Directly Measured Costs of Severe Maternal Morbidity Events during Delivery Admission Compared with Uncomplicated Deliveries

Objective To estimate the actual excess costs of care for delivery admissions complicated by severe maternal morbidity (SMM) compared with uncomplicated deliveries. Study Design This is a retrospective cohort study of all deliveries between October 2015 and September 2018 at a single tertiary academic center. Pregnant individuals ≥ 20 weeks' gestation who delivered during a hospital admission (i.e., a “delivery admission”) were included. The primary exposure was SMM, as defined by Centers for Disease Control and Prevention (CDC) criteria, CDC criteria excluding blood transfusion, or by validated hospital-defined criteria (intensive care unit admission or ≥ 4 units of blood products). Potential SMM events identified via administrative and blood bank data were reviewed to confirm SMM events had occurred. Primary outcome was total actual costs of delivery admission derived from time-based accounting and acquisition costs in the institutional Value Driven Outcomes database. Cost of delivery admissions with SMM events was compared with the cost of uncomplicated delivery using adjusted generalized linear models, with separate models for each of the SMM definitions. Relative cost differences are reported due to data restrictions. Results Of 12,367 eligible individuals, 12,361 had complete cost data. Two hundred and eighty individuals (2.3%) had confirmed SMM events meeting CDC criteria. CDC criteria excluding transfusion alone occurred in 1.0% (n = 121) and hospital-defined SMM in 0.6% (n = 76). In adjusted models, SMM events by CDC criteria were associated with a relative cost increase of 2.45 times (95% confidence interval [CI]: 2.29–2.61) the cost of an uncomplicated delivery. SMM by CDC criteria excluding transfusion alone was associated with a relative increase of 3.26 (95% CI: 2.95–3.60) and hospital-defined SMM with a 4.19-fold (95% CI: 3.64–4.83) increase. Each additional CDC subcategory of SMM diagnoses conferred a relative cost increase of 1.60 (95% CI: 1.43–1.79). Conclusion SMM is associated with between 2.5- and 4-fold higher cost than uncomplicated deliveries. Key Points

Clinical Scores in Veterinary Medicine: What Are the Pitfalls of Score Construction, Reliability, and Validation? A General Methodological Approach Applied in Cattle

Clinical scores are commonly used for cattle. They generally contain a mix of categorical and numerical variables that need to be assessed by scorers, such as farmers, animal caretakers, scientists, and veterinarians. This article examines the key concepts that need to be accounted for when developing the test for optimal outcomes. First, the target condition or construct that the scale is supposed to measure should be defined, and if possible, an adequate proxy used for classification should be determined. Then, items (e.g., clinical signs) of interest that are either caused by the target condition (reflective items) or that caused the target condition (formative items) are listed, and reliable items (inter and intra-rater reliability) are kept for the next step. A model is then developed to determine the relative weight of the items associated with the target condition. A scale is then built after validating the model and determining the optimal threshold in terms of sensitivity (ability to detect the target condition) and specificity (ability to detect the absence of the target condition). Its robustness to various scenarios of the target condition prevalence and the impact of the relative cost of false negatives to false positives can also be assessed to tailor the scale used based on specific application conditions.

Experimental Investigation on Grades of Cement in the Nominal and Design Concrete Mixes

In India, the experience in the use of concrete in housing is more than seven decades old. Concrete mix is a combination of cement, water and aggregates of sand and stone. The relative merits of using 33, 43 & 53 grades of cement in the nominal and design concrete mixes are studied, by testing to destruction hundreds of cubes, cylinders and prisms made using these three grades of cement, the concrete mix having been designed as per the relevant Indian Standard code of practice. The objective of this paper is to make awareness among researchers, engineers and the public about the latest scientific and technical developments in cement, and how to achieve economy in concrete. The foremost objective of concrete mix design is to hand-pick the optimum proportions of various ingredients of the concrete to satisfy the required properties in its fresh and hardened state. As per the investigation, if concrete mixes are designed for different grades adopting separately 33, 43, & 53 grades of cements, grade 53 gives the highest 28 days cube strength, whereas 33 grade cement gives the lowest value. The relative cost of using these three grades is also discussed in the paper.

Domestic Violence Reporting during the COVID-19 Pandemic: Evidence from Latin America

This article examines changes in the frequency and characteristics of domestic violence reports after the start of the pandemic and the imposition of mobility restrictions in six Latin American countries. The study uses three types of data sources: calls to domestic violence hotlines (for the City of Buenos Aires in Argentina, Colombia, and Peru); calls to emergency lines (for Ecuador, Lima in Peru, and Costa Rica); and police/legal complaints (for Colombia, Ecuador, and Uruguay). Data through June 2020 shows that the pandemic's impact on domestic violence reports varied significantly across countries, periods, types of violence, and reporting channels. Calls to domestic violence hotlines soared, but calls to emergency lines and police complaints fell (especially in the first weeks of the pandemic). Significantly distinct patterns are observed between reports of psychological and physical violence, and non-cohabitant and cohabitant violence. These patterns are consistent with the pandemic changing the relative incidence of different types of violence and altering the perceived costs of reporting them through alternative channels. Increases in calls to domestic violence hotlines suggest that this channel was best suited to respond to victims' needs during the pandemic. In turn, the drop in legal complaints and calls to comprehensive emergency lines are consistent with an increase in the perceived (relative) cost of using these channels. The findings reveal how the pandemic altered domestic violence victims' demand for institutional help and highlight the relevance of domestic violence hotlines as an accessible and valuable service.

Keberlanjutan Penerapan Teknologi Padi Sawah Ramah Lingkungan dalam Aspek Kapasitas Petani dan Sifat Inovasi di Sulawesi Tengah

Friendly environment lowland rice management is an alternative way which can be implemented by farmers for getting a balance and sustainability of environment. However, challenges often faced by environmentally friendly agriculture such as the sustainability of its application after the technological innovation was disseminated. Some factors are thought to influence the sustainability of friendly environment rice management namely capacity of farmers and the nature of technology innovation. This study aims to determine the relationship between farmer capacity and the nature of innovation on the sustainability of the application of environmentally friendly rice technology in Central Sulawesi. Data collection was carried out through a survey using a questionnaire to 174 respondents. Data were analyzed descriptively and statistically quantitatively using multinomial logit regression. The results of the analysis show that the capacity of farmers and the nature of innovation that significantly affects the sustainability of the application of environmentally friendly lowland rice technology in Central Sulawesi is the relative cost advantage, relative price advantage, complexity in application, evaluation of farming, and knowledge of environmentally friendly lowland rice management. Therefore, there is a need to increase all significant variabels and to expand the dissemination of innovations in environmentally friendly lowland rice technology.

ПОКАЗНИК ЕФЕКТИВНОСТІ СТВОРЕННЯ МОДИФІКАЦІЙ ПОВІТРЯНИХ СУДЕН ТРАНСПОРТНОЇ КАТЕГОРІЇ ДЛЯ РЕАЛІЗАЦІЇ ЙОГО В ПРОЦЕСІ ВИРОБНИЦТВА

An analysis of the problem of the effectiveness of the creation of aircraft of the transport category was carried out and it was noted that the effectiveness indicator generally expresses the ratio of the operational effect of one aircraft for its service life as the target return in monetary terms to the cost of its creation is the essence of this concept as applied to its specific Implementation for any type of objects, including for modifications of aircraft of the transport category. Analysis of the features of applying an indicator of efficiency to the creation of aircraft modifications made it possible to interpret the operational efficiency for the entire period of operation of the aircraft modifications as the profit of the manufacturer's company, and the cost of manufacturing an object - as the amount of works of labor intensity of technological actions aimed at creating aircraft modifications to the relative cost of these actions, assigned to one norm-hour. Any technological actions include technological operations, processes, cycles, as well as organizational and technical measures, ensuring the effectiveness of creating aircraft modifications, including the cost of purchasing materials and aggregates. The process of forming a contract is considered to produce a series of modifications, in demand by the operator in the air transportation market, consistently acquisition in the initial delivery part of the series, followed by manufacturing and supply with a given sales ratio. The dependence of the total producer's total profit from the timing of the supply of modifications, its prices, production costs and sales coefficients, from which inequality should be determined by the level of permissible costs, as well as the profitability coefficients expressed by the ratio of profit to the sales volume. To find the maximum performance indicator, a technique was proposed for determining the minimum production costs and its implementation algorithm by minimizing the total costs in their set of all technological actions when limiting the regulated values. Recommendations are given to improve the efficiency of the contract in case of non-fulfillment of restrictive inequalities for industrial costs.

Estimating the Direct Medical Cost of Syphilis in China

Background Few studies investigating the direct medical cost of syphilis was conducted in developing countries, including China. Methods The main tasks of our study were to estimate the direct medical costs of syphilis in China at subnational level, and to characterize the distribution of the direct medical cost of syphilis in 31 Chinese provincial districts in relation to GDP. Data on medical expenses for syphilis patients diagnosed at Peking Union Medical College Hospital (PUMCH) was used to estimate direct medical cost per case, which was then multiplied by the number of newly reported cases of syphilis in China to yield the absolute medical cost for syphilis. Relative costs, defined as the absolute costs in per million of gross domestic product (GDP), was also calculated. Comparisons of direct medical cost represented as absolute cost and relative cost respectively, in different years and different provincial districts were conducted. Gini index was used to characterize the distribution of syphilis cases and direct medical cost of syphilis at provincial level. Results Average cost of patients with follow-up more than 36 month was regarded as the most reasonable estimate of direct medical cost per case, and was obtained as US $ 134.43 in primary syphilis, US $ 119.24 in secondary syphilis, US $ 503.76 in tertiary syphilis and US $ 97.59 in latent syphilis. Absolute medical cost of syphilis in China increased from US $ 11.15 million to US $46.89 million from 2004 to 2016. Relative cost in China increased from 2.85 to 5.26 per million of GDP from 2004 to 2010, and decreased from 5.26 to 3.99 per million of GDP from 2010 to 2016. The largest relative cost was always observed in western region. Between 2009 and 2016, a large relative medical cost was observed in 7 to 9 provinces in western region, 3 to 5 provinces in eastern region, 1 to 4 provinces in central region, 1 to 2 provinces in northeastern region. The level of inequality decreased from 2010 to 2016, and kept a continuously moderate equality from 2012 to 2016. Conclusion This study provided a rough estimate of the direct medical costs of syphilis in China and its distribution pattern in 31 Chinese provincial districts. The results highlight that syphilis caused a huge economic burden in China, which distributed disproportionally within provinces. Western region bore a huge and increasing economic burden, while the economic burden in eastern region had once been huge, but tending to decline. Thus, more active and effective control are needed, and strategies on the prevention and control of syphilis be managed according to local conditions.

Association of Neighborhood-Level Material Deprivation With Health Care Costs and Outcome After Stroke

Background and ObjectivesTo determine the association between material deprivation and direct health care costs and clinical outcomes following stroke in the context of a publicly funded universal health care system.MethodsIn this population-based cohort study of patients with ischemic and hemorrhagic stroke admitted to the hospital between 2008 and 2017 in Ontario, Canada, we used linked administrative data to identify the cohort, predictor variables, and outcomes. The exposure was a 5-level neighborhood material deprivation index. The primary outcome was direct health care costs incurred by the public payer in the first year. Secondary outcomes were death and admission to long-term care.ResultsAmong 90,289 patients with stroke, the mean (SD) per-person costs increased with increasing material deprivation, from $50,602 ($55,582) in the least deprived quintile to $56,292 ($59,721) in the most deprived quintile (unadjusted relative cost ratio and 95% confidence interval 1.11 [1.08, 1.13] and adjusted relative cost ratio 1.07 [1.05, 1.10] for least compared to most deprived quintile). People in the most deprived quintile had higher mortality within 1 year compared to the least deprived quintile (adjusted hazard ratio [HR] 1.07 [1.03, 1.12]) as well as within 3 years (adjusted HR 1.09 [1.05, 1.13]). Admission to long-term care increased incrementally with material deprivation and those in the most deprived quintile had an adjusted HR of 1.33 (1.24, 1.43) compared to those in the least deprived quintile.DiscussionMaterial deprivation is a risk factor for increased costs and poor outcomes after stroke. Interventions targeting health inequities due to social determinants of health are needed.Classification of EvidenceThis study provides Class II evidence that the neighborhood-level material deprivation predicts direct health care costs.

The Prognostic Role of Cytogenetics Analysis in Philadelphia Negative Myeloproliferative Neoplasms

Myeloproliferative neoplasms (MPNs) are clonal stem cell disorders characterized collectively by clonal proliferation of myeloid cells with variable morphologic maturity and hematopoietic efficiency. Although the natural history of these neoplasms can be measured sometimes in decades more than years, the cytogenetics analysis can offer useful information regarding the prognosis. Cytogenetics has a well-established prognostic role in acute leukemias and in myelodysplastic syndromes, where it drives the clinical decisions. NGS techniques can find adverse mutations with clear prognostic value and are currently included in the prognostic evaluation of MPNs in scores such as MIPSS, GIPSS, MIPSS-PV, and MIPSS-ET. We suggest that cytogenetics (considering its availability and relative cost) has a role regarding prognostic and therapeutic decisions.