Cost evaluation of cardiovascular magnetic resonance versus coronary angiography for the diagnostic work-up of coronary artery disease: Application of the European Cardiovascular Magnetic Resonance registry data to the German, United Kingdom, Swiss, and United States health care systems.

ABSTRACT: BACKGROUND: Cardiovascular magnetic resonance (CMR) has favorable characteristics for diagnostic evaluation and risk stratification of patients with known or suspected CAD. CMR utilization in CAD detection is growing fast. However, data on its cost-effectiveness are scarce. The goal of this study is to compare the costs of two strategies for detection of significant coronary artery stenoses in patients with suspected coronary artery disease (CAD): 1) Performing CMR first to assess myocardial ischemia and/or infarct scar before referring positive patients (defined as presence of ischemia and/or infarct scar to coronary angiography (CXA) versus 2) a hypothetical CXA performed in all patients as a single test to detect CAD. METHODS: A subgroup of the European CMR pilot registry was used including 2,717 consecutive patients who underwent stress-CMR. From these patients, 21% were positive for CAD (ischemia and/or infarct scar), 73% negative, and 6% uncertain and underwent additional testing. The diagnostic costs were evaluated using invoicing costs of each test performed. Costs analysis was performed from a health care payer perspective in German, United Kingdom, Swiss, and United States health care settings. RESULTS: In the public sectors of the German, United Kingdom, and Swiss health care systems, cost savings from the CMR-driven strategy were 50%, 25% and 23%, respectively, versus outpatient CXA. If CXA was carried out as an inpatient procedure, cost savings were 46%, 50% and 48%, respectively. In the United States context, cost savings were 51% when compared with inpatient CXA, but higher for CMR by 8% versus outpatient CXA. CONCLUSION: This analysis suggests that from an economic perspective, the use of CMR should be encouraged as a management option for patients with suspected CAD.

Ageing prisoners' health care: analysing the legal settings in Europe and the United States.

BACKGROUND: Relatively little is known about the current health care situation and the legal rights of ageing prisoners worldwide. To date, only a few studies have investigated their rights to health care. However, elderly prisoners need special attention. OBJECTIVE: The aim of this article is to critically review the health care situation of older prisoners by analysing the relevant national and international legal frameworks with a particular focus on Switzerland, England and Wales, and the United States (U.S.). METHODS: Publications on legal frameworks were searched using Web of Science, PubMed, MEDLINE, HeinOnline, and the National Criminal Justice Reference Service. Searches utilizing combinations of keywords relating to ageing prisoners were performed. Relevant reports and policy documents were obtained in order to understand the legal settings in Switzerland, England and Wales, and the U.S. All articles, reports, and policy documents published in English and German between 1774 to June 2012 were included for analysis. Using a comparative approach, an outline was completed to distinguish positive policies in this area. Regulatory approaches were investigated through evaluations of soft laws applicable in Europe and U.S. Supreme Court judgements. RESULTS: Even though several documents could be interpreted as guaranteeing adequate health care for ageing prisoners, there is no specific regulation that addresses this issue completely. The Vienna International Plan of Action on Ageing contributes the most by providing an in-depth analysis of the health care needs of older persons. Still, critical analysis of retrieved documents reveals the lack of specific legislation regarding the health care for ageing prisoners. CONCLUSION: No consistent regulation delineates the provision of health care for ageing prisoners. Neither national nor international institutions have enforceable laws that secure the precarious situation of older adults in prisons. To initiate a change, this work presents critical issues that must be addressed to protect the right to health care and well-being of ageing prisoners. Additionally, it is important to design legal structures and guidelines which acknowledge and accommodate the needs of ageing prisoners.

Small-scale non-industrial private forest ownership in the United States : rationale and implications for forest management

Abstract

Genetically Modified Organisms (GMOs) and Agroecology in Agricultural Production in the United States - A Comparative Analysis.

The world’s population is growing at a rapid rate and one of the primary problems of a growing is food supply. To ensure food supply and security, the biggest companies in the agricultural sector of the United States and all over the world have collaborated to produce genetically modified organisms, including crops, that have a tendency to increase yields and are speculated to reduce pesticide use. It’s a technology that is declared to have a multitude of benefits. During the same time period another set of practices has risen to the horizon by the name of agroecology. It spreads across many different sectors such as politics, sociology, environment, health and so on. Moreover, it involves primitive organic techniques that can be applied at farm level to enhance the performance of an ecosystem to effectively decrease the negative effect on environment and health of individuals while producing good quality foods. Since both the processes proclaim sustainable development, a natural question may come in mind that which one seems more favorable? During the course of this study, genetically modified organisms (GMOs) and agroecology are compared within the sphere of social, environmental and health aspects. The results derived upon a comparative analysis of scientific literature tend to prove that GMOs pose a greater threat to the environment, health of individuals and the generalized social balance in the United States compared to agroecological practices. Economic indicators were not included in the study and more studies might be needed in the future to get a broader view on the subject.

Japanese Scientific And Technology Information in the United States - Public Policy and Private Initiatives

In January 1983 a group of US government, industry and university information specialists gathered at MIT to take stock of efforts to monitor, acquire, assess, and disseminate Japanese scientific and technical information (JSTI). It was agreed that these efforts were uncoordinated and poorly conceived, and that a clearer understanding of Japanese technical information systems and a clearer sense of its importance to end users was necessary. That meeting led to formal technology assessments, Congressinal hearings, and legislation; it also helped stimulate several private initiatives in JSTI provision. Four years later there exist better coordinated and better conceived JSTI programs in both the public and private sectors, but there remains much room for improvement. This paper will recount their development and assess future directions.

A comparison of three canopy interception models for a leafless mixed deciduous forest stand in the eastern United States

Canopy interception of incident precipitation is a critical component of the forest water balance during each of the four seasons. Models have been developed to predict precipitation interception from standard meteorological variables because of acknowledged difficulty in extrapolating direct measurements of interception loss from forest to forest. No known study has compared and validated canopy interception models for a leafless deciduous forest stand in the eastern United States. Interception measurements from an experimental plot in a leafless deciduous forest in northeastern Maryland (39°42'N, 75°5'W) for 11 rainstorms in winter and early spring 2004/05 were compared to predictions from three models. The Mulder model maintains a moist canopy between storms. The Gash model requires few input variables and is formulated for a sparse canopy. The WiMo model optimizes the canopy storage capacity for the maximum wind speed during each storm. All models showed marked underestimates and overestimates for individual storms when the measured ratio of interception to gross precipitation was far more or less, respectively, than the specified fraction of canopy cover. The models predicted the percentage of total gross precipitation (PG) intercepted to within the probable standard error (8.1%) of the measured value: the Mulder model overestimated the measured value by 0.1% of PG; the WiMo model underestimated by 0.6% of PG; and the Gash model underestimated by 1.1% of PG. The WiMo model’s advantage over the Gash model indicates that the canopy storage capacity increases logarithmically with the maximum wind speed. This study has demonstrated that dormant-season precipitation interception in a leafless deciduous forest may be satisfactorily predicted by existing canopy interception models.

World Health Organization dietary norms: a quantitative evaluation of potential consumption impacts in the United States, United Kingdom, and France

The member countries of the World Health Organization have endorsed its Global Strategy on Diet, Physical Activity, and Health. We assess the potential consumption impacts of these norms in the United States, France, and the United Kingdom using a mathematical programming approach. We find that adherence would involve large reductions in the consumption of fats and oils accompanying large rises in the consumption of fruits, vegetables, and cereal. Further, in the United Kingdom and the United States, but not France, sugar intakes would have to shrink considerably. Focusing on sub-populations within each country, we find that the least educated, not necessarily the poorest, would have to bear the highest burden of adjustment.