Measuring the societal value of lifetime health

This paper considers two societal concerns in addition to health maximisation: first, concerns for the societal value of lifetime health for an individual; and second, concerns for the value of lifetime health across individuals. Health-related social welfare functions (HRSWFs) have addressed only the second concern. We propose a model that expresses the former in a metric – the adult healthy-year equivalent (AHYE) – that can be incorporated into standard HRSWFs. An empirical study based on this formulation shows that both factors matter: health losses in childhood are weighted more heavily than losses in adulthood and respondents wish to reduce inequalities in AHYEs

Measuring the societal value of lifetime health

This paper considers two societal concerns in addition to health maximisation: first, concerns for the societal value of lifetime health for an individual; and second, concerns for the value of lifetime health across individuals. Health-related social welfare functions (HRSWFs) have addressed only the second concern. We propose a model that expresses the former in a metric – the adult healthy-year equivalent (AHYE) – that can be incorporated into standard HRSWFs. An empirical study based on this formulation shows that both factors matter: health losses in childhood are weighted more heavily than losses in adulthood and respondents wish to reduce inequalities in AHYEs

The detection of airborne transmission of tuberculosis from HIV-infected patients, using an in vivo air sampling model

Background. Nosocomial transmission of tuberculosis remains an important public health problem. We created an in vivo air sampling model to study airborne transmission of tuberculosis from patients coinfected with human immunodeficiency virus (HIV) and to evaluate environmental control measures. Methods. An animal facility was built above a mechanically ventilated HIV‐tuberculosis ward in Lima, Peru. A mean of 92 guinea pigs were continuously exposed to all ward exhaust air for 16 months. Animals had tuberculin skin tests performed at monthly intervals, and those with positive reactions were removed for autopsy and culture for tuberculosis. Results. Over 505 consecutive days, there were 118 ward admissions by 97 patients with pulmonary tuberculosis, with a median duration of hospitalization of 11 days. All patients were infected with HIV and constituted a heterogeneous group with both new and existing diagnoses of tuberculosis. There was a wide variation in monthly rates of guinea pigs developing positive tuberculin test results (0%–53%). Of 292 animals exposed to ward air, 159 developed positive tuberculin skin test results, of which 129 had laboratory confirmation of tuberculosis. The HIV‐positive patients with pulmonary tuberculosis produced a mean of 8.2 infectious quanta per hour, compared with 1.25 for HIV‐negative patients with tuberculosis in similar studies from the 1950s. The mean monthly patient infectiousness varied greatly, from production of 0–44 infectious quanta per hour, as did the theoretical risk for a health care worker to acquire tuberculosis by breathing ward air. Conclusions. HIV‐positive patients with tuberculosis varied greatly in their infectiousness, and some were highly infectious. Use of environmental control strategies for nosocomial tuberculosis is therefore a priority, especially in areas with a high prevalence of both tuberculosis and HIV infection

Early evolution of the extraordinary Nova Del 2013 (V339 Del)

We determine the temporal evolution of the luminosity L(WD), radius R(WD) and effective temperature Teff of the white dwarf (WD) pseudophotosphere of V339 Del from its discovery to around day 40. Another main objective was studying the ionization structure of the ejecta. These aims were achieved by modelling the optical/near-IR spectral energy distribution (SED) using low-resolution spectroscopy (3500 - 9200 A), UBVRcIc and JHKLM photometry. During the fireball stage (Aug. 14.8 - 19.9, 2013), Teff was in the range of 6000 - 12000 K, R(WD) was expanding non-uniformly in time from around 66 to around 300 (d/3 kpc) R(Sun), and L(WD) was super-Eddington, but not constant. After the fireball stage, a large emission measure of 1.0-2.0E+62 (d/3 kpc)**2 cm**(-3) constrained the lower limit of L(WD) to be well above the super-Eddington value. The evolution of the H-alpha line and mainly the transient emergence of the Raman-scattered O VI 1032 A line suggested a biconical ionization structure of the ejecta with a disk-like H I region persisting around the WD until its total ionization, around day 40. It is evident that the nova was not evolving according to the current theoretical prediction. The unusual non-spherically symmetric ejecta of nova V339 Del and its extreme physical conditions and evolution during and after the fireball stage represent interesting new challenges for the theoretical modelling of the nova phenomenon.Comment: 14 pages, 9 figures, 3 tables, accepted for Astronomy and Astrophysic

Der Einfluss von Haftungsunsicherheit auf den Sorgfaltsstandard

Optimal abgestimmte Vergütungs- und Haftungsregeln regen den Arzt zu einer effizienten Ressourcenverwendung und einem angemessenen Sorgfaltsniveau an. Die nicht nur in Deutschland zu beobachtende Abkehr von der Kostenerstattung hin zu Vergütungsformen mit mehr Kostenverantwortung für den Arzt zielt vornehmlich auf eine Ressourceneinsparung. Da sie zugleich aber das Sorgfaltsniveau bedroht, sollte ein geeigneter Haftungsanreiz bestehen. Im vorliegenden Papier beschreibe ich unter prospektiver Vergütung sowie den realistischen Annahmen von Haftungsunsicherheit und Unterschieden zwischen den Ärzten in der Sorgfaltswaltung einen wohlfahrtsoptimalen Sorgfaltsstandard. Dieser entscheidet unter dem herrschenden Verschuldensprinzip über die Verurteilung eines Arztes zu Schadensersatz und definiert damit den Haftungsanreiz. Es erweist sich, dass der Standard in Abhängigkeit von den Eigenschaften der Ärzte, der Wahrscheinlichkeit gerichtlicher Fehlentscheidungen und der relativen gesellschaftlichen Belastung durch Fahrlässigkeit und Defensivmedizin größer oder kleiner als das Wohlfahrtsoptimum unter Sicherheit ist. Dieses Ergebnis steht im Kontrast zu Empfehlungen von Experten, die in Anbetracht eines steigenden Haftungsdrucks eine Absenkung der Sorgfaltsanforderungen befürworten.Optimally designed reimbursement and liability rules lead physicians to practice efficiently and carefully. The introduction of supply-side cost sharing in Germany and elsewhere should therefore be complemented by an appropriate liability incentive. Otherwise, resources are used efficiently but the level of care is too low. Under the assumptions of liability uncertainty and heterogeneous physicians I derive an optimal standard of due care. In deciding whether a physician acted negligently or not, the standard defines the liability threat of the negligence rule. Dependent on the distribution of physicians' types, probabilities of type one and type two errors in courts' judgments, and society's costs of negligence and defensive medicine, this second-best standard may well be above the first-best level of care. In contrast, medico-legal experts currently plead for a decrease of the standard of due care to cope with an increase of liability threat