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Selected AbstractsAlgorithm for Spatial Clustering of Pavement SegmentsCOMPUTER-AIDED CIVIL AND INFRASTRUCTURE ENGINEERING, Issue 2 2009Chientai Yang This article formulates a new spatial search model for determining appropriate pavement preservation project termini. A spatial clustering algorithm using fuzzy c-mean clustering is developed to minimize the rating variation in each cluster (project) of pavement segments while considering minimal project scope (i.e., length) and cost, initial setup cost, and barriers, such as bridges. A case study using the actual roadway and pavement condition data in fiscal year 2005 on Georgia State Route 10 shows that the proposed algorithm can identify more appropriate segment clustering scheme, than the historical project termini. The benefits of using the developed algorithm are summarized, and recommendations for future research are discussed. [source] Managing Stock Option Expense: The Manipulation of Option-Pricing Model Assumptions,CONTEMPORARY ACCOUNTING RESEARCH, Issue 2 2006Derek Johnston Abstract This paper examines whether firms that voluntarily recognize stock option expense in their financial statements manage that expense downward more than firms that do not recognize the expense by adjusting option-pricing model assumptions. To examine this issue, I collect option-pricing model assumptions from fiscal year 2002 for both a sample of firms that voluntarily recognize stock option expense ("recognizing firms") and a sample of control firms that do not ("disclosing firms"). The empirical results suggest that recognizing firms manage the recognized stock-based compensation expense reported in their financial statements downward more than do firms that only disclose the expense. Additional analyses reveal that recognizing firms assume a lower level of volatility than disclosing firms in the option-pricing model calculations; however, I find no evidence that recognizing firms manage the dividend yield and risk-free interest rate assumptions more than disclosing firms. The Financial Accounting Standards Board (FASB) recently issued Statement of Financial Accounting Standards No. 123(R), which requires the expensing of the fair value of stock options, so these results may be of interest to capital-market participants and the FASB as they assess the reliability of stock option expense as determined by option-pricing models. [source] Predictors of injury-related and non-injury-related mortality among veterans with alcohol use disordersADDICTION, Issue 10 2010Sylwia Fudalej ABSTRACT Aims To describe the association between alcohol use disorders (AUDs) and mortality and to examine risk factors for and all-cause, injury-related and non-injury-related mortality among those diagnosed with an AUD. Setting Department of Veterans Affairs, Veterans Health Administration (VHA). Participants A cohort of individuals who received health care in VHA during the fiscal year (FY) 2001 (n = 3 944 778), followed from the beginning of FY02 through the end of FY06. Measurements Demographics and medical diagnoses were obtained from VHA records. Data on mortality were obtained from the National Death Index. Findings Controlling for age, gender and race and compared to those without AUDs, individuals with AUDs were more likely to die by all causes [hazard ratio (HR) = 2.30], by injury-related (HR = 3.29) and by non-injury-related causes (HR = 2.21). Patients with AUDs died 15 years earlier than individuals without AUDs on average. Among those with AUDs, Caucasian ethnicity and all mental illness diagnoses that were assessed were associated more strongly with injury-related than non-injury-related mortality. Also among those with AUDs, individuals with medical comorbidity and older age were at higher risk for non-injury related compared to injury-related mortality. Conclusions In users of a large health-care system, a diagnosis of an AUD is associated significantly with increased likelihood of dying by injury and non-injury causes. Patients with a diagnosis of an AUD who die from injury differ significantly from those who die from other medical conditions. Prevention and intervention programs could focus separately upon selected groups with increased risk for injury or non-injury-related death. [source] Assessing the Fiscal Costs and Benefits of A8 Migration to the UK,FISCAL STUDIES, Issue 1 2010Christian Dustmann J61; H20 Abstract This paper assesses the fiscal consequences of migration to the UK from the Central and Eastern European countries that joined the European Union in May 2004 (A8 countries). We show that A8 immigrants who arrived after EU enlargement in 2004 and who have at least one year of residence, and are therefore legally eligible to claim benefits, are 59 per cent less likely than natives to receive state benefits or tax credits and 57 per cent less likely to live in social housing. Furthermore, even if A8 immigrants had the same demographic characteristics as natives, they would still be 13 per cent less likely to receive benefits and 29 per cent less likely to live in social housing. We go on to compare the net fiscal contribution of A8 immigrants with that of individuals born in the UK, and find that in each fiscal year since enlargement in 2004, irrespective of the way that the net fiscal contribution is defined, A8 immigrants made a positive contribution to the public finances despite the fact that the UK has been running a budget deficit over the last few years. This is because they have a higher labour force participation rate, pay proportionately more in indirect taxes and make much less use of benefits and public services. [source] Case-Mix Adjusting Performance Measures in a Veteran Population: Pharmacy- and Diagnosis-Based ApproachesHEALTH SERVICES RESEARCH, Issue 5 2003Chuan-Fen Liu Objective. To compare the rankings for health care utilization performance measures at the facility level in a Veterans Health Administration (VHA) health care delivery network using pharmacy- and diagnosis-based case-mix adjustment measures. Data Sources/Study Setting. The study included veterans who used inpatient or outpatient services in Veterans Integrated Service Network (VISN) 20 during fiscal year 1998 (October 1997 to September 1998; N=126,076). Utilization and pharmacy data were extracted from VHA national databases and the VISN 20 data warehouse. Study Design. We estimated concurrent regression models using pharmacy or diagnosis information in the base year (FY1998) to predict health service utilization in the same year. Utilization measures included bed days of care for inpatient care and provider visits for outpatient care. Principal Findings. Rankings of predicted utilization measures across facilities vary by case-mix adjustment measure. There is greater consistency within the diagnosis-based models than between the diagnosis- and pharmacy-based models. The eight facilities were ranked differently by the diagnosis- and pharmacy-based models. Conclusions. Choice of case-mix adjustment measure affects rankings of facilities on performance measures, raising concerns about the validity of profiling practices. Differences in rankings may reflect differences in comparability of data capture across facilities between pharmacy and diagnosis data sources, and unstable estimates due to small numbers of patients in a facility. [source] Guidelines for the treatment of chronic hepatitis and cirrhosis due to hepatitis B virus infection for the fiscal year 2008 in JapanHEPATOLOGY RESEARCH, Issue 1 2010Hiromitsu Kumada In the 2008 guidelines for the treatment of patients with cirrhosis, who are infected with hepatitis B virus (HBV), the main goal is to normalize levels of alanine and aspartate aminotransferases by eliminating HBV or reducing viral loads. In patients with compensated cirrhosis, the clearance of HBV from serum is aimed for by entecavir, as the main resort, for histological improvement toward the prevention of hepatocellular carcinoma (HCC). In patients with decompensated cirrhosis, by contrast, meticulous therapeutic strategies are adopted for the reversal to compensation, toward the eventual goal of decreasing the risk of HCC. For maintaining liver function and preventing HCC, branched chain amino acids and nutrient supplements are applied, in addition to conventional liver supportive therapies. For patients with chronic hepatitis B, separate guidelines are applied to those younger than 35 years and those aged 35 years or older. Even for patients with chronic hepatitis who are negative for hepatitis e antigen (HBeAg), but who harbor HBV DNA in titers of 7 log copies/mL or more, a "drug-free state" is aimed for by sequential treatment with interferon (IFN) plus entecavir as the first line. For patients with chronic hepatitis B aged 35 years or older, who are HBeAg-negative and carry HBV DNA in titers of less than 7 log copies/mL, long-term IFN for 24,48 weeks is adopted anew. To HBeAg-negative patients who have either or both platelet counts of less than 150 × 103/mm3 and less than 7 log copies of HBV DNA, also, long-term IFN for 24,48 weeks is indicated. [source] Guidelines for the treatment of chronic hepatitis and cirrhosis due to hepatitis C virus infection for the fiscal year 2008 in JapanHEPATOLOGY RESEARCH, Issue 1 2010Hiromitsu Kumada In the 2008 guidelines for the treatment of patients with chronic hepatitis C, pegylated interferon (Peg-IFN) combined with ribavirin for 48 weeks are indicated for treatment-naive patients infected with hepatitis C virus (HCV) of genotype 1. Treatment is continued for an additional 24 weeks (72 weeks total) in the patients who have remained positive for HCV RNA detectable by the real-time polymerase chain reaction at 12 weeks after the start of treatment, but who turn negative for HCV RNA during 13,36 weeks on treatment. Re-treatment is aimed to either eradicate HCV or normalize transaminase levels for preventing the development of hepatocellular carcinoma (HCC). For patients with compensated cirrhosis, the clearance of HCV RNA is aimed toward improving histological damages and decreasing the development of HCC. The recommended therapeutic regimen is the initial daily dose of 6 million international units (MIU) IFN continued for 2,8 weeks that is extended to longer than 48 weeks, if possible. IFN dose is reduced to 3 MIU daily in patients who fail to clear HCV RNA by 12 weeks for preventing the development of HCC. Splenectomy or embolization of the splenic artery is recommended to patients with platelet counts of less than 50 × 103/mm3 prior to the commencement of IFN treatment. When the prevention of HCC is at issue, not only IFN, but also liver supportive therapy such as stronger neo-minophagen C, ursodeoxycholic acid, phlebotomy, branched chain amino acids (BCAA), either alone or in combination, are given. In patients with decompensated cirrhosis, by contrast, reversal to compensation is attempted. [source] Costs of community-based public mental health services for older adults: variations related to age and diagnosisINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 12 2006Todd Gilmer Abstract Background Several studies have examined service use among older adults although, to our knowledge, none has examined costs from a systems perspective. This study examined use and costs of mental health services among older adults in San Diego County in order to determine how expenditures and modes of service varied by age cohort and psychiatric diagnosis. Methods Utilization data from San Diego County Adult and Older Adult Mental Health Services (AOAMHS) were used to identify older adults (age,,,60) receiving services in the community during fiscal year 2003,2004. Cost data were derived from detailed examination of cost reports, and Medicaid fee schedules. Trends in demographic and clinical characteristics by six age cohorts were described. Multivariate models were used to estimate the relationships between costs, age, and clinical diagnosis while controlling for other demographic and clinical characteristics. Components of costs were also examined. Results Total expenditures declined from age cohorts 60,64 through ages 85 and over. Expenditures were similar, and greatest, for clients with schizophrenia and bipolar disorder, while outlays were lower for those with major depression, other psychotic disorder, other depression, anxiety, substance use disorder, and cognitive disorders. Clients diagnosed with cognitive disorder had high use of emergency services and little connection to outpatient services. Conclusions Expenditures were related to age and clinical diagnosis. Future efforts should investigate older adults' pathways to care, and should determine whether older adults presenting in emergency services would benefit from a specialized case management program providing linkages to community based resources. Copyright © 2006 John Wiley & Sons, Ltd. [source] Administrative claims data analysis of nurse practitioner prescribing for older adultsJOURNAL OF ADVANCED NURSING, Issue 10 2009Andrea L. Murphy Abstract Title.,Administrative claims data analysis of nurse practitioner prescribing for older adults. Aim., This paper is a report of a study to identify the patterns of prescribing by primary health care nurse practitioners for a cohort of older adults. Background., The older adult population is known to receive complex pharmacotherapy. Monitoring prescribing to older adults can inform quality improvement initiatives. In comparison to other countries, research examining nurse practitioner prescribing in Canada is limited. Nurse practitioner prescribing for older adults is relatively unexplored in the international literature. Although commonly used to study physician prescribing, few studies have used claims data from drug insurance programmes to investigate nurse practitioner prescribing. Method., Drug claims for prescriptions written by nurse practitioners from fiscal years 2004/05 to 2006/07 for beneficiaries of the Nova Scotia Seniors' Pharmacare programme were analysed. Data were retrieved and analysed in May 2008. Prescribing was described for each drug using the World Health Organization Anatomical Therapeutic Chemical code classification system by usage and costs for each fiscal year. Results., Antimicrobials and non-steroidal anti-inflammatory drugs consistently represented the top ranked groups for prescription volume and cost. Over the three fiscal years, antimicrobial prescription rates declined relative to rates of other groups of medications. Prescription volume per nurse doubled and cost per prescription increased by approximately 20%. Conclusion., Prescription claims data can be used to characterize the prescribing trends of nurse practitioners. Research linking patient characteristics, including diagnoses, to prescriptions is needed to assess prescribing quality. Some potential areas of improvement were identified with antimicrobial and non-steroidal anti-inflammatory selection. [source] A ,Catch Up' Plan for radiotherapy in New South Wales to 2012JOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 4 2009Graeme Morgan Summary In New South Wales (NSW) from 1996 to 2006, only 34,37% of newly diagnosed cancer patients were treated with radiotherapy instead of the 50% proposed by NSW Health in Radiotherapy Plans released in 1991, 1995 and 2003. As a consequence, over 50 000 cancer patients were not treated and has resulted in the estimated premature death of over 8000 patients and over 40 000 years of life lost. In 2008, there were 42 linear accelerators in NSW rather than the 62 recommended. Based on cancer incidence projections, NSW will require 69 linear accelerators in 2012 , a shortfall of 27 linear accelerators. Already 15 linear accelerators have been approved. NSW Health has funding for seven extra linear accelerators, and eight extra linear accelerators are to be funded by the private sector. To make up the shortfall, a ,Catch Up' Plan is proposed for an additional 12 linear accelerators by the end of fiscal year 2012. This is estimated to cost $200 million over 4 years for one-off establishment costs for buildings and equipment plus $50 million per year for recurrent operating costs such as staff salaries. The ,Catch Up' Plan will create five new departments of radiation oncology in country hospitals and three new departments in metropolitan hospitals. These will be in addition to those already approved by NSW Health and will markedly improve access for treatment and result in an improvement in cancer survival. This significant increase in departments and equipment can only be achieved by the creation of an NSW Radiotherapy Taskforce similar to that proposed in the Baume report of 2002, ,A vision for radiotherapy'. Even if the ,Catch Up' Plan bridges the gap in service provision, forward planning beyond 2012 should commence immediately as 76 linear accelerators will be required for NSW in 2015 and 81 linear accelerators in 2017. [source] Prudential Regulation and the "Credit Crunch": Evidence from JapanJOURNAL OF MONEY, CREDIT AND BANKING, Issue 2-3 2007WAKO WATANABE credit crunch; capital crunch; prudential regulation; instrumental variable The underlying causes of sharp declines in bank lending during recessions in large developed economies, as exemplified by the U.S. in the early 1990s and Japan in the late 1990s, are still being debated due to the lack of any convincing identification strategy of the supply side capital,lending relationship from lending demand. Using within bank share of real estate lending in the late 1980s as an instrumental variable for bank capital, we find that Japanese banks cut back on their lending in response to a large loss of bank capital in fiscal year 1997. [source] Unit cost of Mohs and Dermasurgery UnitJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 4 2010R Wanitphakdeedecha Abstract Background, Appropriate pricing for medical services of not-for-profit hospital is necessary. The prices should be fair to the public and should be high enough to cover the operative costs of the organization. Objective, The purpose of this study was to determine the cost and unit cost of medical services performed at the Mohs and Dermasurgery Unit (MDU), Department of Dermatology, The University of Texas , MD Anderson Cancer Center, Houston, TX from the healthcare provider's perspective. Methods, MDU costs were retrieved from the Financial Department for fiscal year 2006. The patients' statistics were acquired from medical records for the same period. Unit cost calculation was based on the official method of hospital accounting. Results, The overall unit cost for each patient visit was $673.99 United States dollar (USD). The detailed unit cost of nurse visit, new patient visit, follow-up visit, consultation, Mohs and non-Mohs procedure were, respectively, $368.27, $580.09, $477.82, $585.52, $1,086.12 and $858.23 USD. With respect to a Mohs visit, the unit cost per lesion and unit cost per stage were $867.89 and $242.30 USD respectively. Conclusions, Results from this retrospective study provide information that may be used for pricing strategy and resource allocation by the administrative board of MDU. [source] Usefulness of prescription monitoring programs for surveillance,analysis of Schedule II opioid prescription data in Massachusetts, 1996,2006,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 2 2010Nathaniel Katz Abstract Purpose Electronic prescription monitoring programs (PMPs) have been developed in many states as a public health surveillance tool. We analyze herein 11 years of Massachusetts PMP data to evaluate trends in opioid prescribing, dispensing, and usage. Methods Prescription records from the Massachusetts PMP for Schedule II opioids from fiscal year 1996 to 2006 were analyzed. ,Questionable activity' (potential ,doctor shopping') estimates were based on individual use of multiple prescribers and pharmacies, and early refills. Results The number of prescriptions, doses prescribed, and individuals receiving Schedule II prescription opioids steadily increased from 1996 to 2006. Most individuals (87.5%) used 1,2 prescribers, 1,2 pharmacies, and had no early refills (2006). The greater the number of prescribers used, the greater the number of pharmacies used. When defined as the use of ,4 prescribers and ,4 pharmacies, questionable activity accounted for 2748 individuals, 47,953 prescriptions, and 2,966,056 doses (2006). The Schedule II opioid most highly associated with questionable activity was short-acting oxycodone. Conclusions PMPs can become a useful public health surveillance tool to monitor the medical and non-medical use of prescription opioids and to inform public health and safety policy. Copyright © 2009 John Wiley & Sons, Ltd. [source] Does Performance Budgeting Work?PUBLIC ADMINISTRATION REVIEW, Issue 5 2006An Examination of the Office of Management, Budget's PART Scores In this paper, the authors use the Bush administration's management grades from the Program Assessment Rating Tool (PART) to evaluate performance budgeting in the federal government,in particular, the role of merit and political considerations in formulating recommendations for 234 programs in the president's fiscal year 2004 budget. PART scores and political support were found to influence budget choices in expected ways, and the impact of management scores on budget decisions diminished as the political component was taken into account. The Bush administration's management scores were positively correlated with proposed budgets for programs housed in traditionally Democratic departments but not in other departments. The federal government's most ambitious effort to use performance budgeting to date shows both the promise and the problems of this endeavor. [source] Putting the Brakes on the Rush to Spend Down End-of-Year Balances: Carryover Money in Oklahoma State AgenciesPUBLIC BUDGETING AND FINANCE, Issue 3 2006JAMES W. DOUGLAS End-of-the-year spending sprees by government agencies are viewed generally as an example of government wastefulness. Agency personnel, however, rationalize the practice as a means for protecting their budgets from inexpedient cuts. In Oklahoma, a policy has been adopted that allows agencies to carry over and reprogram year-end surpluses as long as the reprogrammed funds are spent within 16.5 months of the end of the fiscal year. Using agency theory as a theoretical lens, we show that this policy restructures the contract between the principal (legislature) and its agents (state agencies) so that their interests are better aligned, regarding end-of-the-year surpluses. [source] Budgeting during a Recession Phase of the Business Cycle: The Georgia ExperiencePUBLIC BUDGETING AND FINANCE, Issue 2 2003Thomas P. Lauth This article describes the impact of the nation-wide recession on Georgia revenue and spending decisions in the 2002 and 2003 fiscal years. The state's strong economy and conservative revenue estimating practices historically provided a hedge against revenue shortfalls during a recession phase of the business cycle. However, when state revenue collections for FY 2002 were 5 percent less than collections for the prior fiscal year, several gap-closing measures became necessary, including state agency spending reductions and substitution of bond proceeds for tax revenues. These revenue and expenditure gap-closing measures were intended to enable the governor to achieve his policy initiatives while maintaining a balanced budget. The state's Rainy Day Fund remained full and was held in reserve for budget balancing in FY 2004, if necessary. Budget balancing during the current recession has been made possible by the state's practice of not overcommitting to program increases and tax cuts during the expansion phase of the business cycle, and by effectively framing the issue of fiscal restraint. [source] Giving the People What They Want?AMERICAN JOURNAL OF POLITICAL SCIENCE, Issue 2 2010The Distribution of Earmarks in the U.S. House of Representatives The common wisdom in journalistic accounts of earmarking is that Congress distributes earmarks on a purely political basis, without any consideration for the demand for federal spending. Academic accounts similarly argue that factors internal to Congress are preeminent in determining where earmarks go, even more than for other types of pork-barrel spending. Using earmarks appearing in the fiscal year 2008 Appropriations bills, I search for both chamber-based and demand-side determinants of the distribution of earmarks. I find that both types of factors are significantly related to the number of earmarks that a House member receives. This result indicates that even while earmarking, members of Congress are at least minimally responsive to voter preferences and calls into question whether earmarks should be treated as an outlier within the universe of spending allocation mechanisms. [source] Corporate Financial Policy and the Value of CashTHE JOURNAL OF FINANCE, Issue 4 2006MICHAEL FAULKENDER ABSTRACT We examine the cross-sectional variation in the marginal value of corporate cash holdings that arises from differences in corporate financial policy. We begin by providing semi-quantitative predictions for the value of an extra dollar of cash depending upon the likely use of that dollar, and derive a set of intuitive hypotheses to test empirically. By examining the variation in excess stock returns over the fiscal year, we find that the marginal value of cash declines with larger cash holdings, higher leverage, better access to capital markets, and as firms choose greater cash distribution via dividends rather than repurchases. [source] Financial Impact of Emergency Department UltrasoundACADEMIC EMERGENCY MEDICINE, Issue 7 2009Olanrewaju A. Soremekun MD Abstract Objectives:, There is limited information on the financial implications of an emergency department ultrasound (ED US) program. The authors sought to perform a fiscal analysis of an integrated ED US program. Methods:, A retrospective review of billing data was performed for fiscal year (FY) 2007 for an urban academic ED with an ED US program. The ED had an annual census of 80,000 visits and 1,101 ED trauma activations. The ED is a core teaching site for a 4-year emergency medicine (EM) residency, has 35 faculty members, and has 24-hour availability of all radiology services including formal US. ED US is utilized as part of evaluation of all trauma activations and for ED procedures. As actual billing charges and reimbursement rates are institution-specific and proprietary information, relative value units (RVUs) and reimbursement based on the Centers for Medicare & Medicaid Services (CMS) 2007 fee schedule (adjusted for fixed diagnosis-related group [DRG] payments and bad debt) was used to determine revenue generated from ED US. To estimate potential volume, assumptions were made on improvement in documentation rate for diagnostic scans (current documentation rates based on billed volume versus diagnostic studies in diagnostic image database), with no improvements assumed for procedural ED US. Expenses consist of three components,capital costs, training costs, and ongoing operational costs,and were determined by institutional experience. Training costs were considered sunken expenses by this institution and were thus not included in the original return on investment (ROI) calculation, although for this article a second ROI calculation was done with training cost estimates included. For the purposes of analysis, certain key assumptions were made. We utilized a collection rate of 45% and hospitalization rates (used to adjust for fixed DRG payments) of 33% for all diagnostic scans, 100% for vascular access, and 10% for needle placement. An optimal documentation rate of 95% was used to estimate potential revenue. Results:, In FY 2007, 486 limited echo exams of abdomen (current procedural terminology [CPT] 76705) and 480 limited echo cardiac exams were performed (CPT 93308) while there were 78 exams for US-guided vascular access (CPT 76937) and 36 US-guided needle placements when performing paracentesis, thoracentesis, or location of abscess for drainage (CPT 76492). Applying the 2007 CMS fee schedule and above assumptions, the revenue generated was 578 RVUs and $35,541 ($12,934 in professional physician fees and $22,607 in facility fees). Assuming optimal documentation rates for diagnostic ED US scans, ED US could have generated 1,487 RVUs and $94,593 ($33,953 in professional physician fees and $60,640 in facility fees). Program expenses include an initial capital expense (estimated at $120,000 for two US machines) and ongoing operational costs ($68,640 per year to cover image quality assurance review, continuing education, and program maintenance). Based on current revenue, there would be an annual operating loss, and thus an ROI cannot be calculated. However, if potential revenue is achieved, the annual operating income will be $22,846 per year with an ROI of 4.9 years to break even with initial investment. Conclusions:, Determining an ROI is a required procedure for any business plan for establishing an ED US program. Our analysis demonstrates that an ED US program that captures charges for trauma and procedural US and achieves the potential billing volume breaks even in less than 5 years, at which point it would generate a positive margin. [source] Nutrition and exercise behavior among patients with bipolar disorder,BIPOLAR DISORDERS, Issue 5 2007Amy M Kilbourne Objectives:, There have been few comprehensive studies of nutrition and exercise behaviors among patients with bipolar disorder (BPD). Based on a national sample of patients receiving care in the Veterans Affairs (VA) health care system, we compared nutrition and exercise behaviors among individuals diagnosed with BPD, others diagnosed with schizophrenia, and others who did not receive diagnoses of serious mental illness (SMI). Methods:, We conducted a cross-sectional study of patients who completed the VA's Large Health Survey of Veteran Enrollees section on health and nutrition in fiscal year (FY) 1999 and who either received a diagnosis of BPD (n = 2,032) or schizophrenia (n = 1,895), or were included in a random sample of non-SMI VA patients (n = 3,065). We compared nutrition and exercise behaviors using multivariable logistic regression, controlling for patient socio-economic and clinical factors, and adjusting for patients clustered by site using generalized estimating equations. Results:, Patients with BPD were more likely to report poor exercise habits, including infrequent walking (odds ratio, OR = 1.33, p < 0.001) or strength exercises (OR = 1.28, p < 0.001) than those with no SMI. They were also more likely to self-report suboptimal eating behaviors, including having fewer than two daily meals (OR = 1.32, p < 0.001) and having difficulty obtaining or cooking food (OR = 1.48, p < 0.001). Patients with BPD were also more likely to report having gained ,10 pounds in the past 6 months (OR = 1.59, p < 0.001) and were the least likely to report that their health care provider discussed their eating habits (OR = 0.84, p < 0.05) or physical activity (OR = 0.81, p < 0.01). Conclusions:, Greater efforts are needed to reduce the risk of poor nutrition and exercise habits among patients diagnosed with BPD. [source] Benefit-Cost Analysis of Addiction Treatment: Methodological Guidelines and Empirical Application Using the DATCAP and ASIHEALTH SERVICES RESEARCH, Issue 2 2002Michael T. French Objective. To provide detailed methodological guidelines for using the Drug Abuse Treatment Cost Analysis Program (DATCAP) and Addiction Severity Index (ASI) in a benefit-cost analysis of addiction treatment. Data Sources/Study Setting. A representative benefit-cost analysis of three outpatient programs was conducted to demonstrate the feasibility and value of the methodological guidelines. Study Design. Procedures are outlined for using resource use and cost data collected with the DATCAP. Techniques are described for converting outcome measures from the ASI to economic (dollar) benefits of treatment. Finally, principles are advanced for conducting a benefit-cost analysis and a sensitivity analysis of the estimates. Data Collection/Extraction Methods. The DATCAP was administered at three outpatient drug-free programs in Philadelphia, PA, for 2 consecutive fiscal years (1996 and 1997). The ASI was administered to a sample of 178 treatment clients at treatment entry and at 7-months postadmission. Principal Findings. The DATCAP and ASI appear to have significant potential for contributing to an economic evaluation of addiction treatment. The benefit-cost analysis and subsequent sensitivity analysis all showed that total economic benefit was greater than total economic cost at the three outpatient programs, but this representative application is meant to stimulate future economic research rather than justifying treatment per se. Conclusions. This study used previously validated, research-proven instruments and methods to perform a practical benefit-cost analysis of real-world treatment programs. The study demonstrates one way to combine economic and clinical data and offers a methodological foundation for future economic evaluations of addiction treatment. [source] Administrative claims data analysis of nurse practitioner prescribing for older adultsJOURNAL OF ADVANCED NURSING, Issue 10 2009Andrea L. Murphy Abstract Title.,Administrative claims data analysis of nurse practitioner prescribing for older adults. Aim., This paper is a report of a study to identify the patterns of prescribing by primary health care nurse practitioners for a cohort of older adults. Background., The older adult population is known to receive complex pharmacotherapy. Monitoring prescribing to older adults can inform quality improvement initiatives. In comparison to other countries, research examining nurse practitioner prescribing in Canada is limited. Nurse practitioner prescribing for older adults is relatively unexplored in the international literature. Although commonly used to study physician prescribing, few studies have used claims data from drug insurance programmes to investigate nurse practitioner prescribing. Method., Drug claims for prescriptions written by nurse practitioners from fiscal years 2004/05 to 2006/07 for beneficiaries of the Nova Scotia Seniors' Pharmacare programme were analysed. Data were retrieved and analysed in May 2008. Prescribing was described for each drug using the World Health Organization Anatomical Therapeutic Chemical code classification system by usage and costs for each fiscal year. Results., Antimicrobials and non-steroidal anti-inflammatory drugs consistently represented the top ranked groups for prescription volume and cost. Over the three fiscal years, antimicrobial prescription rates declined relative to rates of other groups of medications. Prescription volume per nurse doubled and cost per prescription increased by approximately 20%. Conclusion., Prescription claims data can be used to characterize the prescribing trends of nurse practitioners. Research linking patient characteristics, including diagnoses, to prescriptions is needed to assess prescribing quality. Some potential areas of improvement were identified with antimicrobial and non-steroidal anti-inflammatory selection. [source] Securities Regulation, the Timing of Annual Report Release, and Market Implications: Evidence from ChinaJOURNAL OF INTERNATIONAL FINANCIAL MANAGEMENT & ACCOUNTING, Issue 2 2006In-Mu Haw Using a sample of earnings announcements of Chinese firms in the fiscal years 1994,1999, covering the periods before and after the introduction of a regulation to stagger the release of annual reports, we reassess the relation between earnings news and the timing of earnings announcements. We find that even though the reporting lag has significantly shortened as a result of the regulation, the pattern whereby good news is announced earlier than bad news persists. We then examine the behavior of stock prices before earnings announcements and find some indication of information leakage. These findings suggest that the regulation had the expected effect of reducing reporting delay and earnings release clustering. Yet, it did not appear to reduce the extent of the pre-announcement leakage of information. [source] Merit, Management, and Neutral Competence: Lessons from the U.S. Merit Systems Protection Board, FY 1988,FY 1997PUBLIC ADMINISTRATION REVIEW, Issue 2 2000William F. West Despite the centrality of merit principles to governance in the United States over the past century, scant empirical research examines linkages between institutions, and outcomes in the implementation of merit system protections. We argue that the fate of merit principles depends, at a minimum, on two influences that may compete with neutral competence. The first is partisan responsiveness by counter bureaucracies charged with holding agencies accountable to merit principles. The second influence is the sacrifice of merit in the interest of managerial rerogatives at the agency level. This exploratory study assesses both of these influences within the federal government. Our data consist of personal interviews, analyses of U.S. Merit System Protection Board (MSPB) processes, case loads, and decisions between fiscal years 1988 and 1997, and a brief case study of the Justice Department. We find that the MSPB is largely the neutral and competent agency that Congress intended to create when it enacted the Civil Service Reform Act of 1978. Less positively, our analysis also reveals that federal agencies vary in how well their personnel actions fare with the MSPB. This finding is especially germane to reinventing-government reforms that decentralize personnel management to agencies or to line operators within agencies. [source] Budgeting during a Recession Phase of the Business Cycle: The Georgia ExperiencePUBLIC BUDGETING AND FINANCE, Issue 2 2003Thomas P. Lauth This article describes the impact of the nation-wide recession on Georgia revenue and spending decisions in the 2002 and 2003 fiscal years. The state's strong economy and conservative revenue estimating practices historically provided a hedge against revenue shortfalls during a recession phase of the business cycle. However, when state revenue collections for FY 2002 were 5 percent less than collections for the prior fiscal year, several gap-closing measures became necessary, including state agency spending reductions and substitution of bond proceeds for tax revenues. These revenue and expenditure gap-closing measures were intended to enable the governor to achieve his policy initiatives while maintaining a balanced budget. The state's Rainy Day Fund remained full and was held in reserve for budget balancing in FY 2004, if necessary. Budget balancing during the current recession has been made possible by the state's practice of not overcommitting to program increases and tax cuts during the expansion phase of the business cycle, and by effectively framing the issue of fiscal restraint. [source] Foreign Currency Exposure in the Department of DefensePUBLIC BUDGETING AND FINANCE, Issue 4 2000Gerald M. Groshek The Department of Defense (DoD) incurs numerous costs denominated in foreign currencies in fulfilling U.S. alliance and security agreements overseas. Between fiscal years 1993 and 1997, the DoD expended over $10.4 billion in foreign currencies to operate and maintain its overseas facilities, and estimates for fiscal years 1998 and 1999 are $5.4 billion. In line with the government's general, risk-neutral approach to financial risk, the DoD makes no attempt to control its foreign exchange exposure against currency fluctuations. As such, there are inevitable differences in amounts budgeted to fund the DoD's overseas operations and amounts subsequently required to pay them. This paper examines the implications of DoD foreign exchange rate policy and applies an alternative approach to foreign exchange rate risk,one more in line with private-sector practices and overall efforts to reform government operations. The results indicate that forward contracts would inject greater certainty into the budgeting and administration of these programs and might release limited defense funds for use elsewhere. [source] | ||||||||||||||||