To study the decision-making model behind how physicians making prescribing decisions, we studied the effects of the introduction of Medicare Part D in 2006 on numbers and characteristics of medications prescribed by physicians. We identified a significant increase in overall number of medications prescribed due to Medicare Part D but did not find any effects on the number of antibiotics. The result suggests there exist factors distinguishing antibiotics from other medications that led to a change in incentives to prescribe antibiotics, such as costs of antibiotics resistances. . We also identified the heterogeneity responses to Medicare Part D with respect to physician’s employment status, primary care relationship and patient’s gender and diagnostic categories.

The purpose of this study was to investigate the impact of Medicare Part D on prescription utilization, health services utilization, and health care expenditures in the general Medicare population – as well as Medicare sub-populations, including non-Hispanic blacks (NHBs), Hispanics, near poor individuals, and persons with higher disease burden. A retrospective analysis of Medicare beneficiaries (N=32,228) was conducted using the Medical Expenditure Panel Survey 2002 to 2009 data. Multivariable quantile regression was used to estimate the following outcomes, adjusting for socio-demographic characteristics: 1) number of prescription fills; 2) out-of-pocket (OOP) drug expenditures; 3) total drug expenditures; 4) OOP health care expenditures; 5) total health care expenditures; 6) number of hospitalizations; and 7) number of emergency department (ED) visits between the pre-Part D (2002-2005) and post-Part D (2006-2009) periods. All expenditures were inflation-adjusted to 2009 dollars. The average age of the study sample was 71.0 (SD=14.5). In the general Medicare population, Part D was associated with decreases in OOP drug expenditures (-25.7% to -33.6%; p<0.0001) and OOP health care expenditures (-22.1% to -24.3%; p<0.0001) as well as increases in the number of prescription fills (5.8% to 8.4%; p<0.0001) and total drug expenditures (75th percentile: 5.5%; 90th percentile: 10.2%; p<0.0001). Part D was not associated with changes in total health care expenditures in the general Medicare population. Changes in hospitalizations and ED visits were tested at the 90th percentile, and the results were not statistically significant. In sub-group analyses based on race/ethnicity, non-Hispanic whites (NHWs) experienced more significant reductions in OOP drug and/or health care expenditures when compared with NHBs and Hispanics. Near poor beneficiaries experienced larger reductions in OOP drug expenditures than beneficiaries with middle- to high-income, while Medicare beneficiaries with three or more conditions experienced more substantial reductions in OOP drug and OOP health expenditures after Part D was introduced, compared with those with fewer than three conditions. Part D resulted in increases in medication utilization and reductions in OOP drug and OOP health care expenditures among Medicare beneficiaries. Part D was not associated with differences in total health care spending. The effects of Part D were more pronounced in Medicare subgroups, including NHWs, near poor individuals, and patients with higher chronic disease burden. / text

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Detta examensarbete har utförts vid Linköpings universitet i samarbete med Scania Transmission i Södertälje och behandlar kravsättning av ytstrukturer samt processer för hårdbearbetning av kugghjul och axlar. Aktuella artikelritningar innefattar endast krav för Ra-värde, den aritmetiska medelavvikelsen för ytjämnhetsprofilen (R-profilen). Förslag på nya parametrar enligt av Scania tillämpade SS-EN ISO standards har tagits fram, detta för att ge en noggrannare beskrivning av vilken ytstruktur som skall uppnås. Resultatet är generellt tillämpningsbart men fokuseras mot kugghjulens hål, plan och diametrar. Vidare presenteras en jämförelse mellan metoder så att transmissionsverkstäderna kan tillverka kugghjul/axlar på ett kostnadseffektivare sätt. Arbetet grundas på en litteraturstudie av handböcker och standards kompletterat med kartläggning av nuläget genom insamling av mätdata. En omvärldsanalys och några bearbetningsprover med hårdsvarvning har också utförts. Till skillnad från nuläget föreslås en övergång från att ange Ra-värde på ritningarna till att ange en övre gräns för Rz-värde som en begränsning av amplituden. Ytor i relativ rörelse och ytor som ingår i pressförband föreslås kompletteras med en undre gräns för Rz-värde samt en undre gräns för relativ bärighet. Med införandet av ett bärighetskrav ges även en specifikation för profilens fördelning. Angivelse av bearbetningsmetod och eventuellt bearbetningsmönster föreslås att anges i klartext på ritningen då parametrar som beskriver karakteristiska drag för olika bearbetningsmetoder visat sig väldigt variationsbenägna i nulägesanalysen. Jämförelse av hårdbearbetningsmetoder har visat att det i kombinationsmaskiner, hårdsvarvning och slipning, vore intressant att enbart hårdsvarva kugghjulens glidlagerytor, något som enligt bearbetningsprover och omvärldsanalys verkar rimligt. Detta bör efter godkännda riggprover anammas som ett första optimeringssteg. Fler intressanta koncept för framtida bearbetningsalternativ finns att studera i rapportens resultat och diskussionskapitel. / This master thesis report was performed at Linköpings University in cooperation with Scania Transmission in Södertälje and deals with specification of surface textures and processes for hard part machining of cogwheels and shafts. Present blueprints only include requirements for Ra-values, arithmetic mean deviation of the roughness profile (R-profile). Suggestions of new parameters according to SS-EN ISO standards used by Scania have been compiled with the aim of providing a more accurate description of the surface texture that is to be achieved. The result can be applied in general but are focused towards holes of cogwheels, planes and diameters. Furthermore a comparison between different methods is presented so that the transmission workshops can manufacture cogwheels and shafts in a costefficient manner. The work is based on a comparative literature study of handbooks and standards with complementary documentation of the present situation through collecting of measurements. A reference analysis and a few manufacturing tests of hard turning have also been performed. In difference from the present situation a transition from providing Ra-values on the blueprints to specify an upper limit for Rz-value to restrict the amplitude is recommended. Surfaces in relative motion and surfaces in heavy force fit are suggested to be complemented with a lower limit for Rz-values and a lower limit for relative material ratio. With an introduction of material ratio requirements the profiles distribution are also specified. Denunciation of manufacturing method and surface lay if any is suggested to be stated en clair on the blueprint being so that parameters describing characteristic features for different manufacturing methods have shown a wide range of distribution in the present state analysis. Comparison of hard part machining methods have shown that in combination machines, hard turning and grinding, solely hard turning of the cogwheels slide bearing surfaces would be interesting, which also seems plausible due to manufacturing samples and the reference analysis. After approved rigg tests this method can be adopted as a first step of optimization. More interesting concepts for future manufacturing alternatives are provided in the reports result and discussion chapters.

The purpose of this thesis is to clarify the grounds upon which an arbitration clause may be binding in the new relationship between the parties after a transfer of rights and/or obligations. The issue is not regulated by law but instead it has been left to the Supreme Court to regulate. In the Emja-case the Swedish Supreme Court left guidance on the issue. The Supreme Court stated that a third party purchaser of a right where the contract includes an arbitration clause shall be bound by the clause. The arbitration clause is only binding to the remaining part of the initial agreement if no special circumstances exist. The binding effect was justified by the reason that a situation where the purchaser but not the remaining part should be bound to the clause was not sought after and the principle through the 27 § of the Swedish debt instruments act.

No description available.

Syftet med arbetet är att, genom en ekonomisk undersökning skapa underlag som visar vilket alternativ av produktionsmetoderna prefabricerat eller platsbyggt badrum som är att föredra vid en nybyggnation av vårdhem.  Resultatet visar att det platsbyggda badrummet ger en ökad totalt kostnad på 627457 kr vilket motsvarar 11,1 procent dyrare än det prefabricerade badrummet.

Thesis (Ph.D.)--York University, 2004. Graduate Programme in Sociology. / Typescript. Includes bibliographical references (leaves 343-359). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://gateway.proquest.com/openurl?url%5Fver=Z39.88-2004&res%5Fdat=xri:pqdiss &rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&rft_dat=xri:pqdiss:NQ99221

Thesis (M.H.A.)--University of Michigan, 1964.

Thesis (D. Min.)--Bethel Theological Seminary, 1991. / Includes bibliographical references (leaves 134-137).