scholarly journals The Trade-Off between Optimizing Flight Patterns and Human Health: A Case Study of Aircraft Noise in Queens, NY, USA

2018 ◽  
Vol 15 (8) ◽  
pp. 1753 ◽  
Author(s):  
Zafar Zafari ◽  
Boshen Jiao ◽  
Brian Will ◽  
Shukai Li ◽  
Peter Muennig
Keyword(s):  
Indirect Costs ◽  
Ground Level ◽  
Status Quo ◽  
Current Status ◽  
Decision Analytic Model ◽  
Health States ◽  
Life Years ◽  
Automation Systems ◽  
The U.S

Objectives: Airports in the U.S. have gradually been transitioning to automated flight systems. These systems generate new flight paths over populated areas. While they can improve flight efficiency, the increased noise associated with these novel flight patterns potentially pose serious health threats to the overflown communities. In this case study, we estimated the monetary benefits relative to health losses associated with one significant change in flight patterns at LaGuardia Airport, year-round use of “TNNIS Climb”, which happened in 2012 as a result of flight automation in New York City. Prior to that, the use of the TNNIS Climb was limited to the U.S. Open tennis matches. Methods: We developed a decision-analytic model using Markov health states to compare the costs and quality-adjusted life years (QALYs) gained associated with the limited use of TNNIS (old status quo) and the year-round use of TNNIS (current status quo). The TNNIS Climb increases airplane noise to above 60 decibels (dB) over some of the most densely populated areas of the city. We used this increased exposure to noise as the basis for estimating ground-level health using data from sound monitors. The total costs (including both direct and indirect costs), QALYs, and the incremental cost-effectiveness ratio (ICER) were estimated for the limited versus the year-round use of the TNNIS Climb. Results: The incremental lifetime costs and QALYs per person exposed to noise associated with the limited versus the year-round use of TNNIS was $11,288, and 1.13, respectively. Therefore, the limited use of TNNIS had an ICER of $10,006/QALY gained relative to the year-round of TNNIS. Our analyses were robust to changes in assumptions and data inputs. Conclusions: Despite increases in efficiency, flight automation systems without a careful assessment of noise might generate flight paths over densely populated areas and cause serious health conditions for the overflown communities.

scholarly journals Should the Government Be Allowed to Take Control over Your Car as Part of a Disaster Management Plan?

2020 ◽  
Vol 17 (21) ◽  
pp. 7780
Author(s):  
Yipeng Lv ◽  
Zafar Zafari ◽  
Boshen Jiao ◽  
Casey Chun ◽  
Lulu Zhang ◽  
...  
Keyword(s):  
Markov Model ◽  
Incremental Cost ◽  
Autonomous Vehicles ◽  
Credible Interval ◽  
The United States ◽  
Status Quo ◽  
Health States ◽  
Life Years ◽  
Hypothetical Scenario ◽  
The Government

Introduction: With the Safety Ensuring Lives Future Deployment and Research in Vehicle Evolution (SELF DRIVE) Act in the United States, there is a growing interest in autonomous vehicles (AVs). One avenue of innovation would be to use them to mobilize and coordinate response efforts during natural disasters. This study uses an earthquake response in an urban, developed setting as a hypothetical example case study. In this hypothetical scenario, private AVs would be mobilized to help rescue victims from collapsed structures. Methods: A Markov model compared an intervention arm with AVs to a status quo arm using a hypothetical cohort of American earthquake victims. The three possible health states were trapped but alive, rescued and alive, and dead. The cycle length of the Markov model was 6 h. Results: The cost of deploying AVs was $90,139 relative to $87,869 in status quo arm. Using AVs produced an incremental cost of $2269 (95% credible interval (CI) = $−12,985–$8959). Victims have 7.33 quality-adjusted life years (QALYs) in the intervention arm compared to 7.20 QALYs in the status quo arm, resulting in an incremental gain of 0.13 (95% CI = −0.73–2.19) QALYs. The incremental cost-effectiveness ratio (ICER) was $16,960/QALY gained (95% CI = cost-saving–$69,065/QALY). Discussion: The mobilization of private AVs in the setting of an earthquake has the potential to save money and reduce the loss of life. AVs may advance emergency management competencies.

scholarly journals Deceased donor kidney allocation : an economic evaluation of contemporary longevity matching practices

2020 ◽  
Author(s):  
Sameera Senanayake ◽  
Nicholas Graves ◽  
Helen Healy ◽  
Keshwar Baboolal ◽  
Adrian Barnett ◽  
...  
Keyword(s):  
Risk Index ◽  
Deceased Donor ◽  
Base Case ◽  
Decision Analytic Model ◽  
Donor Kidney ◽  
Health States ◽  
Kidney Allocation ◽  
Australian Health ◽  
Life Years ◽  
The Impact

Abstract Background: Matching survival of a donor kidney with that of the recipient (longevity matching), is use in some kidney allocation systems to maximize graft-life years. It is not part of the allocation algorithm for Australia. Given the growing evidence of survival benefit due to longevity matching based allocation algorithms, development of a similar kidney allocation system for Australia is currently underway. The aim of this research is to estimate the impact that changes to costs and health outcomes arising from ‘longevity matching’ on the Australian healthcare system. Methods: A decision analytic model to estimate cost-effectiveness was developed using a Markov process. Four plausible competing allocation options were compared to the current kidney allocation practice. Models were simulated in one-year cycles for a 20-year time horizon, with transitions through distinct health states relevant to the kidney recipient. Willingness to pay was considered as AUD 28000. Results: Base case analysis indicated that allocating the worst 20% of Kidney Donor Risk Index (KDRI) donor kidneys to the worst 20% of estimated post-transplant survival (EPTS) recipients (option 2) and allocating the oldest 25% of donor kidneys to the oldest 25% of recipients are both cost saving and more effective compared to the current Australian allocation practice. Option 2, returned the lowest costs, greatest health benefits and largest gain to net monetary benefits (NMB). Allocating the best 20% of KDRI donor kidneys to the best 20% of EPTS recipients had the lowest expected incremental NMB. Conclusion: Of the four longevity-based kidney allocation practices considered, transplanting the lowest quality kidneys to the worst kidney recipients (option 2), was estimated to return the best value for money for the Australian health system.

The Changing Landscape of Journalism Education in China

2017 ◽  
Vol 72 (3) ◽  
pp. 297-305 ◽  
Author(s):  
Ke Guo ◽  
Peiqin Chen
Keyword(s):  
New Media ◽  
Status Quo ◽  
Current Status ◽  
Journalism Education ◽  
Media Environment ◽  
National Education ◽  
National Education System ◽  
Education In China ◽  
The U.S ◽  
Soviet Model

Journalism education in China can be traced back to the U.S. tradition of the 1920s and was influenced by the Soviet model in the 1950s. Although it has become very Chinese ever since, journalism education in China fluctuates between the two lines represented by the U.S. tradition and the Soviet model. This article hopes to expound upon the current status quo of journalism education in China, including scope of journalism programs, national education system, journalism curricula, and faculty structure. As is in other countries, in this digital age, journalism education in China is undergoing dramatic changes. The article assesses these changes as Chinese journalism education adapts to a new media environment.

scholarly journals Conducting a Time Trade-Off Study Alongside a Clinical Trial: A Case Study and Recommendations

2018 ◽  
Vol 3 (1) ◽  
pp. 5-20 ◽  
Author(s):  
Jing Shen ◽  
Sarah Hill ◽  
David Mott ◽  
Matthew Breckons ◽  
Luke Vale ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Health State ◽  
Health States ◽  
Trade Off ◽  
Life Years ◽  
Related Quality ◽  
Health Related ◽  
Health State Utilities

Abstract Time trade-off (TTO) is an established method in health economics to elicit and value individuals’ preferences for different health states. These preferences are expressed in the form of health-state utilities that are typically used to measure health-related quality of life and calculate quality-adjusted life-years in an economic evaluation. The TTO approach to directly elicit health-state utilities is particularly valuable when generic instruments (e.g. EQ-5D) may not fully capture changes in utility in a clinical trial. However, there is limited guidance on how a TTO study should be conducted alongside a clinical trial despite it being a valuable tool. We present an account of the design and development of a TTO study within a clinical trial as a case study. We describe the development of materials needed for the TTO interviews, the piloting of the TTO materials and interview process, and recommendations for future TTO studies. This paper provides a practical guide and reference for future applications of the TTO method alongside a clinical trial.

scholarly journals Deceased donor kidney allocation: an economic evaluation of contemporary longevity matching practices

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Sameera Senanayake ◽  
Nicholas Graves ◽  
Helen Healy ◽  
Keshwar Baboolal ◽  
Adrian Barnett ◽  
...  
Keyword(s):  
Risk Index ◽  
Deceased Donor ◽  
Base Case ◽  
Decision Analytic Model ◽  
Donor Kidney ◽  
Health States ◽  
Kidney Allocation ◽  
Australian Health ◽  
Life Years ◽  
The Impact

Abstract Background Matching survival of a donor kidney with that of the recipient (longevity matching), is used in some kidney allocation systems to maximize graft-life years. It is not part of the allocation algorithm for Australia. Given the growing evidence of survival benefit due to longevity matching based allocation algorithms, development of a similar kidney allocation system for Australia is currently underway. The aim of this research is to estimate the impact that changes to costs and health outcomes arising from ‘longevity matching’ on the Australian healthcare system. Methods A decision analytic model to estimate cost-effectiveness was developed using a Markov process. Four plausible competing allocation options were compared to the current kidney allocation practice. Models were simulated in one-year cycles for a 20-year time horizon, with transitions through distinct health states relevant to the kidney recipient. Willingness to pay was considered as AUD 28000. Results Base case analysis indicated that allocating the worst 20% of Kidney Donor Risk Index (KDRI) donor kidneys to the worst 20% of estimated post-transplant survival (EPTS) recipients (option 2) and allocating the oldest 25% of donor kidneys to the oldest 25% of recipients are both cost saving and more effective compared to the current Australian allocation practice. Option 2, returned the lowest costs, greatest health benefits and largest gain to net monetary benefits (NMB). Allocating the best 20% of KDRI donor kidneys to the best 20% of EPTS recipients had the lowest expected incremental NMB. Conclusion Of the four longevity-based kidney allocation practices considered, transplanting the lowest quality kidneys to the worst kidney recipients (option 2), was estimated to return the best value for money for the Australian health system.

Legislation on Same-Sex Partnerships in the Post-Communist Area: Case Study of the Czech Republic

2021 ◽  
Vol 46 (3-4) ◽  
pp. 374-399
Author(s):  
Marián Sekerák ◽  
Lukáš Novotný
Keyword(s):  
Status Quo ◽  
Current Status ◽  
Constitutional Court ◽  
Heterosexual Couples ◽  
Political Struggle ◽  
Same Sex ◽  
Best Interest ◽  
The Czech Republic ◽  
Political Debates

Abstract In the Czech context, the issue of same-sex partnerships can be viewed as a “hot potato”. After long political debates, a law allowing civil unions was adopted in 2006. In the post-communist area, there has been a political struggle over the marriage. The Czech Constitutional Court recently published two key decisions that moved this debate forward. At the same time, two major legislative bills were tabled in the Chamber of Deputies: the first extending marriage to non-heterosexual couples, the second preserving the current status quo with regard to marriage. In the article, we explain these recent Czech legal events in the broader context of the perception of marriage in the post-communist area. We argue that if the Court decides in the future on the constitutionality of same-sex marriages, it should take into account the principles of human dignity and the best interest of the child.

Abstract WMP98: Economic Impact Of Dabigatran For Prevention Of Stroke In Patients With Atrial Fibrillation In Colombia

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Rafael Alfonso-Cristancho ◽  
Andres I Vecino ◽  
Santiago Herran
Keyword(s):  
Atrial Fibrillation ◽  
Societal Perspective ◽  
Indirect Costs ◽  
Medical Costs ◽  
Separate Analysis ◽  
Health States ◽  
Usual Practice ◽  
Direct Medical Costs ◽  
Good Investment ◽  
Life Years

INTRODUCTION: Dabigatran is a novel oral anticoagulant considered as an alternative to warfarin in patients with non-valvular Atrial Fibrillation (AF) to prevent Stroke. Hypothesis: dabigatran compared to warfarin for stroke prevention in AF is a good investment for the health care system in Colombia. Methods: We developed a Markov model to represent the health states of AF and its complications: 6 health states (disabling and non-disabling stroke, myocardial infarction, pulmonary embolism and death) and 2 transitional states (major and minor hemorrhage). Probabilities were derived from clinical trials; resource use was estimated from the guidelines of the Colombian Society of Cardiology and validated to adjust to usual practice. Direct medical costs were extracted from public and private insurers and hospitals, and indirect costs (e.g. wages lost, transportation costs, etc.) were obtained from the most recent National Health Survey. Utilities were obtained from a systematic literature review. Two separate analysis, payer and societal perspective, were performed in a 20-year horizon. Multivariate sensitivity analysis was also performed and results were discounted at 3% annually. Results: After 20 years of follow up, cumulative discounted direct medical costs per patient accounted for USD$70,500 for warfarin and $78,840 and $79,860 for 150mg and 110mg of dabigatran, respectively. When taking into account indirect costs, warfarin increased their costs by 13% while dabigatran costs were increased by 7%. Estimated life years (LY) for Dabigatran were higher (9.4 and 9.3 for 150mg and 110mg) as well as the QALYs (8.5, 8.4) than for warfarin 9.1 LY and 8.1 QALYs. The calculated ICER was $23,760 and $34,690 per additional QALY gained with dabigatran 150mg and 110 mg from the payer perspective and $19,380 and $28,730 from the societal perspective. The budget impact of including coverage for dabigatran would not surpass 3% of the current unit of payment per capita. CONCLUSIONS: In Colombia, coverage for dabigatran for the management of non-complicated AF could increase LY and QALYs at a modest financial impact.

scholarly journals Deceased donor kidney allocation: an economic evaluation of contemporary longevity matching practices

2020 ◽  
Author(s):  
Sameera Senanayake ◽  
Nicholas Graves ◽  
Helen Healy ◽  
Keshwar Baboolal ◽  
Adrian Barnett ◽  
...  
Keyword(s):  
Risk Index ◽  
Deceased Donor ◽  
Base Case ◽  
Decision Analytic Model ◽  
Donor Kidney ◽  
Health States ◽  
Kidney Allocation ◽  
Australian Health ◽  
Life Years ◽  
The Impact

Abstract Background Matching survival of a donor kidney with that of the recipient (longevity matching), is use in some kidney allocation systems to maximize graft-life years. It is not part of the allocation algorithm for Australia. Given the growing evidence of survival benefit due to longevity matching based allocation algorithms, development of a similar kidney allocation system for Australia is currently underway. The aim of this research is to estimate the impact that changes to costs and health outcomes arising from ‘longevity matching’ on the Australian healthcare system. Methods A decision analytic model to estimate cost-effectiveness was developed using a Markov process. Four plausible competing allocation options were compared to the current kidney allocation practice. Models were simulated in one-year cycles for a 20-year time horizon, with transitions through distinct health states relevant to the kidney recipient. Willingness to pay was considered as AUD 28000. Results Base case analysis indicated that allocating the worst 20% of Kidney Donor Risk Index (KDRI) donor kidneys to the worst 20% of estimated post-transplant survival (EPTS) recipients (option 2) and allocating the oldest 25% of donor kidneys to the oldest 25% of recipients are both cost saving and more effective compared to the current Australian allocation practice. Option 2, returned the lowest costs, greatest health benefits and largest gain to net monetary benefits (NMB). Allocating the best 20% of KDRI donor kidneys to the best 20% of EPTS recipients had the lowest expected incremental NMB. Conclusion Of the four longevity-based kidney allocation practices considered, transplanting the lowest quality kidneys to the worst kidney recipients (option 2), was estimated to return the best value for money for the Australian health system.

scholarly journals Deceased donor kidney allocation: an economic evaluation of contemporary longevity matching practices

2020 ◽  
Author(s):  
Sameera Senanayake ◽  
Nicholas Graves ◽  
Helen Healy ◽  
Keshwar Baboolal ◽  
Adrian Barnett ◽  
...  
Keyword(s):  
Risk Index ◽  
Deceased Donor ◽  
Base Case ◽  
Decision Analytic Model ◽  
Donor Kidney ◽  
Health States ◽  
Kidney Allocation ◽  
Australian Health ◽  
Life Years ◽  
The Impact

Abstract Background Matching survival of a donor kidney with that of the recipient (longevity matching), is used in some kidney allocation systems to maximize graft-life years. It is not part of the allocation algorithm for Australia. Given the growing evidence of survival benefit due to longevity matching based allocation algorithms, development of a similar kidney allocation system for Australia is currently underway. The aim of this research is to estimate the impact that changes to costs and health outcomes arising from ‘longevity matching’ on the Australian healthcare system. Methods A decision analytic model to estimate cost-effectiveness was developed using a Markov process. Four plausible competing allocation options were compared to the current kidney allocation practice. Models were simulated in one-year cycles for a 20-year time horizon, with transitions through distinct health states relevant to the kidney recipient. Willingness to pay was considered as AUD 28000. Results Base case analysis indicated that allocating the worst 20% of Kidney Donor Risk Index (KDRI) donor kidneys to the worst 20% of estimated post-transplant survival (EPTS) recipients (option 2) and allocating the oldest 25% of donor kidneys to the oldest 25% of recipients are both cost saving and more effective compared to the current Australian allocation practice. Option 2, returned the lowest costs, greatest health benefits and largest gain to net monetary benefits (NMB). Allocating the best 20% of KDRI donor kidneys to the best 20% of EPTS recipients had the lowest expected incremental NMB. Conclusion Of the four longevity-based kidney allocation practices considered, transplanting the lowest quality kidneys to the worst kidney recipients (option 2), was estimated to return the best value for money for the Australian health system.

scholarly journals Deceased donor kidney allocation: an economic evaluation of contemporary longevity matching practices

2020 ◽  
Author(s):  
Sameera Senanayake ◽  
Nicholas Graves ◽  
Helen Healy ◽  
Keshwar Baboolal ◽  
Adrian Barnett ◽  
...  
Keyword(s):  
Risk Index ◽  
Deceased Donor ◽  
Base Case ◽  
Decision Analytic Model ◽  
Donor Kidney ◽  
Health States ◽  
Kidney Allocation ◽  
Australian Health ◽  
Life Years ◽  
The Impact

Abstract BackgroundMatching survival of a donor kidney with that of the recipient (longevity matching), is used in some kidney allocation systems to maximize graft-life years. It is not part of the allocation algorithm for Australia. Given the growing evidence of survival benefit due to longevity matching based allocation algorithms, development of a similar kidney allocation system for Australia is currently underway. The aim of this research is to estimate the impact that changes to costs and health outcomes arising from ‘longevity matching’ on the Australian healthcare system. MethodsA decision analytic model to estimate cost-effectiveness was developed using a Markov process. Four plausible competing allocation options were compared to the current kidney allocation practice. Models were simulated in one-year cycles for a 20-year time horizon, with transitions through distinct health states relevant to the kidney recipient. Willingness to pay was considered as AUD 28000. ResultsBase case analysis indicated that allocating the worst 20% of Kidney Donor Risk Index (KDRI) donor kidneys to the worst 20% of estimated post-transplant survival (EPTS) recipients (option 2) and allocating the oldest 25% of donor kidneys to the oldest 25% of recipients are both cost saving and more effective compared to the current Australian allocation practice. Option 2, returned the lowest costs, greatest health benefits and largest gain to net monetary benefits (NMB). Allocating the best 20% of KDRI donor kidneys to the best 20% of EPTS recipients had the lowest expected incremental NMB. ConclusionOf the four longevity-based kidney allocation practices considered, transplanting the lowest quality kidneys to the worst kidney recipients (option 2), was estimated to return the best value for money for the Australian health system.

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