International Nuclear Information System (INIS)

    Mason, C.H.; Sitton, R.S.

    1976-01-01

    An improved electronic alarm relay for monitoring the current drawn by an ac motor or other electrical load is described. The circuit is designed to measure the load with high accuracy and to have excellent alarm repeatability. Chattering and arcing of the relay contacts are minimal. The operator can adjust the set point easily and can re-set both the high and the low alarm points by means of one simple adjustment. The relay includes means for generating a signal voltage proportional to the motor current. In a preferred form of the invention a first operational amplifier is provided to generate a first constant reference voltage which is higher than a preselected value of the signal voltage. A second operational amplifier is provided to generate a second constant reference voltage which is lower than the aforementioned preselected value of the signal voltage. A circuit comprising a first resistor serially connected to a second resistor is connected across the outputs of the first and second amplifiers, and the junction of the two resistors is connected to the inverting terminal of the second amplifier. Means are provided to compare the aforementioned signal voltage with both the first and second reference voltages and to actuate an alarm if the signal voltage is higher than the first reference voltage or lower than the second reference voltage

  14. Novel fluorescence adjustable photonic crystal materials

    Science.gov (United States)

    Zhu, Cheng; Liu, Xiaoxia; Ni, Yaru; Fang, Jiaojiao; Fang, Liang; Lu, Chunhua; Xu, Zhongzi

    2017-11-01

    Novel photonic crystal materials (PCMs) with adjustable fluorescence were fabricated by distributing organic fluorescent powders of Yb0.2Er0.4Tm0.4(TTA)3Phen into the opal structures of self-assembled silica photonic crystals (PCs). Via removing the silica solution in a constant speed, PCs with controllable thicknesses and different periodic sizes were obtained on glass slides. Yb0.2Er0.4Tm0.4(TTA)3Phen powders were subsequently distributed into the opal structures. The structures and optical properties of the prepared PCMs were investigated. Finite-difference-time-domain (FDTD) calculation was used to further analyze the electric field distributions in PCs with different periodic sizes while the relation between periodic sizes and fluorescent spectra of PCMs was discussed. The results showed that the emission color of the PCMs under irradiation of 980 nm laser can be easily adjusted from green to blue by increasing the periodic size from 250 to 450 nm.

  15. Comparison of time adjustment clauses between DZ3910, AS4000 and STCC

    Directory of Open Access Journals (Sweden)

    David Finnie

    2013-03-01

    Full Text Available This article examines time adjustment clauses, as they relate to time adjustment between standard terms of construction contracts. DZ3910, AS4000 and STCC were compared on the basis of how risks are allocated, how this may impact on the contractor’s pricing, and ease of understanding for each clause. ASTCC was found to be the most easily interpreted contract, followed by AS4000 and then NZS3910. These assessments were based on the following: a whether each contract contains words with multiple meanings, b the number of words used per sentence, c the amount of internal cross-referencing, and d the clarity of the contract structure. The allowable pre-conditions for the contractor to claim a time adjustment are similar for all three contracts, and none of them expressly state which party is to bare the risk of buildability, or address the risk of a designer’s disclaimer clause. All of the contracts adopt the principle of contra preferentum which means that the employer bares the risk of variance if there are any ambiguities in the design documentation. Due to their similarities of risk allocation, all of the contracts provide the employer with a similar amount of price surety. AS4000 is the only contract to contain a stringent time-bar clause, limiting a contractor’s time adjustment claim. ASTCC requires the contractor to apply ‘immediately’ and DZ3910 provides a time-bar of 20 working days or as soon as practicable. None of the contracts clarify whether their timing requirements take precedence over the prevention principle, or over any other ground for claiming a time adjustment. The effect of DZ3910’s pre-notification clause 5.19.3 is discussed, and an alternative contents structure is recommended for DZ3910, using a project management method.

  16. Adjusted Analyses in Studies Addressing Therapy and Harm: Users' Guides to the Medical Literature.

    Science.gov (United States)

    Agoritsas, Thomas; Merglen, Arnaud; Shah, Nilay D; O'Donnell, Martin; Guyatt, Gordon H

    2017-02-21

    Observational studies almost always have bias because prognostic factors are unequally distributed between patients exposed or not exposed to an intervention. The standard approach to dealing with this problem is adjusted or stratified analysis. Its principle is to use measurement of risk factors to create prognostically homogeneous groups and to combine effect estimates across groups.The purpose of this Users' Guide is to introduce readers to fundamental concepts underlying adjustment as a way of dealing with prognostic imbalance and to the basic principles and relative trustworthiness of various adjustment strategies.One alternative to the standard approach is propensity analysis, in which groups are matched according to the likelihood of membership in exposed or unexposed groups. Propensity methods can deal with multiple prognostic factors, even if there are relatively few patients having outcome events. However, propensity methods do not address other limitations of traditional adjustment: investigators may not have measured all relevant prognostic factors (or not accurately), and unknown factors may bias the results.A second approach, instrumental variable analysis, relies on identifying a variable associated with the likelihood of receiving the intervention but not associated with any prognostic factor or with the outcome (other than through the intervention); this could mimic randomization. However, as with assumptions of other adjustment approaches, it is never certain if an instrumental variable analysis eliminates bias.Although all these approaches can reduce the risk of bias in observational studies, none replace the balance of both known and unknown prognostic factors offered by randomization.

  17. Association among depressive disorder, adjustment disorder, sleep disturbance, and suicidal ideation in Taiwanese adolescent.

    Science.gov (United States)

    Chung, Ming-Shun; Chiu, Hsien-Jane; Sun, Wen-Jung; Lin, Chieh-Nan; Kuo, Chien-Cheng; Huang, Wei-Che; Chen, Ying-Sheue; Cheng, Hui-Ping; Chou, Pesus

    2014-09-01

    The aim of this study is to investigate the association among depressive disorder, adjustment disorder, sleep disturbance, and suicidal ideation in Taiwanese adolescent. We recruited 607 students (grades 5-9) to fill out the investigation of basic data and sleep disturbance. Psychiatrists then used the Mini International Neuropsychiatric Interview-Kid to interview these students to assess their suicidal ideation and psychiatric diagnosis. Multiple logistic regression with forward conditionals was used to find the risk factors for multivariate analysis. Female, age, depressive disorder, adjustment disorder, and poor sleep all contributed to adolescent suicidal ideation in univariate analysis. However, poor sleep became non-significant under the control of depressive disorder and adjustment disorder. We found that both depressive disorder and adjustment disorder play important roles in sleep and adolescent suicidal ideation. After controlling both depressive disorder and adjustment disorder, sleep disturbance was no longer a risk of adolescent suicidal ideation. We also confirm the indirect influence of sleep on suicidal ideation in adolescent. © 2013 Wiley Publishing Asia Pty Ltd.

  18. Structural adjustment and drought in Zambia.

    Science.gov (United States)

    Mulwanda, M

    1995-06-01

    While drought is not uncommon in Zambia, the country is now facing the worst drought in history. The monetary and social costs will be enormous. Although it is too early to measure the economic and social costs of the drought on Zambia, it is obvious that the impact is catastrophic on a country whose economy is under pressure. The drought will affect the structural adjustment programme (SAP) unveiled by the new government which has embraced the market economy. The country has imported, and will continue to import, large quantities of maize and other foodstuffs, a situation likely to strain the balance of payments. Earlier targets with regard to export earnings, reductions in the budget deficit, and GDP growth as contained in the Policy Framework Paper (PFP) are no longer attainable due to the effects of the drought.

  19. Do Daily Retail Gasoline Prices adjust Asymmetrically?

    Energy Technology Data Exchange (ETDEWEB)

    Bettendorf, L. [Tinbergen Instituut, Amsterdam/Rotterdam (Netherlands); Van der Geest, S. [Erasmus Universiteit, Rotterdam (Netherlands); Kuper, G. [University of Groningen, Groningen (Netherlands)

    2005-04-15

    This paper analyzes adjustments in the Dutch retail gasoline prices. We estimate an error correction model on changes in the daily retail price for gasoline (taxes excluded) for the period 1996-2004 taking care of volatility clustering by estimating an EGARCH model. It turns out the volatility process is asymmetrical: an unexpected increase in the producer price has a larger effect on the variance of the producer price than an unexpected decrease. We do not find strong evidence for amount asymmetry. However, there is a faster reaction to upward changes in spot prices than to downward changes in spot prices. This implies timing or pattern asymmetry. This asymmetry starts three days after the change in the spot price and lasts for four days.

  20. Adjusting the IP $\\beta$ Functions in RHIC

    CERN Document Server

    Wittmer, W; Pilat, F; Ptitsyn, V; Van Zeijts, J

    2004-01-01

    The beta functions at the IP can be adjusted without perturbation of other optics functions via several approaches. In this paper we describe a scheme based on a vector knob, which assigns fixed values to the different tuning quadrupoles and scales them by a common multiplier. The values for the knob vector were calculated for a lattice without any errors using MADX. Previous studies for the LHC [1] have shown that this approach can meet the design goals. A specific feature of the RHIC lattice is the nested power supply system. To cope with the resulting problems a detailed response matrix analysis has been carried out and different sets of knobs were calculated and compared. The knobs were tested at RHIC during the 2004 run and preliminary results are discussed. Simultaneously a new approach to measure the beam sizes of both colliding beams at the IP, based on the tunability provided by the knobs, was developed and tested.

  1. Laparoscopic Adjustable Gastric Banding and Hypoglycemia

    Directory of Open Access Journals (Sweden)

    Sigrid Bairdain

    2013-01-01

    Full Text Available Obesity is commonplace, and surgical treatment usually includes Roux-en-Y gastric bypasses (RYGBs. RYGBs have the most documented side effects including vitamin deficiencies, rebound weight gain, and symptomatic hypoglycemia; fewer series exist describing hypoglycemia following other bariatric operations. We reviewed all patients undergoing laparoscopic adjustable gastric banding (LAGB at our institution between 2008 and 2012. Three patients were identified to have symptomatic hypoglycemia following LAGB. Mean time from surgery was 33 months (range 14–45 months, and mean weight loss was 32.7 kg (range 15.9–43.1 kg. None of the patients had preexisting diabetes. Therefore, symptomatic hypoglycemia should be investigated irrespective of bariatric operation.

  2. Signalling chains with probe and adjust learning

    Science.gov (United States)

    Gosti, Giorgio

    2018-04-01

    Many models explain the evolution of signalling in repeated stage games on social networks, differently in this study each signalling game evolves a communication strategy to transmit information across the network. Specifically, I formalise signalling chain games as a generalisation of Lewis' signalling games, where a number of players are placed on a chain network and play a signalling game in which they have to propagate information across the network. I show that probe and adjust learning allows the system to develop communication conventions, but it may temporarily perturb the system out of conventions. Through simulations, I evaluate how long the system takes to evolve a signalling convention and the amount of time it stays in it. This discussion presents a mechanism in which simple players can evolve signalling across a social network without necessarily understanding the entire system.

  3. Adjustable speed drive study, part 1

    Science.gov (United States)

    Wallace, A.

    1989-08-01

    Advances in speed control for motors in recent years, notably those in power electronics, have widened the range of application for several adjustable speed drive (ASD) types to include the smaller horsepower sizes. The dc motor drive, formerly in almost universal use for speed control, is being challenged by the high efficiency induction motor/pulse width modulation (PWM) drive; and for special small horsepower size applications, by the permanent magnet motor/PWM inverter drive or by the switched reluctance motor drive. The main characteristics of the several ASD types suitable for small horsepower size applications are discussed, as well as their unwanted side effects: poor power factor, harmonic distortion of the supply, acoustic noise, and electromagnetic interference. A procedure is recommended for determining which, if any, ASD to use.

  4. First adjustments in the solar industry

    International Nuclear Information System (INIS)

    Deye, M.

    2009-01-01

    The European environmental policy goal is to generate 23% of the end-use power consumption from renewable energy sources by 2020. The solar photovoltaic market has shown an exponential growth since 1998 with a record rise of installed capacities in 2008 (+61%). In 2009, the growth should reach 30% only. The solar industry has to face the conjugated effects of the demand decay and of the credit crisis which has led to over-capacities and prices drop. The crisis has hit the solar cell manufacturers but for some of them, it is an opportunity to make some strategic adjustments and to develop products with a higher added value. The market and the demand are still there but the clients encounter more difficulties to obtain the credits for their projects. (J.S.)

  5. Adjustment of gripping force by optical systems

    Science.gov (United States)

    Jalba, C. K.; Barz, C.

    2018-01-01

    With increasing automation, robotics also requires ever more intelligent solutions in the handling of various tasks. In this context, many grippers must also be re-designed. For this, they must always be adapted for different requirements. The equipment of the gripper systems with sensors should help to make the gripping process more intelligent. In order to achieve such objectives, optical systems can also be used. This work analyzes how the gripping force can be adjusted by means of an optical recognition. The result of this work is the creation of a connection between optical recognition, tolerances, gripping force and real-time control. In this way, algorithms can be created, with the aid of which robot grippers as well as other gripping systems become more intelligent.

  6. Adjustable speed drives improve circulating water system

    International Nuclear Information System (INIS)

    Dent, R.A.; Dicic, Z.

    1994-01-01

    This paper illustrates the integration of electrical and mechanical engineering requirements to produce a solution to past problems and future operating demands. The application of adjustable speed drives in the modifications of the circulating water system at Indian Point No. 3 Nuclear Power Plant provided increased operating flexibility, efficiency and avoided otherwise costly renovations to the plant electrical systems. Rectification of the original inadequate design of the circulating water system, in addition to maximizing plant efficiency consistent with environmental considerations, formed the basis for this modification. This entailed replacement of all six circulating water pumps and motors and physical modifications to the intake system. This paper details the methodology used in this engineering task. The new system was installed successfully and has been operating reliably and economically for the past eight years

  7. Can structural adjustment work for women farmers.

    Science.gov (United States)

    Mehra, R

    1991-12-01

    This article discusses the impact of structural adjustment programs (SAPs) on women farmers in developing countries. SAPs aim to improve economic efficiency and promote more rapid economic growth. SAPs are introduced in two phases. The first phase involves short-term loans with the condition that the country adopt monetary restraints and currency devaluation measures. In the second phase, long-term loans are given with the provision that the country deregulate their economy and open up markets. The agricultural sector is affected by SAPs because of their importance in employment, income generation, and export earnings. SAPs result in lower farm commodity prices due to currency devaluations and in removal of subsidies, which results in market-sensitive pricing or higher food prices. The impact of SAPs on agriculture vary between countries. In Morocco and Algeria, agriculture expanded under SAPs. In Indonesia, Bolivia, Costa Rica, and Mexico, the agriculture stagnated or declined. Agricultural growth was slowest in Africa. SAPs were somewhat successful in increasing agricultural exports. Food production grew slowly in many adjusting countries. Blame for failures of SAPs has been placed on government failure to implement reforms properly and overly optimistic assumptions about the timing of productive gains. Little attention has focused on the constraints facing women farmers, who are a large proportion of farmers, particularly in sub-Saharan Africa. This article focuses on the issues of limited access to resources, credit, agricultural extension and information, land ownership, education, and time as constraints to women farmers. Women also must ensure household food security. For SAPs to work effectively, complementary policies must be implemented that reallocate available productive resources and new technologies to women and that deal with women's constraints.

  8. Struggles over patriarchal structural adjustment in Tanzania.

    Science.gov (United States)

    Mbilinyi, M

    1993-10-01

    Within the space of 7 years (1986-93), structural adjustment policies have contributed to a reversal of the gains in economic development achieved in Tanzania in the 1960s and 1970s. Structural adjustment policies have helped large-scale producers and ordinary citizens but have led to a decline in social services which is reflected in drops in primary school enrollment and increases in medical costs. Government revenues are absorbed by foreign debt servicing. The reduction of support for social services has increased women's work; bolstered gender division of labor; and reduced women's access to education, formal employment, and health services. On the other hand, increased participation in market-oriented activities has increased women's mobility and exposure to modern ideas. This has led to changing gender relations which on the positive side can lead to shared decision-making but on the negative side may cause men to abdicate their familial responsibilities. Women suffer, however, from a lack of investment in ways to lighten their household responsibilities and have lost their ability to control food production because of the shift to cash crop production for export. The combination of hard work, low income, and stress has taken a toll on women's health, and both the maternal mortality rate and incidence of HIV infections among teenage girls has increased. In response to this situation, Tanzanian women have formed the Tanzania Gender Networking Programme (TGNP) which seeks to empower women and transform society through such activities as education and training, research, and lobbying and networking. Workshops sponsored by the TGNP have resulted in recommendations for adoption of a people-centered development strategy.

  9. Adjustment to Life with Lung Cancer.

    Science.gov (United States)

    Czerw, Aleksandra I; Religioni, Urszula; Deptała, Andrzej

    2016-01-01

    In Poland, lung cancer is the most common type of cancer in males (20% of all cases) and third most common type of cancer in females (9% of all cases), right behind breast and colorectal cancers. Recently, 28,000 new cases of lung cancer per year were reported in both genders. The objective of the study was to asses coping strategies, pain management, acceptance of illness and adjustment to cancer in patients diagnosed with pulmonary carcinoma and the effect of socioeconomic variables on the abovementioned issues. The study included 243 patients diagnosed with lung cancer during outpatient chemotherapy (classical chemotherapy and molecularly targeted therapies) at the Center of Oncology, Maria Skłodowska-Curie Institute in Warszawa. We applied the Paper and Pencil Interview (PAPI) technique. The questionnaire interview was composed of demographic questions and the following four psychometric tests: BPCQ measuring the influence of factors affecting pain management in patients, CSQ designed to evaluate pain coping strategies, AIS questionnaire, measuring disease acceptance, and the mini-Mac scale, assessing psychological adjustment to disease. The highest mean score recorded in the BPCQ was recorded in the powerful doctors subscale (16.79) and the lowest in the internal factors section (15.64). Education, professional status and income were the variables which differentiated the scores. We recorded the top average score in CSQ in the coping self statements subscale (mean = 19.64), and the lowest score in the reinterpreting pain sensations subscale (mean score = 10.32). The results of the test were differentiated by education and income. Patients had the highest Mini-MAC scale scores in the fighting spirit section (21.91). In the case of patients affected with lung cancer, education and professional status affect the way patients treat doctors in the disease process. These variables are also critical in patients' approach to disease and methods of coping with it.

  10. Relationship adjustment, depression, and anxiety during pregnancy and the postpartum period.

    Science.gov (United States)

    Whisman, Mark A; Davila, Joanne; Goodman, Sherryl H

    2011-06-01

    The associations between relationship adjustment and symptoms of depression and anxiety were evaluated in a sample of pregnant married or cohabiting women (N = 113) who were at risk for perinatal depression because of a prior history of major depression. Women completed self-report measures of relationship adjustment, depressive symptoms, and anxiety symptoms monthly during pregnancy and for the first six months following the birth of their child. Multilevel modeling was used to examine concurrent and time-lagged within-subjects effects for relationship adjustment and depressive and anxiety symptoms. Results revealed that (a) relationship adjustment was associated with both depressive symptoms and anxiety symptoms in concurrent analyses; (b) relationship adjustment was predictive of subsequent anxiety symptoms but not subsequent depressive symptoms in lagged analyses; and (c) depressive symptoms were predictive of subsequent relationship adjustment in lagged analyses with symptoms of depression and anxiety examined simultaneously. These results support the continued investigation into the cross-sectional and longitudinal associations between relationship functioning and depressive and anxiety symptoms in women during pregnancy and the postpartum period. 2011 APA, all rights reserved

  11. Child, parent and family factors as predictors of adjustment for siblings of children with a disability.

    Science.gov (United States)

    Giallo, R; Gavidia-Payne, S

    2006-12-01

    Siblings adjust to having a brother or sister with a disability in diverse ways. This study investigated a range of child, parent and family factors as predictors of sibling adjustment outcomes. Forty-nine siblings (aged 7-16 years) and parents provided information about (1) sibling daily hassles and uplifts; (2) sibling coping; (3) parent stress; (4) parenting; and (5) family resilience. Multiple regression techniques were used. It was found that parent and family factors were stronger predictors of sibling adjustment difficulties than siblings' own experiences of stress and coping. Specifically, socio-economic status, past attendance at a sibling support group, parent stress, family time and routines, family problem-solving and communication, and family hardiness-predicted sibling adjustment difficulties. Finally, siblings' perceived intensity of daily uplifts significantly predicted sibling prosocial behaviour. The results revealed that the family level of risk and resilience factors were better predictors of sibling adjustment than siblings' own experiences of stress and coping resources, highlighting the importance of familial and parental contributions to the sibling adjustment process. The implications of these results for the design of interventions and supports for siblings are discussed.

  12. Measuring Idiosyncratic Risk

    DEFF Research Database (Denmark)

    Sunesen, Eva Rytter

    This paper offers two refinements of the traditional risk measure based on the volatility of growth. First, we condition GDP growth on structural characteristics of the host country that move only slowly and therefore can be partly predicted by an investor. Second, we adjust conditional risk...... for the systematic components due to the global and regional interdependence between alternative investment locations. The decomposition of conditional risk into its systematic and idiosyncratic components reveals that not only are African countries on average characterised by a larger conditional risk than Asian...... and Latin American countries, but the idiosyncratic risk factor also represents a larger share than in other developing countries. As a final contribution, we search the empirical literature on foreign direct investment and risk in order to determine which of the suggested risk measures provide the best...

  13. Iraqi Refugee High School Students' Academic Adjustment

    Science.gov (United States)

    Bang, Hyeyoung

    2017-01-01

    Many Iraqi refugee students in the United States suffer from posttraumatic stress disorder (PTSD) as well as acculturation stresses. These stresses often create challenges for their integration into U.S. schools. The project explored risk factors such as the length of educational gaps in transit, PTSD, and separation and marginalization…

  14. Adjustable Robust Strategies for Flood Protection

    NARCIS (Netherlands)

    Postek, Krzysztof; den Hertog, Dick; Kind, J.; Pustjens, Chris

    2016-01-01

    Flood protection is of major importance to many flood-prone regions and involves substantial investment and maintenance costs. Modern flood risk management requires often to determine a cost-efficient protection strategy, i.e., one with lowest possible long run cost and satisfying flood protection

  15. Adjusting Futures Forecasts of Federal Reserve Policy

    DEFF Research Database (Denmark)

    Chun, Albert Lee; Chun, Olfa Maalaoui

    Our results challenge the traditional way we interpret empirical measures of risk premia, as a signicant part of the predictable component of excess returns is strongly correlated with predictability in survey forecast errors. Using survey forecasts of the federal funds rate to proxy for market e...

  16. 75 FR 33379 - Railroad Cost Recovery Procedures-Productivity Adjustment; Quarterly Rail Cost Adjustment Factor

    Science.gov (United States)

    2010-06-11

    ... information is contained in the Board's June 14, 2010 decision, which is available on our website at http://www.stb.dot.gov . Copies of the decision may be purchased by contacting the office of Public... Cost Adjustment Factor AGENCY: Surface Transportation Board. [[Page 33380

  17. The application of the Ten Group classification system (TGCS in caesarean delivery case mix adjustment. A multicenter prospective study.

    Directory of Open Access Journals (Sweden)

    Gianpaolo Maso

    Full Text Available BACKGROUND: Caesarean delivery (CD rates are commonly used as an indicator of quality in obstetric care and risk adjustment evaluation is recommended to assess inter-institutional variations. The aim of this study was to evaluate whether the Ten Group classification system (TGCS can be used in case-mix adjustment. METHODS: Standardized data on 15,255 deliveries from 11 different regional centers were prospectively collected. Crude Risk Ratios of CDs were calculated for each center. Two multiple logistic regression models were herein considered by using: Model 1- maternal (age, Body Mass Index, obstetric variables (gestational age, fetal presentation, single or multiple, previous scar, parity, neonatal birth weight and presence of risk factors; Model 2- TGCS either with or without maternal characteristics and presence of risk factors. Receiver Operating Characteristic (ROC curves of the multivariate logistic regression analyses were used to assess the diagnostic accuracy of each model. The null hypothesis that Areas under ROC Curve (AUC were not different from each other was verified with a Chi Square test and post hoc pairwise comparisons by using a Bonferroni correction. RESULTS: Crude evaluation of CD rates showed all centers had significantly higher Risk Ratios than the referent. Both multiple logistic regression models reduced these variations. However the two methods ranked institutions differently: model 1 and model 2 (adjusted for TGCS identified respectively nine and eight centers with significantly higher CD rates than the referent with slightly different AUCs (0.8758 and 0.8929 respectively. In the adjusted model for TGCS and maternal characteristics/presence of risk factors, three centers had CD rates similar to the referent with the best AUC (0.9024. CONCLUSIONS: The TGCS might be considered as a reliable variable to adjust CD rates. The addition of maternal characteristics and risk factors to TGCS substantially increase the

  18. 19 CFR 351.413 - Disregarding insignificant adjustments.

    Science.gov (United States)

    2010-04-01

    ... COUNTERVAILING DUTIES Calculation of Export Price, Constructed Export Price, Fair Value, and Normal Value § 351..., constructed export price, or normal value, as the case may be. Groups of adjustments are adjustments for...

  19. Primal and dual approaches to adjustable robust optimization

    NARCIS (Netherlands)

    de Ruiter, Frans

    2018-01-01

    Robust optimization has become an important paradigm to deal with optimization under uncertainty. Adjustable robust optimization is an extension that deals with multistage problems. This thesis starts with a short but comprehensive introduction to adjustable robust optimization. Then the two

  20. Growth Control by Ethylene: Adjusting Phenotypes to the Environment

    NARCIS (Netherlands)

    Pierik, R.; Sasidharan, R.; Voesenek, L.A.C.J.

    2007-01-01

    Plants phenotypically adjust to environmental challenges, and the gaseous plant hormone ethylene modulates many of these growth adjustments. Ethylene can be involved in environmentally induced growth inhibition as well as growth stimulation. Still, ethylene has long been considered a growth

  1. 75 FR 23227 - Trade Adjustment Assistance for Farmers

    Science.gov (United States)

    2010-05-03

    ... DEPARTMENT OF AGRICULTURE Foreign Agricultural Service Trade Adjustment Assistance for Farmers AGENCY: Foreign Agricultural Service, USDA. ACTION: Notice. The Administrator, Foreign Agricultural... be obtained at the Web site for the Trade Adjustment Assistance for Farmers program. The URL is http...

  2. 77 FR 17121 - Quarterly Rail Cost Adjustment Factor

    Science.gov (United States)

    2012-03-23

    ... decision may be purchased by contacting the Office of Public Assistance, Governmental Affairs, and...)] Quarterly Rail Cost Adjustment Factor AGENCY: Surface Transportation Board, Department of Transportation. ACTION: Approval of rail cost adjustment factor. [[Page 17122

  3. Parental Divorce during Adolescence and Adjustment in Early Adulthood.

    Science.gov (United States)

    Richardson, Stacey; McCabe, Marita P.

    2001-01-01

    Examined the impact of parental divorce during adolescence, interparental conflict, and intimacy with parents on young adult adjustment. High levels of interparental conflict were found to be negatively associated with adjustment and current intimacy of parents. (Author)

  4. A properly adjusted forage harvester can save time and money

    Science.gov (United States)

    A properly adjusted forage harvester can save fuel and increase the realizable milk per ton of your silage. This article details the adjustments necessary to minimize energy while maximizing productivity and forage quality....

  5. Capacity Adjustment through Contingent Staffing Outsourcing

    OpenAIRE

    Neubert , Gilles; Adjadj , Philippe

    2009-01-01

    International audience; For a long time, contingent staffing was considered as the responsability of the Human Resource department. The high needs of workforce flexibility combined with disseminated agencies have led some companies to a great number of labor suppliers. This situation has produced important cost variation, poor quality of service, and important risk due to the mistunderstanding by local managers of legal considerations. To face this situation, companies have started to move fr...

  6. 42 CFR 413.231 - Adjustment for wages.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Adjustment for wages. 413.231 Section 413.231... Disease (ESRD) Services and Organ Procurement Costs § 413.231 Adjustment for wages. (a) CMS adjusts the labor-related portion of the base rate to account for geographic differences in the area wage levels...

  7. 8 CFR 1209.1 - Adjustment of status of refugees.

    Science.gov (United States)

    2010-01-01

    ... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Adjustment of status of refugees. 1209.1... IMMIGRATION REGULATIONS ADJUSTMENT OF STATUS OF REFUGEES AND ALIENS GRANTED ASYLUM § 1209.1 Adjustment of status of refugees. The provisions of this section shall provide the sole and exclusive procedure for...

  8. 8 CFR 209.1 - Adjustment of status of refugees.

    Science.gov (United States)

    2010-01-01

    ... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Adjustment of status of refugees. 209.1... STATUS OF REFUGEES AND ALIENS GRANTED ASYLUM § 209.1 Adjustment of status of refugees. The provisions of this section shall provide the sole and exclusive procedure for adjustment of status by a refugee...

  9. Language Ability and Adjustment: Western Expatriates in China

    DEFF Research Database (Denmark)

    Selmer, Jan

    2006-01-01

    was directed to Western business expatriates assigned to China. Controlling for the time expatriates had spent in China, results showed that their language ability had a positive association with their sociocultural adjustment. Not surprisingly, this positive relationship was strongest for interaction...... adjustment and weakest for work adjustment. The straightforward implications of these clear findings are discussed in detail....

  10. 77 FR 58910 - Quarterly Rail Cost Adjustment Factor

    Science.gov (United States)

    2012-09-24

    ..., http://www.stb.dot.gov . Copies of the decision may be purchased by contacting the Office of Public...)] Quarterly Rail Cost Adjustment Factor AGENCY: Surface Transportation Board. ACTION: Approval of rail cost adjustment factor. SUMMARY: The Board has approved the fourth quarter 2012 rail cost adjustment factor (RCAF...

  11. 76 FR 37191 - Quarterly Rail Cost Adjustment Factor

    Science.gov (United States)

    2011-06-24

    ... our Web site, http://www.stb.dot.gov . Copies of the decision may be purchased by contacting the...)] Quarterly Rail Cost Adjustment Factor AGENCY: Surface Transportation Board, DOT. ACTION: Approval of rail cost adjustment factor. SUMMARY: The Board has approved the third quarter 2011 Rail Cost Adjustment...

  12. 75 FR 80895 - Quarterly Rail Cost Adjustment Factor

    Science.gov (United States)

    2010-12-23

    ..., http://www.stb.dot.gov . Copies of the decision may be purchased by contacting the Office of Public...)] Quarterly Rail Cost Adjustment Factor AGENCY: Surface Transportation Board, DOT. ACTION: Approval of rail cost adjustment factor. SUMMARY: The Board has approved the first quarter 2011 Rail Cost Adjustment...

  13. 77 FR 37958 - Quarterly Rail Cost Adjustment Factor

    Science.gov (United States)

    2012-06-25

    ..., http://www.stb.dot.gov . Copies of the decision may be purchased by contacting the Office of Public...)] Quarterly Rail Cost Adjustment Factor AGENCY: Surface Transportation Board, DOT. ACTION: Approval of rail cost adjustment factor. SUMMARY: The Board has approved the third quarter 2012 rail cost adjustment...

  14. 78 FR 37660 - Quarterly Rail Cost Adjustment Factor

    Science.gov (United States)

    2013-06-21

    ..., http://www.stb.dot.gov . Copies of the decision may be purchased by contacting the Office of Public...)] Quarterly Rail Cost Adjustment Factor AGENCY: Surface Transportation Board, DOT. ACTION: Approval of rail cost adjustment factor. SUMMARY: The Board approves the third quarter 2013 Rail Cost Adjustment Factor...

  15. 78 FR 17764 - Quarterly Rail Cost Adjustment Factor

    Science.gov (United States)

    2013-03-22

    ..., http://www.stb.dot.gov . Copies of the decision may be purchased by contacting the Office of Public...)] Quarterly Rail Cost Adjustment Factor AGENCY: Surface Transportation Board, DOT. ACTION: Approval of rail cost adjustment factor. SUMMARY: The Board has approved the second quarter 2013 Rail Cost Adjustment...

  16. 76 FR 59483 - Quarterly Rail Cost Adjustment Factor

    Science.gov (United States)

    2011-09-26

    ... the decision may be purchased by contacting the Office of Public Assistance, Governmental Affairs, and...)] Quarterly Rail Cost Adjustment Factor AGENCY: Surface Transportation Board, DOT. ACTION: Approval of rail cost adjustment factor. SUMMARY: The Board has approved the fourth quarter 2011 Rail Cost Adjustment...

  17. 76 FR 16037 - Quarterly Rail Cost Adjustment Factor

    Science.gov (United States)

    2011-03-22

    ..., http://www.stb.dot.gov . Copies of the decision may be purchased by contacting the Office of Public...)] Quarterly Rail Cost Adjustment Factor AGENCY: Surface Transportation Board, DOT. ACTION: Approval of rail cost adjustment factor. SUMMARY: The Board has approved the second quarter 2011 Rail Cost Adjustment...

  18. 75 FR 58019 - Quarterly Rail Cost Adjustment Factor

    Science.gov (United States)

    2010-09-23

    ..., http://www.stb.dot.gov . Copies of the decision may be purchased by contacting the office of Public...)] Quarterly Rail Cost Adjustment Factor AGENCY: Surface Transportation Board, DOT. ACTION: Approval of rail cost adjustment factor. SUMMARY: The Board has approved the fourth quarter 2010 Rail Cost Adjustment...

  19. 75 FR 16575 - Railroad Cost Recovery Procedures-Productivity Adjustment

    Science.gov (United States)

    2010-04-01

    ...)] Railroad Cost Recovery Procedures--Productivity Adjustment AGENCY: Surface Transportation Board. ACTION: Adoption of a railroad cost recovery procedures productivity adjustment. SUMMARY: By decision served on February 1, 2010, the Board proposed to adopt 1.010 (1.0% per year) as the 2008 productivity adjustment, as...

  20. 77 FR 65100 - Adjustment of Civil Monetary Penalties for Inflation

    Science.gov (United States)

    2012-10-25

    ... Penalties for Inflation AGENCY: Commodity Futures Trading Commission ACTION: Final rule. SUMMARY: The... civil monetary penalties, to adjust for inflation. This rule sets forth the maximum, inflation-adjusted... Federal Civil Penalties Inflation Adjustment Act of 1990, as amended by the Debt Collection Improvement...