[Transportation costs to work and business trips in the income tax].
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Journal Article↗
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Ways to reduce transportation costs.
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Costs and Cost Analysis↗
Outcome, transport times, and costs of patients evacuated by helicopter versus fixed-wing aircraft.
We determined the differences in transport times and costs for patients transported by fixed-wing aircraft versus helicopter at ranges of 101 to 150 radial miles, where fixed-wing and helicopter in-hospital transports commonly overlap. Statistical analysis failed to show a significant difference between the trauma-care patients transported by helicopter (n = 109) and those transported by fixed-wing (n = 86) for age, injury severity score, hospital length of stay, hospital mortality, or discharge disability score. The times in returning patients to the receiving hospital by helicopter (n = 104) versus fixed-wing (n = 509) did not differ significantly. Helicopter transport costs per mile ($24), however, were 400% higher than those of fixed-wing aircraft with its associated ground ambulance transport costs ($6). Thus, helicopter transport is economically unjustified for interhospital transports exceeding 100 radial miles when an efficient fixed-wing service exists.
Aircraft↗
Practical reduction of transplantation costs. Use of commercial transportation instead of charter aircraft for sharing pancreas grafts.
OBJECTIVE: To demonstrate cost savings in pancreas transplantation through use of commercial organ transportation. DESIGN: Retrospective study. SETTING: Independent Organ Procurement Organization, Denver, Colo. SUBJECTS: Forty-three consecutive pancreas grafts recovered by Colorado transplantation surgeons and transported via charter aircraft (53.4%) or commercial airlines (46.6%) to transplantation centers outside Colorado. MEASUREMENTS: Actuarial graft survival at 1 year was calculated. Transportation costs were also obtained. MAIN RESULTS: Transportation of organs via charter aircraft cost an average of $3658.37 compared with an average of $102.40 for commercial airline transportation (average cost difference, $3555.97). Graft survival was 73.9% for chartered grafts vs 80.0% for commercially shipped grafts. Mean preservation times were 13 hours 54 minutes for chartered grafts vs 17 hours 50 minutes for commercial transportation. CONCLUSION: Our data demonstrated a significant cost savings when pancreas grafts were transported via commercial airlines instead of chartered aircraft. These cost savings were obtained without negative sequelae in clinical outcome, encouraging widespread use of commercial airlines for transporting shared pancreas grafts.
Aircraft↗
Cost-benefit analysis of a national screening programme for cystic fibrosis in an Israeli population.
The recently acquired ability to identify 97% of CF carriers in an Israeli Ashkenazi population, prompts an evaluation of a nationwide screening programme. In 1993, the programme would first screen and counsel 9,261 parents, then 396 spouses of carrier parents and finally screen 16.5 fetuses where both parents are carriers. Assuming 92% of screened parents choose abortion of fetus screened positive, 2.33 cases of CF will be prevented in 1993 at a direct cost of $781,000. The $326,000 direct costs of preventing a CF case, exceed the lifetime excess direct costs per case of $297,000. However, benefits of screening also accrue to subsequent pregnancies, resulting in a direct benefit ($14.45 million) to cost ($10.39 million) ratio of 1.39/1 for the period 1993-2032. When benefits and costs resulting from mortality changes, work absences and transport costs are included, the benefit ($15.95 million) to cost ($13.88 million) ratio falls to 1.15/1. Benefit-cost ratios are lower for other ethnic groups in Israel, due to lower carrier rates and lower mutation detection abilities. A CF screening programme will increase the freedom of individuals choice, but should be carried out carefully in order to minimize stigmatization and even discrimination against CF carriers.
Abortion, Eugenic↗
The effect of submergence on heart rate and oxygen consumption of swimming seals and sea lions.
Respiratory, metabolic, and cardiovascular responses to swimming were examined in two species of pinniped, the harbor seal (Phoca vitulina) and the California sea lion (Zalophus californianus). 1. Harbor seals remained submerged for 82-92% of the time at swimming speeds below 1.2 m.s-1. At higher speeds, including simulated speeds above 1.4 m.s-1, the percentage of time spent submerged decreased, and was inversely related to body weight. In contrast, the percentage of time spent submerged did not change with speed for sea lions swimming from 0.5 m.s-1 to 4.0 m.s-1. 2. During swimming, harbor seals showed a distinct breathhold bradycardia and ventilatory tachycardia that were independent of swimming speed. Average heart rate was 137 beats.min-1 when swimming on the water surface and 50 beats.min-1 when submerged. A bimodal pattern of heart rate also occurred in sea lions, but was not as pronounced as in the seals. 3. The weighted average heart rate (WAHR), calculated from measured heart rate and the percentage time spent on the water surface or submerged, increased linearly with swimming speed for both species. The graded increase in heart rate with exercise load is similar to the response observed for terrestrial mammals. 4. The rate of oxygen consumption increased exponentially with swimming speed in both seals and sea lions. The minimum cost of transport calculated from these rates ranged from 2.3 to 3.6 J.m-1.kg-1, and was 2.5-4.0 times the level predicted for similarly-sized salmonids. Despite different modes of propulsion and physiological responses to swimming, these pinnipeds demonstrate similar transport costs.
Aerobiosis↗
Swimming by sea otters: adaptations for low energetic cost locomotion.
The energetics and hydrodynamics of surface and submerged swimming were compared in the sea otter (Enhydra lutris). 1. Sea otters used two distinct speed ranges that varied with swimming mode. Sustained surface swimming was limited to speeds less than 0.80 m/s, while sustained submerged swimming occurred over the range of 0.60 to 1.39 m/s. 2. Rates of oxygen consumption (VO2) at the transition speed (0.80 m/s) were 41% lower for submerged swimming by sea otters in comparison to surface swimming. 3. Total cost of transport for surface swimming sea otters, 12.56 joules/kg.m, was more than 12 times the predicted value for a similarly-sized salmonid fish. Transport costs for submerged swimming at the same speed was only 7.33 times the predicted value. 4. The allometric relationship for minimum cost of transport in surface swimming birds and mammals was y = 23.87 chi -0.15 where y = cost of transport in joules/kg.m and x = body mass in kg. This regression loosely parallels the relationship for salmonid fish. 5. Correlations between aquatic behavior, morphological specialization, and swimming energetics indicate that the development of swimming in mustelids involved transitions from fore-paw to hind-paw propulsion, and from surface to submerged swimming.
Animals↗
Cost and output of mobile clinics in a commercial farming area in Zimbabwe.
Mobile clinics may be useful to improve the geographic accessibility of health services, but their cost may be higher than that of static clinics. In this paper it is determined to what extent mobile clinics in a commercial farming area in Zimbabwe improve geographic accessibility. The opportunity cost of mobile clinics, comprising cost of staff time and transport is estimated. Staff time appears to be more efficiently utilized in mobile clinics than in static clinics. The cost of transport comprises the cost to the health service and that to the population using the service. The consequences of two extreme assumptions are determined. If the first assumption (outreach does not increase coverage) were true, total transport cost would increase if outreach were discontinued. If the second assumption (outreach increases coverage by the number of attendances at mobile clinics) were true, a substantial increase in coverage would be obtained in particular for growth monitoring, immunizations and child spacing, without increasing the cost per contact. It is concluded that outreach clinics should continue in this commercial farming area. The sites of the mobile clinics are being reconsidered as a result of this study.
Agriculture↗
Pregnancy and childbirth among the Amish.
This study examined Amish patterns of perinatal health care utilization from the perspective of Amish women and local health care providers in Geauga County, Ohio. Participant observation and interviews with health care providers and 15 Amish women yielded data on perinatal beliefs and utilization patterns for 76 pregnancies. While local health care providers regard the Amish as suboptimally utilizing prenatal care, this study found a consistent pattern of health seeking behavior. In the absence of symptoms perceived to be serious, Amish women initiated prenatal care earlier for first pregnancies and progressively later with increasing parity. Amish women's perinatal health care utilization must be seen within the context of barriers of transportation, cost, and child care needs. The Amish do not automatically reject medical technology, but select those aspects that are congruent with and that will support and maintain their way of life. Further, despite outward appearances of homogeneity, Amish women display individual variability in responding to pregnancy and childbirth.
Adult↗
Are spinal precautions necessary in all seizure patients?
The purpose of this retrospective chart review study was to evaluate the necessity of spinal precautions in uncomplicated seizure patients. The population was all patients from the Emergency Department with a primary diagnosis of seizure over a 10.5-year period. The setting was a university-affiliated county teaching hospital with an annual patient volume of over 58,000. The key outcome measure was an association of spinal injuries to uncomplicated seizures. A total of 1,656 cases were reviewed. No spinal injuries were found. Three nonspinal fractures were associated with seizure activity. Transportation costs increased approximately 113% and nursing costs increased approximately 57% for patients with seizure placed in spinal precautions. Quality Assurance and Risk Management files showed no complaints or litigation secondary to missed spinal injuries. This retrospective chart review study seriously questions routine use of spinal precautions in uncomplicated seizure cases. If spinal precautions were not used in this group, there would be a significant potential cost savings without increased morbidity. A prospective study is needed to confirm these findings.
Adult↗
Feasibility of an emergency department-based, risk-targeted voluntary HIV screening program.
STUDY OBJECTIVE: To assess the feasibility and effectiveness of an emergency department-based, risk-targeted voluntary HIV screening program. METHODS: We prospectively enrolled consenting adult i.v. drug users (IDUs) not known to have HIV infection in the ED of a large inner-city hospital with a high rate of HIV infection among patients during a 10-week trial. Study patients were given confidential HIV pretest and risk-reduction counseling, with 10- to 14-day on-site ED follow-up. Follow-up included posttest counseling, reinforcement of risk-reduction practices, and a +10 incentive to cover transportation costs. HIV seropositive patients were referred to the hospital HIV clinic for further evaluation and treatment. RESULTS: Of 200 eligible IDUs, 168 (84%) consented to HIV testing. Of the 104 (62%) who returned for follow-up, 17 (16%) tested positive for HIV. Of these patients, 6 (35%) kept their initial hospital HIV clinic referral appointment, a rate consistent with the experience of the hospital HIV clinic. Of nine patients in whom CD4+ counts were performed at time of the visit, three (33%) had counts less than 200. At 3-month follow-up, 4 of 20 active IDUs (20%) had reportedly ceased drug use because of the program. The complete program costs was an estimated $16,659, $99 per enrolled patient and $521 per HIV-positive patient. CONCLUSION: An ED-based, risk-targeted HIV screening program is feasible and over time could detect a significant number of asymptomatic HIV-infected individuals, including those who should receive antiretroviral therapy and prophylaxis for Pneumocystis carinii pneumonia therapy (CD4+ count less than 200). An additional benefit of ED-based HIV screening in high-prevalence EDs is the opportunity to conduct successful risk-reduction counseling in some high-risk individuals.
AIDS Serodiagnosis↗
Metabolism of the lactating cow. I. Animal elements of a mechanistic model.
A mechanistic model of dairy cow metabolism is described. The model was constructed as part of a programme directed toward quantitative and dynamic analysis of concepts and data regarding factors which influence the partition of nutrients in lactating dairy cows. Sensitivity and behavioural analyses undertaken using the model indicate that concepts and data arising from tissue level experiments conducted in vitro can be used to structure and parameterize whole-animal models since the quantitative and dynamic behaviour of such a model is acceptable. These analyses indicate further that such models can be used to evaluate factors which influence patterns of nutrient utilization. By way of illustrating the model's utility regarding evaluation of concepts relating to the interpretation of energy balance experiments, results of a simulated energy balance experiment are presented. Apparent costs of milk synthesis are partitioned among biosynthetic costs, physiological costs, ion transport costs and the reductions in energy expenditures in synthesis of body components which accompany increasingly negative energy balances due to feed restriction.
Animals↗
Travel at low energetic cost by swimming and wave-riding bottlenose dolphins.
Over the past 50 years there has been much speculation about the energetic cost of swimming and wave-riding by dolphins. When aligned properly in front of the bow of moving ships in the stern wake of small boats, on wind waves, and even in the wake of larger cetaceans, the animals appear to move effortlessly through the water without the benefit of propulsive strokes by the flukes. Theoretically, body streamlining as well as other anatomical and behavioural adaptations contribute to low transport costs in these animals. The economy of movement permitted by wave-riding has been perceived as an energetic advantage for the swimming dolphin, but has been hard to prove in the absence of physiological data for exercising cetaceans. Here we determine the aerobic and anaerobic costs of swimming and wave-riding in bottlenose dolphins and find that the minimum cost of transport for swimming dolphins is 1.29 +/- 0.05 J kg-1 m-1 at a cruising speed of 2.1 m s-1. Aerobic costs are nearly twice as high for swimming seals and sea lions, and 8-12 times higher for human swimmers. Wave-riding by dolphins provides additional benefits in terms of speed. The results indicate that behavioural, physiological and morphological factors make swimming an economical form of high-speed travel for dolphins.
Animals↗
Adaptive regulation of intestinal nutrient transporters.
Because most eukaryotic somatic cells are bathed in a constant internal milieu, most of their proteins are constitutive, unlike the adaptive enzymes of bacteria. However, intestinal mucosal cells, like bacteria, face a varying milieu. Hence, we tested for adaptive regulation of intestinal nutrient transporters, sought its functional significance, and compared it with regulation of bacterial proteins. All 12 transporters studied proved to be regulated by dietary substrate levels. Regulation in the intestine is slower than in bacteria and shows lower peak-to-basal activity levels. Regulatory patterns vary greatly among transporters: two sugars and two nonessential amino acids monotonically up-regulate their transporters, two vitamins and three minerals monotonically down-regulate their transporters, and two transporters of essential amino acids respond nonmonotonically to levels of their substrates. These varied patterns arise from trade-offs among four factors: transporter costs, calories yielded by metabolizable substrates, fixed daily requirements of essential nutrients, and toxicity of certain nutrients in large amounts. Based on these trade-offs, we predict the form of regulatory pattern for intestinal transporters not yet studied.
Amino Acids↗
Simulation of the energy costs associated with protein turnover and Na+,K+-transport in growing lambs.
A mathematical representation of the energy-requiring processes of protein turnover and Na+,K+-transport in the tissues of growing lambs is described. This model was then used to examine the relative contributions of these processes to ATP expenditure at two different growth rates (90-230 g/d). Protein turnover accounted for 19% of whole-body ATP expenditure at both growth rates examined, with the gastrointestinal tract (GIT), accounting for 25-27%, muscle for 21-26%, skin for 23-26% and liver for 13% of total protein turnover energy costs. The contribution of Na+,K+-transport increased from 18 to 23% of whole-body heat production as growth rate increased, with the GIT accounting for 39 and 50%, muscle for 17 and 10% and liver for 18 and 23% of total Na+,K+-transport costs at low and high nutrient inputs, respectively. Thus, protein turnover accounted for 19% of the increment in ATP expenditure due to the increased nutrient input at the higher rate of growth, while Na+,K+-transport accounted for 39%, and fat turnover and accretion accounted for 25%, leaving 17% of the ATP increment unaccounted for.
Adenosine Triphosphate↗
A pilot study of the economic cost and clinical outcome of day patient vs inpatient management of active rheumatoid arthritis.
The aims of this pilot study, which compares day patient with inpatient care for management of active RA were (i) to test the feasibility of a trial protocol design including the method of randomization and the practicality of data collection, and (ii) to obtain preliminary information on economic cost and clinical outcome of these two methods of management. Twenty consecutive patients requiring admission for management of active RA were randomized to receive either day patient or inpatient care. All hospital, transport, community and indirect costs incurred over a 6-month period from recruitment were collected for each patient. Disease activity and clinical outcome were assessed using the Ritchie articular index, ESR, Health Assessment Questionnaire, Functional Independence Measure and Hospital Anxiety and Depression Scale. The trial protocol was found to be feasible and no patient allocated to the day patient group requested or required to be transferred to inpatient care. Day care was significantly cheaper than inpatient care despite higher transport costs; the total cost of treating 10 day patients was UK 10,272 pounds compared with 14,528 pounds for 10 inpatients. Clinical outcome was comparable in both groups for all parameters studied and there was no obvious detrimental effect on patients receiving day care. This pilot study demonstrates that day care is feasible and acceptable to patients with active RA. The preliminary data suggest that day care is substantially cheaper than inpatient care and does not apparently compromise clinical outcome.
Ambulatory Care↗
Predicting hypoxia in children with acute lower respiratory infection: a study in the highlands of Papua New Guinea.
Pneumonia accounts for nearly half of all admissions amongst children less than 5 years of age to health centres and hospitals in the highlands of Papua New Guinea. Until recently, the indications for the use of oxygen in the management of childhood pneumonia in Papua New Guinea had been confined to the detection of cyanosis and restlessness. Oxygen is, however, difficult to deliver to many parts of Papua New Guinea, leading to high transport costs and shortages. Health workers in rural areas are continually faced with decisions as to which children should be given oxygen when it is in short supply. This study related clinical signs to the oxygen saturation of the blood using a pulse oximeter, in order to offer rational criteria for the use of oxygen in health centres and hospitals in remote areas. Data were collected on 110 children who were admitted to Tari Hospital with a diagnosis of moderate or severe pneumonia. Following admission, assessments were repeated at 12-hourly intervals until the child was discharged from the intensive nursing ward. All clinical assessments and oximetry readings were taken by a registered nurse. A rule developed via quadratic discrimination analysis was able to correctly classify 80 per cent of children as having adequate/inadequate oxygen saturation, with 'inadequate oxygen saturation' defined as less than 85 per cent. This, however, involved a complicated equation which would not be suitable for general use in a developing country. The use of a 'clinical score' using a summation of the major clinical signs was not found to offer any advantage over the recognition of any one of four 'indicator' signs.(ABSTRACT TRUNCATED AT 250 WORDS)
Child, Preschool↗
An evaluation of urologist-operated ultrasound and its use in the urological out-patient clinic.
The value of urologist-operated real time ultrasound scanning was assessed in the urological out-patient clinic. In terms of accuracy, the urologists' ultrasound scans of the genito-urinary tract proved comparable with those of the radiologists. The techniques were quickly learned and scanning added little to the consultation time. Scanning during clinic time was shown to be both time-saving and cost-effective by allowing more rapid assessment of the patient and a speedier diagnosis. In economic terms considerable savings could be made by reducing the need for formal ultrasound referrals, since patients scanned at the out-patient clinic would be spared two further trips to hospital, one for the formal examination and another for the out-patient clinic review. Clinic turnover thus becomes more efficient and inconvenience to the patient and transport costs are lessened.
Adolescent↗