Objective. Nosocomial bloodstream infections (NBIs) are associated with serious morbidity and prolonged length of stay (LOS) in very low birth weight (VLBW) infants. However, the marginal costs and excess LOS associated with these infections have never been measured in different birth weight (BW) categories after adjustment for many of the potentially confounding demographic variables, comorbidities, and treatments. The objective of this study was to measure the marginal cost and excess LOS caused by NBIs in surviving VLBW infants in different BW categories.Methods. This retrospective study examined data previously collected as part of the Neonatal Intensive Care Quality Improvement Collaborative 2000 and the Vermont Oxford Network clinical outcomes database. Univariate analyses and multiple regression were used to examine the effect of NBIs on hospital costs and LOS. Seventeen neonatal intensive care units that participated in the Neonatal Intensive Care Quality Improvement Collaborative 2000 submitted both clinical and financial data on their VLBW infants who were born from January 1, 1998, to December 31, 1999. This study included data from both university and community hospitals.Results. NBIs occurred in 19.7% of 2809 patients included in this study. NBI was associated with significantly increased treatment costs for infants with BW 751 to 1500 g. The marginal costs of NBIs, as estimated by multiple regression, varied from $5875 for VLBW infants with a BW of 401 to 750 g to $12 480 for those with BW of 751 to 1000 g. LOS was significantly increased in all BW categories. The excess LOS estimated by multiple regression varied from 4 days in VLBW infants with a BW of 1001 to 1251 g to 7 days in those with a BW of 751 to 1000 g.Conclusions. NBIs are associated with increased hospital treatment costs and LOS but by varying amounts depending on the BW. Preventing a single NBI could reduce the treatment costs of a VLBW infant by at least several thousand dollars. These savings are a greater percentage of the total treatment costs in VLBW infants with BW 1001 to 1500 g than in smaller infants.

OBJECTIVE:Very low birth weight (VLBW)infants (those with birth weights <1500 g) account for only 1.2% of births but 46% of infant deaths. Large improvements in neonatal technology in the last 2 decades have significantly improved survival prospects for infants with low birth weights, but at a high cost. Due largely to a lack of data, the costs of medical care during the period in which infant mortality is measured (the first year of life), as well as the cost-effectiveness of that care for VLBW infants, have not been quantified. Despite this fact, public policies both toward providing insurance coverage for their care, as well as denying payment for their treatment, have either been proposed or implemented on cost-effectiveness grounds. PATIENTS:The study includes all VLBW single live births in the state of California during 1986 and 1987 that were continuously eligible (through traditional channels) for the state's Medicaid program. MAIN OUTCOME MEASURES:Treatment costs were measured for all medical care received during the first year of life, including all inpatient and outpatient care received. The cost-effectiveness of care is measured by aggregate treatment costs for all singleton VLBW liveborns divided by the number of first-year survivors. RESULTS:Average treatment costs per first-year survivor for infants <1500 g was $93 800 (in 1987 constant dollars). Treatment costs per survivor were twice as high for infants <750 g ($273 900) as for the next highest birth weight group 750 to 999 g ($138 800) which was itself almost twice as high as for the 1000 to 1249 g group ($75 100). The gradient in cost-effectiveness with birth weight then drops off to $58 000 per survivor for infants with birth weights between 1250 and 1499 g. CONCLUSION:Public policies aimed at improving birth outcomes by providing insurance coverage for pregnant women and children, such as the recent Medicaid expansions, can potentially be very cost-effective. Although maternal interventions such as prenatal care are relatively inexpensive, each normal birth that results instead in a VLBW birth saves $59 700 in first year medical expenses. However, cost savings attributable to increased birth weights depend on where in the birth weight distribution the increase occurs as well as the size of the birth weight increase. For infants with birth weights >750 g, significant gains can accrue from even a small shift in the birth weight distribution. A shift of 250 g at birth saves an average of $12 000 to $16 000 in first year medical costs and a shift of 500 g generates $28 000 in savings. However, there is a threshold effect on birth weight. For infants <750 g, increases in birth weight may increase medical expenditures. For instance, a shift in birth weight to the 750 to 999 g range increases costs by $29 000.

OBJECTIVES:This paper describes the relationship between self-reported general health status and several facets of reproductive history.METHODS:We analyzed survey data on a national probability sample of 1341 women aged 50 and older from the Panel Study of Income Dynamics. We used multivariate regression techniques to control for differences in health indices that assessed health status and functioning.RESULTS:Women with a history of six or more completed pregnancies were found to be disadvantaged in educational attainment, financial resources, and health status compared with women with no or fewer pregnancies. When current sociodemographic factors were controlled, six or more pregnancies were associated with worse general health and worse physical role functioning. When sociodemographic factors and number of births were controlled, among women with at least one delivery, women who had experienced an infant's death reported worse health as measured by all three indices. Women with a first delivery before the age of 18 were more likely to report a functional limitation.CONCLUSIONS:Women with high parity status, a history of an infant's death, and an early first pregnancy may be at greater risk of poor health in later life.

Using data from the 1990 Health Supplement to the Panel Study of Income Dynamics, we examine the determinants of patterns of insurance coverage among the elderly. Among those with supplemental insurance through an employment-based source, the primary determinant of having insurance is work history, specifically job tenure and occupation of household heads and their spouses. Among those who do not have employer-provided insurance, wealth is the most important economic factor in the purchase of private insurance. Blacks, persons with less education and women household heads are less likely to purchase supplemental insurance. We find little evidence that persons in prior poor health are more likely to purchase supplemental insurance, and the most important determinant of dental or drug coverage is having employer-based insurance. The current trend toward decreased generosity of post-retirement benefits implies that fewer older Americans will have insurance for these services.

Levels in 225Fr have been studied by γ-ray and conversion-electron spectroscopy following the β-decay of 225Rn, and by the 226Ra(t,α)225Fr single-proton-pickup reaction. Multipolarities were obtained for ∼50 γ-transitions, and a level scheme was established in which definite spin-parity values were determined for over 20 of the 48 levels. Although low-lying rotational bands of both parities exist for K = 12 and K = 32, there is no experimental evidence to claim these are parity doublets. E1 strengths connecting the Kπ = 32± bands are intermediate between those for nuclides which are reflection symmetric and those claimed to be octupole deformed. The (t,α) cross sections are in better agreement with those predicted for the reflection-symmetric case than with those from an octupole-deformed description. These observations may be confirming theoretical predictions that octupole correlations are important in 225Fr, but that there is no large stable octupole deformation.

Expenditures for prescription drugs are not covered by Medicare and are thus a potential source of large out-of-pocket expenditures for elderly persons. This study, using a new data source, the 1990 Elderly Health Supplement to the Panel Study of Income Dynamics (PSID), demonstrates that, among elderly persons, insurance coverage for drugs reduces the fraction of household income spent on prescription drugs by 50 percent. Groups most likely to benefit from insurance coverage are elderly women and those with common chronic conditions, low incomes, and rural residences.

Using data on 975 elderly persons from the 1990 Health Supplements to the Panel Study of Income Dynamics, we describe the predictors of expenditures for dental services. Forty-four percent of elderly persons reported using some dental services within a year. Thirteen percent had private dental insurance, and 8% had a separate dental policy. The average total expenditure for those who used any dental services was $378, 88% of which was paid out-of-pocket. Persons with a separate dental insurance policy, younger and better educated persons, and those with greater financial resources were more likely to use dental services.

Data from the 1990 Panel Study of Income Dynamics were used to predict, by means of logistic regression, the likelihood that people who had previously driven would continue to drive and to drive after dark after 50 years of age. The results support the conclusion that driving patterns appear to be explained partly by a combination of sociodemographic factors and health status. Furthermore, it is shown that those reported to drive for nondrivers appear to be the same individuals known to provide most informal support for functionally impaired elderly people.

The beta(-) -decay of Rn-223 and Fr-229 have been investigated at the ISOLDE facility. The obtained data for Fr-223 gave evidence for octupole shape of this nucleus. The level structure of Ra-229 is similar to the structure of the lighter octupole deformed Re-isotopes.

The γ-rays following the β− decay of 223Rn have been investigated by means of γ-ray singles including multispectrum analysis, and γγ-coincidence measurements using Ge detectors. Multipolarities of 38 transitions in 223Fr have been established by measuring conversion electrons with a mini-orange electron spectrometer. Most of the observed transitions could be placed in a level scheme comprising 53 excited states of 223Fr. The level structure is interpreted in terms of Kπ = 32± and 12± parity doublet bands, and a second Kπ = 32± higher-lying parity doublet. The experimental data are compared with the theoretical predictions of the reflection-asymmetric rotor model.

Levels in 110Ru have been studied via the gamma-rays following the beta- -decay of 1.0-s Tc-110. The emitted gamma-rays have been investigated by gamma-singles and gamma-gamma(t) coincidence measurements. The technetium activity was separated from the Cf-249-fission products using the on-line centrifuge system SISAK. A level scheme for 110Ru is proposed based on 15 gamma-transitions. In addition, the beta- -decay of 0.9-s Tc-109 has been studied and six gamma-lines could be assigned to this nuclide.

The information on the coexistence of deformed intruder states and normal spherical hole-core coupled states in odd-mass Ag nuclei has been extended to the neutron-rich isotopes $^{113}\mathrm{Ag}_{66}$ and $^{115}\mathrm{Ag}_{68}$. Data have been obtained from an investigation of the \ensuremath{\gamma} rays following the ${\mathrm{\ensuremath{\beta}}}^{\mathrm{\ensuremath{-}}}$ decay of the $^{113,115}\mathrm{Pd}$ precursors. A minimum for the excitation energy of the intruder states occurs in $^{113}\mathrm{Ag}_{66}$, exactly at neutron midshell. The properties of the intruder states in $^{109,111,113,115}\mathrm{Ag}$ are discussed and a description in the framework of the interacting-boson-fermion model is presented.

Levels in111Rh have been investigated via the γ -rays following the β−-decay of 2.1 s111Ru. The Ru activity was produced in the fission of249Cf and separated chemically from the fission product mixture. The emitted γ-rays were studied by γ singles and γ(t) coincidence measurements. Evidence for intruder states in111Rh has been obtained. Their properties are discussed and compared with those in the lighter Rh isotopes.

The new neutronrich isotope 228 Rn was produced by spallation reactions induced by 600 MeV protons in a 232 Th target and identified by massseparation and decay spectroscopy. The Zassignment was confirmed via KX-rays and the genetic relationship to the wellknown daughter product 228 Fr. The halflife of 228 Rn is 65±2 s. Energies and relative intensities of prominent γ-rays are presented for the first time from the decay of both the new isotope 228 Rn and 227 Rn.

Neutron-rich isotopes of astatine have been produced through spallation reactions with 600 MeV protons on a232Th target and identified by spectroscopic techniques combined with one-line mass separation at the ISOLDE facility. The half-lives of218At and219At have been remeasured to be 1.5(3) s and 57(4) s, respectively. Four new isotopes of astatine,220−223At, have been observed for the first time, and their half-lives were found to be 3.73(13) min, 2.3(2) min, 54(10) s, and 50(7) s, respectively. Another nuclide,216Bi, has been observed for the first time as the daughter product of the220At alpha decay, and its half-life has been measured to be 6.6(21) min.

Results from the study of the 104Ru(3He, d) 105Rh reaction reveal evidence for shape coexistence in odd-mass rhodium isotopes. The strongly excited states at 786, 806, 969, 1019 and 1355 keV in 105Rh are good candidates for a rotational-like positive-parity band with Jπ = 12+, 32+, 52+, 72+ and 92+, respectively, coexisting with spherical shell-model states like 1g92, 2p12, 2p32 and 1f52 as well as core-coupled configurations.

Neutron-rich nuclei of Rh and Ag have been investigated by γ-ray spectroscopic measurements as well as single-particle transfer reactions like (d,3He) and (3He,d). The obtained level schemes of 105,107,109,111Rh and 113,115Ag show two different types of excitation: (I) proton-hole states related to a spherical shape of the nucleus and (II) proton-particle states with a rotational band-like structure (intruder band) pointing towards deformation of the nucleus. The “fingerprints” for such a shape coexistence and resulting systematics in these nuclei and the possible interpretation of the intruder band as a rotational band built upon the 1/2+[431] Nilsson configuration are discussed.

The levels in 109Rh have been investigated via the γ-rays following the β− decay of 34.5 s 109Ru. The ruthenium activity was produced in the thermal neutron-induced fission of 149Cf and separated chemically from the fission product mixture with the on-line centrifuge system SISAK. The emitted γ-rays were studied by γ singles and γγ(t) coincidence measurements. In addition, the 110Pd(d, 3He) reaction was investigated at Ed = 50 MeV to study the proton-hole states in 109Rh. From the comparison of the measured angular distributions with DWBA calculations l-transfers and spectroscopic factors were deduced. The level scheme of 109Rh that was obtained is discussed and compared with neighbouring nuclei and with recent calculations in the framework of the interacting bosonfermion model (IBFM-1). An interpretation of the observed candidates for intruder states as a rotational band built upon the [431] Nilsson configuration is proposed.

We have observedγ-rays following the β−-decay of243Np and244Np after chemical isolation of neptunium isotopes from the products of the reaction of 835 MeV136Xe with244Pu. The ground-state of 1.85-min243Np hasJ=5/2. The decay of 2.29-min244Np (probableJπ=7−) populates high-spin members of the ground state rotational band in244Pu.