Doctors at Risk: A Problem As Viewed by Decision Analysis

The authors closely analyze a case in which a Peer Review Organization cited a physician for treatment with potential for significant adverse effect. They also critique the regulatory scheme under which peer review occurs and conclude that such regulation interferes with physicians\u27 primary obligations, fails to encourage cost-effective behavior and may decrease the quality of medical care

Environmental Performance Index for the Forest

Comparative environmental performance indices for energy use, global warming potential (GWP), air, water, and solid waste emissions covering the stages of processing from the harvesting of wood and the extraction of non-renewable materials to the construction of a house using different materials are developed in other articles. Developing performance indices that compare renewable resources and their environmental impacts on the land base to the depletion of non-renewable resources is problematic. Materials that involve mining are inherently not renewable compared to forest resources, which are renewable over some rotation age of the forest. The environmental impacts on the forest are dynamic and are impacted by landscape changes with some related to the production of wood for markets. Forest ecology metrics are developed to show the impact of management alternatives based on changing stand structures. Forest diversity, measured by structure classes, is impacted by longer rotation and thinning alternatives as well as preservation and protection policies.Management alternatives can contribute to some restoration of pre-settlement conditions of forests and provides a benchmark from which to evaluate reduced stand structure diversity and loss of habitat. While a century of commercial management has reduced the diversity in the forest and in particular has increased the share of acres in both the stand initiation stage and the closed canopy or stem exclusion stage, the trend has already turned in response to demands for more forest acres under increased protection and preservation status. Increased thinning from more intensive management and policies to protect threatened species are both contributing to increased understory reinitiation and ultimately more complex old forest structures. Longer rotation management could add to this effect but at a substantial cost since the economics of long rotation management falls below acceptable levels for economic investments

Life-Cycle Impacts of Forest Resource Activities in the Pacific Northwest and Southeast United States

A more intensive management alternative was created for each region by reallocating acres to higher management intensity classes. Harvesting activities were segmented into five stages to allow development of all inputs and outputs: (1) felling, (2) processing (bucking, limbing, cutting to length), (3) secondary transportation (skidding and yarding), (4) loading, and (5) hauling to a process point. The costs and consumption rates of energy and materials for these activities drove the log outputs, emissions, and carbon pools. Logs are allocated to wood product facilities, the primary product of the analysis, or pulp and paper mills as a co-product from the forest. Non-merchantable slash is generally left on site and is disposed of through site preparation activities. Transportation-related activities and the required diesel fuel produce by far the largest contribution to emission outputs. However, fertilizer use contributes to much of the change in emissions as acreage shifts to higher intensity management alternatives

Costs of alternative treatments for incomplete abortion

Unsafely performed abortion is one of the five leading causes of maternal deaths worldwide. Many women who have undergone unsafe abortions enter the healthcare system to seek help for the resulting complications, including incomplete abortion. This human and financial cost of this health problem is tremendous, especially in the developing world. This study examined the potential for reducing costs to healthcare systems by changing the standard method of treatment for incomplete abortion. Vacuum aspiration (VA) has been shown to be safer than dilation and curettage (D&C) for uterine evacuation; the World Health Organization includes VA as an essential service at the first referral level. The technique most commonly used for treating first-trimester incomplete abortion in developing countries, however, is D&C. This study examined the hypothesis that use of manual vacuum aspiration (MVA) - a variation of VA - would be less costly than D&C and thus advantageous to healthcare systems with limited resources. The purpose of the study was to identify and, where possible, to explain the factors that contributed to cost differences between MVA and D&C for treatment of first-trimester incomplete abortion. To achieve this objective, researchers observed patient management and documented resource use at hospital sites in Ecuador, Kenya, and Mexico. In most cases, treatment with MVA required a shorter patient stay and fewer hospital resources than D&C, as the two techniques were practiced at the various study sites. The policy decision to adopt MVA, supported by procurement of instruments and incorporation of training in its use, is the chief prerequisite for achieving these improvements. But the full advantages of MVA are realized only if it is introduced in conjunction with certain changes in patient-management practices, such as offering outpatient treatment of incomplete abortion. Further, decentralizing MVA services can maximize the benefits of the technique, facilitating (hospitals'and) healthcare systems'efforts to decrease the cost of delivery service and improve the quality of care.Health Monitoring&Evaluation,Gender and Health,Health Systems Development&Reform,Information Technology,Business Environment

Motor development in children at-risk of autism: A follow-up study of infant siblings.

Recently, evidence of poor or atypical motor skills in autism spectrum disorder has led some to argue that motor impairment is a core feature of the condition. The current study uses a longitudinal prospective design to assess the development of motor skills of 20 children at increased risk of developing autism spectrum disorder, who were recruited and tested at 9 and 40 months of age, on the basis of having an older sibling diagnosed with the condition. All children completed a range of motor, face processing, IQ and diagnostic assessments at a follow-up visit (aged 5–7 years), providing a detailed profile of development in this group from a number of standardised, parental report and experimental measures. A higher proportion of children than expected demonstrated motor difficulties at the follow-up visit and those highlighted by parental report as having poor motor skills as infants and toddlers were also more likely to have lower face processing scores and elevated autism-related social symptoms at 5–7 years, despite having similar IQ levels. These data lend support to the argument that early motor difficulties may be a risk factor for later motor impairment as well as differences in social communication and cognition, traits that are related to autism spectrum disorder

Distance determination to 12 Type II-P Supernovae using the Expanding Photosphere Method

We use early-time photometry and spectroscopy of 12 Type II plateau supernovae (SNe IIP) to derive their distances using the expanding photosphere method (EPM). We perform this study using two sets of Type II supernova (SN II) atmosphere models, three filter subsets ($\{BV\}$, $\{BVI\}$, $\{VI\}$), and two methods for the host-galaxy extinction, which leads to 12 Hubble diagrams. We find that systematic differences in the atmosphere models lead to $\sim$50% differences in the EPM distances and to a value of ${\rm H_0}$ between 52 and 101 ${\rm km s^{-1} Mpc^{-1}}$. Using the $\{VI\}$ filter subset we obtain the lowest dispersion in the Hubble diagram, {${\rm \sigma_{\mu} = 0.32}$ mag}. We also apply the EPM analysis to the well-observed SN IIP 1999em. With the $\{VI\}$ filter subset we derive a distance ranging from 9.3 $\pm$ 0.5 Mpc to 13.9 $\pm$ 1.4 Mpc depending on the atmosphere model employed.Comment: Accepted for publication in the Astrophysical Journa

Examining sense of belonging among first-year undergraduates from different racial/ethnic groups

This study examined sense of belonging among a national sample of 2,967 first-year students. Guided by the work of Hurtado and Carter (1997), relationships between several aspects of the college environment and sense of belonging were examined. Findings indicated that African American, Hispanic/Latino, and Asian Pacific American students reported a less strong sense of belonging than White/Caucasian students. The social dimensions of the transition to college and residence hall climate and perceptions of the campus racial climate had strong significant relationships to students' sense of belonging. Implications for practice and future research are discussed

Life-Cycle impacts of Inland Northwest and Northeast/North central forest resources

Determining the life-cycle inventory (LCI) and impact of forest harvest, regeneration, and growth is necessary in conducting a life-cycle assessment of wood products. This publication provides quantitative assessments of the economic and environmental impacts of forest management activities covering portions of the Inland Northwest (INW), including Montana, Idaho, and eastern Washington, and of the Northeastern and North Central (NE/NC) forests from Minnesota to Maine and south as far as Missouri, West Virginia, and Pennsylvania. The management scenarios provide the inputs needed to develop an LCI on all the inputs and outputs for wood products as impacted by forest treatments and the harvesting of logs in the region. Productive timberlands were grouped according to forest type, productivity, management intensity, and ownership into three broad forest types in the west: cold, dry, and moist; and four in the east: spruce/fir, northern hardwoods, oak/hickory, and aspen/birch. Spruce/fir represented the feedstock to softwood lumber and a composite of northern hardwoods and oak/hickory the feedstock to hardwood lumber. Simulations used the US Forest Service Forest Vegetation Simulator to estimate standing and harvested biomass and log volumes passed on as resources to the manufacturing segments for lumber, plywood, or oriented strandboard. The combinations of ownership, management intensity, and forest type were stratified and averaged to produce a single estimate of yield and the corresponding harvesting impacts. Both historic harvest rates and increased management intensity scenarios were simulated for each region. In the INW, the shift to the higher intensity scenario increased the average production of merchantable volume at harvest to 249 - 399 m3/ha when averaged across the forested land in each ownership class. For the NE/NC region, the production of merchantable volume averaged 263 m3/ha for softwood and 328 m3/ha for hardwood forests with an insignificant volume response from shifting land into more intensive management. Average growth varied widely for INW forest categories from a low on federal land for the base case of 0.7 - 6.7 m3/haha·yr for moist state and private land under the intensive management alternative. Current condition estimates of softwood log and bark carbon exported for mill processing in the INW and NE/NC regions were 751 and 988 kg/ha·yr, respectively