Daily emotional dynamics and changes in posttraumatic growth and posttraumatic depreciation among people living with HIV

OBJECTIVE

Posttraumatic growth (PTG), and its negative reflection, posttraumatic depreciation (PTD), are two aspects of response to trauma. This study explores whether daily emotional dynamics (inertia and innovation) can translate into positive versus negative changes among people living with HIV (PLWH) in the form of long-term changes in PTG or PTD.

METHODS

The study combined a classical longitudinal approach with two assessments of PTG and PTD within one year and a measurement burst diary design with three weekly electronic diaries. In total, 249 PLWH participated in this study, filling out an expanded version of the Posttraumatic Growth and Depreciation Inventory (PTGDI-X) and a survey of sociodemographic and clinical data. In addition, they assessed their positive affect (PA) and negative affect (NA) at the end of each day in online diaries using a shortened version of the PANAS-X.

RESULTS

Although we observed stable significant inertia and innovation of PA and NA across all bursts, these parameters of daily emotional dynamics were unrelated to the longitudinal changes in PTG and PTD. The same null results were also noted for the average levels of NA and PA.

CONCLUSIONS

The results indicated the relative stability of emotion regulation in PLWH over the course of one year and contributed to understanding its dynamic mechanisms in terms of trait-like characteristics. The null result of the relationship between the PTG and PTD change might suggest a weak role of emotion regulation in shaping these trajectories as well as a lack of validity of the PTG/PTD measures.

Trajectories of posttraumatic growth and posttraumatic depreciation: A one-year prospective study among people living with HIV

Objective

Posttraumatic growth (PTG) and posttraumatic depreciation (PTD) are considered two sides of growth after trauma. Nevertheless, previous studies pointed out that in trauma living with a life-threatening illness, they may be experienced as two independently and share distinct predictors. In our study we aimed to find the different trajectories of PTG and PTD among a sample of people living with HIV (PLWH) and to investigate its predictors out of psychological resilience, and gain and loss of resources from the conservation of resources theory (COR).

Methods

We designed a longitudinal study that consisted of three measurements at 6-month intervals, and we recruited, respectively, 87, 85 and 71 PLWH. Each time participants filled out the following questionnaires: the expanded version of the PTG and PTD Inventory (PTGDI-X), the Brief Resilience Scale (BRS), the Conservation of Resources Evaluation (COR-E), and a survey on sociodemographic and medical data.

Results

We observed two separate trajectories of PTG and PTD within participants and found that each of the trajectories were related to different predictors from the studied variables. More specifically, we found a positive relationship between resilience and a descending PTD trajectory that stabilized over time. Gain of resources generally predicted a PTG trajectory, while loss of resources predicted the dynamics of PTD.

Conclusions

Including two parallel constructs, i.e., PTG and PTD, confirmed the independence of their mechanisms in growth processes among PLWH. The initial insight concerning the role of resilience and resources in PTG/PTD processes may inspire more effective planning for psychological help for PLWH, and it may stimulate studies on growth after trauma to further examine the two sides of this phenomenon.

Environmental aspects of the depreciation of the culturally significant Wall of Cartagena de Indias - Colombia

Among the diverse archeological relics of the past, the Cartagena de Indias Wall is one of the greatest representations of European cultural architecture in South America. To assess the implication of contamination on the depreciation of the culturally significant Wall of Cartagena de Indias - Colombia, a detailed, multi-analytical approach was conducted on components of the wall. Accumulated ultra-fine particles (UFPs) and superficial nano-particles (NPs) containing hazardous elements (HEs) on the wall were identified in an attempt to understand whether atmospheric pollution is hastening the depreciation of the structure itself. Mortar which at one point held the stones together is now weak and has fallen away in places. Irreparable damage is being done by salt spray, acid rain and the site's tropical humid climate. Several HEs and organic compounds found within the local environment are also contributing to the gradual deterioration of the construction. In this study, advanced microscopy analyses have been applied to understand the properties of UFPs and NPs deposited onto the wall's weathered external walls through exposure to atmospheric pollution. Several materials identified by X-Ray Diffraction (XRD) can be detected using high-resolution transmission electron microscopy (HR-TEM) and field emission scanning electron microscope (FE-SEM). The presence of anglesite, gypsum, hematite containing HEs, and several organic compounds modified due to moisture and contamination was found. Black crusts located on the structure could potentially serve as a source of HEs pollution and a probable hazard to not only to the ecosystem but also to human health.

Depreciating and stating the value of hospital buildings what you need to know

Healthcare financial executives of not-for-profit hospitals may be overdepreciating and understating the value of the hospital building on their financial statements. Changing the remaining lives of assets and their depreciation will help enhance the bottom line for many organizations. Ensuring that they are correctly stating the investment value of their assets is one way CFOs can have a positive impact on their organization's bottom line in a tough economy.

Colonoscopy in the office setting is safe, and financially sound ... for now

PURPOSE

In 2000, the Centers for Medicare & Medicaid Services announced a plan to allow for enhanced reimbursement for office endoscopy. This change in reimbursement was phased in during three years. The purpose of this study was to evaluate the fiscal outcomes and quality measures in the first two and a one-half years of performing endoscopy in an office setting under the new Centers for Medicare & Medicaid Services guidelines.

METHODS

The following financial parameters were gathered: number of endoscopies, expenses (divided into salaries and operational), net revenue, and margin for endoscopies performed in the office compared with the hospital. All endoscopies were performed by endoscopists with advanced training (gastroenterology fellowship or colon and rectal surgery residency). Monitoring equipment included continuous SaO2 and automated blood pressure in all patients and continuous electrocardiographic monitors in selected patients. Quality/safety data have been tracked in a prospective manner and include number of transfers to the hospital, perforations, bleeding requiring transfusion or hospitalization, and cardiorespiratory arrest.

RESULTS

The financial outcomes are as follows: 13,285 endoscopies performed from the opening of the unit through December 2003; net revenue per case $504 per case; expense per case has dropped from $205 per case to $145 per case; the overall financial benefit of performing endoscopy in the office compared with the hospital was an additional $28 to $143 per case depending on the insurance carrier. The quality outcomes since inception of the unit include the following: 13,285 endoscopies; 0 hospital transfers, 0 cardiorespiratory arrests; 0 perforations; and 1 bleeding episode that required hospitalization.

CONCLUSIONS

Endoscopy performed in the office setting is safe when done with appropriate monitoring and in the proper patient population. At the time of this study, office endoscopy also is financially rewarding but changes in Centers for Medicare & Medicaid Services reimbursement threaten the ability to retain any financial benefit.

Radiology applications of financial accounting

A basic knowledge of financial accounting can help radiologists analyze business opportunities and examine the potential impacts of new technology or predict the adverse consequences of new competitors entering their service area. The income statement, balance sheet, and cash flow statement are the three basic financial statements that document the current financial position of the radiology practice and allow managers to monitor the ongoing financial operations of the enterprise. Pro forma, or hypothetical, financial statements can be generated to predict the financial impact of specific business decisions or investments on the profitability of the practice. Sensitivity analysis, or what-if scenarios, can be performed to determine the potential impact of changing key revenue, investment, operating cost or financial assumptions. By viewing radiology as both a profession and a business, radiologists can optimize their use of scarce economic resources and maximize the return on their financial investments.

Comparison of economic and environmental impacts between disposable and reusable instruments used for laparoscopic cholecystectomy

BACKGROUND

The economic and environmental effects were compared between disposable and reusable instruments used for laparoscopic cholecystectomy. Special consideration was given to the processing of reusable instruments in the Miele G 7736 CD MCU washer disinfector and the resultant cost of sterilization.

METHODS

The instruments frequently used in their disposable form were identified with the help of surgeons. Thus, of all the instruments used for laparoscopic cholecystectomy, the disposable and reusable versions of trocars, scissors, and Veress cannula were compared.

RESULTS

For the case examined in this study, the performance of laparoscopic cholecystectomy with disposable instruments was 19 times more expensive that for reusable instruments. The higher cost of using disposable instruments is primarily attributable to the purchase price of the instruments. The processing of reusable instruments has little significance in terms of cost, whereas the cost for disposing of disposable instruments is the least significant factor. The number of laparoscopic cholecystectomies performed per year does not substantially influence cost. In the authors' opinion, assessment of the environmental consequences shows that reusable instruments are environmentally advantageous.

CONCLUSIONS

Considering the upward pressure of costs in hospitals, disposable instruments should be used for laparoscopic cholecystectomy only if they offer clear advantages over reusable instruments.

Preparing for asset retirement

Statement of Financial Accounting Standards (SFAS) No. 143 requires organizations to recognize a liability for an asset retirement obligation when it is incurred--even if that occurs far in advance of the asset's planned retirement. For example, organizations must recognize future costs associated with medical equipment disposal that carries hazardous material legal obligations.

The demand for health: an empirical test of the Grossman model using panel data

Grossman derives the demand for health from an optimal control model in which health capital is both a consumption and an investment good. In his approach, the individual chooses his level of health and therefore his life span. Initially an individual is endowed with a certain amount of health capital, which depreciates over time but can be replenished by investments like medical care, diet, exercise, etc. Therefore, the level of health is not treated as exogenous but depends on the amount of resources the individual allocates to the production of health. The production of health capital also depends on variables which modify the efficiency of the production process, therefore changing the shadow price of health capital. For example, more highly educated people are expected to be more efficient producers of health who thus face a lower price of health capital, an effect that should increase their quantity of health demanded. While the Grossman model provides a suitable theoretical framework for explaining the demand for health and the demand for medical services, it has not been too successful empirically. However, empirical tests up to this date have been exclusively based on cross section data, thus failing to take the dynamic nature of the Grossman model into account. By way of contrast, the present paper contains individual time series information not only on the utilization of medical services but also on income, wealth, work, and life style. The data come from two surveys carried out in 1981 and 1993 among members of a Swiss sick fund, with the linkage between the two waves provided by insurance records. In all, this comparatively rich data set holds the promise of permitting the Grossman model to be adequately tested for the first time.

Comparative dynamics in a health investment model

The method of comparative dynamics fully exploits the inter-temporal structure of optimal control models. I derive comparative dynamic results in a simplified demand for health model. The effect of a change in the depreciation rate on the optimal paths for health capital and investment in health is studied by use of a phase diagram.

The use of cash flow to analyze financial distress in California hospitals

Previous studies of financial distress have utilized operating margins to measure this outcome. This study examines financial distress from the standpoint of cash flow, which is defined as net income plus depreciation adjusted for accruals. Defining financially distressed hospitals as ones with negative cash flows, the findings of the study show that these hospitals possess a lower occupancy rate, exhibit a slower collection of receivables, and have higher amounts of debt. However, the findings show that it is harder to predict financial distress defined in terms of cash flow than in profitability.

Comparative dynamic analysis of the full Grossman model

The paper applies the method of comparative dynamic analysis to the full Grossman model. For a particular class of solutions, it derives the equations implicitly defining the complete trajectories of the endogenous variables. Relying on the concept of Frisch decision functions, the impact of any parametric change on an endogenous variable can be decomposed into a direct and an indirect effect. The focus of the paper is on marginal changes in the rate of health capital depreciation. It also analyses the impact of either initial financial wealth or the initial stock of health capital. While the direction of most effects remains ambiguous in the full model, the assumption of a zero consumption benefit of health is sufficient to obtain a definite for any direct or indirect effect.

Analyzing lease/purchase options

The authors' previous article, "Equipment Acquisition Using Various Forms of Leasing," covers information necessary for selecting among the different kinds of leases. This article explains how to reach a proper financial analysis, preferably using two phases. Using a representative example, the article guides the reader through the first phase and introduces the elements needing review in the second phase. Key elements include pretax aftertax and cash flow analyses. Different organizations use different yardsticks to measure the financials of a transaction, but in general, cash is king. Therefore, the most widely used comparison is the purchase versus lease IRR (internal rate of return) produced by measuring the cash flow of the purchase case compared to the cash flow of the lease case.

The demand for health with uncertainty and insurance

This paper develops Michael Grossman's demand-for-health model by letting the depreciation rate depend upon the level of health, by letting the incidence and size of illness be uncertain and by investigating how the individual's demand for health would be affected by the introduction of insurance. Beside the more theoretical results, there are also some results with important policy implications. When formulating the hypothetical scenario in willingness to pay (WTP) studies it is important whether the individual believes that the level of health is uncertain or not. The existence of insurance could also affect the stated WTP amount. Taking this into account could therefore explain some of the differences in the WTP for seemingly identical health care programs in different countries or different areas in the same country.

Activity-based costing in the operating room at Valley View Hospital

This article presents an example of how one hospital reports the results of activity-based costing (ABC). It examines the composition and supporting assumptions of an ABC report for a particular procedure in the operating room (OR). It describes management uses of the information generated. It comments upon how the continuous quality improvement (CQI) is synchronized with the ABC reporting.

Designing a successful investment program

Healthcare organizations have various asset pool funds that can be invested to increase nonoperating revenues. In order to maximize the long-term success of investment efforts, healthcare organizations need to develop comprehensive investment management programs. Such programs identify the assets that can be invested, establish the level of risk each asset type can be exposed to, and match long-term and short-term investment opportunities to the appropriate asset pool. Programs can be managed internally or outsourced to investment management firms with objectives and procedures that are compatible with those of the healthcare organizations' investment policies and guidelines. These policies and guidelines must address asset allocation. Oversight committees must be established to monitor investment performance and reallocate assets, as needed, to take advantage of market movements.

Willingness to pay and cost of illness for changes in health capital depreciation

The paper investigates the relationship between the willingness to pay and the cost of illness approach with respect to the evaluation of economic burden due to adverse health effects. The basic intertemporal framework is provided by Grossman's pure investment model, while effects on individual morbidity are taken to be generated by marginal changes in the rate of health capital depreciation. More specifically, both the simple example of purely temporary changes and the more general case of persistent variations in health capital depreciation are discussed. The analysis generates two principal findings. First, for a class of identical individuals cost as measured by the cost of illness approach is demonstrated to provide a lower bound on the true welfare cost to the individual, i.e. cost as given by the willingness to pay approach. Moreover, the cost of illness is increasing in the size of the welfare loss. Second, if one takes into account the possible heterogeneity of individuals, a clear relationship between the cost values supplied by the two approaches no longer exists. As an example, the impact of variations in either financial wealth or health capital endowment is discussed. Thus, diversity in individual type turns out to blur the link between cost of illness and the true economic cost.

Influences on the use of capital by public hospitals

This paper examines key influences on the volume of capital employed by public hospitals. Empirical models are constructed and analysed separately for total capital employed and for plant and equipment only, using data from 68 Victorian hospitals. Such data provide an empirical base to guide government decisions on funding capital expenditure in hospitals. The analysis finds that the proportion of hospital expenditure devoted to outpatients and teaching, and the proportion of funding derived from government all influence the level of capital utilised per inpatient. The model provided a reasonable fit for plant and equipment, but much improved data coverage and consistent valuation of land and buildings are required to adequately explain influences on total capital.

How the new tax act affects practice sales

The new tax act affecting rate changes also contains new rules for dealing with the intangible assets--including goodwill--involved in practice sales. A second concern is the permanent phaseout of some personal exemptions and certain itemized business deductions. There's still some good news.

Capital investment analysis: three methods

Three cash flow/discount rate methods can be used when conducting capital budgeting financial analyses: the net operating cash flow method, the net cash flow to investors method, and the net cash flow to equity holders method. The three methods differ in how the financing mix and the benefits of debt financing are incorporated. This article explains the three methods, demonstrates that they are essentially equivalent, and recommends which method to use under specific circumstances.

Resource utilization. High dose rate versus low dose rate brachytherapy for gynecologic cancer

A comparative analysis of anesthesia use, perioperative morbidity and mortality, capital, and treatment cost of high dose rate versus low dose rate intracavitary brachytherapy for gynecologic malignancy is presented. To assess current anesthesia utilization, application location, and high dose rate afterloader availability for gynecologic brachytherapy in private and academic practices, a nine-question survey was sent to 150 radiotherapy centers in the United States, of which 95 (63%) responded. Of these 95 respondents, 95% used low dose rate brachytherapy, and 18% possessed high dose rate capability. General anesthesia was used in 95% of programs for tandem + ovoid and in 31% for ovoids-only placement. Differences among private and academic practice respondents were minimal. In our institution, a cost comparison for low dose rate therapy (two applications with 3 hospital days per application, operating and recovery room use, spinal anesthesia, radiotherapy) versus high dose rate treatment (five outpatient departmental applications, intravenous anesthesia without an anesthesiologist, radiotherapy) revealed a 244% higher overall charge for low dose rate treatment, primarily due to hospital and operating room expenses. In addition to its ability to save thousands of dollars per intracavitary patient, high dose rate therapy generated a "cost-shift," increasing radiotherapy departmental billings by 438%. More importantly, perioperative morbidity and mortality in our experience of 500+ high dose rate applications compared favorably with recently reported data using low dose rate intracavitary treatment. Capital investment, maintenance requirements, and depreciation costs for high dose rate capability are reviewed. Application of the defined "revenue-cost ratio" formula demonstrates the importance of high application numbers and consistent reimbursement for parity in high dose rate operation. Logically, inadequate third-party reimbursement (e.g., Medicare) reduces high dose rate parity and threatens the future availability of high dose rate technology.

Accounting practice diversity in the healthcare industry

A recent study examining accounting practices currently being used to prepare annual hospital financial statements indicates relatively little diversity, regardless of organizational type or size. The study's findings should interest those concerned with healthcare accounting and financial reporting issues, especially healthcare administrators and members of standards setting boards who participate in accounting policy deliberations.

Capital update factor: a new era approaches

The Health Care Financing Administration (HCFA) has constructed a preliminary model of a new capital update method which is consistent with the framework being developed to refine the update method for PPS operating costs. HCFA's eventual goal is to develop a single update framework for operating and capital costs. Initial results suggest that adopting the new capital update method would reduce capital payments substantially, which might intensify creditor's concerns about extending loans to hospitals.

Can indirect cost funding be improved?

Like the tax laws many possible loopholes are in these proposed changes and therefore they have to be considered very carefully. If there is such a thing as a collective wisdom, it should be brought to bear on this problem. With strong and well-considered actions, which would be implemented in a controlled way, the mechanisms for funding research could be improved to encourage efficient use of funds.

A cost description of an adult cystic fibrosis unit and cost analyses of different categories of patients

BACKGROUND

There is little information on the costs of running an adult cystic fibrosis centre. The aim of this study was to provide detailed costs to assist funding and planning for these patients.

METHODS

The cost of a regional adult cystic fibrosis centre serving 119 cystic fibrosis patients, categorised according to four treatment regimens, was determined. District health authority, family health service authority, and voluntary resources used from April 1989 to March 1990 were determined, with appropriate bases for allocation of costs and patient based costs from local information.

RESULTS

The total annual cost of treating the 119 patients was 980,646 pounds, with an average cost 8241 pounds per patient. An outpatient reviewed at three monthly intervals cost 2792 pounds a year; an outpatient receiving intravenous antibiotics cost 8606 pounds; an inpatient receiving intravenous antibiotics cost 13,501 pounds; and a patient needing a high level of care cost 19,955 pounds. Medication accounted for 57% (561,395 pounds) of the total cost.

CONCLUSIONS

This analysis has helped us to secure funding for patients with cystic fibrosis and it facilitates the prediction of future requirements. The study also indicates the limitations of using average patient costs and difficulties as a result of the poorly structured British National Health Service accounting and information systems.

Funny money

The introduction of capital charges has created many anomalies. Neil Canwell says a considerable amount of clarification is needed to give managers a framework for effective healthcare planning.