Treatment of child anxiety in the context of maternal anxiety disorder: a randomised controlled trial and economic analysis

Background Cognitive–behavioural therapy (CBT) for childhood anxiety disorders is associated with modest outcomes in the context of parental anxiety disorder. Objectives This study evaluated whether or not the outcome of CBT for children with anxiety disorders in the context of maternal anxiety disorders is improved by the addition of (i) treatment of maternal anxiety disorders, or (ii) treatment focused on maternal responses. The incremental cost-effectiveness of the additional treatments was also evaluated. Design Participants were randomised to receive (i) child cognitive–behavioural therapy (CCBT); (ii) CCBT with CBT to target maternal anxiety disorders [CCBT + maternal cognitive–behavioural therapy (MCBT)]; or (iii) CCBT with an intervention to target mother–child interactions (MCIs) (CCBT + MCI). Setting A NHS university clinic in Berkshire, UK. Participants Two hundred and eleven children with a primary anxiety disorder, whose mothers also had an anxiety disorder. Interventions All families received eight sessions of individual CCBT. Mothers in the CCBT + MCBT arm also received eight sessions of CBT targeting their own anxiety disorders. Mothers in the MCI arm received 10 sessions targeting maternal parenting cognitions and behaviours. Non-specific interventions were delivered to balance groups for therapist contact. Main outcome measures Primary clinical outcomes were the child’s primary anxiety disorder status and degree of improvement at the end of treatment. Follow-up assessments were conducted at 6 and 12 months. Outcomes in the economic analyses were identified and measured using estimated quality-adjusted life-years (QALYs). QALYS were combined with treatment, health and social care costs and presented within an incremental cost–utility analysis framework with associated uncertainty. Results MCBT was associated with significant short-term improvement in maternal anxiety; however, after children had received CCBT, group differences were no longer apparent. CCBT + MCI was associated with a reduction in maternal overinvolvement and more confident expectations of the child. However, neither CCBT + MCBT nor CCBT + MCI conferred a significant post-treatment benefit over CCBT in terms of child anxiety disorder diagnoses [adjusted risk ratio (RR) 1.18, 95% confidence interval (CI) 0.87 to 1.62, p = 0.29; adjusted RR CCBT + MCI vs. control: adjusted RR 1.22, 95% CI 0.90 to 1.67, p = 0.20, respectively] or global improvement ratings (adjusted RR 1.25, 95% CI 1.00 to 1.59, p = 0.05; adjusted RR 1.20, 95% CI 0.95 to 1.53, p = 0.13). CCBT + MCI outperformed CCBT on some secondary outcome measures. Furthermore, primary economic analyses suggested that, at commonly accepted thresholds of cost-effectiveness, the probability that CCBT + MCI will be cost-effective in comparison with CCBT (plus non-specific interventions) is about 75%. Conclusions Good outcomes were achieved for children and their mothers across treatment conditions. There was no evidence of a benefit to child outcome of supplementing CCBT with either intervention focusing on maternal anxiety disorder or maternal cognitions and behaviours. However, supplementing CCBT with treatment that targeted maternal cognitions and behaviours represented a cost-effective use of resources, although the high percentage of missing data on some economic variables is a shortcoming. Future work should consider whether or not effects of the adjunct interventions are enhanced in particular contexts. The economic findings highlight the utility of considering the use of a broad range of services when evaluating interventions with this client group. Trial registration Current Controlled Trials ISRCTN19762288. Funding This trial was funded by the Medical Research Council (MRC) and Berkshire Healthcare Foundation Trust and managed by the National Institute for Health Research (NIHR) on behalf of the MRC–NIHR partnership (09/800/17) and will be published in full in Health Technology Assessment; Vol. 19, No. 38.

Enforcement in environmental law: an economic analysis of citizen suits

Previous to 1970, state and federal agencies held exclusive enforcement responsibilities over the violation of pollution control standards. However, recognizing that the government had neither the time nor resources to provide full enforcement, Congress created citizen suits. Citizen suits, first amended to the Clean Air Act in 1970, authorize citizens to act as private attorney generals and to sue polluters for violating the terms of their operating permits. Since that time, Congress has included citizen suits in 13 other federal statutes. The citizen suit phenomenon is sufficiently new that little is known about it. However, we do know that citizen suits have increased rapidly since the early 1980's. Between 1982 and 1986 the number of citizen suits jumped from 41 to 266. Obviously, they are becoming a widely used method of enforcing the environmental statutes. This paper will provide a detailed description, analysis and evaluation of citizen suits. It will begin with an introduction and will then move on to provide some historic and descriptive background on such issues as how citizen suit powers are delegated, what limitations are placed on the citizens, what parties are on each side of the suit, what citizens can enforce against, and the types of remedies available. The following section of the paper will provide an economic analysis of citizen suits. It will begin with a discussion of non-profit organizations, especially non-profit environmental organizations, detailing the economic factors which instigate their creation and activities. Three models will be developed to investigate the evolution and effects of citizen suits. The first model will provide an analysis of the demand for citizen suits from the point of view of a potential litigator showing how varying remedies, limitations and reimbursement procedures can effect both the level and types of activities undertaken. The second model shows how firm behavior could be expected to respond to citizen suits. Finally, a third model will look specifically at the issue of efficiency to determine whether the introduction of citizen enforcement leads to greater or lesser economic efficiency in pollution control. The database on which the analysis rests consists of 1205 cases compiled by the author. For the purposes of this project this list of citizen suit cases and their attributes were computerized and used to test a series of hypotheses derived from three original economic models. The database includes information regarding plaintiffs, defendants date notice and/or complaint was filed and statutes involved in the claim. The analysis focuses on six federal environmental statutes (Clean Water Act} Resource Conservation and Recovery Act, Comprehensive Environmental Response Compensation and Liability Act, Clean Air Act, Toxic Substances Control Act, and Safe Drinking Water Act) because the majority of citizen suits have occurred under these statutes.

ECONOMIC ANALYSIS of AMAZON RIVER PRAWN FARMING TO THE MARKETS FOR LIVE BAIT and JUVENILES IN PANTANAL, BRAZIL

The implementation of a hypothetical aquaculture facility with hatchery, nursery and grow-out earthen ponds for raising the Amazon River Prawn Macrobrachium amazonicum in the Pantanal was considered. Eight larviculture cycles per year were projected: four to produce post-larvae for stocking in grow-out bait ponds, and four to stock nursery tanks to sell juveniles as seed to grow-out farms, which produce prawns for human consumption. Annual production would be 146,880 dozen bait prawns and 2,938 thousand juveniles. The assumed sale prices were US$ 1.38 per dozen baits and US$ 15.39 per thousand juveniles. The net present value was US$ 555,890.79, internal rate of return was 48% per year, payback period was 2.4 years and benefit-cost ratio was 3.90. The breakeven price to cover total costs per dozen baits was US$ 0.70 and per thousand juveniles was US$ 17.00, indicating that the selling price assumed for juveniles in base scenario is not realistic. Net return was US$ 84,773.80. The results indicate that this activity would be a lucrative and attractive investment in the Pantanal.

Response surface models to predict broiler performance and applications for economic analysis

A study was carried out to elaborate response surface models using broiler performance data recovered from literature in order to predict performance and elaborate economic analyses. Nineteen studies published between 1995 and 2005 were retrieved using the systematic literature review method. Weight gain and feed conversion data were collected from eight studies that fulfilled the pre-established inclusion criteria, and a response surface model was adjusted using crude protein, environmental temperature, and age as independent variables. The models produced for weight gain (r² = 0.93) and feed conversion (r² = 0.85) were accurate, precise, and not biased. Protein levels, environmental temperature and age showed linear and quadratic effects on weight gain and feed conversion. There was no interaction between protein level and environmental temperature. Age and crude protein showed interaction for weight gain and feed conversion, whereas interaction between age and temperature was detected only for weight gain. It was possible to perform economic analyses to determine maximum profit as a function of the variables that were included in the model. It was concluded that the response surface models are effective to predict the performance of broiler chickens and allow the elaboration of economic analyses to optimize profit.

Economic analysis of cucumber and lettuce intercropping under greenhouse in the winter-spring

A análise econômica complementa a avaliação da eficiência dos cultivos consorciados, considerando além da produção física das culturas, o preço dos produtos segundo sua classificação qualitativa e época do ano. Avaliou-se economicamente consórcios de alface crespa e pepino, em duas populações de plantas, no inverno-primavera, em casa de vegetação, em Jaboticabal, SP, Brasil. Foram calculados o custo operacional total (COT), a receita bruta (RB) e o lucro operacional (LO) das culturas do pepino e alface em monocultura e em consórcio. A mão-de-obra foi a componente com maior participação no COT das culturas em consórcio e monocultura. Maiores RB e LO foram observadas nos cultivos consorciados estabelecidos com o transplante da alface e do pepino no mesmo dia, independente da densidade populacional. Considerando-se o lucro operacional e o índice de uso eficiente da área, recomenda-se o cultivo consorciado com transplante da alface até 10 dias após o transplante (DAT) do pepino, com duas linhas, e ao 0 DAT do pepino cultivado com uma linha no canteiro

Economic analysis of the intercropping of lettuce and tomato in different seasons under protected cultivation

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Combined cycle versus one thousand diesel power plants: pollutant emissions, ecological efficiency and economic analysis

The increase in the use of natural gas in Brazil has stimulated public and private sectors to analyse the possibility of using combined cycle systems for generation of electrical energy. Gas turbine combined cycle power plants are becoming increasingly common due to their high efficiency, short lead times, and ability to meet environmental standards. Power is produced in a generator linked directly to the gas turbine. The gas turbine exhaust gases are sent to a heat recovery steam generator to produce superheated steam that can be used in a steam turbine to produce additional power. In this paper a comparative study between a 1000 MW combined cycle power plant and 1000 kW diesel power plant is presented. In first step, the energetic situation in Brazil, the needs of the electric sector modification and the needs of demand management and integrated means planning are clarified. In another step the characteristics of large and small thermoelectric power plants that use natural gas and diesel fuel, respectively, are presented. The ecological efficiency levels of each type of power plant is considered in the discussion, presenting the emissions of particulate material, sulphur dioxide (SO2), carbon dioxide (CO2) and nitrogen oxides (NOx). (c) 2006 Elsevier Ltd. All rights reserved.

Performance, carcass traits, meat quality and economic analysis of feedlot of young bulls fed oilseeds with and without supplementation of vitamin E

The objective of this research was to evaluate average daily gain (ADG), carcass traits, meat tenderness and profitability of keeping cattle fed different oilseeds and vitamin E in feedlot. A total of 40 Red Norte young bulls with initial average body weight of 339±15 kg were utilized. The experimental design was completely randomized in a 2 × 2 factorial arrangement. The experiment lasted 84 days and experimental diets presented soybeans or cottonseeds as lipid sources associated or not to daily supplementation of 2,500 UI vitamin E per animal. The concentrate:roughage ratio was 60:40. Diets had the same amount of nitrogen (13% CP) and ether extract (6.5%). The data were analyzed by means of statistical software SAS 9.1. Neither vitamin supplementation nor lipid source affected ADG. There was no interaction between lipid source and vitamin supplementation for the variables studied. The inclusion of cottonseed reduced the carcass yield. There was no effect of diets on hot and cold carcass weights or prime cuts. The inclusion of cottonseed reduced the backfat thickness. No effect of experimental diets on the rib-eye area was observed. There was no effect of lipid source or vitamin supplementation on meat tenderness, which was affected, however, by ageing time. Diets with soybeans presented higher cost per animal. The utilization of soybean implied reduction of the gross margin (R$ 59.17 and R$ 60.51 for diets based on soy with and without supplemental vitamin, respectively, vs. R$ 176.42 and R$ 131.79 for diets based on cottonseed). The utilization of cottonseed enables improvement of profitability of feedlot fattening, in spite of negatively affecting some carcass characteristics.

Simulation and economic analysis of bovine sex selection

A simulation model implemented in the programming software Delphi XE® was applied to evaluate sex selection in bovine. The hypothesis under investigation was that a dynamic model with stochastic and deterministic elements could detect the sexed semen technique to minimize pregnancy cost and to determine the adequate number of recipients required for in vivo (ET) and in vitro embryo production (IVP) in the proposed scenarios. Sex selection was compared through semen sexed using flow cytometry (C1) and density gradient centrifugation techniques (C2) in ET and IVP. Sensibility analyses were used to identify the adequate number of recipients for each scenario. This number was reinserted into the model to determine the biological and financial values that maximized ET and IVP using sexed semen (C1M and C2M). New scenarios showed that the density gradient technique minimized pregnancy cost based on the proposed scenarios. In addition, the adequate number of recipients (ET - C1M - 115 and C2M - 105)/(IVP - C1M - 145 and C2M - 140) per donor used was determined to minimize the pregnancy cost in all scenarios.

A techno-economic analysis for MCFC cogeneration system

In this paper, a methodology for the study of a fuel cell cogeneration system and applied to a university campus is developed. The cogeneration system consists of a molten carbonate fuel cell associated to an absorption refrigeration system. The electrical and cold-water demands of the campus are about 1,000 kW and 1,840 kW (at 7°C), respectively. The energy, exergy and economic analyses are presented. This system uses natural gas as the fuel and operates on electric parity. In conclusion, the fuel cell cogeneration system may have an excellent opportunity to strengthen the decentralized energy production in the Brazilian tertiary sector.

Technology and industrial exports: a micro-economic analysis of Argentina's recent experience

Includes bibliography

Care: the missing link in economic analysis?

Includes bibliography

Economic analysis of proposed hydroelectric projects

Includes bibliography

Thermodynamic and economic analysis of hydrogen production integration in the Brazilian sugar and alcohol industry

One of the biggest challenges today is to develop clean fuels, which do not emit pollutant and with viable implementation. One of the options currently under study is the hydrogen production process. In this context, this work aims to study the technical and economical aspects of the incorporation process of hydrogen producing by ethanol steam reforming in the sugar cane industry and MCFC (molten carbonate fuel cell) application on it to generate electric power. Therefore, it has been proposed a modification in the traditional process of sugar cane industry, in order to incorporate hydrogen production, besides the traditional products (sugar, ethylic, hydrated and anhydric alcohol). For this purpose, a detailed theoretical study of the ethanol production process, describing the considerations to incorporate the hydrogen production will be performed. After that, there will be a thermodynamic study for analysing the innovation of this production chain, as well as a study of economic engineering to allocate the costs of products of the new process, optimising it and considering the thermoeconomics as being as an analysis tool. This proposal aims to improve Brazil's position in the ranking of international biofuels, corroborating the nation to be a power in the hydrogen era. (C) 2013 Elsevier Ltd. All rights reserved.