Healthcare consumers’ sensitivity to costs: a reflection on behavioural economics from an emerging market

Decision-making regarding healthcare expenditure hinges heavily on an individual's health status and the certainty about the future. This study uses data on propensity of general health exam (GHE) spending to show that despite the debate on the necessity of GHE, its objective is clear—to obtain more information and certainty about one’s health so as to minimise future risks. Most studies on this topic, however, focus only on factors associated with GHE uptake and overlook the shifts in behaviours and attitudes regarding different levels of cost. To fill the gap, this study analyses a dataset of 2068 subjects collected from Hanoi (Vietnam) and its vicinities using the baseline-category logit method. We evaluate the sensitivity of Vietnamese healthcare consumers against two groups of factors (demographic and socioeconomic-cognitive) regarding payment for periodic GHE, which is not covered by insurance. Our study shows that uninsured, married and employed individuals are less sensitive to cost than their counterparts because they value the information in reducing future health uncertainty. The empirical results challenge the objections to periodic health screening by highlighting its utility. The relevance of behavioural economics is further highlighted through a look at the bounded rationality of healthcare consumers and private insurance companies in using and providing the service, respectively

an analysis of current capacity, needs and barriers

Background In times of increasing global challenges to health, it is crucial to create a workforce capable of tackling these complex issues. Even though a lack of GHE in Germany is perceived by multiple stakeholders, no systematic analysis of the current landscape exists. The aim of this study is to provide an analysis of the global health education (GHE) capacity in Germany as well as to identify gaps, barriers and future strategies. Methods An online search in combination with information provided by student representatives, course coordinators and lecturers was used to create an overview of the current GHE landscape in Germany. Additionally, a semi-structured questionnaire was sent to GHE educators and students engaged in global health (GH) to assess the capacity of German GHE, its barriers and suggested strategies for the future. Results A total of 33 GHE activities were identified at 18 German universities. Even though medical schools are the main provider of GHE (42%), out of 38 medical schools, only 13 (34%) offer any kind of GHE. Modules offered for students of other health-related professions constitute 27% of all activities. Most survey respondents (92%, n = 48) consider current GHE activities in Germany insufficient. Suggested formats were GHE as part of medical curricula (82%, n = 45) and dual degree MD/MPH or PhD programs. Most important barriers mentioned were low priority of GH at faculties and academic management levels (n = 41, 75%) as well as lack of necessary institutional structures (n = 33, 60%). Conclusions Despite some innovative academic approaches, there is clearly a need for more systematic GHE in Germany. GHE educators and students can take an important role advocating for more awareness at university management level and suggesting ways to institutionalize GHE to overcome barriers. This study provides key evidence, relevant perceptions and suggestions to strengthen GHE in Germany

Analysis of ground-source heat pumps in north-of-England homes

YesThe performance of Ground Source Heat Pump (GSHP) systems for domestic use is an increasing area of study in the UK. This paper examines the thermal performance of three bespoke shallow horizontal GSHP systems installed in newly built residential houses in the North of England against a control house which was fitted with a standard gas boiler. A total of 350 metres of High Density Polyethylene pipe with an external diameter of 40 mm was used for each house as a heat pump loop. The study investigated (i) the performance of a single loop horizontal Ground Heat Exchanger (GHE) against a double loop GHE and (ii) rainfall effects on heat extraction by comparing a system with an infiltration trench connected to roof drainage against a system without an infiltration trench above the ground loops. Parameters monitored for a full year from October 2013 to September 2014. Using the double GHE has shown an enhanced performance of up to 20% compared with single GHE. The infiltration trench is found to improve performance of the heat pumps; the double loop GHE system with an infiltration trench had a COP 5% higher than that of the double loop GHE system without a trench

On Hurst exponent estimation under heavy-tailed distributions

In this paper, we show how the sampling properties of the Hurst exponent methods of estimation change with the presence of heavy tails. We run extensive Monte Carlo simulations to find out how rescaled range analysis (R/S), multifractal detrended fluctuation analysis (MF-DFA), detrending moving average (DMA) and generalized Hurst exponent approach (GHE) estimate Hurst exponent on independent series with different heavy tails. For this purpose, we generate independent random series from stable distribution with stability exponent {\alpha} changing from 1.1 (heaviest tails) to 2 (Gaussian normal distribution) and we estimate the Hurst exponent using the different methods. R/S and GHE prove to be robust to heavy tails in the underlying process. GHE provides the lowest variance and bias in comparison to the other methods regardless the presence of heavy tails in data and sample size. Utilizing this result, we apply a novel approach of the intraday time-dependent Hurst exponent and we estimate the Hurst exponent on high frequency data for each trading day separately. We obtain Hurst exponents for S&P500 index for the period beginning with year 1983 and ending by November 2009 and we discuss the surprising result which uncovers how the market's behavior changed over this long period

Secondary students beliefs about, understandings of, and intentions to act regarding the greenhouse effect

The greenhouse effect (GHE) is a concern to everyone on this planet. To understand the GHE, students and citizens need an understanding of the chemical processes underlying this environmental phenomenon. Citizens need to be scientifically literate in relation to this phenomenon in order to participate in democratic decision-making and to take appropriate actions in their daily lives. As the GHE is a global issue it will require collective and individual actions to prepare for the likely climatic changes and to reduce the further impact of the GHE. This study focused on high school students\u27 beliefs about, understandings of the GHE and their intentions to act in ways that would reduce greenhouse gas emissions. Aspects of the GHE that are taught in high school science were also investigated. The study was conducted in five schools each in Western Australia (Australia) and Kerala (India) and data were collected from 438 Year 10 and 12 students representing compulsory and post-compulsory stages of education in both states. Two hundred and thirteen students from Western Australia and 225 students from Kerala completed a questionnaire and a sample of students and heads of science were interviewed. A Propositional Knowledge Statement (PKS) was developed, which is a set of propositions that outline science concepts necessary for an understanding of the GHE in terms of its causes, effects, mechanism and actions that can be taken to reduce greenhouse gas emission. In this study the PKS is considered to be the essential knowledge necessary to interpret the GHE, to take appropriate environmental action, and to make informed decisions as a scientifically literate member of society. The questionnaire and interviews were based on the PKS. The study revealed that high school students strongly believe that the GHE is real and affecting the climate at present and will also affect it in the future. They consider that the GHE is a relatively important social issue and they believe that governments should conduct programmes to raise community awareness and enact strict laws to reduce the release of greenhouse gases. Students\u27 understanding of the GHE is inadequate to make informed decisions and take appropriate environmental actions as a scientifically literate member of society. The majority of students and their families are already taking or are considering taking 10 accepted actions to reduce greenhouse gas emissions by household activities. The majority of students are not prepared to sacrifice their personal comforts or conveniences to reduce greenhouse gas emissions and they have strong reasons for that, however, they believe that governments should enact strict laws to reduce greenhouse gas emissions and should sign the Kyoto protocol. The GHE is not adequately represented in Western Australian and Kerala science and chemistry curricula. The heads of school science departments in Western Australia and Kerala consider that school science should do more to teach the GHE, as it is an important aspect of scientific literacy. An ideal scenario for students’ beliefs about, understanding of the GHE and commitments to take action that would enable individuals and communities to reduce greenhouse gas emission was developed based on the PKS and reports such as lPCC (2001), UNEP (2001), AGO (1999; 2000) and UN (1992). The actual scenario was based on the data from this study. The differences between ideal and actual scenarios were discussed and implications for improving education about the OHE were developed. Information about the curriculum and students\u27 sources of information about the GHE, students\u27 beliefs, understandings and intentions to act were mapped against the theory of reasoned action (Ajzen & Fishbein, 1980)

Regulating The Degree Of Contrast Enhancement In Global Histogram Equalization-Based Method For Grayscale Photo Processing

Global Histogram equalization (GHE) is a popular image contrast enhancement method. However, it is rarely used on photo processing because it tends to create noise-artifacts, especially in simple-structure-image. A few GHE-based methods have been proposed to address this issue but whether they are noise-artifacts-proof remains questionable. This is because the methods are fully automatic and the evaluation conducted was not comprehensive. A novel automatic GHE-based method called Minimum Mean Brightness Error Bi-Histogram Equalization (MMBEBHE) has been proposed in this thesis. It has been evaluated thoroughly together with the existing automatic methods. The results have proven that none of the automatic GHE-based methods is noise-artifacts-proof. The conclusion has motivated author to look into scalable GHE-based methods that allows user to regulate the degree of contrast enhancement. A novel scalable GHE-based method called Recursive Mean-Separate Histogram Equalization (RMSHE) has been proposed in this thesis. It has been evaluated thoroughly together with other two existing scalable methods - Clip Limited Adaptive HE (CLAHE) and Stark’s Adaptive HE (StarkAHE). The results of separate evaluations consistently showed that none of the three methods could effectively enhance the contrast of simple-structure-image without creating any noise-artifacts. Another novel scalable GHE-based method called Scalable Global Histogram Equalization with Selective Enhancement (SGHESE) has been developed then to overcome the limitation of the existing methods. Evaluation results showed that SGHESE could enhance the image’s contrast effectively without creating any noise-artifacts. The results of subjective evaluation involving human observer also showed that the preference level of SGHESE was significantly higher compared to those of other methods. Finally, the thesis recommends extending the study of SGHESE to color image processing because majority of the images nowadays are color images

Expanding Global Health Engagement through Multilateral Security Organization

IntroductionMany countries around the world employ defense capabilities in support of global health engagement (GHE) through bilateral and multilateral organizations. Despite this, there does not appear to be a strategic approach and implementation plan for U.S. DoD GHE in support of and through multilateral organizations. The purpose of this research is to identify which security multilateral organizations are engaged in GHE, as well as how and why. These findings could inform an interoperable approach for doing so going forward.MethodsA systematic review was conducted to develop a list of multilateral security organizations and agreements which engage in GHE, or could potentially play a role in GHE.ResultsOf the 3,488 agreements and organizations identified, 15 met the inclusion criteria. Among them, 87% (13/15) of the multilateral organizations are regional and 13% (2/15) are international, all established between 1948 and 2020. The 15 organizations cover all DoD Geographical Combatant Commands. Among them, 20% (3/15) are a legally binding alliance, 73% (11/15) have a treaty, and 7% (1/15) have a diplomatic partnership. Twenty percent (3/15) have an explicit intent to improve health in either their mission statement or as part of their goals, priorities, and/or objectives. Eighty percent (12/15) engage in at least two GHE domains outlined in DoD Policy, 67% in three (10/15), and 47% in all four (7/15). The most common domain is humanitarian assistance and foreign disaster response at 100% (15/15) and least common is Nuclear, Chemical, and Biological Defense Programs at 53% (8/15).ConclusionsAlthough there is high demand for GHE, resourcing to enable implementation has not been prioritized. Therefore, multilateral organizations continue to support what is funded (e.g., disaster response) versus prioritizing capacity building or modifying authorities and appropriations to match demand. It is also worth noting most organizations included in this review support the European theater aligning to historical defense priorities, versus emerging threats in the Indo-Pacific region. Identifying a forum within these multilateral institutions to convene GHE policy makers and practitioners is a logical next step. The forums could guide and direct priorities, devise solutions, and implement best practices. Near term efforts could include GHE financing, governance, assurance, and technical assistance within and across multilateral institutions. Recent efforts highlight growth in both interest and action to support the variety of GHE activities regionally and internationally. As the United States seeks to reinforce multilateral institutions and uphold the international and rules-based order, employing GHE through multilateral cooperation could buttress efforts. Now is a perfect time given the sustained interest in global health, amplified value of allies and partners, and renewed emphasis placed on multilateral cooperation for the DoD to design a multilateral GHE strategy and seek Congressional support to resource it accordingly

Color Histogram Diffusion for Image Enhancement

Various color histogram equalization (CHE) methods have been proposed to extend grayscale histogram equalization (GHE) for color images. In this paper a new method called histogram diffusion that extends the GHE method to arbitrary dimensions is proposed. Ranges in a histogram are specified as overlapping bars of uniform heights and variable widths which are proportional to their frequencies. This diagram is called the vistogram. As an alternative approach to GHE, the squared error of the vistogram from the uniform distribution is minimized. Each bar in the vistogram is approximated by a Gaussian function. Gaussian particles in the vistoram diffuse as a nonlinear autonomous system of ordinary differential equations. CHE results of color images showed that the approach is effective

Career choices and global health engagement: 24-year follow-up of U.S. participants in the Indiana University-Moi University elective

Background Global health experiences evoke a profound awareness of cultural differences, inspire learners to prioritize professional values, and provide a lens for addressing global health care challenges. This study compares the long-term career and practice choices of participants in a 2-month Indiana University-Moi University, Kenya elective from 1989–2013 with those of a control group. Methods Global health elective (GHE) participants and a random sample of alumni without GHE experience were surveyed on their clinical practice, public health and global health activities. Results Responses from 176 former participants were compared with a control group of 177 alumni. GHE participants were more likely than similar controls to provide care to underserved U.S. populations (p=0.037), spend time in global health, public health, and public policy activities (p=0.005) and be involved in global health advocacy (p=0.001). Using multivariable analysis, GHE participants were more likely to be generalists (p<0.05), report that healthcare costs influenced medical decision-making (p<0.05), and provide healthcare outside the U.S. for ≥1 week/year (p<0.001). Conclusions Many years out of training, GHE participants were more likely to be generalists working with underserved populations, to be cost-conscious in their healthcare decision-making, and to be involved in global health, public health or public policy. Implications With the primary care provider shortage and need for greater awareness among providers of healthcare costs, our study shows that that global health experiences may yield broader benefits to the U.S. medical system