Disability Adjusted Research Articles

Effect of disability, homelessness, and neighborhood marginalization on risk-adjustment for hospital performance measurement.

Background It is not known how disability, homelessness, or neighborhood marginalization influence risk-adjusted hospital performance measurement in a universal health care system. Methods We evaluated the effect of including these equity-related factors in risk-adjustment models for in-hospital mortality, and 7- and 30-day readmission in 28 hospitals in Ontario, Canada. We compared risk-adjustment with commonly-used clinical factors to models that also included homelessness, disability, and neighborhood indices of marginalization. We evaluated models in historical data using internal-external cross-validation. We calculated risk-standardized outcome rates for each hospital in a recent reporting period using mixed-effects logistic regression. Results The cohort included 544,805 admissions. Adjustment for disability, homelessness, and neighborhood marginalization had little impact on discrimination or calibration of risk-adjustment models. However, it influenced comparative hospital performance on risk-standardized 30-day readmission rates, resulting in 5 hospitals being reclassified between below-average, average, and above-average groups. No hospitals were reclassified for mortality and 7-day readmission. Conclusion In a system with universally insured hospital services, adjustment for disability, homelessness, and neighborhood marginalization influenced estimates of hospital performance for 30-day readmission but not 7-day readmission or in-hospital mortality. These findings can inform researchers and policymakers as they thoughtfully consider when to adjust for these factors in hospital performance measurement.

Exploring the return-on-investment for scaling screening and psychosocial treatment for women with common perinatal mental health problems in Malawi: Developing a cost-benefit-calculator tool.

This study sought to develop a user-friendly decision-making tool to explore country-specific estimates for costs and economic consequences of different options for scaling screening and psychosocial interventions for women with common perinatal mental health problems in Malawi. We developed a simple simulation model using a structure and parameter estimates that were established iteratively with experts, based on published trials, international databases and resources, statistical data, best practice guidance and intervention manuals. The model projects annual costs and returns to investment from 2022 to 2026. The study perspective is societal, including health expenditure and productivity losses. Outcomes in the form of health-related quality of life are measured in Disability Adjusted Life Years, which were converted into monetary values. Economic consequences include those that occur in the year in which the intervention takes place. Results suggest that the net benefit is relatively small at the beginning but increases over time as learning effects lead to a higher number of women being identified and receiving (cost‑)effective treatment. For a scenario in which screening is first provided by health professionals (such as midwives) and a second screening and the intervention are provided by trained and supervised volunteers to equal proportions in group and individual sessions, as well as in clinic versus community setting, total costs in 2022 amount to US$ 0.66 million and health benefits to US$ 0.36 million. Costs increase to US$ 1.03 million and health benefits to US$ 0.93 million in 2026. Net benefits increase from US$ 35,000 in 2022 to US$ 0.52 million in 2026, and return-on-investment ratios from 1.05 to 1.45. Results from sensitivity analysis suggest that positive net benefit results are highly sensitive to an increase in staff salaries. This study demonstrates the feasibility of developing an economic decision-making tool that can be used by local policy makers and influencers to inform investments in maternal mental health.

Is Mild Really Mild?: Generating Longitudinal Profiles of Stroke Survivor Impairment and Impact Using Unsupervised Machine Learning

The National Institute of Health Stroke Scale (NIHSS) is used worldwide to classify stroke severity as ‘mild’, ‘moderate’, or ‘severe’ based on neurological impairment. Yet, stroke survivors argue that the classification of ‘mild’ does not represent the holistic experience and impact of stroke on their daily lives. In this observational cohort study, we aimed to identify different types of impairment profiles among stroke survivors classified as ‘mild’. We used survivors of mild stroke’ data from the START longitudinal stroke cohort (n = 73), with measures related to sensorimotor, cognition, depression, functional disability, physical activity, work, and social adjustment over 12 months. Given the multisource, multigranular, and unlabeled nature of the data, we utilized a structure-adapting, unsupervised machine learning approach, the growing self-organizing map (GSOM) algorithm, to generate distinct clinical profiles. These diverse impairment profiles revealed that survivors of mild stroke experience varying degrees of impairment and impact (cognitive, depression, physical activity, work/social adjustment) at different time points, despite the uniformity implied by their NIHSS-classified ‘mild’ stroke. This emphasizes the necessity of creating a holistic and more comprehensive representation of survivors of mild stroke’ needs over the first year after stroke to improve rehabilitation and poststroke care.

Social Determinants of Health and Delivery of Rehabilitation to Older Adults During ICU Hospitalization

Older adults with socioeconomic disadvantage develop a greater burden of disability after critical illness than those without socioeconomic disadvantage. The delivery of in-hospital rehabilitation that can mitigate functional decline may be influenced by social determinants of health (SDOH). Whether rehabilitation delivery differs by SDOH during critical illness hospitalization is not known. To evaluate whether SDOH are associated with the delivery of skilled rehabilitation during critical illness hospitalization among older adults. This cohort study used data from the National Health and Aging Trends Study linked with Medicare claims (2011-2018). Participants included older adults hospitalized with a stay in the intensive care unit (ICU). Data were analyzed from August 2022 to September 2023. Dual eligibility for Medicare and Medicaid, education, income, limited English proficiency (LEP), and rural residence. The primary outcome was delivery of physical therapy (PT) and/or occupational therapy (OT) during ICU hospitalization, characterized as any in-hospital PT or OT and rate of in-hospital PT or OT, calculated as total number of units divided by length of stay. In the sample of 1618 ICU hospitalizations (median [IQR] patient age, 81.0 [75.0-86.0] years; 842 [52.0%] female), 371 hospitalizations (22.9%) were among patients with dual Medicare and Medicaid eligibility, 523 hospitalizations (32.6%) were among patients with less than high school education, 320 hospitalizations (19.8%) were for patients with rural residence, and 56 hospitalizations (3.5%) were among patients with LEP. A total of 1076 hospitalized patients (68.5%) received any PT or OT, with a mean rate of 0.94 (95% CI, 0.86-1.02) units/d. After adjustment for age, sex, prehospitalization disability, mechanical ventilation, and organ dysfunction, factors associated with lower odds of receipt of PT or OT included dual Medicare and Medicaid eligibility (adjusted odds ratio, 0.70 [95% CI, 0.50-0.97]) and rural residence (adjusted odds ratio, 0.65 [95% CI, 0.48-0.87]). LEP was associated with a lower rate of PT or OT (adjusted rate ratio, 0.55 [95% CI, 0.32-0.94]). These findings highlight the need to consider SDOH in efforts to promote rehabilitation delivery during ICU hospitalization and to investigate factors underlying inequities in this practice.

Disability Adjustment Counseling: Experiences and Perspectives of Certified Rehabilitation Counselors

Background Disability adjustment counseling (DAC) focuses on the diverse process of adjusting to chronic illness or disability, including responding to the initial diagnosis or the onset and adjusting to changes and barriers that arise from living with a disability. Although DAC is a primary role and function of rehabilitation counselors, there have been limited efforts to explore the use of DAC in the field. Objective The purpose of this study was to survey certified rehabilitation counselors (CRCs) about the extent of DAC utilization and its focus, the theoretical basis for DAC, and professional preparation. Methods A cross-sectional survey was completed with 109 CRCs recruited through the Commission on Rehabilitation Counselor Certification (CRCC). The research team developed a 35-item survey questionnaire for this study. Most respondents identified as white women with master’s degrees (mean age = 51.41 years). Results Approximately two-thirds of the respondents (67.78%) reported engaging in DAC for approximately a third (31.15%) of their professional time. Many respondents reported wanting to spend more of their professional time providing DAC. Most respondents (75%) indicated they do not operate from a specific model of psychosocial adjustment to chronic illness or disability. Nearly half (48.6%) of the respondents reported that there were not adequate options for DAC counseling. Conclusions The survey results confirm that DAC is an important role and function for rehabilitation counselors. Although the sample was too small to permit broad generalizations, the results imply that further exploration of the research questions among a larger sample is warranted.

What's out there? A scoping review of autism-related policies and research interests at U.K. higher education institutions

Background There is a growing number of autistic students in U.K. higher education institutions (HEIs), who may require autism-specific support to optimise their academic achievement, long-term prospects, and well-being. This study undertook the first known review of publicly available autism-related policies at U.K. HEIs. Methods Public websites of 132 HEIs were searched for eleven key terms, and the results of these searches were assessed using a policy appraisal approach. Qualitative framework analysis then explored the content of the policies identified. Results Three hundred thirty-six policies were identified from 92 HEIs, with 40 HEIs having no policies meeting search terms. The most common policy results were ‘autism support’ and ‘disability adjustments’. The qualitative analysis showed a wide range of policies which covered most areas of higher education life but with significant inconsistency in content and quality. Conclusions While many U.K. HEIs appear to be aware of autistic students and the need to support them, most institutions have minimal publicly available policies regarding support for autistic students. The policies to support students which do exist are patchy at best, and non-existent in some cases, requiring more work at individual institutions and across the HEI sector.

UNDERSTANDING AGE-RELATED DISPARITIES AND ENVIRONMENTAL BARRIERS IN OLDER ADULTS WITH MULTIPLE SCLEROSIS

Abstract Given the increasing life expectancy of individuals with multiple sclerosis (MS), the challenges faced by older adults with MS in terms of health changes and decreased physical function contribute to a potentially diminished quality of life. Despite this, our understanding of how this condition manifests in the context of aging remains limited. This study aims to examine age-related variations in fatigue, anxiety, depression, community engagement, and environmental barriers in older adults with MS, as well as to explore health disparities among older adults with MS. This secondary analysis involved 288 individuals with MS, divided into two age groups: below 60 years and 60 years and above. Aim 1 used T-tests and Aim 2 employed ANCOVA with disability adjustment. The results show that older adults with MS had higher levels of community engagement, disability, and behavioral-cognitive fatigue, reporting lower levels of anxiety, cognitive-motor fatigue, fatigue severity, and participation barriers than younger adults with MS. Noteworthy health disparities emerge, characterized by reduced community integration/participation (F=10.622, p=.001) and heightened environmental barriers (F=4.323, p=.039), even when adjusting for disability levels. The study highlights environmental barriers impeding social participation among older adults with MS, emphasizing the need to address these obstacles to enhance their quality of life. This underscores the imperative for customized interventions targeting reduced community disengagement and heightened environmental barriers faced by older adults with MS.

Data collection and analysis on the burden of injuries: Lessons learned from the IDB network

Abstract The EU-IDB (European Injury Database) contains cross-national data on the external causes and circumstances of injuries treated in the emergency departments of hospitals. Its primary purpose is to facilitate the development and evaluation of injury prevention policies and programmes, which aim to control external risks. The information is complementary to death and hospital discharge statistics and specific surveillance systems on road and workplace accidents. Unique is the wealth of information about external circumstances of injuries as needed for evidence-based prevention actions. The IDB data are collected by dedicated national agencies and provided to the Italian National Institute of Health (ISS) which hosts the databank. As part of the EU BRIDGE-Health initiative 2017 (WP9-Injury Surveillance Platform), the EU-IDB Network was commissioned to generate comparable burden of injury estimates across Europe: “Disability Adjusted Life Year (DALY) estimates for injury utilising the European Injury Data Base (IDB)”. DALY estimates were generated for IDB countries and years where both fatal and non-fatal injury data were available. Non-fatal injury data were acquired from Emergency Department data recorded in the IDB Minimum Data Set (MDS), fatal data were obtained from the European Detailed Mortality Database (EDMD). The general approach to calculating DALYs followed that of the Global Burden of Disease (GBD) study but utilised new and different disability weights created by the the Injury-VIBES cohort and detailed injury incidence data from nineteen countries. DALY estimates were between 2-10 times larger than estimates generated by previous studies such as the GBD study, due to much higher incidence figures and larger disability weights. In the workshop, the most recent results of the EU-IDB and the respective DALY estimates will be presented and discussed.

Burden and predictions of hospitalized injuries in a low-middle income country: results from a Tunisian university hospital

ABSTRACT Injuries are responsible for a high premature mortality and disability. They are poorly explored in low and middle income-countries. We aimed to estimate the burden of hospitalized injuries in the Monastir governorate (Tunisia) according to the nature of the injury, trends and projections of hospitalizations for injuries up until 2024, and to identify the distribution of this disease burden based on age and sex. We performed a descriptive study from 2002 to 2012 including all hospitalizations for injuries. Data were collected from morbidity and mortality register of the University Hospital of Monastir (Tunisia). We estimated the burden of injuries using the Disability Adjusted Life Years (DALYs). We described injuries (crude prevalence rate (CPR) and age standardized prevalence rate (ASR)), related mortality (lethality and standardized mortality ratio (SMR)), trends and prediction for 2024. A total of 18,632 hospitalizations for injuries representing 10% of all hospitalizations during study period were recorded. Per 1000 inhabitants per year, CPR was 3.36 and the ASR was 3.44. The lethality was of 17.5 deaths per 1000 injured inpatients per year and the SMR was of 2.95 (Confidence Interval of 95%: 2.64–3.29). Burden related to injuries was 2.36 DALYs per 1000 population per year, caused mainly by Years of Life Lost (83.4%), most frequent among men aged under 40 years. The predicted ASR for 2024 was 4.46 (3.81–5.23) per 1000 person-years. Injuries to the head was the most prevalent (20.7%) causing 67.7% of DALYs; and increasing by 226% through 2024. Injuries had a high prevalence and an important burden in a Tunisian university hospital. Prediction showed increased prevalence for 2024. Preventive measures and a trauma surveillance register should be implemented soon.

Abstract P131: Global Burden Of Stroke Attributable To High Systolic Blood Pressure In 38 Oecd Countries: A Systematic Analysis For The Global Burden Of Disease Study 2019

Background: High blood pressure (HBP) emerges as the primary leading cause of death and disability among all risk factors for stroke in Organization for Economic Cooperation and Development (OECD) countries. Method: This study employed the Global Burden of Disease methodology to evaluate mortality, DALY (Disability Adjusted Life Years) and YLD (Years Lived with Disability) associated with stroke attributable to HBP by age group, sex, year across the 38 OECD countries from 1990-2019. Results: The annual percentage change (APC) of deaths due to stroke attributable to HBP decreased by 22% (557,114-436,389) between 1990-2019, while DALY decreased by 26% (10,970,202-8,087,473) and YLD increased by 19% (1,451,842- 1,727,949). Among the OECD countries, Turkey exhibited the highest APC in deaths at 113% (11,476- 24,440). The highest APC in deaths was observed in the 95+ age group reaching 170% (13,578- 36,655) between 1990-2019. Conclusion: Despite a decreasing burden of stroke due to HBP, OECD countries continue to face significant mortality and DALY rates, necessitating ongoing efforts to reduce the burden.

Associations of Multimorbidity With Stroke Severity, Subtype, Premorbid Disability, and Early Mortality: Oxford Vascular Study.

Patients with multimorbidity are under-represented in clinical trials. Inclusion in stroke trials is often limited by exclusion based on pre-morbid disability, concerns about worse post-stroke outcomes in acute treatment trials, and a possibly increased proportion of haemorrhagic vs ischaemic stroke in prevention trials. Multimorbidity is associated with increased mortality after stroke, but it is unclear whether this is driven by increased stroke severity, or is confounded by particular stroke subtypes or premorbid disability. We aimed to determine the independent association of multimorbidity with stroke severity taking account of these main potential confounders. In a population-based incidence study (Oxford Vascular Study; 2002-2017), pre-stroke multimorbidity (Charlson Comorbidity Index-CCI; unweighted/weighted) in all first-in-study strokes was related to post-acute severity (≈24 hours; NIH Stroke Scale-NIHSS), stroke subtype (haemorrhagic vs ischaemic; Trial of Org 10172 in Acute Stroke Treatment-TOAST), and pre-morbid disability (modified Rankin score/mRS≥2) using age/sex-adjusted logistic and linear regression models, and to 90-day mortality using Cox proportional hazard models. Among 2492 patients (mean/SD age=74.5/13.9; 1216/48.8% male; 2160/86.7% ischaemic strokes; mean/SD NIHSS=5.7/7.1), 1402/56.2% had at least one CCI comorbidity, and 700/28.1% had multimorbidity. Although multimorbidity was strongly related to pre-morbid mRS≥2 (aOR for per CCI comorbidity=1.42, 1.31-1.54, p<0.001) and comorbidity burden was crudely associated with increased severity of ischaemic stroke (OR per comorbidity: 1.12, 1.01-1.23 for NIHSS 5-9, p=0.027; 1.15, 1.06-1.26, for NIHSS≥10; p=0.001), no association with severity remained after stratification by TOAST subtype (aOR=1.02, 0.90-1.14, p=0.78 for NIHSS 5-9 vs 0-4: 0.99, 0.91-1.07, p=0.75 for NIHSS≥10vs0-4), or within any individual subtype. The proportion of intracerebral haemorrhage versus ischaemic stroke was lower in patients with multimorbidity (aOR per comorbidity=0.80, 0.70-0.92, p<0.001), and multimorbidity was only weakly associated with 90-day mortality after adjustment for age, sex, severity, and pre-morbid disability (aHR per comorbidity=1.09, 1.04-1.14, p<0.001). Results were unchanged using the weighted CCI. Multimorbidity is common in patients with stroke and is strongly related to pre-morbid disability, but is not independently associated with increased ischaemic stroke severity. Greater inclusion of patients with multimorbidity is unlikely therefore to undermine the effectiveness of interventions in clinical trials, but would increase external validity.

Estimating public and private costs and benefits of implementing a milk quality assurance system in Kenya: A case study

Assuring food safety is increasingly important in emerging and developing economies. Despite being a public good, food safety in these economies is often addressed through limited private sector innovations while the public health costs and impact of food-borne diseases are largely unknown. This study estimates annual private and public costs and benefits of a quality-based milk payment system (QBMPS) in Kenya. Private costs and benefits were estimated using a partial budget analysis. From a private perspective, results show that participating farmers benefit most from the QBMPS, with a net profit of about USD 0.02 USD/kg) from an additional investment cost USD 0.0125/kg to produce Grade A milk. The cooperatives and processor have a net loss of 0.025 USD/kg milk, mainly driven by testing and initial investment costs. Disease burden was calculated using the Disability Adjusted Life Years (DALYs), while direct and indirect health costs were calculated using an incidence-based analysis. We estimate an annual disease burden of 53,000 DALYs from milk-related infectious diseases and a generated health benefit of 13 KES/kg due to reduction in disease incidence if 15% of Kenya’s milk goes through the QBMPS. These health benefits justify public and private sector support for a QBMPS.

Occupant's health and energy use in an office building: A sensor-enabled life cycle assessment

Indoor air quality (IAQ) has an important impact on human health and productivity. For this reason, its integration into the life cycle assessment (LCA) framework contributes to sustainably manage the operation of a building and improve the living and working conditions in homes and offices. In this study, the damages on human health caused by IAQ are quantified starting from the air pollutants’ concentrations recorded by dedicated sensors placed in an office building located in Luxembourg. Data on concentrations of total volatile organic compounds, particulate matter and radon are combined with estimated occupancy and intake fractions to calculate the total human health impact expressed in Disability Adjusted Life Years (DALYs). The impacts of indoor air quality on human health prove to be relevant, representing one tenth of the score obtained in a conventional LCA on the operational phase of the building. It can be highlighted that radon, a substance usually overlooked in IAQ studies, had the highest impact, contributing to 46% of the impact caused by exposure to indoor pollutants. The heating loads and the influence of different air exchange rates are analyzed starting from a simplified energy model of the building fed with real energy use data. LCA has proven a useful tool to analyze this trade-off in the operation of the building, where it is found that doubling the ventilation rate would reduce the impact of indoor pollutants on human health by 34% while resulting in less than 1% increase in the total energy demand over the studied period.

IMPLEMENTASI KUOTA TENAGA KERJA PENYANDANG DISABILITAS GUNA MEWUJUDKAN PEMENUHAN HAK BEKERJA

This study aims to explore the quota of disabled workers in companies in Tangerang City. To obtain research data information, purposive sampling method is used to determine which companies can be the object of research. The selected company is a private company in Tangerang City. Interview method with the determination of informants through the snowball technique. The findings of this study are that the implementation of the quota for persons with disabilities in Tangerang City still does not fully meet the quota according to the mandate of Law Number 8 of 2016 concerning Persons with Disabilities, this can be seen from the monitoring results of the Tangerang City Manpower Office in 2022 that only 144 people with disabilities work and are spread across 7 companies in Indonesia. Tangerang City. This is partly due to the lack of job training for persons with disabilities held by the Tangerang City Manpower Office and the lack of companies and organizations for persons with disabilities that are partnered with the Tangerang City Manpower Office to be invited to cooperate in distributing workers with disabilities to companies in Tangerang City. Some of the obstacles that exist in fulfilling quotas for people with disabilities in the world of work include the number of companies that do not open job vacancies, both companies that do not know the quota for workers with disabilities mandated by Law Number 8 of 2016 and those who already know, companies still have doubts if people with disabilities have disabilities. people with disabilities can work, companies only accept certain types of disabilities, companies require a minimum of a Diploma three graduate as well as disability adjustment in the world of work which is still difficult so that companies consider whether or not a disability is accepted for work as well as providing accessibility for high-cost people with disabilities who can't afford it. provided by the company so that they choose not to employ persons with disabilities.

Ways to Mitigate Climate Change by Implementing Zero Emission Hospitals – A Case Report

If the global healthcare system would be a country, it would be the fifth largest emitter. Hence various health care systems worldwide have committed themselves to become carbon neutral. In Europe, Germany as an economy and the German healthcare system produces by far the most emissions. This has a significant impact on the health of the population in Germany, Europe and worldwide. It leads to Disability Adjusted Life Years (DALYs) as well as premature deaths. To reduce global climate change related damages, disasters and negative health outcomes, Germany has committed itself through various treaties to become carbon neutral and to transform the healthcare system towards net zero until 2030. The article highlights crucial steps for hospitals how this can be achieved. Important management tools are the SWOT analysis, the PDCA cycle, the DHOW model and the sustainable Balanced Score Card. Hospitals should establish Key Performance Indicators for Scope 1, 2, and 3 emissions and monitor them on a monthly basis. Important action areas are energy sources, insulation of buildings, waste, water consumption, nutrition, transportation, chemicals, pharmaceuticals, climate education and leadership. Leadership should be executed as a top-down as well as a bottom-up approach to involve all relevant stakeholders including staff and patients.

Positive mental health for all serving the under-served.

Mental disorders are major contributors to global burden of disease measured in Disability Adjusted Life Years (7% of all disease burden in 2017). Large treatment gaps for these disorders exist in all parts of the world. In India, overall treatment gap for mental disorders was found to be 83%. Women, children and adolescents, ethnic minorities, LGBTQ+ community, elderly and those living in remote and inaccessible areas have disproportionately higher rates of mental illness. They face unique and characteristic barriers to access to mental healthcare which increases treatment gap. These gaps have persisted despite global efforts and interventions to mitigate these barriers. Hence, there is a need to find alternatives to reduce mental health gap in these groups. Positive Mental Health interventions focuson well-being and health promoting activities, rather than on illness. The potential role of these interventions in promoting mental health and reducing treatment gap has been explored in this article.

Disability and premorbid adjustment in schizophrenia: A retrospective analysis.

Schizophrenia is highly disabling. Though efforts at genetic mapping to identify those at risk of the illness have been promising but same cannot be said about predicting its associated disability before illness-onset (i.e., during premorbid phase). It is envisaged that Schizophrenia-related disability may be ameliorated if premorbid clinical markers are adequately predictive enough to identify those at risk and worked upon them. This study aimed to determine whether there is a relationship between schizophrenia-related disability and premorbid adjustment. This cross-sectional study was conducted at the out-patient clinic of the Neuropsychiatric Hospital, Aro, Abeokuta, Ogun State, Nigeria. Three hundred patients with the diagnosis of schizophrenia and within the age range of 18-64 years were eligible for the study. Mean age of the participants was 41.9 ± 10.05 years with a slight female dominance (50.7%). Spearman's correlation revealed a direct correlation between disability and premorbid adjustment, albeit rather weak (r s = 0.130, p = 0.025). Pre-diagnostic factors such as premorbid functioning may play a role in the subsequent functioning of an individual post-diagnosis. Other research efforts may focus on yet-to-be identified premorbid factors that may be targets of prevention to reduce disability in schizophrenia. This research serves as a pioneer work on disability and premorbid adjustment and has provided a template for the early identification of those at risk of schizophrenia by providing an intervention opportunity at the premorbid stage.

A new method for measuring eco-efficiency

Current methods available to calculate eco-efficiency require a sample of products and are not applicable for one product only. Furthermore, the methods require a weighting process. Thus, they contain subjectivity, or it is possible that the weighting factors' values do not match stakeholders' values. This paper proposes a new method of measuring the eco-efficiency ratio. The numerator is the contribution of a product's life cycle to the economy, and the denominator is the economic burden caused by a product's life cycle. The economic contribution is calculated using the input-output method. The economic burden is calculated by estimating the health damage caused by pollutant emissions over a product's life cycle. The damage is expressed in Disability Adjusted Life Years (DALY) and is valued using the human capital approach. The applicability of the proposed method is presented by calculating the eco-efficiency of electricity generations in Indonesia. The proposed method shows that the eco-efficiency ratio of a product depends on the income and tax multiplier, supply chain process efficiency, value of the product, GDP per capita, and the level of emissions. The proposed method enhances the decision-making process because it is more straightforward, free from subjectivity, and applicable for one product only.

Burden of Disease (BoD) Assessment to Estimate Risk Factors Impact in a Real Nanomanufacturing Scenario.

An industrial nanocoating process air emissions impact on public health was quantified by using the burden of disease (BoD) concept. The health loss was calculated in Disability Adjusted Life Years (DALYs), which is an absolute metric that enables comparisons of the health impacts of different causes. Here, the health loss was compared with generally accepted risk levels for air pollution. Exposure response functions were not available for Ag nanoform. The health loss for TiO2 nanoform emissions were 0.0006 DALYs per 100,000 persons per year. Moreover, the exposure risk characterization was performed by comparing the ground level air concentrations with framework values. The exposure levels were ca. 3 and 18 times lower than the derived limit values of 0.1 μg-TiO2/m3 and 0.01 μg-Ag/m3 for the general population. The accumulations of TiO2 and Ag nanoforms on the soil top layer were estimated to be up to 85 μg-TiO2/kg and 1.4 μg-Ag/kg which was considered low as compared to measured elemental TiO2 and Ag concentrations. This assessment reveals that the spray coating process air emissions are adequately controlled. This study demonstrated how the BoD concept can be applied to quantify health impacts of nanoform outdoor air emissions from an industrial site.

Seminar attendance, lecture capture, and disability adjustments: intuition and evidence*

In this paper we report the outcome of an exercise in which we tested several pedagogical beliefs in regards to student performance that had become important for our practice. The first was the idea that in-person attendance leads to better exam performance than non-attendance and/or reliance on recorded lectures. The second (and quite separate) query was to explore the effectiveness of strategies designed to “level the playing field” for students facing disadvantages. The final belief was that formative coursework was associated with improved exam performance for all students, particularly the weakest ones. We thus regressed the exam performance of students in a taught postgraduate Business Economics course on a range of factors, including seminar attendance, use of online lecture recordings, participation in Disability Access Plans, performance on a formative assessment task, and a range of standard control variables. Our results suggest that seminar attendance was positively associated with superior performance on the final exam. We also found that moderate or complementary use of lecture recordings was beneficial for student performance, while large-scale use had no significant positive or negative impact. We further found an absence of any statistically significant difference in the performance of students with Disability Access Plans relative to other students, suggesting that measures to enhance equity for students are effective.