Impact of DOTS expansion on tuberculosis related outcomes and costs in Haiti

BACKGROUND: Implementation of the World Health Organization's DOTS strategy (Directly Observed Treatment Short-course therapy) can result in significant reduction in tuberculosis incidence. We estimated potential costs and benefits of DOTS expansion in Haiti from the government, and societal perspectives. METHODS: Using decision analysis incorporating multiple Markov processes (Markov modelling), we compared expected tuberculosis morbidity, mortality and costs in Haiti with DOTS expansion to reach all of the country, and achieve WHO benchmarks, or if the current situation did not change. Probabilities of tuberculosis related outcomes were derived from the published literature. Government health expenditures, patient and family costs were measured in direct surveys in Haiti and expressed in 2003 US$. RESULTS: Starting in 2003, DOTS expansion in Haiti is anticipated to cost$4.2 million and result in 63,080 fewer tuberculosis cases, 53,120 fewer tuberculosis deaths, and net societal savings of $131 million, over 20 years. Current government spending for tuberculosis is high, relative to the per capita income, and would be only slightly lower with DOTS. Societal savings would begin within 4 years, and would be substantial in all scenarios considered, including higher HIV seroprevalence or drug resistance, unchanged incidence following DOTS expansion, or doubling of initial and ongoing costs for DOTS expansion. CONCLUSION: A modest investment for DOTS expansion in Haiti would provide considerable humanitarian benefit by reducing tuberculosis-related morbidity, mortality and costs for patients and their families. These benefits, together with projected minimal Haitian government savings, argue strongly for donor support for DOTS expansion

A rum deal: The purser’s measure and accounting control of materials in the Royal Navy, 1665–1832

We draw on archival resources and maritime and accounting history literature to explore the role of Royal Navy (RN) pursers between 1665 and 1832. Through an agency theory lens, we investigate accounting-related practices pursers used to control consumable rations, including the ‘purser’s (short) measure.’ The records pursers were required to keep suggest that the RN was at the forefront of the development of cost and materials accounting, and in the keeping of detailed accounting records. We provide fresh insights in to the purser’s role and his association with the gestation of materials waste controls, standard costing, and audit and accountability processes

Moral choice in an agency framework: The search for a set of motivational typologies

Moral choice, as a precursor to behaviour, has an important influence on the success or failure of business entities. According to Rest, 1983, Morality, Moral Behavior and Moral Development (John Wiley & Sons, New York), moral choice is prompted, amongst other things, by a motivational component. With this in mind, data obtained from a sample of four hundred financial sector operatives, employed in a rapidly developing region of China, was used to construct a relatively stable set of motivational typologies which could be used to predict choice within an agency-based context. A non-egoist version of the agency theory was developed, which permitted the modelling of alternative heuristic patterns. Altruists and persons identified as bordering on the verge of being classified as psychological egoists, refused to reorganize their motives when responding to a problem that included both moral hazard and adverse selection criteria. It was also possible to identify certain personal and contextual issues which discriminated between the typologies

Reexamining the Expected Effect of Available Resources and Firm Size on Firm Environmental Orientation: An Empirical Study of UK Firms

An emergent body of literature examined why some firms apply some environmental initiatives while other firms do not take responsibility for their natural environment? Thus, firm environmental orientation (responsiveness and performance) are linked in the literature to several variables. Unfortunately, the relationship between firm environmental orientation and either available resources or firm size showed mixed results and inconclusive evidence. Therefore, the aim of this paper is to show empirically how available resources and firm size can explain differences in firm environmental responsiveness and environmental performance. Econometric results of environmental responsiveness using the logistic regression model demonstrated that firm size does appear to add something unique in explaining differences in environmental responsiveness while available resource can be safely dropped from the model. However, econometric analysis of environmental performance using the maximum-likelihood random effects model showed strong evidence that available resources and firm size are significant predictors of firm environmental performance. Copyright Springer 2006available resources, environmental orientation, environmental performance, environmental responsiveness, firm size, logistic regression, nested models, random effects model,