942 resultados para direct healthcare cost


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Background: In a number of malaria endemic regions, tourists and travellers face a declining risk of travel associated malaria, in part due to successful malaria control. Many millions of visitors to these regions are recommended, via national and international policy, to use chemoprophylaxis which has a well recognized morbidity profile. To evaluate whether current malaria chemo-prophylactic policy for travellers is cost effective when adjusted for endemic transmission risk and duration of exposure. a framework, based on partial cost-benefit analysis was used Methods: Using a three component model combining a probability component, a cost component and a malaria risk component, the study estimated health costs avoided through use of chemoprophylaxis and costs of disease prevention (including adverse events and pre-travel advice for visits to five popular high and low malaria endemic regions) and malaria transmission risk using imported malaria cases and numbers of travellers to malarious countries. By calculating the minimal threshold malaria risk below which the economic costs of chemoprophylaxis are greater than the avoided health costs we were able to identify the point at which chemoprophylaxis would be economically rational. Results: The threshold incidence at which malaria chemoprophylaxis policy becomes cost effective for UK travellers is an accumulated risk of 1.13% assuming a given set of cost parameters. The period a travellers need to remain exposed to achieve this accumulated risk varied from 30 to more than 365 days, depending on the regions intensity of malaria transmission. Conclusions: The cost-benefit analysis identified that chemoprophylaxis use was not a cost-effective policy for travellers to Thailand or the Amazon region of Brazil, but was cost-effective for travel to West Africa and for those staying longer than 45 days in India and Indonesia.

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Dengue, the most common arbovirus infection globally, is transmitted by mosquito vectors. Healthcare-related transmission, including transmission by blood products, has been documented, although the frequency of these occurrences is unknown. Dengue is endemic to Singapore, a city-state in Asia. Using mathematical modeling, we estimated the risk for dengue-infected blood transfusions in Singapore in 2005 to be 1.625-6/10,000 blood transfusions, assuming a ratio of asymptomatic to symptomatic infections of 2:1 to 10:1. However, the level of viremia required to cause clinical dengue cases is person-dependent and unknown. Further studies are needed to establish the magnitude of the threat that dengue poses to blood safety in countries where it is endemic. It will then be possible to assess whether screening is feasible and to identify approaches that are most cost-effective on the basis of characteristics of local populations and seasonality of dengue.

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Oil and fat as energy sources at low cost are relevant in ruminant nutrition. The aim of this study was to evaluate the effects of palm fatty acid distillate (PFAD) on the degradability and ciliate protozoa population in buffalo. Four rumen fistulated buffaloes were fed a basal diet in a Latin square (4x4) design trial. Treatments were designed with four of different levels of PFAD added directly into the rumen: 0; 200; 420 and 500 g/animal/d. High levels of PFAD (420 and 500 g/d) promoted higher degradation of the soluble fraction and lower in potentially degradable fraction of dry matter (DM) and neutral detergent fibre (NDF) with lower values of potential and effective degradability in two evaluated grasses, bermudagrass and brachiariagrass. Significant decreases in the total number of protozoa/mL of rumen content, Entodinium and ciliates belonging to subfamily Diplodiniinae were observed at higher level of PFDA addition in the rumen. Also, Epidinium and Holotrich ciliates disappeared from the rumen. Significant correlations were observed of the ciliate concentration and composition as a function of dietary lipids content. Entodinium composition increased from 68.0% to 99.6% and Diplodiniinae reduced from 30.4% to 0.4% with increasing PFAD level indicating higher fat toxicity effect on the Diplodiniinae ciliates than Entodinium species and direct action of the larger ciliates on the fibre degradation.

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This Letter reports the first direct observation of muon antineutrino disappearance. The MINOS experiment has taken data with an accelerator beam optimized for (nu) over bar (mu) production, accumulating an exposure of 1.71 x 10(20) protons on target. In the Far Detector, 97 charged current (nu) over bar (mu) events are observed. The no-oscillation hypothesis predicts 156 events and is excluded at 6.3 sigma. The best fit to oscillation yields vertical bar Delta(m) over bar (2)vertical bar = [3.36(-0.40)(+0.46)(stat) +/- 0.06(sys)] x 10(-3) eV(2), sin(2)(2 (theta) over bar) = 0.86(-0.12)(+0.11)(stat) +/- 0.01(syst). The MINOS nu(mu) and (nu) over bar (mu) measurements are consistent at the 2.0% confidence level, assuming identical underlying oscillation parameters.

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We present precise tests of CP and CPT symmetry based on the full data set of K -> pi pi decays collected by the KTeV experiment at Fermi National Accelerator Laboratory during 1996, 1997, and 1999. This data set contains 16 x 10(6) K -> pi(0)pi(0) and 69 x 10(6) K -> pi(+)pi(-) decays. We measure the direct CP violation parameter Re(epsilon'/epsilon) = (19.2 +/- 2.1) x 10(-4). We find the K(L) -> K(S) mass difference Delta m = (5270 +/- 12) x 10(6) (h) over tilde s(-1) and the K(S) lifetime tau(S) = (89.62 +/- 0.05) x 10(-12) s. We also measure several parameters that test CPT invariance. We find the difference between the phase of the indirect CP violation parameter epsilon and the superweak phase: phi(epsilon) - phi(SW) =(0.40 +/- 0.56)degrees. We measure the difference of the relative phases between the CP violating and CP conserving decay amplitudes for K -> pi(+)pi(-) (phi(+-)) and for K -> pi(0)pi(0) (phi(00)): Delta phi = (0.30 +/- 0.35)degrees. From these phase measurements, we place a limit on the mass difference between K(0) and (K) over bar (0): Delta M < 4.8 x 10(-19) GeV/c(2) at 95% C.L. These results are consistent with those of other experiments, our own earlier measurements, and CPT symmetry.

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Correlations of charged hadrons of 1< p(T) < 10 Gev/c with high pT direct photons and pi(0) mesons in the range 5< p(T) < 15 Gev/c are used to study jet fragmentation in the gamma + jet and dijet channels, respectively. The magnitude of the partonic transverse momentum, k(T), is obtained by comparing to a model incorporating a Gaussian kT smearing. The sensitivity of the associated charged hadron spectra to the underlying fragmentation function is tested and the data are compared to calculations using recent global fit results. The shape of the direct photon-associated hadron spectrum as well as its charge asymmetry are found to be consistent with a sample dominated by quark-gluon Compton scattering. No significant evidence of fragmentation photon correlated production is observed within experimental uncertainties.

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The production of e(+)e(-) pairs for m(e+e-) < 0.3 GeV/c(2) and 1< p(T) < 5 GeV/c is measured in p + p and Au + Au collisions at root s(NN) = 200 GeV. An enhanced yield above hadronic sources is observed. Treating the excess as photon internal conversions, the invariant yield of direct photons is deduced. In central Au + Au collisions, the excess of the direct photon yield over p + p is exponential in transverse momentum, with an inverse slope T = 221 +/- 19(stat) +/- 19(syst) MeV. Hydrodynamical models with initial temperatures ranging from T(init) similar to 300-600 MeV at times of similar to 0.6-0.15 fm/c after the collision are in qualitative agreement with the data. Lattice QCD predicts a phase transition to quark gluon plasma at similar to 170 MeV.

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PHENIX has measured the e(+)e(-) pair continuum in root s(NN) = 200 GeV Au+Au and p+p collisions over a wide range of mass and transverse momenta. The e(+)e(-) yield is compared to the expectations from hadronic sources, based on PHENIX measurements. In the intermediate-mass region, between the masses of the phi and the J/psi meson, the yield is consistent with expectations from correlated c (c) over bar production, although other mechanisms are not ruled out. In the low-mass region, below the phi, the p+p inclusive mass spectrum is well described by known contributions from light meson decays. In contrast, the Au+Au minimum bias inclusive mass spectrum in this region shows an enhancement by a factor of 4.7 +/- 0.4(stat) +/- 1.5(syst) +/- 0.9(model). At low mass (m(ee) < 0.3 GeV/c(2)) and high p(T) (1 < p(T) < 5 GeV/c) an enhanced e(+)e(-) pair yield is observed that is consistent with production of virtual direct photons. This excess is used to infer the yield of real direct photons. In central Au+Au collisions, the excess of the direct photon yield over the p+p is exponential in p(T), with inverse slope T = 221 +/- 19(stat) +/- 19(syst) MeV. Hydrodynamical models with initial temperatures ranging from T(init) similar or equal to 300-600 MeV at times of 0.6-0.15 fm/c after the collision are in qualitative agreement with the direct photon data in Au+Au. For low p(T) < 1 GeV/c the low-mass region shows a further significant enhancement that increases with centrality and has an inverse slope of T similar or equal to 100 MeV. Theoretical models underpredict the low-mass, low-p(T) enhancement.

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In this work, we demonstrate field-induced Bose-Einstein condensation (BEC) in the organic compound NiCl(2)-4SC(NH(2))(2) using ac susceptibility measurements down to 1 mK. The Ni S=1 spins exhibit 3D XY antiferromagnetism between a lower critical field H(c1)similar to 2 T and a upper critical field H(c2)similar to 12 T. The results show a power-law temperature dependence of the phase transition line H(c1)(T)-H(c1)(0)=aT(alpha) with alpha=1.47 +/- 0.10 and H(c1)(0)=2.053 T, consistent with the 3D BEC universality class. Near H(c2), a kink was found in the phase boundary at approximately 150 mK.

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We demonstrate that the short-range spin correlator < S(i)center dot S(j)>, a fundamental measure of the interaction between adjacent spins, can be directly measured in certain insulating magnets. We present magnetostriction data for the insulating organic compound NiCl(2)-4SC(NH(2))(2), and show that the magnetostriction as a function of field is proportional to the dominant short-range spin correlator. Furthermore, the constant of proportionality between the magnetostriction and the spin correlator gives information about the spin-lattice interaction. Combining these results with the measured Young's modulus, we are able to extract dJ/dz, the dependence of the superexchange constant J on the Ni interionic distance z.

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Charged-particle spectra associated with direct photon (gamma(dir)) and pi(0) are measured in p + p and Au + Au collisions at center-of-mass energy root(S)(NN) = 200 GeV with the STAR detector at the Relativistic Heavy Ion Collider. A shower-shape analysis is used to partially discriminate between gamma(dir) and pi(0). Assuming no associated charged particles in the gamma(dir) direction ( near side) and small contribution from fragmentation photons (gamma(frag)), the associated charged-particle yields opposite to gamma(dir) (away side) are extracted. In central Au + Au collisions, the charged-particle yields at midrapidity (vertical bar eta vertical bar < 1) and high transverse momentum (3 < (assoc)(PT) < 16 GeV/c) associated with gamma(dir) and pi(0) (vertical bar eta vertical bar < 0.9, 8 < (trig)(PT) < 16 GeV/c) are suppressed by a factor of 3-5 compared with p + p collisions. The observed suppression of the associated charged particles is similar for gamma(dir) and pi(0) and independent of the gamma(dir) energy within uncertainties. These measurements indicate that, in the kinematic range covered and within our current experimental uncertainties, the parton energy loss shows no sensitivity to the parton initial energy, path length, or color charge.

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We report a measurement of high-p(T) inclusive pi(0), eta, and direct photon production in p + p and d + Au collisions at root s(NN) = 200 GeV at midrapidity (0 < eta < 1). Photons from the decay pi(0) -> gamma gamma were detected in the barrel electromagnetic calorimeter of the STAR experiment at the Relativistic Heavy Ion Collider. The eta -> gamma gamma decay was also observed and constituted the first eta measurement by STAR. The first direct photon cross-section measurement by STAR is also presented; the signal was extracted statistically by subtracting the pi(0), eta, and omega(782) decay background from the inclusive photon distribution observed in the calorimeter. The analysis is described in detail, and the results are found to be in good agreement with earlier measurements and with next-to-leading-order perturbative QCD calculations.

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The masses of neutron-deficient nuclides near the N=Z line with A=64-80 have been determined using a direct time-of-flight technique which employed a cyclotron as a high-resolution spectrometer. The measured atomic masses for (68)Se and (80)Y were 67.9421(3) u and 79.9344(2) u, respectively. The new values agree with the 2003 Atomic Mass Evaluation. The result for (68)Se confirms that this nucleus is a waiting point of the rp-process, and that for (80)Y resolves the conflict between earlier measurements. Using the present results and the 2003 Atomic Mass Evaluation compilation, the empirical interaction between the last proton and the last neutron in N=Z nuclei has been revisited and extended.

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In theories with universal extra dimensions, all standard model fields propagate in the bulk and the lightest state of the first Kaluza-Klein (KK) level can be made stable by imposing a Z(2) parity. We consider a framework where the lightest KK particle (LKP) is a neutral, extremely weakly interacting particle such as the first KK excitation of the graviton, while the next-to-lightest KK particle (NLKP) is the first KK mode of a charged right-handed lepton. In such a scenario, due to its very small couplings to the LKP, the NLKP is long-lived. We investigate the production of these particles from the interaction of high energy neutrinos with nucleons in the Earth and determine the rate of NLKP events in neutrino telescopes. Using the Waxman-Bahcall limit for the neutrino flux, we find that the rate can be as large as a few hundreds of events a year for realistic values of the NLKP mass.

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We describe the effect of influenza-like illness (ILI) during the outbreak of pandemic (H1N1) 2009 on health care worker (HCW) absenteeism and compare the effectiveness and cost of 2 sick leave policies for HCWs with suspected influenza. We assessed initial 2-day sick leaves plus reassessment until the HOW was asymptomatic (2-day + reassessment policy), and initial 7-day sick leaves (7-day policy). Sick leaves peaked in August 2009: 3% of the workforce received leave for ILI. Costs during May October reached R$798,051.87 (approximate to US $443,362). The 7-day policy led to a higher monthly rate of sick leave days per 100 HCWs than did the 2-day + reassessment policy (8.72 vs. 3.47 days/100 HCWs; p<0.0001) and resulted in higher costs (US $609 vs. US $1,128 per HCW on leave). ILI affected HCW absenteeism. The 7-day policy was more costly and not more effective in preventing transmission to patients than the 2-day + reassessment policy.