Academic literature on the topic 'Activity-based costing – United States'

ABSTRACT In the 1930s, active industrialization of the economy in the USSR was impossible without using modern management techniques and accounting methods. To increase the manageability of industrial enterprises, attempts to introduce standard costing, imported from the United States, were undertaken. Previously called progressive and useful, after the policy of the Communist Party changed, standard costing was identified as a calculative technique that did not correspond to the goals of the socialist state. Soviet researchers formulated the principles of normative cost accounting, based on standard costing. This new version was greatly simplified and lost its analytical focus. The paper investigates the influence of state policy on the transformation of standard costing methodology during the construction of the Socialist economy. The authors contribute to previous literature by focusing on the periodic press, professional societies, and educational institutions being used as tools of political power to put pressure on accounting theory and practice.

Abstract Background Respiratory syncytial virus (RSV) is a human orthopneumovirus spread by direct contact with symptomatic, infected individuals. An estimated 587,000 RSV LRTIs result in inpatient or outpatient encounters annually among US infants (Rainisch et al 2019). The health care costs associated with RSV include medical costs to insurers, governments, and households, travel, and loss of wages. Initial summary of Inpatient and Ambulatory Medical Costs p Infant w RSV.JPG Jun 17th, 2020 @ 2:44 PM 852 x 572 122.3 Kb Methods A systematic literature review of the costs associated with children who have RSV was conducted. Following PRISMA methodology, key search terms were searched within article titles and abstracts through PubMed, EconLit, and Scopus. A total of 1,942 unique abstracts were screened independently by two authors and reduced to 180 articles after applying inclusion and exclusion criteria. The number of included articles after reviewing the full text was 66. Costing results were adjusted to USD2020 based on the Medical Care Consumer Price Index. Results Costing results were reported mainly for medical costs in inpatient settings. Initial results show that annual mean inpatient costs per RSV patient range among individual studies from $9,825 (SD=$25,227) for full term infants to $26,120 (SD unspecified) for late preterm infants (Table 1). Costing results vary by gestational age, with late preterm infants having an annual mean inpatient cost almost 1.6 times that of a full term infant. Inpatient costs for RSV infants are higher for commercial pay versus Medicaid, for both full term infants (commercial mean=$16,489 SD=$31,068, Medicaid mean=$10,291 SD=$64,625) and late preterm infants (commercial mean=$23,836; SD=$43,709, Medicaid mean=$18,864 SD=$28,716). Annual RSV ambulatory costs per infant vary between $4,371 (SD=$13,411) and $19,963 (SD=$27,269), depending on gestational age. Other relevant RSV costs include preventative drug costs, such as palivizumab (average $11,954 per infant). Conclusion The literature describes the economic impact of RSV primarily for hospitalization of children with underlying comorbidities. There is a need to better understand costing results for RSV, including the burden in ambulatory settings and indirect costs to families affected. Disclosures All Authors: No reported disclosures

All other industrialized countries have some version of a children's allowance, a grant provided to all families based on the number of children they have. In contrast, the United States provides tax deductions for children, which provide the most benefit to the rich and provide no benefit at all to most poor families. The authors argue that a children's allowance could be instituted in this country that would decrease poverty and welfare participation while not costing the federal government any additional resources. A microsimulation model shows the effects of three levels of children's allowances on government revenues, family incomes, welfare use, and labor supply.

Background:Childhood obesity is an epidemic in the United States affecting 12.7 million children (Centers for Disease Control and Prevention, 2015a), and costing the United States $14.1 billion every year (Cawley, 2010). It also costs corporate America about $9 billion in direct costs (Adeagbo, 2015) and $4.3 billion in indirect costs for health-care expenditures (Cawley, 2010). Studies suggest interventions implemented by employers involving the whole family are twice as effective as interventions with employees alone (Adeagbo, 2015).Methods:This quality improvement pilot study used a quasi-experimental pretest and posttest design in an outpatient employee health clinic to evaluate a coaching method for empowering parents to manage childhood obesity. A convenience sample of 10 employed parents who had children between the ages of 2 and 19 years who were overweight or obese and met study criteria, were enrolled. Three coaching sessions lasting 20–30 minutes were provided before administering the posttest questionnaire.Results:The Mann–Whitney U test showed a measurable positive difference after coaching on healthy behaviors and was statistically and clinically significant (Mann–Whitney U = 80, Wilcoxon W = 125, standard error = 12.26 and p = .003).Conclusion:Findings indicate management of childhood obesity through parental education, coaching, and family-based interventions can promote healthy lifestyle changes among children.

Staphylococcal food poisoning is one of the most economically important food-borne diseases in the United States, costing approximately $1.5 billion each year in medical expenses and loss of productivity. The amount of staphylococcal enterotoxin required to cause illness in humans depends on the susceptibility of the individuals. As little as 0.5 to 0.75 ng/ml of enterotoxin A in chocolate milk was shown to be able to cause illness in school children. Many methods have been developed for the detection of enterotoxins: immunological and biological assays. Immunological assays are more sensitive and specific and are the basis for detection of the identified enterotoxins. However, biological assays are useful for the detection of uncharacterized enterotoxins. This article reviews methods currently available for enterotoxin detection, including biological assays, immunodiffusion, radioimmuno-assay, enzyme-linked immunosorbent assay, polymerase chain reaction-based methods, and various commercially available diagnostic kits.

The following report reviews the development and state of engineering economic applications of the second law of thermodynamics. It encompasses virtually all of the work carried out publicly in the United States, and to the best of our knowledge that done in other countries (but also see Tsatsaronis, 1987). The ultimate objective here is to provide direction for future research on the fundamentals and applications of this subject, and for the support thereof. We begin with a historical review, which is important for better comprehension of second law costing, its objectives, its state, and its prospects. Following the history, further relevant background, on cost accounting, is presented in Part II. Part III describes in general terms the different exergy costing methods which are in existence. Parts IV and V constitute the nucleus of the report. Therein the various techniques are analyzed and critiqued, generally by considering successive publications developing and/or based on a technique. Part IV is devoted to algebraic methods for determining and applying exergy costs and Part V, to be presented in the sequel to this article, to calculus methods. These two parts do refer to each other, and the relationships between them are developed. Suggestions regarding further research are incorporated into both sections. It should be mentioned that the references we cite are not intended to be exhaustive. However, it is our intention to refer to the most recent work of each author, so that the reader may trace back to earlier publications. Also, the bibliographies of Wepfer (1979) and Liu and Wepfer (1983) are quite exhaustive.

Cardiovascular disease (CVD) is the leading cause of death in the United States, costing billions of dollars per year in direct and indirect costs, and its prevalence is projected to increase exponentially over the next 15 years. Additionally, low-income and ethnic minority populations are especially at risk for CVD and CVD-related adverse health outcomes. This study aimed to examine the influence of a 12-hr, evidence-based relationship education (RE) program, Within Our Reach (WOR), on relational distress and satisfaction in participants with and without CVD risk factors. Findings indicated that participants significantly improved in their relationship satisfaction following the RE intervention with the female group improving in their relationship satisfaction at an amount significantly greater than the male group. However, no differences were found between CVD risk factor group and non-CVD risk factor group on their relationship satisfaction either before or after the RE intervention. Clinical implications and future directions for research in this area are also discussed.

544 Background: In patients with HER2-positive early breast cancer (BC), pertuzumab (P) added to trastuzumab (T) and chemotherapy has been recognized as a standard-of-care, improving the risk of recurrence. P and T treatments can be given intravenously (PT IV) or, more recently, subcutaneously − via PH FDC SC. Both methods are comparable in terms of efficacy and safety profiles. However, PH FDC SC allows for a faster infusion than that of PT IV, and this can be associated with lower costs. The aim of this study is to estimate the incremental difference in non-drug costs between PH FDC SC and PT IV for a typical patient receiving treatment for HER2-positive early BC in Western Europe and the United States. Methods: A model-based cost-minimization analysis was performed to quantify mean non-drug cost differences per patient over a full course of therapy (18 cycles). Western Europe: costs in the analysis are based on an archetypal country, and explicitly include estimates for costs for patient chair time, active healthcare professional (HCP) time, usage of non-drug consumables, port-a-cath placement surgeries and patients’ productivity losses. Costs are calculated by multiplying the resource use by its corresponding unit price. Costing data were obtained from literature sources on T SC time and cost savings for Western European countries, and assumptions on PH FDC SC and PT IV times and costs. United States: non-drug costs for the two strategies were estimated using average net reimbursement amounts for relevant procedure codes for intravenous and SC therapy administration among commercial payers in the MarketScan databases. Results: PH FDC SC is estimated to reduce non-drug costs by 73% − 80% in Western Europe, and 75% in the United States. Total monetary non-drug savings per patient over 18 cycles of treatment are estimated in the range of €2,474 − €8,975 in Western Europe, and at $10,138 in the United States. In Western Europe, where the analysis allows for a disaggregation by cost category, cost savings related to savings in patient chair time (excluding patients’ productivity losses) are estimated to account for up to 62% of overall non-drug cost savings. Patients’ productivity losses are estimated to explain up to 11% of non-drug cost differences. Conclusions: The use of PH FDC SC for the treatment of HER2-positive BC can potentially result in substantial non-drug cost savings. These savings could easily derive in overall net cost savings to the healthcare system, contributing to the long-term sustainability of the healthcare spending, while still providing a safe and effective therapy.[Table: see text]

Everyday foodborne parasites, which are endemic in Canada, include the protozoansEntamoeba histolytica,Giardia lambliaandCryptosporidium parvum.However, these parasites are most frequently acquired through unfiltered drinking water, homosexual activity or close personal contact such as in daycare centres and occasionally via a food vehicle. It is likely that many foodborne outbreaks from these protozoa go undetected. Transmission of helminth infections, such as tapeworms, is rare in Canada because of effective sewage treatment. However, a common foodborne parasite of significance isToxoplasma gondii. Although infection can be acquired from accidental ingestion of oocysts from cat feces, infection can also result from consumption of tissue cysts in undercooked meat, such as pork or lamb. Congenital transmission poses an immense financial burden, costing Canada an estimated $240 million annually. Also of concern is toxoplasmosis in AIDS patients, which may lead to toxoplasmosis encephalitis, the second most common AIDS-related opportunistic infection of the central nervous system. Exotic parasites (ie, those acquired from abroad or from imported food) are of growing concern because more Canadians are travelling and the number of Canada?s trading partners is increasing. Since 1996, over 3000 cases ofCyclosporainfection reported in the United States and Canada were epidemiologically associated with importation of Guatemalan raspberries. Unlike toxoplasmosis, where strategies for control largely rest with individual practices, control of cyclosporiasis rests with government policy, which should prohibit the importation of foods at high risk.

Background: Over 500 000 carpal tunnel releases costing over $2 billion are performed each year in the United States. The study’s purpose is to perform a cost-minimizing analysis to identify the least costly strategy for carpal tunnel syndrome treatment utilizing existing success rates based on previously reported literature. Methods: We evaluate the expected cost of various treatment strategies based on the likelihood of further treatments: (1) a single steroid injection followed by surgical release; (2) up to 2 steroid injections before surgical release; (3) 3 steroid injections before surgery, and (4) immediate surgical release. To reflect costs, we use our institution’s billing charges to private payers and reimbursements from Medicare. A range of expected steroid injection success rates are employed based on previously published literature. Results: Immediate surgical release is the costliest treatment with an expected cost of $2149 to $9927 per patient. For immediate surgical release to cost less than a single injection attempt, the probability of surgery after injection would need to exceed 80% in the Medicare reimbursement model and 87% in the institutional billing model. A single steroid injection with subsequent surgery, if needed, amounts to a direct cost savings of $359 million annually compared with immediate surgical release. Three injections before surgery, with “high” expected success rates, represent the cost-minimizing scenario. Conclusions: Although many factors must be considered when deciding upon treatment for carpal tunnel syndrome, direct payer cost is an important component, and the initial management with steroid injections minimizes these direct payer costs.

This thesis takes a corporate political strategy perspective of antidumping and countervailing duty cases to understand why some firms are more successful at the prosecution of these trade remedy measures. Trade remedy measures are long standing tools of US trade policy and their use has continued to grow globally amongst member countries of the World Trade Organisation. Between 1980 and 2007 a total of 1606 of these trade remedy cases were investigated by the Department of Commerce and International Trade Commission, an average of 41 antidumping and 17 countervailing duty cases a year, with a value of around US$ 63 billion or 0.3% of all US imports. Thirty-seven percent of the cases by number and 54% by value resulted in duties being imposed on the subject imports. This study uses archival material for five recent trade remedy investigations and forty-five semistructured interviews with business interests, trade attorneys and economic consultants that have experience of prosecuting these cases to understand why some firms may be more successful than others at achieving their preferred policy outcome. The imposition of duties is found to be only the simplest measure of success for US firms that file a case and does not capture the range of potential outcomes for foreign firms that face the duties. Successful prosecution of a trade case has been found to be firm specific, as the DOC determination of individual firm duty rates significantly affects what the outcome of case means for each firm in the US and foreign industries. The successful prosecution of US trade remedy cases is argued to be an informational corporate political strategy that is affected by statutory and administrative biases in the execution of the agency investigations, and creates the potential for indirect rent-seeking bias in the outcomes of cases. This informational corporate political strategy is based on three capabilities that firms need to develop, the capability to gather information, the capability to build and shape the administrative record at the agencies to reflect a firm’s policy preferences and the capability to align business practices with the US trade remedy institutions. These three capabilities are enabled by the bundling of corporate political expertise resources, organisational resources, financial resources and reputational resources. Some of these resources are internal to the firms, including staff, money and information, while other resources are external, such as the trade attorneys and economic consultants.

Industrial ecology is a field of study that encourages the use of closed-loop material cycles to achieve sustainability. Loop closing requires the movement of materials over space, and has long been practiced in the iron and steel industry. Iron and steel (ferrous) scrap generated in the U.S. is increasingly exported to countries in Asia, lengthening the transportation distance associated with closing the loop on the iron and steel life cycle. In order to understand the environmental cost of transporting this commodity, an activity-based maritime transportation model and a theoretical in-land transportation model are used to estimate emissions generated. Results indicate that 10.4 mmt of total emissions were generated, and emissions increased by 136 percent from 2004 to 2009. Increases in the amount of emissions generated are due to increases in the amount of scrap exported and distance it is transported.

To combat social, economic and racial inequality in the United States, the author advocates for 'social awareness' education to be built into the curriculum of the public school system. The purpose of the curriculum is to create a society that respects people and recognizes each individual's worth regardless of gender, socio-economic status, race, ethnicity, age, cultural confines, or religious beliefs. The author suggests a course of action on how to institute a social awareness course into the public school curriculum.

Thesis (M.B.A.)--Naval Postgraduate School, September 2006.<br>Thesis Advisor(s): L. Andrew Jones, Suzanne Bosque. "September 2006." Includes bibliographical references (p. 81-82). Also available in print.

Indiana University-Purdue University Indianapolis (IUPUI)<br>This study questions if the advocacy efforts of community based organizations, like community development corporations, voluntary member associations, and community action agencies, can achieve policy development. Policy development is defined as the proposal of a policy by a community based organization. That policy proposal receives the attention of local decision makers for consideration. This study uses the stages of the policy process to assess what coordinated activities are most effective to achieve policy development. It was concluded that community based organizations can achieve policy development, if they identify an issue or problem, conduct some level of strategic planning, create a policy agenda, and seek access to decision makers. In all three case analyses, the hybrid organization, community action agency, and the voluntary member association were able to achieve policy development. This research does not focus on policy impact or evaluation. The goal was to ascertain how effective an organization can be at proposing a solution and receiving the attention of local decision makers. This research explores how organizational development can become the foundation for advocating for issues and achieve policy development. Community based organizations are not only government funded service providers, but also community collaborators and educators who stimulate citizen participation and increase public awareness about social issues. Their role as autonomous service providers puts them in a conundrum because of their funding streams. Since the 1950s, researchers have explored the roles and responsibilities of government-funded service providers. This study provides an overview of the roles of community based organizations and activities that define their political participation. It explores how these organizations mitigate issues to ensure overall community success.

An estimated 92 million adults in the United States have cardiovascular disease, costing about $316 billion dollars in annual health care expenditures. Furthermore, it is estimated that about 16 million Americans greater than 20 years old have coronary artery disease (CAD), which results in a disruption of the oxygen supply-demand relationship in the myocardium and can have adverse effects on the function of the heart. Management of CAD involves both nonsurgical and surgical interventions, of which coronary artery bypass grafting (CABG) is the main surgical option. The majority of CABG surgery is done with the assistance of the cardiopulmonary bypass circuit (CPB), although in the last 30 years there has been a trend toward performing CABG without CPB, also known as off-pump CABG. Many cardiac surgical patients have other medical comorbidities that make significant contributions to their ability to recover. Management of the patient requiring CABG, both with and without CPB, poses several challenges for the cardiac anesthesiologist. These include planning for appropriate monitoring of hemodynamics and oxygenation, obtaining adequate intravascular access, and anticipating and reacting to changes in pathophysiology related to CPB.

Since the government began tackling the problems of cybercrime, many laws have been enacted. A lack of a comprehensive definition and taxonomy of cybercrime makes it difficult to accurately identify report and monitor cybercrime trends. There is not just a lack of international agreement on what cybercrime is; there are different laws in every state within the United States, reflecting the inconsistency of dealing with cybercrime. There is also concern that many times lawyers and information technology professions are unable to understand each other well. The deficiency of cyber laws is an obvious problem and development of effective laws is emerging as an important issue to deal with cybercrime. This research uses the routine activity theory to develop a unified framework by including the motivation of the offender to use a computer as a tool/target, suitability of the target, and the presence (or absence) of guardian. It could help states that want to update their existing laws and cover areas that were previously uncovered.

This chapter begins with a consideration of the state of school-based assessments as an unavoidable consequence of the contemporary societal emphasis on accountability and curricular prescriptions at the state and national level in the United States of America. Additionally, the authors comment upon the potential inaccuracies inescapable in large scale, high-stakes, standardized assessment instruments, especially when such instruments are turned to the task of evaluation—whether norm- or criterion-referenced—in a teaching and learning engagement. Likewise, the chapter concludes with suggestions and templates (elaborately configured with specific activities and assessment rubrics included) to support teachers who want to develop their own, rigorous, valid, and reliable assessments instruments embedded seamlessly in student-centered learning activities, and that accommodate the reality of literacy as a culturally situated behavior that, for contemporary learners, includes all manner of meaning-making in all manner of modalities from the pencil and paper to the purely electronic (and potentially wordless, at times) video- or audio-based.

This chapter begins with a consideration of the state of school-based assessments as an unavoidable consequence of the contemporary societal emphasis on accountability and curricular prescriptions at the state and national level in the United States of America. Additionally, the authors comment upon the potential inaccuracies inescapable in large scale, high-stakes, standardized assessment instruments, especially when such instruments are turned to the task of evaluation—whether norm- or criterion-referenced—in a teaching and learning engagement. Likewise, the chapter concludes with suggestions and templates (elaborately configured with specific activities and assessment rubrics included) to support teachers who want to develop their own, rigorous, valid, and reliable assessments instruments embedded seamlessly in student-centered learning activities, and that accommodate the reality of literacy as a culturally situated behavior that, for contemporary learners, includes all manner of meaning-making in all manner of modalities from the pencil and paper to the purely electronic (and potentially wordless, at times) video- or audio-based.

Assessment is such an important cornerstone of the current educational landscape that it must be a part of discussion about any educational topic, including TBMI. To paraphrase Duke (2005), rather than thinking about assessment as the culmination of an educational cycle, teachers should embed assessment into every lesson, every activity, and our plans for everything that comes next. Duke stated, “The distinction between the assessments and the substance of instruction day to day should be diminished to the point that the day-to-day activities of instruction closely resemble the assessments themselves” (2005, p. 71). In a TBMI class, this is the scenario for which teachers should strive. Still, assessment remains a thorny issue for TBMI teachers because they are often unaccustomed to assessing the types of work that students do in TBMI classes, examples of which were seen in the sample lessons in chapter 6. Assessing what students do informs us about the extent to which they retain information and achieve learning objectives, the quality of that learning, and students’ abilities to apply conceptual understanding to both familiar and novel situations. If we do it for no other reason, assessing students tells us when they are ready to go on to the next bit of information, the next activity, or the next level of complexity of work. I observed Mr. U during a day trip to his school in a suburb in the northeast United States. Mr. U has been teaching music technology classes at the high school level for about 15 years—perhaps the longest of any teacher profiled in this book—and has been nationally recognized for his excellence in doing so. Over that time, he has gone through many changes of equipment, software, and course designs. He has developed a vast and sophisticated set of projects for his students, who can take level 1 and 2 music technology classes. Most of the assignments and requirements are housed on a website that Mr. U developed as part of a professional development project. His students clearly enjoy the music technology classes he teaches.

Technology transfer is considered as one of the most important instruments of national and regional economic growth in such countries as world leaders such as the United States, Japan, the European Union, China, and others. The importance of developing this direction is not in doubt. It invests a lot of money, is supported at the legislative level. The activity of technology transfer centers is aimed at commercialization of the results obtained in different organizations of the world, ensuring the acceleration of solving technical problems of enterprises, improving the quality and reducing the cost of their products, and developing new types of products. The main goal of the Center is to facilitate the transfer of the Internet intellectual innovative technologies and blockchain technologies developed both in the Republic of Armenia and in the Armenian Diaspora to ensure sustainable growth of the economy, increase the competitiveness of industry, agriculture, science and education, tourism and business attractiveness Republic of Armenia and Artsakh Republic.

Diffuse reflectance spectroscopy in the near-infrared (NIR: 350-2500 nm) region offers a relatively rapid, non-destructive, and high throughput alternative to wet chemistry measurements of soil health. Infrared absorbance frequencies of soil constituents such as organic matter and clay minerals form the basis for developing reliable calibrations for predicting soil health indicators (SHI). To demonstrate suggested practices, and potential challenges to the use of NIR for soil health measurements, the chapter describes use of a NIR spectral dataset of diverse United States soils (n=709) from the USDA NRCS National Soil Survey Center to develop chemometric prediction models of representative SHI: total organic C (TOC), aggregate stability, clay content, and β-glucosidase activity. Future directions for NIR prediction of SHI and thus infrared spectroscopy-based soil health assessment and monitoring are also discussed.

Recidivism of criminal offenders has become a national problem in the United States. New criminal activity along with technical violations of conditions of probation or parole are the results of deficiencies in cognitive behaviorisms. Numerous studies have revealed that weaknesses in cognitive behavior are a common denominator among offenders. These studies have led to the development and implementation of treatment strategies that, when administered to criminal offenders, have proven to be effective in reducing recidivism. Therapeutic programs grounded in evidence-based practices are widely used throughout correctional facilities and probation-parole departments. However, this evidence-based approach in reducing recidivism is moot if correctional leadership is not supportive of rehabilitative programs for offenders. The efficacy and success of these programs are dependent on effective leadership along with professionals and paraprofessionals that are specifically credentialed or licensed and have the qualities and skillsets to provide these types of rehabilitative measures.

Soil survey and mapping is one of the most fundamental and best-known applications of pedology. The preparation of soil maps began in the 19th century (Yaalon, 1997), but systematic county-based soil surveys began in the 20th century in the United States (Simonson, 1987, p. 3). The production of soil maps based on systematic soil surveys has been one of the primary driving forces in pedologic research in both academic and governmental settings in the United States and worldwide through much of the 20th century (Simonson, 1987, 1997; Yaalon and Berkowicz, 1997). For example, soil survey and mapping has been a primary function of the USDA since 1899 (Simonson, 1987, p. 3; Soil Survey Division Staff, 1993, p. 11). Soil maps have been prepared for a variety of uses at scales ranging from a few hectares to those of continental and global magnitude. Published soil surveys contain a wealth of data on landscapes as well as soils, but are generally an underused (and likely misunderstood) resource in geoarchaeology, probably because of their agricultural and land-use orientation. This chapter presents a discussion of what soil surveys are (and are not) and potential as well as realized applications in archaeology. Much of the discussion focuses on the county soil surveys published by the USDA because they are so widely available, although applications of other kinds and scales of soil maps that have been applied in archaeology or that have archaeological applications also are discussed. Many countries in the world have national soil surveys whose primary mission is the mapping and inventorying of the nation’s soil resource. In the United States, soil survey is a cooperative venture of federal agencies, state agencies (including the Agricultural Experiment Stations), and local agencies, coordinated by the National Cooperative Soil Survey (Soil Survey Division Staff, 1993, p. 11). The principal federal agency involved in soil survey is the National Resource Conservation Service (NRCS; formerly the Soil Conservation Service, SCS) of the USDA. The mapping of soils by the NRCS/USDA is probably the agency’s best-known activity. Its many published county soil surveys are its most widely known and widely used product.

This research presents a virtual reality simulator for total hip replacement surgery. The simulator supports a library of 3D hip stem models for different sizes and manufacturers. The 3D hip stems can be adjusted in size and shape by parametric software and sent for 3D printing. Biocompatible materials such as titanium enable the 3D printed stems to be directly implanted on patients. Currently surgical simulation for orthopaedic procedures is not as advanced as other surgical disciplines. As a result there are only limited training simulators available for orthopaedic surgery such as total hip replacement, hip resurfacing or knee replacement. This is demanding since 66,000 hip replacements are performed annually in the UK. One area which is neglected in VR orthopaedic simulation is the digital library generation of implants. Currently orthopaedic surgeons have limited choice in terms of an exact identification of implant specific to patient requirements. We conducted a literature review of orthopaedic training simulators which found no simulators catering for this [9]. Orthopaedic surgeons generally have a positive opinion for the use of virtual reality (VR) training systems. A survey amongst all orthopaedic surgeons in New Zealand found that 77% of qualified surgeons believe simulation is effective for practicing and learning surgical procedures [1]. A separate review from the American Academy of Orthopaedic Surgeons (AAOS) showed that over 80% agreed that surgical skills simulations should become a required part of orthopaedic training, based on views from 185 program directors and 4549 residents. There was a strong agreement that simulation technology should be a required component of orthopaedic resident training [2]. The hip replacement procedure has been considered as the most successful and influential orthopaedic surgery of the twentieth century. Currently over 66,000 total hip replacements (THR) are performed each year in England and Wales by the National Health Service (NHS) and around 75,000 hip fractures are treated each year in the UK. Knee arthroscopy has increased 49% from 1996–2006 and now over 1 million are performed each year [3]. Each year there are an increasing number of orthopaedic procedures due to the aging population. Currently 247,000 hip fractures occur yearly in the United States, with the majority occurring in the population over 45 years old [4]. The incidence of hip fracture is also on the rise, partly due to the aging population, with over half a million hip fractures annually expected by 2040. The cost of these fractures is also expected to rise from $7 billion per year [4], to nearly $16 billion per year by 2040 [5]. Each hip fracture is estimated at costing between $39,555 and $40,600 in the first year after surgery [6]. Hip fractures have the highest cost of any orthopaedic procedure after surgery, and also incur $11,241 each year following surgery in extra health costs. Due to increased life expectancy, worldwide by 2050, it is projected that 6.26 million hip fractures will occur annually [7]. A paradigm shift is underway toward use of surgical training simulations [8]. The conventional master-apprentice learning model for surgical training of ‘see one, do one, teach one’ has recently been seen as inefficient. Due to orthopaedics being heavily dependent on technical skill, orthopaedic VR simulation holds potential to have great impact for improving surgical skill. The transition to VR simulation is relatively new compared to cadaver training which has been the gold standard for several centuries.

Government and commercial decommissioning and remediation activities at nuclear sites and facilities often generate in large volumes and mass radioactive waste that is of low activity. In large part, the low activity radioactive waste generated from decommissioning and remediation activities are below regulatory limits for low level radioactive waste, while not meeting site specific dose and risk-based cleanup criteria. Policies and strategies for the remediation, management, and disposal of low activity radioactive waste in these circumstances often explore alternative options to fully licensed disposal. Primary goals in exploring alternative disposal options are protection of the public and the environment, while achieve a cost-effective solution. Vague regulations and arbitrary interpretation by federal and state regulators may enhance alternative disposal options or quash efforts by those conducting the remediation and decommissioning. Fundamental to the issues is the overriding concern of a lack of clarity and increased liability in the regulatory structure of the grey area that is low activity radioactive wastes. This paper explores the current efforts by the United States of America and International regulatory community to better define low activity radioactive waste and to provide effective and protective waste management and disposal policies and strategies.

At the 2015 International Hospital Federation (IHF) World Congress in Chicago, Illinois, USA, the Global Consortium for Healthcare Management Professionalization presented a call to action to professionalize the field of healthcare management. Governments and organizations that seek to realize the benefits of professional healthcare managers may meet this challenge by providing educational opportunities to established executives who are positioned to lead and ultimately mentor future managers. This paper introduces a case example of an executive graduate program in health administration, delivered by a university in the United States in partnership with the Ministry of Health in Saudi Arabia, with the aim of developing Saudi healthcare professionals as healthcare leaders. We share challenges, experiences and insights related to adapting a US curriculum for the Saudi working executives during a time of transformation in the Kingdom. We also provide a detailed description of the Executive Management Study, an applied synthesis activity required for all executive learners in the program. Results of an alumni survey are incorporated to demonstrate graduates’ perceptions of the effectiveness of the learning experience.

Cardiac arrhythmias are common cardiac disorders characterized by irregular electrical activity of the heart. Each year in the United States alone, about half a million deaths and 835,000 hospital discharges result from arrhythmias. In fact, atrial fibrillation is responsible for 15–20% of all ischemic strokes [1]. Due to the complexity of the electrical conduction pathways in myocardium, computational models are useful platforms for gaining insight into the origin of arrhythmias, as well as the development of corrective options. For these purposes, a quantitative finite element model based on the phenomenological Aliev and Panfilov model [2] was implemented to characterize the electrical behavior of cardiac tissue. Several examples of simulated re-entrant spiral waves demonstrate that our implementation can indeed capture the electrical aspects of cardiac tissue.

What was common between the capsizing of the cruise liner Costa Concordia, engine fire on the Carnival Triumph and the sinking of the Deepwater Horizon rig? In all cases, the people impacted did not believe or find that the authorities, whether public or private, were capable of meeting their immediate needs. Consequently, such biases led to collective behavior or ‘herding’ with devastating outcomes. Holding true to its mission of marine safety, the United States Coast Guard (USCG) finds itself in roles of maritime incident management and provider of training for examination of foreign ships carrying U.S. passengers. Also, following land-based costal events such as Hurricane Harvey, the USCG is called upon to perform rescue operations in which risk assessment through effective communication between stakeholders becomes extremely important. Accordingly, this paper proposes a performance-based approach to occupant safety, occupant circulation, and hazard communication so that both classification rules can be developed and guidelines can be proposed for inclusion in the USCG Incident Management Handbook. Advances in the analysis and modelling of the movement of people, especially in building fires, have established the decision-making processes that individuals or groups undergo before reacting to an imminent danger. When a large number of people have a high commitment either to activity or to inactivity, it becomes important that an equilibrium solution is adopted and the resources are allocated accordingly. The author proposes evaluating incident management as a dynamic system. Like any dynamic system, incident management for any disaster, evolves with time in terms of scale, needed inputs and desired outputs. Engineers today have the capability to influence the outputs by establishing protocols for sharing of information and resources among the stakeholders. The author presented a paper on a similar topic at ASME’s Dynamic Systems and Controls Conference (DSCC 2015)3. Paper published with permission.

Disassemble/Analyze/Assemble (DAA) activities involve the disassembly, analysis, and assembly of an artifact. Such activities are frequently made a part of the undergraduate engineering curricula in the United States (and elsewhere) as they provide useful ‘hands-on’ active learning components that can be easily integrated into various courses. DAA activities are central to product dissection and reverse engineering, terms which have been used interchangeably in the engineering design education literature and course titles. In some cases these activities are coupled with redesign activities, paving the way for a good context and providing a background for a meaningful engineering design. Despite this fact, however, based on our review of the literature it is not clear how do these DAA activities help with the redesign activity, if at all. Accordingly, in this paper we present results of our data collection that aimed at uncovering students’ perception regarding if DAA activities help with redesign (e.g., is it easier to redesign after dissection?). Overall, students had positive perceptions toward dissection, specifically with regards to its impact on redesign. We also report on the relation of student perceptions to design task, team functioning, and tolerance for ambiguity.

The aim of this work is to determine to what extent Robert Parker has lost his influence as a prescriber in the world of wine through a webometric analysis based on a comparative analysis of Parker’s web influence and that of a competitor who represents an anthitetical vision of the world of wine (Alice Feiring). To do this, we carried out a comparative analysis for Parker’s (@wine_advocate) and Alice Feiring’s (@alicefeiring) official Twitter accounts, including a broad set of metrics (productivity, age, Social Activity, number of followees, etc.), paying special attention to specific followers’ features (age, gender, location, and bios text). The results show that Parker’s twitter profile exhibits an overall higher impact, which denotes not only a different online strategy but also a high level of engagement and popularity. The low level of shared followers by Parker and Feiring (1,898 users) offer prima facie evidence of an online gap between these followers, which can indicate the existence of a divided group of supporters corresponding with the visions that Parker and Feiring represent. Finally, special features are notice for Feiring in gender (more women followers), language (more English-speaking followers) and country (more followers from the United States).

Abstract Cancer is one of the most debilitating diseases in the world, affecting over 9.6 million people worldwide every year. Breast cancer remains the second largest cause of death in women. Despite major advances in treatment, over 40,920 women died of breast cancer in 2018 in the United States alone. Early detection of abnormal masses can be crucial for diagnosis and dramatically increase survival. Current screening techniques have varying accuracy and perform poorly when used on heterogeneously and extremely dense breast tissue. Infrared imaging has the potential to detect growing tumors within the breast based on thermal signatures on the breast surface by imaging temperature gradients induced by blood perfusion and tumor metabolic activity. Using clinical patient images, previous methods to estimate tumor properties involve an iterative algorithm to estimate the tumor position and diameter. The details from the MRI are used in estimating the volumetric heat generation rate. This is compared with the published values and the reasons for differences are investigated. The tumor pathology is used in estimating the expected growth rate and compared with the predicted values. The correlation between the tumor characteristics and heat generation rate is fundamental information that is needed in accurately predicting the tumor size and location.

The meaningful United States regulation of onshore oil and gas field waste/soil commenced in the mid 1980’s in response to a series of state, federal, industry and international initiatives. Most initiatives centered on the design, construction and operation of earthen pits used in the exploration and production of oil and gas (E&amp;P). Prior to this time, earthen pits were constructed as needed by the operator and used in all phases of E&amp;P activity. Chief concerns of the regulators were focused on what had gone into pits historically, what was going into them currently and was the E&amp;P exemption excluding high volume E&amp;P wastes from the Resource Conservation and Recovery Act (RCRA) regulations justified. Several investigations, including the comprehensive field study by the Environmental Protection Agency in 1987, determined E&amp;P wastes are ostensibly non-hazardous. EPA concluded regulation of E&amp;P wastes under RCRA Subtitle C was not necessary. To this day there is no U. S. federal regulatory program with exclusive jurisdiction over exempt E&amp;P wastes. Other studies, primarily industry and academic, focusing on land limiting constituents, management practices and pit closure strategies revealed sodium salts and petroleum hydrocarbon in the form of diesel range organics were the primary limiting constituents. One state, Louisiana, adopted the technical aspects of these studies and developed a comprehensive regulation known as Statewide Order 29-B, which was based on the concept of limiting constituents and defined post closure performance standards. These standards limited salinity, sodicity, total metals and total petroleum hydrocarbon (oil &amp; grease) with values varying with respect to landform, land use and closure technique. Other states have adopted some of the concepts and criteria advanced under 29-B but none are as comprehensive. Obviously there is a need to control what goes into pits and how pits should be closed. The industry would best be served by adopting the concepts and standards set forth in the Louisiana 29-B regulation. A few of the provisions could be changed to make it more palatable to industry without sacrificing the protection afforded human and animal health, safety and the environment. Internationally, particularly countries in South America embraced USEPA protocol for testing characteristically hazardous wastes, but 1) without the framework to handle the relatively large volume of non-hazardous E&amp;P waste generated and 2) no regulations or protocols for on-site waste management. Several operators, although partners with state owned oil companies, on their own volition, applied the concepts and standards under Louisiana’s 29-B to rainforests in South America and rice paddies in Indonesia. Canada and European oil and gas producing countries have developed stringent standards not based on science, which favor costly treatment technologies. Generally, these countries prohibit cost effective on-site waste management and closure techniques. This paper traces the evolution of waste/soil remediation within the United States and internationally. We trace the progress as a function of time; the impetus for regulation; and probable future controls.

The Occupational Safety and Health Administration (OSHA) in the United States is responsible for the promulgation and enforcement of rules to protect and enhance worker safety in most medium and large commercial enterprises. To that end, the agency has collected and processed more than 240,000 atmospheric samples of chemicals and aerosols in a variety of workplaces in the past 30 years. Though the agency spends more than $500 million per year even in the face of increasing overall employment, there exist only targeted evaluations of OSHA sampling activity for specific issues like formaldehyde or silica in the published literature. This paper presents a comprehensive analysis of this effort including assessment of the hazard potential distribution of sampled workplace atmospheres for all recorded pollutants over the time period from 1984 to 2011, the budgetary requirements of this activity over time in comparison to the assessed risk, and an evaluation of the probable effectiveness of such activity given changes in US industrial employment over that time period. The effectiveness of the sampling program is assessed according to specific criteria including the probability of detecting exceedances of the National Institute of Occupational Safety and Health (NIOSH) recommended exposure limit (REL) for individual pollutants, the trend in the overall hazard level of detected atmospheres, the coverage of industries by worker population, and the cost-efficiency of the program in identifying hazardous atmospheres. Special attention is given to lead, toluene, and various mineral- and metal-based particulate matter, which have all seen new rules implemented in the recent past. Findings show that the number of samples per employed person has decreased markedly since the beginning of the study period and become less aligned with the changes in population distribution among US regions, however the probability of detecting a hazardous level of a chemical or aerosol pollutant has increased. Extrapolations of this information and the associated changes in industrial sector employment indicate that US workplace atmospheres are marginally less hazardous at the end of the study period than they were at the beginning.

1.1 Macroeconomic summary Economic recovery has consistently outperformed the technical staff’s expectations following a steep decline in activity in the second quarter of 2020. At the same time, total and core inflation rates have fallen and remain at low levels, suggesting that a significant element of the reactivation of Colombia’s economy has been related to recovery in potential GDP. This would support the technical staff’s diagnosis of weak aggregate demand and ample excess capacity. The most recently available data on 2020 growth suggests a contraction in economic activity of 6.8%, lower than estimates from January’s Monetary Policy Report (-7.2%). High-frequency indicators suggest that economic performance was significantly more dynamic than expected in January, despite mobility restrictions and quarantine measures. This has also come amid declines in total and core inflation, the latter of which was below January projections if controlling for certain relative price changes. This suggests that the unexpected strength of recent growth contains elements of demand, and that excess capacity, while significant, could be lower than previously estimated. Nevertheless, uncertainty over the measurement of excess capacity continues to be unusually high and marked both by variations in the way different economic sectors and spending components have been affected by the pandemic, and by uneven price behavior. The size of excess capacity, and in particular the evolution of the pandemic in forthcoming quarters, constitute substantial risks to the macroeconomic forecast presented in this report. Despite the unexpected strength of the recovery, the technical staff continues to project ample excess capacity that is expected to remain on the forecast horizon, alongside core inflation that will likely remain below the target. Domestic demand remains below 2019 levels amid unusually significant uncertainty over the size of excess capacity in the economy. High national unemployment (14.6% for February 2021) reflects a loose labor market, while observed total and core inflation continue to be below 2%. Inflationary pressures from the exchange rate are expected to continue to be low, with relatively little pass-through on inflation. This would be compatible with a negative output gap. Excess productive capacity and the expectation of core inflation below the 3% target on the forecast horizon provide a basis for an expansive monetary policy posture. The technical staff’s assessment of certain shocks and their expected effects on the economy, as well as the presence of several sources of uncertainty and related assumptions about their potential macroeconomic impacts, remain a feature of this report. The coronavirus pandemic, in particular, continues to affect the public health environment, and the reopening of Colombia’s economy remains incomplete. The technical staff’s assessment is that the COVID-19 shock has affected both aggregate demand and supply, but that the impact on demand has been deeper and more persistent. Given this persistence, the central forecast accounts for a gradual tightening of the output gap in the absence of new waves of contagion, and as vaccination campaigns progress. The central forecast continues to include an expected increase of total and core inflation rates in the second quarter of 2021, alongside the lapse of the temporary price relief measures put in place in 2020. Additional COVID-19 outbreaks (of uncertain duration and intensity) represent a significant risk factor that could affect these projections. Additionally, the forecast continues to include an upward trend in sovereign risk premiums, reflected by higher levels of public debt that in the wake of the pandemic are likely to persist on the forecast horizon, even in the context of a fiscal adjustment. At the same time, the projection accounts for the shortterm effects on private domestic demand from a fiscal adjustment along the lines of the one currently being proposed by the national government. This would be compatible with a gradual recovery of private domestic demand in 2022. The size and characteristics of the fiscal adjustment that is ultimately implemented, as well as the corresponding market response, represent another source of forecast uncertainty. Newly available information offers evidence of the potential for significant changes to the macroeconomic scenario, though without altering the general diagnosis described above. The most recent data on inflation, growth, fiscal policy, and international financial conditions suggests a more dynamic economy than previously expected. However, a third wave of the pandemic has delayed the re-opening of Colombia’s economy and brought with it a deceleration in economic activity. Detailed descriptions of these considerations and subsequent changes to the macroeconomic forecast are presented below. The expected annual decline in GDP (-0.3%) in the first quarter of 2021 appears to have been less pronounced than projected in January (-4.8%). Partial closures in January to address a second wave of COVID-19 appear to have had a less significant negative impact on the economy than previously estimated. This is reflected in figures related to mobility, energy demand, industry and retail sales, foreign trade, commercial transactions from selected banks, and the national statistics agency’s (DANE) economic tracking indicator (ISE). Output is now expected to have declined annually in the first quarter by 0.3%. Private consumption likely continued to recover, registering levels somewhat above those from the previous year, while public consumption likely increased significantly. While a recovery in investment in both housing and in other buildings and structures is expected, overall investment levels in this case likely continued to be low, and gross fixed capital formation is expected to continue to show significant annual declines. Imports likely recovered to again outpace exports, though both are expected to register significant annual declines. Economic activity that outpaced projections, an increase in oil prices and other export products, and an expected increase in public spending this year account for the upward revision to the 2021 growth forecast (from 4.6% with a range between 2% and 6% in January, to 6.0% with a range between 3% and 7% in April). As a result, the output gap is expected to be smaller and to tighten more rapidly than projected in the previous report, though it is still expected to remain in negative territory on the forecast horizon. Wide forecast intervals reflect the fact that the future evolution of the COVID-19 pandemic remains a significant source of uncertainty on these projections. The delay in the recovery of economic activity as a result of the resurgence of COVID-19 in the first quarter appears to have been less significant than projected in the January report. The central forecast scenario expects this improved performance to continue in 2021 alongside increased consumer and business confidence. Low real interest rates and an active credit supply would also support this dynamic, and the overall conditions would be expected to spur a recovery in consumption and investment. Increased growth in public spending and public works based on the national government’s spending plan (Plan Financiero del Gobierno) are other factors to consider. Additionally, an expected recovery in global demand and higher projected prices for oil and coffee would further contribute to improved external revenues and would favor investment, in particular in the oil sector. Given the above, the technical staff’s 2021 growth forecast has been revised upward from 4.6% in January (range from 2% to 6%) to 6.0% in April (range from 3% to 7%). These projections account for the potential for the third wave of COVID-19 to have a larger and more persistent effect on the economy than the previous wave, while also supposing that there will not be any additional significant waves of the pandemic and that mobility restrictions will be relaxed as a result. Economic growth in 2022 is expected to be 3%, with a range between 1% and 5%. This figure would be lower than projected in the January report (3.6% with a range between 2% and 6%), due to a higher base of comparison given the upward revision to expected GDP in 2021. This forecast also takes into account the likely effects on private demand of a fiscal adjustment of the size currently being proposed by the national government, and which would come into effect in 2022. Excess in productive capacity is now expected to be lower than estimated in January but continues to be significant and affected by high levels of uncertainty, as reflected in the wide forecast intervals. The possibility of new waves of the virus (of uncertain intensity and duration) represents a significant downward risk to projected GDP growth, and is signaled by the lower limits of the ranges provided in this report. Inflation (1.51%) and inflation excluding food and regulated items (0.94%) declined in March compared to December, continuing below the 3% target. The decline in inflation in this period was below projections, explained in large part by unanticipated increases in the costs of certain foods (3.92%) and regulated items (1.52%). An increase in international food and shipping prices, increased foreign demand for beef, and specific upward pressures on perishable food supplies appear to explain a lower-than-expected deceleration in the consumer price index (CPI) for foods. An unexpected increase in regulated items prices came amid unanticipated increases in international fuel prices, on some utilities rates, and for regulated education prices. The decline in annual inflation excluding food and regulated items between December and March was in line with projections from January, though this included downward pressure from a significant reduction in telecommunications rates due to the imminent entry of a new operator. When controlling for the effects of this relative price change, inflation excluding food and regulated items exceeds levels forecast in the previous report. Within this indicator of core inflation, the CPI for goods (1.05%) accelerated due to a reversion of the effects of the VAT-free day in November, which was largely accounted for in February, and possibly by the transmission of a recent depreciation of the peso on domestic prices for certain items (electric and household appliances). For their part, services prices decelerated and showed the lowest rate of annual growth (0.89%) among the large consumer baskets in the CPI. Within the services basket, the annual change in rental prices continued to decline, while those services that continue to experience the most significant restrictions on returning to normal operations (tourism, cinemas, nightlife, etc.) continued to register significant price declines. As previously mentioned, telephone rates also fell significantly due to increased competition in the market. Total inflation is expected to continue to be affected by ample excesses in productive capacity for the remainder of 2021 and 2022, though less so than projected in January. As a result, convergence to the inflation target is now expected to be somewhat faster than estimated in the previous report, assuming the absence of significant additional outbreaks of COVID-19. The technical staff’s year-end inflation projections for 2021 and 2022 have increased, suggesting figures around 3% due largely to variation in food and regulated items prices. The projection for inflation excluding food and regulated items also increased, but remains below 3%. Price relief measures on indirect taxes implemented in 2020 are expected to lapse in the second quarter of 2021, generating a one-off effect on prices and temporarily affecting inflation excluding food and regulated items. However, indexation to low levels of past inflation, weak demand, and ample excess productive capacity are expected to keep core inflation below the target, near 2.3% at the end of 2021 (previously 2.1%). The reversion in 2021 of the effects of some price relief measures on utility rates from 2020 should lead to an increase in the CPI for regulated items in the second half of this year. Annual price changes are now expected to be higher than estimated in the January report due to an increased expected path for fuel prices and unanticipated increases in regulated education prices. The projection for the CPI for foods has increased compared to the previous report, taking into account certain factors that were not anticipated in January (a less favorable agricultural cycle, increased pressure from international prices, and transport costs). Given the above, year-end annual inflation for 2021 and 2022 is now expected to be 3% and 2.8%, respectively, which would be above projections from January (2.3% and 2,7%). For its part, expected inflation based on analyst surveys suggests year-end inflation in 2021 and 2022 of 2.8% and 3.1%, respectively. There remains significant uncertainty surrounding the inflation forecasts included in this report due to several factors: 1) the evolution of the pandemic; 2) the difficulty in evaluating the size and persistence of excess productive capacity; 3) the timing and manner in which price relief measures will lapse; and 4) the future behavior of food prices. Projected 2021 growth in foreign demand (4.4% to 5.2%) and the supposed average oil price (USD 53 to USD 61 per Brent benchmark barrel) were both revised upward. An increase in long-term international interest rates has been reflected in a depreciation of the peso and could result in relatively tighter external financial conditions for emerging market economies, including Colombia. Average growth among Colombia’s trade partners was greater than expected in the fourth quarter of 2020. This, together with a sizable fiscal stimulus approved in the United States and the onset of a massive global vaccination campaign, largely explains the projected increase in foreign demand growth in 2021. The resilience of the goods market in the face of global crisis and an expected normalization in international trade are additional factors. These considerations and the expected continuation of a gradual reduction of mobility restrictions abroad suggest that Colombia’s trade partners could grow on average by 5.2% in 2021 and around 3.4% in 2022. The improved prospects for global economic growth have led to an increase in current and expected oil prices. Production interruptions due to a heavy winter, reduced inventories, and increased supply restrictions instituted by producing countries have also contributed to the increase. Meanwhile, market forecasts and recent Federal Reserve pronouncements suggest that the benchmark interest rate in the U.S. will remain stable for the next two years. Nevertheless, a significant increase in public spending in the country has fostered expectations for greater growth and inflation, as well as increased uncertainty over the moment in which a normalization of monetary policy might begin. This has been reflected in an increase in long-term interest rates. In this context, emerging market economies in the region, including Colombia, have registered increases in sovereign risk premiums and long-term domestic interest rates, and a depreciation of local currencies against the dollar. Recent outbreaks of COVID-19 in several of these economies; limits on vaccine supply and the slow pace of immunization campaigns in some countries; a significant increase in public debt; and tensions between the United States and China, among other factors, all add to a high level of uncertainty surrounding interest rate spreads, external financing conditions, and the future performance of risk premiums. The impact that this environment could have on the exchange rate and on domestic financing conditions represent risks to the macroeconomic and monetary policy forecasts. Domestic financial conditions continue to favor recovery in economic activity. The transmission of reductions to the policy interest rate on credit rates has been significant. The banking portfolio continues to recover amid circumstances that have affected both the supply and demand for loans, and in which some credit risks have materialized. Preferential and ordinary commercial interest rates have fallen to a similar degree as the benchmark interest rate. As is generally the case, this transmission has come at a slower pace for consumer credit rates, and has been further delayed in the case of mortgage rates. Commercial credit levels stabilized above pre-pandemic levels in March, following an increase resulting from significant liquidity requirements for businesses in the second quarter of 2020. The consumer credit portfolio continued to recover and has now surpassed February 2020 levels, though overall growth in the portfolio remains low. At the same time, portfolio projections and default indicators have increased, and credit establishment earnings have come down. Despite this, credit disbursements continue to recover and solvency indicators remain well above regulatory minimums. 1.2 Monetary policy decision In its meetings in March and April the BDBR left the benchmark interest rate unchanged at 1.75%.