The economic cost of type 2 diabetes attributable to physical inactivity in the United States and Texas in 2007

Type 2 diabetes has grown to epidemic proportions in the U.S., and its prevalence has been steadily increasing in Texas. The physical activity levels in the population have remained low despite it being one of the primary preventive strategies for type 2 diabetes. The objectives of this study were to estimate the direct medical costs of type 2 diabetes attributable to not meeting physical activity Guidelines and to physical inactivity in the U.S. and Texas in 2007. This was a cross sectional study that used physical activity prevalence data from the 2007 Behavioral Risk Factor Surveillance System (BRFSS) to estimate the population attributable risk percentage (PAR%) for type 2 diabetes. These data were combined with the prevalence and cost data of type 2 diabetes to estimate the cost of type 2 diabetes attributable to not meeting Guidelines and to inactivity in the U.S. and Texas in 2007.^ The cost of type 2 diabetes in the U.S. in 2007, attributable to not meeting physical activity Guidelines was estimated to be $13.29 billion, and that attributable to physical inactivity (no leisure time physical activity) was estimated to be $3.32 billion. Depending on various assumptions, these estimates ranged from $7.61 billion to $41.48 billion for not meeting Guidelines, and $1.90 billion to $13.20 billion for physical inactivity in the U.S. in 2007. The cost of type 2 diabetes in Texas in 2007 attributable to not meeting physical activity Guidelines was estimated to be $1.15 billion, and that attributable to physical inactivity (no leisure time physical activity) was estimated to be $325 million. Depending on various assumptions, these estimates ranged from $800 million to $3.47 billion for not meeting Guidelines, and $186 million to $1.28 billion for physical inactivity in Texas in 2007. These results illustrate how much money could be saved annually just in terms of type 2 diabetes cost in the U.S. and Texas, if the entire adult population was active enough to meet physical activity Guidelines. Physical activity promotion, particularly at the environmental and policy level should be a priority in the population. ^

A review of economic analysis in the vaccination program; decision making and governance: Adivisory Committee on Immunization Practices (ACIP)

The Advisory Committee on Immunization Practices (ACIP) develops written recommendations for the routine administration of vaccines to children and adults in the U.S. civilian population. The ACIP is the only entity in the federal government that makes such recommendations. ACIP elaborates on selection of its members and rules out concerns regarding its integrity, but fails to provide information about the importance of economic analysis in vaccine selection. ACIP recommendations can have large health and economic consequences. Emphasis on economic evaluation in health is a likely response to severe pressures of the federal and state health budget. This study describes the economic aspects considered by the ACIP while sanctioning a vaccine, and reviews the economic evaluations (our economic data) provided for vaccine deliberations. A five year study period from 2004 to 2009 is adopted. Publicly available data from ACIP web database is used. Drummond et al. (2005) checklist serves as a guide to assess the quality of economic evaluations presented. Drummond et al.'s checklist is a comprehensive hence it is unrealistic to expect every ACIP deliberation to meet all of their criteria. For practical purposes we have selected seven criteria that we judge to be significant criteria provided by Drummond et al. Twenty-four data points were obtained in a five year period. Our results show that out of the total twenty-four data point‘s (economic evaluations) only five data points received a score of six; that is six items on the list of seven were met. None of the data points received a perfect score of seven. Seven of the twenty-four data points received a score of five. A minimum of a two score was received by only one of the economic analyses. The type of economic evaluation along with the model criteria and ICER/QALY criteria met at 0.875 (87.5%). These three criteria were met at the highest rate among the seven criteria studied. Our study findings demonstrate that the perspective criteria met at 0.583 (58.3%) followed by source and sensitivity analysis criteria both tied at 0.541 (54.1%). The discount factor was met at 0.250 (25.0%).^ Economic analysis is not a novel concept to the ACIP. It has been practiced and presented at these meetings on a regular basis for more than five years. ACIP‘s stated goal is to utilize good quality epidemiologic, clinical and economic analyses to help policy makers choose among alternatives presented and thus achieve a better informed decision. As seen in our study the economic analyses over the years are inconsistent. The large variability coupled with lack of a standardized format may compromise the utility of the economic information for decision-making. While making recommendations, the ACIP takes into account all available information about a vaccine. Thus it is vital that standardized high quality economic information is provided at the ACIP meetings. Our study may provide a call for the ACIP to further investigate deficiencies within the system and thereby to improve economic evaluation data presented. ^

AN INVESTIGATION OF VOLATILE ORGANIC AIR CONTAMINANTS IN THE INDOOR MANUFACTURED HOUSING ENVIRONMENT (TEXAS)

Manufactured housing has been found to have substantial levels of formaldehyde in the indoor air. Because mobile homes are more affordable than conventional housing, there has been a large increase in their use in the U.S. This increase in mobile home use has been substantial in the sunbelt regions such as Texas, where high temperatures and humidities may enhance out-gassing of formaldehyde and other volatile organic compounds from construction and furnishing materials and increase any potential health hazards.^ The influences of environmental, architectural and temporal factors on the presence of indoor formaldehyde and other organic compounds were investigated in conjunction with the Texas Indoor Air Quality Study of manufactured housing. A matched pair of mobile homes, one with electric heating and cooking utilities and the other with propane gas utilities, were used for a series of controlled experiments over a fourteen month period from October, 1982 through November, 1983.^ Over this fourteen month period formaldehyde levels decreased approximately 33%. Daily fluctuations of 20% to 40% were observed even with a constant indoor temperature. An increase in indoor temperature of 8(DEGREES)C doubled the measured formaldehyde concentration. Opening windows resulted in decreases of indoor formaldehyde levels of up to 50%. Studies of the impact of propane as a cooking source showed no increase in formaldehyde levels with stove use.^ The presence and concentration of selected volatile organic compounds is influenced greatest by occupancy. Occupants continually open and close windows and doors, vary the operation and settings (temperature) of air control systems, and vary in their selection of furnishings and use of consumer products, which may act as sources of indoor air contaminants. ^

Elimination of racial/ethnic Hepatitis B vaccination disparities in the US in the 2007--2008 National Health and Nutrition Examination Survey

Viral hepatitis is a significant public health problem worldwide and is due to viral infections that are classified as Hepatitis A, B, C, D, and E. Hepatitis B is one of the five known hepatic viruses. A safe and effective vaccine for Hepatitis B was first developed in 1981, and became adopted into national immunization programs targeting infants since 1990 and adolescents since 1995. In the U.S., this vaccination schedule has led to an 82% reduction in incidence from 8.5 cases per 100,000 in 1990 to 1.5 cases per 100,000 in 2007. Although there has been a decline in infection among adolescents, there is still a large burden of hepatitis B infection among adults and minorities. There is very little research in regards to vaccination gaps among adults. Using the National Health and Nutrition Examination Survey (NHANES) question "{Have you/Has SP (Study Participant)} ever received the 3-dose series of the hepatitis B vaccine?" the existence of racial/ethnic gaps using a cross-sectional study design was explored. In this study, other variables such as age, gender, socioeconomic variables (federal poverty line, educational attainment), and behavioral factors (sexual practices, self-report of men having sex with men, and intravenous drug use) were examined. We found that the current vaccination programs and policies for Hepatitis B had eliminated racial and ethnic disparities in Hepatitis B vaccination, but that a low coverage exists particularly for adults who engage in high risk behaviors. This study found a statistically significant 10% gap in Hepatitis B vaccination between those who have and those who do not have access to health insurance.^

Improving disclosure of medical errors: Including patients and family members in the disclosure process

Over the last decade, adverse events and medical errors have become a main focus of interest for the standards of quality and safety in the U.S. healthcare system (Weinstein & Henderson, 2009). Particularly when a medical error occurs, the disclosure of medical errors and its practices have become a focal point of the healthcare process. Patients and family members who have experienced a medical error might be able to provide knowledge and insight on how to improve the disclose process. However, patient and family member are not typically involved in the disclosure process, thus their experiences go unnoticed. ^ The purpose of this research was to explore how best to include patients and family members in the disclosure process regarding a medical error. The research consisted of 28 qualitative interviews from three stakeholder groups: Hospital Administrators, Clinical Service Providers, and Patients and Family Members. They were asked for their ideas and suggestions on how best to include patients and family members in the disclosure process. Framework Analysis was used to analyze this data and find prevalent themes based on the primary research question. A secondary aim was to index categories created based on the interviews that were collected. Data was used from the Texas Disclosure and Compensation Study with Dr. Eric Thomas as the Principal Investigator. Full acknowledgement of access to this data is given to Dr. Thomas. ^ The themes from the research revealed that each stakeholder group was interested and open to including patients and family members in the disclosure process and that the disclosure process should not be a "one-way" avenue. The themes gave many suggestions regarding how to best include patients and family members in the disclosure process of a medical error. Secondary aims revealed several ways to assess the ideas and suggestion given by the stakeholders. Overall, acceptability of getting the perspective of patients and family members was the most common theme. Comparison of each stakeholder group revealed that including patients and family members would be beneficial to improving hospital disclosure practices. ^ Conclusions included a list of recommendations and measureable appropriate strategies that could provide hospital with key stakeholders insights on how to improve their disclosure process. Sharing patients and family members experience with healthcare providers can encourage a shift in culture where patients are valued and active in participating in hospital practices. To my knowledge, this research is the very first of its kind and moves the disclosure process conversation forward in a patient-family member inclusion direction that will assist in improving disclosure practices. Future research should implement and evaluate the success of the various inclusion strategies.^

Determination of ages and fossil Coleoptera fauna from eight sites in the London region

These data sets report the fossil beetle assemblages identified from the Mesolithic to Late Bronze Age at eight sites in the London region. All but one of the study sites are within 2 km of the modern course of the Thames. The sites produced 128 faunal assemblages that yielded 218 identified species in 41 families of Coleoptera (beetles).  Beetle faunas of Mesolithic age indicate extensive wetlands near the Thames, bordered by rich deciduous woodlands. The proportion of woodland species declined in the Neolithic, apparently because of the expansion of wetlands, rather than because of human activities. The Early Bronze Age faunas contained a greater proportion of coniferous woodland and aquatic (standing water) species. An increase in the dung beetle fauna indicates the presence of sheep, cattle and horses, and various beetles associated with crop lands demonstrate the local rise of agriculture, albeit several centuries after the beginnings of farming in other regions of Britain. Late Bronze Age faunas show the continued development of agriculture and animal husbandry along the lower Thames. About 33% of the total identified beetle fauna from the London area sites have limited modern distributions or are extinct in the U.K. Some of these species are associated with the dead wood found in primeval forests; others are wetland species whose habitat has been severely reduced in recent centuries. The third group is stream-dwelling beetles that require clean, clear waters and river bottoms.

Influence of crowds in the dynamic characteristics of a structure

The interest for modelling of human actions acting on structures has been recurrent since the first accidents on suspension bridges in the nineteenth century like Broughton (1831) in the U.K. or Angers (1850) in France. Stadiums, gymnasiums are other type of structure where the human induced vibration is very important. In these structures appear particular phenomenon like the interaction person-structure (lock-in), the person-person synchronization, and the influence of the mass and damping of the people in the structure behaviour. This work focuses on the latter topic. The dynamic characteristic of a structure can be changed due to the presence of people on it. In order to evaluate these property modifications several testing have been carried out on a structure designed to be a gymnasium. For the test an electro-dynamic shaker was installed in a fixed point of the gym slab and different groups of people were located around the shaker. In each test the number of people was changed and also their posture (standing and sitting). Test data were analyzed and processed to verify modifications in the structure behaviour.

Modifications in the Dynamic Properties of a Structure due to Human Actions

The interest for modelling of human actions acting on structures has been recurrent since the first accidents on suspension bridges in the nineteenth century such as Broughton (1831) in the U.K. or Angers (1850) in France. Stadiums, gymnasiums are other types of structure where human induced vibration is very important. In these structures a particular phenomenon appears such as the interaction personstructure (lock-in), the person-person synchronization, and the influence of the mass and damping of the people in the structural behaviour. This paper focuses on the latter topic. In order to evaluate these property modifications several tests have been carried out on a stand-alone building. For the test an electro-dynamic shaker was installed at a fixed point of the gym slab and different groups of people were located around the shaker. The dynamic characteristics of the structure without people inside have been calculated by two methods: using a three-dimensional finite element model of the building and by operational modal analysis. These calculated experimental and numerical values are the reference values used to evaluate the modifications in the dynamic properties of the structure.

An Investigation of Career Tenure in the European Parliament: Electoral, Party and Individual Considerations. ACES Working Papers, 2012

What explains the length of a Member of the European Parliament’s career? Little evidence of careerism has been uncovered in the European Parliament, particularly when compared to studies of legislator tenure in the U.S. Congress. Due to the different historical contexts in which these two legislatures developed, it seems reasonable to rule out many of the explanations used to account for increasing careerism in Congress in searching for the influences on legislator tenure in the European Parliament. This paper therefore proposes three potential models of careerism in the European Parliament: an electoral systems model, a party model, and an individual model. While the data necessary to test these models has not been fully compiled, this paper outlines the major hypotheses of each model and details plans for the operationalization of all independent and control variables. These models are not intended to be mutually exclusive alternatives, but rather each explanation is expected to influence each MEP in varying degrees.

The Public Health Service strategic plan to combat HIV & AIDS in the United States /

Running title: Strategic plan to combat AIDS & HIV in the U.S.

Annual report on the statistics of railways in the United States.

1921-1942 contain abstracts of periodical reports.

List of technical workers in the Department of agriculture and outline of functions of main branches of the department.

1927- compiled in the Office of personnel and business administration.

The concept of change in the life and thought of the Babylonians /

Mode of access: Internet.

A general history of the Catholic Church: from the commencement of the Christian era until the present time.

"Sketch of the origin and progress of the Catholic church in the United States of America. By Rev. C. I. White, D.D.": v. 4, p. 599-663.

The doctrine of universal restoration examined and refuted : and the objections to that of endless punishment considered and answered, being a reply to the most important particulars contained in the writings of Messrs. Winchester, Vidler, Wright, and Weaver /

Mode of access: Internet.