The cost of radiation treatment at an Ontario regional cancer centre.

The cost of radiation treatment in 1985 at an Ontario regional cancer centre accruing 2500 new patients annually was examined. The radiation treatment department was equipped with three high-energy treatment machines, a treatment simulator and a treatment planning computer and was appropriately staffed. The total average annual cost of operating one high-energy treatment machine was $668,963. Salaries and employee benefits accounted for 78% of the costs. An average of 5439 radiation treatments were given annually with each treatment machine, at a cost $123 per treatment. The cost of a curative course of radiation treatment (average of 21 treatments) was $2583, and the cost of a palliative course (average of 7 treatments) was $861.     

Effect of smoke-free workplaces on smoking behaviour: systematic review

ObjectiveTo quantify the effects of smoke-free workplaces on smoking in employees and compare these effects to those achieved through tax increases.DesignSystematic review with a random effects meta-analysis.SettingWorkplaces in the United States, Australia, Canada, and Germany.ParticipantsEmployees in unrestricted and totally smoke-free workplaces.ResultsTotally smoke-free workplaces are associated with reductions in prevalence of smoking of 3.8% (95% confidence interval 2.8% to 4.7%) and 3.1 (2.4 to 3.8) fewer cigarettes smoked per day per continuing smoker. Combination of the effects of reduced prevalence and lower consumption per continuing smoker yields a mean reduction of 1.3 cigarettes per day per employee, which corresponds to a relative reduction of 29%. To achieve similar reductions the tax on a pack of cigarettes would have to increase from $0.76 to $3.05 (€0.78 to €3.14) in the United States and from £3.44 to £6.59 (€5.32 to €10.20) in the United Kingdom. If all workplaces became smoke-free, consumption per capita in the entire population would drop by 4.5% in the United States and 7.6% in the United Kingdom, costing the tobacco industry $1.7 billion and £310 million annually in lost sales. To achieve similar reductions tax per pack would have to increase to $1.11 and £4.26.ConclusionsSmoke-free workplaces not only protect non-smokers from the dangers of passive smoking, they also encourage smokers to quit or to reduce consumption.

What is already known on this topic

Smoke-free workplaces are associated with lower cigarette consumption per continuing smoker

What this study adds

Smoke-free workplaces reduce prevalence of smoking as well as consumptionThe combined effects of people stopping smoking and reducing consumption reduces total cigarette consumption by 29%To achieve similar results through taxation would require cigarette taxes per pack to increase from $0.76 to $3.05 in the United States and from £3.44 to £6.59 in the United Kingdom     

Cost of Fetal Alcohol Spectrum Disorder Diagnosis in Canada

Background

Fetal Alcohol Spectrum Disorder (FASD) is underdiagnosed in Canada. The diagnosis of FASD is not simple and currently, the recommendation is that a comprehensive, multidisciplinary assessment of the individual be done. The purpose of this study was to estimate the annual cost of FASD diagnosis on Canadian society.

Methods

The diagnostic process breakdown was based on recommendations from the Fetal Alcohol Spectrum Disorder Canadian Guidelines for Diagnosis. The per person cost of diagnosis was calculated based on the number of hours (estimated based on expert opinion) required by each specialist involved in the diagnostic process. The average rate per hour for each respective specialist was estimated based on hourly costs across Canada. Based on the existing clinical capacity of all FASD multidisciplinary clinics in Canada, obtained from the 2005 and 2011 surveys conducted by the Canada Northwest FASD Research Network, the number of FASD cases diagnosed per year in Canada was estimated. The per person cost of FASD diagnosis was then applied to the number of cases diagnosed per year in Canada in order to calculated the overall annual cost.

Results

Using the most conservative approach, it was estimated that an FASD evaluation requires 32 to 47 hours for one individual to be screened, referred, admitted, and diagnosed with an FASD diagnosis, which results in a total cost of $3,110 to $4,570 per person. The total cost of FASD diagnostic services in Canada ranges from $3.6 to $5.2 million (lower estimate), up to $5.0 to $7.3 million (upper estimate) per year.

Discussion

As a result of using the most conservative approach, the cost of FASD diagnostic services presented in the current study is most likely underestimated. The reasons for this likelihood and the limitations of the study are discussed.     

Uncompensated and undercompensated care provided by San Francisco Medical Society physicians.

Practicing physician members of the San Francisco Medical Society were surveyed regarding reimbursement rates for medical care provided to underinsured and uninsured patients. Of 394 respondents, about $51,000 per physician practice was written off as uncompensated care or services not billed for in 1985. An average of 7% of each physician''s patients was estimated to be "no-pay" or charity patients, accounting for $19,000 of this total. Almost $32,000 was reported as being uncompensated care, or that which is billed but not paid. In addition to these amounts, an average of $32,000 was reported as being discounted from the usual fee levels by government insurance programs. Extrapolating these results to the physician membership of the local medical society indicates that physicians in San Francisco may be providing as much as $81 million in uncompensated or charity care annually. These results emphasize that private practitioners are providing a significant amount of medical care at reduced or charity rates, an amount that can be expected to increase given present trends. Substantial changes are needed if the burden of providing medical care to poor and uninsured Americans is not to fall disproportionately on private providers.     

Water hyacinth (eichhornia crassipes) productivity and harvesting studies

Water hyacinth growth rates were monitored from May through October in two sewage lagoons with different nutrient loading rates. The lagoon receiving the heaviest load sustained the highest average growth rates throughout the summer. The lightly loaded lagoon averaged a 29% increase in weight per week over the six month period with the highest growth rate occuring during June with an average weekly weight gain of 71%. The heavily loaded lagoon sustained an average growth rate of 46% per week for the same six month period with the highest measured growth rate of 73% increase in weight per week also occuring in June. In addition, the performance of three harvesters was evaluated. One harvester, consisting of a chopper and conveyor, was capable of picking up and chopping approximately 2.3 t of plants per hour and delivering them to a waiting truck. The second harvester was a single 1.52 m (5 ft) wide conveyor, and the third one was a modified clamshell bucket attached to a dragline. The average harvesting rate of each of these harvesters was approximately 9.3 t of water hyacinths per hour.     

Echinococcosis: An Economic Evaluation of a Veterinary Public Health Intervention in Rural Canada

Echinococcosis is a rare but endemic condition in people in Canada, caused by a zoonotic cestode for which the source of human infection is ingestion of parasite eggs shed by canids. The objectives of this study were to identify risk factors associated with infection and to measure the cost-utility of introducing an echinococcosis prevention program in a rural area. We analyzed human case reports submitted to the Canadian Institutes for Health Information between 2002 and 2011. Over this 10 year period, there were 48 cases associated with E. granulosus/E. canadensis, 16 with E. multilocularis, and 251 cases of echinococcosis for which species was not identified (total 315 cases). Nationally, annual incidence of echinococcosis was 0.14 cases per 100 000 people, which is likely an underestimate due to under-diagnosis and under-reporting. Risk factors for echinococcosis included female gender, age (>65 years), and residing in one of the northern territories (Nunavut, Yukon, or Northwest Territories). The average cost of treating a case of cystic echinococcosis in Canada was $8,842 CAD. Cost-utility analysis revealed that dosing dogs with praziquantel (a cestocide) at six week intervals to control cystic echinococcosis is not currently cost-effective at a threshold of $20,000-100,000 per Quality Adjusted Life Year (QALY) gained, even in a health region with the highest incidence rate in Canada ($666,978 -755,051 per QALY gained). However, threshold analysis demonstrated that the program may become cost-saving at an echinococcosis incidence of 13-85 cases per 100,000 people and therefore, even one additional CE case in a community of 9000 people could result in the monetary benefits of the program outweighing costs.     

A Comprehensive Analysis of Small-Passerine Fatalities from Collision with Turbines at Wind Energy Facilities

Small passerines, sometimes referred to as perching birds or songbirds, are the most abundant bird group in the United States (US) and Canada, and the most common among bird fatalities caused by collision with turbines at wind energy facilities. We used data compiled from 116 studies conducted in the US and Canada to estimate the annual rate of small-bird fatalities. It was necessary for us to calculate estimates of small-bird fatality rates from reported all-bird rates for 30% of studies. The remaining 70% of studies provided data on small-bird fatalities. We then adjusted estimates to account for detection bias and loss of carcasses from scavenging. These studies represented about 15% of current operating capacity (megawatts [MW]) for all wind energy facilities in the US and Canada and provided information on 4,975 bird fatalities, of which we estimated 62.5% were small passerines comprising 156 species. For all wind energy facilities currently in operation, we estimated that about 134,000 to 230,000 small-passerine fatalities from collision with wind turbines occur annually, or 2.10 to 3.35 small birds/MW of installed capacity. When adjusted for species composition, this indicates that about 368,000 fatalities for all bird species are caused annually by collisions with wind turbines. Other human-related sources of bird deaths, (e.g., communication towers, buildings [including windows]), and domestic cats) have been estimated to kill millions to billions of birds each year. Compared to continent-wide population estimates, the cumulative mortality rate per year by species was highest for black-throated blue warbler and tree swallow; 0.043% of the entire population of each species was estimated to annually suffer mortality from collisions with turbines. For the eighteen species with the next highest values, this estimate ranged from 0.008% to 0.038%, much lower than rates attributed to collisions with communication towers (1.2% to 9.0% for top twenty species).     

Costs associated with gunshot wounds in Canada in 1991.

OBJECTIVE: To estimate the costs (in 1993 dollars) associated with gunshot wounds in Canada in 1991. DESIGN: Cost analysis using separate estimates of gunshot incidence rates and costs per incident for victims who died, those who survived and were admitted to hospital and those who survived and were treated and released from emergency departments. Estimates were based on costs for medical care, mental health care, public services (i.e., police investigation), productivity losses, funeral expenses, and individual and family pain, suffering and lost quality of life. SETTING: Canada. OUTCOME MEASURES: Costs per case, costs by type of incident (e.g., assault, suicide or unintentional shooting) and costs per capita. RESULTS: The total estimated cost associated with gunshot wounds was $6.6 billion. Of this, approximately $63 million was spent on medical and mental health care and $10 million on public services. Productivity losses exceeded $1.5 billion. The remaining cost represented the value attributed to pain, suffering and lost quality of life. Suicides and attempted suicides accounted for the bulk of the costs ($4.7 billion); homicides and assaults were the next most costly ($1.1 billion). The cost per survivor admitted to hospital was approximately $300,000; this amount included just over $29,000 for medical and mental health care. CONCLUSION: Costs associated with gunshot wounds were $235 per capita in Canada in 1991, as compared with $595 in the United States in 1992. The differences in these costs may be due to differences in gun availability in the two countries. This suggests that increased gun control may reduce Canada''s costs, especially those related to suicide.     

Impact of a bilingual mobile spay/neuter clinic in a U.S./Mexico border city

There are between 4 and 10 million dogs and cats killed annually in the United States. Although there are no accurate national estimates of the number of companion animals who are sterilized surgically. Approximately 26,000 companion animals are euthanized annually in El Paso County, Texas, located on the U.S./Mexico border. In an effort to determine if a readily available spay/neuter program would be cost effective and eventually help to lower the county's euthanasia rate, a mobile spay/neuter clinic began operation for a 5-month period in 2004, using a volunteer veterinarian and paid staff. Sterilizations performed totaled 1,108: 959 dogs (372 males and 587 females) and 149 cats (50 males and 99 females). The per companion animal sterilization cost of $15.13 ($27.83 had the veterinarian been paid) was considerably cheaper than the rate of $57 per companion animal achieved by a local voucher program contracting with private veterinarians to perform reduced-cost sterilizations.     

Hepatitis B Prevention in Small Rural Hospitals

A retrospective study of 246 potential hepatitis B exposure incidents in 12 rural hospitals in Arizona over a two-year period revealed a rate of 6.3 incidents per 100 employees per year. Needle punctures accounted for 68% of the incidents; 17% were cuts from instruments or broken glassware. Although 51% occurred in nursing personnel, housekeepers accounted for a surprising 19.5% of the reports. Only 50% of the employees received any medical attention following incidents. None received hepatitis B immune globulin (HBIG); seven received immune globulin (IG). The mean cost to the hospitals for the 122 incidents where treatment was given was $64.50 per incident. In all, 10 hospitals had no written policy for hepatitis B prevention, 3 did not stock IG and 11 did not stock HBIG. There was little awareness of hepatitis B as a nosocomial problem within these institutions, perhaps because no reported cases of clinical hepatitis B occurred in employees of the 12 hospitals in the two years.     

Resource Use and Waste Generation by the Tourism Industry on the Big Island of Hawaii

A survey of the tourism industry on the island of Hawaii (the Big Island) in the state of Hawaii in the United States was conducted to collect baseline information on major resources (energy, food, and water consumption) and waste generation from five tourism sectors: accommodations, food and beverages (restaurants), golf courses, tourism services (tours), and rental cars. The questionnaire was developed and 50 establishments from the target sectors participated in this survey. Resource consumption and waste generation were calculated by the number of establishments, employees, and visitors. Using these factors and island‐wide statistics (the number of establishments, job counts, and visitors), this study estimated the current status of island‐wide water, food, and energy consumption and waste generation by these five sectors of the tourism industry. The estimate shows that the tourism sectors surveyed for this study account for 21.7% of the island's total energy consumption, 44.7% of the island‐wide water consumption, and 10.7% of the island‐wide waste generation. Using a per guest emission factor (such as per employee, guest room, and seat) provided in this study, the owners and managers of tourism establishments can calculate a baseline for each resource input and output. This is essential information to improve the industry's efficiency and result in economic savings.     

Population policies,programmes and the environment

Human consumption is depleting the Earth''s natural resources and impairing the capacity of life-supporting ecosystems. Humans have changed ecosystems more rapidly and extensively over the past 50 years than during any other period, primarily to meet increasing demands for food, fresh water, timber, fibre and fuel. Such consumption, together with world population increasing from 2.6 billion in 1950 to 6.8 billion in 2009, are major contributors to environmental damage. Strengthening family-planning services is crucial to slowing population growth, now 78 million annually, and limiting population size to 9.2 billion by 2050. Otherwise, birth rates could remain unchanged, and world population would grow to 11 billion. Of particular concern are the 80 million annual pregnancies (38% of all pregnancies) that are unintended. More than 200 million women in developing countries prefer to delay their pregnancy, or stop bearing children altogether, but rely on traditional, less-effective methods of contraception or use no method because they lack access or face other barriers to using contraception. Family-planning programmes have a successful track record of reducing unintended pregnancies, thereby slowing population growth. An estimated $15 billion per year is needed for family-planning programmes in developing countries and donors should provide at least $5 billion of the total, however, current donor assistance is less than a quarter of this funding target.     

Comparison of the deep inferior epigastric perforator flap and free transverse rectus abdominis myocutaneous flap in postmastectomy reconstruction: a cost-effectiveness analysis

This study compared the deep inferior epigastric perforator (DIEP) flap and the free transverse rectus abdominis myocutaneous (TRAM) flap in postmastectomy reconstruction using a cost-effectiveness analysis. A decision analytic model was used. Medical costs associated with the two techniques were estimated from the Ontario Ministry of Health Schedule of Benefits for 2002. Hospital costs were obtained from St. Joseph's Healthcare, a university teaching hospital in Hamilton, Ontario, Canada. The utilities of clinically important health states related to breast reconstruction were obtained from 32 "experts" across Canada and converted into quality-adjusted life years. The probabilities of these various clinically important health states being associated with the DIEP and free TRAM flaps were obtained after a thorough review of the literature. The DIEP flap was more costly than the free TRAM flap ($7026.47 versus $6508.29), but it provided more quality-adjusted life years than the free TRAM flap (28.88 years versus 28.53 years). The baseline incremental cost-utility ratio was $1464.30 per quality-adjusted life year, favoring adoption of the DIEP flap. Sensitivity analyses were performed by assuming that the probabilities of occurrence of hernia, abdominal bulging, total flap loss, operating room time, and hospital stay were identical with the DIEP and free TRAM techniques. By assuming that the probability of postoperative hernia for the DIEP flap increased from 0.008 to 0.054 (same as for TRAM flap), the incremental cost-utility ratio changed to $1435.00 per quality-adjusted life year. A sensitivity analysis was performed for the complication of hernia because the DIEP flap allegedly diminishes this complication. Increasing the probability of abdominal bulge from 0.041 to 0.103 for the DIEP flap changed the ratio to $2731.78 per quality-adjusted life year. When the probability of total flap failure was increased from 0.014 to 0.016, the ratio changed to $1384.01 per quality-adjusted life year. When the time in the operating room was assumed to be the same for both flaps, the ratio changed to $4026.57 per quality-adjusted life year. If the hospital stay was assumed to be the same for both flaps, the ratio changed to $1944.30 per quality-adjusted life year. On the basis of the baseline calculation and sensitivity analyses, the DIEP flap remained a cost-effective procedure. Thus, adoption of this new technique for postmastectomy reconstruction is warranted in the Canadian health care system.     

The potential trade‐off between artisanal fisheries production and hydroelectricity generation on the Kafue River,Zambia

1. Freshwater resource managers are increasingly obligated to consider the impacts of large river engineering projects on ecosystem services. We evaluated the effect of altered water regime from the operation of a large dam on the production of the downstream tropical floodplain fishery of the Kafue River, Zambia. We compared the benefits of increased hydropower relative to potentially lost fishery production. 2. We compiled a long‐term data set consisting of experimental gillnet catches, artisanal harvesting effort and monthly river flows for 25 years prior to and 29 years after the 1977 completion of the upstream Itezhi‐Tezhi Dam. As a metric of the flood regime, we calculated a canonical correlation score for each hydrological year before and after dam closure. For the period following dam construction, we used the Muskingum method of flood routing to estimate ‘no‐dam’ flows through the fishery area and downstream hydroelectric turbines at the Kafue Gorge Dam. 3. We compared 16 alternative models of catch per unit effort (CPUE) with and without an effect of water regime on fish population growth rate. Using the two best fitting models, we estimated the total observed fishery harvest and simulated ‘no‐dam’ fisheries harvest and found no significant effect of altered water regime on fishery production. 4. We estimate that the large upstream dam increases downstream hydropower production by about $18 million USD per annum. The reduction in fishery production caused by the altered water regime is not significantly different than zero, although the average reduction amounts to about $2.3 million annually. The total estimated value of harvest ranges from $1.3 million to $56 million annually. 5. Large observed declines in fish abundance over the 54‐year study period are attributed primarily with similarly large increases in total fishing effort in this mostly open‐access artisanal fishery. 6. These results contrast with other examples of the effects of flow alteration on fish, probably because levels of fisheries exploitation on the Kafue River are very high relative to better studied regions on other continents; our focus on the whole fish community; and the unprecedented length of the time series we considered. If the goal is to sustain fishery production, investments in altering flow regime are likely to be less effective than investments to decrease fishing effort.     

The agronomical and radiological estimation of application of different kinds and dozes of organic fertilizers at improvement waterless valley types meadows contamination 137Cs and 90Sr

On the basis of agronomical, economic and radiological estimations of results of long-term researches with organic fertilizers (peat, sapropel, manure, mixes manure and peat) it is established, that is effective at improvement of the waterless meadows on sod-podsolic sandy soils contaminated by radionuclides to bring in 40-60 t/ha mixes manure and peat or covering the manure, on a background liming and mineral fertilizers (level of profitability--4.8-8.7%), providing reception of the maximal increase of a crop (6.0-7.5 t/ha of hay) and decrease to 10 times of size of transfer factors of 137Cs and to 3.0 times 90Sr in a crop of long-term cereal herbs (size of the prevented collective doze, deltaD - 0.0060-0.0065 man-Sv per one year; cost of the prevented collective doze, deltaepsilon--11500-13000 $ on 1 man-Sv annually. The application of 40 and 60 t/ga of peat and sapropel in the pure state on a background liming and mineral fertilizers is not expedient, as cost of additional production does not cover total expenses for their entering (level of profitability--20-32.0%), the and cost of the prevented collective doze exceeds 20000 $ US per 1 man-Sv annually.     

THE PERIODIC HEALTH APPRAISAL OF EMPLOYEES

Periodic health appraisals for employees in business and industry are desirable and effective. Male executives over the age of 40 constitute the group most in need of them. Examinations of the kind done for private patients, including careful history-taking and thorough physical observation, are the most reliable, economical and productive.Undesirable factors to be guarded against in these examinations are unnecessary hospitalization, excessive laboratory and radiologic procedures and absence of rapport between examiner and examinee.Ideally, the results of the examination should be made known to the employee only—not to the employer except with the stated permission of the employee.     

基于物质流分析方法的生态海岛建设研究——以长海县为例

建设生态海岛是海岛生态经济系统实现可持续发展的重要途径。运用物质流分析方法对长海县的物质输入与输出状况进行计算,并用物质消耗强度、废物排放强度和环境负荷强度3个指标衡量了该海岛县生态效率的变化,分析了技术进步对海岛生态经济系统生态压力变化的贡献状况。结果表明,2003—2009年间,长海县物质输入总量、物质输出总量和环境负荷总量呈增长态势;生态效率明显提高;技术进步对减轻海岛生态经济系统生态压力的贡献没有抵消经济增长所产生的生态压力的增加量。为了减少物质输入和废物输出,减轻经济活动对海岛生态系统产生的压力,建立创新型管理机制有效促进技术进步,不断提高生态效率具有特别重要的作用。     

Disability payments continue to climb: "Tell us what you see,not what you think," CPP tells MDs

Growing concern about the sustainability of the Canada Pension Plan has led to a closer look at the disability benefits it provides. The federal auditor general reported recently that the number of recipients has almost doubled in the past 10 years, and disability payments have more than tripled, to $3 billion annually. This article looks at the role physicians play in determining whether an applicant is disabled.     

Employee motivation in laboratory animal science: creating the conditions for a happy and productive staff

High rates of employee turnover are the source of a considerable loss of time and resources, but managers are not always aware of the reasons that motivate employees to stay in their positions. The author compares prominent theories of employee motivation and then puts them to the test by surveying 82 cagewashers, animal caretakers, animal technicians, and supervisors working in a laboratory animal facility to determine the job characteristics that motivate them.     

Feasibility studies on the treatment of dairy wastewaters with upflow anaerobic sludge blanket reactors

The feasibility of using upflow anaerobic sludge blanket (UASB) reactors for the treatment of dairy wastewaters was explored. Two types of UASBs were used--one operating on anaerobic sludge granules developed by us from digested cowdung slurry (DCDS) and the other on the granules obtained from the reactors of M/s EID Parry treating sugar industry wastewaters. The reactors were operated at HRT of 3 and 12 h and on COD loading rates ranging from 2.4 kg per m3 of digester volume, per day to 13.5 kg m(-3) d(-1). At the 3 h HRT, the maximum COD reduction in the DCDS-seeded and the industrial sludge-seeded reactors was 95.6% and 96.3%, respectively, better than at 12 h HRT (90% and 92%, respectively). In both the reactors, the maximum, the second best, and the third best COD reduction occurred at the loading rates of 10.8, 8.6 and 7.2 kg m3 d(-1), respectively. At loading rates higher than 10.8 kg, the reactor performance dropped precipitously. Whereas in the first few months the reactors operating on sludge from EID Parry achieved better biodegradation of the waste, compared to the reactors operated on DCDS, the performance of the latter gradually improved and matched with the performance of the former.