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Background: Multiple factors, such as less complex U.S. adult pneumococcal recommendations that could increase vaccination rates, childhood pneumococcal vaccination indirect effects that decrease adult vaccination impact, and increased vaccine hesitancy (particularly in underserved minorities), could diminish the cost‐effectiveness of programs to increase pneumococcal vaccination in older adults. Prior analyses supported the economic favorability of these programs. Methods: A Markov model compared no vaccination and current recommendations (either 20‐valent pneumococcal conjugate vaccine [PCV20] alone or 15‐valent pneumococcal conjugate vaccine plus the 23‐valent pneumococcal polysaccharide vaccine [PCV15/PPSV23]) without or with programs to increase vaccine uptake in Black and non‐Black 65‐year‐old cohorts. Pre‐pandemic population‐ and serotype‐specific pneumococcal disease risk and illness/vaccine costs came from U.S. databases. Program costs were $2.19 per vaccine‐eligible person and increased absolute vaccination likelihood by 7.5%. Delphi panel estimates and trial data informed vaccine effectiveness values. Analyses took a healthcare perspective, discounting at 3%/year over a lifetime time horizon. Results: Uptake programs decreased pneumococcal disease overall. In Black cohorts, PCV20 without program cost $216,805 per quality‐adjusted life year (QALY) gained compared with no vaccination; incremental cost‐effectiveness was $245,546/QALY for PCV20 with program and $425,264/QALY for PCV15/PPSV23 with program. In non‐Black cohorts, all strategies cost >$200,000/QALY gained. When considering the potential indirect effects from childhood vaccination, all strategies became less economically attractive. Increased vaccination with less complex strategies had negligible effects. In probabilistic sensitivity analyses, current recommendations with or without programs were unlikely to be favored at thresholds <$200,000/QALY gained. Conclusion: Current U.S. pneumococcal vaccination recommendations for older adults were unlikely to be economically reasonable with or without programs to increase vaccine uptake. Alternatives to current pneumococcal vaccines that include pneumococcal serotypes associated with adult disease should be considered. See related Editorial by Melissa K. Andrew in this issue. [ABSTRACT FROM AUTHOR]

Objective: To compare the cost-effectiveness of serial non-echo planar diffusion weighted MRI (non-EP DW MRI) versus planned second look surgery following initial canal wall up tympanomastoidectomy for the treatment of cholesteatoma. Methods: A decision-analytic model was developed. Model inputs including residual cholesteatoma rates, rates of non-EP DW MRI positivity after surgery, and health utility scores were abstracted from published literature. Cost data were derived from the 2022 Centers for Medicare and Medicaid Services fee rates. Efficacy was defined as increase in quality-adjusted life year (QALY). One- and 2-way sensitivity analyses were performed on variables of interest to probe the model. Total time horizon was 50 years with a willingness to pay (WTP) threshold set at $50 000/QALY. Results: Base case analysis revealed that planned second-look surgery ($11 537, 17.30 QALY) and imaging surveillance with non-EP DWMRI ($10 439, 17.26 QALY) were both cost effective options. Incremental cost effectiveness ratio was $27 298/QALY, which is below the WTP threhshold. One-way sensitivity analyses showed that non-EP DW MRI was more cost effective than planned second-look surgery if the rate of residual disease after surgery increased to 48.3% or if the rate of positive MRI was below 45.9%. A probabilistic sensitivity analysis at WTP of $50 000/QALY found that second-look surgery was more cost-effective in 56.7% of iterations. Conclusion: Non-EP DW MRI surveillance is a cost-effect alternative to planned second-look surgery following primary canal wall up tympanomastoidectomy for cholesteatoma. Cholesteatoma surveillance decisions after initial canal wall up tympanomastoidectomy should be individualized. Level of Evidence: V. [ABSTRACT FROM AUTHOR]

Business students have long been noted for their differential proclivity to engage in academic misconduct. Unfortunately, the potential for misconduct has been exacerbated in recent years by rapid advances in technology, easy access to information, competitive pressures, and the proliferation of websites that provide students access to information that allows them to directly circumvent the learning process. Using a convenience sample of 631 students matriculating in various business majors at four U.S. universities and structural equations modeling procedures, this study assesses the effects of psychological factors on business students' propensities to utilize the services of homework assistance websites. Specifically, we examine how "Dark Triad" personality traits (i.e., narcissism, Machiavellianism, and psychopathy) interact with Fraud Diamond elements to influence student decisions to engage the services of these websites. We find that each Dark Triad trait exerts a significant influence on at least one of the Fraud Diamond elements, which in turn have a significant direct or indirect positive association with students' reported intentions to utilize, and reported utilization of, these websites. [ABSTRACT FROM AUTHOR]

Trees continuously regulate leaf physiology to acquire CO2 while simultaneously avoiding excessive water loss. The balance between these two processes, or water use efficiency (WUE), is fundamentally important to understanding changes in carbon uptake and transpiration from the leaf to the globe under environmental change. While increasing atmospheric CO2 (iCO2) is known to increase tree intrinsic water use efficiency (iWUE), less clear are the additional impacts of climate and acidic air pollution and how they vary by tree species. Here, we couple annually resolved long‐term records of tree‐ring carbon isotope signatures with leaf physiological measurements of Quercus rubra (Quru) and Liriodendron tulipifera (Litu) at four study locations spanning nearly 100 km in the eastern United States to reconstruct historical iWUE, net photosynthesis (Anet), and stomatal conductance to water (gs) since 1940. We first show 16%–25% increases in tree iWUE since the mid‐20th century, primarily driven by iCO2, but also document the individual and interactive effects of nitrogen (NOx) and sulfur (SO2) air pollution overwhelming climate. We find evidence for Quru leaf gas exchange being less tightly regulated than Litu through an analysis of isotope‐derived leaf internal CO2 (Ci), particularly in wetter, recent years. Modeled estimates of seasonally integrated Anet and gs revealed a 43%–50% stimulation of Anet was responsible for increasing iWUE in both tree species throughout 79%–86% of the chronologies with reductions in gs attributable to the remaining 14%–21%, building upon a growing body of literature documenting stimulated Anet overwhelming reductions in gs as a primary mechanism of increasing iWUE of trees. Finally, our results underscore the importance of considering air pollution, which remains a major environmental issue in many areas of the world, alongside climate in the interpretation of leaf physiology derived from tree rings. [ABSTRACT FROM AUTHOR]

Presents findings from on-site observations of 12 graduate programs in educational technology at 12 universities in the United States and Canada. Highlights include undergraduate requirements; graduate degree programs and organization; markets served; size of programs; and program support. (AEF)

Introduction: Central line–associated bloodstream infections (CLABSIs) lead to significant morbidity and mortality in children with intestinal failure (IF). Ethanol lock prophylaxis (ELP) greatly reduces CLABSI frequency with minimal side effects. However, in the United States, a recently approved orphan drug designation for dehydrated alcohol has greatly increased 70% ethanol cost from about $10/day to $1000/day. We examined the cost‐effectiveness of ELP in relation to these changes. Methods: We simulated a previously developed IF Markov model over 1 year. Costs were measured in 2020 US dollars and effectiveness in quality‐adjusted life‐years (QALYs). CLABSI rate with and without ELP was estimated from the largest available comparative observational study. The primary outcome was incremental cost‐effectiveness ratio (ICER) between treatments. Secondary outcomes included CLABSI frequency. Sensitivity analyses on all model parameters were performed. Results: In the base model, children with IF not using ELP accumulated $131,815 in costs and 0.32 QALYs per patient compared with $437,884 and 0.33 QALYs per patient in those using ELP. The ICER was nearly $17 million/QALY gained. ELP resulted in a 40% reduction in CLABSI frequency. ELP became cost‐effective at $68/day and cost‐saving at $63/day. Sensitivity analysis identified no other plausible parameter variation to reach the benchmark of $100,000/QALY gained. Conclusions: At the current price, ELP is not cost‐effective for CLABSI prevention in children with IF in the United States. This study highlights the critical need for the approval of an affordable lock therapy option to prevent CLABSIs in these children. [ABSTRACT FROM AUTHOR]

Background Teduglutide use in pediatric patients with short bowel syndrome can aid in the achievement of enteral autonomy, but with a price of >$400,000 per y. Objective The current study evaluated the cost-effectiveness of using teduglutide in conjunction with offering intestinal transplantation in US pediatric patients with short bowel syndrome. Design A Markov model was used to evaluate the costs (in US dollars) and effectiveness [in quality-adjusted life years (QALYs)] of using teduglutide compared with offering intestinal transplantation. Parameters were estimated from published data where available. The primary effect modeled was the probability of weaning from parenteral nutrition while on teduglutide. Sensitivity analyses were performed on all model parameters. Results Compared with offering only intestinal transplantation, adding teduglutide cost |${\$}$| 124,353/QALY gained. Reducing the cost of the medication by 16% allowed the cost to reach the typical benchmark of |${\$}$| 100,000/QALY gained. Probabilistic sensitivity analysis favored transplantation without offering teduglutide in 68% of iterations at a |${\$}$| 100,000/QALY threshold. Never using teduglutide created an opportunity cost of over |${\$}$| 100,000 per patient. Conclusions At its current price, teduglutide does not provide a cost-effective addition to transplantation in the treatment of pediatric short bowel syndrome. Further work should look to identify cost-reducing strategies, including alternative dosing regimens. [ABSTRACT FROM AUTHOR]

It has been widely documented that positive school climate significantly contributes to academic success and student well-being. This study explored teachers, students, and parents' perceptions of school climate as measured by the Inviting School Survey- R (ISS-R). The ISS-R was administered to over 10,000 school community members from over 60 schools across the United States. The ISS-R was used to identify perceptions of school climate between factors such as participants, gender, type of school, size of school, and student age. Results showed there were statistically significant association with self-reported perceptions of school climate and these five factors on the six ISS-R scales. The implications of the results are discussed, and it is concluded that the study's findings will facilitate the development of more inviting schools. [ABSTRACT FROM AUTHOR]

Background Adults with short bowel syndrome have a high mortality and significant morbidity due to unsuccessful attempts at rehabilitation that necessitate chronic use of parenteral nutrition (PN). Teduglutide is a novel therapy that promotes intestinal adaptation to improve rehabilitation but with a price >$400,000/y. Objective The current study evaluated the cost-effectiveness of using teduglutide in US adult patients with short bowel syndrome. Methods A Markov model evaluated the costs (in US dollars) and effectiveness (in quality-adjusted life years, or QALYs) of treatment compared with no teduglutide use, with a presumed starting age of 40 y. Parameters were obtained from published data or estimation. The primary effect modeled was the increased likelihood of reduced PN days per week when using teduglutide, leading to greater quality of life and lower PN costs. Sensitivity analyses were performed on all model parameters. Results In the base scenario, teduglutide cost $949,910/QALY gained. In 1-way sensitivity analyses, only reducing teduglutide cost decreased the cost/QALY gained to below the typical threshold of $100,000/QALY gained. Specifically, teduglutide cost would need to be reduced by >65% for it to reach the threshold value. Probabilistic sensitivity analysis favored no teduglutide use in 80% of iterations at a $100,000/QALY threshold. However, teduglutide therapy was cost-saving in 13% of model iterations. Conclusions Teduglutide does not meet a traditional cost-effectiveness threshold as treatment for PN reduction in adult patients with short bowel syndrome compared with standard intestinal rehabilitation. Subpopulations that demonstrate maximum benefit could be cost-saving, and complete nonuse could lead to financial loss. Teduglutide becomes economically reasonable only if its cost is substantially reduced. [ABSTRACT FROM AUTHOR]

Discusses the role that academic and research libraries play in advancing student learning through outcomes assessment in the United States. Development of learning outcomes from the library's perspective; Development of curriculum segments through which the library would achieve the outcomes; Measurement of how well outcomes are being achieved.

The American Academy of Social Work and Social Welfare (AASWSW) identified 12 Grand Challenges of Social Work to unify the profession with focused research, practice and policy applications for the most pressing social issues. Virtual Reality (VR), specifically three-dimensional immersive computer-generated environments, has a history of research and applications to address social and behavioral problems. VR is becoming more readily available, as the technology is becoming more common in mainstream platforms such as mobile technology. While social work interventions are often tailored for vulnerable populations that may not have access to VR computing, it appears that virtual reality is gaining accessibility with these advances. Within the framework of the 12 Grand Challenges of Social Work, researchers from three social work virtual reality laboratories in the United States, Texas State University, the University of Houston, and the University of Alabama, review applications previously tested and currently in development to focus future research and intervention in social work practice. [ABSTRACT FROM AUTHOR]

Virtual reality (VR) has emerged as a promising technological intervention for anxiety disorders. However, there are no existing standards and best practices to evaluate the effectiveness of environments to achieve their intervention goals. The purpose of this study was to develop a VR intervention for student veterans with social anxiety disorder and test feasibility utilizing a three-stage development model. The development of a therapeutic VR environment may benefit from an interdisciplinary collaboration of researchers from various fields of study. Utilizing three stages of prototyping with two virtual reality platforms, fully immersive video (n = 6) and three-dimensional (3-D) immersive virtual reality (n = 8), the research team designed an intervention for student veterans with social anxiety disorder, testing bio-reactivity of participants. Results of prototyping include user feedback validating increased stress levels and increased bio-reactivity specifically in galvanic skin response and heart rate elevation. Implications include the use of 360° video for prototyping 3-D virtual reality interventions. [ABSTRACT FROM AUTHOR]

Background and Aims: Inflammatory bowel disease (IBD) patients are at increased risk of melanoma and non-melanoma skin cancers, and preventive care guidelines in IBD favor annual skin examinations. Here we estimate the cost-effectiveness of annual melanoma screening in IBD.Methods: Melanoma screening was defined as receiving annual total body skin examinations starting at age 40 from a dermatologist. Screening was compared to US background total body skin examination rates performed by primary care practitioners. A Markov model was used to estimate intervention costs and effectiveness. Future costs and effectiveness were discounted at 3% per year over a lifetime horizon. Strategies were compared using a willingness-to-pay threshold of $100,000/quality-adjusted life year (QALY) gained.Results: Annual melanoma screening cost an average of $1961 per patient, while no screening cost $81 per patient. Melanoma screening was more effective, gaining 9.2 QALYs per 1000 persons, at a cost of $203,400/QALY gained. Screening every other year was the preferred strategy, gaining 6.2 QALYs per 1000 persons and costing $143,959/QALY. One-way sensitivity analyses suggested the relative risk of melanoma in IBD, melanoma progression, and screening costs were most influential with clinically plausible variation, leading to scenarios costing < $100,000/QALY gained. Probabilistic sensitivity analyses suggested screening every other year was cost-effective in 17.4% of iterations.Conclusions: Screening for melanoma in IBD patients was effective but expensive. Screening every other year was the most cost-effective strategy. Studies to identify IBD patients at the highest risk of developing melanoma may assist in targeting a prevention program in the most cost-effective manner. [ABSTRACT FROM AUTHOR]

Purpose High-dose trivalent inactivated influenza vaccine (HD-IIV3) or recombinant trivalent influenza vaccine (RIV) may increase influenza vaccine effectiveness (VE) in adults with conditions that place them at high risk for influenza complications. This analysis models the public health impact and cost-effectiveness (CE) of these vaccines for 50–64 year-olds. Methods Markov model CE analysis compared 5 strategies in 50–64 year-olds: no vaccination; only standard-dose IIV3 offered (SD-IIV3 only), only quadrivalent influenza vaccine offered (SD-IIV4 only); high-risk patients receiving HD-IIV3, others receiving SD-IIV3 (HD-IIV3 & SD-IIV3); and high-risk patients receiving HD-IIV3, others receiving SD-IIV4 (HD-IIV3 & SD-IIV4). In a secondary analysis, RIV replaced HD-IIV3. Parameters were obtained from U.S. databases, the medical literature and extrapolations from VE estimates. Effectiveness was measured as 3%/year discounted quality adjusted life year (QALY) losses avoided. Results The least expensive strategy was SD-IIV3 only, with total costs of $99.84/person. The SD-IIV4 only strategy cost an additional $0.91/person, or $37,700/QALY gained. The HD-IIV3 & SD-IIV4 strategy cost $1.06 more than SD-IIV4 only, or $71,500/QALY gained. No vaccination and HD-IIV3 & SD-IIV3 strategies were dominated. Results were sensitive to influenza incidence, vaccine cost, standard-dose VE in the entire population and high-dose VE in high-risk patients. The CE of RIV for high-risk patients was dependent on as yet unknown parameter values. Conclusions Based on available data, using high-dose influenza vaccine or RIV in middle-aged, high-risk patients may be an economically favorable vaccination strategy with public health benefits. Clinical trials of these vaccines in this population may be warranted. [ABSTRACT FROM AUTHOR]

Offering a choice of influenza vaccine type may increase vaccine coverage and reduce disease burden, but it is more costly. This study calculated the public health impact and cost-effectiveness of 4 strategies: no choice, pediatric choice, adult choice, or choice for both age groups. Using agent-based modeling, individuals were simulated as they interacted with others, and influenza was tracked as it spread through a population in Washington, DC. Influenza vaccination coverage derived from data from the Centers for Disease Control and Prevention was increased by 6.5% (range, 3.25%-11.25%), reflecting changes due to vaccine choice. With moderate influenza infectivity, the number of cases averaged 1,117,285 for no choice, 1,083,126 for pediatric choice, 1,009,026 for adult choice, and 975,818 for choice for both age groups. Averted cases increased with increased coverage and were highest for the choice-for-both-age-groups strategy; adult choice also reduced cases in children. In cost-effectiveness analysis, choice for both age groups was dominant when choice increased vaccine coverage by ≥3.25%. Offering a choice of influenza vaccines, with reasonable resultant increases in coverage, decreased influenza cases by >100,000 with a favorable cost-effectiveness profile. Clinical trials testing the predictions made based on these simulation results and deliberation of policies and procedures to facilitate choice should be considered. [ABSTRACT FROM AUTHOR]

Objectives To estimate the cost-effectiveness of an intervention to increase pneumococcal, influenza, and pertussis-containing vaccine uptake in adults aged 65 and older in primary care practices. Design Markov decision analysis model, comparing the cost-effectiveness of the 4 Pillars Practice Transformation Program with no intervention. Setting Diverse primary care practices in two U.S. cities. Participants Clinical trial participants aged 65 and older. Measurements Quality-adjusted life years ( QALYs), public health outcomes, and costs. Vaccination rates and intervention costs were derived from a randomized controlled cluster trial. Other parameters were derived from the medical literature and Centers for Disease Control and Prevention data. All parameters were individually and simultaneously varied over their distributions. Results With the intervention program and extrapolating over 10 years, there would be approximately 60,920 fewer influenza cases, 2,031 fewer pertussis cases, and 13,842 fewer pneumococcal illnesses in adults aged 65 and older. Total per-person vaccination and illness costs with the intervention were $23.93 higher than without the intervention, with a concurrent increase in effectiveness of 0.0031 QALYs, or $7,635 per QALY gained. In sensitivity analyses, no individual parameter variation caused the intervention to cost more than $50,000 per QALY gained. Conclusions Implementing an intervention based on the 4 Pillars Practice Transformation Program is a cost-effective undertaking in primary care practices for individuals aged 65 and older, with predicted public health benefits. [ABSTRACT FROM AUTHOR]

Background: The leading cause of death among firefighters in the United States (U.S.) is cardiovascular events (CVEs) such as sudden cardiac arrest and myocardial infarction. This study compared the cost-effectiveness of three strategies to prevent CVEs among firefighters. Methods: We used a cost-effectiveness analysis model with published observational and clinical data, and cost quotes for physiologic monitoring devices to determine the cost-effectiveness of three CVE prevention strategies. We adopted the fire department administrator perspective and varied parameter estimates in one-way and two-way sensitivity analyses. Results: A wellness-fitness program prevented 10% of CVEs, for an event rate of 0.9% at $1440 over 10-years, or an incremental cost-effectiveness ratio of $1.44 million per CVE prevented compared to no program. In one-way sensitivity analyses, monitoring was favored if costs were < $116/year. In two-way sensitivity analyses, monitoring was not favored if cost was ≥ $399/year. A wellness-fitness program was not favored if its preventive relative risk was >0.928. Conclusions: Wellness-fitness programs may be a cost-effective solution to preventing CVE among firefighters compared to real-time physiologic monitoring or doing nothing. [ABSTRACT FROM AUTHOR]

Objectives To compare the cost-effectiveness of four influenza vaccines available in the United States for persons aged 65 and older: trivalent inactivated influenza vaccine ( IIV3), quadrivalent inactivated influenza vaccine ( IIV4), a more-expensive high-dose IIV3, and a newly approved adjuvanted IIV3. Design Cost-effectiveness analysis using a Markov model and sensitivity analyses. Setting A hypothetical influenza vaccination season modeled according to possible U.S. influenza vaccination policies. Participants Hypothetical cohort of individuals aged 65 and older in the United States. Measurements Cost-effectiveness and public health benefits of available influenza vaccination strategies in U.S. elderly adults. Results IIV3 cost $3,690 per quality-adjusted life year ( QALY) gained, IIV4 cost $20,939 more than IIV3 per QALY gained, and high-dose IIV3 cost $31,214 more per QALY than IIV4. The model projected 83,775 fewer influenza cases and 980 fewer deaths with high-dose IIV3 than with the next most-effective vaccine: IIV4. In a probabilistic sensitivity analysis, high-dose IIV3 was the favored strategy if willingness to pay is $25,000 or more per QALY gained. Adjuvanted IIV3 cost-effectiveness depends on its price and effectiveness (neither yet determined in the United States) but could be favored if its relative effectiveness is 15% greater than that of IIV3. Conclusion From economic and public health standpoints, high-dose IIV3 for adults aged 65 years and older is likely to be favored over the other vaccines, based on currently available data. The cost-effectiveness of adjuvanted IIV3 should be reviewed after its effectiveness has been compared with that of other vaccines and its U.S. price is established. [ABSTRACT FROM AUTHOR]

Introduction: Prior evidence found live attenuated influenza vaccine (LAIV) more effective than inactivated influenza vaccine (IIV) in children aged 2-8 years, leading CDC in 2014 to prefer LAIV use in this group. However, since 2013, LAIV has not proven superior, leading CDC in 2015 to rescind their LAIV preference statement. Here, the cost effectiveness of preferred LAIV use compared with IIV in children aged 2-8 years is estimated.Methods: A Markov model estimated vaccination strategy cost effectiveness in terms of cost per quality-adjusted life-year gained. Base case assumptions were equal vaccine uptake; IIV use when LAIV was not indicated (in 11.7% of the cohort); and no indirect vaccination effects. Sensitivity analyses included estimates of indirect effects from both equation- and agent-based models. Analyses were performed in 2014-2015.Results: Using prior effectiveness data in children aged 2-8 years (LAIV=83%, IIV=64%), preferred LAIV use was less costly and more effective than IIV (dominant), with results sensitive only to LAIV and IIV effectiveness variation. Using 2014-2015 U.S. effectiveness data (LAIV=0%, IIV=15%), IIV was dominant. In two-way sensitivity analyses, LAIV use was cost saving over the entire range of IIV effectiveness (0%-81%) when absolute LAIV effectiveness was >7.1% higher than IIV, but never cost saving when absolute LAIV effectiveness was <3.5% higher than IIV.Conclusions: Results support CDC's decision to no longer prefer LAIV use and provide guidance on effectiveness differences between influenza vaccines that might lead to preferential LAIV recommendation for children aged 2-8 years. [ABSTRACT FROM AUTHOR]

Improving healthcare safety, quality, and coordination, as well as quality of life, are important aims of caring for older adults with multiple chronic conditions and/or functional limitations. Person-centered care is an approach to meeting these aims, but there are no standardized, agreed-upon parameters for delivering such care. The SCAN Foundation charged a team from the American Geriatrics Society ( AGS) in collaboration with a research and clinical team from the Keck School of Medicine of the University of Southern California to provide the evidence base to support a definition of person-centered care and its essential elements. An interprofessional panel of experts in person-centered care principles and practices that the AGS convened developed this statement. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Rivaroxaban is an oral direct factor Xa inhibitor that is noninferior to warfarin in the prevention of recurrent venous thromboembolism (VTE). Whether rivaroxaban is cost-effective in the prevention of recurrent VTE, however, is not known. Material and Methods: To assess the cost effectiveness of rivaroxaban compared with warfarin in the prevention of recurrent VTE, we built a Markov state-transition model over a 10-year time horizon. The base case analysis consisted of a hypothetical cohort of 60-year-old patients with an initial VTE who received secondary prophylaxis with either rivaroxaban or warfarin for 3 to 12months. Cost estimates were derived from the Healthcare and Utilization Project and other sources. Probabilities were based on literature values. Outcomes included costs in 2011 United States dollars, quality-adjusted life-years (QALYs), and incremental cost effectiveness ratios (ICERs) over 10years from a societal perspective. Results: Compared with warfarin, the rivaroxaban strategy cost less ($3,195 vs. $6,188) and was more effective (9.29 QALYs vs 9.14 QALYs). Our results were highly robust in sensitivity analyses. Warfarin was no longer dominated by rivaroxaban when the risk of major bleeding with rivaroxaban exceeds 3.8% (base case estimate: 0.96%). Conclusion: In summary, prophylactic anticoagulation with rivaroxaban appears to be a cost effective, and perhaps cost saving, alternative to warfarin for the prevention of recurrent VTE. [Copyright &y& Elsevier]

Background: The 13-valent pneumococcal conjugate vaccine (PCV13) is approved by the U.S. Food and Drug Administration for adults, but its role in older adults is unclear. Purpose: To compare PCV13 strategies to currently recommended vaccination strategies in adults aged ≥65 years. Methods: Using a Markov model, the cost effectiveness of PCV13 and the 23-valent pneumococcal polysaccharide vaccine (PPSV23), alone or in combination, was estimated, in adults aged either 65 years or 75 years. No prior vaccination, prior vaccination, and vaccine hyporesponsiveness scenarios were examined. Pneumococcal disease rates, indirect childhood PCV13 effects, and costs were estimated using CDC Active Bacterial Core surveillance data and U.S. national databases. An expert panel estimated vaccine-related protection. A societal perspective was taken and outcomes were discounted 3% per year. Results: In those aged 65 years, single-dose PCV13 cost $11,300 per quality-adjusted life-year (QALY) gained compared to no vaccination; at ages 65 and 80 years, PCV13 cost $83,000/QALY. In those aged 75 years, single-dose PCV13 cost $62,800/QALY gained. PPSV23 cost more and was less effective than PCV13. Results were sensitive to varying vaccine effectiveness and indirect effect estimates. In hyporesponsiveness scenarios, cost-effectiveness ratios increased by 37%–78% for single-dose strategies and 29%–35% for multiple-dose strategies. Conclusions: Single-dose PCV13 strategies are likely to be economically reasonable in older adults. [ABSTRACT FROM AUTHOR]

H3N2 influenza viruses have now circulated in the human population for 43 years since the pandemic of 1968, accumulating sequence changes in the hemagglutinin (HA) and neuraminidase (NA) that are believed to be predominantly due to selection for escape from antibodies. Examination of mutations that persist and accumulate led to identification of antigenically significant mutations that are contained in five antigenic sites (A-E) mapped on to the H3 HA. In early H3N2 isolates, antigenic site A appeared to be dominant while in the 1990s site B seemed more important. To obtain experimental evidence for dominance of antigenic sites on modern H3 HAs, we have measured antibodies in plasma of human subjects who received the 2006-07 trivalent subunit influenza vaccine (H3 component A/Wisconsin/67/05) or the 2008-09 formulation (H3 component A/Uruguay/716/07). Plasmas were tested against expressed HA of Wisconsin-like influenza A/ Oklahoma/309/06 and site-directed mutants in antigenic site A (NNES121-124ITEG, N126T, N133D, TSSS135-138GSNA, K140I, RSNNS142-146PGSG), and antigenic site B (HL156-157KS, KFK158-160GST, NDQI189-192QEQT, A196V). ''Native ELISA'' analysis and escape mutant selection with two human monoclonal antibodies demonstrated that antibody E05 binds to antigenic site A and 1•C02 binds to site B. We find that most individuals, after vaccination in seasons 2006-07 and/or 2008- 09, showed dominance of antigenic site B recognition over antigenic site A. A minority showed dominance of site A in 2006 but these were reduced in 2008 when the vaccine virus had a site A mutation. A better understanding of immunodominance may allow prediction of future antigenic drift and assist in vaccine strain selection. [ABSTRACT FROM AUTHOR]

Using daily data we show sudden, extreme declines in the U.S. stock market for crash dates to lead to a capital preserving (as opposed to strategic or tactical) reallocation to government debt securities. In most cases we find flight-induced reallocation reverses direction within one day of a crash. However, for the 1987 world crash we find increased and persistent return volatility in both equity and bond returns lasting up to five days following this dramatic decline in world equity prices. Like previous research in this area, we find equity crashes alter long-run stock/bond return correlations and lead to increased stock and bond return volatility. Finally, we describe the somewhat unique stock and bond correlation adjustments triggered by the 9/11 attack and the impact this event had on the behavior of U.S. equity investors' flight-to-safety reaction. [ABSTRACT FROM AUTHOR]

The article discusses a study of the cost-effectiveness of 13-valent pneumococcal conjugate vaccine (PCV13) and 23-valent pneumococcal polysaccharide vaccine (PPSV23) among adults in the U.S. A Markov state-transition model was used to examine pneumococcal vaccination strategies. Results indicate that PCV13 administered at ages 50 and 65 years can reduce pneumococcal disease burden in an economically reasonable manner. Also noted is the low-range estimate of the PPSV23 effectiveness against invasive pneumococcal disease (IPD). One of the study limitations is the lack of data on PCV13 effectiveness.

Abstract: Influenza vaccination is now recommended for all ages; CDC pneumococcal polysaccharide vaccination (PPV) recommendations are comorbidity-based in nonelderly patients. We constructed a Markov model to estimate the cost-effectiveness of dual influenza and pneumococcal vaccination in 50-year-olds. Patients were followed for 10 years, with differing time horizons examined in sensitivity analyses. With 100% vaccine uptake, dual vaccination cost $37,700/QALY gained compared to a CDC recommendation strategy; with observed vaccine uptake, dual vaccination cost $5,300/QALY. Results were sensitive to shorter time horizons, favoring CDC recommendations. We found dual vaccination of all 50-year-olds economically reasonable. Shorter duration models may not fully account for PPV effectiveness. [ABSTRACT FROM AUTHOR]

The article features Robert C. Armstrong, a chemical engineering professor at the Massachusetts Institute of Technology (MIT) in Cambridge. It says that Armstrong was a native of Baton Rouge in Louisiana, who grew up engaged in technologies that were responding to the energy needs of the U.S. According to the author, Armstrong was named head of the MIT chemical engineering department in 1996, a role that he played until 2007. Details of the awards received by Armstrong and the role he played in the MIT Energy Initiative (MITEI) are also discussed.

The focus of this article is to examine the recent historical record of the US equity and government bond markets in an attempt to associate negative return correlations between the two series to identify flight-to-safety episodes. Using the Inclan-Tsiao algorithm to date changes in equity market volatility, we find evidence of a flight-to-safety phenomenon. The method allows us to identify the dates where the equity index is negative coupled with positive government bond movements. Most of these observations occur during the worldwide crash of October 1987. [ABSTRACT FROM AUTHOR]

The article presents a study on the stress paradigm in accounting settings. It mentions several entities which increase job stress in accountants including the Sarbanes-Oxley Act of 2002 auditing compliance procedure, the market shortages of auditors, and financial scandals. Moreover, it mentions that the study aims to provide additional guidance for accountants who seeks to implement strategies to enhance organizational effectiveness and individual well-being.

Section 3, Standards 2 and 10 of the Association to Advance Collegiate Schools of Business (AACSB) International's 2008 revised Eligibility Procedures and Standards for Business Accreditation addressed the expectations regarding the intellectual contributions of business school faculty and faculty qualifications. To assess the extent to which AACSB International member schools comprehend these 2 critical standards, the authors surveyed deans from 560 AACSB International member schools in the United States regarding the expectations and processes in place at their institutions to ensure compliance with them. The authors received usable responses from 177 (32%) people of those surveyed in the allotted timeframe. The results point to areas of concern with respect to interpretation of both of these standards. [ABSTRACT FROM AUTHOR]

The article offers information on a study concerning the estimation of the quality of life utilities for pelvic inflammatory diseases (PID). It is noted that PID can be considered as a common, expensive, and potentially serious disease for young women. In the United States, figures show that at least ten percent of women will be affected by the mentioned disease during their lifetime. Utilities for PID has the capability to provide significant implications on the intervention's cost-effectiveness to manage and prevent the disease.

The article examines the role of antibiotic costs on the cost-effectiveness of Pelvic Inflammatory Disease (PID) therapy in the U.S. To estimate the incremental cost-effectiveness of the outpatient antibiotic regimens for PID, researchers used a Markov decision model to calculate incremental costs per Quality Adjusted Life Year (QALY). They discovered that antibiotic costs vary between $43 (ceftriaxone and doxycycline) and $188 (ofloxacin/metronidazole). They hypothesize that if the more expensive of these antibiotics decreases the relative risk of PID complications by 1%, then ofloxacin/metronidazole costs $30,200 per QALY gained.

Fiscal reforms in government are continually proposed, frequently adopted, and usually assessed as failing to achieve their desired outcomes. This paper develops a broad contingency framework that focuses on the third step—the assessment of fiscal reforms. The value of the framework is that it provides researchers as well as reformers a lens to assess the net benefits of reforms. Not only does it provide the lens, but it also suggests the accuracy or clarity of the lens in different circumstances. Our framework is contingent on two dimensions: type of fiscal reform (rules vs. judgment) and life cycle (innovators, early adopters, maturity). Our framework is broad in that it combines prior research from the budgeting and accounting literature. Recent budgeting research has suggested that an outcomes view of reform can be replaced with a process view. In addition to these viewpoints, we also analyze the monitoring and signaling viewpoints from accounting research. We believe the four viewpoints are complementary rather than mutually exclusive, and both accounting and budgeting researchers can learn from each other. We argue that signaling may be the best viewpoint for two reasons: (a) It provides insights into the net costs and benefits of adopting a reform, and (b) it provides insights into policy suggestions that are likely to increase the adoption of beneficial reforms. We then apply the framework to performance budgeting reforms of state governments in the United States. Our analysis suggests that performance measures might not be useful for the legislative decision process of allocating resources among disparate goals but appear to be useful for improving the quality and cost of providing services. Three policy suggestions are (a) legislators should focus on incentives for managers to report performance measures, (b) researchers and reformers should consider how performance budgeting could be done on a comparable basis across states, and (c) influential actors such as legislators and the media should be studied in greater detail. [ABSTRACT FROM AUTHOR]

This study examines performance reporting in the publicly available financial reports of U.S. cities and tests various political and economic factors that are expected to be associated with the extent of this reporting. While performance reporting is required in many jurisdictions throughout the world, U.S. cities engage in this process voluntarily. The study addresses the question of whether publicly reporting nonfinancial performance measures appears to be a "quality" reporting activity similar to following GAAP accounting or earning awards for financial reporting. The conclusion is that nonfinancial performance reporting appears to be a quality reporting activity. However, unlike the quality reporting of financial activities, two factors limit the growth of this practice: 1) variability in practice, and 2) managerial resistance. The use of the comparable data method (CDM) is introduced as a possible solution to both limitations. [ABSTRACT FROM AUTHOR]

Reprints an article from a 1988 issue of the 'Journal of the American Geriatrics Society, about the importance of comprehensive geriatric assessment in the United States. Evaluation of the patient in several domains; Goal of dealing effectively with health care issues posed by frail elderly persons; Assessment of the need for services.

Presents a study that described the organizational restructuring process at the Franklin P. Perdue School of Business at Salisbury University in the U.S. Factors that influenced the reorganization of the business school; Discussion on the team structure development and implementation at the school; Information on the self-directed team missions and functions of the school.

This case examines the tax, financial accounting, and governmental reporting consequences of a private Developer's actual purchase, renovation, and transfer of Ridgely House—an historical building in Ridgely, Maryland—to the Town of Ridgely. In short, the Developer purchases the building for $110,000 and incurs $190,000 in renovation costs to convert the property to a Town Hall and Police Station. He then "leases" the property back to the Town under terms and conditions outlined in a lease/purchase agreement (which can be viewed on the Web at http://faculty.ssu.edu/∼kjsmith/ridgely.htm). The case is constructed from the background information and actual lease/ purchase agreement provided by the Developer. The terms of the agreement raise several questions regarding the proper tax and financial accounting treatment of various aspects of the transaction. The Developer (lessor) questions whether the transaction is to be reported for tax and financial-reporting purposes as a rental or a sale, if the property qualifies for a federal historical tax credit, and what net cash flow can be expected from the project. As an optional assignment (at the instructor's discretion), the Town (lessee) questions whether it has entered into an operating or capital lease, how to record the transaction in accordance with Governmental Accounting Standards Board (GASB) guidelines, and what disclosures are required on its Statement of Financial Position. The case background, key lease/purchase agreement terms, and actual lease/ purchase agreement provide the prerequisite material for solving the case requirements. In addition, outside resources (textbooks, online tax and financial accounting web sites, etc.) should be consulted in the process of seeking solutions to the questions posed by the Developer and the Town Commissioners. It is suggested that solutions to the case requirements be presented to the instructor in the form of an Executive Summary with supporting documentation and schedules. [ABSTRACT FROM AUTHOR]

Purpose: Some authorities recommend varicella antibody testing or vaccination for adults without a history of chickenpox, but the cost effectiveness of these interventions is uncertain.Subjects and Methods: Using a Markov decision model, we estimated the cost effectiveness of three strategies for adults with no history of chickenpox: no vaccination, varicella antibody testing followed by vaccination for those without antibody, and vaccinating all. Societal and third-party payer perspectives were taken, with costs and benefits discounted at 3% per year. Assumptions for the baseline analysis were chosen to bias against no vaccination.Results: In the baseline analysis for 20- to 29-year-old patients, testing followed by vaccination compared with no vaccination is cost saving from a societal perspective and costs $6,670 per quality-adjusted life-year (QALY) gained from a third-party payer perspective. When less favorable assumptions are used, results are sensitive to the rates of compliance with vaccination follow-up; testing followed by vaccination costs more than $50,000 per QALY if <75% comply. For patients 30 years of age and older, the incremental cost of testing followed by vaccination is at least $97,100 per QALY compared with no vaccination, with costs greater than $50,000 per QALY unless testing costs less than $7.73, the chickenpox case-fatality rate is >0.067% (baseline 0.025%), or immunity with no chickenpox history is <25% (baseline 71%). In either age group, vaccinating all has an incremental cost of $2 to $16 million per QALY gained compared with testing followed by vaccination.Conclusion: Testing followed by vaccination for varicella in US adults aged 20 to 29 years may be cost effective by conventional criteria but is sensitive to rates of compliance with vaccination protocols. Testing or vaccination of older adults is expensive but may be cost effective in patients with lower probabilities of immunity or in those who have a greater risk of complications from chickenpox. [ABSTRACT FROM AUTHOR]

Presents an ethnographic account of how people rebuilt their lives after the devastation caused by Hurricane Andrew in Dade County, Florida, in August 1992. Account of the events brought about by the hurricane; Themes that describe the recovery period; Time out from everyday life; Life in the zone; Living between two worlds.

This study describes the development of the Primary Teacher Questionnaire (PTQ), a self-report teacher beliefs scale based on the National Association for the Education of Young Children Position Statement on Developmentally Appropriate Practice in the Primary Grades. The study was conducted in three phases: item development, initial testing and scale refinement, and field testing. In the field test, a 42-item version of the PTQ, consisting of an 18-item developmentally based subscale (DAP) and a 24-item traditionally based subscale (TRAD), was administered to 144 elementary and early childhood preservice and inservice teachers. Each subscale highly differentiated respondents on the basis of background in early childhood education. In addition, the PTQ subscales were internally consistent, with high reliability estimates (DAP = .802; TRAD = .867). Factor analysis showed two factors that, although they did not account for a high proportion of the scale variation, did show item clusters that were highly consistent with the logical structure of the guidelines on which the PTQ was based. The PTQ appears to be a useful instrument for examining teacher beliefs about appropriate practice in primary-grade settings. [ABSTRACT FROM AUTHOR]

The cyclical response patterns of major financial and macroeconomic aggregates to money shocks in the US economy is estimated. The data set is limited to the 1953-1965 period. The nature of this temporal window is rare in US economic history; growth was stable and non-inflationary, and there was a marked absence of major downturns, inflationary expectations and supply shocks. These facts permit a more reliable portrayal of the dynamics associated with conventional monetarism than would otherwise be the case. Instead of a formal structural model, the methodology employs a four-variable vector autoregression. Variables are chosen according to the traditional IS-LM model and include money, the Index of Industrial Production, the CPI and various interest rates. While the method is a theoretical, the variables accord with accepted orthodoxy and the results allow theoretically plausible interpretation. Significant patterns of persistence are found in major macrofinance aggregates over the period. Money shocks produce peaks at eight, twelve, and twenty-four months for interest rates, the IIP, and the CPI, respectively. We find the liquidity effect dominated by a short-term income effect. The Fed appears to have engaged in significant monetary accommodation over the period. A stable Phillips curve tradeoff is evident. Finally, we find the conventional upward-sloping yield curve replaced by a hump-shaped configuration about eight months after a money-induced shock to aggregate demand. [ABSTRACT FROM AUTHOR]

For many residents of South Florida, the familiar social and spatial context of everyday life has been disrupted or destroyed by Hurricane Andrew. Material and social resources that is typically available, as part of daily routines can no longer be taken for granted. People living in South Florida, like urban dwellers in other parts of the country, tend to be somewhat estranged from their physical environment. Despite the glorification of sun, sand, and surf, and the public concern for the Everglades, Florida, people typically deal with the environment on their terms, rather than adapting to it as it is presented to them. In fact, people may be less aware of the dangers the environment can present than those who live in more hostile climates. The possibility of a hurricane has always been there, of course, at some level of awareness. The beginning of the annual hurricane season is duly noted with media announcements and a proliferation of hurricane preparedness advice. For many, checking and refilling a box of hurricane supplies is an annual ritual. The common stock of knowledge and usual ways of preparing proved inadequate for Andrew.

The article reports on the application of differential cost analysis techniques to worksite-based health promotion programs in the United States. Worksite-based health promotion programs, designed to both improve employee health and reduce employee health-related costs to sponsoring employers, are prime targets for accounting analyses of program success. Indeed, differential cost analyses techniques may be adapted to the measurement of program effectiveness in financial terms. This study suggests that numerous potential stumbling blocks exist to effective accounting analyses of corporate health promotion efforts. In essence, the task involves accurately measuring behavioral change associated with participation in designated health promotion activities, monetarizing measured behavioral changes, then comparing monetarized changes with associated program costs. Invariably, accountants will find this process challenging in that it requires the dissemination of knowledge not normally within the purview of the accounting profession.

This article presents information on capital gains and losses in accounting. Capital gain has been defined as "profit upon realization of assets otherwise than in the ordinary course of business, this profit being the excess of the proceeds of realization over the cost of the property realized." Accounting makes a careful distinction between realized and unrealized capital increments, the latter generally being designated "appreciation." No matter how capital gain is defined the most significant feature of the transaction is that it does not occur in the ordinary course of business. Another peculiarity of capital gain from the accounting point of view is that it is not recognized until actually realized. The conditions and circumstances which bring about capital losses (realized or unrealized) are various. A change in price levels may be a cause. Obsolescence is frequently associated with capital losses. In the case of security investments, factors related solely to market conditions may be primarily influential. To say that capital losses are always non-recurring and outside the regular fulfillment of the particular function of a business enterprise is hardly accurate because obsolescence and many of the other risks which might result in loss of capital are always present and cannot be disassociated from the purposes of an enterprise.