Excessive Financial Burden Research Articles

A cost analysis of intraoperative microelectrode recording during subthalamic stimulation for Parkinson's disease

Deep brain stimulation of the subthalamic nucleus is the standard of care for treating medically intractable Parkinson's disease. Although the adjunct of microelectrode recording improves the targeting accuracy of subthalamic nucleus deep brain stimulation in comparison with image guidance alone, there has been no investigation of the financial cost of intraoperative microelectrode recording. This study was performed to address this issue. A comprehensive literature search of large subthalamic nucleus deep brain stimulation series (minimum, 75 patients) was performed, revealing a mean operating room time of 223.83 minutes for unilateral and 279.79 minutes for simultaneous bilateral implantation. The baseline operating room time was derived from the published operating room time for subthalamic nucleus deep brain stimulation without microelectrode recording. The total cost (operating room, anesthesia, neurosurgery) was then calculated based on hospitals geographically representative of the entire United States. The average cost for subthalamic nucleus deep brain stimulation implantation with microelectrode recording per patient is $26,764.79 for unilateral, $33,481.43 for simultaneous bilateral, and $53,529.58 for staged bilateral. For unilateral implantation, the cost of microelectrode recording is $19,461.75, increasing the total cost by 267%. For simultaneous bilateral implantation, microelectrode recording costs $20,535.98, increasing the total cost by 159%. For staged bilateral implantation, microelectrode recording costs $38,923.49, increasing the total cost by 267%. Microelectrode recording more than doubles the cost of subthalamic nucleus deep brain stimulation for Parkinson's disease and more than triples the cost for unilateral and staged bilateral procedures. The cost burden of microelectrode recording to subthalamic nucleus deep brain stimulation requires the clinical efficacy of microelectrode recording to be proven in a prospective evidence-based manner in order to curtail the potential for excessive financial burden to the health care system.

Zagadnienie nierówności społecznej w "De Gubernatione Dei" Salwiana z Marsylii : aspekty prawne

Salvian both recognized and censured social inequality, however, without transposing his critical attitude onto the relationship between freemen and slaves. For Salvian, this relationship was a point of reference, though indirect, to the relationship between man and God. Salvian considered the characteristics commonly attributed to slaves against the backdrop of Christian duties before God. When it comes to the situation of slaves, some Salvian’s opinions on the lord’s ius vitaenecisque are in conflict with the existing law, as, for instance, some provisions safeguarding slaves against owners’ abuse or lawlessness. Yet, such provisions might not have been fully observed in practice. Salvian recognizes some undeniable Roman flaws when examining the issue of exploitation of the poor by the rich. The main Salvian’s objections relate to both excessive financial burden laid on citizens by the state, as well as to the wealthy shifting the tax encumbrance to the needy. State legislation took some measures to remedy this situation, but, as follows from Salvian’s account, these regulations remained a dead letter. Salvian repeatedly touches on the problem of the ineffective state apparatus. In Salvian’s opinion, in the aftermath of the unjust state financial system, many Roman citizens fled to become the subjects of the barbarian rule. Salvian attributed ill intentions and oppression of the poor to the councillors; it was largely due to their tax collection powers. As follows from Salvian’s account, the councillors’ assumption of the function of tax collectors was to the significant detriment of social relations in cities. The author briefly reviews their role with the maxim: quot curiales, tot tyranni. Not infrequently, Salvian’s considerations seem rather selective, particularly with respect to the socio-political situation. In his opinion, the Roman Empire of the 5th century faced a dramatic economic slump, first, due to the barbarian invasions, and second, due to the poor administration.

Risk-adjusted supplemental bonding in the Gulf of Mexico

Leases in the Outer Continental Shelf that do not satisfy a minimum threshold financial capacity are required to post a supplemental bond to ensure that the US government is protected from incurring costs associated with lease abandonment. A bonding formula based upon the estimated cost to perform decommissioning was developed in 1991 by the federal government to implement the supplemental bond programme. The purpose of this article is to update and extend the legacy formula using a risk-adjusted mechanism. We review the objectives of the supplemental bond programme and provide a historical perspective of its development. The objectives of a bonding formula are described along with the trade-offs that occur in development. Factors that impact US government decommissioning exposure are highlighted and we present a risk-adjusted mechanism across the three main stages of decommissioning. We advocate the selection of bonding levels that balance the need of the government to minimize its decommissioning exposure at an acceptable level of risk without incurring an excessive financial burden on owners.

Self-Control, Financial Literacy and Consumer Over-Indebtedness

This paper examines the relationship between self-control, financial literacy and over-indebtedness on consumer credit debt among a sample of U.K. consumers using data from a household survey. Both lack of self-control and financial illiteracy are positively associated with non-payment of consumer credit and self-reported excessive financial burdens of debt. Consumers who exhibit self-control problems are shown to make greater use of quick-access but high cost credit items such as store cards and payday loans. We also find consumers with self-control problems are more likely to suffer income shocks, credit withdrawals and unforeseen expenses on durables, suggesting that lack of self-control increases exposure to a variety of risks. In most specifications we find a stronger role for lack of self-control than for financial illiteracy in explaining consumer over-indebtedness.

Employment impact and financial burden for families of children with fragile X syndrome: findings from the National Fragile X Survey

The employment impact and financial burden experienced by families of children with fragile X syndrome (FXS) has not been quantified in the USA. Using a national fragile X family survey, we analysed data on 1019 families with at least one child who had a full FXS mutation. Out-of-pocket expenditures related to fragile X were reported. We used logistic regression to examine the role of insurance, number of affected children, and number of total co-occurring conditions in predicting the financial burden and employment impact of FXS, while adjusting for race, education, marital status and other sociodemographic predictors. Almost half of families affected by FXS reported that they had experienced an increased financial burden and nearly 60% stated that they had had to change work hours or stop work because of FXS. Families with health insurance that met family needs were significantly less likely to report an excess financial burden. The type of insurance (private or public) was not associated with the reported financial burden. Affected children's mutation status, especially male children with the full mutation, was associated with employment impact. The total number of co-occurring conditions was associated with both financial burden and employment impact. Families affected by FXS experienced a significant employment impact and financial burden. Policies designed to help families with FXS need to take into consideration the dimension of co-occurring conditions.

Review and update of the supplemental bonding formula in the outer continental shelf Gulf of Mexico

To ensure that the government is adequately protected from incurring costs associated with offshore lease abandonment, the Minerals Management Service requires operators to post a supplemental bond if at least one record title owner or holder on the lease does not satisfy a financial strength and reliability threshold. In this paper, we review the objectives of the supplemental bond program and provide a historical perspective of its development. The objectives of a formula-based mechanism are described along with trade-offs that occur in development. Factors that impact US Government decommissioning exposure are highlighted and we present a risk-adjusted bonding mechanism across the three main stages of decommissioning that updates a 20 year old legacy formula. We propose the selection of bonding levels that balance the need of the government to minimise its decommissioning exposure at an acceptable level of risk without incurring an excessive financial burden on owners. [Received: January 6, 2010; Accepted May 26, 2010]

Relationship Between BMI And Blood Pressure In Rural Nigerian Dwellers

Hypertension places an excessive financial burden on populations and health systems, consuming scarce resources. Population based preventive approaches are, thus central for the management of elevated blood pressure in developing countries. This cross sectional study was carried out in the Buruku Local Government of Benue State in the middle belt of Nigeria. The body weight, height and blood pressure of 423 subjects were determined. BMI was calculated as weight divided by height squared and hypertension was defined using the JNC VII criteria. The male subjects were significantly taller, heavier and also had significantly higher SBP and DBP than the female subjects. The prevalence of hypertension was higher in the male than the female subjects. There was a positive correlation between the BMI and SBP and DBP. Basic measurement of weight and height to determine the BMI as a routine assessment during clinic visitation with appropriate lifestyle modification would help in controlling hypertension as well as reduce its prevalence and its subsequent financial burden.

Long-term ventilation introduction and perspectives.

An increasing number of patients are receiving prolonged ventilation worldwide. The excessive financial burden associated with chronic ventilation hinders effective discharge from the intensive care unit to any other alternative site of care or to the home. The beneficial outcome of caring for chronic ventilator-dependent patients relies on the organization of the treatment team, quality of the medical and rehabilitative treatment programs, and leadership of the medical director. These patients require a highly organized and integrated care plan that has sufficient and prolonged administrative oversight to ensure optimum outcome and reduce costs.

UMBILICAL CORD BLOOD GAS ANALYSIS

Umbilical cord blood gas and pH values should always be obtained in the high-risk delivery and whenever newborn depression occurs. This practice is important because umbilical cord blood gas analysis may assist with clinical management and excludes the diagnosis of birth asphyxia in approximately 80% of depressed newborns at term. The most useful umbilical cord blood parameter is arterial pH. Sampling umbilical venous blood alone is not recommended because arterial blood is more representative of the fetal metabolic condition and because arterial acidemia may occur with a normal venous pH. A complete blood gas analysis may provide important information regarding the type and cause of acidemia and sampling the artery and vein may provide a more clear assessment. The sampling technique is simple and easily mastered by any treatment person in the delivery room. Preheparinized syringes ensure a consistent dose and amount of heparin. Depending on how normality is defined and on the population studied, normal ranges for umbilical cord blood gas values vary (see Table 1). In general, the lower range for normal arterial pH extends to at least 7.10 and that for venous pH to at least 7.20. Many different factors during pregnancy, labor, and delivery can affect cord blood gases. Umbilical blood sampling for acid-base status at all deliveries cannot be universally recommended because many facilities do not have the capabilities to support such a practice and in doing so may impose an excessive financial burden. Considering the costs, the accumulated published data, and the nonspecificity of electronic fetal monitoring in the evaluation of fetal oxygenation, it may be more rational to implement universal cord blood gas analysis. Care providers and institutions with the logistical capabilities in place should consider the cost efficacy of routine cord blood gas analysis because it is the gold standard assessment of uteroplacental function and fetal oxygenation/acid-base status at birth.

Sustainability, Agriculture, and Agricultural Policy

In this paper, the problem of achieving sustainable development in the context of the Common Agricultural Policy (CAP) and other policy suggestions is examined. Sustainable development is defined as a commitment to conserve necessary biological, cultural, and aesthetic capital for future generations. This is not a costless process. Constraints are required on current economic activity, entailing sacrifices by the current generation, if sustainability requirements are to be met. Specific wildlife sites within the farmed landscape are critical to the sustainability programme. Conservation of these sites entails the continuation of specific and often technically obsolete farming practices. Their conservation cannot be ensured by the practice of efficient sustainable agriculture as advocated by the authors Pretty and Howes. Furthermore, those authors are wrong in believing that such agriculture could be profitable without continuing subsidy. The approach of the CAP is to make payments for the practices necessary to safeguard these sites. However, the economic sustainability of the CAP is doubtful. Its costs are excessive and reforms are not reducing the excessive financial burden and resource costs. Alternative reform packages involving conservation through cross-compliance have even greater resource costs. The ability to safeguard these critical sites in the long run is therefore questionable. This suggests there is a need to rethink sustainability requirements for cultural and biological diversity.

Child Abuse Amendments of 1984: What Are the Issues?

With the passing of the Child Abuse Amendments of 1984, the United States government has created a framework for legal intervention into controversial Baby Doe cases where handicapped newborns are denied medical treatment, including hydration and nutrition. Both sides of four issues in this controversy are discussed: (a) the parents' right, after consulting with their physicians, to make the final decision to treat or to forego treatment for their disabled infants; (b) the omission of the notion of "quality of life" from the law; (c) the excessive financial burdens imposed as a result of decisions to treat; and (d) the role of the Infant Care Review Committees. In view of the evidence, the author supports the move toward federal intervention.

On Putting Culture Back into Agriculture: A Reply to Young

a recent article in this journal, Young (1982:208-215) discusses farmers in the United States under the title, Productive Efficiency and the Adaptations of Small-Scale Farmers. Based on a sample drawn from five western states, Young shows that is generally done at a loss. Farmers who rely exclusively on their small farms are economically doomed, while those who have substantial earnings from off-farm sources are able to sustain their farm losses. It is this latter type of farmer who, … though perhaps not paying their own way, can be considered successful adaptations to limited opportunities in farming (1982:212). In sum, Young concludes, small-scale farmers tend to farm in such a way as to bring personal satisfaction but not to create an excessive financial burden (1982:211).