Parents' willingness to pay for diminishing children's pain during blood sampling.

BACKGROUND: Blood sampling is a frequent medical procedure, very often considered as a stressful experience by children. Local anesthetics have been developed, but are expensive and not reimbursed by insurance companies in our country. We wanted to assess parents' willingness to pay (WTP) for this kind of drug. PATIENTS AND METHODS: Over 6 months, all parents of children presenting for general (GV) or specialized visit (SV) with blood sampling. WTP was assessed through three scenarios [avoiding blood sampling (ABS), using the drug on prescription (PD), or over the counter (OTC)], with a payment card system randomized to ascending or descending order of prices (AO or DO). RESULTS: Fifty-six responses were collected (34 GV, 22 SV, 27 AO and 29 DO), response rate 40%. Response distribution was wide, with median WTP of 40 for ABS, 25 for PD, 10 for OTC, which is close to the drug's real price. Responses were similar for GV and SV. Median WTP amounted to 0.71, 0.67, 0.20% of respondents' monthly income for the three scenarios, respectively, with a maximum at 10%. CONCLUSIONS: Assessing parents' WTP in an outpatient setting is difficult, with wide result distribution, but median WTP is close to the real drug price. This finding could be used to promote insurance coverage for this drug.

Pilot Project - Demonstration of Load Rating Capabilities through Physical Load Testing: Tech Transfer Summary, RB32-013, 2013

This project demonstrated the capabilities for load testing bridges in Iowa, developed and presented a webinar to local and state engineers, and produced a spreadsheet and benefit evaluation matrix that others can use to preliminarily assess where bridge testing may be economically feasible given truck traffic and detour lengths.

The Potential of Friction as a Tool for Winter Maintenance, TR-400, 1998

It is intuitively obvious that snow or ice on a road surface will make that surface more slippery and thus more hazardous. However, quantifying this slipperiness by measuring the friction between the road surface and a vehicle is rather difficult. If such friction readings could be easily made, they might provide a means to control winter maintenance activities more efficiently than at present. This study is a preliminary examination of the possibility of using friction as an operational tool in winter maintenance. In particular, the relationship of friction to traffic volume and speed, and accident rates is examined, and the current lack of knowledge in this area is outlined. The state of the art of friction measuring techniques is reviewed. A series of experiments whereby greater knowledge of how friction deteriorates during a storm and is restored by treatment is proposed. The relationship between plowing forces and the ice-pavement bond strength is discussed. The challenge of integrating all these potential sources of information into a useful final product is presented together with a potential approach. A preliminary cost-benefit analysis of friction measuring devices is performed and suggests that considerable savings might be realized if certain assumptions should hold true. The steps required to bring friction from its current state as a research tool to full deployment as an operational tool are presented and discussed. While much remains to be done in this regard, it is apparent that friction could be an extremely effective operational tool in winter maintenance activities of the future.

Improvement of cardiovascular risk prediction: time to review current knowledge, debates, and fundamentals on how to assess test characteristics.

Cardiovascular risk assessment might be improved with the addition of emerging, new tests derived from atherosclerosis imaging, laboratory tests or functional tests. This article reviews relative risk, odds ratios, receiver-operating curves, posttest risk calculations based on likelihood ratios, the net reclassification improvement and integrated discrimination. This serves to determine whether a new test has an added clinical value on top of conventional risk testing and how this can be verified statistically. Two clinically meaningful examples serve to illustrate novel approaches. This work serves as a review and basic work for the development of new guidelines on cardiovascular risk prediction, taking into account emerging tests, to be proposed by members of the 'Taskforce on Vascular Risk Prediction' under the auspices of the Working Group 'Swiss Atherosclerosis' of the Swiss Society of Cardiology in the future.

Genetic evidence for female-biased dispersal and gene flow in a polygynous primate.

Many models of sex-biased dispersal predict that the direction of sex-bias depends upon a species' mating system. In agreement with this, almost all polygynous mammals show male-biased dispersal whereas largely monogamous birds show female-biased dispersal (FBD). The hamadryas baboon (Papio hamadryas hamadryas) is polygynous and so dispersal is predicted to be male biased, as is found in all other baboon subspecies, but there are conflicting field data showing both female and male dispersal. Using 19 autosomal genetic markers genotyped in baboons from four Saudi Arabian populations, we found strong evidence for FBD in post-dispersal adults but not, as expected, in pre-dispersal infants and young juveniles, when we compared male and female: population structure (F(st)), inbreeding (F(is)), relatedness (r), and the mean assignment index (mAIc). Furthermore, we found evidence for female-biased gene flow as population genetic structure (F(st)), was about four times higher for the paternally inherited Y, than for either autosomal markers or for maternally inherited mtDNA. These results contradict the direction of sex-bias predicted by the mating system and show that FBD has evolved recently from an ancestral state of male-biased dispersal. We suggest that the cost-benefit balance of dispersal to males and females is tightly linked to the unique hierarchical social structure of hamadryas baboons and that dispersal and social organization have coevolved.

Alternatives for Rural Roads, HR-242, 1989

Much of the nation's rural road system is deteriorating. Many of the roads were built in the 1880s and 1890s with the most recent upgrading done in the 1940s and 1950s. Consequently, many roads and bridges do not have the capacity for the increased loads, speed, and frequent use of today's vehicles. Because of the growing demands and a dense county road system (inherited from the land settlement policies two centuries ago), revenue available to counties is inadequate to upgrade andmaintain the present system. Either revenue must be increased - an unpopular option - or costs must be reduced. To examine cost-saving options, Iowa State University conducted a study of roads and bridges in three 100 square mile areas in Iowa: • A suburban area • A rural area with a large number of paved roads, few bridges, and a high agricultural tax base and •A more rural area in a hilly terrain with many bridges and gravel roads, and a low agricultural tax base. A cost-benefit analysis was made on the present road system in these areas on such options as abandoning roads with limited use, converting some to private drives, and reducing maintenance on these types of roads. In only a few instances does abandonment of low traffic volume roads produce cost savings for counties and abutting land owners that exceed the additional travel costs to the public. In this study, the types of roads that produced net savings when abandoned were: • A small percentage (less than 5 percent) of the nonpaved county roads in the suburban area. However, net savings were very small. Cost savings from reducing the county road system in urbanized areas are very limited. • Slightly more than 5 percent of the nonpaved county roads in the most rural area that had a small number of paved county roads. • More than 12 percent of the nonpaved roads in the rural area that had a relatively large number of paved county and state roads. Converting low-volume roads to low-maintenance or Service B roads produces the largest savings of all solutions considered. However, future bridge deterioration and county liability on Service B roads are potential problems. Converting low-volume roads to private drives also produces large net savings. Abandonment of deadend roads results in greater net savings than continuous roads. However, this strategy shifts part of the public maintenance burden to land owners. Land owners also then become responsible for accident liability. Reconstruction to bring selected bridges with weight restrictions up to legal load limits reduces large truck and tractor-wagon mileage and costs. However, the reconstruction costs exceeded the reduction in travel costs. Major sources of vehicle miles on county roads are automobiles used for household purposes and pickup truck travel for farm purposes. Farm-related travel represents a relatively small percent of total travel miles, but a relatively high percentage of total travel costs.

Impact de la prophylaxie hormonale sur les fractures du fémur proximal des femmes postménopausiques: une étude de simulation. [Impact of hormonal prevention on fractures of the proximal femur in postmenopausal women: a simulation study].

A simulation model of the effects of hormone replacement therapy (HRT) on hip fractures and their consequences is based on a population of 100,000 post-menopausal women. This cohort is confronted with literature derived probabilities of cancers (endometrium or breast, which are contra-indications to HRT), hip fracture, disability requiring nursing home or home care, and death. Administration of HRT for life prevents 55,5% of hip fractures, 22,6% of years with home care and 4,4% of years in nursing homes. If HRT is administered for 15 years, these results are 15,5%, 10% and 2,2%, respectively. A slight gain in life expectancy is observed for both durations of HRT. The net financial loss in the simulated population is 222 million Swiss Francs (cost/benefit ratio 1.25) for lifelong administration of HRT, and 153 million Swiss Francs (cost/benefit ratio 1.42) if HRT is administered during 15 years.

Endogenous depth of reasoning

We introduce a model of strategic thinking in games of initial response. Unlike standard level-k models, in this framework the player's `depth of reasoning' is endogenously determined, andit can be disentangled from his beliefs over his opponent's cognitive bound. In our approach,individuals act as if they follow a cost-benefit analysis. The depth of reasoning is a function ofthe player's cognitive abilities and his payoffs. The costs are exogenous and represent the gametheoretical sophistication of the player; the benefit instead is related to the game payoffs. Behavioris in turn determined by the individual's depth of reasoning and his beliefs about the reasoningprocess of the opponent. Thus, in our framework, payoffs not only affect individual choices inthe traditional sense, but they also shape the cognitive process itself. Our model delivers testableimplications on players' chosen actions as incentives and opponents change. We then test themodel's predictions with an experiment. We administer different treatments that vary beliefs overpayoffs and opponents, as well as beliefs over opponents' beliefs. The results of this experiment,which are not accounted for by current models of reasoning in games, strongly support our theory.Our approach therefore serves as a novel, unifying framework of strategic thinking that allows forpredictions across games.

Development of a Subgrade Drainage Model for Unpaved Roads, TR-654, 2015

With over 68 thousand miles of gravel roads in Iowa and the importance of these roads within the farm-to-market transportation system, proper water management becomes critical for maintaining the integrity of the roadway materials. However, the build-up of water within the aggregate subbase can lead to frost boils and ultimately potholes forming at the road surface. The aggregate subbase and subgrade soils under these gravel roads are produced with material opportunistically chosen from local sources near the site and, many times, the compositions of these sublayers are far from ideal in terms of proper water drainage with the full effects of this shortcut not being fully understood. The primary objective of this project was to provide a physically-based model for evaluating the drainability of potential subbase and subgrade materials for gravel roads in Iowa. The Richards equation provided the appropriate framework to study the transient unsaturated flow that usually occurs through the subbase and subgrade of a gravel road. From which, we identified that the saturated hydraulic conductivity, Ks, was a key parameter driving the time to drain of subgrade soils found in Iowa, thus being a good proxy variable for accessing roadway drainability. Using Ks, derived from soil texture, we were able to identify potential problem areas in terms of roadway drainage . It was found that there is a threshold for Ks of 15 cm/day that determines if the roadway will drain efficiently, based on the requirement that the time to drain, Td, the surface roadway layer does not exceed a 2-hr limit. Two of the three highest abundant textures (loam and silty clay loam), which cover nearly 60% of the state of Iowa, were found to have average Td values greater than the 2-hr limit. With such a large percentage of the state at risk for the formation of boils due to the soil with relatively low saturated hydraulic conductivity values, it seems pertinent that we propose alternative design and/or maintenance practices to limit the expensive repair work in Iowa. The addition of drain tiles or French mattresses my help address drainage problems. However, before pursuing this recommendation, a comprehensive cost-benefit analysis is needed.

Laparoscopy in the era of enhanced recovery.

Laparoscopy is one of the cornerstones in the surgical revolution and transformed outcome and recovery for various surgical procedures. Even if these changes were widely accepted for basic interventions, like appendectomies and cholecystectomies, laparoscopy still remains challenged for more advanced operations in many aspects. Despite these discussion, there is an overwhelming acceptance in the surgical community that laparoscopy did transform the recovery for several abdominal procedures. The importance of improved peri-operative patient management and its influence on outcome started to become a focus of attention 20 years ago and is now increasingly spreading, as shown by the incoming volume of data on this topic. The enhanced recovery after surgery (ERAS) concept incorporates simple measures of general management, and requires multidisciplinary collaboration from hospital staff as well as the patient and the relatives. Several studies have demonstrated a significant decrease in postoperative complication rate, length of hospital stay and reduced overall cost. The key elements of success are fluid restriction, a functioning epidural and preoperative carbohydrate intake. With the expansion of laparoscopic techniques, ERAS increasingly incorporates laparoscopic patients, especially in colorectal surgery. However, the precise impact of laparoscopy on ERAS is still not clearly defined. Increasing evidence suggests that laparoscopy itself is an additional ERAS item that should be considered as routine where feasible in order to obtain the best surgical outcomes.

Toimittajaverkoston ja päähankkijan rajapintojen yhdistäminen

Kansainvälisen kaupan ja kanssakäymisen lisääntyminen onpakottanut veturiyritykset verkostoitumaan toisten yritysten kanssa, joustavuuden, tehokkuuden ja kilpailukyvyn parantamiseksi. Tällöin tarvitaan nopeita sähköisen tiedonsiirronvälineitä tilaus- ja toimitusprosesseissa. Tutkimuksen tavoitteena oli saada kehitysmalli kansainvälisen päähankkijan, järjestelmätoimittajan ja toimittajaverkoston välille sähköisen tiedonsiirron kehittämiseksi sellaiselle tasolle, missä voidaan saavuttaa kokonaiskustannushyöty koko toimittajaketjulle. Tutkimuksen mukaan järjestelmätoimittajan ja päähankkijan sähköinen tiedonsiirto oli valtaosassa tutkituista järjestelmätoimittajista hyvällä tasolla. Monessa verkoston yrityksessä sähköisen tiedonsiirron kehitys oli pysähtynyt järjestelmätoimittajatasolle, eikä sitä ole kehitetty edelleen toimittajaverkostoon päin. Ainoastaan yhden tutkimuksessa mukana olleen järjestelmätoimittajan kehityssuunnitelma vastaa päähankkijan asettamia lähitulevaisuuden tavoitteita sähköisen tiedonsiirron kehittämisestä toimittajaverkostossa. Tutkimuksessa havaittiin, ettei sähköinen tiedonsiirtokehity toimittajaverkostossa, elleivät järjestelmätoimittajat ota suurempaa vastuuta sen kehittämiseksi omassa toimittajaverkostossa. Tutkimustulosten perusteella kaikkien osapuolien päähankkijan, järjestelmätoimittajan ja toimittajaverkoston aktiivinen tuki sähköisen tiedonsiirron kehittämiselle parantaa kokonaiskustannusten hallinnan ja imuohjauksen kautta kilpailukykyä.

El valor de uso recreativo de los espacios naturales protegidos. Una aplicación de los métodos de valoración contingente y del coste del viaje

En este articulo se presenta una aplicación de dos de las metodologías desarrolladas para medir los beneficios que se derivan del uso recreativo de los bienes ambientales en ausencia de mercado, el método del coste del viaje (MCV) y el de valoración contingente (MVC). La zona objeto de estudio ha sido el Parque Nacional de "Aigüestortes y Estany de Sant Maunici", situado en el pirineo catalán. El trabajo se ha estructurado de la forma siguiente. Tras una breve introducción, en los apartados Il y III se expone el modelo teórico de ambas metodologías de valoración, se analiza su aplicación y se comentan los principales problemas derivados de su uso. En los apartados IV y V se muestran los resultados obtenidos mediante ambas técnicas de valoración. En el apartado VI se comparan los resultados y se discuten algunos problemas metodológicos derivados de su aplicación haciendo hincapié en la sensibilidad de los mismos alas hipótesis consideradas. Finalmente el trabajo termina con unas reflexiones a modo de conclusión.

Conservation of Campomanesia adamantium (CAMB.) O. berg seeds in different packaging and at varied temperatures

This article aims at evaluating the effects of different packaging and varied storage temperatures on the germination potential of seeds of Campomanesia adamantium Camb. O. Berg. The seeds were packaged in glass, aluminum foil and plastic containers, or maintained inside intact fruits at 5, 10 and 15 ºC during 0, 7, 14 and 21 days. After these periods the seeds were sown in Germitest® germination paper and maintained in incubation chambers at 25 ºC under constant white light for 42 days. Seed moisture contents were evaluated both before and after storage, as well as germination percentages, germination speed index, root and aerial portion of seedlings lengths, and total dry weights. All possible combinations of packing materials, temperatures and storage times were tested, with four repetitions of 25 seeds for each treatment. C. adamantium seeds showed initial water contents of 31.5%. Glass and aluminum packaging were efficient at maintaining the water content of the seeds, and provided greater germination speed index than the other packaging materials. Germination percentages, seedlings lengths and dry weights did not vary among the different temperatures tested. C. adamantium seeds can be stored for up to 21 days at temperatures between 5 and 15 ºC without altering their physiological quality. In terms of cost-benefit efficiencies, these seeds can be stored without significant damage for 21 days while still inside the fruits at temperatures of 5, 10 or 15 ºC.

Knowing What to Respond in the Future Does Not Cancel the Influence of Past Events

Everyday tasks seldom involve isolate actions but sequences of them. We can see whether previous actions influence the current one by exploring the response time to controlled sequences of stimuli. Specifically, depending on the response-stimulus temporal interval (RSI), different mechanisms have been proposed to explain sequential effects in two-choice serial response tasks. Whereas an automatic facilitation mechanism is thought to produce a benefit for response repetitions at short RSIs, subjective expectancies are considered to replace the automatic facilitation at longer RSIs, producing a cost-benefit pattern: repetitions are faster after other repetitions but they are slower after alternations. However, there is not direct evidence showing the impact of subjective expectancies on sequential effects. By using a fixed sequence, the results of the reported experiment showed that the repetition effect was enhanced in participants who acquired complete knowledge of the order. Nevertheless, a similar cost-benefit pattern was observed in all participants and in all learning blocks. Therefore, results of the experiment suggest that sequential effects, including the cost-benefit pattern, are the consequence of automatic mechanisms which operate independently of (and simultaneously with) explicit knowledge of the sequence or other subjective expectancies.

Estimation de l'impact économique de l'introduction d'un test diagnostique rapide pour le dépistage des MRSA au CHUV

Contexte : Parmi les infections nosocomiales, le Staphylocoque méticilline résistant (MRSA) est le germe pathogène le plus couramment identifié dans les hôpitaux du monde entier. La stratégie de contrôle des MRSA au CHUV implique le dépistage des patients à risque. Avec la méthode de dépistage par culture, le temps d'attente est de plusieurs jours. Ceci occasionne des problèmes dans la gestion des flux des patients, principalement à cause des mesures d'isolement. Pour réduire le temps d'attente, l'hôpital envisage d'utiliser une méthode de diagnostic rapide par "polymerase chain reaction" (PCR). Méthodologie : Les données concernant les dépistages réalisés, dans trois services durant l'année 2007, ont été utilisées. Le nombre de jours d'isolement a d'abord été déterminé par patient et par service. Ensuite une analyse des coûts a été effectuée afin d'évaluer la différence des coûts entre les deux méthodes pour chaque service. Résultats : Le principal impact économique de la méthode par PCR dépend principalement du nombre de jours d'isolements évités par rapport à la méthode de culture. Aux services de soins, l'analyse a été menée sur 192 dépistages. Quand la différence de jours d'isolement est de deux jours, le coût des dépistages diminue de plus de 12kCHF et le nombre de jours d'isolement diminue de 384 jours. Au centre interdisciplinaire des urgences, sur 96 dépistages, le gain potentiel avec la méthode PCR est de 6kCHF avec une diminution de 192 jours d'isolement. Aux soins intensifs adultes, la méthode de dépistage par PCR est la méthode la plus rentable avec une diminution des coûts entre 4KCHF et 20K CHF et une diminution des jours d'isolement entre 170 et 310. Pour les trois services analysés, les résultats montrent un rapport coût-efficacité favorable pour la méthode PCR lorsque la diminution des jours d'isolement est supérieure à 1.3 jour. Quand la différence de jours d'isolement est inférieure à 1.3, il faut tenir compte d'autres paramètres, comme le coût de matériel qui doit être supérieur à 45.5 CHF, et du nombre d'analyses par dépistage, qui doit être inférieur à 3, pour que la PCR reste l'alternative la plus intéressante. Conclusions : La méthode par PCR montre des avantages potentiels importants, tant économiques qu'organisationnels qui limitent ou diminuent les contraintes liées à la stratégie de contrôle des MRSA au CHUV. [Auteure, p. 3]