associated infections (HAIs) account for a large proportion of the harms caused by health care and are associated with high costs. Better evaluation of the costs of these infections could help providers and payers to justify investing in prevention. OBJECTIVE To estimate costs associated with the most significant and targetable HAIs. DATA SOURCES For estimation of attributable costs, we conducted a systematic review of the literature using PubMed for the years 1986 through April 2013. For HAI incidence estimates, we used the National Healthcare Safety Network of the Centers for Disease Control and Prevention (CDC). STUDY SELECTION Studies performed outside the United States were excluded. Inclusion criteria included a robust method of comparison using a matched control group or an appropriate regression strategy, generalizable populations typical of inpatient wards and critical care units, methodologic consistency with CDC definitions, and soundness of handling economic outcomes. DATA EXTRACTION AND SYNTHESIS Three review cycles were completed, with the final iteration carried out from July 2011 to April 2013. Selected publications underwent a secondary review by the research team. MAIN OUTCOMES AND MEASURES Costs, inflated to 2012 US dollars. RESULTS Using Monte Carlo simulation, we generated point estimates and 95% CIs for attributable costs and length of hospital stay. On a per-case basis, central line-associated bloodstream infections were found to be the most costly HAIs at $45

QICs have been adopted widely as an approach to shared learning and improvement in healthcare. Overall, the QICs included in this review reported significant improvements in targeted clinical processes and patient outcomes. These reports are encouraging, but most be interpreted cautiously since fewer than a third met established quality and reporting criteria, and publication bias is likely.

BackgroundFiscal policies to fight obesity such as taxation of unhealthy foods or sugar-sweetened beverages (SSBs) have gained considerable attention in recent years. Many studies modelling the impact of various magnitudes of taxes on SSB purchasing and their potential effects on various health outcomes have been published; however, legislation and implementation of such taxes have encountered many obstacles in the countries that have implemented them to date. We investigated the perceptions and views of key opinion leaders, policy makers and various other Israeli stakeholders on taxation of SSBs and unhealthy snacks. We also evaluated the challenges and barriers that may be expected for initiating such a policy.MethodsA qualitative study based on 39 in-depth interviews with Israeli stakeholders in the fields of health, nutrition, economics, public advocacy and policymaking.ResultsAll stakeholders viewed obesity as a combined societal and personal issue that should be under government responsibility. Only stakeholders from economic sectors thought that taxation of SSBs and unhealthy snacks would reduce their consumption, while the prevailing notion among non-economists was that such a tax would not be acceptable because the higher price would not decrease consumption. Concerns were raised that the tax would mostly affect individuals from low socioeconomic backgrounds. Some of the stakeholders indicated that they would support such a tax only if its revenue would be directed to specific causes such as health-promoting plans. Potential barriers to taxation include: opposition of various sectors, technical and bureaucratic obstacles impeding tax implementation, difficulties in defining which products to tax, and opposition of the treasury to earmark tax revenue for health education.ConclusionsTaxation should be a part of a multipronged strategy rather than a sole measure for fighting obesity. Dedicating tax revenues to specific predefined causes should be considered, particularly towards health promotion activities, obesity treatment and prevention, education, and subsidies of healthy food.

The capability of lichens to accumulate different airborne chemical elements, including heavy metals, is aThe major objective of the present study was to identify the reladistinctive feature documented by James (1973), Nietionship of physiologial parameters of the photosynthetic system with the elemental content of the lichen Ramalina lacera (With.) J.R. boer et al. (1978), Richardson (1992), Garty (1993), Laund. Thalli of R. lacera were collected in an unpolluted site and Jacquiot andDaillant (1997). whole. Correlations of Cr and Ni, Cu and Ni, Zn and Cu, Cu and Mn, andThe present study investigated the effect of anthropoZn and Ni could be related to metal processing in the industrial area genic activity on air quality in selected sites in northwest but indicate also vehicular activity as a possible originator.

To determine the environmental impact of industrial activity, we examined and compared the following parameters of physiological integrity in the epiphytic fruticose lichen Ramalina lacera. (1) Potential quantum yield of PSII expressed as the chlorophyll fluorescence ratio Fv/Fm. (2) Spectral reflectance expressed as values of normalized difference vegetation index (NDVI). (3) Production of ethylene. (4) Electrolyte leakage brought about by degrading cell membranes in terms of electric conductivity. (5) The ratio A435nm/A415nm indicating the disintegration of chlorophyll. The amounts of Ba, Cu, K, Ni, S, V and Zn contained in the lichen thallus were measured to quantify the degree of pollution. Some of the lichen‐carrying twigs collected at a relatively unpolluted control site were resuspended on the original trees as controls. Other lichens were transplanted to 19 biomonitoring sites. Transplanted lichens in polluted sites contained higher amounts of Ba, Ni, S, V and Zn than lichens in the control site and in most of the rural sites upon an exposure period of 8 months. Statistical analysis revealed negative correlations between Fv/Fm ratios and Ba contents of transplants. High Ba, Cu, Ni and Zn contents correlated negatively with NDVI values. NDVI values correlated with A435nm/A415nm, Fv/Fm and K. The ratio A435nm/A415nm correlated positively with K and negatively with Ba, Cu and Zn. The production of ethylene correlated positively with Cu and Ba and negatively with A435nm/A415nm, Fv/Fm and NDVI. Electric conductivity values correlated positively with Ba, Cu, Na, S, V and Zn and negatively with NDVI. Both elemental content and physiological alterations in transplants of R. lacera point to a high degree of contamination in the Haifa Bay region, which is polluted by fuel‐oil combustion apart from other industrial activities. The present work suggests that in our specific study area, the most sensitive parameter to assess the vitality of the lichen thallus is electric conductivity whereas ethylene production is less sensitive.

The PDDT scale is a simple and valid instrument that may assist in identifying potential barriers in adherence to recommended treatments and to new treatment options.

From the patients' perspective, oral therapy is the preferred strategy for attaining the treatment goals since the addition of OHAs was not associated with lower QoL or patient-perceived difficulties with care. If early insulin treatment is considered, physicians should address specific diabetes treatment characteristics, mainly the issue of pain, to promote improved QoL and disease control.

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