Summary
We describe an observational survey of diagnostic pathways in 104 patients attending four specialist allergy clinics in the United Kingdom following perioperative hypersensitivity reactions ...to chlorhexidine reactions. The majority were life‐threatening. Men undergoing urological or cardiothoracic surgery predominated. Skin prick testing and specific immunoglobulin (sIg)E testing were the most common tests used for diagnosis. Fifty‐three per cent of diagnoses were made on the basis of a single positive test. Where multiple tests were performed the sensitivity of intradermal, basophil activation and skin prick testing was 68% (50–86%), 50% (10–90%) and 35% (17–55%), respectively. Seven per cent were negative on screening tests initially, and 12 cases were only positive for a single test despite multiple testing. Intradermal tests appeared most sensitive in this context. Additional sensitization to other substances used perioperatively, particularly neuromuscular blocking agents (NMBA), was found in 28 patients, emphasizing the need to test for possible allergy to all drugs to which the patient was exposed even where chlorhexidine is positive.
Perioperative chlorhexidine allergy in the UK is often severe. Investigation is complicated by multiple test positivity to potential culprit agents and false negativity in screening tests to chlorhexidine. Testing by multiple modalities including IDT is useful where initial testing is negative.
We consider the choice experiment approach to valuation, due to its focus on tradeoffs between alternatives. Our study is not hypothetical, but implements a real-payment choice experiment (CE) for a ...multi-attribute good. We use two real wetland parcels to create over 18 descriptions of parcels for conservation under a 10-year development-rights contract. Our payment protocol mitigates incentives to understate willingness to pay through a provision point with a rebate of excess funds. Real choice questions captured significant values for spatial attributes of wetland conservation. Average respondents positively valued 73-acre parcels surrounded by woodland, but required 100acres for parcels surrounded by residential or farm land, and accepted a 19-acre smaller parcel in exchange for full public access.
► The study develops a real-money approach to implementing choice experiments. ► We study valuation of forested wetlands, including acreage, public access, and surrounding lands. ► Actual payment was required under a provision point and proportional rebate mechanism. ► Results suggest that public access was equivalent to adding 19acres to a parcel with no access. ► Rhode Island, USA, residents valued sites in wooded areas over sites in farm or residential areas.
•The joint effect of attentional and bodily resources on cognitive performance is examined.•Attention to a target boosts the short-term memory of coincide background information.•Cardiac phase ...modulates short term memory, with enhanced performance during systole.•These two effects are approximately additive, indicating they may act through distinct underlying pathways.
Studies on mind-body interactions have largely focused on how mental states modulate bodily physiological responses. Increasing evidence suggests that bodily states also modulate mental states. Here we investigated how both may be integrated in the brain at the resolution of a heartbeat, examining how phasic fluctuations of peripheral blood pressure and central attentional resources combine to influence cognition. We examined the effects of cardiac phase on the performance of two simultaneous tasks: a go/no-go letter detection task where targets were concurrently presented on background faces and a short-term memory face discrimination task. Short-term memory for the background face was better when the initial face was encoded during the systole rather than diastole phase and when it was paired with a target rather than a distractor. There was no significant interaction between cardiac phase and letter detection. These data suggest that peripheral blood pressure and central attention independently regulate cognitive performance.
Summary
Immunoglobulin (Ig)G4 disease can have apparently ‘normal’ levels of IgG4 due to antigen excess conditions. IgG4 measurement therefore appears falsely low. UK National External Quality ...Assurance Scheme (UK NEQAS) data and other reports have suggested that this problem occurred despite pre‐existing antigen excess detection steps. To determine the clinical relevance of the problem, we examined the prevalence and characteristics of prozoning in our laboratory and patient cohorts. We establish that the prevalence of raised IgG4 in routine IgG4 analysis is low (< 1%) using one of the two routine methods in use in the United Kingdom. We show that subsequent assay modification appears to have reduced the likelihood of misleading readings. However, the original version of the assay prozoned to low levels (below 0·64 g/l) in 41% of high IgG4 samples in our patients. This may explain the previous reports of low sensitivity of raised IgG4 for IgG4RD, and predictive values should be re‐evaluated in this disease using modified prozone‐resistant protocols. All laboratories providing IgG4 measurements should verify that their assays are fit for the clinical quality requirement of detection raised IgG4 levels and must verify the upper limit of their reference ranges and freedom from prozoning.
The free riding incentive has been a major obstacle to establishing markets and payment incentives for environmental goods. The use of monetary incentives to induce private provision of public goods ...has gained increasing support to help market ecosystem services. Using a series of lab experiments, we explore new ways to raise money from individuals to support private provision of multi-unit threshold public goods. In our proposed mechanisms, individuals receive an assurance contract that offers qualified contributors an assurance payment as compensation in the event that total contributions fail to achieve the threshold provision cost. Contributors qualify by contracting to support provision with a minimum contribution. Evidence from lab experiments shows that the provision probability, group demand revelation, and social welfare significantly increase when the assurance contract is present. Coordination is improved by the assurance payment especially for agents with values above the assurance level, leading to significantly higher aggregate contributions. A medium level of assurance payment used on units with medium and high value-cost ratios is observed to induce the largest improvement on social surplus. Our approach contributes to the private provision of environmental and other types of public goods.
This article implemented four treatments to elicit preferences for a nonmarket good, including (1) a hypothetical referendum, (2) a real referendum lacking incentive compatibility, (3) a real choice ...with incentive compatibility, and (4) a hybrid approach based on (2) and (3). We develop a method to estimate the probability that observed choices do not identify the highest-utility alternative in a choice question. We find that in the hypothetical referendum, the estimated percentage of individuals choosing the alternative that gives the highest utility is the lowest among the treatments. Adding policy consequentiality or payment consequentiality increases the percentage of truthful responses.
Rebate rules in threshold public good provision Spencer, Michael A.; Swallow, Stephen K.; Shogren, Jason F. ...
Journal of public economics,
06/2009, Letnik:
93, Številka:
5
Journal Article
Recenzirano
Odprti dostop
This paper considers how six alternative rebate rules affect voluntary contributions in a threshold public-good experiment. The rules differ by (1) whether an individual can receive a proportional ...rebate of excess contributions, a winner-takes-all of any excess contributions, or a full rebate of one's contribution in the event the public good is provided and excess contributions exist, and (2) whether the probability of receiving a rebate is proportional to an individual's contribution relative to total contributions or is a simple uniform probability distribution set by the number of contributors. The paper adds to the existing experimental economics literature on threshold public goods by investigating both aggregate and individual demand revelation under the winner-take-all and random full-rebate rules. Half of the rules (proportional rebate, winner-take-all with uniform probability among
all group members, and random full-rebate with
uniform probability) provide total contributions that nearly equal total benefits, while the rest (winner-take-all with
proportional probability, winner-take-all with uniform probability among
contributors only, and random full-rebate with
proportional probability) exceed benefits by over 30%. Only the proportional rebate rule is found to achieve both aggregate and individual demand revelation. Our experimental results have implications for both fundraisers and valuation practitioners.
This paper develops a method that incorporates the public value for environmental cobenefits when a conservation buyer can purchase water quality credits based on nonmarket valuation results. We ...demonstrate this approach through an experiment with adult students in a classroom laboratory environment. Our application contributes to the study of individual preference and willingness to pay for cobenefits associated with the production of water quality credits in relation to the Ohio River Basin Trading Project. We use three different methods to elicit individuals' willingness to pay (WTP), including (1) a hypothetical referendum, (2) a real referendum lacking incentive compatibility, and (3) a real choice with incentive compatibility. Methodologically, our WTP estimates suggest individuals are more sensitive to the cost changes and reveal the lowest value in the real choice with incentive compatibility. Practically, we find individuals value certain cobenefits and credits as public goods. Incorporating public value toward cobenefits may improve the overall efficiency of a water quality trading market. Based on our specification of a planner's welfare function, results suggest a substantial welfare improvement after identifying an optimal allocation of a buyer's budget across credits derived from agricultural management practices producing different portfolios of cobenefits.
Key Points:
We incorporate public co‐benefits value to purchase WQ credits
Individuals reveal the lowest value with a real choice under incentive compatibility treatment
Incorporating public co‐benefits value leads to a substantial welfare improvement
Communities in exurban areas increasingly rely on land preservation as a strategy to balance sprawling land development with maintaining environmental amenities. Based on a review of existing ...approaches for preserving land, we consider a conceptual model of environmental impact fees (EIFs) coupled with conservation payments for managing private land of ecosystem value. In this framework, conservation payments are intended to cost-effectively target fair market value compensation for heterogeneous land for preservation that sustains ecosystem health. EIFs serve as a financial instrument to augment conservation payments and to allow flexibility for landowners with private information to pursue development opportunities while accounting for environmental impacts. Using a bioeconomic model of nature-reserve design, we develop an empirical illustration of how to estimate the EIF of development damage to critical habitat in southern Rhode Island in an effort to preserve land as an environmental infrastructure that maintains ecosystem health.
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