Essays in health economics: Volume-Outcome Effect, upcoding behaviour and the evaluation of a short-term intervention program

Evidence in the literature suggests a negative relationship between volume of medical procedures and mortality rates in the health care sector. In general, high-volume hospitals appear to achieve lower mortality rates, although considerable variation exists. However, most studies focus on US hospitals, which face different incentives than hospitals in a National Health Service (NHS). In order to add to the literature, this study aims to understand what happens in a NHS. Results reveal a statistically significant correlation between volume of procedures and better outcomes for the following medical procedures: cerebral infarction, respiratory infections, circulatory disorders with AMI, bowel procedures, cirrhosis, and hip and femur procedures. The effect is explained with the practice-makes-perfect hypothesis through static effects of scale with little evidence of learning-by-doing. The centralization of those medical procedures is recommended given that this policy would save a considerable number of lives (reduction of 12% in deaths for cerebral infarction).

Empowerment and intentions to resist future change: the moderating effect organization-based self-esteem

Nowadays, organizations face a constant need for adaptability, increasing the importance of change management. Our study focuses of how empowering leadership influences intentions to resist future changes, mediated by the effects of psychological and structural empowerment. From the responses of the two questionnaires (N1=230; Ntf=113), we found that empowering leadership fosters psychological and structural empowerment. Structural empowerment was the main driver in reducing intentions to resist future change when an employee has high organization-based self-esteem. Our findings add to the literature by examining how we can anticipate and manage change under an empowering context, building on social exchange and uncertainty reduction theories

The effect of moisture on decomposition processes in the disturbed peatlands of the Wainfleet bog /

The purpose of this study was to determine the effect of increased soil moisture levels on the decomposition processes in a peat-extracted bog. Field experiments, in which soil moisture levels were manipulated, were conducted using 320 microcosms in the Wainfleet Bog from May 2002 to November 2004. Decomposition was measured using litter bags and monitoring the abundance of macro invertebrate decomposers known as Collembola. Litter bags containing wooden toothpicks (n=2240), filter paper (n=480) and Betula pendula leaves (n=40) were buried in the soil and removed at regular time intervals up to one year. The results of the litter bag studies demonstrated a significant reduction of the decomposition of toothpicks (p<0.001), filter paper (p<0.001), and Betula pendula leaves (peffect of increased moisture levels on the abundance of Collembola was more variable and difficult to interpret. The conclusions of this study indicate that the Wainfleet Bog is a highly disturbed peatland and that the greatest reductions in decomposition can be obtained by restoring the soil moisture levels near those of undisturbed conditions.

Effect of citrate on the redox properties of cytochrome C and its kinetic and binding behaviour with cytochrome oxidase /

Increasing citrate concentration, at constant ionic strength (30 mM) decreases the rate of cytochrome ~ reduction by ascorbate. This effect is also seen at both high (600 mM) and low (19 mM) ionic strengths, and the Kapp for citrate increases with increasing ionic strength. Citrate binds d both ferri -and ferrocytochrome ~, but with a lower affinity for the latter form (Kox . .red d = 2 mM, Kd = 8 mM) as shown by an equilibrium assay with N,N,N',N', Tetramethyl E- phenylenediamine. The reaction of ferricytochrome ~with cyanide is also altered in the presence of citrate: citrate increases the K~PP for cyanide. Column chromatography of cytochrome ~-cytochrome oxidase mixtures shows citrate increases the dissociation constant of the complex. These results are confirmed in kinetic assays for the "loose"site (Km = 20 pM) only. The effect of increasing citrate observable at the "tight" site (Km = 0.25 pM) is on the turnover number and not on the K . These results suggest a mechanism m where anion binding to cytochrome £ at the tight site affects the equilibrium between two forms of cytochrome c bound cytochrome oxidase: an active and an inactive one.

The effect of nitrate fertilization on the distribution of exported 14c-photosynthate in nodulated soybean (Glycine max (L.) Merr.) plants

Soybean (Glycine ~ (L.) Merr. cv. Harosoy 63) plants inoculated with Rhizobium japonicum were grown in vermiculite in the presence or absence of nitrate fertilization for up to 6 weeks after planting. Overall growth of nodulated plants was enhanced in the presence of nitrate fertilization, while the extent of nodule development was reduced. Although the number of nodules was not affected by nitrate fertilization when plants were grown at a light intensity limiting for photosynthesis, at light intensities approaching or exceeding the light saturation point for photosynthesis, nitrate fertilization resulted in at least a 30% reduction in nodule numbers. The mature, first trifoliate leaf of 21 day old plants was allowed to photoassimi1ate 14C02. One hour after·· the initial exposure to 14C02, the , plants were harvested and the 14C radioactivity was determined in the 80% ethanol-soluble fraction: in. o:rider to assess· "the extent of photoassimilate export and the pattern of distribution of exported 14C. The magnitude of 14C export was not affected by the presence of nitrate fertilization. However, there was a significant effect on the distribution pattern, particularly with regard to the partitioning of 14C-photosynthate between the nodules and the root tissue. In the presence of nitrate fertilization, less than 6% of the exported 14C photosynthate was recovered from the nodules, with much larger amounts (approximately 37%) being recovered from the root tissue. In the absence of nitrate fertilization, recovery of exported 14C-photosynthate from the nodules (19 to 27%) was approximately equal to that from the root tissue (24 to 33%). By initiating- or terminating the applications of nitrate at 14 days of age, it was determined that the period from day 14 to day 21 after planting was particularly significant for the development of nodules initiated earlier. Addition of nitrate fertilization at this time inhibited further nodule development while stimulating plant growth, whereas removal of nitrate fertilization stimulated nodule development. The results obtained are consistent with the hypothesis that nodule development is inhibited by nitrate fertilization through a reduction in the availability of photosynthate to the nodules.

Gas chromatographic electron capture negative ionization mass spectrometric (GC/ECNI/MS) determination of unique fluorinated compounds in the sediments of Lake Ontario and the effect of high-boiling alcohols (as injection solvents) on chromatographic behaviour of polycyclic aromatic hydrocarbons in gas chromatography

Part I - Fluorinated Compounds A method has been developed for the extraction, concentration, and determination of two unique fluorinated compounds from the sediments of Lake Ontario. These compounds originated from a common industrial landfill, and have been carried to Lake Ontario by the Niagara River. Sediment samples from the Mississauga basin of Lake Ontario have been evaluated for these compounds and a depositional trend was established. The sediments were extracted by accelerated solvent extraction (ASE) and then underwent clean-up, fractionation, solvent exchange, and were concentrated by reduction under nitrogen gas. The concentrated extracts were analyzed by gas chromatography - electron capture negative ionization - mass spectrometry. The depositional profile determined here is reflective of the operation of the landfill and shows that these compounds are still found at concentrations well above background levels. These increased levels have been attributed to physical disturbances of previously deposited contaminated sediments, and probable continued leaching from the dumpsite. Part II - Polycyclic Aromatic Hydrocarbons Gas chromatography/mass spectrometry is the most common method for the determination of polycyclic aromatic hydrocarbons (PAHs) from various matrices. Mass discrimination of high-boiling compounds in gas chromatographic methods is well known. The use of high-boiling injection solvents shows substantial increase in the response of late-eluting peaks. These solvents have an increased efficiently in the transfer of solutes from the injector to the analytical column. The effect of I-butanol, I-pentanol, cyclopentanol, I-hexanol, toluene and n-octane, as injection solvents, was studied. Higher-boiling solvents yield increased response for all PAHs. I -Hexanol is the best solvent, in terms of P AH response, but in this solvent P AHs were more susceptible to chromatographic problems such as peak splitting and tailing. Toluene was found to be the most forgiving solvent in terms of peak symmetry and response. It offered the smallest discrepancies in response, and symmetry over a wide range of initial column temperatures.

The Effect of Functional Electrically Stimulated Ambulation Training on Locomotor Function and Quality of Life in Individuals With Incomplete Spinal Cord Injury

The purpose of this study was to investigate the effects of a 12-week FES-ambulation program on locomotor function and quality of life after incomplete spinal cord injury. Six individuals with incomplete SCI participated in the study. Over-ground walking endurance (6MWT), speed (10MWT), independence (WISCI II) and body-weight support were assessed. Quality of life was assessed via the SF-36, WHOQOL-BREF, Perceived Stress Scale, Center of Epidemiological Studies for Depression scale, and task self-efficacy. Participants experienced significant improvements in walking endurance (223.6±141.5m to 297.3±164.5m; p=0.03), body-weight support (55.3±12.6% to 14.7±23.2%; p= 0.005) and four of the six participants showed improvements on the WISCI II scale (1-4 points). In addition, there was a significant reduction in reported bodily pain (6.5±1.2 to 5.0±1.7; p=0.04). Therefore, FES-ambulation is an effective means for enhancing over-ground locomotor function in individuals with incomplete SCI. It may also be an effective method for reducing pain in individuals with SCI.

The effect of a segmental, localized lower limb cooling protocol on muscular strength and balance

The human neuromuscular system is susceptible to changes within the thermal environment. Cold extrinsic temperatures can significantly reduce muscle and nervous system function and communication, which can have consequences for motor performance. A repeated measures design protocol exposed participants to a 12°C cold water immersion (CWI) up to the ankle, knee, and hip to determine the effect that reduced skin and muscle temperature had on balance and strength task execution. Although a linear reduction in the ability to perform balance tasks was seen from the control condition through to the hip CWI, results from the study indicated a significant reduction in dynamic balance (Star Excursion Balance Test reach distance) performance from only the hip CWI (P<0.05). This reduced performance could have been due to an increase in joint stiffness, increased agonist-antagonist co-contraction, and/or reduced isokinetic muscular strength. Reduced physical performance due to cold temperature could negatively impact outdoor recreational athletics.

Phase-I clinical trial on the effect of palatal brushing on denture stomatitis

Introduction: La stomatite prothétique est une condition inflammatoire chronique de la muqueuse buccale recouverte par une prothèse. Cette maladie est considérée comme la lésion buccale la plus fréquente chez les porteurs de prothèses amovibles. Des études récentes sur l'étiologie de la stomatite prothétique suggèrent que des traitements basés sur la réduction de l'inflammation seraient efficaces dans le traitement de cette maladie. Objectifs: Évaluer l'efficacité du brossage du palais dans le traitement de la stomatite prothétique. Méthodes: Quarante-huit participants (âge moyen : 66,0 ± 11,2 ans) avec un diagnostic de stomatite prothétique, ont été sélectionnés à partir d’un examen préalable de 143 individus, afin de participer à cet essai clinique de phase I à deux centres, réalisé selon un devis de type pré-test/post-test à un seul groupe. L'intervention a consisté en un brossage du palais avec une brosse manuelle après chaque repas et avant le coucher. Des examens cliniques et microbiologiques ont été effectués avant le traitement, et à 1 mois et 3 mois de suivi. Des données supplémentaires ont été obtenues par l'utilisation d'un questionnaire validé. Les résultats primaires et secondaires étaient, respectivement, la rémission de stomatite prothétique et la diminution du nombre de colonies de Candida. Des tests statistiques descriptifs et non paramétriques ont été menés pour analyser les données. Résultats: À 3 mois de suivi, 10,4 % des participants ont été guéris et 70,8 % ont eu une amélioration clinique de la stomatite prothétique grâce au brossage du palais. Une réduction statistiquement significative de la surface et de l’intensité de l’inflammation après 3 mois de brossage du palais a été démontrée (p < 0,0001). L’ampleur de l’effet a varié d’un effet modéré à important (0,34 à 0,54) selon la classification utilisée pour le diagnostique de la stomatite prothétique. De plus, le nombre de colonies de Candida, recueillies par sonication des prothèses et par échantillonnage du palais, a diminué de manière statistiquement significative après 3 mois de brossage (p ≤ 0,05). Conclusion: Les résultats de cette étude suggèrent que le brossage du palais est efficace comme traitement de la stomatite prothétique.

Effect of dietary sodium restriction on taste perception of sodium chloride

The effect of dietary sodium restriction on perceived intensity of and preference for the taste of salt was evaluated in 76 adults, 25-49 years, with diastolic blood pressure between 79-90 mmHg. Participants were volunteers from clinical Hypertension Prevention Trials (HPT), at the University of California, Davis and the University of Minnesota, Minneapolis. Participants followed one of four HPT diets: 1600 mg Na+/day (NA, n=lS), 1600 mg Na+ plus 3200 mg K+/day (NK, n=lS), 1600 mg Na+/day plus energy restriction to achieve weight loss (NW, n=l3) and weight loss only (WT, n=l3). All participants attended regularly scheduled nutri­tion intervention meetings designed to help them achieve the HPT dietary goals. A fifth, no-intervention group, consisted of 20, no-diet-change controls CCN). Sodium, potassium and energy intakes were monitored by analysis of single, 24-hour food records and corresponding overnight urine speci­mens, obtained at baseline and after 12 and 24 weeks of intervention. Hedonic responses to sodium chloride in a prepared cream of green bean soup were assessed by two methods : 1) scaling of like/dislike for an NaCl concentration series on 10-cm graphie line scales and 2) ad libitum mixing of unsalted and salted soups to maximum level of liking. Salt content of the mixes was analyzed by sodium ion-selective electrode. The concentration series was also rated for perceived saltiness­intensity on similar graphie line scales. Tests were conducted at base­line and after approximately 1, 3, 6, 8, 10, 13 and 24 weeks of intervention. Reduction in sodium intake and excretion in NA, NK and NW partici­pants was accompanied by a shift in preference toward less saltiness in soup. The pattern of hedonic responses changed over time: scores for high NaCl concentrations decreased progressively while scores for low concentrations increased. Hedonic maxima shifted fran a concentration of 0.55% at the onset to 0.1-0.2% added NaCl at week 24. During the same time period, the preferred concentration of ad libitum mixes declined 50%. These shifts occurred independently of changes in salti­ness intensity ratings, potassium or energy intakes, and were consistent across the two participating study sites. Like/dislike and sd. libitum responses were similar after 13 and 24 weeks of diet, as were measures of sodium intake and excretion. These findings suggest that after three months of sodium restriction, preference for salt had readjusted to a lower level, reflective of lower sodium intake. Mechanisms underlying the change in preference are unclear, but may include sensory, context, physiological as well as behavioral effects. In contrast, few changes were noted within WT and CN groups. The pattern of hedonic responses varied little in controls while the WT group showed increased liking for mid-range NaCl concentrations. Small, but significant fluctuations in ad libitum mix concentration occurred in both of these groups, but the differences appeared to be random rather than systematic. The results of this study indicate that preference for the taste of salt declines progressively toward a new baseline following reductions in sodium intake. These alterations may enhance maintenance of low­sodium diets for the treatment and prevention of hypertension. Further investigation is needed to establish the degree to which long-term com­pliance is contingent upon variation in salt taste preference.

Study of the Effect of Polyethylene Glycols and Glycerol in Filled Natural RubberLatex Vulcanizates

The mechanical properties of filled natural rubber latex vulcanizates were found to be improved by the addition of polyethylene glycols of different molecular weight and glycerol. There is a slight reduction in the optimum cure times of the compounds containing PEG/Glycerol. The morphology study shows that the filler distribution is more uniform in the compounds containing PEG/Glycerol.

Studies on the Effect of an External Flaw on the Tensile Strength of Short Kevlar Fiber-Thermoplastic Polyurethane Composites

The effect of an external flaw on the tensile strength of short kevlar fiber-thermoplastic composites has been studied with respect to fiber content, fiber orientation, location of the external flaw, and the temperature of test. The composites showed a three-step reduction in tensile strength with increasing flaw size. The critical flaw-length region was shifted to higher flaw-size levels with increasing fiber content. With increasing temperature, the critical flaw length was increased in the case of unfilled TPU, whereas it remained more or less constant in the case of short kevlar fiber-filled-TPU composite.

Effect of Urethane Based Bonding Agent on the Cure Characteristics and Mechanical Properties of Styrene Butadiene Rubber - Whole Tyre Reclaim - Short Nylon Fiber Composite

The cure characteristics and mechanical properties of short nylon fiber- styrene /whole tyre reclaim (SBR/WTR) composites with and without an interfacial bonding agent based on 4,4 diphenyl methane diisocyanate and polyethylene glycol (MDI/PEG) have been studied. An 80:40 blend of SBR/ WTR reinforced with 20 phr of short nylon fiber has been selected and the MDI/ PEG ratio has been changed from 0.67:1 to 2:1. The minimum and maximum torques increased with isocyanate concentration. The scorch time and cure time showed an initial reduction. The cure rate showed an initial improvement. Tensile strength, tear strength and abrasion resistance increased with MDI/PEG ratio, these values were higher in longitudinal direction. Resilience and compression set increased with isocyanate concentration.

Decreased GABAA Receptors Functional Regulation 3 in the Cerebral Cortex and Brainstem of Hypoxic Neonatal Rats: 4 Effect of Glucose and Oxygen Supplementation

Hypoxia in neonates can lead to biochemical and molecular alterations mediated through changes in neurotransmitters resulting in permanent damage to brain. In this study, we evaluated the changes in the receptor status of GABAA in the cerebral cortex and brainstem of hypoxic neonatal rats and hypoxic rats supplemented with glucose and oxygen using binding assays and gene expression of GABAAa1 and GABAAc5. In the cerebral cortex and brainstem of hypoxic neonatal rats, a significant decrease in GABAA receptors was observed, which accounts for the respiratory inhibition. Hypoxic rats sup- plemented with glucose alone and with glucose and oxygen showed, respectively, a reversal of the GABAA receptors, andGABAAa1 and GABAAc5 gene expression to control. Glucose acts as an immediate energy source thereby reducing the ATP-depletion-induced increase in GABA and oxygenation, which helps in encountering anoxia. Resuscitation with oxygen alone was less effective in reversing the receptor alterations. Thus, the results of this study suggest that reduction in the GABAA receptors functional regulation during hypoxia plays an important role in mediating the brain damage. Glucose alone and glucose and oxygen supplementation to hypoxic neonatal rats helps in protecting the brain from severe hypoxic damage.

Preparation of Low-Protein Natural Rubber Latex: Effect of Polyethylene Glycol

Low-protein content natural rubber latex was produced by using a nonionic surfactant-polyethylene glycol (PEG). Extractable protein content of natural rubber latex was found to decrease with PEG treatment and reduction increased with increase in the molecular weight of PEG. The low-protein latex samples were characterized by tensile testing, Fourier transform infrared and thermogravimetric analysis. The results have shown 35% reduction in the extractable protein content, without any compromise on the mechanical properties of the latex; however, thermal stability of low-protein latex was found to be reduced marginally with PEG treatment.