Background: Lifestyle change interventions (LCI) for prevention of type 2 diabetes are covered by Medicare, but rarely by US Medicaid programs that constitute the largest public payer system in the USA. We estimate the long-term health and economic implications of implementing LCIs in state Medicaid programs. Methods: We compared LCIs modeled after the intervention of the Diabetes Prevention Program versus routine care advice using a decision analytic simulation model and best available data from representative surveys, cohort studies, Medicaid claims data, and the published literature. Target population were non-disability-based adult Medicaid beneficiaries aged 19–64 years at high risk for type 2 diabetes (BMI ≥25 kg/m2 and HbA1c ≥ 5.7% or fasting plasma glucose ≥ 110 mg/dl) from eight study states (Alabama, California, Connecticut, Florida, Iowa, Illinois, New York, Oklahoma) that represent around 50% of the US Medicaid population. Incremental cost-effectiveness ratios (ICERs) measured in cost per quality-adjusted life years (QALYs) gained, and population cost and health impact were modeled from a healthcare system perspective and a narrow Medicaid perspective. Results: In the eight selected study states, 1.9 million or 18% of non-disability-based adult Medicaid beneficiaries would belong to the eligible high-risk target population – 66% of them Hispanics or non-Hispanic black. In the base-case analysis, the aggregated 5- and 10-year ICERs are US$226 k/QALY and US$34 k/QALY; over 25 years, the intervention dominates routine care. The 5-, 10-, and 25-year probabilities that the ICERs are below US$50 k (US$100 k)/QALY are 6% (15%), 59% (82%) and 96% (100%). From a healthcare system perspective, initial program investments of US$800 per person would be offset after 13 years and translate to US$548 of savings after 25 years. With a 20% LCI uptake in eligible beneficiaries, this would translate to upfront costs of US$300 million, prevent 260 thousand years of diabetes and save US$205 million over a 25-year time horizon. Cost savings from a narrow Medicaid perspective would be much smaller. Minorities and low-income groups would over-proportionally benefit from LCIs in Medicaid, but the impact on population health and health equity would be marginal. Conclusions: In the long-term, investments in LCIs for Medicaid beneficiaries are likely to improve health and to decrease healthcare expenditures. However, population health and health equity impact would be low and healthcare expenditure savings from a narrow Medicaid perspective would be much smaller than from a healthcare system perspective.
The author conducts research to estimate optimal allocations of infrastructure investments. These optimal allocations are then compared to actual distributions to generate a measure of economic distortion, called "influence costs." The paper examines the extent to which these costs can be attributed to political influence on public-capital expenditure decisions. The measure of economic distortion is used to bench-mark the role of political influence. Several interesting results emerge. The distribution of the distortion clearly shows the North dominating the South in terms of political influence, with the oil producing areas of the South faring the worst. Overall the losses exceed the gains, which is a net welfare loss to the nation. We offer several plausible explanations for this outcome based on the central role of the Military and its early capture by the North. In the face of increasing decentralization, a way out of future distortion in infrastructure investments is through the resolute pursuit of privatization of the delivery of infrastructure services.
This study argues that of the varieties of inequality, deprivation through poor governance is the most disconcerting because of its pervasive role in perpetuating wealth inequality. Health is wealth. Using standardized UNDP data on education and health—two strategic factors for growth and human development—we benchmark Nigeria’s long-term governance record on citizen-care. Africa’s largest oil producer, having the largest market potential, the largest GDP and a generous endowment of natural-resource diversity ranks 36 out of 46 countries in the sample, locating at the cusp of the lowest quintile of the quality of governance rank ordering, above Gabon but below Chad, Cameroon and very far below Togo. Why?
Sharing and exchange are common practices for minimizing food insecurity in rural populations. The advent of markets and monetization in egalitarian indigenous populations presents an alternative means of managing risk, with the potential impact of eroding traditional networks. We test whether market involvement buffers several types of risk and reduces traditional sharing behavior among Tsimane Amerindians of the Bolivian Amazon. Results vary based on type of market integration and scale of analysis (household vs. village), consistent with the notion that local culture and ecology shape risk management strategies. Greater wealth and income were unassociated with the reliance on others for food, or on reciprocity, but wealth was associated with a greater proportion of food given to others (i.e., giving intensity) and a greater number of sharing partners (i.e., sharing breadth). Across villages, greater mean income was negatively associated with reciprocity, but economic inequality was positively associated with giving intensity and sharing breadth. Incipient market integration does not necessarily replace traditional buffering strategies but instead can often enhance social capital.
During the past four decades, mining and oil/gas developments have increasingly become the centrepiece, the Holy Grail, of economic and social development in Papua New Guinea (PNG). This is highly evident in national-level discourse and in local desires for mega-development. One may take by example an eight-page full-colour PNG advertising spread in The Wall Street Journal (WSJ), which came to news-stands in the US in November 2018 (Eye on PNG 2018). Based on published advertising rates for the WSJ, the newspaper insert cost about USD2 million, or about 6.5 million kina, for distribution in the US alone. This is equivalent to 1 kina and 20 toea for every man and women in PNG over the age of 15. A prominent statement of self-promotion to the larger world of global investment and finance, this advertising section is also a significant statement of national self-identification and aspiration.
There is evidence for Greek-speaking mariners in the area of the Red Sea earlier in the 19th century and intermittently since Hellenistic times. But the opening of the Suez Canal in 1869 ushered a new era in the maritime labor networks between the two seas. Colonial regimes (British, French, Italian) in the Red Sea and Horn region attracted European and Southern Mediterranean entrepreneurs, who acted in sub-imperial roles. Small-scale maritime enterprise via the Suez Canal appears to have constituted a discrete-if not unrelated-strand in the global networking and opportunities for transnational encounters that the Canal generated. A case in point is the remarkable diary of Michalis Kantounias, a sponge merchant from the island of Syme. The diary describes a pearl-oyster fishing venture from his home port to the Red Sea in 1890. This project summarizes and evaluates the information the diary contains about geography, toponymy, marine economy and maritime networks of the Southern Red Sea in the late 19th-century. It also explores the interplay between small-scale maritime labor initiative and imperial-colonial structures in the Red Sea region in the 19th and early 20th century. Histories of sponge and pearl fisheries.The last decade of 19th century is a turning point in the history of Aegean sponge fisheries because of two developments: a) the introduction and gradual adoption of the diving helmet (or "diving machine," μηχανή, and b) the subsequent mechanization of sponge-diving vessels. These developments ushered new realities in the organization of sponge fisheries and in the lives of the fishermen (Olympitou 2022). Very little is known about sponge diving in the Red Sea; the first observations about sponge exploitation come from the mid-to late 19th century (eg. Munzinger 1864). Pearl-diving in the southern Red Sea became the subject of intense colonial, especially Italian, interest in this same period at the close of the 19th century (Zaccaria 2007).
This policy brief, which is based on an internal memo, summarizes the institutional and operational features observed in the 27 countries that have gained experience with inflation targeting (IT). It finds considerable convergence in many IT practices across countries over the past 10 to 15 years but much variation in policymakers ’ choices concerning such key issues as how they treat the borders of the target range. On the whole, most IT banks have chosen to practice inflation targeting in a more flexible and, thus, resilient fashion than many analysts once feared—seemingly without much loss of credibility. Currently, however, after a prolonged period of rapidly rising commodity and asset prices, followed by a period of sharp oil and asset price declines, IT is clearly facing the greatest challenges in its short history of relatively widespread use. Fortunately, one key lesson that emerges from our experience to date is that much of the ability of inflation targeting to help moor inflation expectations likely stems from the premium it places on improving transparency standards. These standards are available to all central banks, whether they choose to practice inflation targeting or not.
This essay analyses the innovative architectonic approaches developed by Soviet architects in their entries to a 1927 design competition for a new socialist housing type, the so-called dom-kommuna or house-commune. The competition, sponsored by the preeminent architectural journal, Sovremennaia Arkhitektura, sought solutions to address Moscow’s severe housing shortage within the limits of economic stringency. While the eight published entries abound with charts and graphs to substantiate claims of eficiency, these technocratic accoutrements obscure radical spatial complexity. At the scale of both the building and the unit, the competition designs capitalize on architectural expertise to wrest generosity from Spartan conditions. In each entry, careful allocation of program and circulation resulted in a masterful balance of plan minimalism and sectional expansiveness. This paper situates the house-commune competition entries within their historic context, but also thoroughly analyzes the architectural solutions to elicit programmatic and spatial and strategies that may be instructive for current practice.
The effective use of any medical imaging modality and the interpretation of images requires some understanding of the physical principles of the image formation process. This is because the ability to visualize specific anatomical structures or pathologic conditions depends on the inherent characteristics of a particular modality and the set of imaging factors selected by the user. The relationship between visibility and imaging factors is rather complex and often involves compromises and trade-offs among the different aspects of image quality.
All imaging methods deposit some form of energy in the patient's body. This is not always without risk. Radiation exposure is usually a variable factor and often has an effect on image quality. An optimized image procedure is one in which these two factors- image quality and radiation exposure-are properly balanced.
This book provides the physics and scientific knowledge that enables the physician to make appropriate technical decisions in all phases of the imaging process. It is written primarily for the physicians studying in a radiology residency program and is also a useful reference for the practicing radiologist who is often faced with day-to-day decisions concerning imaging equipment, procedures, and patient safety.
This text contains much of the material from the author's previous books: The Physical Principles of Diagnostic Radiology, The Physics and Instrumentation of Nuclear Medicine, and the first edition of Physical Principles of Medical Imaging and it has been updated and supplemented especially in the areas of ultrasound, emission tomography and magnetic resonance imaging.
The selection of topics and presentation of concepts is based on the physics component of the radiology residency program at Emory University. It assumes no previous knowledge of physics but rather a sincere desire on the part of the reader to understand the physical principles of the medical imaging profession.
People in the Singida region of Tanzania have long utilized diverse energy sources for subsistence. The wind separates grain from chaff. The sun ripens the millet and dries it for storage. More recently, solar panels charge phones and rural electricity investments extend the national grid. Yet as an electric frontier, Singida remains only peripherally and selectively served by energy infrastructures and fossil fuels. This article sketches Singidans’ prospect from this space and time of energy transition. Drawing on ethnographic research conducted between 2004 and 2019, it asks: how do rural Singidans eke energy from their natural and social environment? How can ideas of the sun and of labour in Nyaturu cosmology inform understandings of energy? And how are new energy technologies reshaping Singida's social and economic landscape? I theorize energy as a deeply relational and gendered configuration of people, nature, labour and sociality that makes and sustains human and natural life.