The cost of inappropriateness of coagulation testing [I costi dell'inappropriatezza in coagulazione]

Background. Laboratory utilization has steadily increased with a corresponding increase in overall costs; several authors have attempted to measure the impact of inappropriateness on clinical outcomes but data are insufficient. The aim of the study is to assess the cost of inappropriateness of test-ordering behaviour for second-level coagulation tests (hemorrhagic diathesisand thrombophilia). Methods. We reviewed all second-level coagulation testrequests received by our department during a six months period. Clinicians must fill out a specific order form for these kind of tests, containing all informations deemed necessary for the laboratory specialist to evaluatethe appropriateness of the request. We identified all inappropriate requests and counted the numbers and types of all coagulation tests that were not performed during the period. An analysis of the laboratory activity costs was done in order to calculate the global costof each test in our department and to estimate the savings achieved. Results. On a total of 1664 second-level coagulationtest requests, we estimated 150 as completely inappropriate. We found an overall of 295 inappropriate testswhich were not performed. This resulted in an economic saving of 20.000 euro in 6 months. Conclusions. The analysis of cost of our intervention shows the urgent need for a definite and sustained reduction in inappropriate requests of second-level coagulation tests. Even though we estimated only the economic aspect of inappropriate testing, this is also associated with the overuse of diagnostic tests which entailsthe risk of generating erroneous results with potentialnegative consequences on patients' health.

Flood Plain Management & Hazard Mitigation Task Force Report, August 2008

The Flood Plain Management and Hazard Mitigation Task Force emphasizes the long-term benefits of mitigation and management to the entire state in preventing or reducing damages from floods and other hazards faced in Iowa. Investments in efforts to manage watershed areas and to mitigate any damages from floods or other disaster events benefit individuals, families, communities, agriculture, business and industry, and certainly public entities and infrastructure. The Task Force encourages the Rebuild Iowa Advisory Commission to balance the immediate needs for rebuilding to include the beginning of the investments required to effectively mitigate future damage and maintain effective policy in Iowa’s watersheds. The significance of the damage seen in Iowa from the tornadoes, storms, and floods of 2008 include the loss of eighteen Iowans in disaster-related events. This alone should inspire investment in mitigation efforts for all hazards. Much of the damage resulting from the disasters can be tied to floodplain management and hazard mitigation, pointing the way toward enhanced efforts and new initiatives to safeguard lives, property, and communities’ economic health. Even so, it must be recognized that the weather events throughout last winter and spring added impetus to the rains and storms that ultimately resulted in record flooding. Some perspective must be maintained as planning progresses and significant investments in mitigation are considered to meet a specific level of safety and protection from future threats. The Task Force identified a number of issues, and four were agreed-upon as those with the highest priority to be addressed by the Task Force through a set of recommendations.

Supplemental Information to the August 2008 Flood Plain Management & Hazard Mitigation Task Force Report, August 2008

The Flood Plain Management and Hazard Mitigation Task Force emphasizes the long-term benefits of mitigation and management to the entire state in preventing or reducing damages from floods and other hazards faced in Iowa. Investments in efforts to manage watershed areas and to mitigate any damages from floods or other disaster events benefit individuals, families, communities, agriculture, business and industry, and certainly public entities and infrastructure. The Task Force encourages the Rebuild Iowa Advisory Commission to balance the immediate needs for rebuilding to include the beginning of the investments required to effectively mitigate future damage and maintain effective policy in Iowa’s watersheds. The significance of the damage seen in Iowa from the tornadoes, storms, and floods of 2008 include the loss of eighteen Iowans in disaster-related events. This alone should inspire investment in mitigation efforts for all hazards. Much of the damage resulting from the disasters can be tied to floodplain management and hazard mitigation, pointing the way toward enhanced efforts and new initiatives to safeguard lives, property, and communities’ economic health. Even so, it must be recognized that the weather events throughout last winter and spring added impetus to the rains and storms that ultimately resulted in record flooding. Some perspective must be maintained as planning progresses and significant investments in mitigation are considered to meet a specific level of safety and protection from future threats. The Task Force identified a number of issues, and four were agreed-upon as those with the highest priority to be addressed by the Task Force through a set of recommendations. Supplemental Information to the August 2008

Rainfall erosivity and rainfall return period in the experimental watershed of Aracruz, in the coastal plain of Espirito Santo, Brazil

Knowledge on the factors influencing water erosion is fundamental for the choice of the best land use practices. Rainfall, expressed by rainfall erosivity, is one of the most important factors of water erosion. The objective of this study was to determine rainfall erosivity and the return period of rainfall in the Coastal Plains region, near Aracruz, a town in the state of Espírito Santo, Brazil, based on available data. Rainfall erosivity was calculated based on historic rainfall data, collected from January 1998 to July 2004 at 5 min intervals, by automatic weather stations of the Aracruz Cellulose S.A company. A linear regression with individual rainfall and erosivity data was fit to obtain an equation that allowed data extrapolation to calculate individual erosivity for a 30-year period. Based on this data the annual average rainfall erosivity in Aracruz was 8,536 MJ mm ha-1 h-1 yr-1. Of the total annual rainfall erosivity 85 % was observed in the most critical period October to March. Annual erosive rains accounted for 38 % of the events causing erosion, although the runoff volume represented 88 % of the total. The annual average rainfall erosivity return period was estimated to be 3.4 years.

[Voyage en Italie : 1824-1830]. , Eglise dell' Annunziata, Sur une Echelle de 0,002 1/2 PM : [plan d'ensemble de l'église et de ses abords] : [dessin] / h. L. [Henri Labrouste]

Référence bibliographique : Weigert, 124