Using a multi-level tailored design process to develop a customer satisfaction survey for university evaluation

A multi-level procedure is described in order to develop a total quality management survey tool in the field of engineering academia. As a first step a review of available evaluation tools for universities is conducted, resulting in over 150 items used for evaluation purposes. Secondly all dimensions of educational evaluation used in previous research are summarized, resulting in 15 dimensions. In a third step, items are assigned to the dimensions, overlapping items were combined or removed, and item content and dimensions were adjusted to the specific conditions of the target faculty. Fourthly, the resulting twelve dimensions were used in first, investigative interviews in the target population. Results indicate that eleven dimensions sufficiently mapped all aspects of evaluation. After revising the items to improve understanding in a fifth step cognitive pretests were conducted. The final revision resulted in 83 items assigned to eleven dimensions

Impact of smoking on health system costs among cancer patients in a retrospective cohort study in Ontario, Canada

Objective Smoking is the main modifiable cancer risk factor. The objective of this study was to examine the impact of smoking on health system costs among newly diagnosed adult patients with cancer. Specifically, costs of patients with cancer who were current smokers were compared with those of non-smokers from a publicly funded health system perspective. Methods This population-based cohort study of patients with cancer used administrative databases to identify smokers and non-smokers (1 April 2014-31 March 2016) and their healthcare costs in the 12-24 months following a cancer diagnosis. The health services included were hospitalisations, emergency room visits, drugs, home care services and physician services (from the time of diagnosis onwards). The difference in cost (ie, incremental cost) between patients with cancer who were smokers and those who were non-smokers was estimated using a generalised linear model (with log link and gamma distribution), and adjusted for age, sex, neighbourhood income, rurality, cancer site, cancer stage, geographical region and comorbidities. Results This study identified 3606 smokers and 14 911 non-smokers. Smokers were significantly younger (61 vs 65 years), more likely to be male (53%), lived in poorer neighbourhoods, had more advanced cancer stage,and were more likely to die within 1 year of diagnosis, compared with non-smokers. The regression model revealed that, on average, smokers had significantly higher monthly healthcare costs ($5091) than non-smokers ($4847), p<0.05. Conclusions Smoking status has a significant impact on healthcare costs among patients with cancer. On average, smokers incurred higher healthcare costs than non-smokers. These findings provide a further rationale for efforts to introduce evidence-based smoking cessation programmes as a standard of care for patients with cancer as they have the potential not only to improve patients' outcomes but also to reduce the economic burden of smoking on the healthcare system

Estimates and predictors of health care costs of esophageal adenocarcinoma : A population-based cohort study

Background: Esophageal adenocarcinoma (EAC) incidence is increasing rapidly. Esophageal cancer has the second lowest 5-year survival rate of people diagnosed with cancer in Canada. Given the poor survival and the potential for further increases in incidence, phase-specific cost estimates constitute an important input for economic evaluation of prevention, screening, and treatment interventions. The study aims to estimate phase-specific net direct medical costs of care attributable to EAC, costs stratified by cancer stage and treatment, and predictors of total net costs of care for EAC. Methods: A population-based retrospective cohort study was conducted using Ontario Cancer Registry-linked administrative health data from 2003 to 2011. The mean net costs of EAC care per 30 patient-days (2016 CAD) were estimated from the payer perspective using phase of care approach and generalized estimating equations. Predictors of net cost by phase of care were based on a generalized estimating equations model with a logarithmic link and gamma distribution adjusting for sociodemographic and clinical factors. Results: The mean net costs of EAC care per 30 patient-days were $1016 (95$955-$1078) in the initial phase,$669 (95% CI, $594-$743) in the continuing care phase, and $8678 (95$8217-$9139) in the terminal phase. Overall, stage IV at diagnosis and surgery plus radiotherapy for EAC incurred the highest cost, particularly in the terminal phase. Strong predictors of higher net costs were receipt of chemotherapy plus radiotherapy, surgery plus chemotherapy, radiotherapy alone, surgery alone, and chemotherapy alone in the initial and continuing care phases, stage III-IV disease and patients diagnosed with EAC later in a calendar year (2007-2011) in the initial and terminal phases, comorbidity in the continuing care phase, and older age at diagnosis (70-74 years), and geographic region in the terminal phase. Conclusions: Costs of care vary by phase of care, stage at diagnosis, and type of treatment for EAC. These cost estimates provide information to guide future resource allocation decisions, and clinical and policy interventions to reduce the burden of EAC

Method to compute the stress-energy tensor for the massless spin 1/2 field in a general static spherically symmetric spacetime

A method for computing the stress-energy tensor for the quantized, massless, spin 1/2 field in a general static spherically symmetric spacetime is presented. The field can be in a zero temperature state or a non-zero temperature thermal state. An expression for the full renormalized stress-energy tensor is derived. It consists of a sum of two tensors both of which are conserved. One tensor is written in terms of the modes of the quantized field and has zero trace. In most cases it must be computed numerically. The other tensor does not explicitly depend on the modes and has a trace equal to the trace anomaly. It can be used as an analytic approximation for the stress-energy tensor and is equivalent to other approximations that have been made for the stress-energy tensor of the massless spin 1/2 field in static spherically symmetric spacetimes.Comment: 34 pages, no figure

Angiopoietin-2 confers Atheroprotection in apoE-/- mice by inhibiting LDL oxidation via nitric oxide

Atherosclerosis is promoted by a combination of hypercholesterolemia and vascular inflammation. The function of Angiopoietin (Ang)-2, a key regulator of angiogenesis, in the maintenance of large vessels is unknown. A single systemic administration of Ang-2 adenovirus (AdAng-2) to apoE-/- mice fed a Western diet significantly reduced atherosclerotic lesion size 8 40%) and oxidized LDL and macrophage content of the plaques. These beneficial effects were abolished by the inhibition of nitric oxide synthase (NOS). In endothelial cells, endothelial NOS activation per se inhibited LDL oxidation and Ang-2 stimulated NO release in a Tie2-dependent manner to decrease LDL oxidation. These findings demonstrate a novel atheroprotective role for Ang-2 when endothelial cell function is compromised and suggest that growth factors, which stimulate NO release without inducing inflammation, could offer atheroprotection

Model-assisted ultrasonic calibration using intentionally embedded defects for in-process weld inspection

Automated in-process Non-Destructive Testing (NDT) systems are rapidly gaining traction within the manufacturing industry as they reduce manufacturing time and costs. When considering calibration and verification of such systems, creating defects of known geometry and nature during the deposition of a weld can: (I) help examine the capability of the automated system to detect and characterise defects, (II) be used to form a database of signals associated with different defect types to train intelligent defect classification algorithms, and (III) act as a basis for in-process gain calibration during weld inspection at high temperatures, where the ultrasound beam can be skewed as a result of velocity gradients. In view of this, this paper investigates two unique methodologies for introducing: (a) lack of fusion weld defects by embedding tungsten in the weld and (b) creating artificial weld cracks by quenching to imitate the real cracking scenarios. According to the results of Phased Array Ultrasound Testing (PAUT) inspections, the methodologies used for embedding the artificial defects were successful. The validity of inspections was also verified by extracting micrographs from the defective sections of the welds, and model-based simulations were carried out to gain a better understanding of the wave propagation path and interaction with the generated defects

Public Health and Cost Benefits of Successful Reperfusion After Thrombectomy for Stroke

Background and Purpose- The benefit that endovascular thrombectomy offers to patients with stroke with large vessel occlusions depends strongly on reperfusion grade as defined by the expanded Thrombolysis in Cerebral Infarction (eTICI) scale. Our aim was to determine the lifetime health and cost consequences of the quality of reperfusion for patients, healthcare systems, and society. Methods- A Markov model estimated lifetime quality-adjusted life years (QALY) and lifetime costs of endovascular thrombectomy-treated patients with stroke based on eTICI grades. The analysis was performed over a lifetime horizon in a United States setting, adopting healthcare and societal perspectives. The reference case analysis was conducted for stroke at 65 years of age. National health and cost consequences of improved eTICI 2c/3 reperfusion rates were estimated. Input parameters were based on best available evidence. Results- Lifetime QALYs increased for every grade of improved reperfusion (median QALYs for eTICI 0/1: 2.62; eTICI 2a: 3.46; eTICI 2b: 5.42; eTICI 2c: 5.99; eTICI 3: 6.73). Achieving eTICI 3 over eTICI 2b reperfusion resulted on average in 1.31 incremental QALYs as well as healthcare and societal cost savings of $10 327 and$20 224 per patient. A 10% increase in the eTICI 2c/3 reperfusion rate of all annually endovascular thrombectomy-treated patients with stroke in the United States is estimated to yield additional 3656 QALYs and save $21.0 million and$36.8 million for the healthcare system and society, respectively. Conclusions- Improved reperfusion grants patients with stroke additional QALYs and leads to long-term cost savings. Procedural strategies to achieve complete reperfusion should be assessed for safety and feasibility, even when initial reperfusion seems to be adequate

Shepherding sub-Saharan Africa's wildlife through peak anthropogenic pressure toward a green anthropocene

Sub-Saharan Africa’s (SSA’s) iconic biodiversity is of immense potential global value but is jeopardized by increasing anthropogenic pressures. Elevated consumption in wealthier countries and the demands of international corporations manifest in significant resource extraction from SSA. Biodiversity in SSA also faces increasing domestic pressures, including rapidly growing human populations. The demographic transition to lower fertility rates is occurring later and slower in SSA than elsewhere, and the continent’s human population may quadruple by 2100. SSA’s biodiversity will therefore pass through a bottleneck of growing anthropogenic pressures, while also experiencing intensifying effects of climate change. SSA’s biodiversity could be severely diminished over the coming decades and numerous species pushed to extinction. However, the prospects for nature conservation in SSA should improve in the long term, and we predict that the region will eventually enter a Green Anthropocene. Here, we outline critical steps needed to shepherd SSA’s biodiversity into the Green Anthropocene epoch.http://www.annualreviews.orgam2023Mammal Research InstituteZoology and Entomolog