Evaluating the length of stay and value of time in a pediatric emergency department with two models by comparing two different albuterol delivery systems

Abstract

Objective:

Asthma is one of the most common childhood illnesses and accounts for a substantial amount of pediatric emergency department visits. Historically, acute exacerbations are treated with a beta agonist via nebulizer therapy (NEB). However, with the advent of the spacer, the medication can be delivered via a metered dose inhaler (MDI?+?S) with the same efficacy for mild-to-moderate asthma exacerbations. To date, no study has been done to evaluate emergency department (ED) length of stay (LOS) and opportunity cost between nebulized vs MDI?+?S. The objective of this study was to compare ED LOS and associated opportunity cost among children who present with a mild asthma exacerbation according to the delivery mode of albuterol: MDI?+?S vs NEB.

Methods:

A structured, retrospective cross-sectional study was conducted. Medical records were reviewed from children aged 1–18 years treated at an urban pediatric ED from July 2007 to June 2008 with a discharge diagnosis International Classification of Disease-9 of asthma. Length of stay was defined: time from initial triage until the time of the guardian signature on the discharge instructions. An operational definition was used to define a mild asthma exacerbation; those patients requiring only one standard weight based albuterol treatment. Emergency department throughput time points, demographic data, treatment course, and delivery method of albuterol were recorded.

Results:

Three hundred and four patients were analyzed: 94 in the MDI?+?S group and 209 in the NEB group. Mean age in years for the MDI?+?S group was 9.57 vs 5.07 for the NEB group (p?<?0.001). The percentage of patients that received oral corticosteroids was 39.4% in the MDI?+?S group vs 61.7% in the NEB group (p?<?0.001). There was no difference between groups in: race, insurance status, gender, or chest radiographs. The mean ED LOS for patients in the MDI?+?S group was 170 minutes compared to 205 minutes in the NEB group. On average, there was a 25.1 minute time savings per patient in ED treatment time (p?<?0.001; 95% CI?=?3.8–31.7). Significant predictors of outcome for treatment time were chest radiograph, steroids, and treatment mode. Opportunity cost analysis estimated a potential cost savings of $213,532 annually using MDI?+?S vs NEB.

Conclusion:

In mild asthma exacerbations, administering albuterol via MDI?+?S decreases ED treatment time when compared to administering nebulized albuterol. A metered dose inhaler with spacer utilization may enhance opportunity cost savings and decrease the left without being seen population with improved throughput.

Limitations:

The key limitations of this study include its retrospective design, the proxy non-standard definition of mild asthma exacerbation, and the opportunity cost calculation, which may over-estimate the value of ED time saved based on ED volume.     

Exchange rate pass-through and product heterogeneity: Does quality matter on the import side?

This paper investigates theoretically and empirically the heterogeneous response of exporters to real exchange rate fluctuations due to the quality of imported inputs and exported output. We develop a model where the production of high-quality products requires high-quality inputs sold in monopolistically competitive foreign markets. The model predicts that exporters using imported inputs have low exchange rate pass-through, but this effect is weaker for firms shipping high-quality goods. This is due to the heterogeneous price adjustments of foreign suppliers selling inputs of different quality. We test the predictions of the model using Italian firm-level trade data for the period 2000–2006. The empirical analysis shows that the imports of intermediates have a significantly weaker effect in reducing the exchange rate pass-through into the export price of high-quality varieties. By showing that the import price of high-quality inputs is less sensitive to exchange rate variations, we provide evidence supporting the theoretical hypothesis that the pricing power of input suppliers weakens the import channel.     

An Analysis of Assortment Choice in Grocery Retailing

Consumers in grocery retailing commonly buy bundles of products to accommodate current and future consumption. When all products in a particular bundle share common attributes (and are selected from the same product category), the consumer is said to assemble an assortment. This research examines the impact of assortment variety on the assortment choice process. In particular, we test the prediction that consumers demand less variety for higher quality items. To investigate this relationship, we employ a flexible choice model, suitable for the analysis of assortment choice. The model, based upon the assumption that the utility of purchase of one item in an assortment depends upon the set of items already selected, allows for a general utility structure across the assortment items. We apply the model to household assortment choice histories from the yogurt product category. Substantively, we show that yogurt choice is affected by brand quality perceptions (quality-tier competition). Moreover, we show that reaction to reductions in variety (number of yogurt flavors) is mediated by brand quality perceptions. Taken together, these empirical facts paint a picture of a consumer who is willing to trade-off variety against product quality in assortment choice.     

Reprint of “Quality management,environmental management maturity,green supply chain practices and green performance of Brazilian companies with ISO 14001 certification: Direct and indirect effects”

This study aims to test a new conceptual model based on the relationship between quality management (QM), environmental management maturity (EMM), adoption of external practices of green supply chain management (GSCM) (green purchasing and collaboration with customers) and green performance (GP) with data from 95 Brazilian firms with ISO 14001. To our knowledge, such links and relationships are not simultaneously identified and tested in the literature. The results indicate the validation of all of the research hypotheses. This paper highlights that an improvement in green performance will require attention to quality management, environmental management maturity, and green supply chain.     

地方高校文化与区域文化互动发展模式--文化素质提升工程的有效路径

文化根植于特定的社会历史和自然环境，归属于一定的地域。地方高校作为区域文化的中心，它的文化始终是包含在区域文化中的，带有区域文化的印记。区域文化与地方高校之间相互作用和影响，存在着紧密的互动关系，其有效互动发展模式是文化素质工程提升的有效路径。     

Assessment of transport quality of life as an alternative transport appraisal technique

In the United Kingdom the New Approach to Transport Appraisal (NATA) is used to appraise the economic, environmental and social impacts of transport projects. This analytical tool has recently been updated, but still fails to fully evaluate individual’s experiences of transport. It is important to understand more about passengers current journey quality for an informed judgement on the impact of future schemes. This paper presents findings of a methodological tool that can appraise Transport quality of life (TQoL) on all modes of transport in one city. Quality of life (QoL) techniques were applied to the transport networks of Glasgow and Manchester to determine if this is a valuable alternative in transport appraisal. Effective assessment confirmed the validity of the method highlighting in both locations that fixed modes, particularly Light Rapid Transport, are providing a significantly better quality of life compared to the bus.     

How the Fall of the Iron Curtain Has Affected Consumers' Perceptions of Urban and Rural Quality of Life in Romania

Summary

Marketing and quality of life (QOL) literature is reviewed to conceptualize a model of the impact of marketing activity on QOL. This model outlines how the four elements of the marketing mix affect the life domain of shopping, dealing with the acquisition, possession, use, and consumption of goods. In turn, four strategic considerations/indicators connecting this life domain with QOL are identified: the four A's linking marketing with QOL -i.e., appearance of goods in the market, and awareness, availability, and affordability of goods for consumers. A large-scale field study in urban and rural Romania, a country undergoing rapid marketization, was conducted to test hypotheses and to validate secondary data findings relating availability and affordability of goods with QOL for urban and rural consumers. The findings support the predictions that availability and affordability are positively related to QOL. Secondary data findings concerning changes in the availability and affordability of goods and services, and hypotheses concerning changes in the QOL in Romania between the years 1989 and 1993/1994 were also validated and supported. The findings indicate that availability has improved during this period, whereas afford-ability has decreased. Overall, as hypothesized, these changes have resulted in the deterioration of QOL in Romania in today's marketizing economy, as compared to the planned economy, before the revolution. Finally, urban versus rural differences in the impact of marketization in terms of changes in the availability and affordability and in QOL are also studied.     

浅谈提高人才的培养质量与竞争力

社会对毕业生质量的整体评价,主要是评价毕业生群体能否很好地适应国家、社会、市场的需求。高校提高人才培养质量,就是提高人才培养对社会的适应程度,提高人才培养与培养目标的符合程度。近年来,笔者对本院毕业生的质量进行了跟踪调查,在此基础上提出了提高人才培养质量与人才竞争力的措施与对策。     

OFDI逆向技术溢出、制度质量与区域创新能力

基于2005—2016年我国省际面板数据,首先通过OLS、DIFF GMM、SYS GMM3种基准线性回归方法论证了OFDI逆向技术溢出对我国区域创新能力的促进作用。以OFDI为核心解释变量,分别构建以地区腐败、市场化程度和知识产权保护为门槛变量的动态门槛回归模型。结果发现：随着地区腐败程度加深,我国区域创新能力逐渐减弱;以市场化程度、知识产权保护为门槛变量,跨越门槛点后OFDI对我国区域创新能力的拉动作用依次增强。最后,结合面板向量自回归模型进一步研究对外直接投资过程中地区腐败、市场化程度和知识产权保护对区域创新能力的动态即期冲击。结果显示:市场化程度单位变动对区域创新能力的影响呈现正向冲击且持续性较强,知识产权保护对区域创新能力的拉动最为迅速但后期持续性较弱,地区腐败对区域创新能力产生负向冲击作用。     

高校科技成果转化现实障碍及其破解机制

高校科技成果转化率低的现实早已引起社会各界警觉,但理论研究和实践探索都将权属改革视为破解圭臬,并未实现预期目标。事实上,高校科技成果转化的真正障碍是专利技术水平和转化价值低、专业转化人才与机构缺失、中试环节薄弱且资金匮乏。因此,为了针对高校成果转化痛点精准施策,释放创新驱动效能,我国应改革专利管理体制和科研评价机制,提升专利质量并加大科学研究对企业需求的关照;可借鉴牛津大学的做法,由高校在不增加编制的前提下,独资建立自负盈亏的专业转化服务公司;优化科研经费投入结构,引导多元风险资金进入,健全科技成果转化风险投资机制。