Contract Parameters Research Articles

Value-Based Healthcare in Practice: IDEATE, a Collaboration to Design and Test an Outcomes-Based Agreement for a Medicine in Wales.

To develop a sustainable, scalable methodology for the design of outcome-based agreements (OBAs) that works on the ground and dynamically overcomes historical challenges. Project IDEATE co-created solutions to known (and emergent) challenges via iterative workshops and real-world data analysis to develop and refine a hypothetical model for an OBA in a trusted research environment. A cross-disciplinary collaboration between National Health Service (NHS) Wales, industry and academia was developed. Data were collected from Welsh national datasets and used to construct a novel linked dataset. OBA scenarios, with different contract parameters, were analysed to assess impact on the proportion of contract payment due and the volatility of payments. An approved, in market, locally advanced and metastatic breast cancer treatment was selected as the test case. The total number of patients in the treatment cohort (2017-2020) was n = 99, and 286 in the control cohort (2014-2016). The final outcome variables selected were: (1) 1-year survival,( 2) intolerance to treatment (deferral), and (3) the total days disrupted by care. The primary scenario included all three outcomes measured at the population level and used a linear payment model. Volatility analyses demonstrated contract parameters can dramatically alter the contract output with greatest risk from a single, binary outcome contract design. The design of an OBA is a complex process that requires a multi-disciplinary approach. By assessing solutions to data, outcomes and contracting challenges, IDEATE provides a strong foundation for future success of OBAs in the UK. Outcome-based agreements (OBAs) are a way to pay for medicines if they help patienthealth in a specific way over time. These agreements can make it faster for people to get new medicines, but they also have challenges, like needing a lot of time and effort to manage them. A team from the NHS Wales, life sciences, and Swansea University created Project IDEATE to find a better way to design OBAs and solve some of these problems. Welsh datasets were used to create a new breast cancer dataset to test different OBAs and see how payments would change. A breast cancer treatment was used for the project. The project had 99 patients who got the medicine (2017-2020) and 286 patients who had breast cancer but did not get the medicine (2014-2016). Three health outcomes were measured: (1) living for one year after treatment, (2) patients needing to stop the medicine, and (3) days spent in care. The main OBA option we tested used all three health outcomes; the more the outcomes improved, the more the payments could go up until they hit the highest amount agreed. The analysis showed that the way an OBA is designed can make a big difference in how stable or risky it is, especially if one ofthe health outcomes has only two options. Project IDEATE showed that making an OBA can be hard, but when people from different fields work together, they can overcome many challenges and succeed.

Patient-reported disability progression outcomes among patients with multiple sclerosis: Results of an outcomes-based agreement.

Outcomes-based agreements (OBAs) are agreements between payers and manufacturers in which payment for medications is tied to patient outcomes. These contracts aim to measure the value of prescription medications on predefined clinical indicators in real-world patient populations. OBAs are gaining traction in the United States as the health care industry shifts from volume-based to value-based care. Multiple sclerosis (MS) is an appealing therapeutic area for OBAs because of its prevalence, high cost of medications, and multiple effective therapeutic options. To describe findings from an OBA that was prospectively conducted in a large regional health system for patients with MS taking interferon β-1a or dimethyl fumarate. In this prospective real-world analysis, commercial or health insurance exchange members were included based on the parameters of the OBA. Disability progression was assessed using a patient-reported outcome, patient-determined disease steps (PDDS). In the OBA, members aged 18 years or older with an MS diagnosis were included in the contract. A baseline score was collected for eligible members, with follow-up scores occurring between a 90-day and 180-day postbaseline score. If a follow-up score was greater than the baseline score, a subsequent PDDS score was collected between 90-days and 120-days to determine if the PDDS score remained elevated, indicating that the member had disability progression. During the contract period, 410 patients were eligible for PDDS collection, with 241 and 169 patients in the dimethyl fumarate and interferon β-1a cohorts, respectively. There were 162 patients who were lost to follow-up, and 64 patients who were ineligible per contract parameters. Of the remaining 184 eligible patients (107 on dimethyl fumarate and 77 on interferon β-1a), 21 (11%) patients had confirmed disability progression (6 on dimethyl fumarate [5.6%] and 15 on interferon β-1a [19.5%]). Our findings suggest that meaningful patient-reported outcomes, such as disability progression, can be operationalized in an innovative OBA.

AS ENTRELINHAS DO CONTRATO BANCÁRIO: UMA ANÁLISE DOS RISCOS DE TAXAS ABUSIVAS

This study aimed to analyze, through a bibliographic review, the legislative framework ruling banking contracts in Brazil, highlighting the inconsistencies stemming from abusive fees and onerous clauses in banking operations. In Brazil, the definitions of abusive clauses in contracts are determined by the Civil Code and the Consumer Defense Code, under which agencies such as the Central Bank of Brazil (BCB), the Delegacia do Consumidor and PROCON operate to uphold the principle of good faith. It was concluded that the imposition of a series of contractual parameters inaccessible to borrowers by financial institutions generates inequities and disparities in treatment that are incompatible with the economic order. The research might provide preventive and protective precautions to consumers confronted with banking contracts, this way assisting at the divulgation of secure economic practices and avoiding the overcrowding of the Judiciary with processes entailed by leonine clauses and abusive fees.

Applying fixed order commitment contracts in a capacitated supply chain

Demand uncertainty can lead to excess inventory holdings, capacity creation, emergency deliveries, and stock-outs. The costs of demand uncertainty may be directly borne by upstream suppliers, but can propagate downstream in the form of higher prices. To address these problems, we investigate a practical application of a fixed order commitment contract (FOCC) in which a manufacturer commits to a minimum fixed order quantity each period and receives a per unit price discount from the supplier for the commitment. We model a FOCC as a Stackelberg game in which the supplier offers a price discount anticipating the manufacturer’s response, and the manufacturer subsequently decides on the optimal commitment quantity. We show that a FOCC can smooth the orders received by the supplier, mitigating the negative consequences of demand uncertainty for the supplier, the manufacturer, and the supply chain. We extend the current literature by solving for an endogenous price discount instead of treating it as an exogenous value, and validate our model insights with our research partner, a large international materials handling equipment manufacturer. Using data on 863 parts, we evaluate the relationships between the model parameters, contract parameters, and the contract effectiveness, and show the conditions under which the FOCC generates greater cost savings for both the manufacturer and supplier. Our results help operations managers better understand how to obtain the optimal contract parameters for a FOCC and the circumstances under which such a contract is most beneficial for the company and its supply chain.

Контракции калибровочных групп и спонтанное нарушение симметрии

Contractions of gauge models with orthogonal Cayley-Klein groups SO(2; ϵ), SO(3; ϵ), unitary groups SU(2; ϵ) as gauge groups are studied. In the limit of zero contraction parameters, orthogonal groups are isomorphic to the nonsemisimple Euclidean and Newton groups of the corresponding dimension, and the spaces of matter fields become fibered spaces with a degenerate metric. Particular attention is paid to the coordination of spontaneous symmetry breaking with the group contraction procedure. It is shown that contracted gauge theories describe the same set of fields with the same masses as theories with the original simple groups, if the chosen vacuum in the corresponding limit belonged to the base of the fibered space of matter fields. Lagrangians of the models depending on the contraction parameters are obtained, which makes it possible to trace the order of zeroing of terms in the Lagrangians as the contraction parameters tend to zero.

Effect of C60 Fullerene on Muscle Injury-Induced Rhabdomyolysis and Associated Acute Renal Failure.

Rhabdomyolysis, as an acute stage of myopathy, causes kidney damage. It is known that this pathology is caused by the accumulation of muscle breakdown products and is associated with oxidative stress. Therefore, the present study evaluated the effect of intraperitoneal administration (dose 1 mg/kg) of water-soluble C60 fullerenes, as powerful antioxidants, on the development of rat kidney damage due to rhabdomyolysis caused by mechanical trauma of the muscle soleus of different severity (crush syndrome lasting 1 min under a pressure of 2.5, 3.5, and 4.5 kg/cm2, respectively). Using tensometry, biochemical and histopathological analyses, the biomechanical parameters of muscle soleus contraction (contraction force and integrated muscle power), biochemical indicators of rat blood (concentrations of creatinine, creatine phosphokinase, urea and hydrogen peroxide, catalase and superoxide dismutase activity), glomerular filtration rate and fractional sodium excretion value, as well as pathohistological and morphometric features of muscle and kidney damages in rats on days 1, 3, 6 and 9 after the initiation of the injury were studied. Positive changes in biomechanical and biochemical parameters were found during the experiment by about 27-30 ± 2%, as well as a decrease in pathohistological and morphometric features of muscle and kidney damages in rats treated with water-soluble C60 fullerenes. These findings indicate the potential application of water-soluble C60 fullerenes in the treatment of pathological conditions of the muscular system caused by rhabdomyolysis and the associated oxidative stress.

Quantitative Analysis of Right Atrial Functions by 2D-Speckle Tracking Echocardiography During Healthy Pregnancy.

The role of speckle tracking in the assessment of right atrial (RA) deformation parameters has not been investigated yet. The purpose of this article is to establish the effects of normal pregnancy on RA mechanical changes obtained by 2-dimensional speckle-tracking echocardiography. A total of 49 healthy pregnant women were included in the study. All participants were followed for each trimester and postpartum period, encompassing standard assessments of both RA and ventricular functions, as well as measurements of RA global peak atrial longitudinal strain (RA-Global-PALS) and RA global peak atrial contraction strain (RA-Global-PACS). Additionally, the RA segments were individually evaluated with respect to strain parameters. During pregnancy, the increased volume load resulted in elevated RA reservoir function, as indicated by RA-Global-PALS, and increased contraction parameter, as indicated by RA-Global-PACS. These changes were within physiological limits and reversible. Segmental analysis of the right atrium showed similar findings for regional PACS and PALS parameters. In this study, we established normal RA deformation parameters for healthy pregnancies. These data will aid in discerning various measures of RA phasic function in cardiovascular and systemic conditions among normal pregnant women. Moreover, they may offer insights into potential cardiac pathologies that may arise during the pregnancy.

Neuropeptide Y is involved in the regulation of the frequency and strength of rat atrium spontaneous contraction

BACKGROUND: The relevance of the problem increases due to the established cardioprotective effect of neuropeptide Y in pathological conditions such as hypertension, heart failure, and its possible therapeutic use in cardiovascular diseases. AIM: Study of the effect of neuropeptide Y on the frequency of spontaneous activity and amplitude-time parameters of the myocardium contraction of the rats’ right atrium during different periods of postnatal ontogenesis. MATERIAL AND METHODS: The experiments used 73 white outbred rats of 7 days (n=23), 21 days (n=25) and 100 days (n=25) of age. Using the classical strain-gauge method, the parameters of isometric contraction of isolated rat atrial myocardium were determined with the addition of a non-selective Y-receptor agonist. The isometric contraction curve was processed using the Chart 8.0 program. Statistical processing of the results was performed in MS Excel and IBM SPSS Statistics 2020. The significance of the differences was calculated using the Student’s t test. Data were presented as mean ± error of mean (M±m); n was the number of atrial myocardium preparations used. Changes were considered statistically significant at p 0.05. RESULTS: Neuropeptide Y at a concentration of 10–7 M reduces the frequency of spontaneous activity of the right atrium strips of rats with a preserved sinus node in 7, 21 and 100-day-old animals by 8.1%, 15% (p=0.038) and 7.9% (p=0.046) respectively in comparison with the control value. The amplitude of isometric contraction of the atrial myocardium in 7-day-old animals decreases by 12.4% (p=0.041), the duration of contraction decreases in 21-day-old animals by 12% (p=0.040), and in 100-day-old animals does not change compared to control. CONCLUSION: Neuropeptide Y reduces the frequency of spontaneous activity, increases the contraction duration, reduces the isometric contraction amplitude of rat myocardial strips in early postnatal ontogenesis.

С60 fullerene protective effect against the rat muscle soleus trauma

Muscle trauma is one of the most common body injuries. Severe consequences of muscle trauma are ischemic injuries of the extremities. It is known that the intensification of free radical processes takes place in almost most acute diseases and conditions, including muscle trauma. C60 fullerene (C60) with powerful antioxidant properties can be considered a potential nanoagent for developing an effective therapy for skeletal muscle trauma. Here the water-soluble C60 was prepared and its structural organization has been studied by the atomic force microscopy and dynamic light scattering techniques. The selective biomechanical parameters of muscle soleus contraction and biochemical indicators of blood in rats were evaluated after intramuscular injection of C60 1 h before the muscle trauma initiation. Analysis of the force muscle response after C60 injection (1 mg kg−1 dose) showed its protective effect against ischemia and mechanical injury at the level of 30 ± 2 % and 17 ± 1 %, accordingly, relative to the pathology group. Analysis of biomechanical parameters that are responsible for correcting precise positioning confirmed the effectiveness of C60 at a level of more than 50 ± 3 % relative to the pathology group. Moreover, a decrease in the biochemical indicators of blood by about 33 ± 2 % and 10 ± 1 % in ischemia and mechanical injury, correspondingly, relative to the pathology group occurs. The results obtained demonstrate the ability of C60 to correct the functional activity of damaged skeletal muscle.

The evolution of cardiac function in patients with non-Hodgkin’s lymphoma under chemotherapy

In clinical practice, the treatment of non-Hodgkin’s lymphoma (NHL) often involves the combination of several chemotherapy agents, radiotherapy and immunotherapy. While these multimodal approaches improve the efficacy of pathology-specific treatment, they also increase the risk of cardiovascular complications, the most common of which is ventricular dysfunction induced by anti-tumor therapy. Aim of the study: Evaluation of the impact of anti-tumor treatment of NHL on the trajectory of left and right ventricular echocardiographic function. Materials and methods: 127 randomly selected patients from the hematology departments of the PSMI Institute of Oncology were included in the study. Patients were investigated during 3 visits by comprehensive echocardiography, the first visit was up to the onset of anti-tumoral treatment, the 2nd visit was 1 month after initiation and the 3rd visit at 6 months after the debut of chemotherapy. Results: During the anti-tumor treatment, a statistically significant decrease in left ventricular systolic indicators was attested by following parameters: left ventricular ejection fraction (LV EF), mean left ventricular S’, the ratio between the maximum velocity of the E wave and the flow propagation velocity (E/Vp), with an ANOVA p-value <0.001. Regarding the right ventricular systolic function, the indices reflected by TAPSE and S’ right ventricular free wall were reduced statistically significantly also (p ANOVA <0.001). The given analysis confirmed the impairment of ventricular relaxation throughout the treatment, the increase in left ventricular filling pressures, the ratio E/A and E/e’ showed a statisticallysignificant increase, parameters such as the deceleration time of the E wave, the relaxation isovolumetric time, the ratio e’/a’ did not register a statistically significant dynamic (p ANOVA = 0,897; 0,705 and 0,145 respectively). 6 months after the start of treatment, cardiac dysfunction associated with cancer therapy (CTRCD) was found in 18 patients (14,2%), 8 (6,3%) presented a moderate asymptomatic form, 7 (5,7%) had a mild asymptomatic form and 3 (2,4%) a symptomatic one.Conclusion: The left ventricular systolic function was statistically significantly reduced under the impact of the applied treatment, which was confirmed by the LV EF, the mean S’ value at the LV and the E/Vp ratio, the diastolic function having an impact through the E/A and E/e’ ratio. Regarding the function of the right ventricle, we attested statistically significant changes only in the longitudinal contraction parameters. CTRCD was confirmed in 18 patients.

Weather rebate sharing contract for enhancing supply chain performance

Weather risk in a supply chain has become a potential issue. We propose a new class of contract, a weather rebate sharing contract, that enhances the supply chain performance under weather risk. To design the contract parameters, the risk aversion of supply chain members is taken into account. The Conditional Value at Risk (CVaR) function is used to measure a firm’s objective under risk. The optimal hedging and ordering decisions are obtained by maximizing the CVaR of the supply chain’s expected profit. The weather rebate sharing contract parameters have been designed so that both parties obtain a Pareto-improving solution. We have investigated the performance of the traditional revenue sharing contract and our designed contract under weather risk by using industry demand data and corresponding temperature data. Irrespective of the risk aversion of the supply chain members, we conclude that our designed contract coordinates effectively under all weather conditions and performs better than a traditional revenue sharing contract. Moreover, our results show that the designed contract coordinates under different weather conditions and provides a better coordination framework than the previously designed contracts under weather risk. We recommend that practitioners use this class of contract for administering the supply chain under weather-related uncertainties.

Patient-specific left atrium contraction quantification associated with atrial fibrillation: A region-based approach

Background and objectivesAtrial fibrillation (AF) is a widespread cardiac arrhythmia that significantly impacts heart function. AF disrupts atrial mechanical contraction, leading to irregular, uncoordinated, and slow blood flow inside the atria which favors the formation of clots, primarily within the left atrium (LA). A standardized region-based analysis of the LA is missing, and there is not even any consensus about how to define the LA regions. In this study we propose an automatic approach for regionalizing the LA into segments to provide a comprehensive 3D region-based LA contraction assessment. LA global and regional contraction were quantified in control subjects and in AF patients to describe mechanical abnormalities associated with AF. MethodsThe proposed automatic approach for LA regionalization was tested in thirteen control subjects and seventeen AF patients. After dividing LA into standard regions, we evaluated the global and regional mechanical function by measuring LA contraction parameters, such as regional volume, global and regional strains, regional wall motion and regional shortening fraction. ResultsLA regionalization was successful in all study subjects. In the AF group compared with control subjects, results showed: a global impairment of LA contraction which appeared more pronounced along radial and circumferential direction; a regional impairment of radial strain which was more pronounced in septal, inferior, and lateral regions suggesting a greater reduction in mechanical efficiency in these regions in comparison to the posterior and anterior ones. ConclusionAn automatic approach for LA regionalization was proposed. The regionalization method was proved to be robust with several LA anatomical variations and able to characterize contraction changes associated with AF.

The effect of C60 fullerenes on the recovery of muscle soleus contraction dynamics in rats after chronic alcoholization

Background. It has been shown that the available therapeutic agents do not eliminate the consequences of miotic pathologies in chronic alcoholism, the most significant of which are disturbances in the dynamics of muscle contraction. A positive effect of biocompatible water-soluble C60 fullerenes on the contraction parameters of damaged muscles has been established. In addition, administration of C60 fullerene aqueous solution during chronic alcoholization of rats protects muscle tissue from damage caused by oxidative stress. Materials and Methods. Biomechanical parameters such as the values of the minimum and maximum contraction force and the muscle force impulse were evaluated using tensometry. The blood levels of creatine phosphokinase and lactate dehydrogenase, creatinine and lactate as well as the level of oxidative processes in muscle tissue of experimental animals (content of hydrogen peroxide, activity of catalase, glutathione peroxidase and superoxide dismutase) as markers of muscle damage were determined using methods of biochemical analysis. Results. The C60 fullerene aqueous solution effect on the skeletal muscle contraction dynamics in rats after chronic alcoholization for 9 months and cessation of alcohol consumption for 1 month was investigated. It was established that water-soluble C60 fullerenes (daily dose of 1 mg/kg) reduce the effects of chronic alcoholization by 35–40±2 % on the studied biomechanical parameters and by 20±1 % on the studied biochemical parameters compared to the group of alcoholized animals, thus increasing the energy capabilities of the muscular system. Conclusions. The obtained data indicate a pronounced protective effect of C60 fullerenes on the muscle soleus contraction dynamics during the development of alcoholic myopathy, which opens up the potential possibility of their use for the prevention and correction of miotic damage.

Solving Particle–Antiparticle and Cosmological Constant Problems

We solve the particle-antiparticle and cosmological constant problems proceeding from quantum theory, which postulates that: various states of the system under consideration are elements of a Hilbert space H with a positive definite metric; each physical quantity is defined by a self-adjoint operator in H; symmetry at the quantum level is defined by a representation of a real Lie algebra A in H such that the representation operator of any basis element of A is self-adjoint. These conditions guarantee the probabilistic interpretation of quantum theory. We explain that in the approaches to solving these problems that are described in the literature, not all of these conditions have been met. We argue that fundamental objects in particle theory are not elementary particles and antiparticles but objects described by irreducible representations (IRs) of the de Sitter (dS) algebra. One might ask why, then, experimental data give the impression that particles and antiparticles are fundamental and there are conserved additive quantum numbers (electric charge, baryon quantum number and others). The reason is that, at the present stage of the universe, the contraction parameter R from the dS to the Poincare algebra is very large and, in the formal limit R→∞, one IR of the dS algebra splits into two IRs of the Poincare algebra corresponding to a particle and its antiparticle with the same masses. The problem of why the quantities (c,ℏ,R) are as are does not arise because they are contraction parameters for transitions from more general Lie algebras to less general ones. Then the baryon asymmetry of the universe problem does not arise. At the present stage of the universe, the phenomenon of cosmological acceleration (PCA) is described without uncertainties as an inevitable kinematical consequence of quantum theory in semiclassical approximation. In particular, it is not necessary to involve dark energy the physical meaning of which is a mystery. In our approach, background space and its geometry are not used and R has nothing to do with the radius of dS space. In semiclassical approximation, the results for the PCA are the same as in General Relativity if Λ=3/R2, i.e., Λ>0 and there is no freedom for choosing the value of Λ.

Research on Supply Chain Coordination Decision Making under the Influence of Lead Time Based on System Dynamics

Supply chain coordination has been a research hot spot in supply chain management. This paper constructs a secondary supply chain system. Taking the abatement of the bullwhip effect and the double marginal effect as the coordination objective, a simulation study of supply chain decision coordination was conducted using system dynamics. First, by controlling the lead time, it was found that in the decentralized decision-making model, the profit of the supplier and the whole supply chain increases with the shortening of the lead time, and vice versa for the retailer. In the centralized decision-making model with the addition of information sharing and contract, it was found that the retailer’s profit is consistent with the trend of the supplier and the supply chain as a whole, and the supplier’s profit is lower than that of decentralized decision making in the pre-cooperation period. In addition, it is also found that adjusting the contract parameters can effectively improve the situation. Finally, the above models were analyzed for supply chain coordination decisions based on two scenarios: “cooperative stability” or “balance of effects”.

Trade credit contracting in a risk-averse supply chain under adverse selection and moral hazard

Trade credit, as an effective tool for integrating and coordinating material, information, and financial flows in supply chain management, is becoming increasingly widespread. We explore how a manufacturer can design optimal trade credit contracts when a risk-averse retailer hides its sales cost information (adverse selection) and selling effort level (moral hazard). We develop incentive models for a risk-averse supply chain when adverse selection and moral hazard coexist, which are then compared with the results under single information asymmetry (moral hazard). Moreover, we analyze the effects of private information and risk-aversion coefficient on contract parameters, selling effort level and the profit or utility of the supply chain. The study shows that when the degree of retailer’s risk aversion is within a certain range, reasonable trade credit contracts designed by the manufacturer can effectively induce the retailer to report its real sales cost and encourage it to exert appropriate effort. Furthermore, we find that the optimal trade credit period, optimal transfer payment, and retailer’s optimal sales effort level under dual information asymmetry are less than under single information asymmetry. Numerical analysis are conducted to demonstrate the effects of the parameters on decisions and profits.

Additional contract selection and parameter design under supplier credit guarantee financing

Additional contract selection and parameter design under supplier credit guarantee financing

Diaphragm Assessment by Multimodal Ultrasound Imaging in Healthy Subjects.

In recent years, diaphragm ultrasound (DUS) has been used to identify diaphragm dysfunction in the intensive care unit (ICU). However, there are few studies on DUS parameters to evaluate function, normal ranges, and influencing factors in population. The aim of this study is to provide a methodological reference for clinical evaluation of diaphragm function by measuring different DUS parameters in a healthy population. A descriptive study was conducted 212 (105 males, 107 females) subjects with normal spirometry underwent ultrasound imaging in this study. The diaphragm contraction and motion related parameters and shear wave velocity (SWV) were measured in the supine position. The effects of gender, age, body mass index (BMI) and lifestyle on diaphragm ultrasound parameters were analyzed. The diaphragm thickness at end-expiration (DT-exp) was 0.14 ±0.05 cm, the diaphragm thickness at end- inspiration (DT-insp) was 0.29±0.10 cm, with thickening fraction (TF) was 1.11±0.54. The diaphragm excursion (DE) was 1.68±0.37cm and diaphragm velocity was 1.45±0.41 cm/s during calm breathing. During deep breathing, the DE was 5.06±1.40cm and diaphragm velocity was 3.20±1.18 cm/s. The Diaphragm shear modulus-longitudinal view were Mean16.72±4.07kPa, Max25.04±5.58kPa, Min11.06±3.88kPa, SD2.56±0.98. The results of diaphragmatic measurement showed that the DT of males was significantly greater than that of females (P< 0.05), but there was no significant difference in TF. The DT-insp (r=0.155, P= 0.024) and the DT-exp (r=0.252, P=0.000) were positively correlated with age, and the DE during calm breathing was negatively correlated with age (r=-0.218, P= 0.001) and BMI (r=-00.280, P= 0.000). The DE (R=0.371, P=0.000) and velocity (R=0.368, P=0.000) during deep breathing were correlated with lifestyle. Our study provides normal reference values of the diaphragm and evaluates the influence of gender, age, body mass index and lifestyle on diaphragmatic morphology.

Application of Index Insurance in Iran's Agriculture: case of wheat growers.

Drought-induced risk endangers farmers in arid and semi-arid regions. Insurance is recognized as an appropriate policy alternative to support farmers facing with financial losses associated with production reduction. In this context, present study developed an ex ante index-based insurance program to deal with drought-induced risk of production losses. We applied this model to wheat growers in Iran. After the calibration of the contract parameters, an insurance scheme was optimized and tested. We showed that optimal insurance contracts generate low gain of certain equivalent income, high compensation, and a high basis risk. The best contract was not proportional to the complexity of the proposed index. The insurance program studied is recommended as a proper alternative for currently applying yield insurance.

Bonus or Penalty? Designing Service-Level Agreements for a Decentralized Supply Chain: The Implication of Return on Investment

We study the coordination of two-echelon supply chains via service level-dependent bonus and penalty contracts and assume that the manufacturer maximizes its profit while enabling the supplier to achieve its performance target. Profit and return on investment (ROI) are considered as the supplier’s performance measures. We compute optimal contract parameters and perform a numerical study. In addition, we perform a simulation-based study to analyze the profit risk of the considered parties. For supplier profit targets, bonus and penalty contracts lead to the same profit for both parties, but bonus contracts lead to lower costs, hence, a higher ROI. For supplier ROI targets, bonus contracts always lead to higher manufacturer profit, and no optimal penalty contracts exist. For every contract service level, optimal bonus contracts exist that maximize profit and ROI of the manufacturer simultaneously. Thus, we analyze the profit risk for the manufacturer and the supplier and show that it can be significantly reduced by setting an appropriate contract service level. The manufacturer usually should prefer bonus contracts. They allow to optimize profit and ROI simultaneously and even offer an additional degree of freedom to reduce the profit risk.