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PubMedDate not supplied

Getting a return on investment from spending capital dollars on new beds.

In assessing this bed-purchase process and the resulting return on investment, I identified the following critical success factors related to capital investments: Evaluation of capital equipment for return on investment from the expense side, particularly when looking at use of manpower for critical positions in the organization Evaluation of capital equipment for increasing nursing satisfaction, a factor in addressing the healthcare worker shortage in today's environment Involvement of a representative team to create personal ownership through individuals wanting to take care of something they are involved in purchasing Spin-off timesaving that can be realized through the adage "form follows function" The last factor was found not only in savings of nurse staff time but also in pharmacy time because the weight function on the new beds saved approximately one hour, allowing for speedier calculation of creatinine clearance in antibiotic dosing. Changing my position and perspective was rewarding. The persistence of the CNO and the involvement of the employees made the experience gratifying on a personal level as well.

Beds↗

PubMed2004

Capital optimization: linking investment with strategic intent.

With operating margins showing some improvement in 2003, Y2K being a distant memory, and many critical capital investment decisions delayed as long as possible, hospitals have been on a relative spending spree, building new facilities, renovating operating rooms and inpatient units, and investing in new medical and information technologies. However, with pressure on both cost and revenue expected to continue, if not increase, this spending spree may be short-lived, and hospitals must improve their capital planning efforts; align them with their mission, vision, and strategies; and ensure that capital is available when unplanned or even expected needs arise. This article explores some of the challenges that hospitals face in their capital planning efforts and, more importantly, suggests the necessity for hospitals to integrate capital and strategic planning. Capital planning must be driven by an organization's strategies; however, we also argue that an organization's ability to execute its strategies is highly dependent on the existence of a cohesive capital prioritization and planning process. In this article, we explore a number of issues critical to developing a comprehensive capital plan, including estimating capital costs, evaluating and designing strategies to contend with risk, saving for the proverbial "rainy day," and recognizing the role and value of philanthropy, while challenging some conventional thinking of hospital executives with respect to investment, growth, and planning.

Capital Expenditures↗

PubMed2005

Returns, not burns: how to ensure successful health IT investments.

With many types of financial investments, the hospital financial community has long-established, and relatively straightforward, practices for projecting and measuring returns. Not so with health IT investments, however, where returns can be difficult to identify and quantify and even harder to track. Yet the success of such an investment depends on measuring the returns--whether they be tangible or intangible, short-term or long-term--because effectively tracking returns is the only way to be sure of achieving them.

Capital Expenditures↗

PubMedDate not supplied

Beyond the professional fee: basic legal issues for physicians investing in the technical side of healthcare services, part 2.

As reimbursement for professional services shrinks compared with physicians' educational debt and practice expenses, physicians are looking for additional sources of revenue to supplement their practice income. A natural option to consider is investment in healthcare entities or equipment in order to share in the technical fees generated by such entities or equipment. Part 1 of this article reviewed relevant legal authorities and common investment opportunities. Part 2 looks at issues that physician investors face-specifically, the choice of whether to invest in a separate entity or to expand an existing practice to include a technical service, hospital investors, and service agreements.

Investments↗

PubMedDate not supplied

Public investment in providing information for chronic disease prevention for adults in Alberta.

BACKGROUND: The World Health Organization in 2000 cited specific chronic diseases (chronic obstructive pulmonary disease, heart disease, diabetes and certain cancers) as major and preventable health hazards. There have subsequently been calls for increased investment in prevention activities. Currently there is no information on the economic magnitude of these promotion activities. In this study, we present an estimate of the investment in Alberta, by public organization, for chronic disease prevention activities which provide information that promotes behaviour changes in adults at risk. METHODS: We surveyed board members of the Alberta Healthy Living Network (AHLN) to obtain economic data and information on activities related to chronic disease (primary) prevention. We also asked for further contacts on programs in other agencies. We continued the ("snowball") process until no new agencies were identified. Agencies provided the information on a survey form. RESULTS: In 2003 in Alberta, the cost of publicly provided information to change risk behaviours related to chronic diseases for persons over 20 was dollars 24.9 million. This investment was diffused over a large number of bodies. Anti-smoking programs used the largest proportion of the money. The total cost per person at risk was about dollars 15. Regional Health Authorities spend about 1/10th of 1% of their budget on these activities. DISCUSSION: There are difficulties in collecting and organizing society-level data on chronic disease prevention. Nevertheless, all indications are that the amount of resources devoted in this area is small, and much smaller than has been suggested.

Adult↗

PubMed1979

Investment decision making in the health care industry: the future.

The economic and political environment in which providers of health care will operate during the 1980s will continue to be increasingly restrictive. Any private-sector organization's long-run survival depends directly on the quality of its investment decisions, broadly defined. This decision making will require three major innovations if private sector health care providers are to survive: 1) traditional biases about the economics of not-for-profit entities must be abandoned; 2) standard data, procedures, and personnel from the accounting discipline must be supplemented with information, methodologies, and people from the discipline of corporate finance; and 3) economic and fiscal risk must be measured and incorporated into both investment decisions and interactions with external regulators. Practitioners can begin to implement these innovations immediately. Although substantial literature exists developing all these concepts generally and applying them to for-profit settings, the literature purporting to treat investment decision making for private-sector health care providers is, on average, replete with conceptual error, simplistic thinking, erroneous applications, and out-of-date methodologies. The literature is, in a word, horrid. Authors, both practitioner and academic, should stop writing terrible books and booklike periodicals for easy royalty dollars, and, instead, pursue sound applied research and disseminate their results in classrooms and in refereed journals.

Decision Making↗

PubMed1982

Reproduction of details using dental stones and investment material in impressions of elastomers and waxes.

In the fabrication of crowns and inlays it is very important that all the details of the impression are exactly reproduced by the cast. These requirements prevail between elastomeric impression materials and dental stones as well as between waxes and investment materials. Inadequate filling of the details of the impression will result in rounded inner corners of the casting, which then may not properly seat on the prepared tooth. Two brands of elastomeric impression material, dental stone, wax, investment material and wetting agent were chosen to study the reproduction of details. A master model of stainless steel, shaped like a truncated cone with a convex top and 60 degrees threads, was used. The shape of this model made it possible to make microscopic measurements of the reproduced detail of the threads. No significant difference, by different prepouring treatment of the impressions was found in reproducing details with elastomeric impression materials and dental stones. All combinations of elastomeric impression materials and dental stones reproduced, however, significantly more details than combinations of waxes and investment materials. The relevance of transferring conclusions from the laboratory investigation to clinical conditions are discussed as well as the clinical value of reproducing details.

Calcium Sulfate↗

PubMed1993

Titanium. A review of investments for high temperature casting.

Conventional silica (SiO2) based dental casting investments are used for the casting of pure titanium using casting machines specifically developed for this metal. Highly reactive molten titanium reduces SiO2 and titanium is in turn oxidised. For this reason possible alternatives to SiO2 have been studied in the past decade and MgO and Al2O3 are the most common in current commercial investments released for titanium casting. The surface of titanium castings presents a layered structure and its evaluation in relation to clinical performance requires further study. It is also urgently required to know setting and thermal behaviour of the newly developed investments for successful compensation of metal shrinkage.

Aluminum Oxide↗

PubMed2001

INVEST: results of combined strategies to control blood pressure.

The treatment of hypertension continues to be challenging due to the lack of understanding regarding underlying modulators of blood pressure as well as co-existing conditions such as atherosclerosis and diabetes. This has led to uncertainty regarding treatment strategy and intensity. The INternational VErapamil SR/trandolapril STudy (INVEST) is designed to evaluate the relationship between cardiovascular risk and blood pressure modulators. Based on a review of preliminary data, it appears that the treatment regimen used in the INVEST trial has been more successful than other studies at controlling systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure. These preliminary data from INVEST suggest that a high proportion of coronary artery disease (CAD) patients with hypertension should receive combination therapy to achieve contemporary blood pressure targets.

Clinical Trials as Topic↗

PubMed2001

How will INVEST and other hypertension trials change clinical practice?

Three large, ongoing, international clinical trials will greatly improve our understanding of hypertension management. The trials, which include the INternational VErapamil SR/trandolapril STudy (INVEST), the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), and the Controlled ONset Verapamil INvestigation of Cardiovascular Endpoints (CONVINCE) trial, enrolled a combined total of 81,649 patients over a 7-year period from 18 different countries in North America, South America, Europe, and Australia-Asia. The mean age of all subjects was 66 years, and the mean body mass index (BMI) was 29.5. In addition, 30% of all patients had diabetes and 43% had documented coronary artery disease (CAD). In INVEST, 100% of enrolled patients had documented CAD and 27% had diabetes. Of patients treated for 12 months in INVEST, a systolic blood pressure (SBP) <140 mmHg was achieved by 70% of nondiabetics, and 66% of patients with diabetes achieved that level. Of all the patients enrolled in the three trials, 38% were smokers, 25% had a history of myocardial infarction (MI) or stroke, and 52% had a history of dyslipidemia. Although these clinical trials are likely to influence treatment guidelines, they may not affect the way medicine is practiced. A survey of primary care physicians found that 41% had not heard of or were not familiar with the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) guidelines. The JNC VI and European guidelines provide management strategies based on severity of coronary risk factors, target organ damage, and blood pressure levels. Primary care physicians have a responsibility to be educated about risk stratification, goals of treatment based on risk, and management strategies for hypertension from available treatment guidelines.

Aged↗

PubMed1997

Helping-at-the-nest in Arabian babblers: signalling social status or sensible investment in chicks?

Helping-at-the-nest in Arabian babblers, Turdoides squamicepshas been uniquely explained as an altruistic 'signal' used to 'show-off' and gain 'social prestige' within the group. Evidence from other cooperatively breeding bird species, however, instead suggests that helpers invest in nestlings in order to gain kin-selected benefits. This study investigates patterns of provisioning behaviour among parents and helpers for 27 broods over three breeding seasons, and assesses the potential for chick-feeding to operate as a signal in Arabian babblers. Provisioning rate accounted for much of the variation in fledging brood mass, suggesting that observed provisioning effort had potential fitness consequences for the brood. All group members provisioned at similar rates and made similar adjustments in feeding effort, irrespective of sex and/or dominance rank within the group. Chick age had a positive linear effect, and group size a negative linear effect, upon provisioning rates of all group members. There was no obvious evidence that nestling provisioning operated as a signal within groups in any way. Contrary to earlier reports, individuals did not appear to 'interfere' with the provisioning efforts of subordinates; individuals in larger groups did spend longer in the nest tree before reaching the nest, but this was unaffected by sex, dominance rank and presence of other (more dominant) birds. These results suggest that provisioning by both helpers and parents in Arabian babblers functions not as a signal, but as sensible investment in chicks. In this species, high relatedness within groups may provide helpers with kin-selected benefits via such investment, although possible advantages from augmentation of group size cannot be ruled out.Copyright 1997 The Association for the Study of Animal Behaviour

Journal Article↗

PubMed1998

Male-biased investment in fallow deer: an experimental study.

To find the causes of faster growth in males, we studied the growth and behaviour of six male and five female fallow deer, Dama dama, fawns, hand-reared on the same amount and quality of milk, and compared them with naturally reared fawns. The bottle-reared fawns grew more slowly. In particular, the difference in weight gain between bottle- and mother-reared fawns was significantly larger for males during the time when they consumed only milk. Male fawns also sucked harder and were more motivated to obtain milk. These results indicate that male fallow deer fawns receive more milk from their mothers than female fawns under natural conditions and, hence, maternal investment seems male biased in this species. Males grew slightly, but significantly, faster until 10 weeks old, which revealed that sex-differential growth during the period of maternal investment is possible in the absence of differential maternal investment. The results could not reveal whether this small difference in growth is brought about by physiological or behavioural differences between the sexes.Copyright 1998 The Association for the Study of Animal Behaviour

Journal Article↗

PubMed1998

Genetic variation in paternal investment in a seed beetle.

Males of many species invest resources in their offspring. For paternal investment to evolve, it must exhibit heritable variation. Using a standard half-sibling quantitative genetic design, we investigated whether genetic variation in male ejaculate size, a trait that affects female fecundity and copulation duration, are present in the seed beetle Callosobruchus maculatus. Ejaculate size was estimated as the amount of weight lost by males during mating. Dams, but not sires, had significant effects on their sons' absolute ejaculate size (both replicates) and relative ejaculate size (proportion of body weight; one replicate only), explaining 21-25% of the variance in absolute ejaculate size and 8-16% of the variance in relative ejaculate size. These results suggest either a large maternal effect on ejaculate size or sex-linkage of loci that affect the variation in ejaculate size. The proportion of phenotypic variance explained by sex- linkage (assuming no maternal effects) was 42 and 49% (ejaculate size) and 17 and 31% (relative ejaculate size) in the two replicates. These results indicate that male paternal investment can respond to selection, and that it may be able to do so especially rapidly because sex-linked traits have the potential to evolve much more quickly than autosomal traits. There were only weak negative correlations between ejaculate size and mating duration, contrary to what we predicted. There was additive genetic variation in female copulation duration, but not in male copulation duration, suggesting that copulation duration is under female control. Copyright 1998 The Association for the Study of Animal Behaviour.

Journal Article↗

PubMed1999

Positive Illusions and Forecasting Errors in Mutual Fund Investment Decisions.

This study examines the portfolio allocation decisions of 80 business students in a computer-based investing simulation. Our goal was to better understand why investors spend so much time and money on actively managed mutual funds despite the fact that the vast majority of these funds are outperformed by pas sively managed index funds. Participants' judgments and decisions provided evidence for a number of biases. First, most participants consistently overestimated both the future perfor mance and the past performance of their investments. Second, participants overestimated the intertemporal consistency of portfolio performance. Third, participants were more likely to shift their portfolio allocation following poorer performance than following better performance, and this tendency had a negative impact on portfolio returns. We speculate that these biases in investor behavior may contribute to suboptimal investment decisions in real financial markets. Copyright 1999 Academic Press.

Journal Article↗

PubMed2003

Reproductive energy investment in corals: scaling with module size.

In colonial modular organisms, differences in module size and colony growth patterns among species have the potential to impose varying constraints on reproductive investment. Here, we compare reproductive output among seven morphologically different species of spawning reef corals, and analyse the relationship between reproductive output and module (polyp) size. Reproductive output ranged between 132 and 384 J cm(-2), with lipid constituting the key indicator of energy investment. Lipid decreased by 85-100%, whereas protein and carbohydrate were relatively invariant between pre- and post-spawning tissues in all species, representing 1-15% and <1%, respectively, of the energy investment to reproductive output. The ratio of energy content in reproductive to somatic tissues (gonadosomatic index, GSI) varied among species from 0.20 (Symphyllia recta) to 1.31 (Acropora tenuis), the latter being the highest value reported for any iteroparous marine invertebrate. Surprisingly, small-polyped species (Acropora, Montipora) had 2- to 6-fold higher GSIs than large-polyped ones (Lobophyllia, Symphyllia). Energy equivalents of tissues increased with the 1.50-1.76 power of polyp diameter for somatic tissues and with the 1.42-1.80 power of polyp diameter for reproductive output. In both cases, increases in energy equivalents with polyp diameter were less than the scaling exponent of 3 predicted for an isometric relationship between tissue volume (or mass) and polyp diameter, indicating significant constraints of space, design or physiological energetics with increasing polyp size. We hypothesise that such constraints have played a key role in the evolution of modularity in cnidarians.

Adaptation, Physiological↗

PubMed2006

Pigment-based skin colour in the blue-footed booby: an honest signal of current condition used by females to adjust reproductive investment.

In monogamous species, the value of present reproduction is affected by the current condition of the mate, and females may use male ornaments to evaluate his condition and adjust their level of investment according. Many animals display colour in fleshy structures which may be accurate indicators of quality due to their potentially rapid response to changes in condition. Here we show that in the blue-footed booby, Sula nebouxii, male foot colour is structurally (collagen arrays) and pigment based. In 48 h foot colour became duller when males were food deprived and brighter when they were re-fed with fresh fish. Variation of dietary carotenoids induced comparable changes in cell-mediated immune function and foot colour, suggesting that carotenoid-pigmentation reveals the immunological state of individuals. These results suggest that pigment-based foot colour is a rapid honest signal of current condition. In a second experiment, we found that rapid variation in male foot colour caused parallel variation in female reproductive investment. One day after the first egg was laid we captured the males and modified the foot colour of experimental males with a non-toxic and water resistant duller blue intensive make-up, mimicking males in low condition. Females decreased the size of their second eggs, relative to the second egg of control females, when the feet of their mates were experimentally duller. Since brood reduction in this species is related to size differences between brood mates at hatching, by laying lighter second eggs females are facilitating brood reduction. Our data indicate that blue-footed booby females are continuously evaluating their mates and can perform rapid adjustments of reproductive investment by using dynamic sexual traits. We suggest that this fine-tuned adjustment may be widespread in socially monogamous animals.

Animal Communication↗

PubMed2004

The parental investment conflict in continuous time: St. Peter's fish as an example.

The parental investment conflict considers the question of how much each sex should invest in each brood, thereby characterizing different animal species. Each species usually adopts a certain parental care pattern: female-care only, male-care only, biparental care, or even no parental care at all. The differences in care patterns are usually explained by the different costs and benefits arising from caring for the offspring in each animal species. This paper proposes a game-theoretical model to the parental investment conflict based on the parental behavior of St. Peter's fish. St. Peter's fish exhibit different parental care patterns, allowing the examination of the factors which determine the particular behavior in each mating. We present a continuous time, two-stage, asymmetric game, with two types of players: male and female. According to the model's results, three parental care patterns: male-only care, female-only care and biparental care, are possible evolutionarily stable strategies. The evolutionarily stable parental care pattern in a certain mating depends on a parent's increase in mortality due to parental care, and on its advantage from biparental care. These results may explain the different parental care patterns observed in a variety of animal species, including those found in the St. Peter's fish.

Animals↗

PubMed2002

The economic value of medical research: is it worth the investment?

OBJECTIVE: To provide a brief commentary regarding the economic evaluation of medical research by summarizing a recent report from the Mary Woodard Lasker Charitable Trust. METHODS: A review of the report Exceptional Returns: The Economic Value of America's Investment in Medical Research was conducted. In this report, nine economists translated the accomplishments of medical research into dollars by placing a monetary value on better health and longer life. This manuscript focuses on implications of this report to women's health research. RESULTS: After first isolating the impact of medical research from other gains unrelated to research and development, the increase in life expectancy due to advances in health during the 1970s and 1980s were worth $57 trillion to Americans. Gains associated with prevention and treatment of cardiovascular disease alone totaled $31 trillion. CONCLUSION: Our nation's contribution into medical research provides a very high "return on investment." The likely returns from research are so favorable that the payoff from any "portfolio" of research investments would be enormous.

Health Facilities↗