Economic evaluation: what does a nurse manager need to know?

This paper considers how health economists can assist nurse managers, using the concepts and tools of economic evaluation. We aim to clarify these and also explode some of the myths about economic evaluation and its role in health care decision-making. Economic evaluation techniques compare alternative courses of action in terms of their costs and consequences. There are four principal methods; cost-minimization, cost-effectiveness, cost-utility and cost-benefit analysis, all of which synthesize costs and outcomes, at different levels of outcome. Economic evaluation is an intrinsic part of national decision-making about the efficient provision of effective treatments and services, and increasingly, organizational matters. In the UK, such technology evaluation is disseminated in guidelines from the National Institute for Clinical Effectiveness (NICE), having a top-down impact on the nurse manager. But economic evaluation is increasingly relevant to the nurse manager at local level, through newer techniques such as Programme Budgeting Marginal Analysis (PBMA), which facilitates explicit, transparent decisions, from the bottom-up. Nurse managers need to weigh up competing demands on resources and decide in ways which maximize health gain. Economic evaluation can help here because it presents evidence to challenge or support existing allocations, and provides a systematic framework to analyse health care decisions. In the current context of competition for scarce resources, we suggest that nurse managers need to embrace these techniques, or be marginalized from the resource allocation process

Currency Unions and International Integration

This paper characterizes the integration patterns of international currency unions (such as the CFA Franc zone and the East Caribbean Currency Area). We empirically explore different features of currency unions, and compare them both to countries with sovereign monies, and to regions within nations. We ask: are countries within international currency unions as integrated as regions within political unions? We do this by examining the criteria for Mundell's concept of an optimum currency area. We find that members of currency unions are more integrated than countries with their own currencies, but less integrated than regions within a country. For instance, we find that currency union members have more trade and less volatile real exchange rates than countries with their own monies, but less trade and more volatile exchange rates than regions within individual countries. Similarly, business cycles are more highly synchronized across currency union countries than across countries with sovereign monies, but not as synchronized as regions of a single country. Finally, currency union membership is not associated with significantly greater risk sharing, though risk sharing is widespread within countries.

Speculative Attacks on Pegged Exchange Rates: An Empirical Exploration with Special Reference to the European Monetary System

This paper presents an empirical analysis of speculative attacks on pegged exchange rates in 22 countries between 1967 and 1992. We define speculative attacks or crises as large movements in exchange rates, interest rates, and international reserves. We develop stylized facts concerning the univariate behavior of a variety of macroeconomic variables, comparing crises with periods of tranquility. For ERM observations we cannot reject the null hypothesis that there are few significant differences in the behavior of key macroeconomic variables between crises and non-crisis periods. This null can be decisively rejected for non-ERM observations, however. Precisely the opposite pattern is evident in the behavior of actual realignments and changes in exchange rate regimes. We attempt to tie these findings to the theoretical literature on balance of payments crises.

Contagious Currency Crises

This paper is concerned with the fact that the incidence of speculative attacks tends to be temporally correlated; that is, currency crises appear to pass contagiously from one country to another. The paper provides a survey of the theoretical literature, and analyzes the contagious nature of currency crises empirically. Using thirty years of panel data from twenty industrialized countries, we find evidence of contagion. Contagion appears to spread more easily to countries which are closely tied by international trade linkages than to countries in similar macroeconomic circumstances.

Informed Consent and the Research Process: Following Rules or Striking Balances?

Gaining informed consent from people being researched is central to ethical research practice. There are, however, several factors that make the issue of informed consent problematic, especially in research involving members of groups that are commonly characterised as \'vulnerable\' such as children and people with learning disabilities. This paper reports on a project funded by the UK Economic and Social Research Council (ESRC) which was concerned to identify and disseminate best practice in relation to informed consent in research with six such groups. The context for the study is the increased attention that is being paid to the issue of informed consent in research, not least because of the broad changes taking place in research governance and regulation in the UK. The project involved the analysis of researchers\' views and experiences of informed consent. The paper focuses on two particular difficulties inherent in the processes of gaining and maintaining informed consent. The first of these is that there is no consensus amongst researchers concerning what comprises \'informed consent\'. The second is that there is no consensus about whether the same sets of principles and procedures are equally applicable to research among different groups and to research conducted within different methodological frameworks. In exploring both these difficulties we draw on our findings to highlight the nature of these issues and some of our participants\' responses to them. These issues have relevance to wider debates about the role of guidelines and regulation for ethical practice. We found that study participants were generally less in favour of guidelines that regulate the way research is conducted and more in favour of guidelines that help researchers to strike balances between the conflicting pressures that inevitably occur in research.Informed Consent; Research Ethics; Regulation of Research; Research Governance; Professional Guidelines

Development of a high-voltage laser triggered switch facility including initial optical and electrical diagnostics

2019 Fall.Includes bibliographical references.Pulsed power programs have been part of the United States strategic plan to address the nation's energy and defense needs since the 1960s. With escalating energy demand, one of the greatest challenges of our time is to develop clean and reliable energy sources with controlled fusion being an exciting and favorable candidate. Developing this technology has been an arduous and taxing effort with a breakthrough (supposedly) coming just around the corner for decades. Arguably, one of the leading testbeds for fusion research is Sandia National Laboratories (SNL) Z machine which is part of SNL's pulsed power program. The Z machine can create fusion-like conditions and allows the global research community to investigate pathways forward to a viable fusion reactor. Integral to developing future pulsed power technology and the next Z-pinch style machines, high voltage spark gap switches are an active research area and the focus of this thesis. Partnering with SNL this body of work details our efforts to develop a high voltage laser triggered switch facility at Colorado State University (CSU). We present the design and development of the Pulsed Power and Plasma Science Center (P3SC) along with preliminary diagnostic measurements of a millimeter gap length optically accessible high-voltage laser triggered switch (HV-LTS). The current thrust of the P3SC laboratory is to investigate switch closure plasma characteristics associated with recently discovered gaps in the Tom Martin switch model which describes temporal plasma channel resistance of these HV-LTSs. Basic background and theory of the Martin model are discussed including laying out two key assumptions we believe are related to the error recently found. Specifically, radial switch closure plasma channel growth fits an Atk trend (A and K are constants), and constant electrical conductivity are assumed both spatially and temporally. Considering extremely high voltages and nanosecond timescales of switch closure, direct measurements of these characteristics are extremely difficult. Therefore, we present contact and non-contact optical measurements that can be utilized to help inform the assumptions laid out herein. Specifically, a current viewing resistor (CVR) that was designed to withstand peak energies involved during switch closure was used to directly measure voltage, and subsequent current, associated with switch closure. CVR measurements along with triggering data allowed for determination of essential electrical characteristics common for HV-LTS technology. With knowledge of these macroscopic electrical characteristics a non-contact optical measurement scheme was devised to investigate switch closure plasma's more closely, including schlieren imaging and optical emission spectroscopy (OES). Specifically, temporal mapping of the switch closure plasma channel through direct imaging allows for characterization of radial growth (first assumption), and OES can be used to calculate electron temperatures which can be related to the electrical conductivity (second assumption). Given this backdrop we present key electrical characteristics on an optically accessible HV-LTS including: self-break behavior, switch run time, jitter, and equivalent circuit resistance and inductance. Further, radial plasma growth is measured (from intensified camera images) and found to agree with the Martin model assumptions, albeit with variability yielding a potential error in calculated resistance of ~15%. OES of switch closure plasmas are also recorded and show the spectra to be dominated by continuum at early times with emission lines becoming visible at ~200 ns after a 25 kV shot and ~500 ns after a 50 kV shot. This data, to the best of the author's knowledge, represents the first publication of HV-LTS emission spectra. With this data we have shown that the electrical conductivity assumption is the most likely cause of the error found in the Martin model. Continued investigation is warranted, and a more robust optical measurement like Thomson scattering is being considered to inform the Martin model and more generally the next generation of pulsed power technolog