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Assessing the damage from cigarette smoking in New York State.

Although there is clear evidence that smoking is the leading preventable cause of death in the United States today, almost one third of American adults continue to smoke. To promote public awareness of smoking's adverse effects, we applied a previously established methodology to estimate the impact of cigarette smoking in New York State. Using New York State-specific mortality data, cigarette smoking prevalence rates, and total health care costs, we found that cigarette smoking caused almost 27,000 deaths in 1985, resulting in 335,000 years of potential life lost (mean, 12 years per person). The estimated annual cost of smoking totaled +4.7 billion, including direct (health care) and indirect (lost income and productivity) costs from smoking-attributable deaths and illness. The New York State Department of Health publicized these findings to gain support for a statewide regulation for smoking control in public places. This methodology can easily be applied elsewhere to assess the adverse impact of smoking and to support smoking control activities.

Adult↗

[Maximization of economic yield, minimum cost optimal diets and cultivation diversification for small scale farmers of the highland region of Guatemala].

The present study was conducted as part of an evaluation of the economic and nutritional effects of a crop diversification program for small-scale farmers in the Western highlands of Guatemala. Linear programming models are employed in order to obtain optimal combinations of traditional and non-traditional food crops under different ecological conditions that: a) provide minimum cost diets for auto-consumption, and b) maximize net income and market availability of dietary energy. Data used were generated by means of an agroeconomic survey conducted in 1983 among 726 farming households. Food prices were obtained from the Institute of Agrarian Marketing; data on production costs, from the National Bank of Agricultural Development in Guatemala. The gestation periods for each crop were obtained from three different sources, and then averaged. The results indicated that the optimal cropping pattern for the minimum-cost diets for auto consumption include traditional foods (corn, beans, broad bean, wheat, potato), non-traditional foods (carrots, broccoli, beets) and foods of animal origin (milk, eggs). A significant number of farmers included in the sample did not have sufficient land availability to produce all foods included in the minimum-cost diet. Cropping patterns which maximize net incomes include only non-traditional foods: onions, carrots, broccoli and beets for farmers in the low highland areas, and raddish, broccoli, cauliflower and carrots for farmers in the higher parts. Optimal cropping patterns which maximize market availability of dietary energy include traditional and non-traditional foods; for farmers in the lower areas: wheat, corn, beets, carrots and onions; for farmers in the higher areas: potato, wheat, raddish, carrots and cabbage.

Agriculture↗

Quantitative evaluation of a combined pulse oximetry and end-tidal CO2 monitor.

Interest in combined noninvasive respiratory monitors is increasing. The combination of a pulse oximeter and an end-tidal CO2 monitor in one unit reduces space requirements and, potentially, production costs. One such unit (POET, Criticare Systems, Inc.) was tested for accuracy in 15 healthy nonsmoking adult volunteers. Each patient was subjected to inspired O2 fractions of 1.0, 0.21, 0.12, 0.10, and 0.08, then to CO2 concentrations of 0, 3, 6, and 7.5%. Pulse oximetry sensors were placed on the index finger (SpfO2) and the forehead (SphO2). For each oxygen concentration tested, a 30-second steady state of SpfO2 and SphO2 was established before arterial blood was drawn for SaO2 determination. A sampling line for end-tidal carbon dioxide tension (PETCO2) was placed just distal to the one-way exhalation valve. Samples of arterial blood were drawn and analyzed for PaCO2 after PETCO2 had been stable for 30 seconds for each concentration of carbon dioxide. Linear regression was used for data analysis. The regression equations were: SpfO2 (y) vs. SaO2 (x), y = 0.93x + 6.70, r = 0.98 (p less than 0.001); SphO2 (y) vs. SaO2 (x), y = 0.85x + 13.76, r = 0.95 (p less than 0.001); PETCO2 (y) vs. PaCO2 (x), y = 1.08x - 2.66, r = 0.95 (p less than 0.001) (when subjects were not hyperventilating). The authors conclude that this combined pulse oximeter and end-tidal CO2 monitor can accurately refect SaO2 and PaCO2 in clinically useful ranges.

Blood Pressure↗

[Development of new type plastics air turbine handpiece for dental use].

The noise generated by the metal air turbine handpiece employed in dental practice is considerable and attended with predominant high frequency components. Therefore, investigation of the noise generation mechanism and development of a silent air turbine handpiece was only a matter of course. In addition, the metal air turbine hardpiece is comparatively heavy and its production cost is high. From this point of view as well, production of a light air turbine handpiece at low cost is also desirable. In order to overcome the objections to the metal air turbine handpiece, appropriate plastics materials were employed wherever possible. In this study, the number of revolutions, noise level, frequency analysis, start pressure and weight of newly produced plastics handpieces and metal handpieces were examined and compared. The following results were obtained: 1. The number of revolutions of single-nozzle type air turbine handpieces encased in plastics housings and fitted with metal turbine rotors was higher than that of all-metal air turbine handpieces. The noise level of the former tended to be lower. 2. The number of revolutions of multi-nozzle type air turbine handpieces encased in plastics housings and fitted with turbine rotors with plastics turbine blades was almost equal to that of similar metal handpieces, with the noise level tending to be lower. 3. In the case of handpieces fitted with turbine rotors with dynamic balance, the number of revolutions was high and the noise level was low. This indicated that dynamic balance was a factor affecting the number of revolutions and noise level. 4. Narrow band sound frequency analysis of single-nozzle type air turbine handpieces showed a sharp peak at the fundamental frequency which was the same as the number of revolutions multiplied by the number of rotor turbine blades. It is thought that the noise from air turbine handpieces was aerodynamic in origin, being generated by the periodical interruption of steady air flow by rotor turbine blades. 5. The start pressure of plastics handpieces was almost equal to that of metal handpieces. 6. The weight of plastics handpieces was 20%-50% of that of metal handpieces. The present results indicate that it is possible to produce a new type of light, silent and aesthetical air turbine handpiece.

Dental Cavity Preparation↗

[Lightweight construction--sense and nonsense].

Lightweight construction techniques make sense as long as certain basic principles are observed. This requirement is best met by the shell construction technique. Lightweight constructions using the ultralite foil technique have considerable shortcomings, and it is only in rare cases that they may be used on a long-term basis. The assessment of the expected chewing forces as well as the shape and dimension of the bridge, limited by the given clinical conditions of the case, are the factors governing the decision for a specific framework construction. The design of the interproximal spaces requires particular attention. The most economical solution is a durable construction involving low material and production costs.

Denture Design↗

A new parallel plate dialyser. II. Description of design and in vitro performance.

Using a high efficiency membrane support pattern, described in the previous paper, a prototype of a new parallel plate dialyser has been developed. The new dialyser is designed in such a way that the number of components is reduced to one item per blood layer and the membrane is folded as a continuum. This permits a semiautomatic assembly of the unit, which reduces production costs. Furthermore this technique facilitates aseptic handling of the item. The in vitro performance has been tested and it compares favorably with commercially available disposable parallel plate dialysers.

Biomedical Engineering↗

Mentoring the novice clinical nurse specialist.

Mentoring can be a very important component in the personal and professional development of the clinical nurse specialist (CNS). Successful mentoring can be a highly productive, cost effective way to increase performance levels, develop leadership skills, improve morale, and increase self-esteem and value of both the mentor and mentee. This article will look at mentoring relationships and the mentoring process as they relate to the CNS.

Humans↗

Economic modeling of the use of gonadotropin-releasing hormone at insemination to improve fertility in dairy cows.

Economic and sensitivity analysis methods were used to evaluate financial returns from use of gonadotropin-releasing hormone (GnRH) at the time of insemination to enhance fertility of dairy cows. A computer spread sheet was used to determine the best service(s) for GnRH treatment, the increase in conception rate required for economic benefit from treatment, and how profits from GnRH treatment are affected by drug cost, herd reproductive efficiency, and production costs. Financial returns increased from use of GnRH at insemination under most herd conditions. Herds with conception rates less than or equal to 45% benefited from GnRH treatment at any 1 or 2 inseminations. Herds with conception rates greater than or equal to 60% benefited from GnRH treatment only at second or later services. Selection of second and/or third insemination as the GnRH treatment service usually resulted in the greatest total return. The enhancement of fertility necessary to achieve the break-even point with GnRH treatment at third service was 2% for low- and 5% for high-conception-rate herds. Base-line herd conception rates, estrus detection efficiency, replacement costs, value of excess days not pregnant, and cost of treatment had the greatest effect on returns from treatment. Herds with high conception rates and low replacement costs were likely to realize the least benefit from GnRH treatment at insemination. On the basis of our findings, we concluded that GnRH treatment at insemination is a profitable procedure under most herd conditions. Optimal treatment regimens for specific herds may best be determined by using herd performance and management data for calculating returns.

Animals↗

Cost accounting, management control, and planning in health care.

Advantages and pharmacy applications of computerized hospital management-control and planning systems are described. Hospitals must define their product lines; patient cases, not tests or procedures, are the end product. Management involves operational control, management control, and strategic planning. Operational control deals with day-to-day management on the task level. Management control involves ensuring that managers use resources effectively and efficiently to accomplish the organization's objectives. Management control includes both control of unit costs of intermediate products, which are procedures and services used to treat patients and are managed by hospital department heads, and control of intermediate product use per case (managed by the clinician). Information from the operation and management levels feeds into the strategic plan; conversely, the management level controls the plan and the operational level carries it out. In the system developed at New England Medical Center, Boston, Massachusetts, the intermediate product-management system enables managers to identify intermediate products, develop standard costs, simulate changes in departmental costs, and perform variance analysis. The end-product management system creates a patient-level data-base, identifies end products (patient-care groupings), develops standard resource protocols, models alternative assumptions, performs variance analysis, and provides concurrent reporting. Examples are given of pharmacy managers' use of such systems to answer questions in the areas of product costing, product pricing, variance analysis, productivity monitoring, flexible budgeting, modeling and planning, and comparative analysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Boston↗

In vitro studies on the antibacterial activity of phenoxyethanol in combination with lemon grass oil.

Lemon grass oil (LGO) has been reported to possess appreciable antibacterial activity especially against Grampositive bacteria. The effect of LGO on the antibacterial activity of phenoxyethanol was studied using MIC, growth inhibition, diffusion tests and bactericidal activity studies. Results showed appreciable increase in the activity of phenoxyethanol against Escherichia coli and Staphylococcus aureus when combined with 0.03% v/v LGO but not against Pseudomonas aeruginosa. The results show that the combined use of LGO and phenoxyethanol would increase the spectrum of activity of phenoxyethanol whose activity is mainly against Ps. aeruginosa. In addition, the combination reduced the effective concentration of both compounds necessary for activity. This would reduce any toxicological hazards as well as production costs.

Anti-Bacterial Agents↗

Principles and methods of managerial cost-accounting systems.

An introduction to cost-accounting systems for pharmacy managers is provided; terms are defined and examples of specific applications are given. Cost-accounting systems determine, record, and report the resources consumed in providing services. An effective cost-accounting system must provide the information needed for both internal and external reports. In accounting terms, cost is the value given up to secure an asset. In determining how volumes of activity affect costs, fixed costs and variable costs are calculated; applications include pricing strategies, cost determinations, and break-even analysis. Also discussed are the concepts of direct and indirect costs, opportunity costs, and incremental and sunk costs. For most pharmacy department services, process costing, an accounting of intermediate outputs and homogeneous units, is used; in determining the full cost of providing a product or service (e.g., patient stay), job-order costing is used. Development of work-performance standards is necessary for monitoring productivity and determining product costs. In allocating pharmacy department costs, a ratio of costs to charges can be used; this method is convenient, but microcosting (specific identification of the costs of products) is more accurate. Pharmacy managers can use cost-accounting systems to evaluate the pharmacy's strategies, policies, and services and to improve budgets and reports.

Accounting↗

Educating patients with Osteoarthritis.

An education program was developed for geriatric patients with osteoarthritis utilizing adult learner methods. The format used was slide/tape with accompanying booklets. Sixty-seven patients were tested before, immediately after, and three weeks after viewing the programs. A change in knowledge was noted for all objectives and was statistically significant (P .05) in five of six objectives. Although initial production costs are substantial, duplication costs are minimal. These results suggest that geriatric patients with osteoarthritis are able to learn and the method used is a cost-effective one.

Cost-Benefit Analysis↗

Helping staff to manage conflict well.

A hospital that trains its staff to deal assertively with conflict can become more effective in terms of productivity, cost effectiveness, and patient satisfaction. A training model for handling conflict in the work setting is described.

Aggression↗

Developing drug-use profiles from drug-charge records.

The potential for developing a drug-use profile from drug-charge records was studied at an 830-bed community hospital. Patient drug charges were reviewed retrospectively for one year (1975) to identify: (1) which key drugs accounted for a high percentage of cost and usage; (2) where key drugs were used within the hospital; (3) how they were used; and (4) who were the chief prescribers. Of the drugs used, 8% accounted for 80% of total drug product costs. Seven drug groups (10% of the total drug groups) appeared in the top 10 of both drug cost and quantity categories. Six individual drugs also appeared in the top 10 of both categories. According to cost, cephalosporin antibiotics were ranked first among drug groups but were sixth according to quantity. Analgesics-antipyretics were ranked first among drug groups by quantity and second by cost. Cephalothin was ranked first among individual drugs by cost and was not in the top 10 in quantity. Diazepam was ranked first among individual drugs by quantity and third by cost. Patients' drug-charge records can be used effectively to generate drug-use profiles for ongoing drug use review, quality assurance and cost containment programs.

California↗

The need for integrated control programs for zoonoses affecting livestock.

Prior to recognition of etiologic agents of zoonoses (infections transmitted between animals and man), physicians encountered these illnesses in man and veterinarians observed them in animals. As the agents were identified, interspecies relationships (and spread) became evident and control programs evolved without consideration of cost-effectiveness. Today, the public demands efficient use of financial resources. Human health as well as economic losses are concerns of animal health agencies. Zoonoses affecting livestock, though not major priorities among public health agencies, cannot be ignored. It seems economical, therefore, to combine the efforts of these agencies in zoonoses control. This would benefit human health by reducing the animal reservoirs and the livestock industry will benefit by lowered production costs.

Animals↗

[Combined vaccines in veterinary medicine in the developing countries].

It is in the interest of developing countries to have combined vaccines in veterinary medicine, not so much because they reduce production costs, but rather because they increase convenience and efficacy concerning the logistics of prophylactic projects in the field, thus lowering the cost of these projects. Their drawbacks are basically due to the biological compatibility of immunogens (possible immunosuppression by some viruses) and to the interaction of the various components when mixed, or when lyophilization is carried out. Some examples of such associations of vaccines are: (1) cattle plague + pleuropneumonia and possibly anthrax, (2) anthrax + blackleg, (3) sheeppox + anthrax, (4) pleuropneumonia + blackleg, (5) Newcastle disease + fowlpox + fowl typhoid, (6) fowl typhoid + chicken pasteurellosis. Practical results have been most positive and include the eradication of cattle plague - a major scourge of almost all of the African continent - and control over peripneumonia as a first step towards its eradication.

Africa↗

Karyology: vaccine manufacturers' views.

Chromosomal analyses and life span studies of WI-38 cell cultures used for vaccine production at the Connaught Laboratories Ltd will be described. Twenty cultures derived from the same seed lot and 25 cultures derived from different starter cultures were analyzed. Karyology tests at population doublings 31 and higher were within acceptable limits. The WI-38 cells reached a finite lifespan of approximately 65 population doublings. Normal growth characteristics were observed within 2/3 of the finite lifespan, i.e. until population doubling 40. The finite lifespan of MRC-5 was found to be 75 population doublings, with normal growth pattern until passage 50. The karyology test results, cell yields and the finite lifespans indicated that these cells could be used as substrates for vaccine production at higher passage levels than previously suggested. Using serially subcultivated cells at higher passage levels would make possible an increase in the volume of vaccine from existing cell seed and would also result in significant reduction in production costs.

Cell Survival↗

C.A.B.: a practical contact lens option?

The rigid contact lens continues to offer many prescription features which are difficult to match in the flexible lens realm, e.g.,: readily measured parameters, predictable optics, low production cost and minimum patient care requirements for reasonable hygienic safety. But poor tear pump efficiency remains a challenge in many conventional (i.e., PMMA) cases, even today. Oxygen permeable rigid materials represent the obvious solution to this problem, but how adequately do they perform? Two such materials are examined in this report in relation to the oxygen needs of the cornea.

Cellulose↗